By Vincent M. Kiberu
The World Health Organization recognises electronic health (e-Health) as a potential remedy to healthcare challenges in developing countries especially in Africa. e-Health; electronic medical records systems(EMRs), mHealth and tele-health simply means the use of information and communication technology (ICT) for healthcare activities. Such activities involve disease surveillance, primary health data acquisition and analysis, tele-consultation, tele-education, research, and patient management. Commonly used technology tools for e-Health services may include: social platforms, fixed/mobile phones, radio/television, Internet/email and other devices for text messaging.
Development of e-Health services requires right policies, strategies, regulations, and resources in place to guide the use of technology enabled services such as the Internet - a major driver of voice, video and data communications. The rapid development in ICT and its use in many of the public sectors in Uganda present an opportunity for collaboration and partnership for health information access and dissemination, timely access to healthcare delivery, and to enhance the quality of teaching and learning. Internet penetration has grown steadily - now estimated at 31% of the total population (Internet usage statistics for Africa 2016).
Scale-up of the national data transmission backbone and e-Government infrastructure (NBI/EGI) project together with the massive deployment of the city-wide Wi-Fi hotspots starting with Kampala, increases access to internet. The NBI/EGI that links major towns and cities reduces internet bandwidth, facilitating government entities with services using video-conferencing, data, and voice communication. Health institutions, medical practitioners and other citizens regardless of geographical location shall be able to link with medical experts and share knowledge.
The absence of a national e-Health policy strategy simply denotes e-Health standards and systems have not been defined! No national guidelines for secure management of individuals’ electronic health information and services. Security for personal information and access by unauthorized individuals have not yet been addressed. Consequently, this hinders the adoption of e-Health and the realization of its benefits such as enhancement of health information sharing and effective management of the health system. The existing data protection, legislation and regulatory frameworks, do not ensure security, confidentiality and privacy of personal information. This may lead to access to personal information by unauthorized persons and mistrust in the health system by the intended users.
Uganda has trialled several e-Health solutions, most e-Health applications and products have run in silos: not interoperable and compatible. Several technology innovations have remained as pilots for life - they aren’t scalable right from inception certainly due to diverging platforms. Similar to other developing countries, such e-Health initiatives are donor funded and a proof-of-concept where technology is demonstrated within a limited context. There’s a need to ensure that such small pilot projects are designed in 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. Currently, there is reliance on imported hardware and software in the face of fast changing technology. This has led to the proliferation of hardware, software and communication equipment used in the numerous fragmented donor-funded projects, which do not share information and provide limited information to healthcare professionals for managing patients effectively.
Delivery of and access to good quality, equitable, and affordable healthcare is critical! Although negatively impacted by limited human resources in terms of both numbers and skills mix. Uganda’s demographic and health survey reports eight physicians per 100,000 people, 44% of the established positions within the healthcare system vacant while majority of the population rely on nurses, aid workers, and traditional birth attendants (TBAs) for healthcare. Human resources for e-Health comprise of health workers, IT professionals and electronic content developers.
Health consumers who are individuals or communities also require knowledge and skills to use IT equipment and systems. Most health workers and consumers especially those in rural areas are not computer literate. In addition, most nurses and doctors feel overwhelmed by their routine work and feel that ICT is an extra burden that will draw them away from their core duties. However, in some health institutions/facilities where health workers are computer literate, computers are not used for routine official work.
IT professionals to manage and maintain the IT equipment and support the health workers in the use of IT equipment and systems, are not available especially in the lower health facilities at districts, sub-districts and communities.
A national e-Health policy strategy in place shall guide implementation of sustainable e-Health programmes, enabling to build a skilled and knowledgeable health workforce to use e-Health services.
The writer is a PhD(Tele-health) Student