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Adesina Iluyemi PhD Candidate CHMI, Univ of Portsmouth, UK Member, eMobility ETP Adesina.iluyemi@port.ac.uk 22.04.2008 W

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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Adesina Iluyemi PhD Candidate CHMI, Univ of Portsmouth, UK Member, eMobility ETP Adesina.iluyemi@port.ac.uk 22.04.2008 W

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. Health Workers using mobile devices WWRF#20 · Adesina Iluyemi · adesina.iluyemi@port.ac.uk · 22.04.2008 · Wireless eHealth for Africa

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. User-centric mHealth conceptual model

  25. mHealth Users’ Context

  26. Users issues 1 Technical Human Computer Interface (HCI) Open Source (Hardware & Software) Social Adoption issues (Development & Implementation) Culture Local Knowledge Language

  27. 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

  28. 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

  29. 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

  30. 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)

  31. 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)

  32. 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)

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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

  40. 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

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