Digital Reach Initiative Strategic Plan Ϯϭϭϵͳϯϭϯθ

DIGITAL REACH INITIATIVE STRATEGIC PLAN ϮϬϭϵͳϮϬϮϴ

DIGITAL REGIONAL EAST AFRICAN COMMUNITY HEALTH INITIATIVE TOWARDS A REGIONAL COMMITMENT TO IMPROVE HEALTH OUTCOMES THROUGH DIGITAL TECHNOLOGY EAST AFRICAN HEALTH RESEARCH COMMISSION Research for Health and Prosperity

Digital REACH Initiative Strategic Plan 2019 – 2028

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--"+!&5 ǿ *-)"*"+11&,+ 1&3&1&"0 ǖǖ6 Definition of Terms

DIGITAL HEALTH AND ͟HEALTH (used interchangeably in this report) Umbrella terms to encompass all concepts and activities at the intersection of health and information and communications technologies (ICTs) — including mobile health (mHealth), health information technology, electronic health records, and telehealth — comprising three main functions: • The delivery of health information, for health professionals and health consumers, through the internet and telecommunications media • The use of ICTs to improve public health services (e.g., through the education and training of health workers) • The use of health information systems (HIS) to capture, store, manage, or transmit information on patient health or health facility activities DIGITAL HEALTH SOLUTION +&+!&3&!2)-/,!2 1,/0"/3& "Ǿ,/ ,* &+1&,+,#*2)1&-)"-/,!2 10,/0"/3& "0Ǿ /"1"!1,0"/3"0-" &Ɯ %")1%0601"*, '" 1&3"Ǿ,ƞ"+&+3,)3&+$ ,* &+1&,+,#%/!4/"Ǿ0,ƞ4/"Ǿ&+#/01/2 12/"Ǿ+!0"/3& "0 required to meet this objective.

DIGITAL HEALTH SYSTEM The interrelated set of technologies, processes, and structures within a digital health ecosystem, typically including numerous solutions and organisations. eLEARNING Learning using electronic technologies to access educational curriculum outside of a traditional classroom.

ENVIRONMENTAL ENABLERS Components of the ecosystem that support digital health, namely leadership and governance, strategy and investment, the workforce, harmonisation of standards and technical interoperability, and legislation, policy, and compliance.

FRAMEWORK Conceptual structure guiding the Digital REACH Initiative components.

HEALTH PROVIDER/WORKER The health professional whose key responsibility is the provision of healthcare services irrespective of their organisations.

HEALTHCARE SERVICES Prevention and management of disease, illness, injury, and other physical and mental impairments delivered by healthcare provider to individuals through the healthcare system.

HEALTH SYSTEMS All the activities whose primary purpose is to promote, restore, and maintain health, including the people, institutions, resources, and policies that governments put in place to improve public health.

INITIATIVE %"&$&1)"$&,+)01#/& +,**2+&16 ")1%ț Ȝ +&1&1&3"Ǿ+"401+!&+$ ,!64&1%!"Ɯ+"! governance structure set up to oversee the creation of an enabling environment for digital health across the EAC region and to implement digital health programmes to improve regional health in the EAC.

4 INTEROPERABILITY %" &)&16,#!&ƛ"/"+1&+#,/*1&,+1" %+,),$60601"*0+!0,ƞ4/"--)& 1&,+01, ,**2+& 1"Ǿ"5 %+$" !1Ǿ+!20"1%"&+#,/*1&,+1%1%0 ""+"5 %+$"!ǽ +1"$/1&,+)),4014,--)& 1&,+01,"5 %+$" information, interoperability allows many. mHEALTH The delivery of healthcare services through mobile networks and devices.

SOCIAL HEALTH PROTECTION A series of public or publicly organised and mandated private measures against social distress and economic loss caused by the reduction of productivity, stoppage or reduction of earnings, or the cost of necessary treatment that can result from ill health.

STANDARDS 2)"0,/$2&!")&+"01%1"+02/" ,+0&01"+ 6&+1%" ,+1"51&+4%& %1%"6/"--)&"!ǽ2)"0,/$2&!")&+"01%1 "+02/" ,+0&01"+ 6&+1%" ,+1"51&+4%& %1%"6/"--)&"!ǽ

TRANSFORMATIONAL TECHNOLOGIES A new technology that replaces an established technology, or an innovative technology that creates a completely new industry.

TELEMEDICINE %"20",#*,!"/+1" %+,),$&"01,!")&3"/%")1%0"/3& "01,-1&"+10+!1,# &)&11"/"*,1""5 %+$"+! sharing of health information with healthcare providers within accepted jurisdiction.

UNIVERSAL HEALTH COVERAGE All people and communities can use promotive, preventive, curative, rehabilitative, and palliative health 0"/3& "00+""!"!4&1%,21"5-,0&+$1%"20"/1,Ɯ++ &)%/!0%&-ǽ

5 Abbreviations

AMR Antimicrobial resistance LMICs Low and middle-income countries

CBHU Cross-Border Health Unit M&E Monitoring and Evaluation

CHW Community Health Worker MNO , &)""14,/(-"/1,/

CoE "+1/",#5 "))"+ " MoH Ministry of Health

CPD Continuous Professional Development MoITC Ministry of Information Technology and Communication DHIS2 District Health Information System version 2 MOOC 00&3"-"++)&+",2/0"

EAC East African Community NCD Non-communicable disease

EAACH East African Academy for NEAT [Telemedicine] Networks for East Community Health African Tertiary [Healthcare Services] EAHRC East African Health Research Commission NGO ,+Ȓ$,3"/+*"+1)/$+&01&,+

EAIDSNet East African Integrated Disease OpenHIE -"+ ")1% +#,/*1&,+5 %+$" Surveillance Network OpenMRS -"+"!& )" ,/!601"* EAHC East African Health Cloud PMO /,'" 1+$"*"+1ƛ& "

EASTECO East African Science and PPP Public-private partnership Technology Commission RAD Regional Action through Data Consor- ECOWAS Economic Community of West African tium States REACH Regional East African Community EWG 5-"/1,/(&+$ /,2- Health

GHSA ), ) ")1%" 2/&16$"+! READSCoR Regional East Africa Disease Surveillance, Control, and GPO /,2-2/ %0&+$/$+&01&,+ Response

HMIS Health Management Information RHO "$&,+) ")1% 0"/31,/6 System RFP Request for Proposal HR Human Resources SACIDS Southern African Consortium for ICT or IT Information and Communication Infectious Disease Surveillance Technology SOP 1+!/!-"/1&+$/, "!2/" ID !"+1&Ɯ 1&,+ USAID United States Agency for International IGAD Inter-governmental Authority on Devel- Development opment

IUCEA Inter-University Council for East Africa

6 Acknowledgments

The concept for Digital REACH Initiative was created and commissioned by the East African Community (EAC) through the East African Health Research Commission (EAHRC). In developing the Strategic Plan, EAHRC /" "&3"!Ɯ++ &)02--,/1+!1" %+& )00&01+ "#/,*1%"Ǿ1%"+&1"!11"0$"+ 6#,/ +1"/+1&,+) "3"),-*"+1ț ȜǾ1%"&))ǔ")&+! 1"0 ,2+!1&,+Ǿ&$&1).2/"Ǿ01&)" ")1%Ǿ1%", ("#"))"/ ,2+!1&,+Ǿ+!1%"&1,) ,2+!1&,+ǽ%"!, 2*"+1404/&11"++!"!&1"! 6&1)3"Ǿ + ǽ

The EAHRC would like to thank the multiple stakeholders who have been engaged throughout the process of !"3"),-&+$1%" ,01"!&$&1) 1/1"$& )+ǽ-" &)1%+(0/""51"+!"!1,1%"#,)),4&+$ ,+1/& 21,/0 for their contribution to the development of the costed Strategic Plan:

• &))+!")&+! 1"0 ,2+!1&,+Ǿ"11)"Ǿ • &+&01/6,#2 )& ")1%+! &$%1$&+01 Ǿ • East African Community (EAC), Arusha, United Republic of Burundi Republic of Tanzania • Ministry of Health, Republic of Kenya • 01#/& +"+1/",#5 "))"+ "&+&,*"!& ) • Ministry of Health, Republic of Rwanda Engineering and eHealth, Republic of Rwanda • Ministry of Health, Republic of Uganda • 01#/& +"+1/",#5 "))"+ "#,//!&,30 2)/ • Ministry of Health, Community Development, Sciences, United Republic of Tanzania "+!"/Ǿ)!"/)6+!%&)!/"+Ǿ+&1"!"-2 )& ,# • 01#/& +"+1/",#5 "))"+ "#,/+ ,),$6Ǿ Tanzania Republic of Uganda • &+&01/6,# &$%"/!2 1&,++! &"+1&Ɯ • 01#/& +"+1/",#5 "))"+ "#,//,),$6+! Research, Republic of Burundi Nephrology, Republic of Kenya • Muhimbili University of Health and Allied Sciences • 01#/& +"$&,+)"+1/",#5 "))"+ "#,/ (MUHAS), United Republic of Tanzania &+"0Ǿ **2+&71&,++! ")1%2--)6%&+Ǿ • Muhimbili National Hospital, United Republic of Republic of Rwanda Tanzania • East African Health Research Commission (EAHRC), • National Commission for Science, Technology, and Bujumbura, Republic of Burundi Innovation, United Republic of Tanzania • East African Science and Technology Commission • National Institute for Medical Research (NIMR), țȜǾ&$)&Ǿ"-2 )& ,#4+! United Republic of Tanzania • 5-"/1,/(&+$ /,2-0,#1%"01#/& + ")1% • National Institute of Public Health, Republic of Research Commission (EAHRC) in the EAC Partner Burundi States • Management, Republic of Rwanda • Hewlett-Packard, Palo Alto, USA • Rwanda Biomedical Centre, Republic of Rwanda • Inter-University Council for East Africa (IUCEA), • The World Bank Kampala, Republic of Uganda • • PATH/Digital Square, Seattle, USA Kamenge University Hospital, Republic of Burundi • • $+!1&,+) ")1%"0"/ %/$+&01&,+ Kenya Medical Research Institute (KEMRI), Republic ț ȜǾ"-2 )& ,#$+! of Kenya • • University of Rwanda, School of Medicine and Last Mile Health, Boston, USA Health Sciences, Republic of Rwanda • &+&01/6,#ƛ&/0Ǿ"-2 )& ,#2/2+!& • University Teaching Hospital of Kigali, Republic of • &+&01/6,#ƛ&/0+!"$&,+)"3"),-*"+1Ǿ Rwanda Republic of Kenya • United States Agency for International • &+&01/6,#ƛ&/0Ǿ"-2 )& ,#4+! Development (USAID) • &+&01/6,#ƛ&/0Ǿ+&1"!"-2 )& ,#+7+& • &1)3"Ǿ + ǽǾ • &+&01/6,#ƛ&/0Ǿ"-2 )& ,#$+!

%"#2)))&01,#&+!&3&!2)04%, ,+1/& 21"!1,1%&01/1"$& )+ + "#,2+!&+--"+!&5ǽ

7 Foreword by Hon Amb Liberat Mfumukeko EAC Secretary General Health is a central pillar for the prosperity of the citizens of the East African Community (EAC). East African countries have been cooperating on matters of health for over a hundred years, denoting the value that health brings to socioeconomic prosperity. In its determination for regional integration, the EAC has opened borders to facilitate the free movement of people, services, and 20&+"00ǽ%&0#/""*,3"*"+101+!01, ,+1/& 21"0&$+&Ɯ +1)61, the socioeconomic agenda, but it requires robust health systems and collaboration across the region. This millennium the world Hon Amb Liberat Mfumukeko has witnessed how Information and Communication Technology EAC Secretary General ț Ȝ +/"3,)21&,+&0"0, &," ,+,*& 0Ȁ1%"!")&3"/6,#Ɯ++ &) 0"/3& "0&+01#/& %00&$+&Ɯ +1)6&*-/,3"!1%/,2$%1%"20",#!&$&1)1" %+,),$6ǽ &3"+1%"-,4"/,# the technology, the EAC has taken another step, to integrate technology into the health sector using digital health, as a way of strengthening regional healthcare services. In realising the value of digital health, the East African Health Research Commission (EAHRC), an institution of the EAC, established to guide the provision of "3&!"+ "Ȓ 0"!%")1%0"/3& "0Ǿ ,+ "-12)&0"!+! ,,/!&+1"!1%""ƛ,/11,!"3"),-1%"&$&1)"$&,+) East African Community Health (Digital REACH) Initiative. Digital REACH is an implementation science-led initiative. The Initiative will develop and implement regional health programmes that require economies of scale and regional capabilities which the EAC is uniquely -,0&1&,+"!1,!!/"00ǽ%" +&1&1&3"&0!"0&$+"!1, ,*-)"*"+1Ǿ&*-/,3"Ǿ+!01/"+$1%"+ ,2+1/6Ȓ0-" &Ɯ work in digital health and has been developed in collaboration with Partner States to ensure alignment with national strategies and priorities. The EAHRC will coordinate all stakeholders to bring about the digital health best practices into the mainstream of the regional health system. This initiative has come at the right time. A time when the EAC is grappling with multiple health challenges including the threat of disease outbreaks, the increasing impact of non-communicable diseases, and emerging infectious diseases. Through the Digital REACH Initiative, we are optimistic that health professional training will improve, continuity of care for EAC citizens will not be hampered by the movements of people across borders, and that communities in remote areas will be able to access specialised health services. In addition to this, the generation and use of data by the region will empower the EAC to establish a health system that is evidence- based and that allows citizens to take greater ownership of their own health. The completion of this costed Digital REACH Initiative’s Strategic Plan is an implementation of the priorities for health investment that were approved by the Heads of all the EAC Partner States. The Digital REACH Initiative marks a new era in health for EAC, and the world at large.

Sincerely, Hon Amb. Liberat Mfumukeko " /"1/6 "+"/)

8 Foreword by Professor Gibson Kibiki, Executive Secretary of the EAHRC A healthy population is essential for the prosperity of the East African Community (EAC). Sustainable development is built on a productive society that is able to thrive in a healthy region, free ,#%")1%1%/"10Ǿ4&1%".2&1 )"+!"ƛ" 1&3" /"ǽ01#/& + leaders and citizens have shown determination to construct a powerful and sustainable East African regional economic and political bloc that allows free movement of people, services, and

Professor Gibson Kibiki, MD, MMed, PhD goods. Strengthening healthcare provision at all levels of the Executive Secretary – East African health system, from national all the way to the regional level, Health Research Commission is critical to regional health security and to facilitate access to quality healthcare across the region. Technology is an important part of this vision. There is a clear opportunity for East Africa to utilise digital 1" %+,),$&"01,!3+ "1%"%")1%+!-/,0-"/&16,#1%"/"$&,++!&10 &1&7"+0&+4601%1/"*,/""ƛ" 1&3" +!"ƛ& &"+1ǽ%&)"/1+"/11"0%3"" %*!"-/,$/"00&+&+ ,/-,/1&+$1" %+,),$6&+1%"&/-/,3&0&,+ of healthcare, there is work to be done so that all EAC countries can reap the rewards. ƞ"/0"/&"0,#01/1"$& -)++&+$!&0 200&,+0 ,,/!&+1"! 61%"01#/& + ")1%"0"/ %,**&00&,+ ț ȜǾ1%"/1+"/11"0,ƛ& &))6/" ,**"+!"!,+ǗǗ+! " /2/6ǗǕǖǝ&+*-)Ǿ$+!1%11%" region harness the potential of digital technology by scaling uptake and utilisation of digital technologies and solutions for improved health service delivery and health outcomes. The recommendation was approved as %")1%-/&,/&16#,/&+3"01*"+1 61%" "!0,#1%"0&5/1+"/11"0!2/&+$1%" ,&+1 "!0,#1%" 11""1/"1,+ +#/01/2 12/"+! ")1%"3"),-*"+1,+Ǘǘ/! " /2/6ǗǕǖǝ&+*-)Ǿ$+!ǽ The Digital Regional East African Community Health Initiative (Digital REACH Initiative) is the vision for realising the recommended priority. This strategic plan builds on the Digital REACH Initiative roadmap, which 40--/,3"! 61%"*&+&01"/0,#%")1%,#1%"0&5/1+"/11"0!2/&+$1%"ǖǚ1%/!&+/6""1&+$,# 1%"" 1,/),2+ &),#&+&01"/0,# ")1%#/,*ǖǘ1%1,ǖǜ1%,3"* "/ǗǕǖǜ&+*-)Ǿ$+!ǽ%" document details the approach to take this Initiative forward, along with further detail on the activities and implementations that will realise its mission of a strong digital health ecosystem in East Africa. I would like to thank the representatives of the EAC Partner States, EAHRC Commissioners, EAHRC National , ),&+10ȉ"5-"/10Ǿ%")1%"5-"/10Ǿ +!" ")1%$,3"/+*"+1,ƛ& &)0#/,*/1+"/11"0Ǿ+,+Ȓ governmental organisations, and development partners for their valuable inputs and support to the EAHRC 1%/,2$%,211%&0-/, "00ǽ%"6%3" ""+"00"+1&)1,!"3"),-&+$1%&0&++,31&3"ǾƜ/01Ȓ,#Ȓ&10Ȓ(&+!01/1"$61%1 02--,/101%" +1"$/1&,+$"+!1,4/!0Ȋ+"",-)"Ǿ+" ")1%601"*ȋ1(&+$/"$&,+)-"/0-" 1&3" in advancing technology for health.

Sincerely, Professor Gibson Kibiki, MD, MMed, PhD 5" 21&3"" /"1/6Ȕ01#/& + ")1%"0"/ %,**&00&,+

A prosperous and healthy region is one in which Executive Summary each EAC Partner State THE DIGITAL REGIONAL EAST AFRICAN can participate fully in COMMUNITY HEALTH INITIATIVE trade and industry within A prosperous and healthy region is one in which each EAC an environment that Partner State can participate fully in trade and industry within an sustains and nourishes environment that sustains and nourishes its people, free of health its people, free of health 1%/"10+! - )",#-/,3&!&+$2+&3"/0) /"1,))ǽ-"+ ,/!"/0 and the continuous movement of people underscore the need for a threats and capable of regional approach to track and respond to regional health priority providing universal care needs, while laying the groundwork for a robust and sustainable to all. regional economy. Technology can help to strengthen regional health systems by bolstering the access, use, and performance of health services. The Digital Regional East African Community Health (Digital REACH) Initiative will be a new, ground-breaking Initiative within the East African Community (EAC) that will implement regionally-focused, interoperable information and communications technology (ICT) across all dimensions of the health sector in East Africa, 4%&)")"3"/$&+$"5&01&+$ ,2+1/6!&$&1)%")1%&+3"01*"+10ǽ 1%01%"-,4"/1,02--,/12+&3"/0)%")1% ,3"/$" 6&*-/,3&+$%")1% /"!")&3"/6 /,001%"/"$&,+Ǿ1/+0#,/*&+$1%")&3"0,#,3"/ǖǛǕ*&))&,+-",-)"ǽ The Initiative has been developed based on collaboration and inputs from representatives of the EAC Partner 11"0+!&002--,/1"! 6))/"0&!"+10,#1%"Ǿ0-" &Ɯ ))61%""-2 )& ,#2/2+!&Ǿ1%""-2 )& ,#"+6Ǿ1%" Republic of Rwanda, the Republic of South Sudan, the United Republic of Tanzania, and the Republic of Uganda. Each of the Digital REACH workstreams described in this document support the EAC’s integration agenda ,#Ȋ+"",-)"Ǿ+" ")1%601"*ȋǽ%&002--,/1,#/"$&,+)&+1"$/1&,+&04%1*("01%"&$&1) Initiative unique and is why it has received the highest levels of political support in the EAC region.

ǿ MATTERS NOW !,-1&,+*,+$01))%")1%01("%,)!"/0Ȕ#/,*-1&"+101,%")1%*&+&01"/0Ȕ%0, 2//"!0, quickly and thoroughly that the term digital health is losing its novelty. This signals its maturity and the need for coordination across the ecosystem, moving away from a fragmented approach to digital health — characterised by siloed applications, waste, and variable data — to a holistic digital health model with coordinated investments and common assets leveraged across multiple health programmes. Strong leadership, the right supportive, enabling environment, and alignment with the new Principles of Donor )&$+*"+1#,/&$&1) ")1% +-/,-")1%&0*,!")1,/")&16Ǿ-/"3"+1&+$!2-)& 1&,+,#"ƛ,/1 /,001%"/"$&,+ +!$"+"/1&+$)/$"Ȓ0 )" ,01"ƛ& &"+ &"0ǽ The EAC has the opportunity to play a major role in creating and supporting the enabling environment for digital health and in the design and use of digital health implementations, to ensure sustainability and scale across the region. The purpose of the Digital REACH Initiative is to harness this opportunity through coordinated regional action. PURPOSE OF STRATEGIC PLAN Created and owned by the EAC, this Strategic Plan presents a ten-year plan for implementing the Digital REACH Initiative. It follows the EAC's approval of the &$&1) ,!*- by Partner State Ministers of Health, presenting a common regional vision and strategic approach for regional collaboration in health. It also serves as a platform for development partners’ and private-sector input to support coordination and shared investment. The plan will allow the EAC to pursue the funding necessary to launch the Initiative and plan for #2))Ȓ0 )",-"/1&,+0 6"/)6ǗǕǖǞǽ%&0&01%"Ɯ/011&*"+#/& ++&,+/"$&,+%0 ,*"1,$"1%"/1, /"1"+ ambitious and coordinated approach to digital health that is prioritised for investment by all Presidents of the EAC Partner States.

10 VISION AND MISSION The Digital REACH Initiative is guided by the following vision and mission:

&0&,+ǗǕǗǝ Interconnected health systems for a healthy and prosperous East Africa &00&,+11"*"+1 Maximise the power of digital health in East Africa by ensuring an enabling environment and by implementing scaled, coordinated, transformational, and innovative approaches.

DIGITAL REACH INITIATIVE OUTCOME GOALS %"0-" &Ɯ ,21 ,*"$,)0,#1%"&$&1) +&1&1&3"/")&01"! "),4ǽ%"0"%3" ""+&!"+1&Ɯ"! 6 /1+"/11"/"-/"0"+11&3"01%/,2$%0"/&"0,#4,/(0%,-0&+ǗǕǖǜ+!ǗǕǖǝǽ

-1&*&0"1%"/"3"+1&,+Ǿ&$+,0&0Ǿ+!/"1*"+1,#/&,/&16 ")1%,+!&1&,+0 Improve quality, access, and continuity of care across EAC countries for communicable and non- communicable diseases. *-/,3" ")1%,/("/!2 1&,++!/&+&+$ Provide standardised and recognised healthcare training and capacity building for pre and in-service health workers. *-/,3"2--)6%&+ƛ& &"+ 6 Take advantage of economies of scale for dealing with suppliers and vendors that impact the region. + +%+ "2 )& ")1%!2 1&,++!4/"+"00 Improve and support community health-related knowledge and provide patient education for preventive care, and behavior change. 2--,/1+&3"/0) "001, ")1% /" Enhance social health protection in the region and the portability of health insurance. *-/,3"&0"0"2/3"&))+ "+!"0-,+0" Build capacity and improve regional disease surveillance to prevent, detect, and respond to infectious diseases, emergencies, and outbreaks. -1&*&0" 2*+"0,2/ ")), 1&,++!+$"*"+1 -1&*&0"%")1%4,/("/*, &)&01&,++!# &)&11"%")1%4,/("/(+,4)"!$"0%/&+$ /,001%"/"$&,+0ǽ ,+&1,/,-2)1&,+ ")1%1120 Track regional priority health indicators and promote use of health research to support health policies and further the regional health agenda.

The Initiative has been structured into nine workstreams. They will run in parallel and support one another, 01/1&+$4&1%0")" 1-/&,/&16 1&3&1&"0+!"5-+!&+$&+1,,1%"//"0,#4,/(0$&+0/"*!"+!/"0,2/ "0 become available. Implementation of workstreams will be staggered in line with these priorities. The Health /,$/**"0,/(01/"*4&))#, 20,+1%"&*-)"*"+11&,+,#0-" &Ɯ Ǿ01/1"$& %")1%-/,$/**"0Ǿ4%&)" the seven Enabling Environment Workstreams will focus on the creation of an enabling environment for digital health that can be shared across Partner States and that supports health programme implementations. An ,3"// %&+$4,/(01/"*#,/ +&1&1&3"+$"*"+14&)))"!+!*+$"1%" +&1&1&3"ǽ02**/6,#1%"!&ƛ"/"+1 workstreams can be found below.

11 INITIATIVE MANAGEMENT

HEALTH PROGRAMMES Regional, on-the-ground, health service delivery programmes driven by digital technology

THE EAST REGIONAL REGIONAL EAST EAC REGIONAL AFRICAN HEALTH AFRICA DISEASE HEALTH HEALTH CLOUD SERVICES Ǿ (EAHC) CONTROL AND (RHO) RESPONSE (READSC,R)

TELEMEDICINE EAST AFRICAN REGIONAL INNOVATIONS IN ACADEMY FOR MANAGEMENT TECHNICAL HEALTH FOR EAST COMMUNITY AND PEER ASSISTANCE AFRICAN HEALTH LEARNING FOR DIGITAL TERTIARY (EAACH) HEALTH (NEAT) HEALTHCARE SERVICES

Create the enabling environment for digital health in the region

INFRASTRUCTURE SERVICES AND LEADERSHIP STRATEGY AND Ǿ STANDARDS APPLICATIONS AND INVESTMENT Ǿ AND INTER- Create the ADVOCACY COMPLIANCE Build health technical global Identify and Negotiate with worker goods that support the Advocate, "51"/+) 1,/0 Develop the professional support all other development socialise, lay the on behalf of the policies and capacity across Identify and workstreams of reusable and groundwork, region to realise guidelines the region to develop and provide interoperable remove political economies needed, and facilitate human common regional tech 0,ƞ4/" obstacles, and of scale work to gain their resource sharing guidelines, support services and garner political and greater adoption across and improve standards, and applications support for "ƛ& &"+ &"0 Partner States care protocols to lay built for regional implementations the foundation and national #,/+"ƛ" 1&3" use regional digital health ecosystem

Much investment has already been made across a number of these workstreams by Partner States and !"3"),-*"+1-/1+"/0ǽ+"/)60 +,#4%1)/"!6"5&010 /,001%"/"$&,+4&)) " //&"!,21,+ "" % 4,/(01/"*&00"12-Ǿ1, 2&)!,++!02--,/1"5&01&+$&+&1&1&3"0+!)"/+#/,*-/"3&,20&*-)"*"+11&,+0ǽ

IMPLEMENTATION APPROACH ("6!&ƛ"/"+1&1,/,#1%"&$&1) +&1&1&3"&01%1&11("0+"3&!"+ "Ȓ 0"!--/, %Ǿ&*-)"*"+1&+$ targeted regional digital health programmes while also creating the supportive foundations that will make those programmes successful. This is a ground-breaking dimension of this Initiative. It makes it possible to not only identify evidence of impact, but also to apply that evidence in a way that structures and drives work on the enabling environment and subsequent health programme implementations. %"0" 1&,+ "),4-/,3&!"0+,3"/3&"4,#1%"!&ƛ"/"+14,/(01/"*0+!1%"&!"+1&Ɯ"!-/&,/&16 1&3&1&"0 for each, selected based on input from EAC and Partner States, the feasibility and potential impact of implementation, the critical dependencies of these activities to other areas of works, and the importance of striking a balance between building foundations and establishing quick-wins towards progress and impact.

