The document provides an overview of a peer review workshop on ICT for health in Africa held in Johannesburg, South Africa. It summarizes the contents of the workshop, which included discussions of: 1) The project goals to raise awareness of how ICTs can improve health sector activities in Africa. 2) A landscape analysis of current ICT applications for health across Africa, including examples from several countries. 3) The challenges facing healthcare in Africa at both the micro level of individual sectors and macro systemic level, and how ICTs could help address some of these challenges. The summary identifies the key topics covered in each chapter, including definitions of ICT for health, analyses of the

1. Vital Wave Consulting
Field Teams
eTransform Africa:
Latin America
Argentina
Brazil
Health Sector
Chile
Costa Rica
Dominican Republic
Mexico
Peru The World Bank | African Development Bank | African Union
Asia
India
China
Cambodia
Uzbekistan
PEER REVIEW WORKSHOP
Eastern Europe
Estonia Johannesburg, South Africa
Ukraine
Africa
Egypt
January 28, 2011
South Africa
Nigeria
Kenya
Brooke Partridge
CEO
Middle East
United Arab Emirates Brendan Smith
Director of Consulting Services
United States Nam Mokwunye
California (Headquarters) Senior Consultant, Tech Transfer

2. Agenda
1 Project Goals & Outcomes
2 Chapter 1 Summary
3 Chapter 2 Summary
4 Chapter 3 Summary
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3. Project Goals and Outcomes
Overarching Project Goal
Raise awareness and stimulate action, among African
governments and development practitioners, of how ICTs can
contribute to the improvement and transformation of traditional
and new economic and social activities in the Health sector.
Intended Outcomes
The study provide an overview and analysis of current ICT for
Health across SSA and beyond. It will also recommend ways in
which to scale up the successful application of ICTs to further
operationalize their use within the Health sector, while paying
appropriate attention to associated risks.
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4. Chapter 1: Role of ICT in Health Sector
Summary (1)
• Defines ICT
 ICT in the health sector, also called eHealth, is the use of information and communication
technology (ICT)—such as computers, mobile phones, satellites, applications, information
systems and digital platforms —to enable, support and deliver health services to patients and
populations.
• Discusses state of health care in African countries in reference to MDGs 4, 5 and 6
• Establishes a framework for looking at health sector development and determines
that most African countries are transitioning from phase 1 to 2 with some transitioning
from phase 2 to 3
• Establishes that progress has been made in MDGs 4,5, and 6 but still much left to do
 …under-five child mortality is 20 times (1 in 8) as severe in sub-Saharan Africa it is in OECD
regions (1 in 167) and 1.75 times as in Southern Asia (1 in 14), Nigeria (10%) and India (21%)
account for nearly one-third and Southern Asia and Sub-Saharan Africa (42%) accounts for
92% of the global under-five mortality cases.
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5. Chapter 1: Role of ICT in Health Sector
Summary (2)
• Establishes that some African countries are doing better while other are not
 Some African countries, such as Eritrea, Liberia, Ethiopia and Madagascar (4 of the world’s
top-10 performers) either reduced under-five deaths by 100 per 1,000 lives, at least 50% or at
a reduction rate of at least 5%., The Millennium Development Goals Report 2010
• Establishes why ICT could be a game changer for MDGs 4,5 and 6
 Enables curbing of wasteful spending
 Provides tools to help address 5 obstacles to affordable health discussed further in chap. 3
 Funding shortage
 Equipment and supplies shortages
 Insufficient quantity of skilled health care workers
 Population uneducated about prevention and treatment of preventable diseases
 Lack of health system infrastructure and communication between rural and urban
centers
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6. Chapter 2: Landscape Analysis of eHealth
Summary
• Provides landscape analysis of ICT in health sector, first worldwide, then within Africa
• Identifies early evidence of eHealth activity in African countries with a focus on
 Botswana (eLearning and Health Chat by SMS)
 South Africa/Tanzania/Botswana (BEANISH/HIS)
 Gabon (Gamelto e-health record cards)
 Ghana (MoTech mid-wife survey and advisory)
 Rwanda (TracNet, national eHealth system)
 Tunisia (Visionet, video network for physicians)
• Concludes that health indicators improve with GDP per capita and ICT prevelance
• Provides graphed data sets comparing African countries to themselves
 Also to Thailand, which has a well-regarded health system, and highlights Tunisia which is
possibly transitioning from phase 3 to 4, unlike other African countries
• Provides substantial resources: interventions, blogs and publications
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7. Chapter 2: Landscape Analysis
Online Comments and Recommendations
• “Interesting perspective on the ICT landscape across selected countries in
Africa and Thailand. The examples provided were interesting showing the
wide use of ICT programs with external financing in selected countries.”
