BearingPoint Institute - ICT and Health Systems, Unlocking African Healthcare

7/27/2019 BearingPoint Institute - ICT and Health Systems, Unlocking African Healthcare

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Whowillbet

hewinnersinthemobilepaymentsbattle?

Could technology be the key to overcoming

Africas health problems?

ICT and health systems:unlocking African healthcare


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ICT and health systems

in AfricaCould technology be the key to overcoming Africas health problems?

U of Ifoatio adCouicatio Tchoogy (ICT)i xadig aidy aco thhathca cto

Technology cannot solve all problems by itself, but it

can assist health service delivery by reducing travel

overheads and enabling faster communications.

Over 2% of healthcare spending in Africa is ICT-

related, with a strong annual growth of 9%. While

many projects are still at an experimental stage,

they offer an indication of how this domain will

evolve.

Health-related challenges are greater in Africa than

anywhere else in the world. Three structural issues

affect healthcare across the continent:

Health insurance acceptance and use needs to

be broadened. This includes protection against

non-payment risks. By keeping the moment of

payment separate from treatment, insurance

encourages use of health services. Software

solutions can underpin the risk-sharing process,

enable more effective and secure management

and encourage financial pooling of risk.

There exists a chronic shortage of trained

healthcare personnel. Via telemedicine-based

solutions, ICT can partially compensate for this

shortfall.

The quality and reach of healthcare

infrastructure can be significantly improved,

from treatment centres to medicine distribution,

catalysed by the fight against counterfeit

drugs or enabling networks of expertise. ICT

can respond here as well, through connecting

hospitals, improving operational logistics for

medicines and so on.

ICT companies cannot solve all of Africas

healthcare problems, but they can offer innovative

solutions. As shown by the mobile phone payment

model (M-Payment) which substitutes for bank

accounts and associated mechanisms, ICT services

offer alternative solutions to mitigate health-

specific obstacles and those felt more broadly across

the continent (such as road quality). While ICT

offers one element of the overall response, it still

deserves specific focus due to its innovative nature.

The challenge for ICT companies

(telecommunications operators, equipment

providers, software and general IT providers,

etc.) is as much to identify economic models that

ensure project viability, as to propose appropriate

technological solutions to reduce the impact ofthese structural issues. But how can ICT companies

working in this area identify sustainable sources

of finance? We estimate that the ICT market for

African healthcare is just over a billion dollars,

of which half is in five countries South Africa,

Nigeria, Egypt, Algeria and Morocco. When

considered against the extent of need, this

highlights the necessity for financial diversification

and reinforcement, whether from private or public

sources, at a local or international level.

BearingPoint Institute ICT and health systems in Africa


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Diagoig Afica hath

Sub-Saharan Africa is plagued by many diseases and

lacks various resources in each country. Traditional

tropical diseases (Such as malaria, trypanosomiasis

the infamous sleeping sickness, Ebola, etc.) and

illnesses relating to modern life (changing health

situation in cities, AIDS epidemic) affect largesections of the continent while the lack of resources

to cure them is acutely felt.

Dvoig th akt fo hathad atd ICT vic i Afica1

Despite the challenges listed above and contrary

to popular belief, financial resources do exist.

In fact, health spending in African countries islinked to country wealth whatever the standard

of living, constituting about 4% of GNP, as

shown by empirical studies from the World Health

Organisation (WHO)2 . Overall health spending

across the continent rose to 51 billion dollars in

20103, i.e. slightly more than 50 dollars per person.

For comparison, the average figure in France is

greater than 3,000 euros.

According to a 2007 study from the International

Finance Corporation (IFC)4, about 60% of the

17 billion dollars total health expenditure across

sub-Saharan Africa comes from private sources

(commercial organisations, social enterprises,NGOs, etc.) and about 50% goes to private

companies. Meanwhile, the informal health sector

encompassing healers, midwives and medicine

sellers cannot be ignored. In Zambia, 40,000

practising traditional healers receive 60% of

total health payments from households (13% of

total health spending) and in rural Nigeria, initial

consultations take place with a traditional healer in

12% of cases.

Hath iu i Afica

Beyond these statistics, three significant issues

stand out regarding the development of a stronger

African health sector. They concern the three major

Source: La Documentation Francaise, UNDP, 2005, WHO, 2003

ICT and health systems in Africa BearingPoint Institute


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health-related shortages across the continent:

financial structures, competent personnel and

sufficiently developed infrastructure. These

elements are crucial to understanding healthcare-

related issues in Africa7.

Promoting health insurance

African health services financing would greatlybenefit from a system of health insurance8 in each

country. Health insurance protects against financial

risk; in addition, the moment of payment is kept

separate from treatment, encouraging patients to

use medical services. Insurance requires a similar

eco-system to the one enabling access to healthcare

in Europe.

Health insurance provides an opportunity for

both healthcare providers and beneficiaries, as

risk-sharing approaches are widely seen as better

than one-off payment methods9. They providethe general population with protection against

financial risk and encourage a level of fairness

via shared financing. Risk-sharing approaches

(e.g. where risk is shouldered by the business and/

or the government) aid access to healthcare and

contribute to better health across the population.

However according to a WHO report10, health

spending within a social security or a pre-paid

private insurance framework makes up less than15% of total expenditure in nearly all sub-Saharan

African countries (e.g. 14.9% in Mali, 6.9% in the

Ivory Coast, 3.0% in Madagascar and near-zero in

Cameroon).

Figure 1: The informal health sector cannot be ignored

Distribution of healthcare spend (USD billions) by provider type (2005)

In Zambia, 40,000 practising

traditional healers receive 60%

of total health payments

from households

%, billions of dollars

Public

Private

Breakdown of

providers

Private sector

providers:

Commercial

Social enterprise

Not for profit

Traditional healers

100% = 16,7 100% = 8,3

~50%

~50%

~10%

~10%

~15%

~65%

Source: tude IFC, comptes nationaux de la sant, 2005



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Figure 2: African healthcare ICT spend is dominated by only a few countries

Healthcare ICT spend (USD Millions) across Africa

BearingPoint analysis, 2010, based on data from IMF, World bank, OECD, United Nations Conference on trade and development, EBRD,

United Nations, Deutsche Bank, Merill Lynch, JP Morgan, Morgan Stanley, Goldman Sachs, Oxford economics, Feri and Consensus Forecasts,

Missions conomiques et ambassades de France, Gouvernements, Banques Centrales et Missions conomiques et ambassades franaises

Country Spend ($m)