12 ǖǿ ,/(01/"*ǖǾ1%" +&1&1&3"+$"*"+14,/(01/"*Ǿ4&))%,)&01& ))6$2&!"Ǿ ,,/!&+1"Ǿ+!*5&*&0"1%" impact of the other eight Initiative workstreams. It aims to -/,3&!"01/1"$& ,/$+&01&,+)!&/" 1&,+ /,00 1%""+1&/" +&1&1&3"Ǿ /"1",-"/1&,+)"ƛ& &"+ &"0Ǿ!/&3"4/"+"00,#1%" +&1&1&3"1%/,2$%2+&Ɯ"! *"00$&+$+!-2 )& /")1&,+0, and "+02/" ,*-)&+ "4&1%/"$2)1&,+0+!$/+1/".2&/"*"+10. It will coordinate across all other workstreams, making sure all are working towards the achievement of the vision and mission of the Initiative. %"/,'" 1+$"*"+1ƛ& "țȜ4&))/"0&!"&+1%&04,/(01/"*+!4&)) "1%" "+1/)&0"!*+$"*"+1 organisation of the Digital REACH Initiative, providing leadership and coordination across all other 4,/(01/"*0ǽ%"#2))1/1"$& )+"5-)&+0&+#2/1%"/!"1&)%,41%&04&)) "0"12-+!*+$"!ǽ5*-)" priority activities include:

1.1 Set up the appropriate entity and structures to lead and manage the Initiative and provide ongoing operational support across workstreams 1.2 Provide leadership across all workstreams and encourage cross-workstream synergies 1.3 00&01,1%"/4,/(01/"*04&1%%&/&+$+!1/&+&+$01ƛț)"$)02--,/1Ǿ%2*+/"0,2/ "0Ȝ 1.4 Manage grants and communications with grant partners for the Initiative 1.5 ,,/!&+1"*,+$01"5&01&+$-/1+"/0&+1%"-2 )& +!-/&31"0" 1,/+!-2/02"+"4-/1+"/0%&-0 throughout the lifespan of the Initiative 1.6 "12-/,21&+"-/, "00"01,/"-,/1,21,+-/,$/"00+!Ɯ++ &+$,# 2//"+1 1&3&1&"0+!-/&,/&1&0"#212/" 4,/(01/"* 1&3&1&"04&1%)"!"/0%&-+!1%"" %+& )!3&0,/6 /,2-++2))6 PRIORITY ACTIVITIES 1.7 Conduct M&E, thought leadership, and performance management across all workstreams 1.8 Share and duplicate best practices among Partner States and other regional organisations

PARTNERS’ FORUM (Partner States, EAC Organs and Board of Directors Institutions, development partners, and the private sector) (Partner States, EAC Organs and Institutions, development partners, and the private sector) Digital REACH Initiative PMO TECHNICAL ADVISORY GROUP (Executive Director and the Digital REACH Directorate) { (Local and international health and technology experts)

3"/0&$%1 /,00))1%"/,/(01/"*0

Workstreams will have their own Workstream Lead, teams, management structure, and budget and report to the ǽ,/(01/"*Ȓ0-" &Ɯ -/1+"/0%&-04&)) "*+$"!11%"4,/(01/"*)"3")

HEALTH PROGRAMMES

INFRASTRUCTURE SERVICES AND LEADERSHIP STRATEGY AND Ǿ STANDARDS APPLICATIONS AND INVESTMENT Ǿ AND INTER- ADVOCACY COMPLIANCE

13 Ǘǿ

%" ")1%/,$/**"0,/(01/"*4&))#, 20,+&*-/,3&+$%")1% /"&+1%"1%/,2$%0-" &Ɯ /"$&,+) !&$&1)%")1%&*-)"*"+11&,+0ǽ3"/1%" ,2/0",#1%" +&1&1&3"1%&04,/(01/"*4&)),3"/0""+!&*-)"*"+1 +&+"%")1%-/,$/**"0, as detailed below. Not all implementations will start at once; some have been &!"+1&Ɯ"!0-/&,/&1&"0 61%"Ǿ4%&)",1%"/04&)) "01/1"!,+ "1%" +&1&1&3"&+2+!"/46+!/"0,2/ "0 are available. The Health Programmes workstream provides implementation oversight, M&E, and coordination across all Health Programmes implemented in this workstream.

Level of Priority: &$% ,4

TELEMEDICINE REGIONAL EAST AFRICAN ACADEMY EAC REGIONAL THE EAST AFRICAN EAST AFRICA DISEASE FOR COMMUNITY HEALTH CLOUD (EAHC) AFRICAN TERTIARY Ǿ HEALTH (EAACH) (RHO) (NEAT) HEALTHCARE CONTROL AND Set up the EAHC to SERVICES RESPONSE Establish a community Create a Regional support other health (READSC,R) training and learning ")1% 0"/31,/6 programmes, inform Implement platform to improve to facilitate access health research, and to telemedicine to link Design a health alert health education and to data, information, better understand health East African Centres and early warning awareness, and train analyses, and trends and outcomes in ,#5 "))"+ "+! system for disease frontline workforce in the empirical evidence the region. specialised health care outbreaks and community leveraging for monitoring and facilities across the epidemics in the digital technology. evaluating regional region. region. health.

REGIONAL HEALTH REGIONAL TECHNICAL INNOVATIONS IN Key OPTIMISE THE PREVENTION, SERVICES MANAGEMENT AND ASSISTANCE FOR HEALTH DIAGNOSIS, AND TREATMENT OF PEER LEARNING DIGITAL HEALTH PRIORITY HEALTH CONDITIONS SUPPORT UNIVERSAL ACCESS TO Implement programmes Design implementations HEALTHCARE that strengthen cross- with new digital Support peer learning Build digital health IMPROVE HEALTH WORKER border and regional health and the creation of capacity in Partner technologies to support EDUCATION AND TRAINING by sharing data in priority reusable assets in States in areas &*-/,3"!"ƛ& &"+ &"0+! OPTIMISE HUMAN RESOURCE cross-border communities the region through that support the "ƛ" 1&3"+"00&+-2 )& ALLOCATION AND MANAGEMENT IMPROVE DISEASE SURVEILLANCE and supporting portability the implementation implementation health. AND RESPONSE

of health insurance. of knowledge of Digital REACH IMPROVE SUPPLY CHAIN management Initiative. EFFICIENCY platforms. + ENHANCE PUBLIC HEALTH EDUCATION AND AWARENESS

MONITOR POPULATION HEALTH STATUS

+ + +

,/(01/"*ǘȒǞǿ/"1&+$++ )&+$+3&/,+*"+1 +",#1%"*',//,)"01%"&$&1) +&1&1&3"4&))-)6&+1%"/"$&,+&01, /"1"+!02--,/11%""+ )&+$ environment for digital health, to ensure sustainability and scale. An enabling environment can also facilitate entry of the private sector and development partners for the provision of sustainable digital health systems and services. Part of the Digital REACH Initiative strategy is to create an ecosystem that is attractive to large companies as well as small, local entrepreneurs so that digital health can grow as an industry. It will do this by: • Directly engaging and partnering with the private sector to implement workstream activities (e.g., through PPPs) • Creating an enabling environment that will attract and stimulate investment in the region (e.g., through supportive regulatory framework and policies) ,/(01/"*0ǘȔǞ4&))4,/(1, /"1"1%&0"+ )&+$"+3&/,+*"+1ǽ %4,/(01/"*4&))-)6("6/,)" in stimulating private sector investment. The Strategy and Investment workstream will lead the overall

14 engagement of the private sector but it will be the responsibility of each workstream to identify areas where the private sector can be brought in and engaged to support their activities.

ǘǿ

The overall goal of this workstream is to &!"+1Ǿ 2&)!Ǿ%,01Ǿ+!&*-)"*"+1 ,**,+1" %+,),$& ) ,*-,+"+10 and systems that will allow other workstreams and health programmes to achieve the Digital REACH Initiative’s outcome goals. This workstream also includes the technical support required to maintain systems over time. Priority activities are:

3.1 Build the East African Health Cloud (EAHC) and set up a regional support team to maintain it over time to enable real-time storing, capturing, analysing, and retrieving of health data on priority diseases and outbreaks, and to support health research 3.2")" 1+!&*-)"*"+1#,2+!1&,+)1" %+,),$&"01,"+ )"/"$&,+)&+#,/*1&,+"5 %+$"ț"ǽ$ǽǾ "14""+ PRIORITY

ACTIVITIES EAHC and other regional and Partner State HIS) including a client registry, terminology services, and interoperability layer

Ǚǿ

This workstream will identify and invest in /"20 )"+!&+1"/,-"/ )"!&$&1)0,)21&,+0#,//"$&,+)+! +1&,+)20" that support the realisation of Digital REACH Initiative goals. It will support the access and *+$"*"+1,#/"$&,+)%")1%Ȓ!")&3"/60"/3& "0#,/1%"/"$&,+1%/,2$%0-" &Ɯ !&$&1)0,)21&,+,ƛ"/&+$0 +!0,ƞ4/"1,,)0Ǿ&!"+1&+$$-0&+"5&01&+$0,)21&,+0+!&+3"01&+$&+ ,**,+$,,!01,!!/"001%,0" gaps. Users include health workers, the general public, patients, and health and insurance providers. Priority activities are:

4.1"3"),-!" &0&,+Ȓ02--,/11,,)0 2&)1&+1,+"4,/"5&01&+$0601"*01,02--,/1%")1%4,/("/0!")&+$4&1% cases of outbreaks and health emergencies (e.g., outbreak alerts, an alert to notify the regional body, care instruction, alerts with updates to protocols) 4.2 Support and promote implementation of interoperable unique ID systems 4.32--,/1"+$$"*"+14&1%1%"/")"3+1-"+ +!,1%"/$), ) ,**2+&1&"01,)"3"/$" "01-/ 1& "0 +!"51"/+)"5-"/1&0"&+1%"!"0&$++!&*-)"*"+11&,+,#!&$&1)%")1%0"/3& "0+!--)& 1&,+0 4.4 +3"01&+0,ƞ4/"0,)21&,+01%102--,/11%"/")&01&,+,#/"$&,+)!&$&1)-,/1 )"%")1%&+02/+ " -/,!2 1ț"ǽ$ǽǾ )&*02 *&00&,+Ǿ")&$& &)&163"/&Ɯ 1&,+Ǿ*, &)"-6*"+10#,//"&* 2/0"*"+10Ȝ

PRIORITY ACTIVITIES 4.5 Provide support with contractual agreements with technology solutions vendors for Partner States and the Digital REACH Initiative and work with Strategy and Investment team for potential group pricing discounts

ǚǿ

%&"3&+$1%"&$&1) +&1&1&3",21 ,*"$,)04&)),ƞ"+/".2&/"02 01+1&) %+$"*+$"*"+1+! political buy-in. The Leadership and Advocacy workstream will 00&01,1%"/4,/(01/"*01,$&+-,)&1& ) 02--,/1#,/1%"&/ 1&3&1&"0Ǿ4%& %&0+" "00/6Ɯ/0101"-1,# &)&11"02 % %+$"ǽ %&04,/(01/"*4&)) ",214/!# &+$ǽ* 00!,/0ț&+!&3&!2)04&1%!""-"5-"/1&0"+! ,++" 1&,+0 &+1%"/"$&,+Ȝ4&))&+1"/ 14&1%0"+&,/")" 1"!,ƛ& &)0+!$,3"/+*"+1!" &0&,+*("/0,+ "%)#,#1%" Digital REACH Initiative, collecting high-level feedback and rallying support from key government decision *("/0+!")" 1"!,ƛ& &)0#,/1%" +&1&1&3"ȉ0-/,'" 10ǽ2 %02--,/14&))$/"1)6# &)&11"1%"-/1& &-1&,+ ,#$,3"/+*"+1,ƛ& &)0+!,1%"/0&+1%" %+$"0 "&+$&+1/,!2 "!1%/,2$%1%" +&1&1&3"ȉ0-/,'" 10ǽ/&,/&16 activities are:

15 5.1 Advocate for agreement on data sharing and storage in a regional cloud 5.2 Advocate for regional agreement on health insurance portability for all EAC citizens 5.3 !3, 1"#,/',&+1/"$&,+)-,0&1&,+,+--/, %1,-2 )& %")1%"*"/$"+ &"01,&*-/,3"1%""ƛ& &"+ 6 +!"ƛ" 1&3"+"00,#/"0-,+0"&+1%""3"+1,#!&0"0",21 /"( 5.4 Advocate with development partners for a reduced common set of priority reporting health indicators across all EAC Partner States to reduce data collection and reporting burden for health workers 5.5 Advocate for a holistic approach to use of digital technologies and solutions in the health sector within the PRIORITY ACTIVITIES EAC region

Ǜǿ

This workstream will make use of skilled business analysts and negotiators to !"3"),-1%" 20&+"00 0"0 that will be used to engage with the private sector and the development community on behalf of the EAC in order 1,/")&0"" ,+,*&"0,#0 )"+!$/"1"/"ƛ& &"+ &"0. This workstream will also work to engage with the private sector to develop an investment mechanism to "5-+! ,**2+& 1&,+&+#/01/2 12/"&+/"04&1%),4 ,++" 1&3&16+!1,+"$,1&1"+!01/2 12/"-2 )& Ȓ private partnerships (PPPs) that can be utilised across the Initiative. Priority activities are:

6.1 Conduct feasibility assessment, develop business case, and identify opportunity for public private partnerships (PPPs) for the build and maintenance of the EAHC and NEAT 6.2 Conduct business case assessments and use for negotiating agreements with mobile network operators ț0Ȝ#,/ƛ,/! )" +!4&!1%+!&*-/,3"!+"14,/( ,++" 1&3&161,02--,/1-/&,/&16%")1%-/,$/**"0 (starting with prioritised telemedicine -supported facilities) 6.3 Support the development of a business case for regional insurance, partnering with private health insurers for favourable premium rates and packages 6.4 Aggregate demand based on Partner States’ supply needs and develop a business case to support PRIORITY ACTIVITIES negotiation for reduced pricing with suppliers to reduce cost of healthcare for providers and patients

ǜǿ Ǿ Ǿ

Critical to the success of the Digital REACH Initiative will be the ability to put into place conducive regional policies that are embraced by Partner States. This workstream acts as the regional facilitator that works in the service of /"1&+$-,)& 6"+3&/,+*"+11,-/,*,1"!&$&1)%")1% on behalf of EAC Partner States. %" &)&161,4,/("ƛ" 1&3")64&1%-,)& 6,ƛ& &)0&+/1+"/11"0&0("6ǽ,!,0,Ǿ1%&04,/(01/"*4&))#,/* "$&,+),)& 65-"/1,/(&+$ /,2-ț Ȝ*!"2-,#02 '" 1Ȓ*11"/"5-"/10+!-,)& 6,ƛ& &)0#/,* Partner States, who will act together to scope and review policies and legislation drawn up by the workstream. Priority activities are:

7.1 "0&$+-,)& 6+!)"$&0)1&,+/,2+!/"*,1"!1%,01&+$ț&+ )2!&+$!1-/&3 6+! ,+Ɯ!"+1&)&16 standards and requirements) 7.2 Develop policy and legislation to support data sharing in cases of disease outbreaks and telemedicine to )),4-1&"+101, "+"Ɯ1#/,* ,+1&+2&16,# /"+!&*-/,3"!%")1%0" 2/&16+!02/3"&))+ " /,001%" region 7.3 Establish a policy for managing public health emergencies (e.g., how to drive commitment of Partner States 1,*, &)&0"/"0,2/ "&+"*"/$"+ &"0Ȝ1,"+02/""ƛ& &"+ 6+!"ƛ" 1&3"+"00,#/"$&,+)/"0-,+0" 7.4 Develop a shared policy that supports portability of health insurance to allow EAC citizens to access a PRIORITY ACTIVITIES regional insurance product

16 ǝǿ

The overall goal of this workstream is to 2&)!1%" - &16,#%")1%4,/("/0&+1%"/"$&,+ to facilitate human resource sharing across countries, strengthen patient care and outcomes, and overcome shortages of skilled health workers. The workstream will work in close collaboration with professional bodies and academic &+01&121&,+0+!4,/(4&1%&+"5&01&+$/"$&,+)#/*"4,/(0ț"ǽ$ǽǾ01#/& +2)&Ɯ 1&,+0 /*"4,/(#,/ Higher Education) and forums. The workstream will promote eLearning and support training institutions in 01#/& ǽ 104,/(4&))&+ )2!" ,,/!&+1"!/"3&"4,#"5&01&+$!&$&1)%")1%1/&+&+$&+1%"/"$&,++!1%" harmonisation across Partner States of minimum standards in teaching curricula, which include the use of digital tools and ICT as well as data sharing and security. Priority activities are:

8.1 Work with universities and training institutions to harmonise and make available eLearning course content +!00&3"-"++)&+",2/0"0ț0Ȝ#,/&+Ȓ0"/3& "+!-/"Ȓ0"/3& "%")1%-/,#"00&,+)01%1 + " shared within the East African region using an eLearning platform 8.2 Work with universities, training institutions, and global and regional partners to harmonise curricula for digital health and telemedicine for healthcare professionals and health IT professionals 8.3 Work with universities to embed digital learning methods in medical and healthcare worker training programmes to promote independent, student-centred learning 8.4 Train health care professionals on the use of digital health for health services provision (e.g. in public health PRIORITY ACTIVITIES emergencies)

Ǟǿ

This workstream will &!"+1+!!"3"),- ,**,+$2&!")&+"0Ǿ01+!/!0Ǿ+!-/,1, ,)0 to lay the foundation for an "ƛ" 1&3"+!&+1"/,-"/ )"/"$&,+)!&$&1)%")1%" ,0601"* in East Africa. The workstream sets common and shared standards, while adhering to the Principles for Digital Development and 4,/(&+$1%/,2$%"5&01&+$$), )+!/"$&,+)"ƛ,/10Ǿ1,"+ )"1%"/")&01&,+,#1%"&$&1) +&1&1&3" ,21 ,*"$,)0ǽ%&0"ƛ,/1&+ )2!"0!"3"),-&+$+!-/,*,1&+$/"$&,+)-/&+ &-)"01%1-/,*,1" "001, healthcare services and interoperability across the EAC region. %"4,/(01/"*4&))#,/*+! "$2&!"! 61+!/!0+! +1"/,-"/ &)&16 1%1&0*!"2-,# 4,/(01/"*02 '" 1*11"/"5-"/10+!/1+"/11",ƛ& &)0 1&+$1,$"1%"/1,0 ,-"+!/"3&"401+!/!0 !"3"),-"! 61%"4,/(01/"*ǽ%" 4&)))0,-)6 ,*-)&+ "/,)"Ǿ&+1%1&14&))/"3&"4/1+"/11" progress with implementation of agreed-upon standards. Priority activities are:

9.1 Develop data sharing, security, and management guidelines, protocols, and standards 9.2 Create a regional data dictionary, mapped to international standards, and supporting governance process, 1,02--,/1&+1"/,-"/ )"!1"5 %+$" "14""+/1+"/11" &+1%"/"$&,+ț"ǽ$ǽǾ#,/&+02/+ " -/,3&!"/01,)),4 &1&7"+01,Ɯ)" )&*0Ǿ1,"5 %+$"-1&"+1/" ,/!0*,+$/1+"/11"0Ȝ 9.3 2--,/1+!-/,*,1"1%""5 %+$",#2+&.2" 0+!-1&"+1%")1%/" ,/!0 /,00/1+"/11"0#,/ "ƛ" 1&3" /"!")&3"/6+! ,+1&+2&16,# /" 9.4 "3"),-!1"5 %+$"01+!/!0#,/-,/1 &)&16,#%")1%&+02/+ "Ǿ1,02--,/1 )&*02 *&00&,+Ǿ")&$& &)&16 3"/&Ɯ 1&,+Ǿ+!/"&* 2/0"*"+10

PRIORITY ACTIVITIES 9.5 Provide regional guidelines for diagnosis, treatment, and standards of care to facilitate continuity and quality of care across the region

17 THE PATH FORWARD

%"-2/-,0",#1%"01/1"$& -)+&01,ǖȜ&+#,/*&*-)"*"+11&,+-)+0#,/" %4,/(01/"*+!02--,/1 foundational decisions that need to be made for each one, including the selection of appropriate partners, and 2) support resource mobilisation with potential partners and funders. The long-term success of the Digital +&1&1&3"4&))/")6,+1%"3&) &)&16+!02--,/1,#3/&"!/"0,2/ "0ǽ &3"+1%"0 ,-"+!1&*")&+",# this initiative it is understood that mobilising the necessary resources for implementation will be an ongoing +! ,)) ,/1&3"-/, "00ǽ ,,!-/1+"/0%&-/".2&/"0+,-"+*&+!*,+$$,3"/+*"+10Ǿ!"3"),-*"+1 partners, and the private sector alike, and it is in this spirit that resource mobilisation for the Digital REACH +&1&1&3"4&)) " ,+!2 1"!ǽ 1&0"5-" 1"!1, "+&1"/1&3"-/, "00Ǿ1%14&))/".2&/"1%"&!"+1&Ɯ 1&,+,# complementary priorities with potential partners. These materials provide the EAC and Partner States with 1%"*1"/&)01,*, &)&0"1%"/"0,2/ "0+" "00/61,)2+ %1%"&$&1) +&1&1&3"&+"/)6ǗǕǖǞǽ

Strategic Plan Prepare Approval of for Digital REACH Costing Launch Execution Initiative Road- and Map Resources Mobilisation Launch

ǙǗǕǖǜ ǖǗǕǖǝ Ǘ ǘ Ǚ ǖǗǕǖǞ

Engagement with a range of stakeholders is critical for the success of the Digital REACH Initiative. A multi- 01("%,)!"/"+$$"*"+1--/, %4&))"+02/"1%1 /&1& )&+1"/+1&,+)"5-"/1&0"&021&)&0"!+!1%11%" Initiative is structured in a way that ensures sustainability from the start. Priority will be given to partners who /" ,$+&0"1%"&*-,/1+ ",#-211&+$), )"5-"/1&0"11%"#,/"#/,+1+!!!/"00&+$$-0&+1%"/"$&,+1%/,2$% knowledge transfer and capacity building, rather than providing long-term continuous support. %"Ɯ$2/" "),4!"-& 100,*",#1%"460" %0" 1,/ + ,+1/& 21"1,&$&1) +&1&1&3" 1&3&1&"0+! the value they will derive from participation.

