Aligning eHealth Initiatives for Results: Study Summary

1. Aligning eHealth Initiatives for Results: Study Summary Photo: Gary McNutt/Community to Community Productions  March 21, 2013

2. eHealth: Today’s Presentation 1. Aligning for Results Overview and Landscape 2. Study Design and Respondents 3. Snapshot of Results 4.Conclusion Photo:iStockphoto

3. eHealth Aligning Initiatives for Results • IDRC SEARCH Study: Aligning eHealth Initiatives for Results • Study Duration: 10 months, initiating in November 2011 • Grantee: World Health Organization eHealth and Informatics Unit, led by KMS Director Najeeb Al-Shorbaji • Research and Study Team: Dr. Christopher Seebregts (Jembi Health Systems), Ticia Gerber, MHS/HP (Integrative Center for eHealth) • General Objective: To record stakeholder perspectives on better aligning siloed eHealth efforts and funding with national health priorities, particularly in LMICs. • Study Milestones: • Draft list of more than 100 key eHealth leaders worldwide, with LMIC emphasis • Design and test publicly available and reusable research instruments • Conduct eHealth stakeholder interviews • Revise ICT funding and cooperation principles • Summarize study findings Photo:iStockphoto

4. eHealth Aligning Initiatives for Results Study supports IDRC SEARCH objectives to: u Enhance alignment of different eHealth projects and programs to address national priorities; u Foster dialogue and research on eHealth policies, strategies and governance structures; u Foster collaboration and networking; and u Promote research uptake through appropriate knowledge translation practices. Study also supports WHO objectives to: u Provide leadership on matters critical to health; u Shape research agendas; u Catalyze change; and u Stimulate the generation, translation and dissemination of valuable knowledge. Photo:iStockphoto

5. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results: WHY NOW? eHealth Movement is at a Critical Juncture u Informative eHealth research is scant; u Pilotitis continues; u Public-private eHealth path lacking; u Alignment of eHealth activities with national health priorities is not ideal; u Global eHealth framework discussions brewing; u Reusable, standards-based national eHealth planning tools vacuum; u Donor alignment persistent LMIC theme; u Increased investment in local private and academic eHealth capacity is necessary; u More dialogue needed between ICT movements (HIS, mHealth, eHealth); u Anemic Global North-South information sharing; and u eHealth movement burn-out. Photo:iStockphoto

6. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results: WHY NOT BEFORE? care car Conflicting Interests Shifting Landscape Global Scope Market Maturity Politics Photo:iStockphoto

7. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results WHAT MAKES THIS STUDY UNIQUE AND IMPORTANT? u eHealth research covers broad range of geography and interests; u Tested, reusable, publicly available research instruments produced; u Focus on LMIC eHealth landscape as alignment calls grow louder; u MDG 2015 targets nearing; and u Provides insight to eHealth, health planning, health services and public health communities. Photo:iStockphoto

8. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results - Study Design Study team: u Employed consultative methodology; u Compiled interviewee list of 127 key eHealth stakeholders worldwide; u Received critical input from WHO headquarters and regional offices; u Drafted three separate 30 question interview questionnaires for: (1) donors; (2) government decision-makers; and (3) researchers, recognized experts and consultants; u Provided responder channels via phone interview or on-line Lime Survey portal. Photo:iStockphoto

9. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results - Study Design Specific Study Objectives u Obtain a snapshot of global eHealth players, interests and investments in LMICs; u Establish an initial understanding of LMIC eHealth projects (successes and failures); u Learn about relationships between external eHealth funding and national health priorities; and u Stimulate conversations about streamlined and better coordinated eHealth donor requirements. Photo:iStockphoto

10. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results - Study Responders u44 responders during 6-week study period; u8 phone interviews, 36 on-line surveys; u50% LMIC interviewee goal, 45% achieved; Geography of Responders (WHO Region) uAFRO 4 u EURO 4 u PAHO 23 u SEARO 8 u WPRO 5 u EMRO 0 Responder Classifications uGovernment Decision-makers 6 u Donors 9 u Researchers, recognized experts and consultants29 Photo:iStockphoto

11. eHealth Aligning Initiatives for Results Study Results – eHealth “Hotspots” u Interviewees cited 58 LMICs in which they fund, operate and/or implement eHealth projects or programs; u Nearly half of all countries cited located in the African Region; and u Countries most frequently cited as eHealth hotspots were: Kenya, India, Tanzania, Rwanda, South Africa, Peru, Vietnam, Thailand, Philippines, Indonesia and China. Photo:iStockphoto

12. eHealth Aligning Initiatives for Results Countries of eHealth program involvement for study respondents (58)

13. eHealth Aligning Initiatives for Results Study Results – National Health Priorities and eHealth When LMIC government decision-makers cited top national health priorities that eHealth could support they said: u Improving maternal and child health u Developing primary health care u Achieving progress on universal coverage u Integrating the health care system u Capacity-building u Increasing evidence-based medicine u Reinforcing community participation u Decentralizing functions to district level Photo:iStockphoto