South Africa 218.20

Nigeria 133.42

Egypt 112.65

Algeria 110.78

Morocco 60.52

Libya 53.24

Angola 47.48

Sudan 35.28

Tunisia 26.16

Kenya 22.81

Ethiopia 16.97

Cameroon 16.64

Ivory Coast 15.66

Ghana 13.95

Tanzania 11.69

Uganda 10.14

Botswana 9.41

Zambia 9.40

Senegal 8.86

Gabon 8.31

Equatorial Guinea 8.03

DR Congo 7.03

Namibia 6.75

Mauritius 6.37

Mozambique 6.13

Congo 6.02

Madagascar 5.87

Country Spend ($m)

Mali 5.71

Burkina Faso 5.44

Benin 4.71

Niger 3.72

Rwanda 3.09

Malawi 3.04

Guinea 2.94

Swaziland 2.31

Mauritania 1.92

Somalia 1.91

Togo 1.81

Lesotho 1.64

Sierra Leone 1.44

Central African Republic 1.24

Cape Verde 1.20

Zimbabwe 1.16

Eritrea 1.12

Burundi 0.82

Seychelles 0.79

Djibouti 0.69

Liberia 0.50

The Gambia 0.50

Chad 0.39

Comoros 0.34

Guinea Bissau 0.30

Sao Tome 0.16



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By developing software solutions to underpin the

risk-sharing process, ICT companies can contribute

to more effective and secure management and

encourage the financial pooling of risk. They help

improve the current information systems efficiency,

and moving forward can enable creation of new

software packages11.

Compensating shortage of medical personnel

Another problem concerns human resources.

Countries in sub-Saharan Africa represent 11% of

the global population but make up 25% of the world

death rate12 against 9% in Europe. In an unfortunate

inverse pattern, health-related staff population

percentage in Africa is only 3% compared with 28%

on the European continent.

Health budgets in Africa are less than 1% of globalspending in this domain. Out of 57 countries

worldwide that suffer a critical lack of health

personnel (such as those defined by the WHO using

the Anand Baernighausen regression13), 36 are found

in Africa14 with 0.21 doctors per 1000 inhabitants.

ICT offers solutions to support automation,

telecommunication, collaboration and education,

offering a response to the shortfall of medically

trained personnel.

Iovig quaity ad dity ofga ifatuctu ikd tohathca

A third issue covers the entire healthcare supply

chain and therefore health centres, traceability of

medicines (and therefore the fight against drug

counterfeiting) and general access to healthcare

services. Health infrastructure concerns the entire

range of hospital equipment. In many Africancountries heavy equipment (e.g. scanners) is often

concentrated in a very small number of hospitals, or

even a single hospital for an entire country. Otherwise,

the healthcare network is composed of dispensaries

offering first port of call but without adequate

equipment to perform analyses or operations15.

The sparse distribution of infrastructure combines

with frequently large distances between people

and resources, exacerbated due to poor-quality

road systems only 29% of roads on the African

continent are surfaced. As well as direct costs for

the individual, attending a hospital just for an

examination involves travel costs of up to several

days, sometimes for two people.

Low-quality or counterfeited medicines are another

scourge in the region. Many medicines contain

an insufficient quantity of the active ingredient, or

indeed do not contain any active ingredient at all.

Numerous examples exist:

According to the WHO16, in Nigeria, 48% of

samples across 27 medicines sold in pharmacies

in Lagos and Abuja did not have sufficient

quantity of active ingredient and 100% did not

contain enough metronidazole17, pyrazinamide18

or anti-malarials.

In seven sub-Saharan countries, the majority

of medicines sold in the private sector failed to

achieve the required level of quality. 47% of

chloroquine tablets were not compliant, and 71% of

sulfadoxine/pyrimethamine failed dissolution trials.

11% Countries in sub-Saharan Africarepresent 11% of the global populationbut make up 25% of the world death rate 25%

ICT companies can contribute

to more effective and securemanagement and encourage the

financial pooling of risk



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These issues illustrate the health challenges in

Africa for the coming decades. Information and

communications technologies offer several solutions

to solve shortages detailed here. ICT companies

cannot resolve every problem but they offer one

part of an innovation-based starting point for their

resolution.

ICT o to hathcaiu i Afica

ICT companies and healthcare in Africa

The healthcare sector has already been positively

affected by the use of ICT.

Broadly speaking, the key value of technology is torespond to multiple needs in this sector by improving

data exchange and remote communications,

enabling productivity gains while gradually

improving information exchange. For example,

before travelling patients can determine the

location/opening hours of a dispensary, or the

availability of medicines, or indeed request the

direct advice of a doctor19. Healthcare does not stopat diagnosis level; remote communication plays an

important role at each link in the healthcare chain

from prevention, through treatment to continued

improvement (medicines, training etc.).

The following table summarises examples of

productivity gains linked to ICT in healthcare.

Most of the above projects have been in launch

mode since 2008 or 2009: initial results confirmtheir value in each of the challenge areas20.

Figure 3: Medical personnel numbers are well below World Health Organisation recommendations

Number of healthcare resources per 1000 inhabitants, by region

Translation?

Doctors 0.21 15%Nurses and midwives 1.07 74%

Subtotal: 1.28 89%

Medical assistants 0.03 2%

Community health workers 0.07 5%

Total medical personnel: 1.38 96%

Managers 0.04 3%

Researchers 0.01 1%

Heads of public health 0.01 1%

General total: 1.44 100%

WHO threshold

Sub-Saharan Africa

South-East Asia

Eastern Mediterranean

Western Pacific

Americas

Europe 11.1

7.0

2.9

2.0

1.7

1.3

Source: Joint Learning Initiative, OMS, 2006



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Healthcare

supply chainInformation-related needs

Principal benefits brought

by ICTExamples

Prevention

Data and information exchange(collective access points)

Information on risk-based situations

(e.g. epidemics)

Educating on rules of hygiene/safety

Access to vaccinations and screening

for HIV/AIDS

Verification of medicine authenticity

Obtaining a list of compulsory

vaccinations

Use of radio or telephony (SMS) to sendan alert or a preventative message

(these are most broadly spread ICT

capabilities in Africa)

Monitoring medicines using

technologies such as RFID or other,

more secure formats based on NFC

The Psinet programme in Mali, whichmonitors infant weight

Phones for Health in several African

countries: a communication

programme (epidemics, good

practice) implemented by GSMA

Diagnosis

Identifying patients in need for

surveillance of infectious diseases

Downloading/consulting data libraries

Carrying out remote diagnoses inisolated locations

Remote management of diagnosis

(avoid travel for both patients or

doctors)