CHARACTERISATION OF DIGITAL REACH INITIATIVE PARTICIPATION BY SECTOR

DEVELOPMENT PARTNERS FOR-PROFIT PRIVATE SECTOR REGIONAL AND PARTNER STATE Support in the areas that align with Support in areas that support their GOVERNMENTS their own agenda and goals through business models through direct Support in areas that support direct funding (e.g., grants, local funding (e.g., grants or equity national or regional health agendas or private-sector loss guarantees) investment) and in-kind support through various methods, (e.g., and in-kind support (e.g., technical ț"ǽ$ǽǾ-/,3&0&,+,#&/1&*" 60Ǿ political support, in-kind support assistance, participation in advisory /"!2 "!-/& &+$Ǿ0,ƞ4/")& "+ "0Ǿ technical assistance, participation ,!&"0Ǿ02--,/14&1%!3, 6"ƛ,/10Ȝ participation in PPPs and advisory in advisory bodies, support with bodies) !3, 6"ƛ,/10Ȝ

LOCAL SERVICE PROVIDERS AND CIVIL SOCIETY GROUPS 2--,/1&+/"01%102--,/1(+,4)"!$""5 %+$"1%/,2$% Support in the areas that align with their own agenda in-kind support (e.g., research support, participation in and goals through in-kind support (e.g., technical !3&0,/6 ,!&"0Ǿ02--,/14&1%!3, 6"ƛ,/10Ȝ assistance, participation in advisory bodies, support 4&1%!3, 6"ƛ,/10Ȝ

CONCLUSION /"1"!+!,4+"! 61%"Ǿ1%&0&01%"Ɯ/011&*"+#/& ++&,+"$&,+) ,+,*& ,**2+&16țȜ has come together to create an ambitious and coordinated approach to digital health that is priori-tised for investment by all Presidents of the Partner States. A successful implementation of the Digital REACH Initiative 4&))#2))602--,/11%"ȉ0&+1"$/1&,+$"+!,#Ȋ+"",-)"Ǿ+" ")1%601"*ȋǽ

18 Introduction

igital health is a way of augmenting health services with digital technologies. Technology can strengthen Dhealthcare services by bolstering the access, use, and performance of health services in pursuit of improved %")1%,21 ,*"0ǽ 1 +02--,/1 "11"/%")1% /" 6&*-/,3&+$1%""ƛ& &"+ 6+!"ƛ" 1&3"+"00,#%")1% /" delivery services, creating a more skilled health workforce through targeted and relevant training and capacity building, supporting research through the availability and access to better and higher quality evidence, and improving governance using data to support policies and decision making. Digital technologies can also support health security by helping authorities prevent, track, and respond to health threats, such as infectious diseases and epidemics that can rapidly spread across borders. Currently, the EAC region has a variety of digital health implementations amongst Partner States (Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda) addressing access to health services and improving health ,21 ,*"0#,/ &1&7"+0ǽ /"1!3+ "0/" "&+$*!"Ǿ6"11%"/"/"*+6,--,/12+&1&"01, 1/"$&,+))6Ǿ+!#,/ the EAC to lead and coordinate across Partner States, development partners, and private companies to improve %")1%,21 ,*"0 6&*-)"*"+1&+$0201&+ )"!&$&1)1" %+,),$&"01%1"5-+!1%"460-1&"+100""(.2)&16 care wherever they are in the EAC The Digital Regional East African Community Health (REACH) Initiative is seizing that opportunity. The Initiative provides a foundation for coordinated action. It builds upon collective momentum and understanding to create a regional strategy for digital health which allows the EAC Partner States to: • --)6 /,001%""+1&/"%")1%0" 1,/#,/1%"&*-/,3"*"+1,#%")1%,21 ,*"0+!1%" "+"Ɯ1,#-1&"+10 and the general population, across East Africa • "3"/$""5&01&+$00"10+!01/"+$1%0 /,00 ,2+1/&"0Ǿ)),4&+$/1+"/11"01,1("!3+1$",# advances in other countries for sustainable development • Harmonise standards and policies to support the free movement of services and people, allowing access to and continuity of care across the region • "+"Ɯ1#/,*" ,+,*&"0,#0 )"4&1%/"$/!01,1%"&+3"01*"+1&++!*&+1"++ ",#0%/"!&+#/01/2 12/"Ǿ resources, and applications • Increase bargaining power with third parties like private companies and development partner organisations by negotiating as one and speaking with one regional voice on strategic digital health issues • 5&*&0"!"3"),-*"+1-/1+"/+!-/&31"Ȓ0" 1,/ ,,/!&+1&,++!&+3"01*"+1Ǿ/"!2 &+$2++" "00/6 !2-)& 1&,++!#/$*"+1"!&*-)"*"+11&,+0Ǿ+!*5&*&0&+$1%"&*- 1,#"51"/+)&+3"01*"+1 • Enhance sustainability of health programmes and reduce dependence on development partner funding This strategic plan builds on the &$&1) +&1&1&3",!*-Ǿ4%& %40--/,3"! 61%"0&5%"!0,#011" !2/&+$1%"ǖǚ1%/!&+/6""1&+$,#1%"" 1,/),2+ &),#&+&01"/0,# ")1%#/,*ǖǘ1%1,ǖǜ1%,3"* "/ ǗǕǖǜ&+*-)Ǿ$+!ț0""--"+!&5Ȝǽ 1-/"0"+101%"1"+Ȓ6"/1/1"$& )+#,/&*-)"*"+1&+$1%"&$&1) REACH Initiative and will allow the EAC to pursue the resources necessary to launch the Initiative and plan for #2))Ȓ0 )",-"/1&,+0 6"/)6ǗǕǖǞǽ 1&0#,/4/!Ȓ# &+$!, 2*"+11%1!"0 /& "0$,)0Ǿ("6*&)"01,+"0Ǿ01/1"$& approaches, considerations for implementation, and organising principles for advancing digital health in the EAC. To realise the EAC’s goal of becoming a globally competitive, upper-middle-income region with well-educated +!%")1%6%2*+/"0,2/ "01%1-/,3&!" "001,%")1%0"/3& "0#,/"3"/6 &1&7"+ 6ǗǕǚǕǾ01#/& + governments and their partners must continue to promote and invest in resilient health systems and coordinated digital health programmes. The Digital REACH Initiative Strategic Plan will serve as a blueprint to that future.

WHY DIGITAL HEALTH? As East African leaders develop their vision and strategies for digital health across the region, recognising the transformative potential of digital technology is important. Across sub-Saharan Africa, mobile phone ,4+"/0%&-%00,/"!Ǿ-/,3&!&+$+"43"+2"#,//" %&+$ &1&7"+04&1%0"/3& "0ǽ ,/!&+$1,1%" Ǿ 2+&.2"*, &)"02 0 /& "/-"+"1/1&,+&+1%"/"$&,+/" %"!ǙǙʢ&+ǗǕǖǜ+!&0-/,'" 1"!1,&+ /"0"1,ǚǕʢ 6ǗǕǗǘǽǖ#/& ++1&,+0 ,2)!20"!&$&1)1,,)0+! 1,Ȉ)"-#/,$ȉ)"$ 60601"*0+!*5&*&0""ƛ& &"+ 6Ǿ impact, and accessibility. East Africa is already a recognised leader in demonstrating this potential, with digital

19 &++,31&,+0)&("1%"*"0*, &)"*,+"60601"* %&"3&+$02 "00&+&+ /"0&+$-",-)"ȉ0 "001,Ɯ++ &) 0"/3& "0ǽ ,3"/+*"+10&+1%"/"$&,++!,/$+&01&,+002 %01%" /"0""(&+$1,)"3"/$"1%"-,4"/,# digital technology through initiatives like Transform Africa. )1%,2$%1%"/"/"&+%"/"+1!&ƛ"/"+ "0&+1%"%")1%0" 1,/Ǿ"0-" &))60&1/")1"01,1%" ,*-)"5&16,#1%" " ,0601"*+!&002"0/")1"!1,!1-/&3 6+! ,+Ɯ!"+1&)&16Ǿ!&$&1)%")1%0,)21&,+0+,+"1%")"00%3" the potential to revolutionise service delivery and access to information. In Africa and other developing regions, digital health solutions deployed over the last decade have demonstrated promising results in patient "%3&,/+!%")1%0601"*#2+ 1&,+&+$ǽ ,/"5*-)"Ǿ+1&,+4&!"-/,$/**" ))"!,*,++" 1&+,21% #/& 1%10"+!0&+#,/*1&,+1,"5-" 1&+$*,1%"/0%0/" %"!,3"/*&))&,+4,*"+Ǿ4&1%"/)6/"02)10 0%,4&+$1%1"+/,))"!*,1%"/04%,/" -,0&1&3"%3"%&$%"//1"0,#+1"+1)3&0&111"+!+ "1%+1%,0" who do not.21%"/0,)21&,+0%3"&*-/,3"!-1&"+1 "001,1")"*"!& &+"Ȓ 0"!0"/3& "0ț0&+"+63 ) and %")1%4,/("/0ȉ &)&161,1/ (02--)&"0,#*"!& 1&,++!,1%"/ ,**,!&1&"0ț#,/"5*-)"Ǿ&++7+&4 ). In *+6 0"0Ǿ0,)21&,+0 +!!/"00!"Ɯ &10&+),4+!*&!!)"Ȓ&+ ,*" ,2+1/6ț Ȝ%")1%0601"*0Ǿ&+ )2!&+$ shortages of trained workforces and poor health infrastructure. Although a stronger evidence base for the long-term impact of digital health is needed, these initial indicators 2&)!1%" 0"#,/&+3"01*"+1 6$,3"/+*"+10Ǿ!"3"),-*"+1-/1+"/0Ǿ+!,1%"/" ,0601"* 1,/0ǽ"1)"00,+0 from these implementations underscore the fact that obtaining a return on these investments requires strengthening the ecosystem in which solutions operate. Digital solutions that provide real-time decision 02--,/10"/3& "0#,/%")1%4,/("/011%"-,&+1,# /"Ǿ#,/"5*-)"Ǿ*6 ")"00"ƛ" 1&3"&#!1+"14,/(0 /"+,1#2+ 1&,+&+$ǽ%"0"3"+ ,*-,+"+10,#1%" Ȓ " ")1%,,)(&1ǚ , which include areas such as a country’s policy environment and physical infrastructure, provide a blueprint for political and digital health leaders to create an enabling environment in which digital health can thrive. &3"+1%"&*-,/1+ ",#1%"0"")"*"+10+!1%"0 )",#1%"&+3"01*"+1+""!"!&+1%"*Ǿ1%" +-)6 -,0&1&3"/,)"&+!3+ &+$!&$&1)%")1%&+1%"/"$&,+ǽ /,*"+ ,2/$&+$%/*,+&01&,+,#01+!/!01,1%" development of shared infrastructure and the deployment of regional solutions, cooperation by Partner States &+1%"&$&1) +&1&1&3" +%")--/,*&0&+$0,)21&,+03,&!1%"-&1#))0"5-"/&"+ "!")0"4%"/"Ȕ4%&)" %/+"00&+$1%"/"0,2/ "0+!"5-"/&"+ "+" "00/6#,/0 )"ǽ

Supporting the successful implementation of digital health programmes is an enabling environment that incorporates: leadership and political buy-in; strategy and investment; a health workforce; legislation; policy and compliance; and harmonised standards and interoperability. These environmental enablers help to ensure sustainability and scale. They can also facilitate the entry of parties like the private sector and development partners, in the provision of digital health systems and services, in a sustainable manner. +",#1%"*',//,)"01%"&$&1) +&1&1&3"4&))-)6&+1%"/"$&,+&01, /"1"+!02--,/11%""+ )&+$ environment for digital health. While it is possible for an individual country to create its own enabling "+3&/,+*"+1Ǿ1%"/"/"0&$+&Ɯ +1 "+"Ɯ101,!!/"00&+$1%"0" ,*-,+"+10&+4%,)",/&+-/111%"/"$&,+) ,/"3"+$), ))"3")ǽ +#/01/2 12/"+!0"/3& " ,*-,+"+10Ȕ02 %0!1 ),2!0Ǿ1/&+&+$-/,$/**"0Ǿ +!%")1%&+#,/*1&,+0601"*0Ȕ + "!"3"),-"!Ǿ/"Ɯ+"!Ǿ+!20"! /,00*2)1&-)"$",$/-%&"0Ǿ resulting in economies of scale and better-quality components. Additionally, the creation and application of internationally agreed-upon standards and policies enables cross-country health programming across the /"$&,+1%1&0,1%"/4&0"!&ƛ& 2)11, %&"3" 6" %/1+"/11"&+!"-"+!"+1)6ǽ

1KWWSVZZZJVPDLQWHOOLJHQFHFRPUHVHDUFK"¿OH FHIEGIGFHE GRZQORDG http://www.health.gov.za/index.php/mom-connect KWWSVZZZLWXLQWQHWZVLVVWRFNWDNLQJSURMHFWV3URMHFW'HWDLOV"SURMHFW,G KWWSVZZZMVLFRP-6,,QWHUQHW5HVXOWVDUWLFOHGLVSOD\FIP"W[W*HR$UHD ,17/ LG WKLV6HFWLRQ 5HVXOWV F- WLG QD FLG QD WLG KWWSVZZZLWXLQWGPVBSXELWXGRSEVWU'675(B+($/7+3')(SGI

20 Ȓ +&*-,/1+1!&*"+0&,++! "+"Ɯ1,# /"1&+$+"+ )&+$"+3&/,+*"+1#,/!&$&1)%")1%&+1%"&0 01&*2)1&+$-/&31"Ȓ0" 1,/&+3"01*"+1ǽ%"-/&31"0" 1,/ +-)6+&*-,/1+1/,)"&+!!/"00&+$ ,*-)"5Ǿ systemic challenges that the public sector may be ill-suited to solve. It can also support the move towards the Ɯ++ &)Ǿ,-"/1&,+)Ǿ+!1" %+& )0201&+ &)&16,#1%"&$&1) +&1&1&3"+!&10-/,$/**"0ǽ Tackling issues such as policies and infrastructure and making a clear business case for partnerships and &+3"01*"+1 +%")- /&+$1%"&+Ɲ2"+ "+!01/"+$1%,#1%"-/&31"0" 1,/1, "/,+!&$&1)%")1%ǽ/1,#1%" Digital REACH Initiative strategy is to create an ecosystem that is attractive to large companies as well as small, local entrepreneurs so that digital health can grow as an industry. The Digital REACH Initiative will stimulate private sector investment in two ways: • By directly engaging and partnering with the private sector to implement key workstream activities • By creating an enabling environment that will attract and stimulate more investment in the region

VALUE OF A REGIONAL APPROACH TO DIGITAL HEALTH ,,/!&+1&+$!&$&1)%")1% 1&3&1&"0+!-/,$/**"0&+1%"4&1%4"))Ȓ-)++"!Ǿ&+1"+1&,+)"ƛ,/104&)) &*-/,3"1%".2)&16,#%")1%Ȓ0"/3& "!")&3"/64&1%&++! /,001%"/"$&,+Ǿ+! /"1" "+"Ɯ10+!" ,+,*&"0 of scale that cannot be achieved by any one country alone. A robust, region-wide enabling environment will )),4/1+"/11"01,!")&3"/%")1%0"/3& "01%1/"*,/""ƛ" 1&3"1%+ ,2+1/6Ȓ0-" &Ɯ %")1%&+&1&1&3"0Ǿ &*-/,3&+$-1&"+10ȉ"5-"/&"+ "0+!,21 ,*"0ǽ5*-)"0,#1%&0/"!"1&)"!&+ &$2/"ǖ "),4ǽ A regional approach allows for economies of scale, improved services, shared engineering capacity, and ),4"/02--,/1 ,010ǽ ,/"5*-)"Ǿ 2&)!&+$Ǿ*&+1&+&+$Ǿ+!$,3"/+&+$0%/"!0"/3& "0 ),2!1%1)),40 *2)1&-)" ,2+1/&"01,20"1%"0*"0,ƞ4/"+!02--,/14,2)!"+ )"" %/1+"/11"1,0%/""5-"/1&0" +! /&1& )!1ǽ 14,2)! /"1")/$"Ȓ0 )""ƛ& &"+ &"0#,/1%"/"$&,+Ǿ/"!2 &+$ ,010#,/1%"!"-),6*"+1+! maintenance of digital health systems. Coordinated and shared digitised systems also enable capabilities such as real-time disease surveillance, regional health records management, and access to insurance coverage. Regionally-aligned policies and data standards can advance interoperability of systems, which will facilitate the movement of medical data with a moving population. This can strengthen the health security and prosperity of the EAC and advance Partner State strategies and plans.

&$2/"ǖǿ)2",#"$&,+)--/, %1,&$&1) ")1%&+01#/&

/"$&,+)--/, %1,!&$&1) ȁ4%&)"/"!2 &+$1%" ,010,# ȁ+!)"!&+$1,#01"/+! %")1%&*-/,3"0%")1% "00+! !&$&1)0,)21&,+01," %/1+"/ "11"/&*-)"*"+11&,+&+)) ,21 ,*"011%"+1&,+))"3") State ,2+1/&"0 ")1% /"ǿ Supports ability of EAC citizens %/"! "01-/ 1& "0ǿ Establishes a 3&!"+ " 0"ǿ "+"/1"001/,+$"/ to access care anywhere, encouraging the free community of practice that allows for sharing evidence base for cost savings associated movement of people by increasing access to ,# "01-/ 1& "0+!), )"5-"/10 /,001%" with international health and allows for the health services and continuity of care across region development of evidence-based healthcare the region ,010ǿ Reduces the costs for deployment and delivery strategies to be implemented for %/"!!1ǿ Enhances ability to share *&+1"++ ",# ,2+1/6Ȓ0-" &Ɯ !&$&1)%")1% target health priorities public heath data across countries to support systems through shared hosting and use of ")1%/"0"/ %ǿ Supports health research continuity of care and surveillance of disease common digital global goods in the region &+1%"/"$&,+ 6"5-+!&+$1%",--,/12+&16 threats with appropriate access, privacy, and ,*-"1&1&3"!3+1$"ǿ Increases bargaining for monitoring of trends across the entire ,+Ɯ!"+1&)&16 ,+1/,)0 power for Partner States to negotiate EAC, creating the opportunity to use evidence 2/3"&))+ "+!%")1%0" 2/&16ǿ5-+!0 changes and enhancements with suppliers, 1,!"0&$+1/$"1"!+!"ƛ" 1&3"/"$&,+) surveillance capabilities and access to and international partners, and service providers implementations use of data for regional and national decision ƛ& &"+ &"0ǿ Creates opportunity for skilled "$&,+)%")1%-/,$/"00ǿ Accelerates health making to improve health security in the resources to be shared and utilised across implementation progress at the Partner State region the region and for model agreements and and regional level, enabling the EAC region to approaches that can be replicated in Partner position itself as a new leader in digital health States implementation

21 A Call to Action: Supporting Digital REACH and Why It Matters Now

The distinction between digital health and the broader health system is growing smaller by the year.

CT adoption amongst all health stakeholders from patients to health ministers — has occurred so quickly Iand thoroughly that the term digital health is losing its novelty. This signals its maturity and the need for coordination across the ecosystem, moving away from a fragmented approach to digital health — characterised by siloed applications, waste, and variable data — to a holistic digital health model with coordinated investments and common assets leveraged across multiple health programmes. Strong )"!"/0%&-+!$,3"/++ " +-/,-")1%&0*,!")1,/")&16Ǿ-/"3"+1&+$!2-)& 1&,+,#"ƛ,/1 /,001%" /"$&,++!$"+"/1&+$)/$"Ȓ0 )" ,01"ƛ& &"+ &"0Ǿ&*-/,3"!%")1%,21 ,*"0Ǿ+!#01"/+! "11"/%")1% programme implementations. The purpose of the Digital REACH Initiative is to harness this opportunity for digital health technologies through coordinated regional action. /"1"!+!,4+"! 61%"1%/,2$%1%" Ǿ1%&0&01%"Ɯ/011&*"+#/& ++&,+/"$&,+%0 ,*" together to create an ambitious and coordinated approach to digital health that is prioritised for investment by all Presidents of the EAC Partner States.

PATH TO IMPLEMENTATION

This Strategic Plan is an important step towards coordinated regional action in digital health. The Digital REACH Initiative Strategic Plan provides a common regional vision and strategic approach that is aligned with country -)+0ǽ 1)0, /"1"0-)1#,/*#,/1%"*, &)&01&,+,#/"0,2/ "0#,/1%"0-" &Ɯ &*-)"*"+11&,+ 1&3&1&"0,21)&+"! in this document. %"Ɯ$2/" "),40%,401%"1&*")&+"#,/1%"!"3"),-*"+1,#1%&01/1"$& )++! ,01&+$-)+4%& %4&))-,0&1&,+ the EAC and Partner States to mobilise funding necessary to launch the Digital REACH Initiative, plan for full-scale ,-"/1&,+0Ǿ+!*,3".2& ()6&+1,&*-)"*"+11&,+*,!"01/1&+$&+"/)6ǗǕǖǞǽ

Strategic Plan Prepare Approval of for Digital REACH Costing Launch Execution Initiative Road- and Map Resources Mobilisation Launch

ǙǗǕǖǜ ǖǗǕǖǝ Ǘ ǘ Ǚ ǖǗǕǖǞ

22 The Digital REACH Initiative

DIGITAL REACH INITIATIVE VISION AND MISSION STATEMENTS

he free movement of people, services, and goods across the EAC relies on a healthy population. Through Tdigital technologies and political will, the region can realise seamless access to improved healthcare services for all EAC citizens, enhanced surveillance of diseases, real-time response to health security threats such as disease outbreaks, and market-driven distribution of the health workforce to achieve a healthy and wealthy East Africa. Additionally, the regional implementation of digital health infrastructure and other enabling components that can be shared by Partner States in their country-level strategies will create "ƛ& &"+ &"0+! - &)&1&"01%14,2)!+,1 " %&"3"!,1%"/4&0"ǽ This section lays out the goals, key milestones, strategic approaches, considerations for implementation, +!,/$+&0&+$-/&+ &-)"0#,/!3+ &+$!&$&1)%")1%&+1%"ǽ 1,ƛ"/0*2)1&!&*"+0&,+)Ǿ%,)&01& 3&"4,# how the region can move forward with digital health by laying out key roles and responsibilities for the region and for EAC Partner States. It also describes key approaches for how this Strategic Plan can be implemented through the Digital REACH Initiative. The Digital REACH Initiative is guided by the following vision and mission:

&$2/"Ǘǿ&$&1) +&1&1&3"&0&,++!&00&,+

U0"/0,#1%&01/1"$& )+ 1ƛ+!)++&+$/1+"/0 4&))20"1%&01/1"$& )+1,#2/1%"/!"Ɯ+",3"/))/"$&,+)+""!0+! - &1&"0Ǿ*("!" &0&,+0,+/"$&,+)-/&,/&1&"0Ǿ +!!"3"),- 1&,+ )"&*-)"*"+11&,+-)+0ǽ%"64&)))0,20"1%&01/1"$& )+1,0" 2/"Ɯ++ &)02--,/1#,/1%" set up and implementation of the Digital REACH Initiative. /1+"/11"0 will use this Strategic Plan to identify their role in supporting the Digital REACH Initiative, including any human resources and other assets that can support the Initiative. "3"),-*"+1/1+"/0 will use this Strategic Plan and costing plan to identify opportunities to mobilise and provide support. /&31"" 1,/ will use this Strategic Plan and costing plan to identify opportunities for investment and partnerships. +&1&1&3"1ƛ will use this Strategic Plan as a reference guide to set up and manage the Initiative and its workstreams and to develop implementations plans that work in concert towards common goals.

23 DIGITAL REACH INITIATIVE OUTCOME GOALS %"0-" &Ɯ ,21 ,*"$,)0,#1%"&$&1) +&1&1&3"/")&01"! "),4ǽ%"0"%3" ""+&!"+1&Ɯ"! 6 /1+"/11"/"-/"0"+11&3"01%/,2$%0"/&"0,#/"$&,+)4,/(0%,-0&+ǗǕǖǜ+!ǗǕǖǝǽ

&$2/"ǘǿ21 ,*" ,)0,#1%"&$&1) +&1&1&3"

-1&*&0"1%"/"3"+1&,+Ǿ&$+,0&0Ǿ+! 2--,/1+&3"/0) "001, ")1% /" /"1*"+1,#/&,/&16 ")1%,+!&1&,+0 • Enhance regional social health protection (e.g., ș *-/,3"1%".2)&16+!"ƛ& &"+ 6,# /" /,00 through the portability of health insurance) countries through clear and monitorable harmonised guidelines and protocols, and regional collaboration • Improve access and continuity of care across countries by ensuring the patients and their histories remain at the centre of care regardless of their location

*-/,3" ")1%,/("/!2 1&,++!/&+&+$ *-/,3"&0"0"2/3"&))+ "+!"0-,+0" • Support standardised and recognised healthcare • Strengthen regional health security by building training and capacity building across the region - &16#,/"ƛ" 1&3"!"1" 1&,+Ǿ-/"3"+1&,+Ǿ+! for pre and in-service health workers response to health threats (e.g., disease emergencies, outbreaks) • Improve continuous disease surveillance across the region and in cross-border areas

*-/,3"2--)6%&+ƛ& &"+ 6 -1&*&0" 2*+"0,2/ ")), 1&,+ ș *-/,3"02--)6 %&+"ƛ& &"+ 6 61(&+$!3+- +!+$"*"+1 tage of economies of scale when negotiating with ș &)&11"%")1%4,/("/(+,4)"!$"0%/&+$ /,00 suppliers and vendors the region • Support harmonised health worker education in ways that enable mobilisation across the region

+ +%+ "2 )& ")1%!2 1&,++!4/"- ,+&1,/,-2)1&,+ ")1%1120 +"00 • Track regional priority health indicators to • Improve community health-related knowledge support the creation of evidence-backed health and patient education across the region through policies collaboration • Support health research and use of evidence to promote the regional health agenda

Success against these goals will be measured by the regional nature of the outcomes. The illustration on the +"51-$"!"-& 101%"* &1&,203&0&,+1%"&$&1) +&1&1&3"4&))01/&3"1, %&"3"1,&*-/,3"1%"-1&"+1 "5-"/&"+ " /,001%"1%/,2$%1%" ,3",21 ,*"$,)0ǽ

24 IMPROVING HEALTHCARE THROUGH THE DIGITAL REACH INITIATIVE

ONSET OF SYMPTOMS: Mary feels unwell while traveling in Kenya. She decides to visit a She visits a local health facility and is registered. local health facility... Patient is able to access treatment in another Partner State Patient remembers SMS and is able to pay campaign explaining for it because of a similar and encouraging region EAC insurance presentation at clinic. product.

/6&01/&$"! 0"!,+06*-1,*0,/3&) &)&16,#01ƛǽ She is seen by a doctor at the clinic.

Doctor accesses patient Health worker reviews information using standard regional task a regional health shifting protocols to platform. identify appropriate level of care.

Mary is diagnosed with a regional priority disease that cannot be treated at this facility. She is referred to a hospital that can treat her. Health worker shares necessary data with referral hospital in a different Partner State; Health workers in the other Health workers access treatment Partner State have received the and diagnosis tools to support same training and are aware of diagnosis and confirms necessary protocols. regional treatment protocols electronically; If diagnosis is a priority disease area health worker follows regional protocols and guidelines to share information with other Partner States.

She is treated and discharged with medication or a prescription Mary goes back home to Tanzania and follows the instructed treatment regimen

Patient visit hospital in their own Partner State where telemedicine is used for a local specialist to consult with a specialist Health worker conducts real- in another Partner State; time treatment compliance Medication is affordable and monitoring using electronic available. pillboxes and reminds patient to take medication by SMS if any missed; If patient travels prescriptions are recognized in other Partner States.

She travels to her local health facility for follow up actions related to her treatment Mary is cured and goes home. Outcomes of her treatment are documented.

Health outcomes are documented and help to inform research and Patient can visit hospital in the development of other Partner State to manage evidence-based health condition. Relevant data like policy; Researchers antibiotic resistance is recorded gather insights using and reported to the region and data stored in the Partner States. EAOSCH and utilise for research.

