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ICTs to transform health in Africa: Can we scale up governance and accountability?

Meera Shekar's picture

Uganda man sends health SMS.

Start-up eHealth innovations are popping up all over Africa, providing a glimpse of how ICTs can transform the delivery and governance of health services in the region. Many of these pilots show promise, but their rapid growth also poses challenges: At an eHealth conference held in Nairobi in May and co-organized by the World Bank, health professionals and development partners discussed how to identify the best of these evolving tools and bring them to scale.

Uganda is one example of a country where eHealth start-ups have developed quicklyUganda poster on SMS reporting of drug supplies..  One innovation, a simple text message-based application, can be used in a health center to report when lifesaving drugs are not available. Not only does the application improve availability of drugs, it also improves transparency and accountability by ensuring that patients and clients can report drug stock-outs directly without having to go through health workers.

Another tool, U-Report, captures citizen feedback on development issues through mobile phone-based data collection.  With a membership list of 121,000, the service has great potential to enhance citizen engagement and government accountability, and to improve health service delivery.

While such technologies are exciting, and they seem intuitively useful and have high potential for impact, we still lack empirical evidence that they improve the efficiency of delivery of health services. So, the World Bank is investing in evaluating some of these experiments. We also need to ensure that these small pilot projects are designed in such a way that they can inform broader transformations in the health system in the country, instead of remaining as small islands of excellence in districts or regions.

The map below, of Uganda, shows how even good intentions can translate into a case of “pilotitis” –with more than 50 eHealth pilots in one country. Most of these will likely remain as pilots for life, because they are not designed to be scalable from day one and/or because they do not necessarily share common platforms and are not inter-operable. The idea is not to suggest that all pilots must follow the design-pilot-evaluate-scale approach, but to ensure that all pilots and innovations are designed with scale and inter-operability in mind, from the get-go.



Since many countries are developing their own national eHealth strategies, we need to make sure that the wide array of eHealth applications can “speak” to each other (that is, they are inter-operable), and that they are designed as plug-and-play applications with a common platform.

How can countries scale up these types of innovations? What can the World Bank do to support this process? Should we support an overall systemic fix and a common platform, with simple plug-and-play “apps” for different diseases (malaria, TB, malnutrition) and issues (supply chain management, health information systems), or should we encourage countries to invest in different platforms for different diseases or problems?

When it comes to ICTs and health, the developed world has not always made the best choices. In the United States, for example, competing commercial electronic health record programs mean that even hospitals within the same city cannot smoothly transfer patient data. Perhaps ICTs and eHealth can be one area where developing countries can learn from the mistakes of developed countries and from south-to-south learning.

If ICTs are applied strategically in a way that they scale cost-effectively, surely they could be as transformational in health as they have been in finance in Kenya, for example, where many people pay electricity bills and transfer money via mobile phones (through the mPesa program) instead of going to the bank.

As one of our government partners in Kenya said, “The greatest challenge for us is change.” This refers not to the technology development or training or budgeting, but to the actual ability to change mindsets that may not be accustomed to an ICT solution, and to engage a younger generation for whom “tech-savvy” is an inherent quality. 

Are we up for the challenge?

Uganda map by Text to Change via Flickr.

Comments

Submitted by Juan Cervantes on
Dear Meera, While the diversity of approaches to development issues in all parts of the world becomes a challenge in itself, that's the only way countries, institutions and communities have been able to come up with solutions even if of local scale in some cases. It's been proven again and again that one size fits all approach has never worked out in development. Why is it that development agencies find hard to understand that even within relatively small community settings there are huge differences that prevent a single model to perform homogenously? A "common platform" for every single health intervention is not going to resolve a myriad disparate problems. Trying to push the idea that totally diverse health problems such as malaria, TB and malnutrition can be addressed through "simple plug-and-play apps” is overly narrow and simplistic, and it reflects a poor understanding of public health in particular and of socioeconomic development challenges in general. On the other hand, why is it that the World Bank and other development agencies seem to continue obsessed with technologies (ICTs in this case) as the light at the end of the tunel, when it's been shown long ago that what prevents countries from moving forward are factors of purely human nature? Until governments and societies in developing countries realize that they need to change the way they educate their citizens, the way they elect their leaders, the way elected leaders work for the interests of the entire society and the way society participates in every step of the process, their reality wil pretty much remain unchanged, despite rossy indicators.