Compensates for low numbers ofhealth care staff and also for transport

difficulties for patients and doctors

Healthline from the Grameen

Foundation (in Bangladesh, with

development planned in Africa)

remote diagnosis managed from ahospital and avoiding travel

Tele-radiology in Mali, or Tele-

diagnosis in Egypt, via Orange

Treatment

Uploading or consulting databases

Receive advice from pharmacists

Monitoring treatment effectiveness

exchanges between practitioners

Verification of medicine authenticity

Remote health-related

recommendations in isolated locations

Logistics monitoring of distribution of

medicines

Optimisation of admittance of patients

in hospital (data transfer via fixed line

for small hospitals, IP VPN for larger

hospitals, and in certain cases GPRS/

EDGE)

MPedigree, Ghana, fights against

counterfeiting of medicines (MTN and

Tigo among other partners)

e-logistics for distribution of

tritherapies

Monitoring

Data capture

Monitoring tele-assistance

Monitoring chronic diseases

Benefit from monitoring vaccinations

Remote transmission of medical

information to monitor chronic diseases

Remote coaching of unqualified and

basic level personnel

Alert by SMS for taking tritherapy in

South Africa (Vodacom)

Improvement

Training health personnel

Transmitting data between peers

Being informed about health news, new

recommendations, alerts, etc.

Receiving information about medicines

(e.g. logistics, changes in dosage,

counterfeiting)

Creating a network of rural dispensaries,

information centres and the hospital

Any improvement to information

systems, either for the patient (e.g.

insurance ), or personnel (e.g. e-learning

: remote training of health care staff)

Automation of information flows for

employees that benefit from health

insurance

AMREF in Kenya (remote training

of nurses, prevention, water and

hygiene, mobile doctors)

RAFT, French-speaking Africa:

expansion of telemedicine, remote

education and creation of online

medical content

Figure 4: ICT provides productivity gains throughout the health chain



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Promote health insurance via micro-insurance

services or automation of information flows

A number of early examples of insurance process

automation are in progress, improving use of

technology in corporate insurance plans. As in

France, such schemes only work properly if relevant

information systems enable adequate managementof patient records, payment/re-imbursement policy

rules and control of resulting transactions to be

controlled for the benefit of patients, doctors, health

professionals and indeed, businesses (through

automated restriction of fraud).

Senegal, along with the French Institutions for

Illness Prevention (Instituts de Prvoyance Maladie,

IPM), has been working on such modernisation

programmes since 2009, in parallel with developingother channels. As a result, remote medical data

collection services to monitor chronic illness, alert

systems and solutions to enable management of

emergencies, created in association with an insurance

company or an agent, subscribe to these ideas.

A highly relevant example illustrating the potential

use of telecoms currently being piloted21, is a micro-

insurance service offered via mobile phone, coupled

with external consultation. This system provides

access to medical assistance for a small monthly

fee. One element of the service is weekly monitoringdelivered via questionnaires (covering weight and

medical symptoms), sent to the subscribers mobile

phone. Medical experts analyse responses and

decide whether a medical consultation is necessary,

the cost of which is included in the subscription. A

further plan is to implement a tele-payment system

enabling users to pay for treatment given to their

relatives. This example is currently at test stage

(with possible financing from public institutions, as

discussed below).

Such services are equally useful for public institutions

and their end-users. The difficulty is less about

technology and more about identifying a viable

economic model, since ICT companies only support

the development of an insurance strategy. ITC

companies can help develop health insurance or

mutual schemes like in Europe but this depends

on good will and the capacity of a political entityor an industrial body to support development. In

the Maghreb region for example, political power

is a good catalyst to drive these developments.

In South Africa and Senegal meanwhile, private

companies are key stakeholders in the development

of mutualised systems22.

Prioritising tele-medicine to reduce the shortage

of healthcare personnel

A number of operators offer tele-medicine

solutions which partially compensate for Africas

resource shortages and the low distribution of

doctors, enabling access to healthcare for isolated

populations. These services and can take a

variety of forms such as the Ikon tele-radiology

service in Mali. Ikon was developed in 2004 for

a 5-year pilot phase by the Malian Society of

Medical Imagery (Socit Malienne dImagerie

Mdicale, SOMIM), assisted by the International

Institute for Communication and Development

(lInstitut International pour la Communication

et le Dveloppement, IICD). It uses ICT services to

transfer and interpret radiology images captured at

regional hospitals and health centres, compensating

for the absence of radiologists.

This concept is being broadened to areas such

as tele-dermatology or tele-pathology. In Egypt,

Orange has developed a tele-dermatology solution

in which a health professional, not necessarily aspecialist but located near the patient (e.g. in a

dispensary), takes a photo of the dermatological

problem and logs details of symptoms as well as age,

sex and other data which are sent to a database.

Working remotely, medical specialists can register

themselves on the site, review symptoms and

photos, and establish a diagnosis and treatment

plan. Back with the patient, the health worker

receives the results on a mobile device and relays

them to the patient.

Large medical equipment

can be concentrated in a single

hospital for an entire country



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This achieves three levels of benefit:

Time saved for the patient: he/she does not have

to travel to a distant hospital, given the travel

difficulties encountered in Africa (road quality,

state of cars, long distances, etc.).

Improved access to medical services: even

if training more specialists was a solution,

strengthening competences whilst reducing

the distance challenge makes up for the lack of

specialist resources.

Collective benefit: by enabling more direct access

to expert advice, medical errors can be reduced23.

Another solution is the Psinet remote paediatric

diagnosis service, set up in 2007 in Mali, Senegal and

Niger. The service is based on regular monitoring

of weight curves, plus medical consultations and

delivery of standard medicines. Regular monitoringof infant health between 05 years enables

conditions to be dealt with swiftly, for the broadest

group of people, at an affordable price. The Psinet

service depends on GSM network as it requires

agents to visit families and weigh children, using

a mobile application to collect and send data (on

weight, cough, diarrhoea, fever, vomiting) from the

field. An online application linked to a database

enables a doctor to monitor children remotely in

real-time.

The system was developed by a range of private

organisations and NGOs/foundations, with the first

version financed by partners:

Alcatel-Lucent and Afrique Initiatives brought

financial support and technical expertise to help

initiate the pilot.

Mdicament Export contributed to project

financing and supplied the stock of medicines

required for the duration of the pilot phase.

Fondation Orange Mali also brought financial

support and provided equipment (eight baby

scales and six mobile phones).

