Transcript eHEALTH NETWORK FOR AFRICA: NEED FOR LOWCOST MOBILE/WIRELESS INFRASTRUCTURES RESEARCH & DEVELOPMENT PROPOSAL Adesina Iluyemi PhD Candidate CHMI, Univ of Portsmouth, UK Member, eMobility ETP [email protected] 22.04.2008 WWRF #20

eHEALTH NETWORK FOR
AFRICA: NEED FOR LOWCOST MOBILE/WIRELESS
INFRASTRUCTURES
RESEARCH & DEVELOPMENT PROPOSAL
Adesina Iluyemi
PhD Candidate
CHMI, Univ of Portsmouth, UK
Member, eMobility ETP
[email protected]
22.04.2008
WWRF #20
Content
• Health Problems in Africa
• Definition and Policy drivers for eHealth in Africa through
wireless technologies
• Introducing the concept of wireless i-DeHI in Africa
• Barriers to wireless i-DeHI in AfricA
• Opportunities for WWRF
• Research and Development proposal
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Health Problems in Africa
• Africa has a population of about ONE billion people
- Up to 70% lives in isolated rural areas
- Half lives on half a dollar per day
- Poor telecom & transportation infrastructure
• Lack of Infrastructure and Capacity Healthcare delivery
• Brain Drain: International and Local (Rural vs. Urban)
• Africa has 10% of world population with 25% of global health burden but
with only 3% of global health workforce
• Poverty & Financial constraints
- HIV/AIDS accounted for 2.4 million deaths alone in 2002
- 40% survive on less than $1 per day
- Malaria related mortality is at 1 million deaths (mostly children) yearly
• Enormous economic cost on health systems
- 10% of individual income
- 50% of Africa’s population pays out of pocket
- Human resources impact
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eHealth as a developmental tool
• eHealth is the use of information (data) and communication
technologies for health processes (Health System) either locally
and at a distance (WHO 2005).
• eHealth involves telemedicine, telehealth, telecare, health
management information systems, health knowledge systems
etc.
• Health System is information, data and communication intensive
and requires more than SMS
- Health Workers as “Knowledge Workers”
- Patients as citizens (Citizen-centric eHealth)
- Health System as Data processing organization
• Wireless technologies plus eHealth = mHealth
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Policy for eHealth in Africa
• Africa Union/ New Partnership for Africa’s
Development (NEPAD)
• NEPAD’s Action Plan Strategy on sector development
- Alignment between telecom and health sectors
- Calls for a continental-wide eHealth infrastructure based on
wireless telecom infrastructure
• NEPAD’s eHealth for:
- Communication system
- Integration of & access to vertical HISs
- Extending healthcare to isolated and rural communities and
populations
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Global Policy for eHealth
• Global initiatives in favour of eHealth is being championed by
The World Health Organisation (WHO) under the Global
Observatory for eHealth (GOe) (WHA 58.18)
• The European Union has plans for eHealth in Africa
- Using wireless/mobile technologies
• International Telecommunication Union (ITU) since 1998 has
commissioned eHealth projects in developing countries using
mostly wireless technologies
- The ITU-D Q14 Working Group is focussed on eHealth strategy and
policy development with interest in mobile/wireless technologies
especially in developing countries
• All support Public-Private Partnerships (PPPs) for eHealth
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Why eHealth for Africa
• To provide access to distributed health knowledge and
information to mostly rural health workers.
• Urgency is required to meet the MDGs targets and to reverse the
poor health and developmental ratings
• Geographical barriers to access health service provision
especially in Africa (rural areas).
• Connectivity ( wireless telecommunications) is becoming widely
accessible and available even in rural communities
• But there are issues: Cost, telecom infrastructure, existing health
problems etc
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Rationale for Wireless eHealth in Africa
• Mobile devices are relatively cheaper that Fixed computers
• Consumes less power (Lack of electricity)
• They are portable, hence more secured?
• Wireless networks are relatively cheaper and faster to build
relative to build than fixed networks. For example , the Nigerian
case
• Mobile/ Wireless technologies provide the best opportunity for
Africa to achieve the “ Africa interconnectivity objective and for
building eHealth Infrastructure
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Wireless tools use for
eHealth in Africa
•Wireless technologies use:
GSM/GPRS/3G, WiFi, WiMAX,
WLL (Fixed or Mobile CDMA),
Broadband wireless, Satellite,
VSAT (Mobility vs Universal
Access)
•Mobile devices: PDAs,
Smartphone, Cellular phones,
Tablet PCs, Laptops, smart
cards, memory sticks, USB
keys, sensors.
