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eHEALTH NETWORK FOR AFRICA: NEED FOR LOW-COST MOBILE/WIRELESS INFRASTRUCTURES. RESEARCH & DEVELOPMENT PROPOSAL . Adesina Iluyemi PhD Candidate CHMI, Univ of Portsmouth, UK Member, eMobility ETP Adesina.iluyemi@port.ac.uk 22.04.2008 WWRF #20. Content. Health Problems in Africa

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eHEALTH NETWORK FOR AFRICA: NEED FOR LOW-COST MOBILE/WIRELESS INFRASTRUCTURES

RESEARCH & DEVELOPMENT PROPOSAL

Adesina Iluyemi

PhD Candidate

CHMI, Univ of Portsmouth, UK

Member, eMobility ETP

Adesina.iluyemi@port.ac.uk

22.04.2008

WWRF #20

content
Content
  • Health Problems in Africa
  • Definition and Policy drivers for eHealth in Africa through wireless technologies
  • Introducing the concept of wireless i-DeHI in Africa
  • Barriers to wireless i-DeHI in AfricA
  • Opportunities for WWRF
  • Research and Development proposal

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

health problems in africa
Health Problems in Africa
  • Africa has a population of about ONE billion people
    • Up to 70% lives in isolated rural areas
    • Half lives on half a dollar per day
    • Poor telecom & transportation infrastructure
  • Lack of Infrastructure and Capacity Healthcare delivery
  • Brain Drain: International and Local (Rural vs. Urban)
    • Africa has 10% of world population with 25% of global health burden but with only 3% of global health workforce
  • Poverty & Financial constraints
    • HIV/AIDS accounted for 2.4 million deaths alone in 2002
    • 40% survive on less than $1 per day
    • Malaria related mortality is at 1 million deaths (mostly children) yearly
  • Enormous economic cost on health systems
    • 10% of individual income
    • 50% of Africa’s population pays out of pocket
    • Human resources impact

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

ehealth as a developmental tool
eHealth as a developmental tool
  • eHealth is the use of information (data) and communication technologies for health processes (Health System) either locally and at a distance (WHO 2005).
  • eHealth involves telemedicine, telehealth, telecare, health management information systems, health knowledge systems etc.
  • Health System is information, data and communication intensive and requires more than SMS
    • Health Workers as “Knowledge Workers”
    • Patients as citizens (Citizen-centric eHealth)
    • Health System as Data processing organization
  • Wireless technologies plus eHealth = mHealth

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

policy for ehealth in africa
Policy for eHealth in Africa
  • Africa Union/ New Partnership for Africa’s Development (NEPAD)
  • NEPAD’s Action Plan Strategy on sector development
    • Alignment between telecom and health sectors
    • Calls for a continental-wide eHealth infrastructure based on wireless telecom infrastructure
  • NEPAD’s eHealth for:
    • Communication system
    • Integration of & access to vertical HISs
    • Extending healthcare to isolated and rural communities and populations

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

global policy for ehealth
Global Policy for eHealth
  • Global initiatives in favour of eHealth is being championed by The World Health Organisation (WHO) under the Global Observatory for eHealth (GOe) (WHA 58.18)
  • The European Union has plans for eHealth in Africa
    • Using wireless/mobile technologies
  • International Telecommunication Union (ITU) since 1998 has commissioned eHealth projects in developing countries using mostly wireless technologies
    • The ITU-D Q14 Working Group is focussed on eHealth strategy and policy development with interest in mobile/wireless technologies especially in developing countries
  • All support Public-Private Partnerships (PPPs) for eHealth

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

why ehealth for africa
Why eHealth for Africa
  • To provide access to distributed health knowledge and information to mostly rural health workers.
  • Urgency is required to meet the MDGs targets and to reverse the poor health and developmental ratings
  • Geographical barriers to access health service provision especially in Africa (rural areas).
  • Connectivity ( wireless telecommunications) is becoming widely accessible and available even in rural communities
  • But there are issues: Cost, telecom infrastructure, existing health problems etc