Submitted by Charles Chima on
There is no doubt that ICT has a huge potential to trasform health care delivery in reosurce-poor settings of Sub-Saharan Africa. Take Nigeria, for example, in the past it had taken weeks to detect Cholera outbreaks in remote settings. If there were such wide use of mobile health apps, both the local manpower and the people in the affected community can alert regional health authorities earlier enough to fast-track response. I agree that developing countries should avoid the mistakes of the industrialized world when it comes to technological application in health care. There is need to streamline the process such that the different e-health applications have a common platform. The fragmentation and duplicity that has characterized foreign aid to Africa should not be allowed to repeat itself in this promising yet evolving element of health system strenghtening. This would definitely be a challenging task but the best time to make such a move is now; before they rapidly become commonplace in the developing world. The World Bank certainly has the reach to lead such a call to action.

Nice blog and case study sharing, is there currently a clear forum that the World bank has identified on how to engage with providers of ICT solutions in health? I an asking as I would be interested since I work for a start up offering an ICT solution to health.

Submitted by Jayme on
ICT has man huge improvements in resource poor countries a topic I am actually looking into for a senior health class. If anyone has some other successful ehealth projects in Uganda feel free to post them on my blog http://ehealthutsc.wordpress.com/.

Submitted by Meera on
Thanks everyone, for your thoughtful comments. I’d like to address a few of these individually: Juan -- We are not suggesting a one-size fits all approach or a common platform for all countries --what we are proposing is an ICT platform for each country that would be developed in-country, tailored to the country needs and epidemiology, owned by the country and be common across the health system of that particular country. As you are probably aware, most countries have limited management (and ICT) capacities in the Ministries of health. Ministries of Health generally try to make the most efficient use of their own management (and ICT) capacities. If they have to manage different ICT applications and separate systems for supply chain management (for example) for malaria drugs, and then again for TB drugs or nutrition supplies, their capacities are stretched to the limit and there are inherent inefficiencies in this approach. If we can support each country to develop a common ICT solution/platform that works for its needs and then encourage/support them to build applications for these different health problems that can plug in to this common platform, we would be helping to build something that was scalable and that could significantly reform the health system and reduce inefficiencies in the health system. Does that seem reasonable? Imagine if Mpesa in Kenya did not have a common platform. Would it have been able to scale-up as it did so rapidly? And, would it have been as transformative as it had been? Charles -- Yes --we agree with you and we are looking for ways to do this systematically and at scale. Thank you for the feedback. Caroline -- The Bank is engaging with ICT providers through existing forums such as the mHealth alliance and meetings such as those organised by anadach group in Kenya in April. We will continue to do this, and to engage with individual private sector partners in-country as relevant. Meera

Submitted by Okoye, 'Gozie FKO on
For a truth, this is a welcome development that will help in no little measure in health service delivery capacity building. I owe tribute to the management of World Bank, who has over the years swun to a total interest in alleviating poor health condition of people across the whole World. It is for real a commendable effort. Now, introducing ICT platform to transform the system, is going to be obvious that less or no link to management or government who have access to ICT gadgets can combat some crime practiced by some health Workers. And I believe that this will actually help to modify health service delivery, even in the remote areas of various contries. I will like to get the process data details when launched in Nigeria, if there could be any way I would help, I will definitly do it to the tends of my capability. Because this will need to sensitise, mostly in the rural communities and river-line areas, in a way to make efficient use of the Drugs delivered to them, therefore creating a healthy people in the socioeconomic developing contries, which I saw the core target goal of the World Bank on this project. Achieving this goal will make them and I happy as it's for the purpose of good work to humanity. God will bless your generous effort. Thanks. FKO.

Submitted by Okoye, 'Gozie FKO on
For a truth, this is a welcome development that will help in no little measure in health service delivery capacity building. I owe tribute to the management of World Bank, who has over the years swun to a total interest in alleviating poor health condition of people across the whole World. It is for real a commendable effort. Now, introducing ICT platform to transform the system, is going to be obvious that less or no link to management or government who have access to ICT gadgets can combat some crime practiced by some health Workers. And I believe that this will actually help to modify health service delivery, even in the remote areas of various contries. I will like to get the process data details when launched in Nigeria, if there could be any way I would help, I will definitly do it to the tends of my capability. Because this will need to sensitise, mostly in the rural communities and river-line areas, in a way to make efficient use of the Drugs delivered to them, therefore creating a healthy people in the socioeconomic developing contries, which I saw the core target goal of the World Bank on this project. Achieving this goal will make them and I happy as it's for the purpose of good work to humanity. God will bless your generous effort. Thanks. FKO.

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