FMFI 2007
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Health Workers using mobile devices
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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A Innovative Concept Proposal
• Health Systems in Africa are operated through a District
Health System (DHS)
- Hierarchical and pyramidal territorial enterprise
- A distributed and geographically dispersed Enterprise
- An information and process intensive Enterprise
- A central urban hospital linked to peripheral semi-urban/rural health
centres
- Has different cadres of Health (Knowledge) Workers with information
needs for patient care & enterprise management
• Integrated District eHealth Infrastructure (i-DeHI)
- Built on Wireless Infrastructure
- Including mobile/portable hardware, software & wireless networks
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Continental
National
Regional
District Hospital
Facility: Health Posts, Health Centres
Community
i-DeHI Innovation
i-DeHI as the basic unit for an Africa-wide eHealth
Infrastructure
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A District eHealth Network
Basic architecture for health care delivery in Africa
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A Cluster of District Wireless eHealth Network = Regional eHealth Network
Regional or National eHealth Infrastructure will require use of different devices
and wireless networks with implications for interoperability and integration
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Lessons from African Cases
• UHIN-GPRS:- still limited in bandwidth
- Early generation PDAs-Planning for Smartphones
• Solar Energy
• Cell-Life- GPRS/3G- Business model
- PDAs/Smartphones
• FMFI/MUTI Telehealth- Long distance WiFi- WAN&LAN, VSATexpensive, policy barriers
- Considering 3G
- Desktop
Laptops
WiFi -CellPhones
- Solar Energy
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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FMFI 2007
A District eHealth Network
A rural eHealth project in rural South Africa using low-cost Mesh Wi-Fi networks
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Barriers to Wireless eHealth in Africa
• Technological
• Telecommunication Infrastructure ( policy, high investment costs
, availability)
• Power /Electrical Infrastructure
• Economic/Financial Infrastructure - Low-income
• Organizational/Management issues
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Barrier 1: Telecom/Technological Infrastructures
• Lessons from an Africa-wide eHealth Network
• Multilateral Initiative on Malaria Communication Network
(MiMCom)
- A continental-wide eHealth Infrastructure with 12 National nodes
• Inter-national nodes mostly with VSATs
- VSATs chosen over fibre-optics at inception
• Intra-national communication with terrestrial wireless-WiFi,
microwave link
• Devices-Laptops, PDAs, PCs
• Reveals different solutions for national nodes- depends on
availability and costs of bandwidths
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MiMCom continent-wide eHealth Network in Africa
This depicts national nodes with different networks
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Lessons from African Cases
Melanges of devices and networks: Need for Ambient Network
FMFI 2007
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Barrier 2: Financial Infrastructure
• Issues
- Non-availability of Low-cost Broadband Access
- High costs of broadband access especially of satellite connectivity
access
• Possible solution ?
- Low-cost Broadband Wireless Infrastructure
- Introducing EU funded Digital World Foundation project on Low-cost
Technology initiative
- Bring this issue into global business and developmental agendas
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Introducing DigitalWorld EU Project
• European Research Framework
– Framework Programme 7 (2007-2013) just started
– DigitalWorld FP7-216513 is an 18 month research project
• ICT-1-9.1 - International Cooperation (Africa and Latin America)
• Coordination and Support Action
• Started January 1, 2008
• Duration: 18 Months
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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User-centric mHealth conceptual model
Human & Organisational issues
Technology
EHR
DDS
HMIS Telemedicine
Web Applications
Devices: Mobile, Nomadic & Portable
Integration
Interoperability
Connectivity
Access
Mobility
Wireless Infrastructure
Location: Homes, Facility & Community Levels
Geography: Rural/Urban
USERS: HEALTH
WORKERS/ PATIENTS
mHealth Users’ Context
Wireless Networks
Ad-hoc/Real-time
Devices
Mobile/Fixed
Facility
Applications/Contents
Community
Geography
Rural/Urban
USERS: Health Workers/Patients
Users issues 1
• Technical
- Human Computer Interface
(HCI)
- Open Source (Hardware &
Software)
• Social
- Adoption issues
(Development &
Implementation)
- Culture
- Local Knowledge
- Language
Users issues: software & interface design
• HCI
- Screen size and design
(Adaptive)
- Network Configuration-Thin &
Thick clients, remote & located
synchronisation
• Software
- Palm OS
- Symbian
- Windows Mobile
- Google Android
Users issues: Hardware 1
• Open Source design?
• Multi-wireless connectivity
• Power- Solar? (Global Green
Movement)
• Memory (Stable and Labile)
• Security
• Structure- (Ruggedized)
• Low-cost devices• Simputer
- OLPC
- Classmate,
- EeePC
Users issues: Hardware 2
• Device Morphology/Transition
- mobile
portable
nomadic
• Ultra mobile portable devices (UMPCs)?
• Isomerism?
