Feng Zhao, Ph.D, MPH,MD eHealth Coordinator Africa HNP, World
Bank
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Outline See todays World through Telecomm World 2009 Geneva
Address health challenges using ICT Demystify eHealth/mHealth
Identify major bottlenecks in scaling up eHealth Recognize the
importance of eHealth Why Bank should care about eHealth Take
advantage of eHealth -Options for the Bank
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Telecomm World 2009 Geneva Open Networks - Connected Minds
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President Paul Kagame
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Nelson Mandela
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African Countries at Telecomm 2009
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Consensus The world is a very different place from it was just
a few years ago. By the end of 2009, the world will reach 4.6
billion mobile phone subscriptions and 1.8 billion internet users
(more than half have broadband access). ICTs have been an engine
for economic growth in both developed and developing countries; are
resilient to the financial crisis. ICTs are directly responsible
for job creation in the knowledge economy. ICTs are answers to many
challenges we are facing, and it can help achieve MDGs. ICTs are
part of everything we do in the modern world. We are at a historic
time, and should take advantage of the new environment and not miss
the opportunity.
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eHealth at Telecomm 2009
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Implications to the health sector We are dealing with a new
world: A world that is increasingly connected. A world that
presents a new meaning for access particularly for rural
population. With a mobile phone in the hand, the world is just one
call away. A world that provides a new set of tools and options for
health service delivery and utilization. A world that requires
strategic vision and change of behavior to proactively adapt to the
new environment
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Roles of ICT in Health From the well-know models The Classic
two-level health production function: H = f(S, O); S = f(H, C, O)
ICTs can alter both the inputs (H, C, O) and efficiency (f) Service
delivery function = Availability + accessibility + utilization +
continuation +quality (+information/data management)
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Evidence Availability Brazils eHealth Program Accessibility
Zambia eHealth centers to expand coverage Utilization Indias mobile
phone games for HIV knowledge Continuation South Africa mobile
message for TB treatment Quality Ethiopia patient smart card and
follow up Information/data management - Uganda PDA Projects ICTs
contributions to service delivery are comprehensive and
systematic
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New ways of health planning for addressing long-standing health
challenges Shortage of health professionals (telemedicine,
diasporas programs) Resource allocation M&E and
information
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Demystify eHealth/mHealth Perception 1: Developing countries
are not ready for eHealth due to its limited infrastructure and
connectivity
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Connectivity The speed for improving connectivity has been
amazing for the past decade. It can only get better. Just two years
after the Connect Africa Summit in Kigali in October 2007:
Investments in communications infrastructure alone exceeded eight
billion US dollars, and have produced returns of over 40 billion US
dollars for the investors. Planned investments totalling USD 55
billion were announced to expand ICT connectivity and services to
the entire continent by 2015, including a goal of interconnecting
cities to broadband by 2012.
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Connectivity vs. Content/Application eHealth/mHealth are broad
areas and reliance on connectivity varies. Some effective
mHealth/eHealth programs are built on dial-up connection Start
small and create demand for better connectivity. Given the urgency
of health problems and MDGs, waiting is not an option.
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Demystify eHealth/mHealth Perception 2: eHealth/mHealth
programs are too costly for developing countries
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Paying too much The relative price for ICT services is highest
in Africa, the region with the lowest income level Significant room
for cost reduction. Actually, the ICT service charges were reduced
by 30% in Africa after 2007. Economist: The price of a basic model
of a mobile handset steadily fell, from around $250 in 1997 to
around $20 today. Cell phone service charges can be as low as $5
(in India). Low cost model is possible for developing
countries
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Cost and effectiveness Investment in ICT, as other health
infrastructure investment, will yield high return and efficiency
gain. Cost-effective (Uganda PDA): The Uganda PDA project not only
results in better data but also achieved 24 percent cost savings
over traditional paper-and-pencil methods Saving money: Studies in
developed countries (Australia, Greek, US, Canada, etc.) indicated
that eHealth approaches (virtual consultation, tele-pediatric,
home-based monitoring of chronic disease management, school-based
telehealth centers) are cost saving when comparing to traditional
ways.
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Demystify eHealth/mHealth Perception 3: eHealth is something
for rich countries.
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Developing countries are in greater need of ICT Developed
countries: cost and quality Developing countries: access and basic
health need For developing countries, eHealth/mHealth is not an
option; it is necessity Developing countries need ICT even
more
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Traditional way to seek health care
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New ways of health care delivery
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Major bottlenecks Knowledge Integration and coordination Policy
development (eHealth strategy/mater plan) Capacity and skills
Lacking of hard evidence and impact evaluation
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Knowledge In favor of eHealth services Uganda 96.6% Pakistan
86.5% Bhutan 87.5% Sri Lanka 81% Saudi Arabia 90.7% Mongolia
77%
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What is nesessary to speed up the implementation?
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Why Bank Should Care About eHealth/mHealth ICTs can help
achieve health-related MDGs ICTs become essential instruments for
health system strengthening, a focus of the Bank HNP strategy ICTs
represent a new ways to tackle health challenges ICTs can help
improve the performance of the Bank health operations
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Banks Comparative Advantages The Bank is financing health
operations and ICT projects in almost all the developing countries
Increasingly, the Bank is working with countries to assist the
development of health and ICT policies and strategies The Bank is
supporting (sometimes leading) donor coordination and harmonization
(e.g. IHP, HHS) The Banks HD, ICT, and IFC provide skills and
implementation capacity to mainstream eHealth
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Application of ICTs in HNP Projects is lagging behind
Education: For the fiscal years 2006-2008, 114 projects approved by
the Education Sector Board contained an ICT various components.
Agriculture and Rural development: An FY08 portfolio review shows
that over 80% of FY08 projects included ICT as an "implementation
approach and instrument", up from just over 20% in 2004. Governance
and Public Sector Reform is perhaps the Bank sector that has shown
the most interest in ICT in recent years. A growing number of
"e-Government" projects seek to use a range of ICT to improve
information flows and information analysis within government HNP:
Only a handful of projects explicitly included ICTs components.
There is no strategic plan to mainstream ICTs in health
operations.
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Options for the Bank Service line 1: Knowledge sharing Service
line 2: Policy, framework and guideline development Service line 3:
Capacity building Service line 4: Piloting and evaluation Service
line 5: Mainstreaming ICT in health operations -At project design
stage eHealth as an option -At project implementation stage eHealth
as a mean to achieve PDOs
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Partnership eHealth is a multidisciplinary field which requires
strong partnership with clients, ITU, WHO, Foundations, Academia,
private sector, etc. Internally, HD, ICT and IFC need to work
closely We are working closely with WHO and ITU to develop eHealth
guideline and training materials We are working with several
universities on evidence and piloting We will need technical input
from partners on strategy and plans for mainstreaming eHealth in
our projects.