OPTIMISE THE DIAGNOSIS AND TREATMENT OF PRIORITY IMPROVE HEALTH WORKER EDUCATION AND TRAINING INCREASE SURVEILLANCE AND IMPROVE RESPONSE ENHANCE PUBLIC HEALTH EDUCATION AND AWARENESS KEY HEALTH CONDITIONS GUARANTEE UNIVERSAL ACCESS TO QUALITY HEALTH CARE OPTIMISE RESOURCE ALLOCATION AND MANAGEMENT IMPROVE SUPPLY CHAIN MANAGEMENT IMPROVE POPULATION HEALTH STATUS

25 Digital REACH and Partner States

EAST AFRICAN SITUATION ANALYSIS AND IMPLICATIONS FOR DIGITAL REACH cross the EAC region the health strategic plans of Partner States demonstrate commitment to universal Ahealth coverage as a cornerstone of national and regional development. An overview of the current status ,#!&$&1)%")1%&+1%"/"$&,+&+!& 1"04")1%,#"5&01&+$00"101%102--,/1 ,,/!&+1"!--/, %ǽ %"/"/"0"3"/)!&$&1)%")1%00"10 /,00/1+"/11"01%1 + ")"3"/$"!1,"5-+!!&$&1)%")1% 1%/,2$%,211%"/"$&,+02 %0/"$&,+)02/3"&))+ "&+&1&1&3"0ț"ǽ$ǽǾ "1ȜǾ0601"*0ț ǗǾ-"+Ǿ 1&,+) 0"/31,/&"0ȜǾ/1+"/11" ,**&1*"+10ț"ǽ$ǽǾ +!+"Ȓ ")1%Ȝ+!+1&,+)00"10ț"ǽ$ǽǾ developed policies, insurance products). Partner States have also reported similar challenges, such as the ) (,#!&$&1)%")1%"5-"/1&0"Ǿ)&*&1"!&+#/01/2 12/"Ǿ2+/")& )" ,++" 1&3&16Ǿ+!#/$*"+1"!" ")1% initiatives with multiple development partners and misaligned time frames, which all present opportunities for coordinated regional action. There are, however, distinctions between EAC Partner States which could pose a challenge to regional ,)) ,/1&,+ǽ/1+"/11"0/"1!&ƛ"/"+101$"0,#!"3"),-*"+14&1%/"$/!01,1%"&/!&$&1)%")1% strategy and implementation, and clear governance structures for coordinating digital health have not been established in all countries. These distinctions create an opportunity for Partner States to share lessons, information, and reusable assets to close gaps across the region. %" 2//"+101120,#!&$&1)%")1%#,/" %/1+"/11" + "#,2+!&+--"+!&5ǽ+ ")2+ %"!Ǿ " %4,/(01/"*4&)) ,+!2 1 0")&+"00"00*"+1,#"5&01&+$00"10&+" %/1+"/11"ǽ,/(&+$4&1% Ministries responsible for health and ICT, national research institutes, and other relevant national bodies, the Digital REACH Initiative will identify key assets to be leveraged for each workstream.

ROLE OF PARTNER STATES IN DIGITAL REACH

• %/" &+#,/*1&,+,+"5&01&+$00"10+! ș /,4+!!"3"),-)/$"/-,,),#), )1" %+& ) implementations "5-"/1&0"1%102--,/10" ,+,*& !&3"/0&Ɯ 1&,+ • Agree on common approach to protocols, policies, beyond the health sector, as countries outside of the standards, and other assets 0""(1, "00!&$&1)%")1%"5-"/1&0" • 2--,/1 regional implementations ș"+"Ɯ1#/,*1%"!"3"),-*"+1,#$,)!01+!/!00"10 that support an improved digital health environment • !,-1 common protocols, policies, and without having to develop individual assets in each development of standards country • *-)"*"+1+!20" assets created with support • Realise cost savings through economies of scale and the from the region sharing of digital health resources across the region • /,3&!" feedback on assets created and • Receive direct technical assistance for digital health implementations to build evidence base through the Technical Assistance health programme • /1& &-1"&+&$&1) 0 ș2--,/1+1&,+)"ƛ,/101,4/!011&+&+$2+&3"/0) %")1% ,3"/$" 6 "+"Ɯ1&+$#/,*&*-/,3"!%")1% /" services in the region • Receive guidance on the design and implementation of digital health solutions and the appropriate governance structures that support them

26 Strategic Alignment with EAC and Partner States

This strategic plan builds on the Digital REACH Initiative Roadmap, which 40--/,3"! 61%"0&5%"!0,#011"!2/&+$1%",2+ &),#&+&01"/0&+ ,3"* "/ǗǕǖǜǽ 1&0#2))6)&$+"!4&1%1%"01#/& +%")1%&+3"01*"+1 priorities and serves as a complement to individual Partner State health strategies.

ALIGNMENT WITH EAC HEALTH PRIORITIES ƞ"/0"/&"0,#01/1"$& -)++&+$!&0 200&,+0Ǿ1%"/1+"/11"0,ƛ& &))6/" ,**"+!"!,+ǗǗ+! " /2/6ǗǕǖǝ&+*-)Ǿ$+!1%11%"/"$&,+țǖȜharness the potential of digital technology to address current and emerging health threats through stronger health management information systems, capacity building, diagnostics, and treatment; (2) establish stronger partnerships with the private sector, including in /"0,#), )*+2# 12/&+$,#%")1%-/,!2 10Ǿ1%/,2$%"ƛ" 1&3"&+ "+1&3"002 %0ƛ,/! )"Ɯ++ &+$+! enabling legal frameworks; and (3) facilitate meaningful engagement of key stakeholders. To achieve this, 1%"#,)),4&+$%")1%Ȓ0" 1,/-/&,/&1&"0#,/1%"01#/& /"$&,+%3" ""+--/,3"! 6))0&5%"!0,#011" ƞ"/ "&+$-/"0"+1"!1,1%"%&/,#1%",2+ &),#&+&01"/0,# ")1%ǿ ǖǽ5-+0&,+,# "001,0-" &)&0"!%")1% /"+! /,00Ȓ ,/!"/%")1%0"/3& "0 2. Strengthen the network of medical reference laboratories and the regional rapid response mechanism to protect the region from health security threats including pandemics, bio- terrorism, and common agents ǘǽ5-+0&,+,# - &161,-/,!2 "0(&))"!+!-/,#"00&,+)4,/(#,/ "#,/%")1%&+1%"/"$&,+ 0"!,+ harmonised regional training and practice standards and guidelines Ǚǽ + /"0" "001,0#"Ǿ"ƛ& &,20Ǿ+!ƛ,/! )"*"!& &+"0Ǿ3 &+"0Ǿ+!,1%"/%")1%1" %+,),$&"0 #, 20&+$,+-/"3)"+1!&0"0"002 %0*)/&ǾǾ ȡ +!,1%"/%&$% 2/!"+ ,+!&1&,+0 ǚǽ-$/!&+$,#%")1%&+#/01/2 12/"+!".2&-*"+1&+-/&,/&16+1&,+)+!02 +1&,+)%")1%# &)&1&"0+! hospitals Ǜǽ01 )&0%*"+1,#01/,+$-/&*/6+! ,**2+&16%")1%0"/3& "00 0&0#,/%")1%-/,*,1&,++! diseases prevention and control ǜǽ5-+0&,+,#%")1%&+02/+ " ,3"/$"+!0, &)%")1%-/,1" 1&,+ ǝǽ *-/,3"*"+1,#.2)&16,#%")1% /"Ǿ%")1%0" 1,/"ƛ& &"+ 6Ǿ+!%")1%011&01& 0

Ǟǽ1/"+$1%"+&+$,#%")1%/"0"/ %+!!"3"),-*"+1 ǽ2 -/&,/&16Ǟǽǖǿ01 )&0%+"$&,+) ")1%"0"/ %+!"3"),-*"+1 &)&11&,+ Mechanism ǽ2 -/&,/&16ǞǽǗǿ01 )&0%+"$&,+) 0"/31,/6,+%")1%/"0"/ %+!!"3"),-*"+1 c. 2 -/&,/&16Ǟǽǘǿ +3"01*"+1&+! &$&1)%")1%1" %+,),$6#,/ "11"//"0"/ %#,/%")1%Ǿ %")1%0"/3& "0!")&3"/6Ǿ+!%")1%,21 ,*"0

,/1%"ƛ& &)""1&+$"-,/10,#1%"ǖǚ1%" 1,/),2+ &),1%"ǘǚ1%51/Ȓ/!&+/6""1&+$,#1%",2+ &) ,#&+01"/0Ǿ and the 17th Sectoral Council--/,3&+$1%"&$&1) +&1&1&3",!*-+!Strategic Plan-)"0"0""--"+!&5ǽ

)),#1%"&$&1) +&1&1&3"ȉ0,21 ,*"$,)0!&/" 1)6,/&+!&/" 1)602--,/11%" ,3"/" ,**"+!1&,+0+!-/&,/&1&"0ǽ ,/*--&+$,#1%"%")1%-/&,/&1&"0+!02 Ȓ-/&,/&1&"01,&$&1) +&1&1&3",21 ,*"$,)0Ǿ-)"0"0""--"+!&5ǽ

27 ALIGNMENT WITH PARTNER STATE PRIORITIES

Partner States have been heavily involved in the conceptualisation and creation of the Digital REACH Initiative Roadmap and this Strategic Plan.

+/ %ǗǕǖǜǾ1%" -/"0"+1"!1%" ,**&00&,+"/04&1% ,+ "-1+,1""+1&1)"!Towards a shared commitment to improve health outcomes through digital technology. The EAHRC Commissioners, and later the " 1,/),2+ &),#&+&01"/0,# ")1%+!1%" 2)),2+ &)Ǿ--/,3"!1%" ,+ "-1ǽ ,)),4&+$1%&0Ǿ the EAHRC organised the Regional East Africa Digital Health Roadmap Conference in Kampala, Uganda in "-1"* "/ǗǕǖǜǾ4%"/",3"/ǖǕǕ("601("%,)!"/0#/,* /,0001#/& *"1+!/".2"01"!1%11%"/"$&,+ take on a larger role in creating an enabling environment for digital health. During this meeting, stakeholders &!"+1&Ɯ"!0-" &Ɯ /"0-,+0& &)&1&"0#,/1%"/"$&,+1%14,2)! ,*-)"*"+1+!02--,/1/1+"/11"01/1"$&"0 &+%")1%ǽ%&040#,)),4"! 64,/(0%,-0&+/"0)*Ǿ+7+&+!+1" "Ǿ$+!1,#2/1%"//"Ɯ+" and socialise the roadmap with Partner State stakeholders. The EAC Sectoral Council of Ministers of Health --/,3"!1%"&$&1) +&1&1&3",!*-11%"ǖǚ1%/!&+/6""1&+$,#1%"" 1,/),2+ &) ,#&+&01"/0,# ")1%1%11,,(-) "#/,*ǖǘ1%1,ǖǜ1%,3"* "/ǗǕǖǜ&+*-)Ǿ$+!ǽ%" was directed to continue its work by developing the Strategic Plan for implementation of the Digital REACH Initiative. %&01/1"$& )+0"/3"00#2/1%"//"Ɯ+"*"+1,#&$&1) ȉ0 1&3&1&"0ǽƛ& &)0#/,*/1+"/11"0 3"11"!1%"-)+Ǿ ,+Ɯ/*"!1%1&140&+)&$+*"+14&1%" %,#1%"&/-/&,/&1&"0Ǿ+!-/,3&!"!!"1&)"! #""! (!2/&+$Ɯ3"Ȓ!64,/(0%,-&+ 2+"ǗǕǖǝ%,01"! 61%" &+/20%Ǿ+7+&ǽ%&040#,)),4"! by a series of in-country meetings with key health, education, ICT, and academic stakeholders across each of 1%"/1+"/11"0&+ 2)6+!2$201ǗǕǖǝǽ A full list of the individuals who contributed to the Digital REACH Initiative Roadmap and Strategic Plan can be #,2+!&+--"+!&5ǽ

VALUES AND STRATEGIC PRINCIPLES OF THE DIGITAL REACH INITIATIVE The Digital REACH Initiative will operate in accordance with the strategic principles laid out below and adhere 1,1%"/&+ &-)"0#,/&$&1)"3"),-*"+1Ǿ4,/(&+$1%/,2$%"5&01&+$$), )+!/"$&,+)"ƛ,/104%"/"-,00& )"ǽ These principles will be at the core of how each workstream is set up and run.

&$2/"Ǚǿ)2"0+!1/1"$& /&+ &-)"0#,/&$&1) +&1&1&3"

ǖǽ+$"/"$&,+))6+! ,++" 1$), ))6 Ǘǽ"3"/$""5&01&+$00"104%"/"-,00& )" Conduct coordination and management with local Build on what is working and avoid creating unnecessary hubs across the EAC. Regional management will also new assets or silos. Leverage innovations, best practices, " ,++" 1"!4&1%$), )/"0,2/ "01,)"3"/$""5&01&+$ and investment made into other initiatives (e.g., RAD and &+1"/+1&,+)"5-"/1&0"Ǿ4%"/"--/,-/&1"ǽ &$&1).2/"Ȝ+!"+$$"4&1%/"$&,+)"5-"/10+! /1+"/11"01%/,2$% 01,0%/")"00,+0+!21&)&0" "5&01&+$00"10Ǿ4%"/"-,00& )"ǽ

ǘǽ+02/"*2)1&!&0 &-)&+/6+!$"+!"/Ȓ&+ )20&3" Ǚǽ/"1"*" %+&0*0#,/#""! ( --/, % + ,/-,/1"+"4+!"5-"/13,& "020&+$/1+"/11" Practice gender inclusivity and multidisciplinarity in every and international technical advisers and consultative dimension of the Initiative, based on support from key /1+"/11" 0 /,001%" +&1&1&3"ǽ ministries and digital health partners in all Partner States, 04"))0), )+!&+1"/+1&,+)%")1%+! "5-"/10ǽ

28 ǚǽ"-1&"+1Ȓ "+1/& +!"3&!"+ "Ȓ!/&3"+ Ǜǽ2/02"-/1+"/0%&-0+!Ɯ++ &+$ Adopt an implementation-science approach by using +$"+!-2/02"01/1"$& -/1+"/0%&-0+!Ɯ++ &+$ evidence generated by the Initiative to drive decision throughout the life of the Initiative through involvement making and the health implementation agenda in ways of government, development partners, and the private that improve on-the-ground health-service delivery. sector.

ǜǽ2&)!#,/0 )"+!0201&+ &)&16 ǝǽ , 20,+/"$&,+)3)2" Build and implement for scale and sustainability from the Maintain focus across the Initiative on the unique value very beginning and in every dimension of the Initiative so of a regional approach to digital health. This should be that relevant infrastructure and assets can remain in place done primarily through each workstream strategy and and be improved and adapted in the long term. activities.

Ǟǽ+02/"1" %+,),$60,)21&,+0/"Ɲ"5& )"+! + " ǖǕǽ 2/+1""/"$&,+),4+"/0%&-Ǿ!1-/,1" 1&,+Ǿ ), ))6*+$"! +!-/&3 6 -"/1&,+0+!02--,/1,#1" %+,),$620"!#,/1%" Develop a clear plan and associated legal frameworks +&1&1&3"0%,2)!+,1 " ,2+!1,0-" &Ɯ 3"+!,/0)),4&+$ to ensure data generated is owned by the region, that professional services to be obtained from multiple individual privacy is respected, and that health data is -/1+"/01, "0102&11%"&+!&3&!2) ,+1"51+!-/"3"+1 protected. vendor lock-in.

,1",+1" 2/&16+!/&3 6 &$&1)%")1%!1&0"5-,0"!1,%&$%0" 2/&16/&0(+!&10-/,1" 1&,+&0%&$%-/&,/&16#,/1%"&$&1) Initiative. It is of the utmost importance that data that is generated by or shared with Digital REACH "01,/"!0#")6+!0" 2/")6ǽ%&04&))/".2&/"%/!4/"Ǿ0,ƞ4/"Ǿ+!/"$2)1,/6*" %+&0*01%1 protect against unauthorised access, use, or disclosure of sensitive health data. The following are a list of considerations that the Digital REACH Initiative will integrate into all of its activities, through the creation of associated policies, data standards, and the design and build of infrastructure and digital solutions, to safeguard health data privacy and security. ǖǽ/,3&!"0" 2/"&!"+1&16*+$"*"+10"/3& "0+!21%"+1& 1&,+*" %+&0*0&+ )2!&+$20",#*2)1&Ȓ factor authentication and secure web portals 2. Provide variable user access roles for sensitive data (e.g., user roles, location, sensitivity of data, consent -,)& &"0Ǿ"5-&/1&,+-"/&,!0#,/ "00Ȝ ǘǽ0"&+!201/601+!/!"+ /6-1&,+)$,/&1%*0țȒǗǚǛȜǾ1/"01+!&+*,1&,+ 4. Protect privacy of sensitive personal data through anonymisation, aggregation, and other statistical *"1%,!0#,/, 0 2/&+$&!"+1&Ɯ )"&+#,/*1&,+ ǚǽ+02/" ,*-)&+ "1,&+#,/*"! ,+0"+1-,)& &"0#,/1%" ,))" 1&,++!0%/&+$,#0"+0&1&3"!1 Ǜǽ/,3&!" ,*-/"%"+0&3"2!&11/&)#,/))%")1%/" ,/!0+!20" 1&3&16 A specialised audit function will be created to oversee and monitor compliance across the Initiative.

29 %"1"+-/&+ &-)"0&!"+1&Ɯ"!&+1%"Ɯ$2/" ,3")61%",/$+&01&,+)#,2+!1&,+#,/1%"&$&1) Initiative. The Initiative has been structured into nine workstreams. They will run in parallel and support one +,1%"/Ǿ01/1&+$4&1%0")" 1-/&,/&16 1&3&1&"0+!"5-+!&+$&+1,,1%"//"0,#4,/(0$&+0/"*!"ǽ %" ")1%/,$/**"0,/(01/"*4&))#, 20,+1%"&*-)"*"+11&,+,#0-" &Ɯ Ǿ01/1"$& /"$&,+)%")1% programmes, while the seven Enabling Environment Workstreams will focus on the creation of an enabling environment for digital health that can be shared across Partner States and that supports health programme implementations. An overarching workstream for Initiative Management will lead and manage the Initiative. A 02**/6,#1%"!&ƛ"/"+14,/(01/"*0 + "#,2+! "),4ǽ

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INITIATIVE MANAGEMENT

HEALTH PROGRAMMES Regional, on-the-ground, health service delivery programmes driven by digital technology

THE EAST REGIONAL REGIONAL EAST EAC REGIONAL AFRICAN HEALTH AFRICA DISEASE HEALTH HEALTH CLOUD SERVICES Ǿ (EAHC) CONTROL AND (RHO) RESPONSE (READSC,R)

Create the enabling environment for digital health in the region

The underpinnings of this Strategic Plan stem from the correlation and relationship between the Digital REACH Initiative workstreams and the outcome goals. Workstream strategies will focus on having a direct or indirect &*- 1,+ %&"3&+$1%",21 ,*"$,)0ǽ )"ǖ0%,404%& %,21 ,*"$,)04&)) "&*- 1"! 64%& % workstream.

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31 Approach to Implementation

The section below details the Digital REACH Initiative’s approach to implementation.

The Digital REACH Initiative will utilise an implementation-science approach to running the Initiative. This will include ongoing and careful M&E as well as the building of an evidence base to demonstrate the impact of health programmes and workstreams, all the while sharing learnings across workstreams. Building an evidence base will be a fundamental element of all work done. This approach is especially &*-,/1+1$&3"+1%" 2//"+1) (,#),+$&12!&+)!1+!"3&!"+ ",#!&$&1)%")1%"ƛ& 61%1&0!"0&/"! 6 the global health community.

("6!&ƛ"/"+1&1,/,#1%"&$&1) +&1&1&3"&01%"!6+*& --/, %!"0 /& "! ,3"1,&*-)"*"+1 targeted regional digital health implementations while also creating the supportive foundations that will make those implementations and Partner State programmes successful. This is a ground-breaking dimension of this Initiative, making it possible to not only identify evidence of impact, but also to apply that evidence in a way that structures and drives work on the enabling environment and subsequent health programmes. A summary ,#1%&0&00%,4+&+1%"Ɯ$2/" "),4ǽ

&$2/"ǜǽ")1&,+0%&- "14""+ ")1%/,$/**"+!+ )&+$+3&/,+*"+1,/(01/"*0

HEALTH PROGRAMMES

The Enabling Environment Workstreams provide Health Programmes drive the demand for assets the assets required for created by Enabling Environment Workstreams using implementation of health programmes implementation science

Enabling Environment Workstreams

INFRASTRUCTURE SERVICES AND LEADERSHIP STRATEGY AND Ǿ STANDARDS APPLICATIONS AND INVESTMENT Ǿ AND INTER- ADVOCACY COMPLIANCE

As health programmes are implemented, they will require and utilise assets created by Enabling Environment Workstreams (e.g., supportive policies, a capable workforce, data standards, the appropriate ICT infrastructure +!0,)21&,+0Ǿ-,)&1& ) 26Ȓ&+Ȝǽ&*&)/)6Ǿ0&*-)"*"+11&,+0, 2/Ǿ+"4, 01 )"04&)) "&!"+1&Ɯ"!Ǿ+! evidence will be generated, in ways that will drive the demand for new assets to be created by Enabling Environment Workstreams. In this way, the successful implementation of the Health Programmes Workstream &0&+"51/& )6)&+("!4&1%1%"02 "00#2)&*-)"*"+11&,+,#1%"+ )&+$+3&/,+*"+1,/(01/"*0ǽ,!,0,Ǿ all workstreams must work closely together to identify synergies and dependencies throughout the duration of the Initiative.

32 %"&$&1) +&1&1&3"&0!"0&$+"!1, ,*-)"*"+1Ǿ&*-/,3"Ǿ+!01/"+$1%"+ ,2+1/6Ȓ0-" &Ɯ 4,/(&+ digital health, not replace it. A robust, region-wide enabling environment will allow Partner States to deliver %")1%0"/3& "01%1/"*,/""ƛ" 1&3"1%+ ,2+1/6Ȓ0-" &Ɯ %")1%&+&1&1&3"0ǽ%" +&1&1&3"0""(01,)"3"/$" 00"101%1)/"!6"5&01 /,001%"&+4601%14&)))),4)) ,2+1/&"0&+1%"/"$&,+1,&*-/,3"1%"&/ digital health capacity and service delivery. The activities listed in this document have been requested and 3"11"! 6/1+"/11"01%/,2$%*2)1&-)"&+Ȓ-"/0,+*""1&+$0&+ǗǕǖǜ+!ǗǕǖǝ1,"+02/")&$+*"+1+! synergy with national strategies. Partner States will be a key part of workstream consultations and implementation. The process below details %,4/"$&,+)+!+1&,+)$,3"/++ ",#1%"&$&1) +&1&1&3"ȉ0 1&3&1&"0&+1"/0" 1+!%,40-" &Ɯ 00"10 /"1"! 61%"/"$&,+/" /"1"!+!&*-)"*"+1"!ǽ,/"!"1&),+1%"/,)",#/1+"/11"01,#2)Ɯ) 0-" &Ɯ /"0,#4,/( + "#,2+!&+" %4,/(01/"*ǽ

Implementation through Digital 01ƛ Digital REACH Experts from Present to Present to the Report to the Feedback is 4,/(01/"* Partner States the ,/!,# " 1,/) EAC ,2+ &) received from 01ƛcarry participating ,**&00&,+"/0 ,2+ &) ,# Implementation Partner State through National out Initiative in Workstream for review and ")1% for institutions Stakeholders activities 5-"/1,/(&+$ approval review and to improve /,2-0are approval under the design and coordination of consulted implementation 1&,+) , ) of Initiative ,&+10in each activities Partner State, reporting to the relevant Workstream Lead All Activities Depending on the workstream and on activities that require policy decisions and implementation at the Partner State level

IDENTIFYING PRIORITY ACTIVITIES Successful implementation will require a clear prioritising of key areas /&1"/&#,//&,/&1&01&,+ of work that are discreet and achievable to ensure quick-wins towards progress and impact and garner further support and enthusiasm ,# 1&3&1&"0 for the Initiative, while also working on building foundations that 1ǽ+!/1+"/11"Ȓ&!"+1&Ɯ"! /" /&1& )1,1%"02 "00,#1%" +&1&1&3"04%,)"ǽ0&+$Ɯ3" areas of priority based on alignment with country priorities /&1"/&Ǿ-/&,/&16 1&3&1&"0%3" ""+&!"+1&Ɯ"!#,/" %4,/(01/"*ǽ and regional value These can be found in the section below and in each workstream. Additional activities that can be targeted once progress has been Ǘǽ !"+1&Ɯ"!.2& (Ȓ4&+0Ǿ&*-,/1+1 for political buy-in and resource *!",+1%"-/&,/&16 1&3&1&"0 + "#,2+!&+--"+!&5ǽ mobilisation Throughout the creation of this document, input on priority activities ǘǽ"Ɯ+"!+!!&0 /"1" 1&3&1&"01%1 for each workstream have been gathered from the EAC, Partner State /" %&"3 )"4&1%&+Ɯ/01#"46"/0 "5-"/10Ǿ1%"!"3"),-*"+1 ,**2+&16Ǿ+!1%"-/&31"0" 1,/ǽ of activity

+ "1%"0" 1&3&1&"0/"2+!"/46Ǿǔ4&)) " ,+!2 1"!1, Ǚǽ !"+1&Ɯ"!0!"-"+!"+ &"0#,/ monitor progress and document value and lessons learned. This will implementing workstream and health programme priorities help to review and refresh priority activities on an annual basis and to identify additional areas of work that had not been considered before 5. Foundational piece of work with and to help mobilise funding for additional activities in future years. 0&$+&Ɯ +13)2"#,//"$&,+ "1&)0#,/1%&0/"!"0 /& "!&+,/(01/"*ǖ "),4ǽ

33 Digital REACH Initiative Priority Activities and Timeline

&3"+1%"!"-1%+! /"!1%,#4,/()&!,21&+1%&01/1"$& )+&14&)) " /&1& )1,-/&,/&1&0"4,/(01/"* activities and health programmes. The timeline below breaks down the priority activities and dependencies #,/1%"Ɯ/01ǚ6"/0%&01&*")&+"&0*"+11,0"/3"001/1&+$-,&+1#,/!&0 200&,+0/,2+!&*-)"*"+11&,+ and resource mobilisation and may be adjusted depending on the resources and capacity of partners. ǖ Ǘ ǘ Ǚ ǚ Ǜ ǜ ǝ Ǟ ǖǕ ȒǾ Ǿ

5.2. Advocate for joint regional position on public health emergency response

4.1. Invest in decision-support tools for dealing with outbreaks and public health emergencies

7.3. Establish a regional policy for public health emergencies

8.4 Train health care professionals on the use of digital health for health services provision (e.g. in public health emergencies) Implement and use READSCoR

6.1. Identify PPPs to support telemedicine deployment and maintenance

9.1. Develop data sharing, security, and management protocols and standards

9.5. Provide regional guidelines for diagnosis, treatment, and standards of care* Implement and operate NEAT* * 7.2. and 9.5* are not required for NEAT to be set up but it will support the expansion of the implementation use case over time, allowing data to be shared and treatment to be provided across borders

8.1. Harmonise and make available eLearning course content for pre- and in-service professionals 8.3. Embed digital health learning methods into health training Implement and + operate EAACH

5.1. Advocate for agreement on data sharing and storage in a regional cloud

6.1. Identify PPPs for EAHC build and maintenance

7.1. Design legislation and policies for remote data hosting 3.1 Build and operate the EAHC and regional support team Conduct research using EAHC Set-up and use Regional Health Observatory

9.2. Create a regional data dictionary for interoperable data exchange between Partner State and regional HIS

9.3. Support and promote the exchange of unique IDs and patient health records across EAC Partner States

4.2. Support and promote implementation of interoperable unique ID systems 3.2 Implement and maintain a regional client registry, terminology services, and interoperability layer Regional Health Services: Cross-border Health Services

5.3. Advocate for regional agreement on health insurance portability

7.4. Develop a regional policy for portability of health insurance

ǞǽǙǽ"3"),-!1"5 %+$"01+!/!0#,/!,&+$ )&*02 *&00&,+Ǿ")&$& &)&163"/&Ɯ 1&,+Ǿ+!/"&* 2/0"*"+10

6.3. Support the development of a business case for regional insurance for favourable premium rates and packages

ǙǽǙǽ +3"01&+0,ƞ4/"0,)21&,+0#,/ )&*02 *&00&,+Ǿ")&$& &)&163"/&Ɯ 1&,+Ǿ*, &)"-6*"+10#,//"&* 2/0"*"+10 Regional Health Services: Portable Health Insurance

Knowledge Management and Peer Learning (initial activities already started) Regional Technical Assistance

Innovations in Health

8.2. Harmonise digital health curricula for healthcare and health IT professionals

4.3. Support engagement with OpenHIE and other global communities for best practices

4.5. Provide support with contractual agreements with technology solutions vendors for Partner States 6.2. Conduct business case assessments and use for negotiations with MNOs for improved bandwidth 6.4. Aggregate demand based on Partner States’ supply needs and negotiate for reduced pricing 5.4. Advocate for a reduced common set of priority donor reporting indicators across the EAC 5.5. Advocate for a holistic approach to use of digital technologies and solutions the health sector within the EAC region • • • • • Ǿ Ǿ • • • 34 MANAGEMENT AND OVERSIGHT

WORKSTREAM 1: INITIATIVE MANAGEMENT

35 WORKSTREAM 1: INITIATIVE MANAGEMENT

OVERVIEW

%"&$&1) +&1&1&3"&0!"Ɯ+"! 64&!"/+$",# 1&3&1&"01, "&*-)"*"+1"! /,00*2)1&-)" workstreams. The ten-year time frame and aspirational set of goals associated with the Initiative require strong leadership. Coordination across the eight activity-based workstreams also presents the need for an !!&1&,+)Ǿ,3"// %&+$4,/(01/"*1%14&))%,)&01& ))6$2&!"Ǿ ,,/!&+1"Ǿ+!*5&*&0"1%"&*- 1,#1%" +&1&1&3"ǽ%&0%0 ""+) "))"!,/(01/"*ǖǽ ,/(01/"*ǖǾ1%" +&1&1&3"+$"*"+14,/(01/"*Ǿ"01 )&0%"01%""00"+1&)01/2 12/"0/".2&/"!1, implement the Digital REACH Initiative. It articulates the organisational and operating mechanisms to *+$"1%" +&1&1&3"Ǿ&+ )2!&+$1%""5" 21&,+,#1%",1%"/"&$%14,/(01/"*0ǽ +!!&1&,+Ǿ&1-/,3&!"0 strategic organisational direction, orchestrating and knitting together all the other workstreams, so that each workstream is moving in the same direction towards the Initiative outcome goals. As such, this workstream runs parallel to, and is integrated with, the other eight workstreams. It is a vehicle for managing change at both the regional and Partner State levels.