14. eHealth Aligning Initiatives for Results Study Results – National eHealth Budgets Funded National eHealth Strategy u 83% of LMIC government decision-makers surveyed reported the presence of a national roadmap or strategy for eHealth for which there is government funding. National eHealth Budgets u Most LMIC government decision-makers cited eHealth budgets of $900,000 USD per annum (pa) or more. u More than 50% of eHealth projects cited by LMIC government decision-makers are funded from sources other than government budgets. u The amount of donor eHealth funding cited by LMIC government decision-makers varied widely from $100,000 USD pa to more than $10 million USD pa. u All LMIC decision-makers surveyed believe that their country budget for eHealth will increase in the next three years. Photo:iStockphoto

15. eHealth Aligning Initiatives for Results Study Results – Health System Strengthening and eHealth Donors u 80% of donors responding reported that national health priorities always or very often influence what and how their organization funds eHealth projects and programs in LMICs. u 73% of donors confirmed that eHealth is part of their strategy for health systems strengthening in LMICs. Photo:iStockphoto

16. eHealth Aligning Initiatives for Results When questioned about which of seven strategies for improving eHealth collaboration and alignment with national health priorities would be most impactful: Government decision-makers said: u eHealth Councils – A collaborative of national eHealth Stakeholder Councils ueHealth Expert Committees - Forming committees of eHealth experts uBest Practice Sharing - Increased sharing of eHealth implementation experiences and best practices Donors said: uReuse and Interoperability Principles - Building reuse considerations and interoperability principles into eHealth Researchers, recognized experts and consultants said: uReuse and Interoperability Principles - Building reuse considerations and interoperability principles into eHealth uCommon Principles - Common eHealth project design and evaluation principles Photo:iStockphoto

17. eHealth Aligning Initiatives for Results • The following determinants of successful LMIC eHealth projects were mentioned by individual respondents: • Experienced, well-respected, open partners who have worked together in the past • Team work • Peer Leadership • Long term interest by different donors in eHealth • Clear, well articulated strategy, plans and architecture that partners and stakeholder support • Countries in the driver’s seat • National ownership and leadership supported from beginning of effort • Commitment of some key staff toward project success • Governments that are involved and can insure compliance • Mastery of organizational and legal governance issues • Donors who understand the value of local capacity building and have patience to build it • Self-service, versatile products and outputs: Things that can be repurposed by program staff on the ground to address changing priorities over time without the need for consultants or programmers • Programs led by an MOH where the sustainability must be evaluated before starting an eHealth project • Form core networks at the implementation level • Leverage open source tools and community • Train project participants with broad eSkills Photo:iStockphoto

18. eHealth Aligning Initiatives for Results • The following determinants of unsuccessful LMIC eHealth projects were mentioned by individual respondents: • Impatience of external collaborators to move things along quickly • Unresolved collaborative tension between organizations with broader scope and small groups needing to have meaningful impact speedily • Assuming "ehealth" or EMR is the answer to all health information challenges • Weak leadership skills that cannot transcend egos • People who don’t understand project implications (time, money, effort) • Burn-out and high turnover from technical people and decision makers • Lack of technical and/or policy capacity • Project collaborations that are forced marriage or marriage of convenience, where power dynamics are potent • Lack of strong government buy-in • Lack of coordination between Ministry departments, faith and other external organizations • Refusal to extend participation in eHealth decisions to a larger multi-sectoral audience • Product driven intervention only • Lack of monetary incentives for change management • Vendors who cannot take a leadership role or don’t deliver • Jump to implementation without sustainable business models • Organizations that have the delivery capacity to scale but are not technology focused • No sustainability plan after funding expires • Avoidance of hard vendor and implementer questions like “Have you ever implemented your solution at the scale of a country like mine? When does your solution fail or break down? Why? What are you doing about it?” Photo:iStockphoto

19. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results Key Outputs u Summary of key informant interviews and study findings; u Tested, publicly available and reusable research instruments; and u Updated Approach toImproving Health Outcomes with Information and Communications Technology principles NOTE: The study team is still seeking feedback on the revised principles Improving Health Outcomes and Equity Using eHealth: An Agenda for Action which can be found along with questionnaires used for the study interviews at: http://www.globalhit.net/IDRC-Results/. E-Mail feedback to: comments@globalhit.net. Photo:iStockphoto

20. eHealth Aligning Initiatives for Results Aligning eHealth Initiatives for Results Recommendations for Further Research uA mini-survey on steps that should be taken in the next 12 and 24 months to better align siloed eHealth efforts and funding with national health priorities in LMICs; uShort case studies (1-2 per WHO Region) that profile the countries most frequently identified as eHealth hotspots; uA larger survey probing government decision-makers on eHealth projects, budgets and their alignment with national health priorities; and uFunding communications and educational work to operationalize the principles of the Approach to Improving Health Outcomes with Information and Communications Technology and to gain a critical mass of support for their implementation. Photo:iStockphoto

21. DR. CHRISTOPHER SEEBREGTS Executive Director Jembi Health Systems chris@jembi.org MS. TICIA GERBER, MHS/HP Founder Integrative Center for eHealth tgerber@globalhit.net Photos (l to r): Perry Kroll/iStockphoto, Heidi Sheppard/iStockphoto, Carolina K. Smith, M.D./iStockphoto/iStockphoto (2), NASA, Gary McNutt