Malian association Kafo Yeredeme Ton is

responsible for deploying the service in the field.

The current challenge is making the systemsustainable, particularly regarding its financing

model (network, tools, doctor time).

Although a large scale benefits study has not yet

taken place, the outcomes from these initiatives

appear promising as they enable medical assistance

and support to be scaled. Two significant limitations

remain:

The economic model is not yet stable, so support

from a public organisation (either directly or viaNGOs) remains necessary.

Use of ICT is not always suitable for all patients,

for example due to illiteracy or time available for

questions.

Interviews that we were able to conduct with regard

to Psinet in Mali illustrate this difficulty24. The

solution is of genuine benefit, having saved multiple

lives. But it is kept at arms length by volunteers and

cannot have 100% coverage if it is limited to people

with a mobile phone and an infant. Experience

confirms the benefits of tele-medicine solutions,

but the economic model remains unstable if it lacks

recourse to public financing or foundations25.

And e-learning

Another potential opportunity concerns staff training,

which can also leverage ICT companies to improve

the quality of healthcare services. For example the

network of health information experts in Uganda26,aimed at health sector workers and implemented

through the collaboration of SATELLIFE, Uganda

Chartered HealthNet and the Faculty of Medicine of

Makere University. The experts network was created

in 2003 but the current phase, with ICT companies

playing a central part, was started in 2008. Using

the cellular telephone network and low-footprint

mobile terminals (e.g. personal digital assistants), this

network has reduced costs and improved both quality

and accessibility of health-related information.

The difficulty is less about

technology and more about

identifying a viable

economic model



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The network also equips health workers with a

means to collect and distribute information that can

improve healthcare, particularly in rural or distant

regions. A connection linking Mengo Hospital to

Mulago University Hospital enables doctors with

different specialties (e.g. surgery, paediatrics,

obstetrics and gynaecology) from both units to

exchange diagnosis and proposed treatmentopinions via transfer of images and patient records.

Other projects, incorporating technologies such

as WiFi, are being designed to improve health

information transmission within five participating

districts by enhancing the health information

network through the deployment of access points

equipped with advanced communications functions.

This example is inspiring other countries to develop

similar strategies, such as the health information

network in Mozambique (MHIN) and the educationand health network in Rwanda (RHEIN), both still at

a project stage27.

A further example is a mobile learning solution

incorporating a healthcare module (WapEduc28).

This works equally well with students, who gain

access to (potentially interactive) educational health

content, and health professionals who benefit from

sending preventive messages and alerts. The project

was borne of the need to capitalise on students use

of ICT by broadcasting healthcare related content.

Each user needs a mobile phone as available

content has been specially formatted for mobiles.

A partnership with an healthcare professionals

association ensures content relevance, however

service sustainability requires local government

and (more importantly) health ministry support to

validate the content, both in ethical and sometimes

legal terms29.

E-course content integrates web-based fulllessons incorporating a PowerPoint presentation

and an audio/video recording of the session, plus

seminars and conferences. Archiving for later use

is possible, thus 74 lessons were archived in 2008,

54 in 2009 and 16 for the first term of 2010. In

March 2010, lesson titles included Acute Seasonal

Intestinal obstructions by phytobezoars, Childhood

Hydrocephalus, Adult urinary infection: the case

of Antananarivo, Type 2 Diabetes: understanding

the bases of treatment, Dealing with ophidian

evenomations in Burkina Faso and even a course on

ICT and health: Using the Virtual Internet Patient

Simulator (VIPS) in French-speaking Africa30. These

lessons can be delivered both in Africa but also in

Europe.

Improve the healthcare infrastructure (tele-

support, information flows and monitoringmedicines)

As well as promoting health insurance and

responding to shortfalls in staff, ICT companies,

telecoms operators and equipment providers

can also help improve healthcare infrastructure,

for example by enabling connections between

hospitals, improving logistical management of

medicines, etc. From deploying a simple telephone

number or mobile application to implementing aninformation system, providers have started a large

number of initiatives in recent years to improve the

productivity of healthcare services: here we focus

on four examples regarding patient registration,

information monitoring, hospital life and medicine

monitoring.

For example, in 2007 Vodacom in South Africa

deployed an end-to-end tele-assistance capability

for its customers, based on a special number

available 24 hours a day. Tele-operators (including

second-line doctors) can supply information about

transport to health centres, guidance for non-urgentsituations, advice in case of trauma, or indeed

medical aid.

To improve the quality and reach of the medical

networks in Rwanda and Tanzania, also in 2007

the GSM Association Development Fund proposed

the Phones for Health service with a number

of parties (operators and equipment providers).

This service enables healthcare workers to use a

standard mobile phone, mobile device or PDA,

Telecoms operators and equipment

providers can also help improve

healthcare infrastructure



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equipped with an application downloaded on thehandset, to upload patients health information on

to a central database via a GPRS connection. If the

GPRS network is not available, transfers can take

place via SMS. The system also incorporates SMS

alerts, communications and co-ordination tools

aimed at teams in the field who can send medical

prescriptions and upload treatment information

using the application.

Hospitals based in capitals or other cities can alsobenefit from ICT company assistance, not only

via tele-medicine but also through improvements

to patient records management, equipment

monitoring31 and service delivery. This type of

project is being undertaken by better-off countries

in Africa, notably in South Africa or the Maghreb

region, either in the context of building new

towns from scratch (referred to as smart cities32,

in particular in the Maghreb region) or private

financing for hospitals for medical tourism (Tunisia,

Mauritius)33. Such solutions are less widespread in

more traditional hospitals.

Finally, ICT can help improve productivity across

the medical supply chain by automating previously

manual (therefore onerous, fastidious and fraud-

sensitive) information flows. For example, the

Kenyan government requested that Telkom Kenya

deploy of a system to reduce counterfeiting,

fraud and reporting delays in the provisioning34

of antiretroviral therapies35. The solution underconstruction uses basic operator-provided services

over mobile networks to transfer information

between participants in the chain dispensaries,

logistics management units, central medical depots,

district and provincial chemists and indeed, patients.

For example a simple line of SMS information

enables professionals to be informed quickly about

new pharmacological insights, changes in dosage,

recommendations in case of epidemic, etc.

The system also tackles counterfeiting using by

sending a code via SMS36, proving receipt of the

authentic product.

Whatever the principal challenges confronting

Africas health systems, technical solutions do exist

they just need to be deployed. This demands strong

support from government, which is the main catalyst

to accelerate deployment. Such support is notsufficient by itself however: a number of constraints

and limitations specific to healthcare-related ICT

projects in Africa also need to be taken into account.