GOALS • %&"3"*5&*2*&*- 1,#1%",3"/)) +&1&1&3"1%/,2$%,3"/0&$%1+!02--,/1,#))4,/(01/"* activities. • Ensure compliance with the legal and regulatory framework and funding requirements across all workstreams. • /"1",-"/1&,+)"ƛ& &"+ &"04%"/"-,00& )" /,001%" +&1&1&3"ǽ • /"1"4/"+"00,#1%" +&1&1&3"1%/,2$%2+&Ɯ"!*"00$&+$+!-2 )& /")1&,+0ǽ • /"1"3)2"#,/1%"Ɯ")!,#!&$&1)!"3"),-*"+1Ǿ-/1& 2)/)6!&$&1)%")1%Ǿ+!#,/,1%"//"$&,+0 looking to improve healthcare services, through thought leadership.

Overall Strategic Approach

%&04,/(01/"*4&))-/,3&!""5-"/&"+ "!,3"/0&$%1 6"01 )&0%&+$ ,1"+1&)"ƛ& &"+ &"0 ,/"01ƛ1%1&+ )2!"0), ))"!"/0%&-Ǿ"5-"/&"+ "!*+$"*"+1Ǿ +!1" %+& )"5-"/1&0"ǽ +!!&1&,+1,1%"1/!&1&,+))6 "+1/)&0"! This workstream could realise management functions, human resources, communications and public ,01"ƛ& &"+ &"0 6&!"+1&+$ /"0,2/ "0)&("0%/"!,ƛ& "0- " /")1&,+0ǾƜ++ "Ǿ Ǿ-/1+"/0%&-*+$"*"+1Ǿ+!)"$)02--,/14&)) " +!01ƛ1,/"!2 "0"1Ȓ2- -/,3&!"! 6*&5,#&+1"/+)+! ,+1/ 1"!/"0,2/ "0ǽ and running costs. +$"*"+101/2 12/"04&)) "Ɲ"5& )"+!)"+Ǿ ,+1/ 1&+$,21 resources for period of time when possible. Specialised functions such as M&E and thought leadership will draw on stakeholder contributions (e.g., universities, research bodies) as internal capacity is developed. This --/, %4&))*5&*&0"1%" ,))" 1&3"&*- 1,#1%" +&1&1&3"1%/,2$% ,)) ,/1&,+4&1%3/&,204,/(01/"*0ǽ %"1"*4&))0,)& &1+! ,,/!&+1"!3&0,/6&+-21#/,*"5-"/10 /,00)),1%"/4,/(01/"*0+!/1+"/ 11"01,"+02/"1%10-" &Ɯ "5-"/1&0"ț"ǽ$ǽǾ&+ - &16 2&)!&+$Ǿ&+#/01/2 12/"!"3"),-*"+1Ǿ01+!/!0 creation) is embraced by the organisation overall, as well as in other individual workstream activities.

36 As the management hub of the Initiative, this workstream will oversee the activities listed below.

ASSOCIATED ACTIVITIES

ǖǽ/$+&01&,+ • Set up the appropriate entity and structures to lead and manage the Initiative (including 2&)!&+$+! 01ƛ&+$Ǿ)"$) ,+1/ 10Ȝ +$"*"+1 • Conduct initial and ongoing governance development (set up, maintain, and potentially /"!"0&$+$,3"/++ "01/2 12/"Ȝ#,/1%" +&1&1&3",++,+$,&+$ 0&01,"+02/"Ɲ"5& &)&16 • Provide ongoing operational support for the Initiative • Create workstream strategy and operational plan

Ǘǽ /+1 • Manage administrative aspects of grants and funds as well as communications with grant +$"*"+1+! and funding partners on behalf of the Initiative "-,/1&+$ • Develop reports and briefs for updating key stakeholders and partners

ǘǽ/1+"/0%&- • Manage development partner and private-sector engagement for the Initiative +$"*"+1 • Liaise with grant partners, EAC stakeholders, Partner State government representatives such as Ministries of Health, digital health teams, and other relevant bodies ș,,/!&+1"*,+$01"5&01&+$-/1+"/0+!-2/02"+"4-/1+"/0%&-01%/,2$%,211%")&#"0-+ of the Initiative

Ǚǽ"!"/0%&- • Provide leadership across all workstreams and encourage cross-workstream synergies /,00 4%"/"--/,-/&1"ǽ5*-)"0&+ )2!"',&+1-/,'" 10,/ 1&3&1&"0 /,00!&ƛ"/"+1 ,/(01/"*0 4,/(01/"*0+!,--,/12+&1&"0#,/,+"4,/(01/"*1,-/,3&!""5-"/1&0"1,+,1%"/ǽ • Uphold the values of the Initiative and set the tone across the organisation by upholding 1%"&$&1) +&1&1&3"/$+&01&,+)/&+ &-)"0ț &$2/"ǛȜǽ%&0 + "!,+" 60"11&+$ up aligned structures and policies across the Initiative and tracking adherence across workstreams. ș3"/0""02--,/11,/1+"/11"0#/,*4,/(01/"*0+!"+02/" ,,/!&+1&,+ "14""+ workstreams ș3"/0""+++2)/"3&"4,#-/&,/&164,/(01/"* 1&3&1&"04&1%02--,/1#/,*1%" 0Ǿ Workstream Leads, and the EAC

ǚǽ%,2$%1 ș3"/0""+!*+$"1%"(+,4)"!$"*+$"*"+1-)1#,/*#,/1%" +&1&1&3"+!0%/" "!"/0%&- )"00,+0)"/+"!&+1"/+))6+!4&1%"51"/+) 1,/0Ǿ0--/,-/&1" ș/1& &-1"&+/"$&,+)"3"+10+!0%/"Ɯ+!&+$0+!!14&1%,1%"//"$&,+) ,!&"0 seeking to learn from the Initiative model • Promote the Initiative at conferences, events, and public forums

Ǜǽǔ • Create M&E plan for the Initiative, starting with priority activities and health programmes • Conduct M&E and performance management across all workstreams and coordinate with independent M&E partner • Use M&E data to mobilise funding based on tangible results and outputs

Managing and overseeing all workstreams requires creating a multidimensional team to provide a strong mechanism for collaboration, oversight, guidance, project management, resource mobilisation, and technical "5-"/1&0"ǽ%&0*2)1&!&0 &-)&+/6,/$+&01&,+4&)) ,+0&01,#"+1/)+$"*"+1 2 , made up of a ,/! ,#&/" 1,/0 and a Digital REACH Initiative /,'" 1+$"*"+1ƛ& "țȜǽ%"4&)),3"/0""+! manage the work done by the Initiative, and will report directly to the Board of Directors which will be made up of high-level Partner State and EAC representatives, the private sector, and development partners. The 4&)))0,*+$"("6 +&1&1&3"-/1+"/0%&-0Ǿ&+ )2!&+$ǿ • A /1+"/0ȉ ,/2* made up of Partner States Ministries and departments for ICT and digital health, education and development, EAC Secretariat, EAC institutions, development partners, and the private sector will be kept up to date of the Initiative’s progress and consulted throughout the life of the Initiative.

37 • A " %+& )!3&0,/6 /,2- will also be set up to gather inputs regarding the implementation of the &$&1) +&1&1&3"ǽ"* "/0%&-1,1%&0" %+& )!3&0,/6 /,2-*6,3"/)-4&1%1%"/1+"/0ȉ ,/2* 21*"* "/04&)) "*,/"%"3&)6&+3,)3"!&+1%" ,+1"+1,#1%" +&1&1&3"Ǿ-/,3&!&+$01/1"$& !3&0,/602--,/11,01ƛ /,001%""+1&/"4,/(01/"*Ǿ!"-"+!&+$,+1%"&//"0,#"5-"/1&0"+!1%" need. Workstreams will have their own budget, leadership, team, management structure, and progress indicators, +!/"-,/11,1%"ǽ/1+"/0%&-01%1&*- 1" %4,/(01/"*4&)) "*+$"!11%"4,/(01/"*)"3")Ǿ &+ )2!&+$ ,,/!&+1&,+4&1%/1+"/11"01("%,)!"/0&+3,)3"!&+0-" &Ɯ /"0,#4,/(Ǿ1%/,2$% 0ǽ Below is the high-level organisation structure.

&$2/"ǝǿ/$+&01&,+) /*"4,/(#,/&$&1) +&1&1&3"

PARTNERS’ FORUM (Partner States, EAC Organs and Board of Directors Institutions, development partners, and the private sector) (Partner States, EAC Organs and Institutions, development partners, and the private sector) TECHNICAL ADVISORY GROUP Digital REACH Initiative PMO { (Local and international health and (Executive Director and the Digital REACH Directorate) technology experts)

3"/0&$%1 /,00))1%"/,/(01/"*0

Workstreams will have their own Workstream Lead, teams, management structure, and budget and report to the ǽ,/(01/"*Ȓ0-" &Ɯ -/1+"/0%&-04&)) "*+$"!11%"4,/(01/"*)"3")

HEALTH PROGRAMMES

INFRASTRUCTURE SERVICES AND LEADERSHIP STRATEGY AND Ǿ STANDARDS APPLICATIONS AND INVESTMENT Ǿ AND INTER- ADVOCACY COMPLIANCE

The Initiative will be led by the 5" 21&3"&/" 1,/who At the start of the Initiative, the PMO will will be responsible for creating, planning, implementing, be expected to set up a smaller, leaner and integrating the strategic direction and vision of the management structure while other Digital REACH Initiative. The &$&1) &/" 1,/1" will workstreams are also set up. This will allow /"-,/11,1%"5" 21&3"&/" 1,/+! ,+0&01,#&/" 1,/,# more resource allocation to the technical workstreams. As resource become available, /,$/**"0 4&1%"5-"/1&0"&+-2 )& +! )&+& )%")1%+! 01ƛ&+$ + " ,*"*,/"0-" &)&0"!Ǿ digital health and technology, and a &/" 1,/,#-"/1&,+0. allowing management structures to grow. The &/" 1,/,#/,$/**"0 will provide oversight and This will allow the Initiative to get started on 02--,/11,))1" %+& )"5-"/10+!4,/(01/"*0ǽ % priority activities and demonstrate quick- 4,/(01/"*4&))%3",/(01/"*"!ț+!02--,/1&+$01ƛȜ wins that will attract further resources while putting the organisation in place. who will report to the Director of Programmes. M&E will also 2ƛ& &"+11&*"0%,2)!)0, ")), 1"!1, fall under this function. The &/" 1,/,#-"/1&,+0oversee %&/&+$1%"/&$%101ƛǽ )"5& )"01/2 12/"4&)) " internal activities and includes legal, human resources, internal important to ensure that work on priorities ,-"/1&,+0ǾƜ++ "Ǿ ,**2+& 1&,+0Ǿ-2 )& /")1&,+0Ǿ+! can begin, at least in part, while larger hiring thought leadership. These functions will also provide support "ƛ,/10/",+$,&+$ǽ and oversight to each workstream.

38 %"#,)),4&+$Ɯ$2/"&))201/1"01%"-/,-,0"!,/$+&01&,+)01/2 12/"#,/"+1&/"&$&1) +&1&1&3"ǽ &$2/"Ǟǽ/$+&01&,+)%/1#,/&$&1) +&1&1&3" DIGITAL REACH INITIATIVE MASTER ORGANISATIONAL CHART

+$&+$&/" 1,/

&/" 1,/,#-"/1&,+0 &/" 1,/,#/,$/**"0

Finance IT ")1%/,$/**"0"! /1+"/0%&- ǔ +$"*"+1 2*+ %,2$%1 -"/1&,+0+! "0,2/ "0 "!"/0%&- !*&+&01/1&,+ 51"/+) +!"-"+!"+1 Legal Marketing ǔ/1+"/ ǔ EAHC "$&,+) ")1% ,"! "! "/3& "0"! , EAHC "$&,+) ")1% ,,/!&+1,/ ,,/!&+1,/ "/3& "0 ,,/!&+1,/ +#/01/2 12/""! Note: M&E, and Operations and "! "! "! !*&+01ƛ4&))02--,/1*,/"1%+ -"/1&,+0+! ,,/!&+1,/0 !*&+&01/1&,+ one workstreams at a time and will RHO NEAT EAACH 2 '" 1Ȓ11"/ /"-,/11,1%"ǔƛ& "/+!1%" ,,/!&+1,/ ,,/!&+1,/ ,,/!&+1,/ 5-"/10 Director of Operations respectively +,4)"!$" "$&,+) /+0#,/*1&,+) +$"*"+1 " %+& ) " %+,),$&"0 )1#,/*0"! 00&01+ ""! "!

+,4)"!$" "$&,+) /+0#,/*1&,+) "/3& "0+!--)& 1&,+0"! +$"*"+1 " %+& ) " %+,),$&"0 -"/1&,+0+! ,,/!&+1,/0 )1#,/*0 00&01+ " ,,/!&+1,/ !*&+&01/1&,+ ,,/!&+1,/ ,,/!&+1,/ 2 '" 1Ȓ11"/ 5-"/10

!3, 6"! 1/1"$6+! +3"01*"+10"!

-"/1&,+0+! 2 '" 1Ȓ11"/ -"/1&,+0+! "$,1&1,/0 !*&+&01/1&,+ 5-"/10 !*&+&01/1&,+ 20&+"00+)6010

* 00!,/0

"! ,/(#,/ ""!

-"/1&,+0+! ,,/!&+1,/0 -"/1&,+0+! ,,/!&+1,/0 !*&+&01/1&,+ !*&+&01/1&,+ 2 '" 1Ȓ11"/ 2 '" 1Ȓ11"/ 5-"/10 5-"/10

1+!/!0+!&+1"/,-"/ &)&16"!

,1) -"/1&,+0+! ,,/!&+1,/0 !*&+&01/1&,+ 01&*1"! 2 '" 1Ȓ11"/ 5-"/10 "! ,2+11 )" ǚǚȒǛǕ All Workstreams will be supported by Expert Working Groups made up of Partner State and EAC experts. Coordinators will be responsible for managing and running these working groups.

2/1%"/!"1&),+1%"*+$"*"+1+!,-"/1&,+0,#1%&04,/(01/"*Ǿ&+ )2!&+$,/$+&01&,+01/2 12/"0Ǿ /"0-,+0& &)&16/"0Ǿ("6-"/#,/*+ "&+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ activities can be found in the&$&1) +&1&1&3",/(01/"*,*-"+!&2*.

39 As the Digital REACH Initiative is set up, its leadership will need to take a strategic approach to identifying and hiring the minimum capable team to launch and implement priority activities that will secure more long- 1"/*#2+!&+$ǽ%",/$+&01&,+4&))+""!01ƛ4&1%)"!"/0%&-+!*+$"*"+10(&))0Ǿ04"))01%,0"4&1% 1%"1" %+& ) &)&1&"0ț"ǽ$ǽǾ-/,$/**+$"/0Ǿ*"!& )!, 1,/0Ǿ"+$&+""/0Ǿ1" %+& )"5-"/10Ǿ ,,/!&+1,/0Ȝ required for actual implementation. The table below, taken directly from the Digital REACH Costing tool, 0%,401%"+1& &-1"!%"! ,2+1+!%&/&+$/*-2-Ǿ#,/01ƛ+! ,+02)1+10-"/4,/(01/"*,3"/1%"Ɯ/01 Ɯ3"6"/0,#1%"&+&1&1&3"ǽ 1&0 0"!,+1%"002*-1&,+1%11%"*',/&16,#/"0,2/ "0 + "*, &)&0"!#,/1%" Ɯ/016"/,#1%"&+&1&1&3"1,02--,/1))-/&,/&166"/ǖ 1&3&1&"0ǽ

)"ǖǽ+1& &-1"! "! ,2+1#,/1ƛ+!,+02)1+10ț"/0ǖȒǚȜ

,/(01/"* Year 1 Year 2 "/ǘ "/Ǚ "/ǚ ǝǖǘǖǘǖǗǖǗ ǖǿ +&1&1&3"+$"*"+1

33 ǜǜǝ Ǘǿ ")1%/,$/**"0

Ǖ ǚ ǖǕ ǖǕ ǖǕ ǘǿ +#/01/2 12/"

Ǚǿ"/3& "0+! 4 ǝǜǜǜ --)& 1&,+0 ǚǿ"!"/0%&-+! 4 ǛǛǚǚ !3, 6 4 ǜǜǜǜ Ǜǿ1/1"$6+! +3"01*"+1

ǜǿ"$&0)1&,+Ǿ,)& 6Ǿ+!,*- 4 ǝǝǝǝ -)&+ " 4 ǚǖǖǖǕǖǕ ǝǿ,/(#,/ "

Ǟǿ1+!/!0+! 3 ǜǜǝǝ +1"/,-"/ &)&16

40 DIGITAL REACH INITIATIVE HEALTH PROGRAMME IMPLEMENTATIONS

WORKSTREAM 2: HEALTH PROGRAMMES

41 WORKSTREAM 2: HEALTH PROGRAMMES

OVERVIEW %" ")1%/,$/**"0,/(01/"*,3"/0""0+!*+$"01%"&*-)"*"+11&,+,#0-" &Ɯ %")1% programmes that seek to improve health-service delivery and outcomes while building the human, technical, and functional infrastructure to deliver the Digital REACH Initiative’s outcome goals. This workstream will focus on implementations that are regional and cross-border in nature and that improve the quality and access to healthcare services across the EAC, while also supporting the needs and mandates for the other seven activity-based workstreams.

GOALS %"4,/(01/"*4&))#, 20,+&*-)"*"+1&+$%")1%-/,$/**"01%102--,/1 ,01Ȓ"ƛ" 1&3"&*-/,3"*"+101, the quality of healthcare services in the EAC region while utilising the assets developed by other workstreams +! 2&)!&+$/"$&,+)"5-"/1&0"1,02--,/11%"&$&1) +&1&1&3",21 ,*"$,)0ǽ&+"-/&,/&16%")1% -/,$/**"01%102--,/11%" +&1&1&3"ȉ0,21 ,*"$,)0%3" ""+&!"+1&Ɯ"! 61%"#,/&*-)"*"+11&,+ 2+!"/1%"&$&1) +&1&1&3"ǽ%"0"%3" ""+-/&,/&1&0"!00%,4+&+1%"Ɯ$2/" "),4ǽ &$2/"ǖǕǿ&$&1) +&1&1&3"/&,/&16 ")1%/,$/**"0 Level of Priority: &$% ,4

REGIONAL HEALTH REGIONAL TECHNICAL INNOVATIONS IN Key OPTIMISE THE PREVENTION, SERVICES MANAGEMENT AND ASSISTANCE FOR HEALTH DIAGNOSIS, AND TREATMENT OF PEER LEARNING DIGITAL HEALTH PRIORITY HEALTH CONDITIONS SUPPORT UNIVERSAL ACCESS TO Implement programmes Design implementations HEALTHCARE that strengthen cross- with new digital Support peer learning Build digital health IMPROVE HEALTH WORKER EDUCA- border and regional health and the creation of capacity in Partner technologies to support TION AND TRAINING by sharing data in priority reusable assets in States in areas &*-/,3"!"ƛ& &"+ &"0+! OPTIMISE HUMAN RESOURCE cross-border communities the region through that support the "ƛ" 1&3"+"00&+-2 )& ALLOCATION AND MANAGEMENT IMPROVE DISEASE SURVEILLANCE and supporting portability the implementation implementation health. AND RESPONSE

of health insurance. of knowledge of Digital REACH IMPROVE SUPPLY CHAIN management Initiative. EFFICIENCY platforms. + ENHANCE PUBLIC HEALTH EDUCATION AND AWARENESS

MONITOR POPULATION HEALTH STATUS

+ + +

42 STRATEGIES AND GUIDELINES FOR IMPLEMENTATION At its core, the Digital REACH Initiative is an evidence-based, implementation science-led Initiative designed 1,20"0-" &Ɯ %")1%-/,'" 101,!"*,+01/1" ,01"ƛ& &"+ 6Ǿ%")1% "+"Ɯ10Ǿ+!"3&!"+ ",#&*- 1+!1, apply that evidence in a way that drives subsequent implementations. Health programmes will place East African ownership at the forefront, with technical assistance provided in the background. Work on some of the health programmes has already begun (indicated in each health programme below), implementation on others will be staggered. Priority health programmes have been &!"+1&Ɯ"!20&+$1%" /&1"/&,+-$"ǘ3ǽ The Health Programmes Workstream team will be responsible for prioritising implementation opportunities +! ,,/!&+1&+$/"0,2/ "0*,+$01&1Ǿ4/&1&+$1%",3"/))4,/(01/"*-)+04"))00-" &Ɯ -)+0#,/ " %&*-)"*"+11&,+ǽ ")1%-/,$/**"04&)) " ,*-)&0%"! 6 ,1%1%" ,/"01ƛ+!,210,2/ "! implementation partners (e.g., private sector, development partners). The workstream team will be heavily involved in oversight, M&E, and alignment with regional and national health goals and funding. It will also be /"0-,+0& )"#,//2++&+$1%" ,*-"1&1&3" 01,&!"+1&*-)"*"+11&,+-/1+"/0ǽ Successfully architecting, implementing, and scaling the nine health programmes requires an overall process #,/&+1"$/1&,++!-/&,/&1&01&,+ǽ%"!&$&1)%")1%)+!0 -"%0*2)1&-)""5*-)"0,##&)"!-/,'" 101%1 either never worked or were never able to scale. The key principle for this workstream will be to rely heavily on an agile methodology that allows for rapid iterations and staged implementations built upon a solid / %&1" 12/"Ǿ&!"+1&Ɯ"!1%/,2$% ,+02)11&,+04&1%/1+"/11"0ǽ"20",#1,,)0+! "01-/ 1& "04&)) -/,3&!" ,01"ƛ& &"+ &"0Ǿ 21*12/&16*,!")4%"/"&+&1&)&*-)"*"+11&,+0/"3)&!1"!+!1%"+"3,)3" 0"!,+"5-"/&"+ "Ǿ&0"00"+1&)1,02 "00ǽ The following are strategic guidelines for the operationalisation of this approach: • All health programme implementations will involve an early scan of what work is already being done in related areas by Partner States and development partners • Place emphasis on East African ownership and local capacity development, with international technical assistance provided where needed • Ensure alignment with EAC health-sector priorities and secure political support for regional health-service implementations • Coordinate with other workstreams to utilise supportive assets being developed (e.g., standards and policies) in ways that support health programme implementations • Work closely with all other workstreams to request the creation of assets (e.g., policies, standards, 0,ƞ4/"0"/3& "0Ȝ 0"!,+$-0+! %))"+$"0"5-"/&"+ "!!2/&+$&*-)"*"+11&,+,#%")1% programmes 2/1%"/!"1&),+1%"*+$"*"+1+!,-"/1&,+0,#1%&04,/(01/"*Ǿ&+ )2!&+$,/$+&01&,+01/2 12/"0Ǿ /"0-,+0& &)&16/"0Ǿ("6-"/#,/*+ "&+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ activities can be found in the &$&1) +&1&1&3",/(01/"*,*-"+!&2*.

