The use of ICT offers new ways to increase access to services, improve quality and strengthen health systems
Increasingly one of the key tools for enhancing access to health services and improving their quality is the use of e-health – which essentially means employing information and communication technologies (ICT) for the benefit of the health sector.
E-health is now an integral part of most health strategies. At the regional and national level, it is used to convert evidence into policies, then develop and put into practice healthcare protocols that improve quality. It plays a part in assessing the need for more doctors and nurses, more access to healthcare, improved quality and improved performance.
Using technology to help healthcare professionals access and share information enables them to be more effective, while telemedicine benefits patients, carers and healthcare professionals, especially in remote areas. For example, radio frequency identification strengthens healthcare logistics, such as improving supply chains for medicine.
Benefits from e-health are maximised when they strengthen clinical practice and public health. Many successful vaccination programmes use inexpensive web-based e-health solutions. Surveillance information for epidemic responses can combine data from many sources, such as weather, migration and disease, to enable health professionals to advise and sound alerts. Another area of clear benefit is the field of e-learning. Many nursing auxiliaries now train online at a fraction of the conventional cost, and Seychelles has graduated its first cohort of nurses without a nursing school.
E-health also carries risks. It must be integrated with the wider health strategy. Although all Commonwealth countries already use e-health, the scale and range varies widely. A Secretariat survey in 2008 confirms countries’ interest in exploring and developing e-health further. The findings identify many challenges that need addressing for success.
E-health also needs to be affordable. Countries that implement e-health projects have to factor in the costs of purchasing equipment and telecommunications infrastructure. Funding sources vary across countries, and include public-private partnerships, and public sector money, although donor agencies are the main financiers of many e-health initiatives.
The most commonly reported barriers to take-up include a lack of infrastructure, low bandwidth and limited inter-operability. Technophobia is another problem. In Uganda for example, staff saw e-health “as additional work without remuneration”. And in Jamaica, there is concern that policy makers needed to “perceive technology as an additional tool to facilitate improved efficiency in the delivery of health care and not as a ‘monster’”.
Ethical issues can also be of concern when e-health is used for medical records. Consent, confidentiality, the secondary use of data and the acceptability of electronic signatures need to be taken into consideration, and many countries are now developing their legal frameworks to address this.
E-health is never an easy option because complex ICT. There are many technical difficulties that are not always easy to resolve. It is wise to acknowledge these difficulties and to recognise that e-health also takes time. Healthcare professionals and other stakeholders must be engaged – ignoring user requirements is a route to e-health disaster.
Pursuing e-health as a rapid response is not a good idea. E-health must deliver realistic goals within strict, careful and direct management. Both the ICT and the changes needed have to be delivered simultaneously, with health workers, executives, managers and ICT specialists all working together in order to realises the benefits.
The Commonwealth Health Ministers Meeting in May 2008 mandated the Secretariat to advocate and promote e-health in member states. In Africa, two regional dialogues have been completed, Kenya’s Ministry of Medical Services has developed an e-health strategy and other countries have started national consultations. Other regional dialogues are underway.
A methodology, tool and templates have been developed by the Secretariat to help stakeholders in member states engage in an intellectual discussion towards the development of their e-health strategies. The Secretariat has three priorities in advocating for e-health in the Commonwealth. First, to continue structured e-health policy discussions. Second, to foster exchanges of technical expertise between member countries. And third, to raise resources to develop pilot interventions and best practices.
The starting point is to create coherent national e-health policies and strategies in tune with national development plans, national ICT policies and with buy-in from healthcare workers. Many countries do not have the resources or expertise to develop their strategies consistently on their own, so the Secretariat supports countries by breaking e-health strategies down into their components, enabling decision-makers to deal with each part in a way that is successful, then constructing them back into the bigger e-health picture. The support of ICT suppliers has been crucial in this endeavour.