With respect to ICT financing, BearingPoints

analysis5 of the African health market has shown

that patients alone cannot generate sufficient

revenues to assure the sustainability of the

economic model. Out of the 51 billion dollars spent

on healthcare overall, slightly more than a billiondollars are allocated to ICT budgets6. Threshold

analysis shows that 47 countries spend less than

50 million dollars, 37 countries less than 10 million

dollars, 24 countries less than 5 million dollars and

9 countries less than a million dollars on healthcare-

related ICT. The viability of the model cannot

therefore be dependent exclusively on patients. ICT

organisations need investment from third parties

such as nation-states, or even financial institutions.

Otac to ICT fo hathcai Afica

Potential obstacles to healthcare ICT initiatives

are not generally to do with the technology once

a telecoms network is in place and can deliver the

expected baseline in terms of quality of service,

that is. The majority of solutions are based on

simple tools and protocols such as SMS, which are

well-suited for the data transmission requirementsof doctors (tele-radiology, telemedicine etc.), and

can be straightforward to access from the patients

perspective.

Limitations are more concerned with how systems

are used, access to electricity and finally financing.

Patient literacy is a clear hurdle for this type of

technology often more for writing than for reading,

where numbers and simple words are generally

accessible. In African countries with a high official

Individual ICT companies can

lack real strategy around

healthcare in Africa



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rate of illiteracy, certain types of information like

medicine posology are therefore sent via USSD, a

simple telecoms standard which uses numbers and

special characters such as * and #. In Europe, this

system is used to access certain operator services but

is otherwise rarely used.

A greater technological limitation is to do with theregular provisioning and continuity of electricity.

Energy access is as much of a challenge for end-

users (e.g. for charging batteries) as healthcare

providers (continuity of data transfers, never mind

broader operations, cold chain requirements for

certain medicines, etc.). This hurdle is so great that

even telecoms operators consider it when specifying

solutions, for example deploying portable solar

equipment (costing more than generators) at kiosks

used the sale of scratch cards37

.

In the African context, the final, still-unresolved

challenge for ICT companies remains finding an

economically viable and sustainable model for

these solutions. The success of an ICT healthcare

project needs to meet three conditions: a stated

requirement issued from a stable and sustainable

ecosystem; a relevant ICT solution designed in

response; and an economically sustainable model

that ensures its viability (both in terms of initial

investment and maintenance over time).

Financing can come from market dynamics, but the

figures in the first section of this report (of a billion

dollar market for healthcare-specific ICT across

the whole continent) show that it is not enough.

Financing from a public aid institution therefore

makes sense. While aid strategies have been

disputed as being less effective than other means

(such as market dynamics or loans) since the success

of the book by Dambisa Moyo, Dead Aid38, inputfrom international aid organisations continues to

make sense in the healthcare context. However this

requires two sets of current aid approaches to be

considered and modified.

First, healthcare aid projects often finance the

initial investment rather than providing support for

the duration of the project. Without such support

however, the question of financial viability for the

term of the ICT project remains. Indeed, given

that ICT solutions are usually proposed by private

organisations, the viability and sustainability of each

depends on its longer-term profitability. Existing

aid may offer a tactical method to compensate for

a structurally weak market, but it should also offer

concrete routes to financing in the long term.

In addition, individual ICT companies can lack realstrategy around healthcare in Africa, inhibiting

the potential for improved cooperation between

parties, or generally coordinated momentum

to finance these programmes. Foundations

certainly exist: the 189 member-states of the

UN are committed to achieving the Millennium

Development Goals by 2015, of which three are

relevant to healthcare: Reduce infant mortality,

Improve Maternal Health, and Combat AIDS,

malaria and other diseases. In addition, a range of

investment opportunities exists across the African

healthcare sector. Part of the direct funding for

these investments usually comes from governments

(e.g. AFD, USAID), from international organisations

(e.g. UN, World Bank) and, less often, from private

donations (e.g. Bill and Melinda Gates Foundation).

Beyond declarations of intent however, no truly

coherent policy exists for financing healthcare

projects in general, nor their ICT dimension in

particular. Participants are numerous but they do not

work together on targeted countries or illnesses, nor

the selected financing mechanisms39.

By moving beyond this dual constraint (the needfor long-term rather than seed financing and the

lack of coordinated strategy), a way forward for

greater effectiveness in the deployment of ICT

companies can be achieved to the benefit of

healthcare in Africa.

Limitations are more concerned with

how systems are used, access to

electricity and finally financing



14/22

mHeAlTH AllIAnCe besT prACTICes In 2011

The mHealth Alliance promotes using mobile technologies to improve healthcare throughout the world, across

a number of sectors. Working with a diverse range of partners, the alliance brings the mHealth community together to

overcome common challenges by sharing tools, knowledge, experience and best practice.

The mHealth Alliance advocates for more high quality research and study to grow the evidence base; seeks to build

capacity across health and industry decision-makers, managers, and practitioners; promotes sustainable business

models; and supports systems integration by advocating the standardization and interoperability of mHealth platforms.

The winning Top 11 innovators in the 2011 Innovators Challenge at the mHealth Summit are:

1) mCare an integrated mobile system facilitating pregnancy surveillance and registration to optimize care delivery

to pregnant women and new-borns, and facilitates emergency response.

2) Pesinet a system combining local resources and mobile technology to increase care and reduce child mortality in

Mali.

3) Voice Net a personalized voice-based information retrieval and transaction system with local language voice

recognition to effectively aid healthcare delivery in India.

4) Cost-effective and field-portable microscope and diagnostics tools for telemedicine application in resource-poor

areas and developing countries in Africa, South America, and South Asia.

5) mPedigree a platform to combine mobile technology and cloud computing to fight counterfeit medicines by

providing free access to an instant drug quality verification system via text messaging in Africa and South Asia.

6) CommCare-Sense a localized multimedia system to improve quality of care in four districts in India

7) MDNet a networking program for physicians in Ghana and Liberia, allowing physicians to call and text each

other at no cost, leading to the first-ever doctor directories and a bulk SMS system through which government

administrators can send alerts and collect data.

8) An application that enables menu-driven applications to run directly from a SIM card on even the least expensive

phones in Malawi and Cameroon.

9) MiDoctor a system that allows to address problems associated with non-communicable diseases in low-resourcesettings by connecting patients and their providers via automated phone calls and SIM messages, alerting clinical

staff of high-risk situations for patients, and contributing to electronic medical records.