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

rationale for wireless ehealth in africa
Rationale for Wireless eHealth in Africa
  • Mobile devices are relatively cheaper that Fixed computers
    • Consumes less power (Lack of electricity)
    • They are portable, hence more secured?
  • Wireless networks are relatively cheaper and faster to build relative to build than fixed networks. For example , the Nigerian case
  • Mobile/ Wireless technologies provide the best opportunity for Africa to achieve the “ Africa interconnectivity objective and for building eHealth Infrastructure

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

wireless tools use for ehealth in africa
Wireless tools use for eHealth in Africa

Wireless technologies use: GSM/GPRS/3G, WiFi, WiMAX, WLL (Fixed or Mobile CDMA), Broadband wireless, Satellite, VSAT (Mobility vs Universal Access)

Mobile devices: PDAs, Smartphone, Cellular phones, Tablet PCs, Laptops, smart cards, memory sticks, USB keys, sensors.

FMFI 2007

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

health workers using mobile devices
Health Workers using mobile devices

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

a innovative concept proposal
A Innovative Concept Proposal
    • Health Systems in Africa are operated through a District Health System (DHS)
      • Hierarchical and pyramidal territorial enterprise
      • A distributed and geographically dispersed Enterprise
      • An information and process intensive Enterprise
      • A central urban hospital linked to peripheral semi-urban/rural health centres
    • Has different cadres of Health (Knowledge) Workers with information needs for patient care & enterprise management
  • Integrated District eHealth Infrastructure (i-DeHI)
    • Built on Wireless Infrastructure
    • Including mobile/portable hardware, software & wireless networks

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

i dehi innovation

i-DeHI

i-DeHI Innovation

i-DeHI as the basic unit for an Africa-wide eHealth Infrastructure

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

a district ehealth network
A District eHealth Network

Basic architecture for health care delivery in Africa

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

a cluster of district wireless ehealth network regional ehealth network
A Cluster of District Wireless eHealth Network = Regional eHealth Network

Regional or National eHealth Infrastructure will require use of different devices and wireless networks with implications for interoperability and integration

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

lessons from african cases
Lessons from African Cases
  • UHIN-GPRS:- still limited in bandwidth
    • Early generation PDAs-Planning for Smartphones
  • Solar Energy
  • Cell-Life- GPRS/3G- Business model
    • PDAs/Smartphones
  • FMFI/MUTI Telehealth- Long distance WiFi- WAN&LAN, VSAT- expensive, policy barriers
    • Considering 3G
    • Desktop Laptops WiFi -CellPhones
    • Solar Energy

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

slide16
WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa
a district ehealth network17

FMFI 2007

A District eHealth Network

A rural eHealth project in rural South Africa using low-cost Mesh Wi-Fi networks

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

barriers to wireless ehealth in africa
Barriers to Wireless eHealth in Africa
  • Technological
  • Telecommunication Infrastructure ( policy, high investment costs , availability)
  • Power /Electrical Infrastructure
  • Economic/Financial Infrastructure - Low-income
  • Organizational/Management issues

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

barrier 1 telecom technological infrastructures
Barrier 1: Telecom/Technological Infrastructures
  • Lessons from an Africa-wide eHealth Network
  • Multilateral Initiative on Malaria Communication Network (MiMCom)
    • A continental-wide eHealth Infrastructure with 12 National nodes
  • Inter-national nodes mostly with VSATs
    • VSATs chosen over fibre-optics at inception
  • Intra-national communication with terrestrial wireless-WiFi, microwave link
  • Devices-Laptops, PDAs, PCs
  • Reveals different solutions for national nodes- depends on availability and costs of bandwidths

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

mimcom continent wide ehealth network in africa
MiMCom continent-wide eHealth Network in Africa

