1. 2013
Hassan Rashid Hassan
Limkokwing University - PGC
E-HEALTH STRATEGIES AND DEVELOPMENT IN
DEVELOPING COUNTRIES.

2. E-HEALTH STRATEGIES AND DEVELOPMENT IN
DEVELOPING COUNTRIES.
1.0 INTRODUCTION:
Technology is about meeting human needs through the creative process of designing and
making. Technology capability is acquired through the two profile components of design and
innovation of a creative thinking, which if coupled with information is referred to information
technology. In this century most companies, organizations and government use this technology
and the efficient utilization of these technology always provide and ensures better services to
the public.
Few countries around the world are generally regarded as “developed Nations”; the term
developed country is used to describe countries that have a high level of development
according to some criteria. One of the main reasons responsible for their development, is
adapting technology in their daily life. While on the other side we find most developing
countries must rely largely on imported technologies as sources of new productive knowledge.
One of the critical point developing countries are facing is transforming government to e-
government.
E-Government (short for electronic government, also known as e-gov, digital government,
online government or transformational government) is a diffused neologism used to refer to
the use of information and communications technologies to improve the efficiency,
effectiveness, transparency and accountability of government, providing better services,
transactions and interactions with citizens, businesses, and other arms of government.
However this paper takes a closer look on the e-health sector of e-government.

3. 1.1 WHAT IS AN E-HEALTH?
The World Health Organization (WHO), defines e-health as “The use of information and
communication technologies (ICTs) for health to, for example, treat patients, pursue research,
educate students, track diseases and monitor public health”.1
In practical terms, e-health is the use of secured electronic networks to support the delivery of
a quality and effective healthcare, by delivering reliable information to the right person at the
right time.
The Need for an E-Health:
Currently in developing country, most of the hospitals keeps a paper based recorded of their
patient, medicines and overall performance of the hospital, those data or information then
gathered from across all hospitals in the country and send to the national health ministry for
analysis. This process takes months and the result at the end is mostly not to reflect the current
health status in the country since by the time the data gathered and analyzed is most likely to
be outdated data and not valid for any decision support.
With time the amount of data will massively increased and analyzing them will become very
difficult if not impossible.
With this in mind the need for effective electronic health system is more appreciated.
The key benefits to be achieved through a comprehensive e-Health system and strategy
include:
- improved data and information to generate evidence to support timely and informed clinical
and non clinical decision as well as planning.
- improve logistic and supply chain due enhanced management information system for medical
and non medical supplies.
-improve financial management by improving accountability and financial accessibility to
healthcare services and cost reduction.
- improve access and availability of healthcare services in remote or rural areas.
-improve quality of care as result of reduction in wait times for medical treatment and surgical
procedures.
1 – http://www.who.int/topics/ehealth/en/

4. - enhance access to data and cases for researchers.
- facilitate the adoption of eLearning system in the medical education and training fields.
- Immediate alarm for national health tragedy.
As a result for the key point listed above, e-Health will turn in improving patient health
outcomes and an increase for life age average in the country.

5. PROBLEMS & CHALLENGES FACING E-HEALTH DEVELOPMENT IN DEVELOPING
COUNTIES:
The following quotation from NSDA 2010-20104 sums up the problem statement for e-Health
strategy:
“although large sums of money have been use to produce health ICT and HIS in south Africa in
the past, the ICT & HIS within the health system is not meeting the requirements to support the
business process if the health system thus rendering the healthcare system incapable of
adequately producing data and information for management and for monitoring and evaluating
the performance of the national health system. This results from the lack of technology
regulations and a lack of policy frameworks for all aspects of infrastructure delivery.”
This quotation was specifically made regarding the e-Health in South Africa, however it also
suite most of the developing countries as well.
One major challenge developing countries are facing is the lack if recourses, tools and common,
reusable building blocks available to plan and create their own country specific enterprise
architectures and solutions; as result, developing countries teemed to outsource their project
to another countries. In this case it’s mostly for the project to fail as result of bad
communication and requirement gathering issues. Each country is unique in its own way;
therefore we strongly believe that such a national system should be build internally, helps from
other countries with a better experience in the field is very recommended, however
outsourcing the hall project may not likely to work.
The following are specific challenges identified with respect to e-Health:
 Poor national e-Health Strategy:
The lack of having clear structured plans for reaching e-Health maturity, also the issue of who is
in charge of developing this plan; although the end benefiter of e-Health is Ministry of Health ,
yet Ministry of Telecommunication & Information Technology or E-Government represented
have a huge impact on developing such a plan. Therefore all stakeholders in this project should
work together on developing a clear strategy in order to a chive e-Health system in the country.
 Widely different level of e-Health maturity:
Different states and hospitals have different level of e-Health maturity, while some hospitals
have adopted an electronic system for keeping patient record, other are still using the normal
paper based system.