43 Health Programme 1: The East Africa Health Cloud (EAHC)

OVERVIEW *- 1"!21 ,*" ,)0ǿ The East Africa Health Cloud (EAHC) is a technology-driven, • Data on the regional health interoperable health information system (HIS) that will enable situation used to drive the real-time storing, capturing, analysing, and retrieving of health regional health agenda data across the region, including data related to access to care • Local health researchers are and care delivery, health worker mobilisation and training, supply capacitated to analyse and use chain, public health statistics, and surveillance and response data information. • Underlying cloud infrastructure Placed in a common EAC cloud and not in a single Partner supports all other outcome State, the EAHC will allow users to securely access, analyse, goals through various health and use health data across the region, following formal data programmes 0%/&+$$/""*"+104&1%/1+"/11"0ǽ 2&!"! 6"1%& )!1 Supporting Workstreams: -/ 1&0"0&+ )2!&+$!10" 2/&16Ǿ-/&3 6Ǿ+! ,+Ɯ!"+1&)&16Ǿ1%" EAHC will facilitate greater regional cooperation. It will initially +#/01/2 12/": Provides underlying provide insights and evidence into health system governance infrastructure for programme to operate from the perspective of regional changes in demographics, 1/1"$6+! +3"01*"+1: Helps to socioeconomics, disease trends, and mobility. It will then provide identify sustainable operating models the basis for case reporting and disease management to support for the cloud infrastructure through regional health security and regional healthcare delivery. private sector engagement The EAHC will be used to: "$&0)1&,+Ǿ,)& 6Ǿ+!,*-)&+ ": • 1/"+$1%"+ - &161,#,/*2)1""ƛ" 1&3"%")1%-,)& &"0Ȁ Designs the legislation and policies for remote data hosting • Provide health workers with relevant data and knowledge to improve health practice and decision making; "!"/0%&-+!!3, 6: Advocates for sharing of data across borders • Strengthen the potential of data to serve as early warning #,/1&*")6+!"ƛ" 1&3"/"0-,+0"ț"ǽ$ǽǾ"/)6!&$+,0&0,# !"3&1&,+0#/,*"5-" 1"!!&0"0" "%3&,2/Ǿ+!ȡ,/+"4+! 2+"5-" 1"!%")1%1%/"10ȜȀ • Establish mechanisms for data utilisation, using clear /&1"/&,#"1%& )-/ 1& "Ǿ1,*("!1Ɯ+! )"Ǿ "00& )"Ǿ %"1/"%,20" interoperable, and reusable, driving policy decisions, the The EAHC is complementary to current regional health agenda, and health research; "ƛ,/101,%,01%")1%&+!& 1,/!1 • Contribute to improved universal health coverage (UHC) and collected through DHIS2 in the EAC accessibility to quality healthcare services in remote areas Data Warehouse. In addition to health and for low-income members of society, by using data to indicator data, the EAHC will also act drive the regional health agenda. as a central repository for other types The EAHC will help to strengthen the ongoing analyses of health- of data. Data inside the EAC Data science data, regionally and for Partner States, by creating the Warehouse will be made available ,**,+&+#/01/2 12/"Ǿ0"/3& "0Ǿ+!0(&))0+""!"!1,"51/ 1 through the EAHC. valuable insights from data.

44 IMPLEMENTATION VALUE 6"01 )&0%&+$/")Ȓ1&*"Ǿ/"$&,+) #,/ -12/&+$Ǿ01,/&+$Ǿ/"1/&"3&+$Ǿ+)60&+$Ǿ+!*+$&+$!"&!"+1&Ɯ"! +1&,+)+!/"$&,+)%")1%!1Ǿ1%" 4&)),ƛ"/1%",--,/12+&161,!/*1& ))6&+ /"0"1%""3&!"+ " base with which health policy and services can be designed across the EAC. Priority data sets will be fed into the EAHC and analysed to create high-value common goods (e.g., algorithms to trigger outbreak alerts, routine +)60"0,+ ,*-/1&3""ƛ" 1&3"+"00,#%")1%-/,$/**"0Ǿ01+!/!&0"!1,,)0#,/!1 ,))" 1&,+Ȝǽ1 will also be made available through secured electronic channels, such as a secure web portal or virtual private +"14,/(țȜǾ1,01("%,)!"/002 %0$,3"/+*"+1-"/0,++")Ǿ.2)&Ɯ"!/"0"/ %"/0Ǿ+! !"*& &+0 whose access will drive further insights and evidence for health in general. The establishment of the EAHC will support the Digital REACH Initiative by providing the underlying infrastructure to store and analyse data necessary to: • 5*&+"1%"0, &)!6+*& 0,# "001,+!21&)&01&,+,#%")1%0"/3& "0Ǿ&+ )2!&+$%")1%0601"*0 $,3"/++ "+!%")1%Ɯ++ &+$ț"ǽ$ǽǾ/"*&11+ "0Ȝ#/,*1%"-"/0-" 1&3",#$), ) %+$"0&+ demographics, mobility, migration, and technology • Strengthen the continuous, ongoing analyses , and sharing of health-science data to achieve lasting 0601"*01/+0#,/*1&,+1%/,2$%&++,31&,+Ǿ$,3"/++ "Ǿ+!0201&+ )"Ɯ++ &+$ • /,*,1"+!# &)&11" "00& &)&16Ǿ0201&+ &)&16Ǿ-/"!& 1 &)&16Ǿ"ƛ" 1&3"+"00Ǿ+!.2)&16,#%")1% /" 0"/3& "0&+),4Ȓ&+ ,*"Ǿ/2/) ,**2+&1&"0Ǿ-,01Ȓ ,+Ɲ& 1/"0Ǿ!&0-) "! ,**2+&1&"0Ǿ /,00Ȓ ,/!"/ communities, and amongst vulnerable groups (e.g., the elderly and children) • Share and access health training and learning materials including health worker training • Identify relevant regional events or trends to inform dissemination of tailored and timely public health messages to health workers and EAC citizenry through digital tools (e.g., alerts on outbreaks, alerts on disease trends and associated factors)

IMPLEMENTATION APPROACH The EAHC architecture will be designed This health programme will work very closely with the to receive and provide access to real-time Infrastructure workstream to build and implement the data on diagnostics, treatment adherence, EAHC. The implementation approach will prioritise regional causes of ill-conditions, hotspots, and health security while rolling out incremental functionality resources. The system will interconnect data to build a robust platform supporting all the use cases on services from facilities and communities above. Design and development of the EAHC will begin within selected areas in each Partner State by identifying an achievable use case. This will allow for and across the EAC, including: building out the right security and privacy protocols to suit the use case, and embedding principles of patient-level ǖǽ,21&+"%")1%0601"*&+!& 1,/0ț"ǽ$ǽǾ protection, privacy, and data portability from the very start. Partner State HMIS, EAC Data Warehouse) 2. M&E survey data (e.g., Demographic and + "1%" &0&+-) "Ǿ), )/"0"/ %"/0ț&+ )2!&+$ Health Surveys (DHS), Multiple Indicator PhD students and post-doctoral fellows) will then be able Cluster Survey (MICS), Household Budget to utilise the database for research and analysis of health Survey (HBS) with MEASURE and the trends. This will also enhance the regional and global body World Bank) of knowledge on health in the EAC region and build the capacity of local researchers and health professionals. 3. Country statistics (e.g., census) 4. Common data registries (e.g., master facility lists, diagnosis codes, client registry and shared health records for management of cross-border case- based surveillance)

45 This health programme will actively work with %")1%-/,$/**"0Ǘ1,Ǟ!"0 /& "! "),41, 20"!1#/,*%")1%-/,$/**" 1&3&1&"0ǽ ,/ "5*-)"Ǿ!13&) )"#/,*1%"01#/& + Cross-Border Health Services implementation in Health Programme 2 (Regional Health Services) can be used to inform the design and &*-)"*"+11&,+,#01+!/!&0"!!&$&1) ȡ 4,/(Ɲ,40Ǿ)$,/&1%*0Ǿ+!-/,1, ,)0&+ selected sites to allow for comparative analyses ,#$$/"$1"!1,+ ȡ3/& )"0ǽ%" %")1%-/,$/**"1"*4&)))0,"5-),/"460,# optimising for regional use the architecture and !"0&$+0,#4,/(Ɲ,40Ǿ)$,/&1%*0Ǿ+!-/,1, ,)0 developed and used by the EAC Partner States. Real-time, data-driven, pilot studies will be designed and conducted by this health programme when the EAHC infrastructure and services have been optimised, and EAC Partner States skills to use EAHC tools and its data-driven &+0&$%10%3" ""+!"3"),-"!ǽ5*-)"0,# potential pilot studies include: • Real-time treatment compliance monitoring for TB patients, capturing data through ICT 20&+$*, &)"-%,+"0+!")" 1/,+& -&)) ,5"0Ǿ also known as electronic directly observed 1%"/-6ț"Ȝǽ!!&1&,+)--)& 1&,+0 include capture and analyses of diagnostics, cohort, MTB subtypes, MDR TB data, and %,10-,10,#ǾǾȡ ,&+#" 1&,+ǽ • +)60"0,# -1&"+1!1ț"ǽ$ǽǾ!&$+,01& 0Ǿ &/ 2)1&+$ 02 16-"0Ǿ1/"+!0,#3&/)),!ǾǙ ,2+10Ǿ )&+& )-/*"1"/0Ǿ%,10-,10Ǿ+! ,+1 10Ȝ1,&!"+1 "01-/ 1& "0+!&*-/,3" ,01"ƛ" 1&3"+"00,# treatment. • /&,20&*-)"*"+11&,+0,#!&$&1)%")1%#,/!&0"0"-/"-/"!+"00Ǿ!"1" 1&,+Ǿ+!/"0-,+0"1,!&0"0" ,21 /"(0ț"ǽ$ǽǾ"-&!"*& 0Ǿ-+!"*& 0Ǿ+" ")1%Ǿ ,+1&+2,20!1+)61& 0Ǿ /&"#0Ȝ • %"&*- 1,#/"*&11+ "0+!!,*"01& Ɯ++ &+$,+ "001,%")1%0"/3& "0&+ /,00Ȓ ,/!"/ communities. 4&)) "/, 201+!"ƛ" 1&3"1,,)1,-/,3&!"!11%14&)) ,*-)"*"+1+!$2&!"1%"!")&3"/6,#%")1% 0"/3& "0 6&01/& 1 ")1%ƛ& "/0+!1%", 0&+/1+"/11"0ǽ%"4&))4,/(4&1%,1%"/-/1+"/0&+ 1%&00- "ț"ǽ$ǽǾ +!&+01&121&,+0Ȝǽ

46 Health Programme 2: Regional Health Services

OVERVIEW *- 1"!21 ,*" ,)0ǿ To address the key and unique challenges associated with • Supports continuity of care providing quality health services for mobile populations and across the region communities residing along the EAC border areas, Health • Supports portability of health Programme 2 will develop or support health programmes insurance that demonstrate the value of coordinating digital health and • Supports sharing of increasing public health security in the region. information across borders which can support surveillance IMPLEMENTATION VALUE Supporting Workstreams: /""!,*,#*,3"*"+1/"02)10&++&+ /"0&+$+""!#,/ /,00Ȓ +#/01/2 12/"ǿBuilds client registry border access to healthcare. As mobility increases, people and shared health records to support become further removed from their traditional medical support cross-border health care systems in their home countries, making them more vulnerable to health risks. Recent studiesǛ#,2+!1%11%"/"&00&$+&Ɯ +1 "/3& "0+!--)& 1&,+0ǿInvests undocumented travel across porous borders in the EAC region, in unique ID systems and solutions to and that this includes travel for the purpose of accessing health process insurance claims regionally services. In fact, people living in border communities have even 1+!/!0+! +1"/,-"/ &)&16ǿ indicated a preference for using cross-border facilities because 2--,/10!"3"),-*"+1,#!1"5 %+$" ,#01&$*+!!&0 /&*&+1&,+Ǿ-/1& 2)/)6#,/!&0"0"0)&(" standards and TB, as well as perceived quality and distance. This creates a ,)& 6Ǿ"$&0)1&,+Ǿ+!,*-)&+ "ǿ number of challenges for providers and patients including stock- Supports sharing of data across borders outs, lack of data to support continuity of care across borders and health resource allocation, and lack of insurance to pay for "!"/0%&-+!!3, 6ǿAdvocates services received in another country. for sharing of data across borders ,/1/2)6&+1"$/1"!Ǿ&1&0&*-,/1+1#,/-",-)"1, " ,1"+1&)ƛ& &"+ &"0+! )"1,0""("ƛ" 1&3" /"+64%"/"&+1%"/"$&,+ǽ%" ")1% /1+"/0%&-0ǿ/1+"/4&1% ,+ Programme 2 team will be responsible for identifying and shared border areas. Leverage lessons implementing key regional and cross-border programmes that learned from other programmes support continuity and access to healthcare across the region, on providing care for cross-border along with the associated skills and performance indicators populations (e.g., from the RAD required. consortium)

IMPLEMENTATION APPROACH 4,&*-)"*"+11&,+0%3")/"!6 ""+&!"+1&Ɯ"!#,/02--,/12+!"/1%&0%")1%-/,$/**"ǿ • +01#/& /,00Ȓ,/!"/ ")1%"/3& "ǿTo support the continuity of care for priority diseases along strategic border areas of East Africa • , &) ")1%/,1" 1&,+ǿ,/1 )"%")1%&+02/+ "&+ )2!&+$ 0& "+"Ɯ10- ($" Both implementations have been conceptualised by the EAHRC. Work is currently underway to secure the political support and buy-in from key Partner State decision makers.

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47 ǖǿ C Ȓ HEALTH SERVICE The East Africa Cross-Border Health Service (EACBHS) will strengthen cross-border healthcare and allow for ,+1&+2,20+!/")Ȓ1&*"!1"5 %+$" on priority health issues associated with mobile populations and communities HC HC HC HC HC HC residing along strategic border areas of HC HC HC HC HC HC East Africa, supporting the continuity of care for priority diseases in those localities with a focus on serving the patient. The EACBHS will target ǖǚ-/&,/&16 ,/!"/0&1"0ǜǾ01/1&+$4&1%ǚ&+1%"Ɯ/016"/+!/,))&+$,211%"!!&1&,+)ǖǕƞ"/1%1ǽ 1 2&)!0 on the Cross-Border Health Integrated Partnership Program (CB-HIPP), a regional project funded by USAID/ +!&*-)"*"+1"! 6 ǘǛǕ+!-/1+"/0ǽ 14&))1-&+1,)"/+&+$0#/,* /,00Ȓ ,/!"/-&),1-/,$/**"0 being implemented elsewhere on the continent e.g., programme under the Regional Action through Data țȜ,+0,/1&2*1%1&0 "&+$&*-)"*"+1"!&+1%" ,2+1/&"01%1#,/*1%" +1"/Ȓ ,3"/+*"+1)21%,/&16,+ "3"),-*"+1ț ȜǾ+!1%" ,+,*& ,**2+&16,#"01#/& +11"0țȜǽ-,+--/,3) 6 and its Partner States, implementation of the EACBHS will focus on the following areas:

• Real-time data sharing for decision making amongst cross-border health facilities • Cross-border data collection and real-time data analysis, interpretation, reporting, and utilisation • ,+1&+2,20!&0"0"02/3"&))+ "#,/-/&,/&16!&0"0"0+!&!"+1&Ɯ 1&,+,#!&0"0"&+ 2 1&,+%,10-,10+! # 1,/01%1&+Ɲ2"+ "!&0"0"0&+ /,00Ȓ ,/!"/ ,**2+&1&"0 • *-/,3"*"+10&+ /,00Ȓ ,/!"/),001,#,)),4Ȓ2-Ǿ ,+1 11/ &+$Ǿ+!1/"1*"+1 ,*-)&+ ",# +! patients

Under this Health Programme, other regional health services programmes will also be established to address important regional health conditions such as non-communicable diseases (NCDs) (e.g., cancer, heart, )2+$Ǿ+!(&!+"6!&0"0"0Ȝ04"))0/,!1/ƛ& &!"+10ǽ%" 4&))4,/( ),0")64&1%1%" ")1% /,$/**"ǖ1"*1,21&)&0"!101,/"!&+1%" ǽ%" 4&))"+ )"1%"&+1"$/1&,+,#-"/0,+)%")1% records to allow for dashboards, cloud analytics, and reporting.

Ǘǿ ǿ FOR THE EAC REGION This implementation will work to support portability of health insurance across the EAC, in line with the EAC Social Health Protection (SHP) Portability Strategy and Roadmap developed by EAC Secretariat. This health -/,$/**"4&))!"Ɯ+"-,/1 )" 0& "+"Ɯ1- ($" 0"!,+1%"/"$&,+Ȇ0%")1%-/&,/&1&"0ǽ 14&)))0, work closely with the enabling environment workstreams to design the supportive infrastructure needed to roll-out portable insurance, including the appropriate policy and standardised service delivery protocols and guidelines, development of harmonised unique ID, and the establishment of partnerships with public and private organisations.

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48 Health Programme 3: Regional East Africa Disease Surveillance, Control and Response (READSCoR)

OVERVIEW *- 1"!21 ,*" ,)0ǿ The READSCoR health programme aims to establish a digital • Supports timely surveillance mechanism for regional surveillance of disease outbreaks of disease outbreaks and for early preparedness, including prediction, detection, and emergencies response. READSCoR will set up health alerts and an early warning system for disease outbreaks and epidemics. It will Supporting Workstreams: support regional health security by helping authorities prevent, "/3& "0+!--)& 1&,+0: Invests in track, and respond to health threats such as infectious diseases decision support tools for dealing with and epidemics that can rapidly spread across the region. outbreaks ,)& 6Ǿ"$&0)1&,+Ǿ+!,*-)&+ ": IMPLEMENTATION VALUE Establishes policy for regional ,/,20 ,/!"/0+!1%"Ɲ2&!*,3"*"+1,#-",-)"Ǿ+&*)0Ǿ+! surveillance and response agricultural produce across the EAC Partner States underscore "!"/0%&-+!!3, 6: Advocates the need for a regional approach to tracking and responding to for joint position on health emergencies health needs and emergencies. A regionally integrated digital ,1"+1&)ƛ& &"+ &"0+! surveillance, alert, and early warning system will ensure the /1+"/0%&-0: Partner with EAIDSNet 0-""!+!"ƛ& &"+ 6,#!1 ,))" 1&,+Ǿ+)60&0Ǿ-/"3"+1&,+Ǿ+! and SACIDS on disease surveillance in public health response to outbreaks. the region. Leverage work being done in IMPLEMENTATION APPROACH participating countries to support READSCoR will create the algorithms for continuous, real-time +!+" ")1%Ǿ04"))0 data generation, transmission, storage, and analyses, using the surveillance tools, protocols, and EAHC to identify potential outbreaks and generate alerts and early best practices from the widespread !"1" 1&,+,#+!"ƛ" 1&3"/"0-,+0"1,,21 /"(0ǽ%"0601"* implementation of the IDSR framework will provide regular updates on the general status of health in the to create more predictive algorithms region and priority health conditions including public health risks and alerts to prevent future outbreaks. and threats. Look to lessons from the Regional %"0601"*4&))!/4,+"5&01&+$02/3"&))+ "0601"*002 %0 Disease Surveillance Systems the East African Integrated Surveillance Network (EAIDSNet), Enhancement Program (REDISSE) Southern African Consortium for Infectious Disease Surveillance supported by the Bill and Melinda (SACIDS) and other data collection systems used in Partner 1"0 ,2+!1&,+ǽǾ,/)!+(Ǿ States, the EAC, and other data stored in the EAHC to generate +!1%" #,/01/"+$1%"+&+$/"$&,+) information that will enable READSCoR to reliably predict, rapidly health systems and collaboration of /" 1Ǿ+!"ƛ" 1&3")6/"0-,+!1,+! ,+1&+!&0"0",21 /"(0Ǿ disease surveillance and epidemic epidemics, and other health security threats. preparedness in West Africa. READSCoR will utilise the EAHC as a central data warehouse for aggregate and case-based data, as applicable, and create and /"Ɯ+"01+!/!"-&!"*&,),$& ))$,/&1%*01,!"1" 1-,1"+1&) threats by analysing clinical and epidemiological characteristics ))201/1&3"!11%1 ,2)! "20"! ,#,21 /"(0ǽ%"-/,$/**"4&))"+%+ ""5&01&+$02/3"&))+ " #,/,ǿ tools in the region or deploy novel tools as needed to standardise • Case incidents data collection for analysis, for which the EAHC will also provide • Supplies and stock-outs technical assistance. • Weather patterns ,4&))-/1+"/4&1%("601("%,)!"/011%" +! • Behaviour patterns Africa CDC to assist with the development of algorithms and the • Agricultural and livestock abnormalities creation of alert and response activities.

49 Health Programme 4: Telemedicine Networks for East African Tertiary (NEAT) Healthcare Services

OVERVIEW This health programme will implement telemedicine to link East *- 1"!21 ,*" ,)0ǿ #/& +"+1/"0,#5 "))"+ "ț,Ȝ+!0-" &)&0"!%")1% /" • Supports access and continuity facilities with other health and academic facilities across the of care across the region region. The networks will provide advanced and specialised • Allows resources to be shared healthcare services and provide continuous medical education to across the region remotely health workers in the region. • Supports training of health workers remotely IMPLEMENTATION VALUE Supporting Workstreams: CoE have been set up across the region to provide specialised 1/1"$6+! +3"01*"+1: Helps to care to patients based on their relative areas of strength. However, identify sustainable operating models CoEs are currently working in relative isolation. The Telemedicine for the telemedicine network through NEAT Healthcare Services programme aims to link CoEs and their private sector engagement specialists to address the need for timely, high-quality specialty medical care in countries where such specialists may be lacking. 1+!/!0+! +1"/,-"/ &)&16: Services will include patient care, education, research, and public Establishes standards for care and data health consultation and training. sharing ,)& 6Ǿ"$&0)1&,+Ǿ+!,*-)&+ ": IMPLEMENTATION APPROACH Supports data sharing for patients seek- This health programme will start by connecting CoEs with one ing care another across the region, enabling medical practitioners to ,1"+1&)ƛ& &"+ &"0+! ,+02)1+!0%/""5-"/1&0"ǽ+ " ,++" 1&,+0/""01 )&0%"!Ǿ /1+"/0%&-0ǿ1&)&0&+$"5&01&+$,Ǿ operational and in use, the implementation can move into a and relevant grants to support their second phase in which specialised healthcare facilities across build, across the region the region will be linked with selected healthcare facilities within " %/1+"/11"ǽ +1%"1%&/!-%0"Ǿ1%&0)&+("51"+!01,,1%"/%")1% /"# &)&1&"0 /,001%"/"$&,+ǽ%&04&)) enable CoEs to provide tertiary health services to facilities that lack the capacity to deal with emerging health conditions such as NCDs and (re)emerging diseases. While establishing these networks, emphasis will also be put on transforming the CoEs into digital-driven training and research centres to provide state-of-the-art 1/&+&+$1,+"51Ȓ$"+"/1&,+%")1%-/,#"00&,+)0+!1, ,+!2 1/"0"/ %ǽ The health programme will closely work with the East African CoEs, the Partner States, and EAC Institu-tions to develop the programme. It will also work with Partner States to identify other activities being conducted in 1%&00- "1,"&1%"/)"/+,/)"3"/$"#/,*1%"&/"5-"/&"+ "ǽ

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,&+&,*"!& )+$&+""/&+$Ǿ " ")1%+! ")1% "% &)&11&,+ &"+ "0 ,#,/ &+"0Ǿ ,#,//!&,30 2)/ **2+&71&,++! ")1% &"+ "0Ǿ 2--)6%&++$"*"+1Ǿ +&1"!"-2 )& "-2 )& ,#4+! ,#+7+&

50 Programme 5: East African Academy for Community Health (EAACH)

OVERVIEW *- 1"!21 ,*" ,)0ǿ This health programme will establish the East African Academy • Builds capacity of community for Community Health (EAACH), a community platform for health workers improving health awareness and education to increase • Support public education and EAC citizen’s ownership of the health agenda and their own awareness among communities wellbeing and provide training for community health workers • Capacitates health workers to (CHWs). + better identify public health emergies and outbreaks IMPLEMENTATION VALUE Supporting Workstreams: The EAACH aims to make EAC citizens responsible for their ,/(#,/ "ǿ Supports the integration own health, and for the health of their communities. The of digital learning tools into health connection between care and timely continuing education is a worker training and the harmonisa- key element of an integrated healthcare system. It is important tion of digital health training curricu- for communities to be well equipped to manage their own lum health. The EAACH will be designed with the recognition that citizen participation is central to the promotion of sustainable ,1"+1&)ƛ& &"+ &"0+! community health and healthcare. The academy will bring /1+"/0%&-0ǿ Leverage lessons from awareness, ownership, and skilled CHWs to the community. Last Mile Health’s Community Health Academy in West Africa Implemented as a technological-driven learning platform, the EAACH will equip communities with the ability to prevent and Learn from ongoing eLearning pro- manage diseases and provide education on disease prevention grammes in Partner States (e.g., the 1%/,2$%1%"1" %&+$,## 1,/01%1&+Ɲ2"+ "&))%")1%+! CHWs eLearning pilot implementation health conditions. It will serve as a community platform for in Rwanda better understanding and learning about health matters in the region.