10) A mother and child tracking system, based on SMS technology that provides updates from auxiliary nurse midwives

in India.

11) AMPATH a clinical decision-support system that incorporates patient data within electronic health records to

provide patient-specific and timely reminders about deficiencies in care to clinicians in Kenya.



15/22

15

Cocuio

Health-related issues remain more critical in Africa

than in any other continent as the mortality gap,

with the level of pandemics on one hand and

resources on the other hand, continues to widen.

ICT companies bring elements of the solution:

they compensate in part for a lack of technicaland human resources, promoting data exchange

to enable medical investment and expertise to be

concentrated in fewer locations.

Once networks are in place, this sharing of

resources enables significant productivity gains as

maintenance costs are low and the obsolescence of

ICT is slower than for medical resources.

The question of financing remains unresolved,

however. As on other continents, ICT solutions

in Africa are delivered by private companies that

ensure upgrades and continued development of the

technologies concerned. Even in Africa, ICT service

quality needs to be maintained and continuously

improved, requiring constant attention from those

driving health projects. It is therefore crucial to

identify sustainable financing mechanisms.

Aid funds add value particularly in early stages, but

they cannot respond to the comprehensive set of

needs across the duration of programmes, either

macro-economically, as Dambisa Moyo proved40,

or to support the monitoring of patients daily

activities which requires the broader solvency of

Africas health sector.

ICT companies can offer significant help to Africas

health sector (maybe a great deal more to whatthey provide in developed countries, in relative

terms). However the challenges to overcome

(chronic low equipment levels, the brain drain loss

of medical practitioners to Europe and the Middle

East, the scale of health crises, the lack of a genuine

system of shared financing) mean that ICT can only

offer a partial solution. As the m-payment example

shows however, technology can help identify new

solutions by aligning with the behaviours of the

populations concerned. State-led, generalised

therapeutic policies do not always match specific

patients needs and habits: ICT companies can help

address these needs.

Technology can help identifynew solutions by aligning with

the behaviours of the

populations concerned

Health-related issues remain

more critical in Africa than in

any other continent



16/22

About the authors

Jean-Michel Huet is a

Director at BearingPoints

Paris office. He works on

different issues relating

to marketing andinternational development

of telecoms, media and

utilities companies. He has

published numerous articles and point of views on

entry strategies, management and convergence,

including books (Le meilleur de la stratgie et

du management, Village Mondial, 2009; What

if telecoms were the key to the third industrial

revolution?, Pearson, 2010). Prior to joining

BearingPoint, Jean-Michel was a Product Manager

at France Tlcom and worked at a consulting firm.

He is a graduate of Reims Management School and

Sciences Po Paris.

[email protected]

Tariq Ashrafis a Manager

within BearingPoints

Communications, Media

and Entertainmentpractice in Paris and has

10 years consulting

experience in the telecoms

industry.

He has business strategy as well as strategic

marketing expertise (service offering definition/

cartography, strategic product roadmap definition).

Tariq has conducted multiple market research and

market study assignments and has an international

profile, serving clients in Europe, North America andNorth Africa as well as in India.

[email protected]



17/22

Sources

1 For more detailed analysis TIC et systmes de sant en

Afrique, Note Ifri, mai 2010 in Tcheng, Henri, Huet, Jean-

Michel, Romdhane, Mouna,

2 The WHO reported, based on analysis of empirical data,

that the relationship between GNP per inhabitant and total

health spending followed the following equation: Total health

spending/inhab. = 0.0383*GNP/inhab. 0.249 with a margin

of error of 5%, redcuing to 2% for countries in the zone

Africa/Middle-East. Source: IFC, World Bank, The Business of

Health in Africa: Partnering with the Private Sector to Improve

Peoples Lives, 138 pages, 2007

3 BearingPoint Analysis, 2010, based on data from the IMF,

World Bank, OECD, United Nations Conference for trade

and development, European Bank for Reconstruction and

Development, UN, Deutsche Bank, Merill Lynch, JP Morgan,

Morgan Stanley, Goldman Sachs, Oxford Economics, Feri et

Consensus Forecasts, French economic missions, governments

and central banks.

4 IFC, World Bank, The Business of Health in Africa: Partnering

with the Private Sector to Improve Peoples Lives, 138 pages,

2007. The International Finance Corporation (IFC), an

organisation of the World Bank charged with encouraging

economic development of countries via financing of private

sector projects. The IFC invests about 1.5 billion dollars per

year in Africa, particularly in ICT and health.

5 BearingPoint Analysis, 2010, op. cit.

6 Or rounding up, one dollar per person, per year. We estimate

that this figure is 60 times greater in France.

7 H. Tcheng, J-M. Huet, op. cit.

8 Relevant insurance model is a topic on its own beyond the

scope of this study. The social security system could be a

solution (Tunisia is following this route, for example) but in

sub-Saharan Africa (for example Senegal) mutual companies

are the most promising.

9 In practice, separation between the medical treatment and

payment reduces consumption frictions.,: B. Fantino, G.

Ropert, Le systme de sant en France, Paris, Dunod, 2008,

358 pages

10 WHO, World Health Report - Health systems: Improving

performance, 2008. See also WHO, The Health of the People:

The African Regional Health Report, 2006.

11 Effect of mutual packages remains limited because it covers

only employees of larger companies or administrative

organisations, which does not make up the majority of

employment in these countries.

12 Death rate shows the incidence and the prevalence of

illnesses on the population at a global level. It is oftenconfused with the mortality rate (Number of deaths across

the population related to illness)

13 The Anand Baernighausen regression shows that 2.5 health

workers for 1000 inhabitants are needed to ensure two basic

interventions, namely vaccination of children under 1 year

old against measles, and births assisted by qualified health

personnel, for at least 80% of the population. This indicator

is generally called the WHO threshold. The rate is from 11

in Europe and from 1.44 in sub-Saharan Africa. (source: IFC,

World Bank, op .cit.). the breakdown of this latter figure is

shown in the graph number of medical resources per 1000

inhabitants.

14 IFC, World Bank, op. cit.

15 Source : BearingPoint interviews in 2008 and 2009, plus H.

Tcheng, J-M. Huet, Les TIC pour aider pallier les faiblesses

de la sant en Afrique , Tlcoms, n 200, p. 70 72, June

2009.

16 WHO, World Health Report - Health systems: Improving

performance; WHO, reports between 2001 and 2007.

17 Metronidazole is an antibiotic and antiparisitic treatment

18 Molecule involved in the treatment of pulmonary

tuberculosis.

