Director of Strategy and Impact at the African Centre for eHealth Excellence (Acfee), Tom Jones, discusses the outcomes of the recent Acfee eHealth Forum (AeF). Tom is an editor and writer for eHealth News Africa (eNA), Acfee’s daily online blog, and he has also helped many African countries with their eHealth strategies and has completed over 60 economic evaluations in over 20 countries.

eHealth pushes ahead in countries globally, sometimes in a cycle of a few steps forward and a few steps back as eHealth’s potential encounters its many risks. Many of Africa’s health systems are facing numerous long-standing constraints, so they’ve moved on at a slower, steadier pace. There are many reasons for this, and some were identified and reviewed at the first AeF in Cape Town in July 2015 where the Acfee met with its Advisory Board and industry partners.

The overall outcome from the AeF is the absolute need to allocate resources to fixing the numerous eHealth challenges and it needs a place in eHealth plans alongside eHealth systems and programmes in order to become enablers for more eHealth systems. Broken down, it fits in a context of eHealth themes, outlined in Advancing eHealth in Africa, and summarised here briefly.

Health & Healthcare Priorities

Saving lives is at the top of the list of health priorities throughout Africa. Next is enabling healthier and more productive lives. Alongside these are other priorities, including better response to epidemics, better surveillance, better management of CDs and NCDs and serving unmet needs in rapidly increasing populations. It’s vital that eHealth programmes contribute fundamentally to better health but this isn’t always the case with a number of these eHealth initiatives.

Underpinning these health priorities are necessary improvements in healthcare priorities such as quality, efficiency and access. Currently, these improvements are guided by the Millennium Development Goals (MDGs), and now Strategic Development Goals (SDGs) but eHealth’s impact in meeting these objectives is mixed. While there are numerous initiatives that aim to support improvements, not all of them are always totally effective.

eNA, Acfee’s online blog, houses numerous reports on  the types of eHealth that fail to fulfil their potential and the many eHealth initiatives that are beacons for others to aspire to.

eHealth Contributions

Africa presents numerous opportunities for effective eHealth that are expanding almost daily. mHealth is a widely known mechanism for healthcare delivery in various forms. Increasing emphasis on predictive analytics is an emerging opportunity that African countries can prepare to harness in the drive towards eHealth enabled personalised and responsive care.

But even if eHealth is being leveraged at its fullest potential, its contribution alone is not enough to address the challenges African healthcare faces. Only integrated investment in resources such as medicines, medical supplies, and increased number of health workers in conjunction with eHealth, can start to address the barriers to healthcare delivery and rectify historically low levels of investment in healthcare in Africa.

eHealth Challenges

This is perhaps the most critical aspect of eHealth in the current African context. Acfee’s Advisory Board members are facing numerous long-standing eHealth challenges: over 60. These are inhibitors to progress, and need fixing. This is easy to say, but far more demanding to do.

Fixing eHealth challenges needs investment in several, related initiatives:

  • Enhanced eHealth leadership across health systems
  • Expanded eHealth human capacity
  • Constructive, transparent relationships with suppliers before procurement
  • Investment only in sustainable eHealth, including fixing the challenges
  • Rebalanced eHealth investment
  • Realising more benefits of eHealth: the justification for all eHealth programmes

eHealth Solutions

Health information management systems and mHealth are arguably widely used throughout parts of Africa but also serve to highlight the need to invest in other eHealth solutions to generate the desired impact. eSurveillance, EHRs, patient registries, integrated mHealth solutions, telemedicine, predictive analytics, Big Data and supply chain management need to be incorporated into broader eHealth programmes and strategies to achieve true health systems strengthening as witnessed in countries outside of Africa. This is also in addition to investment to fix long-standing challenges, which isn’t necessarily a set of stand-alone projects and therefore it’s feasible to incorporate some of these into mainstream eHealth programmes to build the momentum to move forward.

eHealth Action Plans

Two emerged from the AeF: one for countries and the other for Acfee. For countries, these are substantial, ranging over several themes, including:

  • Enhanced, rebalanced strategies
  • Expanded human and ICT capacity
  • Leading and managing complex change
  • Continuing relationships with suppliers outside procurement
  • Sustainability, including technical and affordability
  • Better eHealth performance
  • Developed eHealth informatics
  • Rigorous business cases for all eHealth projects, including risk management
  • Improved benefits realisation
  • Regulation and governance
  • More effective procurement
  • Enhanced eHealth in medical education
  • Scaling up to whole countries

The Way Forward

A general way forward is that eHealth strategies need to place more emphasis on rebalanced strategies that include:

  • Investment in fixing the challenges alongside investment in new eHealth systems.
  • More eHealth solutions at point of care that offer patients and health workers direct benefit during a care encounter and beyond, and less emphasis on eHealth that produces management and reporting information where benefits for patients, communities and health workers are more tenuous, and may be well into the future.
  • Investing in both large-scale eHealth, such as EHRs, and smaller-scale eHealth, such as mHealth, so when large-scale eHealth projects slip in time, which they invariably do, resources can be allocated to smaller-scale eHealth to fill some of the investment void.

The findings from the AeF don’t make eHealth any easier. They make it more realistic and achievable, and need enhanced leadership, human capacity, informatics, and analytical skills, techniques and methodologies to succeed. It’s Acfee mission to help Africa’s countries to develop and use these in way that:

  • Is applicable to local contexts
  • Creates strong, locally relevant vision and leadership
  • Has a carefully constructed implementation plan to execute it
  • An annual update and review to make sure it’s on track
  • Enables meaningful stakeholder participation from the outset

Acfee’s Advisory Board played a critical and constructive role in eliciting this new perspective on eHealth in Africa. As very senior leaders in health and healthcare, their perspectives were more about what eHealth has to offer and how they can use it to good effect, rather than how eHealth does it. This focus is vital in making eHealth work. eHealth enthusiasts and workers are an essential component of eHealth’s family, but we’re not enough.

Within these wider corporate teams, there’s a need for more eHealth enthusiasts and workers, and Acfee’s actively setting out to develop these. Later this year, a short learning programme on eHealth will kick-off at Monash University in South Africa. From 2016, diploma and master’s in eHealth programmes are being planned with Monash. Parts of the curriculum for these courses are being provided to some African countries to run locally. These will complement existing courses on technical aspects of eHealth, such as health informatics. Acfee’s curriculum has a broader content, including topics such as eHealth leadership, benefits realisation, business cases and risk management.

The aim is to begin to create a cadre of health workers of all types with enhanced eHealth skills so they can drive this increasingly complex investment programme in their own countries. As the cadre expands, it’ll create a broad eHealth community extending across Africa.

The extensive range of findings in Advancing eHealth for Africa, especially the breadth and complexity of Africa’s long-standing eHealth challenges, helps to explain why eHealth in Africa moves at a steady pace, and has to be integrated with other health and healthcare initiatives. It also sets out a way ahead that countries can use to achieve this.

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