IMPLEMENTATION APPROACH This health programme will oversee the establishment of a digital technology platform to support strong +!"ƛ& &"+1-/&*/6+! ,**2+&16%")1%0"/Ȓ3& "00 0&0#,/ 2/1"%")1%!1$"+"/1&,++! 1/+0*&00&,+Ǿ"ƛ& &"+1!&0"0"002/3"&))+ "ț"ǽ$ǽǾ&+#" 1&,20!&0"0"0ǾǾ/"Ȓ+!Ȓ"*"/$&+$!&0"0Ȓ"0Ȝ+! "ƛ" 1&3"%")1%-/,*,1&,+ǽ%" !"*64&))#, 20,+"!2 1&,++!4/"+"00,#"+1&/" ,**2+&1&"0 and train CHWs, as the frontline health work-force, to be responsible for promoting, addressing, managing community health conditions, and reporting on health matters to the appropriate channels. EAACH will work together with other organisations conducting similar initiatives (e.g., Last Mile Health).

51 Programme 6: EAC Regional Health Observatory (RHO)

OVERVIEW *- 1"!21 ,*" ,)0ǿ This health programme will set up the EAC Regional Health • Track regional health priority 0"/31,/6ț ȜǾ4%& %%0 ""+&!"+1&Ɯ"!0-/&,/&16 indicators to drive the health #,/1%"ț0""-$"Ǘ7Ȝǽ 14&))-/,3&!" ,+0,)&!1"!3&"4 agenda of regional health and highlight trends using core indicators, database views, publications, information products, and other Supporting Workstreams: evidence-driven knowledge management platforms. It will +#/01/2 12/"ǿ Provides underlying in- serve as an EAC regional resource for monitoring and evaluating frastructure for programme to operate regional health. 1/1"$6+! +3"01*"+1ǿHelps to identify sustainable operating models IMPLEMENTATION VALUE for the cloud infrastructure through 0&+$!1 ,))" 1"!Ǿ1%" 4&))*,+&1,//"$&,+)%")1% private sector engagement -/&,/&1&"0ǽ 14&)) ,+1/& 21"1,1%"&!"+1&Ɯ 1&,+,#$-0+! ,1"+1&)ƛ& &"+ &"0+! opportunities for health research and development priorities. /1+"/0%&-0ǿCoordinate with It will support coordinated actions on health research and /1+"/11"0+!1%" 1,)"/+ development in ways that are aligned with regional public health #/,*"5-"/&"+ ",#0"11&+$2-+- !"*+!0+!+""!0ǽ,!,1%&002 "00#2))6Ǿ1%" 4&))ǿ tional (e.g., Kenya) and global health • 1%"/Ǿ+)60"Ǿ06+1%"0&0"Ǿ0%/"Ǿ+!21&)&0".2)&16 observatories. information on health and health services. • Take social relationships and sociological factors into account including cultural, economic, geophysical, and geographical factors. • ,+&1,/%&$%Ȓ)"3")%")1%"3"+10+!1/"+!020&+$, '" 1&3"0+!3"/&Ɯ )"*"1%,!0+!00"00-/,$/"00 towards agreed-upon health-related targets and provide empirical evidence for monitoring and evaluating the population health situation of the region.

IMPLEMENTATION APPROACH %" 4&))20"1%" +!4,/(4&1%/1+"/11"01,, 1&+ "001,/")"3+1 ,2+1/6!10,2/ "0Ǿ (e.g., routine HMIS) and data in the EAC Data Ware-house, master facility lists, and statistical databases that include aggregate demographic data. The EAHC will facilitate analysis of cross-country data sources through 01+!/!&01&,+,#!1+! /"1&,+,#!1 0"3&"401,# &)&11".2"/&"0 61%" ǽ 2/1%"/1" %+& ) assistance will be provided to improve each Partner State’s data systems to capture standardised data that allows for more comprehensive analyses of regional health indicators. %" 4&)) ",/$+&0"! 6-/&,/&16%")1%1%"*1& /"0ǽ21-2104&))&+ )2!"/,21&+"/"-,/10+!,1%"/ information products such as objective recommendations to harmonise quality and access to care across EAC Partner States. Technical briefs and recommendations will be generated to support decision making and information products will be published and disseminated via the EAHC knowledge repository, further driving 2-1(",#1%" 0 "+1/)-)1#,/*#,/!1+!(+,4)"!$"ǽ+ *!"2-,#&+1"/+1&,+)+! /1+"/11""5-"/104&))!3&0",+-/&,/&1&"0#,/+"4%")1%&+3"01*"+10 0"!,+&+#,/*1&,+-/,3&!"! 6 1%" ǽ%"4&)))0, ,+1/& 21"1,$), )(+,4)"!$" 6 ,)) ,/1&+$4&1%,1%"//"$&,+),/&+1"/+1&,+) ,!&"0+!,/$+&01&,+02+!"/Ȓ1(&+$0&*&)/&+&1&1&3"0ț"ǽ$ǽǾ ), ) ")1% 0"/31,/6Ǿ#/& Ȝǽ

52 Programme 7: Knowledge Management and Peer Learning

OVERVIEW *- 1"!21 ,*" ,)0ǿ %&0%")1%-/,$/**"4&))02--,/1,+$,&+$"ƛ,/10 //&"! • Learnings shared through the out by the EAHRC in areas of peer learning and knowledge platforms can cover any area of the management in the region. outcome goals

IMPLEMENTATION VALUE By creating a platform for the sharing of knowledge across the region, this health programme will provide Partner States with + the ability to learn about and apply lessons and tools already developed by others in the region, avoiding duplication of Supporting Workstreams: "ƛ,/10ǽ 14&))0"/3"0%2 #,/-/,*,1&+$4,/( "&+$!,+"&+ +#/01/2 12/"ǿ Provides underlying in- the region, sharing evidence generated by the Digital REACH frastructure for programme to operate Initiative and other health research, supporting capacity building )),1%"/4,/(01/"*0ǿ "+"/1"!1 of future health professionals and researchers, and using and knowledge that can be shared digital technology to disseminate and manage health related through these platforms and networks information in the region. ,1"+1&)ƛ& &"+ &"0+! /1+"/0%&-0ǿ"3"/$""5&01&+$ 1&3&- IMPLEMENTATION APPROACH ties being carried out by the EAHRC. Work will be divided into two categories: peer learning and knowledge management.

""/"/+&+$+!"14,/()1#,/*0 This area of work will connect researchers, government leaders, and health professionals across the region to provide a forum for decision making and learning.

PLATFORM DESCRIPTION

,2+$01#/& + %&0#,/2**"+1,/0+"51Ȓ$"+"/1&,+%")1%)"!"/01%/,2$%01/2 12/"!--/, %20&+$ ")1%"0"/ % !&$&1)1" %+,),$6Ǿ4,/(0%,-0Ǿ+!*"+1,/&+$ǽ40)2+ %"!&+ǗǕǖǝ+!&0 "&+$ &"+1&010ȉțȜ implemented by the EAHRC. ,/2*

01#/& + This forum brings together East African government leaders and parliamentarians from the ,3"/+*"+1"!"/0Ǿ EAC Secretariat and Partner States, members of the East African Legislative Assembly (EALA), "$&0)1,/0Ǿ+! and Partner State judiciary systems, with the aim of sharing information on pertinent health "$)5" 21&3"0ȉ issues, gaining consensus, and making collective decisions on the best path forward. ")1%ț Ȝ ,/2*

01#/& + ")1% The biennial EAHSC, coordinated by the EAHRC, strengthens regional cooperation in health +! &"+1&Ɯ in line with the articles of the Treaty for the establishment of EAC and relevant provisions of ,+#"/"+ " (EAHSC) the EAC Common Market Protocol. It brings together stakeholders of the health sector from țǾ01#/& +"$&0)1&3"00"* )6Ǿ01#/& +,2/1,# 201& "Ǿ*"* "/0 of the EAC council of ministers, members of the summit, and EAC institutions); EAC Partner 11"0&+ )2!&+$*&+&01"/0,#%")1%ǾƜ++ "Ǿ%&$%"/"!2 1&,+Ǿ0 &"+ "+!1" %+,),$6Ȁ *"* "/0,#-/)&*"+1#/,*+1&,+)00"* )&"0Ȁ$,3"/+*"+1,ƛ& &)0Ȁ/"0"/ %"/0Ȁ scientists; practitioners; civil society; media; development partners; and the general public.

53 +,4)"!$"+$"*"+1)1#,/*0 This area of work will implement regional knowledge management platforms that allow capturing, !&01/& 21&+$Ǿ+!"ƛ" 1&3")620&+$(+,4)"!$" ,21%")1%-,)& 6Ǿ$,3"/++ "Ǿ+!0"/3& "0&+1%"/"$&,+ǽ%" platforms listed below can also be used as a vehicle for disseminating and socialising evidence generated through the Digital REACH Initiative.

PLATFORM DESCRIPTION

01#/& +" The web portal www.eahealth.org will be a comprehensive single-point-of-access ,/1)ǿ knowledge management platform for EAC health information. It will be dynamic and %",ƛ& &) interactive with an intuitive interface that allows users to browse through categories of comprehensive health information that range from healthcare services, academics, research, databases, compendium of %")1%&+!& 1,/0Ǿ*"!& )&+!201/6Ǿ-/,Ɯ)",#%")1%+!/"0"/ %-/,#"00&,+)0Ǿ', health information in opportunities, and the mapping of health and health research capacity. The web portal East Africa aims to improve the accessibility and utilisation of health services, medical products, and study and career opportunities for the citizens of East Africa. The portal will also provide the global citizenry with a one-stop centre for comprehensive health information about East Africa. Health journals, news, events, conferences, and %")1%Ȓ/")1"!0, &)*"!&4&)) "3&) )"1%/,2$%1%"-,/1)ǽ--,/12+&1&"01,21&)&0" 1" %+,),$61,02--,/121,*1"!(+,4)"!$"*+$"*"+14&)))0, ""5-),/"!ǽ

EAHRC JOURNALS

01#/& + ")1% %" #, 20"0,+01/"+$1%"+&+$+1&,+)+!/"$&,+)%")1%-,)& 6+!-/ 1& "Ǿ!"3"),-&+$ "0"/ % ,2/+) %2*+/"0,2/ " - &1&"0+!0(&))0Ǿ-/,*,1&+$"5 %+$"+!!&00"*&+1&,+,#%")1%/"0"/ % (EAHRJ): The Basis information, advocating for evidence generated from health research, and accessing research and for Better Policy and 0 &"+1&Ɯ 4,/(#/,*01#/& ǽ Practice The journal aims to represent the East African perspective on the health sector and provide information that is relevant to the EAC. It will be an engine for knowledge production and dissemination and provide a forum for sharing ideas and knowledge in the region. It will also 0"/3"0+3"+2"#,/ ),0&+$1%"Ȉ(+,4)"!$"$-ȉ&+%")1%/"0"/ %1%1"5&010 "14""+ high-income countries and LMICs. Creating a forum for researchers from EAC to be more visible globally will enable scholarly recognition of professionals and institutions and support the career development of health research professionals, contributing to the economic and social development of the region. &+))6Ǿ 602--,/1&+$%")1%/"0"/ %Ǿ1%" 4&)) " )"1,-/,3&!"!&/" 1&,+ 0"!,+ evidence for the setting of health research priorities in the region.

01#/& &"+ " EASci aims to contribute to the economic and social development of the EAC through research (EASci): Search, innovation and development in health by representing East African innovations in the health Discover, Develop sector. The EASci will serve as a forum for sharing innovations and knowledge in heath through research, discovery, and development of solutions to priority EAC issues. It will focus on showcasing research and technology innovations in health, health research and development in the region. By doing this, the EASci will serve as a catalyst for innovation and use of science and technology including digital health technologies and solutions and guiding the development of products and services in health that harness the advancement of science and technology.

54 Programme 8: Regional Technical Assistance for Digital Health

OVERVIEW *- 1"!21 ,*" ,)0ǿ EAC Partner States have requested aid to provide additional • Technical assistance provided can and complementary support to country-level digital health cover any area of the outcome goals &*-)"*"+11&,+0ǽ ")1%/,$/**"ǝ0"102-#2+!4%"/" 6 Partner States can apply to receive technical assistance directly from the Digital REACH Initiative. %&)"&1&0!&ƛ& 2)11,-/,'" 14%1(&+!,#02--,/1&0+""!"!Ǿ + the purpose of this health programme is to create a fund and *" %+&0*1,-/,3&!"0-" &Ɯ !&$&1)%")1%Ȓ/")1"!02--,/11, Supporting Workstreams: each Partner State. ))4,/(01/"*0ǿ Support to Partner States supports implementation of IMPLEMENTATION VALUE assets created by all workstreams %"-2/-,0",# ")1%/,$/**"ǝ&01,-/,3&!"!&$&1)%")1% ,1"+1&)ƛ& &"+ &"0+! support to EAC Partner States in areas where there is clear /1+"/0%&-0ǿ Learnings for how to "+"Ɯ1#/,*/"$&,+)&+3,)3"*"+1ǽ%&0%")1%-/,$/**" set-up and run this fund will be taken ,ƛ"/0/1+"/11"01%",--,/12+&161,1-&+1,!&$&1) from other similar programmes (e.g., %")1%"5-"/1&0"+! /"1"+1&,+)00"101%102--,/11%" the West Africa Health Informatics implementation of the Digital REACH Initiative. This will help Team (WAHIT) programme team from to improve the enabling environment for digital health in 1%""01#/& + ")1%/$+&01&,+ East Africa and support the achievement of Digital REACH’s ț Ȝǽ outcome goals.

IMPLEMENTATION APPROACH Partner States will apply for support in areas where regional involvement brings the highest value, and not on /"01%1 ,2+1/&"0 +&*-)"*"+1,+1%"&/,4+ǽ%/""16-"0,#02--,/1%3" ""+&!"+1&Ɯ"!ǿ01/1"$6+! advocacy, implementation and management, and optimisation and institutionalisation. ,"+02/"#&/+"00*,+$01/1+"/11"0Ǿ" % ,2+1/64&)) ")), 1"!*5&*2**,2+1,#02--,/1ǽ /1+"/11"04&))0,)& &12-1,1%1*,2+11,#2+!&$&1) +&1&1&3"01ƛ+!+6,210,2/ "!02--,/1 1%1&0+""!"!ǽ3"/1%" ,2/0",#Ɯ3"6"/0Ǿ" % ,2+1/6 +/" "&3"1,1),#ʏǘ*&))&,+Ǿ4%& % + " spent in any of the three support types. Partner States will submit a request for support in collaboration with 1%" ")1%/,$/**"ǝ ,,/!&+1,/0ǽ Learnings for how to set-up and run this fund will be taken from the West Africa Health Informatics Team ț Ȝ-/,$/**"1"*#/,*1%""01#/& + ")1%/$+&01&,+ț Ȝǽ 5*-)"0,#1%"16-",#02--,/1+!1%""01&*1"! ,01000, &1"!4&1%" %16-"/"0%,4+&+1%"1 )" "),4ǽ%""5*-)"0-/,3&!"!/"+,1"5%201&3"Ǿ+!&1&0"5-" 1"!1%1,3"/1%" ,2/0",#1%"Ɯ3"6"/0+"4 /"04&)) "&!"+1&Ɯ"!11%"/".2"01,#/1+"/11"0ǽ

55 )"ǜǿ ")1%/,$/**"ǝȕ2--,/16-"0Ǿ5*-)"0Ǿ+!01&*1"!,01

TYPE ILLUSTRATIVE EXAMPLES OF SUPPORT ESTIMATED COST ($USD)

1/1"$6+!!3, 6 • Development of standards and policies for digital health that ʏǗǚǕǾǕǕǕ align with regional objectives • Development of a strategy for electronic patient record implementation • Academic curriculum development and aligning accreditation • Update of country digital health plan • Technical assistance for the development of strategies for private sector engagement • Support with change management and business process engineering for digital health implementations

*-)"*"+11&,++! • Technical assistance for country implementations that use shared ʏǜǚǕǾǕǕǕ +$"*"+1 regional assets or provide a model that can be replicated by other Partner States • Implementation support for national ID that aligns with a regional unique ID • Implementation support for telemedicine infrastructure across Partner States for remote medical consultations • Local capacity building for areas that align with Digital REACH Initiative workstream activities

-1&*&01&,++! • Capacity building for a new workforce in digital health, including ʏǚǕǕǾǕǕǕ +01&121&,+)&01&,+ education and training at the university level and through peer- learning and sharing • Support for interoperability and standards creation in ways that support regional interoperability

1&0&*-,/1+11,+,1"1%1(+,4)"!$"1/+0#"/4&)) "+"5-)& &1-/1,#))02--,/1-/,3&!"!2+!"/ ")1% /,$/**"ǝǽ%&0&0"00"+1&)#,/0201&+ &)&16,#&*-)"*"+11&,+0+!&0&*-,/1+1#,/ - &16 2&)!&+$ in the region. Knowledge transfer mechanisms should be suggested by Partner States when they apply for 02--,/12+!"/ ")1%/,$/**"ǝǾ+!(+,4)"!$"1/+0#"/-)+4&)) "-/1,#1%"$/+1 ,+1/ 1ǽ /+104&)) "*+$"!+!,3"/0""+ 61%"%")1%-/,$/**"1"*ǽǔ!14&)) " ,))" 1"! 61%" 4,/(01/"*1"*+!0%/"!4&1%,/(01/"*ǖ#,/+)60&0ǽ+ "4/!"!$/+1Ǿ/1+"/11"0*201 adhere to the M&E requirements for continuation of the grant.

56 Programme 9: Innovations in Health

OVERVIEW *- 1"!21 ,*" ,)0ǿ %&)"*,01%")1%-/,$/**"04&))"*-%0&0""ƛ" 1&3"20" • Innovations implemented can impact ,#1"01"!1" %+,),$&"0Ǿ ")1%/,$/**"Ǟ4&))0"12- any of the outcome goals group dedicated to understanding and piloting new potential applications of technology for health. Where appropriate, this group will also support the integration of those technologies &+1,0-" &Ɯ 1&3&1&"0+!-/,$/**"0 /,001%" +&1&1&3"+! + advise on the degree to which they should be used. Supporting Workstreams: IMPLEMENTATION VALUE )) ")1%/,$/**"0ǿ "+"/1"0 &3"+1%"1"+Ȓ6"/1&*"#/*",#1%&0 +&1&1&3"+!1%"/-&!)6 evidence of innovative technologies changing technology landscape, it is critical that Digital REACH that can support the implementation keep up to date on the latest technological innovations and the of all health programmes &*- 1&1 +%3",+/")&0&+$"ƛ& &"+ &"0&+1%"%")1%0" 1,/ǽ ,1"+1&)ƛ& &"+ &"0+! Designed to function like an incubator, this health programme /1+"/0%&-0ǿ 2+ 1&,+)&("01/1Ȓ will actively integrate technologies into selected test up with a small, lean team overseeing implementations. It will support the design of and provide select pilot implementations funding for innovative implementations, testing potential Identify opportunities for coworking "ƛ& &"+ &"0#,/1%"%")1%0" 1,/+!,1%"/%")1%-/,$/**"0ǽ spaces within EAC institutions or in the region IMPLEMENTATION APPROACH Coordinate on incubating digital health Suggestions for new technology implementations will be with EAC Institutions, the East Afri- /" "&3"!+!/"3&"4"! 61%" ")1%/,$/**"Ǟ4,/(01/"* can CoE for eHealth in Rwanda, and governance group through a joint submission by a Partner Science and Technology institutions in State Ministry of Health or ICT and other Digital REACH Initiative EAC Partner States workstreams. Up to two new concepts per year will be selected. %" ")1%/,$/**"Ǟ1"*4&))1%"+!"0&$++!1"011%" ,+ "-1,3"/14,Ȓ6"/-"/&,!ǽ"-"+!&+$ on the concept, implementation can be done in collaboration with Partner States or at the regional level in collaboration with other implementations being carried out by Workstream 2. The following approaches will be part of this programme’s work: • , 201+! ,+1&+2,20ǔǿ Implementations will be subject to robust M&E to test and measure their success. If, following a successful implementation, a technology is deemed scalable, applicable, and successful, it will be integrated into other Initiative-backed health programmes and workstreams. Partner States will have the opportunity to provide feedback on the innovative implementations to build the evidence base. A mechanism for standardising the collection and dissemination of evidence from &*-)"*"+11&,+04&)) "!"3"),-"!1,)),4#,/ ,*-/ )"&+0&$%10 /,00Ɯ+!&+$0ǽ &+!&+$04&)) " published in in peer-reviewed journals (e.g., the EASci). • &0(Ȓ1(&+$ 2)12/"ǿ ")1%/,$/**"Ǟ4&))"+ ,2/$"/&0(Ȓ1(&+$+!&++,31&3" 2)12/"4&1%&+&10 team. Success will not be measured by the number of successful implementations but by the evidence collected and the lessons learned. • /,3"+1" %+,),$&"0ǿ,*5&*&0"1%"-,1"+1&)#,/&*- 1Ǿ1%"$/,2-4&))-/&,/&1&0"1" %+,),$&"01%1 %3"-/,3"+ &)&161,0 )"&+,1%"/ ,+1"510ǽ • "/&,!& 00"00*"+10ǿ: The group will develop a plan for running nine health programmes which will include an initial assessment of the technology landscape, followed by annual refresher assessments.

57 POTENTIAL APPLICATIONS OF TRANSFORMATIONAL TECHNOLOGIES FOR HEALTH ,*""5*-)"0,#&++,31&3"--)& 1&,+0,#1" %+,),$6&+%")1%/")&01"!&+1%"1 )" "),4ǽ%&0)&01,ƛ"/0 potential targets for early implementation, starting with technologies that have been proven elsewhere, &+ )2!&+$$), )$,,!0 "&+$!"3"),-"!2+!"/&$&1).2/"1,/"!2 "1%"/&0(,#Ȋ-&),1&1&0ȋȕ1%"&+ &)&161, break out of pilot stage — and stretching resources too thin.

)"ǝǿ5*-)"0,# ++,31&3"--)& 1&,+0,#" %+,),$6#,/ ")1%

INNOVATION GOOD FOR… ESTIMATED COST

&$1+)61& 0 • Automating data mining and modelling for early disease outbreak ʏȒʏʏ alerts ș,+&1,/&+$#,/!&0"0"02/3"&))+ "/"!Ɲ$0 • Tracking travel pattern trends and linking to disease outbreaks • Tracking of online health information-seeking behaviour among citizens

), ( %&+ ș)&!1&+$1%"!")&3"/6,#-%60& )+!+,+Ȓ-%60& )00"101" % ʏʏ stage to the end user (supply chain management) • Streamlining procurement activities through smart contracts • Creating an indelible record and audit trail (medical health record)

+1"/+"1,#%&+$0 - Tracking smaller physical assets moving through delivery systems ʏȒʏʏ ț ,Ȝ - Monitoring the state of target goods and structures through sensors, over time

, &)",+"6 • Insurance premium payments ʏȒʏʏ

-1&)+)60&0 • Modelling predictive risk for surveillance and response ʏ

, &)"!& ș,+&1,/&+$/"!Ɲ$0#,/!&0"0",21 /"(0 ʏȒʏʏ ț%10--Ǿ " ,,(Ǿ • Engaging citizens directly for outreach and public health messaging 4&11"/Ȝ ș,)& &1&+$0-" &Ɯ #""! (-/, 1&3")6,+-/,$/**""5-"/&"+ "

Costs shown in US Dollar estimates: $ (10,000 - $99,000), $$ (100,000 - $999,999) ,1"ǿ &3"+1%"/-&!)6 %+$&+$1" %+,),$6)+!0 -"Ǿ1%&000"00*"+10%,2)! "/"+"4"!"3"/66"/,+ " ")1%/,$/**"Ǟ%0 ""+)2+ %"!ǽ

58 CREATING AN ENABLING ENVIRONMENT THROUGH THE DIGITAL REACH INITIATIVE

WORKSTREAM 3: INFRASTRUCTURE WORKSTREAM 4: SERVICES AND APPLICATIONS WORKSTREAM 5: LEADERSHIP AND ADVOCACY WORKSTREAM 6: STRATEGY AND INVESTMENT WORKSTREAM 7: LEGISLATION, POLICY, AND COMPLIANCE WORKSTREAM 8: WORKFORCE WORKSTREAM 9: STANDARDS AND INTEROPERABILITY

59 ESTABLISHING FOUNDATIONAL TECHNOLOGY COMPONENTS

WORKSTREAM 3: INFRATRUCTURE

60 WORKSTREAM 3: INFRASTRUCTURE

OVERVIEW The Infrastructure workstream will develop the foundational ,1"+1&)ƛ& &"+ &"0+! technical components and global goods needed to support all other /1+"/0%&-0ǿ workstreams in the Digital REACH Initiative. The workstream creates Identify sustainable operating the foundation for a regional approach to digital health through the models for the cloud infrastructure building and facilitation of improved connectivity and digital health through private sector engagement infrastructure, allowing for timely data access and sharing and ,,(1,-"+ *-)"*"+11&,+ enabling services and applications to function. It also includes the 2&!"01,02--,/1 2&)!+!/,))Ȓ technical support required to maintain systems over time. out of assets

GOALS The overall goal of this workstream is to identify, build, host, and implement common technological components and systems that will allow other workstreams and health programmes to achieve the Digital REACH Initiative’s outcome goals.