19 From a western county standpoint, access to location and

hours of dispensaries may appear secondary but it is key

from a a African countries local economy perspective. By way

of example, one part of this information, easily accessible in

Europe, is not so in Africa due to the absence of a universaltelecoms service. Universal service collects a set of services

giving easy access to telecoms services including where

those are not economically viable. in France for example,

Universal Service allowed the financing of telephone cabins

in towns with less than 20,000 residents, directory enquiry

services, telephone directories, etc., all of which services that

Europeans would expect to see but which are missing on the

African continent.

20 Elements presented below are those which are available. A

major part of these projects is in fact in development with

strong confidentiality clauses attached. Authors do present

principles which they are able to communicate and that are

which are proven today in specific projects exact figures,

which are confidential.21 Experiments will take place in 2010 or 2011 in West African

countries within the context of public-private financing.

22 BearingPoint Interviews , 2008 et 2009.

23 20 examples from Timbuktu in the first year of function for

IKON. By way of example, the case of radiography of a hand

which happened at a patients home in Mopti for mundane

reasons. It shows an image called built by the bone spans

at the level of one of the metacarpals. For the doctors at

the level of Mopti, it had been taken for a bone lesion and a

costly and dangerous operation had been envisaged. Radio

pictures sent by the new system to the specialists enabled

a radiologist in Bamako to see that it was, quite simply, a

less grave variant. (Source : The International Institution for

Communication and Development (lInstitut Internationalpour la Communication et le Dveloppement, IICD, 2010

http://www.iicd.org).



18/22

18

24 BearingPoint Interviews, 2008, 2009.

25 Several records of tele-medicine financing by USAID, for

example.

26 Uganda Health Information Network (UHIN).

27 Source : International Development Research Center, IDRC,

2010 http://www.idrc.ca/en/ev-1-201-1-DO_TOPIC.html

28 WapEduc was launched in France first of all as a mobile

phone education system. Its creator, Philippe Steger decided

in 2009 to extend his service to African countries. The firstpilot country is Senegal.

29 Mmore details on technology options linked to education

in Africa, read Tcheng, H., Huet, J-M., Romdhane, M.,

Roubaud, J., Le tl-enseignement, un espoir pour lAfrique

?, Journal des tlcoms, , n 200, p. 55, October 2009. In

particular, regarding population awareness, training issues

and broadcasting of best practices or simple techniques

in health promoted by the WHO and UNICEF, it is shown

that ICT companies can bring media, in particular radio

and mobile telephony which are the two terminals the

most widespread in Africa (radio in rural locations, mobile

telephony in urban areas, other means such as television or

the PC lagging far behind).

30 Source: RAFT, 2010. This last course indeed covers the useof a computer simulator for continued medical training and

help to isolated healthcare professionals in Africa. (Course

delivered by Caroline Coquoz and Georges Bediang (Geneva

University Hospitals) on Thursday 18 March 2010 at 11.00

GMT link to access course:

http://www.dudal.net/dudal/apps/jws/uiclient?/raft/

suisse/20100318_1100).

31 A BearingPoint study in 2009 involving several hospital

managers showed a major loss of time linked to searching for

lost trolleys within the same hospitals.

32 The smart city concept refers to constructing towns that

incorporate the generalised use of new technologies. The

majority of these intelligent, indeed futuristic city projects are

financed by Gulf investors . Some smart cities are present in

all or part as true medical cities (in Tunisia or Morocco but

mainly in the, in Jordan, and GCC countries such as Qatar or

UAE-Dubai) and it is the set of health-related benefits, air

quality, post-operative convalescence, care for older people

that is put first. Telecoms operators should bring technology

that powers this cities (Connections between and within

hospitals, from tracing medicines to calling a nurse and

including video on demand packages in rooms). Strictly

speaking, these projects follow logic closer to tourism than

healthcare but are worth mentioning.

33 Medical centres for rich tourists in the GCC region or in Europe

which want to benefit from recovery from an operation in

a sunny environment. This practice, widespread in several

countries, does exist , but is is not covered in this researchnote.

34 BearingPoint, 2009.

35 BearingPoint, 2009.

36 Or in a more sophisticated manner that is also better adapted

to central depots via 2D bar codes which enable an accurate

trace of product information.

37 D. Florin, J.-M. Huet, Le dveloppement par lnergie solaire

, Les Echos, January 2009.

38 D. Moyo, Dead Aid: Why Aid is Not Working and How There

is Another Way for Africa, Allen Lane, 190 pages. Criticismswere made regarding this release. The two most relevant are

in the context of our works: on one side, principles posed in

this release become generic (aid in the wider sense); on the

other hand, by viewing a privatisation of aid, the dimension

of universal cover disappears in the context of healthcare or

this coverage/universal service becomes a key dimension.

39 Source: interviews conducted by BearingPoint in the first

quarter of 2009

40 D. Moyo, op. cit.



19/22

19

References

Aker, J., Does Digital Divide or Provide? The Impact of Cell Phones on

Grain Markets in Niger, 61 pages, http://www.cgdev.org/ 2008.

World Bank, Improving Health, Nutrition, and Population Outcomes in

Sub-Saharan Africa,, 2005.

Bayes, A., von Braun, J., Akhter, R., Village Pay Phones and Poverty

Reduction: Insights from a Grameen Bank Initiative in Bangladesh,

ZEF, Berlin, 1999.

Chowdhury, S. K., Investments in ICTCapital and economic

performance of small and medium scale enterprises in east Africa.

Journal of International Development, 2006, vol. 18, n 4, p. 533-552.

Coyle, D., Overview, Africa: The impact of mobile phones, The

Vodafone Policy Paper Series, n 2, 2005, p. 3-9.

Datamonitor, Disease management and drug adherence, 128 pages,

juin 2007.

Donner, J., The social and economic implications of mobile telephony

in Rwanda: An ownership/access typology, in Glotz, P., Bertschi, S.,

Locke, C. (eds), Thumb culture: The meaning of mobile phones for

society, Bielefeld (Allemagne), Transcript Verlag, 2005, p. 3752.

Donner, J., The use of mobile phones by microentrepreneurs in Kigali,

Rwanda: Changes to social and business networks, Information

Technologies and International Development, vol. 3, n2, 2006, p. 3-19.

Forestier, E., Grace, J., Kenny, C., Can Information and Communication

Technologies be Pro-Poor? , Telecommunications Policy, n 26, 2002,p. 623 - 646

Garbacz, C., Thompson, H G., Demand for telecommunication services

in developing countries. Telecommunications Policy, vol. 31, n5, 2007,

p. 276-289.