• Users’ opinion from Africa
- Desktop
Laptops
WiFi -CellPhones
UMPCs
•Low-cost UMPCs for Health
•OLPC case
Users: Social issues
• Doctors in South Africa (Banderker et al 2005)
- Job relevance
- Usefulness
- Perceived User resources
- Device Characteristics
- Supports from Public National government & hospital administrators
- Patient influence
- Legal issues (Decision Support Systems, Drug directories)
Organizational issues 1
Technology
• Technology is not enough!
• Positive economic benefits
• Users led and focus
• Social and ethical issues
• Health workers’ responsibility
• Device and applications development and regulation.
(HealthService 24- 2006)
Organizational issues 2
Environment
• Health Policies, regulation, structure and financing
• Evaluation in real-life contexts
• Multiple actors and structures
• Health IT infrastructure (organisation).
• Users’ Trust
• Users’ led model
(MOSAIC -2005)
Sustaining eHealth projects in Africa
• 70% of IT investments globally are failures: Note failure here is
multifaceted
• Africa is not faring better either
• Same problem with eHealth projects especially in Africa
• Hence, problem is sustainability which can be:
- Organisational /Environmental
- Social/cultural
80% cause of IT
Failure
- Human (Health Workers)
- Technological
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Sustainability issues
• Building a sustainable Business Model for ‘Win-Win Situation’
- Understanding and Meeting Multiple Stakeholders
- End-users needs for design: Pro Poor vs. Niche markets
- Understanding Organizational Process for innovation diffusion
- Understanding Environmental Constraints and Enablers:
Policies/Regulation, Electricity (Renewable Energy),
Financial/Economic/Funding
- Instituting sustainable Global & Local Public-Private Partnerships
(PPPs)
- Supporting Local Small & Medium Enterprise (SMEs)
- Supporting Low Access/Entry costs models
• Technological- Low cost Broadband Infrastructure
- Wireless Telecom such as WiMax, WiFi, Broadband Satellite
- Low cost mobiles devices and Laptops (OLPC, Intel Classmate etc
- Open Source vs. Proprietary Software & Hardware?
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Sustainable Solutions
• High investment, implementation and purchasing costs of
wireless telecom infrastructures as barriers (Gilhooly 2005, World
Bank 2008)
• Policy needed to stimulate:
-
Public service innovation/re-engineering (eHealth)
Mass and low-cost production of components
Appropriate Business models- “Bottom of the Pyramid” (BOP) model
Local and Global Public-Private Partnerships (PPPs) (NEPAD e-Schools
project)
- Social and developmental inputs in Telecom regulation & business
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Opportunities for WWRF-WG 1
• User-centric wireless products & services in developing countries
- Case studies demonstrate the feasibility of mHealth in Africa
Health System
- Low-cost portable and mobile devices like the OLPC are needed
- Low-cost broadband wireless infrastructure are also required
• Research to influence future design and development
• To support wireless eHealth business model in developing
countries
- Being developed with Rural Living Labs Europe
- To be instituted in four regions of Africa
- To develop a sustainable wireless eHealth model
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Opportunities for WWRF-WG 2
• Transmission
- Wireless Broadband for eHealth web services and applications
• Development of optimal/low-cost mobile/portable/nomadic
devices, infrastructures and software
• Ambient Wireless Networks
- Melanges of wireless networks
- Need to explore interoperability for facility, community, district,
provincial, national regional and continental access and connectivity
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Ongoing Research Work @ CHMI
• Reviewing all eHealth projects in developing countries especially
on mHealth
- Focus is specifically on the factors affecting eHealth sustainability or
success in Africa
- Operational & strategic management of eHealth implementation &
use in Africa
- Developing a holistic framework to evaluate existing eHealth
systems in Africa i.e. linking operational with strategic (policy) level
• Framework will capture process and outcome impacts from
design to implementation and use
• Funding required for field trips to Africa
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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Conclusion
• A call to WWRF to support research into:
• Low-cost mobile/wireless technologies for Development in Africa
-
eHealth
e-Education
e-Agriculture
e-Business, e-Commerce, e-Banking
• Scoping change management issues in using mobile/wireless
technologies for eHealth in Africa / Developing countries
• THANK YOU FOR LISTENING!
WWRF#20 · Adesina Iluyemi · [email protected] · 22.04.2008 · Wireless eHealth for Africa
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eHEALTH NETWORK FOR
AFRICA: NEED FOR LOWCOST MOBILE/WIRELESS
INFRASTRUCTURES
RESEARCH & DEVELOPMENT PROPOSAL
Dr Adesina Iluyemi
PhD Candidate
CHMI, Univ of Portsmouth, UK
Member, eMobility ETP
[email protected]
22.04.2008
WWRF #20