6. Also among hospitals which adopted more electronic approach for keeping patient record, we
find that each hospital has chosen a totally different system with different technologies and
structures than the others.
 The lack of strong information governance:
Having strong information governance will ensure compliance with the necessary standards and
procedures for, and appropriate use of, health information.
 The lack or absence of Medical coding system:
Not having a unique code for each disease, medicine and medical procedure makes it very hard
if not impossible to gather all data from hospitals and analysis it. A very good example of
medical coding system is International Statistical Classification of Diseases and Related Health
Problems ICD -10, which developed by the WHO and been adopted widely and internationally.
 Human Capacity Building:
Opportunity for education in e-Health are currently limited, most available courses are either a
post graduate programs or a small short training programs. Additionally there are no clear
defined career path fir e-Health professionals.
 Funding:
In developing countries, the priority in the health sector is to invest in direct services such as
procurement of drugs, vaccines and medical supplies, while e-Health programs typically require
large sustained investment over five to ten years, which is not very attractive funding candidate
for most of the donors.
 Broadband connectivity is expensive and out of reach of many.

7. PRINCIPLE OF DEVELOPING NATIONAL E-HEALTH STRATEGY
Having a well function e-Health system will have it huge impact needed for improving the
health of our community, especially for those in the rural areas. However an immediate
development of e-Health system without developing e-Health strategy will lead to a negative
result.
This is a very common case scenario when it comes to development countries, the country will
immediately rush into the implementation of e-Health system without having a reference or
guideline. Achieving a fully integrated mature e-Health system must start from the very basic by
having a clear vision & mission of the e-Health and developing a strategy.
The strategy should provide a clear framework for the design and roll out of e-Health in the
health sector. It addresses the issues of standers and inter-operability and mechanisms for
coordination that will help to minimize the frequent failures usually encountered in the
adoption of e-Health solution.
In the Summary of Australian Health Ministers’ conference – December 2008, seven strategic
Principles were underlined, in which we will be discussing in dept:
NATIONAL INFRASTRUCTURE:
While developing a national e-Health strategy, a wild observation of the current available IT
infrastructure within the country should be made and analysis for better understanding of the
current status and how it can be used for delivering e-Health system. Also future country plans
in developing IT infrastructure should be closely studied for matching it with the development
of the national e-Health system timeline making it more effective to deliver core elements of
enabling national e-Health infrastructure once, rather than duplicating development efforts and
increasing the likelihood of rework and duplications.
STAKEHOLDER ENGAGEMENT:
The engagement of stakeholder in any project is essential for any project success, however in
many cases and for different reasons we find that only less than 50% of the project stakeholder
are actually engaged with the development plans, therefore the project actually get build
without taken their requirements in consideration. National e-Health system stakeholder
includes but not limited to:
 Ministry of Health.
 Ministry of IT & Telecommunication.
 E-Government presenter.
 Hospital Managers.