Goodman, J., Linking mobile phone ownership and use to social

capital in rural South Africa and Tanzania , Africa: The impact of

mobile phones, The Vodafone Policy Paper Series, n 2, 2005.

Grajek, M., Estimating Network Effects and Compatibility in

Mobile Telecommunications, Wissenschaftszentrum Berlin fr

Sozialforschung, December 2003.

GSMA Fund Development, Phones For Health, 2007.

Hammond, A.L., Kramer, W.J., Katz, R.S., Tran, J.T., Walker, C., The next 4

Billion Market size and business strategy at the bottom of the pyramid,

Washington, DC, IFC et World Resources Institute, 2007.

Hardy, A, The role of the telephone in economic development,

Telecommunications Policy, 1980, vol. 4, n 4, p. 278-286.

Huet, J-M, Viennois, I., Mobiles, concurrence et dveloppement, Les

Echos, March 2010.

IFC, Banque Mondiale, Investir dans la sant en Afrique, Le secteur

priv : un partenaire pour amliorer les conditions de vie des

populations, 151 pages, 2007.

IFC, Banque Mondiale, Comptes nationaux de la sant, 2006.

Ivatury, G., Moore, J., Bloch, A., A doctor in your Pocket: health hotlines

in developing countries, GSMA Note, 29 pages, 2009.

Jensen, R., The digital provide: Information (technology), market

performance, and welfare in the South Indian fisheries sector.

Quarterly Journal of Economics, vol. 122, n 3, 2007, p. 879-924.

Kyem, P., A., LeMaire, P-K. Transforming recent gains in the digital

divide into digital opportunities: Africa and the boom in mobile phonesubscription. Electronic Journal of Information Systems in Developing

Countries, vol. 28, n 5, 2006, p. 1-16.

Lindeloew, M., et al., Buying results? Contracting for health service

delivery in developing countries, Lancet, vol. 366, n 9486 , 2005, p.

676-81.

Marek, T., et al., Trends and Opportunities in Public-private

Partnerships to Improve Health Service Delivery in Africa, World Bank,

Human Development Sector, African Region, 2005.

Moyo, D, Dead Aid: Why Aid is Not Working and How There is Another

Way for Africa, , Allen Lane, 190 pages

Navas-Sabater, J., Andrew, D., Niina, J., Telecommunications and

Information Services for the Poor , World Bank Discussion Paper, n

432, avril 2002.

Norton, S W., Transaction Costs, Telecommunications, and the

Microeconomics of Macroeconomic Growth. Economic Development

and Cultural Change, vol.41, n1, 1992, p. 175 - 196.

WHO, Africa Region Health Report, Geneva, 2008.

WHO, Health financing: a strategy for the African region, Geneva,

2006.

Reynolds, R., Kenny, C., Liu, J., Zhen-Wei Qiang, C., Networking for

foreign direct investment: the telecommunications industry and its

effect on investment, Information Economics and Policy, vol. 16, n 2,

2004, p 159-164.

Roeller, L-H., Waverman, L., Telecommunications Infrastructure

and Economic Development: A Simultaneous Approach, American

Economic Review, vol. 91, n 4, 2001, p 909-23.

Sekhri, N., Savedoff, W., Private health insurance: implications for

developing countries, Bulletin of the World Health Organization, vol.

83, n 2, 2005, p. 127-34.

Socit financire internationale, Report to the donor community on

technical assistance programs. Washington, DC, IFC, 2006.

Souter, D., Scott, N., Garforth, C., Jain, R., Mascararenhas, O., McKemey,

prnom?, The economic impact of telecommunications on rural

livelihoods and poverty reduction: A study of rural communities

in India (Gujarat), Mozambique, and Tanzania, Commonwealth

Telecommunications Organisation for UK Department for

International Development, 2005.

Sridhar, K. S., and Sridhar, V., 2006. Telecommunications and growth:

Causal model, quantitative and qualitative evidence, Economic and

Political Weekly, p. 2611-2619.

Tcheng, H., Huet, J-M., Les TIC pour aider pallier les faiblesses de lasant en Afrique, Tlcoms, n, 154, June 2009, p. 70-72.

Tcheng, H., Huet, J-M., Romdhane, M., Roubaud, J., Le tl-

enseignement, un espoir pour lAfrique ?, Journal des tlcoms,n

200, October 2009, p. 55.

Tcheng, H., Huet, J.-M., Romdhane, M., Les enjeux financiers de

lexplosion des tlcoms en Afrique subsaharienne, Note de lIFRI,

February 2010

Tcheng, Henri, Huet, Jean-Michel, Romdhane, Mouna, TIC et systmes

de sant en Afrique, Note de l Ifri, May 2010

Tcheng, H., Huet, J-M., Viennois, I., Romdhane, M., Tlcom et

dveloppement en Afrique, Expansion Management Review, n 129,

Summer 2008, p. 114-124.

USAID, Private health insurance in India: promise and reality, February

2008, 268 pages.

Waverman, L., Meschi, M., Fuss, M., The Impact of Telecoms on Economic

Growth in Developing Countries, Africa: The impact of mobile phones,

The Vodafone Policy Paper Series, n 2, 2005, p. 10-23.

Wellenius, B., Extending Telecommunications Beyond The Market:

towards a universal service in competitive markets , World Bank, 2000.

Zhen-Wei Qiang, C., Economic impacts of Broadband , in: World Bank,

Information and Communications for development 2009: extending

reach and increasing impact, p. 35-50.

Zibi, G., Promesses et incertitudes du march africain de la tlphonie

mobile, La Revue de Proparco, Secteur Priv & Dveloppement,

Number 4, November 2009, pp 3-6

Web referencesBanque Mondiale - http://www.banquemondiale.org/

Banque Europenne pour la reconstruction et le dveloppement -

http://www.ebrd.com/

Deutsche Bank Research - http://www.dbresearch.com

Fond Montaire International (FMI) - http://www.imf.org/

International Telecommunication Union (ITU) - http://www.itu.int

Ifremmont Labs - http://www.ifremmont.com/ifrelab/

Organisation de Coopration et de Dveloppement Economiques

(OCDE) - http://www.oecd.org

Organisation Mondiale de la Sant - http://www.who.int/fr/

Organisation des Nations Unies - http://www.un.org

Oxford Economics - http://www.oef.com/

Programme des Nations Unies pour le Dveloppement (PNUD) -

http://www.undp.org


20/22

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