E-Health Africa: Overcoming the barriers to its implementation. A Case Study of Sub Sahara Africa.

1. E-Health Africa: Overcoming the barriers to its implementation. A Case Study of Sub Sahara Africa. Presented by Akeh Lucas and Morfaw Zigo August , 2007 Karlstad University

2. Introduction It is of utmost importance to be in good health. Good health will make us happy, means we are active and productive since healthy citizens will contribute enormously to the growth and development of the economy. Hence, health is very important and calls for concern around the world. In Sub Sahara Africa, the health situation demands greater attention. The region is a �DANGER� zone. Home to thousands of diseases, including

3. Introduction Con�t Malnutrition, malaria, sleeping sickness, HIV/AIDS etc these diseases claim millions of souls every year. Despite efforts carried out so far, the health situation seems to be deteriorating everyday. More efforts are needed. New solutions must be put in place to remedy the health situation. The authors are of the opinion that e-health will go a long way to remedy the health situation. However, studies show that a number of barriers prevent the successful implementation of E-health in this region

4. Introduction Con�t The authors intend to identify these barriers and proffer solutions. Thus, we intend to answer two very important questions: 1) What are the barriers that prevents the successful implementation of E-health in SSA? 2) How can we overcome these barriers?

5. Methodology

6. What is E-health? �e-health is an emerging field in the intersection of medical informatics, public health and business referring to health services and information delivered or enhanced through the internet and related technologies. In a broader sense the term characterises not only a technical development but also a state-of-the mind, a way of thinking, an attitude and a commitment for a networked, global thinking, to improve health care locally, regionally and worldwide by using information and communication technology.� Eysenbach (2001), e-health guru

7. Our working definition of e-health is� �the use of ICTs for all aspects of healthcare from clinical diagnosis, home care delivery, education of health professionals, transparent management of health resources to general e-commerce involving both healthcare providers and consumers� (Own Source) Therefore, what are the benefits of E-health?

8. Potential benefits of E-health Heeks (2004) identified two benefits such 1) task level benefit such as the improvement in the cost or speed of data handling tasks 2) improvement in the speed and quality of health management Thus, ICTs can cut the costs of tasks and processes and reduce the time to perform these tasks and processes Mbarika et al, (2002) e-health would link hospitals and other medical institutions and result to an overall improvement of health care services, efficiency, and proper monitoring of patients

9. Potential benefits of E-health Con�t Eysenbach (2001), listed �10Es� of E-health, some of the �Es� include 1) Efficiency 2) Empowering of consumers and customers 3) Education of physicians through online resources 4) Ethics as a new form of patient-physician interaction etc. They argue SSA stands to benefit these and more if there is a successful implementation of E-health system in the region. So, where is Sub Sahara Africa?

10. Locating the Region Wikipedia defines SSA as a term used to describe those countries of the African continent that are not considered part of political North Africa. The dividing line is the southern edge of the Sahara Desert, though Chad, Mali, Mauritania, and Niger belong to both regions. As shown in the map the North and Sub Sahara regions of Africa have been separated by the harsh climate of the sparsely populated Sahara. Source: http://www.idrc.ca/uploads/user-S/11184166631Map_-_Africa_LRG.jpg

11. Health and ICTs in SSA The spread of the internet in various parts of the world have highlighted the fact that SSA, part of the world�s second largest continent is the region with the lowest level of economic, technological and internet development in the world. There is still very low level of internet connectivity. UN Global E-government reports (2003, 2004, 2005, and 2006) proved that middle Africa has the lowest rate of e-readiness in the world Internet World Stat (2006) proved that Africa, despite the fact that it inhabit 14.10 per cent of the world�s total population and way ahead of Europe (12.40 per cent), North America (5.10 per cent) Middle America (2.9 per cent) etc use only 2.60% of the world�s total internet usage. However,�

12. However, SSA countries are becoming more aware of the potentials of ICTs especially in the health care sector. In many SSA countries sporadic use of ICTs use in the health sector have been initiated and carried out by government and foreign donors e.g. Ghana, Kenya etc. But many of these projects fail or do not achieve the desired results. So, Why do these projects fail? Why is it difficult to implement successful e-health systems in this region? Barriers???