8.  National Medicine Suppliers.
 National Department of Drugs.
 Private Sector presenters.
 Medical Universities.
 Doctors, Specialist, Nurses, Pharmacist, etc.
INCREMENTAL APPROACH
Building long term national e-Health capability in an incremental and pragmatic manner,
focusing initial investment in those areas that deliver the greatest benefits for consumer, care
provider and health care managers.
RECOGNIZING DIFFERENT STARTING POINTS
Since there are different e-health maturity levels across the country, it must be taken in
consecration there are different starting point for each level. Therefore we must have a
balancing support level between care providers will less developed capability and others with
more advance participants to progress.
LEVERAGE
More effectively leverage and scale e-Health activity across the country. Meaning development
of e-Health shouldn’t be centralized or limited to a specific part of the country, the
development should be leverage across the hall country. Even if each part is not actually at the
same level of maturity yet, the plan should cover the hall country.
BALANCING ALIGNMENT & INDEPENDENCY
Developing a national e-Health system in the country, doesn’t mean limiting the ability for
healthcare providers to implement their local system. However the strategy must cover a type
of mechanism allowing linking those systems to the national e-Health system. The strategy
must also include specific standers that must be followed by all healthcare providers if they
wished to implement their local system.
RELEVANT SKILLS
Ensuring enough number of skilled practitioners is available to support the delivery of national
e-health strategy.

9. Other than those seven listed by the Australian Health Ministers’ Conference, there are quite
few others worth mentioning such as:
 Establishing national co-ordination on all initiatives in order to improve the
addictiveness of e-Health at all levels.
 Encouraging a collaborative approach by leveraging partnerships.
 Increase e-Health reliability and trust by looking for the early wings in implementations
and benefits to build the confidence of health professionals.
Among developing a national e-Health strategy, there are six points been listed by Institute of
Medicine (IOM) for achieving healthcare quality which must be taken on consideration.
 Safety:
Avoiding any type of harm to patients from the care that is intended to help them.
In e-health, safety may also include patients’ information safety and security.
 Effectiveness:
Providing service based on scientific knowledge to all who could benefit and refraining
from providing services to those not likely to benefit from.
In e-health, effectiveness may means providing the right information to the right person with
the right permission at the right time.
 Patient – centeredness:
Providing care that is respectful of and responsive to individual patient preferences,
need and values and ensuring that patient values guide all clinical decisions.
 Timeliness:
Reducing waiting times and potentially harm delays for both those who receive and
those who give healthcare.
 Efficiency:
Avoiding any type of west; including west of equipment, supplies, information, energy
and time.
 Equitability:
Providing an equal healthcare services to all public regardless of their gender, ethnicity,
geographic location, and socioeconomic status.

10. E-HEALTH STANDARDS
For successful implementation of an e-Health strategy, technical standards are required to
ensure national and international compatibility, interoperability, open architecture, modularity
and capacity for upgrade.
Nationally adopted standards should enable the procurement and implementation of
affordable, cost effective and accessible technology that complies with these standards.
While internationally a wide range of e-Health standards developed by standards development
organizations like ISO and CEN are available, very few of these have been localised and formally
adopted by South Africa.
Two that have been adopted by the South Africa Bureau of Standards (SABS) are ISO/TS
18308:2004 (SANS
18308 Health Informatics - Requirement for an EHR Architecture) and ISO/TR 20514:2005 (SANS
20514 Health informatics - EHR – Definition, scope and context).
Current work by an active group of experts on the localization of ISO 21549: Patient Healthcare
Data is nearing completion. This work is coordinated by the SABS and the local standard will be
referred to as SANS 828-2 Health informatics – Health smart (HS) card.
However, in general, there is limited work done in the country on the localization of
international standards for developing countries setting. Advocacy and adoption is also limited.
The implementation of the e-health Strategy needs to be handled with care as different sectors
have invested substantial resources in developing the existing systems, hence constructive
engagement between the private and the public sector will be very important. The areas of
focus for this process are the following:
• Pharmaceutical Coding.
• Diagnostic Coding Schema.
• Procedural Coding Schema.
• Diagnostic Related Groups (DRGs).
• Standards for Clinical Content.
There is an active Private Healthcare Information Standards Committee (PHISC) which aims to
maximize cooperation in e-Health standards across the country. PHISC provides “an important
forum for debate and consensus on health information standards issues for the private sector
with the overall aim of identifying
Appropriate common standards applicable to both the public and private sectors.”
South Africa requires an e-Health Standards Board or similar body to address some of the
current risks and deficiencies. The country does not currently have participant (“P”) status and
as an observer (“O”) is unable to vote on the development and maintenance of international e-
Health standards.