This depicts national nodes with different networks

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

lessons from african cases21
Lessons from African Cases

Melanges of devices and networks: Need for Ambient Network

FMFI 2007

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

barrier 2 financial infrastructure
Barrier 2: Financial Infrastructure
  • Issues
    • Non-availability of Low-cost Broadband Access
    • High costs of broadband access especially of satellite connectivity access
  • Possible solution ?
    • Low-cost Broadband Wireless Infrastructure
    • Introducing EU funded Digital World Foundation project on Low-cost Technology initiative
    • Bring this issue into global business and developmental agendas

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

introducing digitalworld eu project
Introducing DigitalWorld EU Project
  • European Research Framework
    • Framework Programme 7 (2007-2013) just started
    • DigitalWorld FP7-216513 is an 18 month research project
  • ICT-1-9.1 - International Cooperation (Africa and Latin America)
  • Coordination and Support Action
  • Started January 1, 2008
  • Duration: 18 Months

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

users issues 1
Users issues 1

Technical

Human Computer Interface (HCI)

Open Source (Hardware & Software)

Social

Adoption issues (Development & Implementation)

Culture

Local Knowledge

Language

users issues software interface design
Users issues: software & interface design

HCI

Screen size and design (Adaptive)

Network Configuration-Thin & Thick clients, remote & located synchronisation

Software

Palm OS

Symbian

Windows Mobile

Google Android

users issues hardware 1
Users issues: Hardware 1

Open Source design?

Multi-wireless connectivity

Power- Solar? (Global Green Movement)

Memory (Stable and Labile)

Security

Structure- (Ruggedized)

Low-cost devices-

Simputer

OLPC

Classmate,

EeePC

users issues hardware 2
Users issues: Hardware 2

Device Morphology/Transition

mobile portable nomadic

Ultra mobile portable devices (UMPCs)?

Isomerism?

Users’ opinion from Africa

Desktop Laptops WiFi -CellPhones

  • Device Morphology/Transition
    • mobile portable nomadic
  • Ultra mobile portable devices (UMPCs)?
  • Isomerism?
  • Users’ opinion from Africa
    • Desktop Laptops WiFi -CellPhones
  • Device Morphology/Transition
    • mobile portable nomadic
  • Ultra mobile portable devices (UMPCs)?
  • Isomerism?
  • Users’ opinion from Africa
    • Desktop Laptops WiFi -CellPhones
  • Device Morphology/Transition
    • mobile portable nomadic
  • Ultra mobile portable devices (UMPCs)?
  • Isomerism?
  • Users’ opinion from Africa
    • Desktop Laptops WiFi -CellPhones
  • Device Morphology/Transition
    • mobile portable nomadic
  • Ultra mobile portable devices (UMPCs)?
  • Isomerism?
  • Users’ opinion from Africa
    • Desktop Laptops WiFi -CellPhones
  • Device Morphology/Transition
    • mobile portable nomadic
  • Ultra mobile portable devices (UMPCs)?
  • Isomerism?
  • Users’ opinion from Africa
    • Desktop Laptops WiFi -CellPhones

UMPCs

UMPCs

UMPCs

UMPCs

  • Low-cost UMPCs for Health
    • OLPC case
  • Low-cost UMPCs for Health
    • OLPC case
  • Low-cost UMPCs for Health
    • OLPC case
  • Low-cost UMPCs for Health
    • OLPC case
  • Low-cost UMPCs for Health
    • OLPC case
  • Low-cost UMPCs for Health
    • OLPC case
users social issues
Users: Social issues

Doctors in South Africa (Banderker et al 2005)

Job relevance

Usefulness

Perceived User resources

Device Characteristics

Supports from Public National government & hospital administrators

Patient influence

Legal issues (Decision Support Systems, Drug directories)

organizational issues 1
Organizational issues 1

Technology

Technology is not enough!

Positive economic benefits

Users led and focus

Social and ethical issues

Health workers’ responsibility

Device and applications development and regulation.

(HealthService 24- 2006)

organizational issues 2
Organizational issues 2

Environment

Health Policies, regulation, structure and financing

Evaluation in real-life contexts

Multiple actors and structures

Health IT infrastructure (organisation).