13. Barriers to e-health implementation in Sub Sahara Africa. Based on our research method, we have classified barriers to e-health in four categories: political, economic, socio-cultural and technical barriers as shown in the diagram (Own Source)

14. Political barrier has to deal with the following: leadership and vision, political will, self interest, corruption, low expectancy of governmental organisationsWHO (2005), few governments have develop roadmaps for e-health, but most are still lagging behind due to lack of vision and insufficient political willOECD (2005) reports lack of e-health experts or leaders to champion e-health projectsHaque et al. (2006) Sub Sahara Africa is governed by leaders who prefer the status quo or present state of affairs (leaders are afraid of change)Ajayi (2006) argues that corruption is endemic and leaders are pushed by greed to satisfy their own personal ambitions

15. Transparency International agree that SSA is home to the world�s most corrupt countries Amokeode (2004) states that about $100 billion was stolen from Nigeria alone by its leaders from 1993 to 1998 during the leadership of Late General Sanni Abacha These trends have not changed much Hence money meant for public expenditures are directed to private pockets There are also legal barriers that prevent the adoption and use of ICTs in the health care sector WITSA (2006) most government enact laws that prevent advances in technology e.g. regulations may require health care providers to maintain patient�s record in a paper-based format such laws are barriers to the use of ICTs in the health sector

16. Economic barriers include financial resources at the disposal of the governments. E-health, like e-business, e-government and e-education cannot succeed without a well established communication networks WBG (2005) reports, that there are a multitude of projects apart from e-health in this region, hence, e-health projects will have to compete with other projects for the limited resources UNDP (2004) citizens in this region are very poor and they cannot afford basic essentials such as food and clean water and 70% live in rural areas far away from the urban areas where most ICTs are found Also there are frequent power cuts which is a barrier to e-health. Frequent power cuts leads to loss of data UNECA (2005) under developed telecommunication infrastructure is another potential barrier to e-health development in SSA

17. UNECA argue that SSA has to invest heavily in infrastructure in order to benefit from the opportunities offered by ICTs Internet World Stats, SSA has less than 2 per cent of the Worlds telephone lines, less than 1.5 per cent of the total number of PCs, and less than 1 per cent of the total internet users. These low figures are all barriers to e-health adoption

18. SSA has one of the world�s lowest adult literacy rate, with only 60 per cent of the population of 15 and over able to read and write in 2000. UNESCO Global Monitoring Report (2006) Lack of trained professionals and skills in disseminating ICTs based training in e-health Issue of digital divide within and without countries in this region Shortage of medical personnel, particularly specialists Some doctors not willing to accept a change to new technology (resistance to change) Local health care workers fear this change may lead to job loss Patients also not willing to stay away from their doctors for fear of their confidentiality of medical records

19. Overcoming barriers to e-health development in SSA. This part has been broken down into two 1) what governments, organisations, individuals, scholars have said and have done and are doing and, 2) What the authors believe ought to be done.

20. Legislation amended to reduce taxes on ICTs equipments The need for New Public Management, hence a general overhaul of the public service Corruption must be stamped and be punishable by law Embezzled funds must be redirected to finance e-health projects The need for e-health experts Solutions to political barriers

21. Solutions to Economic barriers Infrastructure development Poverty alleviation Assistance from donor organisations Solutions to Socio-Cultural barriers Education Digital divides Use of ICTs in public services

22. What ought to be done It is important to identify the barriers first and potential barriers. Examine their nature, the causes of the barriers and which of these barriers are the most problematic Can a solution to these problematic barriers result to the elimination of all other barriers Proffer solutions to tackle them

23. Priority factor Governments, the civil society, organisations should concentrate on educating citizens in Sub Sahara Africa. Education has the potential to eliminate most of the barriers to e-health in the region. It will Empower citizens of the region Create employment Provide e-health experts Reduce resistance to change Bridged the digital divide and produce upright citizens.

24. So what should governments do? Education should be provided free in primary schools ICTs should be made compulsory in the national curriculum in primary, secondary and tertiary institutions. Governments should offer scholarships for students to be trained in advanced ICT institutions.

25. Conclusion Research was out to Identify barriers to the successful implementation of E-health in SSA Discuss solutions to these barriers. This has been done. E-health in SSA faces a number challenges which includes political, economic, socio-cultural and technological challenges. So what is the way forward? Reforms are needed, bridging the digital divide is an urgent issue, education is of primary importance to bridge this divide Urgent need for better public management and good governance. Assistance is needed from Multi-national Corporation and foreign donors etc We would like to say that SSA governments have to do better than what they have done. It is not a rich institutional arrangement that matters. It is not attending conferences and signing papers that matters. What is needed is action. Words, policies, strategies, must be matched with actions. THANKS FOR LISTENING