-Egbe Osifo-Dawodu
• Mention role of physicians and local developers (software)
• More private sector examples
• Role of telecom sector in making e/mHealth possible
• More government uses examples
 mobile phone based Internet in south African clinics
 mobile-phone armed midwives in Nigeria
• Group by services
• Group by country size
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8. Chapter 3: Challenges and Opportunities
Summary (1)
• Expounds on chapter 2’s discussion of obstacles to affordable health care and
identifies them as micro-challenges
 Funding shortage
 Equipment and supplies shortages
 Insufficient quantity of skilled health care workers
 Population uneducated about prevention and treatment of preventable diseases
 Lack of health system infrastructure and communication between rural and urban centers
• Identifies opportunities to use ICT to overcome micro-challenges
 SMS (educational/instructional)
 IVR (voice menus)
 Video (tele-medicine)
 Radio
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9. Chapter 3: Challenges and Opportunities
Summary (2)
• Posits that systemic (macro-) challenges make it difficult for African nations to
overcome sector-specific micro-challenges—as is being experienced by the health
sector
 Capital constraints (financial, human—urbanization, intellectual—brain drain)
 Capacity building
 Organizational issues
 Process considerations
 Infrastructure
 Social cultural pressures
 Inadequate safety net
• Offers that eHealth intervention opportunities are equally dependent on macro-
challenges being addressed
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10. Chapter 3: Challenges and Opportunities
Summary (3)
• Provides tools for analyzing the relationship between macro, micro and ICT challenges
in the health sector
• Graphs data sets that compare micro, macro and ICT challenges between African
countries with highlights of Thailand
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11. Chapter 3: Challenges and Opportunities
Matrix (1.1): Micro, Macro and ICT
Health Sector (Micro-level) System-wide (Macro-Level)
Impact on Citizens ICT Opportunity ICT Challenge Path to Health
Challenge Influencer
1 Funding Shortage  Relatively high cost to  Reduced confidence in  Reduce costs  Insufficient infrastructure  0.5-1YR: low-cost,
provide civil services leaders’ ability to deliver (mHealth/tele- (telecom/power) preventive interventions;
 Limited revenue sources public services medicine)/increase  Existing intellectual assets reprioritize health
 Health deprioritized  Residual impact on cross-sector revenues (spectrum) not maximized funding in policies and
quality of life with ICT platform  No cross-sectoral budget
 High mortality (telco/mMoney) collaboration  1-5YRS: resolve ICT
 Loss of economic  Fund health with ICT-  Commitment of leadership challenges; high-cost
productivity assisted interventions
savings/revenues
2 Equipment and Supplies  Funding shortage  Service gaps  Deploy real-time ICT to  Low rural connectivity  0.5-1YR: target rural
Shortage  Limited access between  More deaths related to enable 1) urban-rural  Device interoperability providers for low-
urban and rural areas “multiple delays” communication (tele-  Inefficient supply chain capacity (mobile) supply
 Inefficient manual supply  Reduced trust levels medicine) 2) mobile- process (done by hand) chain interventions
chain mgmt. (SCM)  Higher preventable assisted supply chain  Commitment of leadership  1-5YRS: increase rural
processes mortality management (MASCM) connectivity, roads
transportation; higher-
capacity database
systems
3 Insufficient Quantity of  Underfunded skilled  Increase in “third  Reduce training cost  Low rural connectivity  0.5-1YR: video
Skilled Healthcare Workers education system delay”-related mortality and increase penetration  Device and service usability broadband group
 High unemployment  Spread of communicable with ICT (broadband, for healthcare workers training at urban and
 “Brain drain” diseases video/IVR/SMS)  No proven scalable and rural health centers;
 Loss of economic  Increase rural access to stainable business model low-cost mobile
productivity due to third specialized care training  Commitment of leadership continuing education
delay with ICT (tele-  1-5YRS: increase rural
medicine) connectivity; improve
education system
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12. Chapter 3: Challenges and Opportunities
Matrix (1.2): Micro, Macro and ICT
Health Sector (Micro-level) System-wide (Macro-Level)
Impact on Citizens ICT Opportunity ICT Challenge Path to Health
Challenge Influencer
4 Population Uneducated  Underfunded primary and  Avoidable high rates of  Radio, TV, and mobile  Literacy of rural populace  0.5-1YR: maximize
About Prevention and secondary education system transmission and education campaigns  Mobile phone ownership telecom networks for
Treatment of Preventable  Sociocultural norms that mortality due to promoting disease  Cultural norms SMS/voice/video
Diseases encourage misunderstanding preventable diseases prevention healthy training
 Commitment of leadership
of communicable diseases  Spread of epidemics living  1-5YR: improve mobile
and unhealthy behaviors  Patient reminders and broadband
improve timing and connectivity; increase
quality of treatment investment in education
5 Lack of Health System  Lack of financial capital to  Limited access to proper  Use ICT to maximize  Low rural connectivity  0.5-1YR: establish
Infrastructure to Enable develop and maintain health medical care community-based  Commitment to inefficient broadband VPNs
Communication Between care system  Low levels of trust in health/reduce need for data collection process between centers; arm
Rural and Urban Centers  Inadequate rural connectivity healthcare system HSI.  Commitment of leadership healthcare workers with
due to licensing regimes,  Bad health translates to  Complete patients’ useful technology;
rapid payback models and low economic medical record database digitize records system
reduced ROI for operators productivity  Implement VPNs and  1-5YRS: Improve
inter-connect rural and broadband connectivity;
urban health centers maximize tele-medicine
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13. Chapter 3: Challenges and Opportunities
Matrix (3): ICT and Macro
ICT
INTERVENTIONS SYSTEMIC (macro-level) CHALLENGES
METHOD
Capital Constraints Capacity Building Infrastructure Socio-Cultural Norms Social Safety Net
Financial Human Intellectual Organiz- Process Regulat Telecom Power Devices Diet & Gender Language Leader- Insu- Social
Ational ory Medi- issues ship rance security
cation
Digital Health
1 X X X X X X
Ecosystem (DHE)
2 SMS X X X X X X X
3 IVR X X X X X X
Video (tele-
4 X X X X X X X
medicine)
5 Radio X X X X X X
6 TV X X X X X X X
7 HMIS X X X X X X X
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14. Thank you