Users’ Trust

Users’ led model

(MOSAIC -2005)

sustaining ehealth projects in africa
70% of IT investments globally are failures: Note failure here is multifaceted

Africa is not faring better either

Same problem with eHealth projects especially in Africa

Hence, problem is sustainability which can be:

Organisational /Environmental

Social/cultural

Human (Health Workers)

Technological

Sustaining eHealth projects in Africa

80% cause of IT Failure

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

Page 35

sustainability issues
Sustainability issues
  • Building a sustainable Business Model for ‘Win-Win Situation’
    • Understanding and Meeting Multiple Stakeholders
      • End-users needs for design: Pro Poor vs. Niche markets
      • Understanding Organizational Process for innovation diffusion
    • Understanding Environmental Constraints and Enablers: Policies/Regulation, Electricity (Renewable Energy), Financial/Economic/Funding
      • Instituting sustainable Global & Local Public-Private Partnerships (PPPs)
      • Supporting Local Small & Medium Enterprise (SMEs)
      • Supporting Low Access/Entry costs models
  • Technological- Low cost Broadband Infrastructure
      • Wireless Telecom such as WiMax, WiFi, Broadband Satellite
      • Low cost mobiles devices and Laptops (OLPC, Intel Classmate etc
      • Open Source vs. Proprietary Software & Hardware?

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

sustainable solutions
Sustainable Solutions
  • High investment, implementation and purchasing costs of wireless telecom infrastructures as barriers (Gilhooly 2005, World Bank 2008)
  • Policy needed to stimulate:
    • Public service innovation/re-engineering (eHealth)
    • Mass and low-cost production of components
    • Appropriate Business models- “Bottom of the Pyramid” (BOP) model
    • Local and Global Public-Private Partnerships (PPPs) (NEPAD e-Schools project)
    • Social and developmental inputs in Telecom regulation & business

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

opportunities for wwrf wg 1
Opportunities for WWRF-WG 1
  • User-centric wireless products & services in developing countries
    • Case studies demonstrate the feasibility of mHealth in Africa Health System
    • Low-cost portable and mobile devices like the OLPC are needed
    • Low-cost broadband wireless infrastructure are also required
  • Research to influence future design and development
  • To support wireless eHealth business model in developing countries
    • Being developed with Rural Living Labs Europe
    • To be instituted in four regions of Africa
    • To develop a sustainable wireless eHealth model

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

opportunities for wwrf wg 2
Opportunities for WWRF-WG 2
  • Transmission
    • Wireless Broadband for eHealth web services and applications
  • Development of optimal/low-cost mobile/portable/nomadic devices, infrastructures and software
  • Ambient Wireless Networks
    • Melanges of wireless networks
    • Need to explore interoperability for facility, community, district, provincial, national regional and continental access and connectivity

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

ongoing research work @ chmi
Ongoing Research Work @ CHMI
  • Reviewing all eHealth projects in developing countries especially on mHealth
    • Focus is specifically on the factors affecting eHealth sustainability or success in Africa
    • Operational & strategic management of eHealth implementation & use in Africa
    • Developing a holistic framework to evaluate existing eHealth systems in Africa i.e. linking operational with strategic (policy) level
  • Framework will capture process and outcome impacts from design to implementation and use
  • Funding required for field trips to Africa

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

conclusion
Conclusion
  • A call to WWRF to support research into:
  • Low-cost mobile/wireless technologies for Development in Africa
    • eHealth
    • e-Education
    • e-Agriculture
    • e-Business, e-Commerce, e-Banking
  • Scoping change management issues in using mobile/wireless technologies for eHealth in Africa / Developing countries
  • THANK YOU FOR LISTENING!

WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

slide42

eHEALTH NETWORK FOR AFRICA: NEED FOR LOW-COST MOBILE/WIRELESS INFRASTRUCTURES

RESEARCH & DEVELOPMENT PROPOSAL

Dr Adesina Iluyemi

PhD Candidate

CHMI, Univ of Portsmouth, UK

Member, eMobility ETP

Adesina.iluyemi@port.ac.uk

22.04.2008

WWRF #20