Dr Joseph Amuzu
The Commonwealth, an association of 53 independent states consulting and co-operating in the common interest of their people, has in an attempt to harness its member nations’ evidently extraordinary appetite for latest technologies, recently launched an international eHealth initiative across countries and continents. The Adviser – Health Section of the Commonwealth Secretariat shares the challenges and the way forward with eHEALTH.
Q. What are the issues the Commonwealth Secretariat is looking at, in the national policies of member countries to strengthen their practice of eHealth?
A. The Commonwealth Secretariat is developing a guideline for the development of eHealth policy and strategy and accompanying tools for the assessments needed to provide evidence for the policy and strategy development.
Q. What are the measures taken by the Commonwealth Secretariat towards capacity building, knowledge exchange and financial support for developing country members to adopt eHealth in their health systems?
A. The Commonwealth Secretariat is organising high-level dialogues for both Ministers of Health and Ministers responsible for ICT to share information on eHealth, towards the development of plans of action to address the gaps in eHealth policies and strategies at country and regional levels. We are also doing needs assessment in Commonwealth countries to identify the needs for standards, legislation, infrastructure and capacity building. The Commonwealth Secretariat plans to make a business case for new eHealth initiatives at both regional and country level for resource mobilisation to support the regions and countries.
Q. You believe that partnerships are a way to increase access to health information. Could you give us some examples of successful partnerships from within the Commonwealth? Are there attempts to replicate these across regions?
A. There was a successful partnership with the private sector in organising the first high-level dialogue of Ministers of Health and ICT in the East Central and Southern Africa region. The Commonwealth Secretariat coordinated the meeting and the resources for the meeting were contributed by the Commonwealth Secretariat, the countries and the private sector. The private sector participants made presentations at the meeting thus contributing knowledge.
Q. The penetration rate of mobile phones and the Internet is growing fastest in parts of Africa and Asia. How does Com Sec plan to incorporate these new channels for dissemination of information / as tools to improve health indicators?
A. The Commonwealth Secretariat is advocating to member countries to take advantage of the simple technologies such as mobile phones and Internet to disseminate information, for referral of patients, for disease surveillance and data transfer. Swaziland for example is using mobile phones to trace AIDS treatment defaulters. The Internet is helping the Swazi Ministry of Health coordinate the health activities of physicians in the remote areas and also provides a means for healthcare workers to access information.
Q. Do you see the lack of standards and interoperability as a major hindrance to the spread of eHealth within the Commonwealth? Are steps being taken to standardise medical and health data practices in the member countries?
A. Standards and interoperability are two important areas that the Ministers at the ECSA dialogue identified as a hindrance to regional integration of eHealth facilities. The issues of lack of standards and interoperability are being addressed through the dialogues we are holding across the Commonwealth regions. These dialogues provide information and guidance for Ministers to take common decisions on regional and country policies, strategies, legislation, infrastructure, standards and interoperability.
Q. The range and scale of implementation of eHealth varies greatly across various member states of the Commonwealth. What, according to you are the main achievements and challenges of such implementations?
A. Countries have developed national ICT policies and strategies but there is generally a lack of specific policies and strategies on eHealth. eHealth projects have been implemented in countries but these are fragmented, small in scale and do not reach the ‘last mile’. The benefits of eHealth are generally known but the resources to scale up small projects are not available. As I said previously, legislation, ICT infrastructure, standards and interoperability remain huge challenges. Donors are also unwilling to go into these areas as they stick to the traditional support for vertical disease specific programmes. There must be recognition of the fact that eHealth cuts cost and is a technological support for the effective and efficient delivery of services. Saving man-hours and saving costs by introducing Health/Hospital Information Management Systems for example; mobile phones for surveillance purposes; availability of the Internet for health information and virtual consultation with colleagues at the other end; eLearning – a lot of opportunities indeed.
The Commonwealth Secretariat plans to make a business case for new eHealth initiatives at both regional and country level for resource mobilisation to support the regions and countries.”
Q. Many countries outside the developed world do not have well-defined privacy laws. What are the ethical issues you face when proposing eHealth initiatives?
A. The implementation of eHealth to improve the storage and use of medical records has raised ethical issues in most countries. The key ethical issues in most countries are related to i) consent; ii) confidentiality; iii) the secondary use of data; and iv) the acceptability of electronic signatures. In many countries legal frameworks are being revised or developed to address these concerns.
Q. Up to 80% of expenditure in the health domain goes into administration. What do you think can be done to minimise this expenditure so that more funds are freed up for core medical services?
A. I would suggest the use of more local expertise and knowledge and a reduction in the number of external consultants.