STRATEGIES AND GUIDELINES FOR IMPLEMENTATION This workstream will be responsible for establishing the technological infrastructure and platforms that 02--,/11%" +&1&1&3"ȉ04,/(ǽ%"/"-,00& )"Ǿ1%&04,/(01/"*4&))*("02/"1,21&)&0""5&01&+$&+#/01/2 12/" 1%1)/"!6"5&010&+1%"/"$&,++! /,00/1+"/11"0ǽ + 0"04"/"02 %&+#/01/2 12/"!,"0+,1)/"!6 "5&01Ǿ+"4&+#/01/2 12/"4&)) " 2&)1ǽ !"2-,#"+$&+""/0Ǿ0,ƞ4/"!"3"),-"/0Ǿ+!1" %+,),$&010Ǿ1%"1"*4&))4,/( ),0")64&1%/")"3+1 -/1+"/,/$+&01&,+0&+1%"!"3"),-*"+1 ,**2+&16+!1%"-/&31"0" 1,/Ǿ/1+"/11",ƛ& &)0Ǿ+!,1%"/ workstreams to provide and build the infrastructure needed to support the Initiative’s outcome goals. The 4,/(01/"*1"*4&)))0,-/,3&!"-,,)"!1" %+& )"5-"/1&0" /,00/1+"/11"01, 2&)!+!02--,/1 Digital REACH Initiative platforms. %"1"*4&)))0,4,/(4&1%1%"1, ,,/!&+1"4&1%,1%"/4,/(01/"*0+!&!"+1&+#/01/2 12/)+""!0 and services (e.g., hosting, data security, integration, technical support). The following are strategic guidelines for the operationalisation of this approach: • , 20,+1%"!"3"),-*"+1+!!,-1&,+,# ,+0&01"+1Ǿ&+1"/,-"/ )"1" %+,),$&"0+!,-"/1&+$*,!")0 across Digital REACH activities and encourage Partner States to adopt similar technologies and models. • Establish a trusted, regional hosting environment and secure data access a portal with appropriate regional and national cybersecurity policies, standards, and safeguards. • Develop regional platforms and services for prioritised regional and national use cases, promoting common applications and global goods where appropriate. • *-)"*"+1-,,)"!0,ƞ4/""+$&+""/&+$02--,/1+!/"$&,+)ǗǙȒ%,2/1" %+& )02--,/1+!"01 )&0% *&+1"++ "$2&!")&+"0#,/0,ƞ4/"+!%/!4/"ǽ • Implement with sustainability in mind, so that relevant infrastructure can remain in place and be improved and adapted in the long term. • -"/1&,+0+!02--,/1,#1" %+,),$&"00%,2)! ,*-)64&1%1%"/&+ &-)"0#,/&$&1)"3"),-*"+1+! +,1 " ,2+!1,0-" &Ɯ 3"+!,/0Ǿ)),4&+$-/,#"00&,+)0"/3& "01, ", 1&+"!#/,**2)1&-)"-/1+"/01, prevent vendor lock-in. • Work with relevant workstreams, including Legislation, Policy, and Compliance and Standards and Interoperability, to create an enabling environment for data to be hosted in the regional cloud, including data protection. • Work in support of the health programme workstream by providing technical assistance and by prioritising infrastructure based on health programme implementation needs.

61 IMPROVING HEALTHCARE THROUGH INFRASTRUCTURE

INFRASTRUCTURE PRIORITY ACTIVITIES PARTNER STATE ROLE Key OPTIMISE THE PREVENTION, țǗǕǖǞȔǗǕǗǘȜ DIAGNOSIS, AND TREATMENT OF PRIORITY HEALTH CONDITIONS

SUPPORT UNIVERSAL ACCESS TO 3.1 Build the EAHC and set up a regional • Agree on information to be HEALTHCARE IMPROVE HEALTH WORKER support team to maintain it over time uploaded to the digital health EDUCATION AND TRAINING to enable real-time storing, capturing, regional services cloud OPTIMISE HUMAN RESOURCE ALLOCATION AND MANAGEMENT analysing, and retrieving of health data • Revisit national ICT strategies and IMPROVE DISEASE SURVEILLANCE AND RESPONSE on priority diseases and outbreaks, and guidelines and provide an enabling IMPROVE SUPPLY CHAIN to support health research framework that allows for the EFFICIENCY + ENHANCE PUBLIC HEALTH sharing of up-to-date information to EDUCATION AND AWARENESS the regional cloud and the adoption 3.2 MONITOR POPULATION HEALTH Select and implement foundational STATUS + and use of regionally hosted ALL OUTCOME GOALS technologies to enable regional components &+#,/*1&,+"5 %+$"ț"ǽ$ǽǾ "14""+ EAHC and other regional and • Set aside resources for maintenance Partner State HIS) including a client of platforms in national budgets registry, terminology services, and • Contribute to the development, interoperability layer adoption, and use of platforms through the contribution of resources and content and the integration of national systems

%"-/&,/&1&"0)&01"!%"/"4&)) "/"3&"4"!++2))6 6,/(01/"*ǖ+!&10-/1+"/0ǽ!!&1&,+) 1&3&1&"0 #,/1%&04,/(01/"*1%1 + "1/$"1"!1)1"/01$"0 + "#,2+!&+--"+!&5ǽ%"0-" &Ɯ 0(&))0+! - &)&1&"0/".2&/"!#,/1%&04,/(01/"* + "#,2+!&+--"+!&5 ǽ &3"+1%"-/&,/&16,#1%" #2/1%"/ !"1&),+0-" &Ɯ &*-)"*"+11&,+ 1&3&1&"0,+ "1%"&$&1) +&1&1&3"&0)2+ %"! + "#,2+!&+ --"+!&5 ǽ 2/1%"/!"1&),+1%"*+$"*"+1+!,-"/1&,+0,#1%&04,/(01/"*Ǿ&+ )2!&+$,/$+&01&,+01/2 12/"0Ǿ /"0-,+0& &)&16/"0Ǿ("6-"/#,/*+ "&+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ activities can be found in the &$&1) +&1&1&3",/(01/"*,*-"+!&2*.

62 SUPPORTING THE ACCESS, EXCHANGE, AND MANAGEMENT OF DATA AND CONTENT

WORKSTREAM 4: SERVICES AND APPLICATIONS

63 WORKSTREAM 4: SERVICES AND APPLICATIONS

OVERVIEW "Ɯ+&1&,+0ǿ The Services and Applications workstream will support the development of common, reusable, and interoperable digital "/3& "0can be provided by the solutions and global goods for regional and national use. It government or the private sector (e.g., supports the products and services that provide tangible means 0,ƞ4/"00"/3& "Ǿ!1+)60&0Ȝǽ #,/"+ )&+$!&$&1)%")1%0"/3& "0+!0601"*01,"5 %+$"+! --)& 1&,+0 include point-of-care manage information and content. 0601"*020"! 6%")1%01ƛ1,!")&3"/ care. GOALS 0"/0include the general public, patients, and health and insurance The overall goal of this workstream is to design, make available, providers. foster, and invest in the use of shared services and applications that are built for regional and national use in ways that support the achievement of Digital REACH Initiative’s outcome goals and associated health programmes.

STRATEGIES AND GUIDELINES FOR IMPLEMENTATION ,1"+1&)ƛ& &"+ &"0+! /1+"/0%&-0ǿ !"2-,#"+$&+""/0Ǿ0,ƞ4/"!"3"),-"/0Ǿ+!1" %+,),$&010Ǿ the team will work with other workstreams to identify what !"+1-/,*&0&+$"5&01&+$1,,)0+! tools and services are needed to support activities and health invest in global goods that improve programme implementations. The team will work with the 1%"&/"ƛ" 1&3"+"00,/"5-+!1%"20" &$&1) +&1&1&3"1,&!"+1@%"/"&1 +)"+! cases they are currently able to serve support. Set up a community of practice to %"/"-,00& )"Ǿ1%"1"*4&))&!"+1+!)"3"/$""5&01&+$ optimise funds received, reduce assets (e.g., national assets, services and applications in place) redundant work and technology that can be used and scaled across the region and encourage fragmentation, and provide an open the use of common design principles to facilitate usability of new forum for collaboration, new partner- tools developed. ships, and sharing of knowledge and The following are strategic guidelines for the operationalisation best practices of this approach: • Implement a regional service provision team to support Utilise data available from Part- /1+"/11"0&+ ,+Ɯ$2/&+$+!20&+$/"$&,+)0"/3& "0+! ner States and the EAC on eHealth applications. readiness e.g., the eHealth Readiness • Develop guidelines for usability of regional services and 02/3"6 "&+$ ,+!2 1"! 6 applications and establish data ownership and data-sharing agreements to protect and codify allowable access of data. • %,,0" ,**,+0,ƞ4/"--)& 1&,+0ț$), )$,,!0Ȝ 0"!,+-,1"+1&)3)2"1,/1+"/11"0Ǿ+! document potential cost savings and value unlocked by their adoption. • "12-01+!/!,-"/1&+$-/, "!2/"0ț0Ȝ+!-/, "00"0#,/1%"-/&,/&1&01&,+,#0,)21&,+01,4,/(,+Ǿ /&1"/&#,/0")" 1&,+,#"5&01&+$0,)21&,+01,&+3"01&+Ǿ+!1%" /"1&,+,#0,ƞ4/"!"3"),-*"+1/,!*-0ǽ • 2--,/1/1+"/11"0&+0")" 1&+$+!01+!/!&0&+$+1&,+)20",#,-1&*)0,ƞ4/"--)& 1&,+0 #,/0-" &Ɯ 20" 0"0ț&ǽ"ǽǾ04&1 %&+$,3"/#/,*0"3"/)!&0 ,++" 1"!--)& 1&,+01,0&+$)"Ǿ0 ) )" application for which this workstream could provide better support), based on national interest. • Ensure compliance with agreed-upon data standards, align national applications to use data standards for /"-,/1&+$Ǿ+!"+ )"&+1"/,-"/ )""5 %+$",#!14&1%,1%"//"$&,+)0"/3& "0+!--)& 1&,+0ǽ • + ,2/$"/"$&,+)0,ƞ4/"0%/&+$1%/,2$%&+1"/+1&,+)&01&,+,#0,ƞ4/"+!-/,3&0&,+,#), ) translation where needed.

64 • -"/1&,+0+!02--,/1,#1" %+,),$60%,2)!+,1 " ,2+!1,0-" &Ɯ 3"+!,/0)),4&+$-/,#"00&,+) services to be obtained from multiple partners to prevent vendor lock-in. • Work with the Standards and Interoperability workstream to choose standards regionally, publish them, and support their adoption (e.g., national health indicators, diagnosis codes, patient record formats, civil registration IDs, disease surveillance alerts, process for referrals). • Work in support of the health programme workstream by providing technical assistance and by prioritising the development of services and applications based on health programme needs. • Work with the Legislation, Policy, and Compliance workstream to ensure data protection and ,+Ɯ!"+1&)&16+!1%1&+1"))" 12)-/,-"/16/&$%10/"02--,/1"!ǽ

IMPROVING HEALTHCARE THROUGH SERVICES AND APPLICATIONS

SERVICES AND APPLICATIONS PRIORITY PARTNER STATE ROLE Key OPTIMISE THE PREVENTION, țǗǕǖǞȔǗǕǗǘȜ DIAGNOSIS, AND TREATMENT OF PRIORITY HEALTH CONDITIONS

SUPPORT UNIVERSAL ACCESS TO + 4.1 Develop decision-support tools built • Share information on current tools HEALTHCARE IMPROVE HEALTH WORKER &+1,+"4,/"5&01&+$0601"*01,02--,/1 being used and help to document key EDUCATION AND TRAINING health workers dealing with cases of gaps OPTIMISE HUMAN RESOURCE ALLOCATION AND MANAGEMENT outbreaks and health emergencies (e.g., • Provide input on any functional IMPROVE DISEASE SURVEILLANCE outbreak alerts, an alert to notify the requirements for tools being invested AND RESPONSE IMPROVE SUPPLY CHAIN regional body, care instruction, alerts in and/or developed EFFICIENCY with updates to protocols) + ENHANCE PUBLIC HEALTH • Adopt and integrate with regional EDUCATION AND AWARENESS 4.2 Support and promote implementation services and applications MONITOR POPULATION HEALTH STATUS

of interoperable unique ID systems ALL OUTCOME GOALS

4.3 Support engagement with the relevant -"+ +!,1%"/$), ) ,**2+&1&"0 to leverage best practices and "51"/+)"5-"/1&0"&+1%"!"0&$++! implementation of digital health services and applications 4.4 +3"01&+0,ƞ4/"0,)21&,+01%102--,/1 the realisation of a regional digital portable health insurance product (e.g., )&*02 *&00&,+Ǿ")&$& &)&163"/&Ɯ 1&,+Ǿ mobile payments for reimbursements) 4.5 Provide support with contractual agreements with technology solutions vendors for Partner States and Digital REACH and work with Strategy and Investment team for potential group pricing discounts.

%"-/&,/&1&"0)&01"!%"/"4&)) "/"3&"4"!++2))6 6,/(01/"*ǖ+!&10-/1+"/0ǽ!!&1&,+) 1&3&1&"0 #,/1%&04,/(01/"*1%1 + "1/$"1"!1)1"/01$"0 + "#,2+!&+&+--"+!&5ǽ%"0-" &Ɯ 0(&))0+! - &)&1&"0/".2&/"!#,/1%&04,/(01/"* + "#,2+!&+--"+!&5 ǽ 2/1%"/!"1&),+1%"*+$"*"+1 and operations of this workstream, including organisation structures, responsibility areas, key performance &+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ 1&3&1&"0 + "#,2+!&+1%" Digital +&1&1&3",/(01/"*,*-"+!&2*.

65 ADVOCATING FOR DIGITAL REACH

WORKSTREAM 5: LEADERSHIP AND ADVOCACY

66 WORKSTREAM 5: LEADERSHIP AND ADVOCACY

OVERVIEW ,1"+1&)ƛ& &"+ &"0+! The activities of the Leadership and Advocacy workstream will /1+"/0%&-0ǿ be outward facing, and the workstream will interact with senior The workstream lead for Leadership ")" 1"!,ƛ& &)0+!$,3"/+*"+1!" &0&,+*("/0,+ "%)# and Advocacy will also function as of the Digital REACH Initiative. In so doing, it will collect high- 1%""!!3, 1"!2/&+$1%"Ɯ/01#"4 level feedback and rally support from key government decision years of the Initiative *("/0+!")" 1"!,ƛ& &)0#,/1%" +&1&1&3"ȉ0-/,'" 10ǽ2 % support will greatly facilitate the participation of government The workstream team will also use the ,ƛ& &)0+!,1%"/0&+1%" %+$"0 "&+$&+1/,!2 "!1%/,2$%1%" ,/2*1, ,+!2 1!3, 6 Initiative. on behalf of the Initiative

GOALS %",3"/))$,),#1%&04,/(01/"*&01,!3, 1"#,/1%"&$&1) +&1&1&3"+!0, &)&0"&10"ƛ,/10 /,00 /1+"/11"0ǾǾ" 1,/),2+ &),+ ")1%Ǿ+!1%",2+ &),#&+&01"/01,)61%"$/,2+!4,/(Ǿ remove obstacles, and garner political support for the Initiative at the Partner State and regional level.

STRATEGIES AND GUIDELINES FOR IMPLEMENTATION %&"3&+$1%"&$&1) +&1&1&3",21 ,*"$,)04&)),ƞ"+/".2&/"02 01+1&) %+$"*+$"*"+1ǽ ,)&1& )02--,/1&0+" "00/6Ɯ/0101"-1,# &)&11"02 % %+$"ǽ%""!"/0%&-+!!3, 64,/(01/"* will assist other workstreams to gain such support for activities. %&04,/(01/"*4&))1/$"1%&$%Ȓ)"3")-,)&1& )Ɯ$2/"0+!!" &0&,+*("/0ț"ǽ$ǽǾ*&+&01"/0Ǿ01ƛȜ1,)6 1%"$/,2+!4,/(#,/0-" &Ɯ -/,'" 10Ǿ ,+1&+2" ,+02)11&,+0!2/&+$1%"!"3"),-*"+1-%0"&#+" "00/6Ǿ+! conduct high-level socialisation for projects nearing completion. Digital REACH Initiative methodologies will be designed in line with EAC policies and procedures and will work through EAC channels. The following are strategic guidelines for the operationalisation of this approach: • Identify and advocate with relevant decision makers and high-level politicians. • 2&)!$,,! ,+02)11&3"/")1&,+0%&-04&1%01("%,)!"/0&+/1+"/11"0ǾǾ" 1,/),2+ &) on Health, and EAC Council of Ministers. • Build awareness of and commitment to the value of digital health amongst stakeholders. • +1"/ 14&1%01("%,)!"/0,+0-" &Ɯ !&$&1)%")1%&002"0+! 1&3&1&"0ǽ • Build agreement on approaches and collect feedback about the Initiative to ensure projects are acceptable and useful. • Work in support of the Health Programme Workstream by prioritising advocacy targets based on health programme implementation needs. • Create positive incentives for Partner States that support Digital REACH Initiative activities (e.g., highlight work and publicly acknowledge support and success stories).

67 IMPROVING HEALTHCARE THROUGH LEADERSHIP AND ADVOCACY

LEADERSHIP AND ADVOCACY PARTNER STATE ROLE Key OPTIMISE THE PREVENTION, DIAGNOSIS, AND TREATMENT OF țǗǕǖǞȔǗǕǗǘȜ PRIORITY HEALTH CONDITIONS

SUPPORT UNIVERSAL ACCESS TO 5.1 • Integrate EAC initiatives into country HEALTHCARE Advocate for agreement on data IMPROVE HEALTH WORKER sharing and storage in a regional strategies EDUCATION AND TRAINING OPTIMISE HUMAN RESOURCE cloud șƛ" 1&3")6!3, 1"#,//"$&,+) ALLOCATION AND MANAGEMENT coordination in the areas of Digital IMPROVE DISEASE SURVEILLANCE AND RESPONSE

REACH Initiative workstream activities IMPROVE SUPPLY CHAIN EFFICIENCY • Advocate with regulatory authorities 5. 2 Advocate for regional agreement on + ENHANCE PUBLIC HEALTH to provide frameworks and platforms EDUCATION AND AWARENESS health insurance portability for all to allow cross-border sharing of MONITOR POPULATION HEALTH EAC citizens STATUS information and implement by regional ALL OUTCOME GOALS 5.3 Advocate for a joint regional position agreement on approach to public health • Establish and advocate for frameworks, emergencies that strengthens the guidelines, and regulations that allow ability of national health systems to sharing and harmonisation of data respond to disease outbreaks 5.4 Advocate with development partners for reduced common set of priority reporting health indicators across all EAC Partner States to reduce data collection and reporting burden on health workersǝ 5.5 Advocate for a holistic approach to the use of digital technologies and solutions in the health sector within the EAC region

%"-/&,/&1&"0)&01"!%"/"4&)) "/"3&"4"!++2))6 6,/(01/"*ǖ+!&10-/1+"/0ǽ!!&1&,+) 1&3&1&"0 #,/1%&04,/(01/"*1%1 + "1/$"1"!1)1"/01$"0 + "#,2+!&+--"+!&5ǽ%"0-" &Ɯ 0(&))0+! - &)&1&"0/".2&/"!#,/1%&04,/(01/"* + "#,2+!&+--"+!&5 ǽ 2/1%"/!"1&),+1%"*+$"*"+1+!,-"/1&,+0,#1%&04,/(01/"*Ǿ&+ )2!&+$,/$+&01&,+01/2 12/"0Ǿ /"0-,+0& &)&16/"0Ǿ("6-"/#,/*+ "&+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ activities can be found in the &$&1) +&1&1&3",/(01/"*,*-"+!&2*.

7RDYRLGWKHULVNRIUHVWULFWLQJRSSRUWXQLWLHVIRUIXQGLQJWKLVDFWLYLW\ZLOOEHFDUULHGRXWLQSDUWQHUVKLSZLWKGHYHORS- ment partners. Once progress is made over time and buy-in for a reduced set of indicators is achieved this activity can EHPRYHGWRWKH6WUDWHJ\DQG,QYHVWPHQW:RUNVWUHDPWRGULYHLWIRUZDUG

68 NEGOTIATING ECONOMIES OF SCALE

WORKSTREAM 6: STRATEGY AND INVESTMENT

69 WORKSTREAM 6: STRATEGY AND INVESTMENT

OVERVIEW ,1"+1&)ƛ& &"+ &"0+! /1+"/0%&-0ǿ The Strategy and Investment workstream will negotiate with the private Look to best practices and sector and development partners, based on common Partner State $2&!")&+"0#/,* 01, positions and on behalf of the region, to realise economies of scale and reduce the costs of set-up and $/"1"/"ƛ& &"+ &"0ǽ operationalisation

GOALS Partner with the East African The overall goal of this workstream is to create economies of scale at ,**2+& 1&,+0/$+&0- the regional level, by obtaining access for Partner States to cheaper bulk 1&,+1,4,/(4&1%0 procurement and speaking with one voice in strategic negotiations with private sector, local industries, and development partners. "/+#/,*-01"5-"/&"+ Ȓ &+$,#4,/(&+$4&1%01, "5-+! ,++" 1&3&161%/,2$% STRATEGIES AND GUIDELINES FOR IMPLEMENTATION loss-guarantees (e.g., USAID %"4,/(01/"*4&))#2+ 1&,+0 /,2-2/ %0&+$/$+&01&,+ț ȜǾ ȉ0-/1+"/0%&-4&1% ,,$)" leveraging the economies of scale and larger market achieved through 1, /&+$Ɯ "/ /,! +!1, the regional bloc to obtain a greater negotiating position, discounts, and Monrovia) better service from vendors and development partners. It will make use of skilled business analysts and negotiators to prepare business cases, based on common regional positions, that will be used to engage with the private sector, industries and the development community on behalf of Partner States. The following are strategic guidelines for the operationalisation of this approach: • /&+$1,$"1%"//")"3+1/1+"/11",ƛ& &)0Ǿ4%,0"&+3,)3"*"+14&)) " /&1& )#/,*&+&1&)!&0 200&,+0 through to business case development and negotiation. • ,/(4&1%/1+"/11"*&+&01/&"0ț"ǽ$ǽǾ ")1%Ǿ Ǿ &++ "Ȝ1, ,*"1, ,**,+-,0&1&,+0,+4%& %1, base negotiations. • Work with the relevant government ministries in Partner States to ensure allocation of budget for procurement of negotiated goods and services by making sure that investments align with regional and Partner State priorities. • Develop business cases based on aggregate demand data collected from Partner States, and highlight "+"Ɯ10,/" ,+,*&"0,#0 )"+!/"!2 "! ,010,#/"$&,+)--/, %ǽ • 1/2 12/"-/1+"/0%&-01, "*212))6 "+"Ɯ &)4%&)"3,&!&+$!"-"+!"+ ",+0&+$)"-/1+"/#,/ 0-" &Ɯ /,)"0ǽ2&)! ,2+1 &)&16&+1,-/1+"/0%&-*,!")0ǽ • Develop clear prioritisation for investment areas based on input from other workstreams. • Negotiate with third parties using data developed through business case modelling. Partner States’ procurement regulations will be factored in to business cases and deals negotiated. • +!-/, "00+!$/""*"+10,3"/1,/1+"/11",ƛ& &)0,+ "!")0/"+"$,1&1"!Ǿ%"6/"1%" purchasing agencies. • Work in support of the Health Programme Workstream by providing technical assistance and by prioritising negotiations and investments that support health programme implementation needs. • Work closely with the Infrastructure workstream to engage closely with the private sector to develop an &+3"01*"+1*" %+&0*1%14&)))),4/1+"/11"01,"5-+! ,**2+& 1&,+&+#/01/2 12/"&+/"0 with low connectivity and negotiate and structure PPPs that can be utilised across the Initiative. • ,,(1, *,!")0&+1%"-/&31"0" 1,/#,/$2&!+ ",+0+!-,)& &"0ǽ

70 IMPROVING HEALTHCARE THROUGH STRATEGY AND INVESTMENT

STRATEGY AND INVESTMENT PRIORITY PARTNER STATE ROLE Key OPTIMISE THE PREVENTION, țǗǕǖǞȔǗǕǗǘȜ DIAGNOSIS, AND TREATMENT OF PRIORITY HEALTH CONDITIONS

SUPPORT UNIVERSAL ACCESS TO 6.1 Conduct feasibility assessment, develop ș%&ƞ#/,* &)1"/)1,/"$&,+) HEALTHCARE IMPROVE HEALTH WORKER business case, and identify opportunity negotiations on per-issue basis EDUCATION AND TRAINING for PPPs for the build and maintenance OPTIMISE HUMAN RESOURCE • Commit to using negotiated goods ALLOCATION AND MANAGEMENT

of the EAHC and NEAT and services IMPROVE DISEASE SURVEILLANCE AND RESPONSE 6.2 Conduct business case and use • Assess needs that will inform IMPROVE SUPPLY CHAIN assessments for negotiating 01/1"$61,"5-+! ,**2+& 1&,+ EFFICIENCY + ENHANCE PUBLIC HEALTH $/""*"+104&1%0#,/ƛ,/! )" infrastructures nationwide EDUCATION AND AWARENESS bandwidth and improved network MONITOR POPULATION HEALTH connectivity to support priority health • Develop business models to support STATUS programmes (starting with prioritised digital health ALL OUTCOME GOALS telemedicine-supported facilities) șƛ" 1&3")6$2&!"01/1"$6+! 6.3 Support the development of a business investment in line with local and case for regional insurance, partnering regional priorities with private health insurers for favourable premium rates and packages 6.4 Aggregate demand based on Partner States’ supply needs and develop a business case to support negotiation for reduced pricing with suppliers to reduce cost of healthcare for providers and patients

%"-/&,/&1&"0)&01"!%"/"4&)) "/"3&"4"!++2))6 6,/(01/"*ǖ+!&10-/1+"/0ǽ!!&1&,+) 1&3&1&"0 #,/1%&04,/(01/"*1%1 + "1/$"1"!1)1"/01$"0 + "#,2+!&+--"+!&5ǽ%"0-" &Ɯ 0(&))0+! - &)&1&"0/".2&/"!#,/1%&04,/(01/"* + "#,2+!&+--"+!&5 ǽ 2/1%"/!"1&),+1%"*+$"*"+1+!,-"/1&,+0,#1%&04,/(01/"*Ǿ&+ )2!&+$,/$+&01&,+01/2 12/"0Ǿ /"0-,+0& &)&16/"0Ǿ("6-"/#,/*+ "&+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ activities can be found in the&$&1) +&1&1&3",/(01/"*,*-"+!&2*.

71 ESTABLISHING COMMON GUIDELINES, POLICIES, AND PROTOCOLS

WORKSTREAM 7: LEGISLATION, POLICY, AND COMPLIANCE

72 WORKSTREAM 7: LEGISLATION, POLICY, AND COMPLIANCE

OVERVIEW The Legislation, Policy, and Compliance (LPC) workstream will develop the policies needed to support the Digital REACH ,1"+1&)ƛ& &"+ &"0ǿ Initiative and to gain policy adoption across Partner States. It "3"/$""5&01&+$-,)& &"0+!)"0- will also work with Partner States to ensure that country policies sons learned from Partner States and legislation are amended to facilitate the implementation of and use as a starting point for policy Digital REACH Initiative interventions and technologies. and legislation development where appropriate. GOALS "#"/"+ ""5&01&+$&+1"/+1&,+)$2&!"- The overall goal of this workstream is to create a policy lines, best practices, and frameworks environment across the EAC that facilitates the implementation to guide the development of policies of digital health and creates a supportive regional enabling and legislation. environment for better health infrastructure and policies. It will also support Partner States in their adoption of new policies and promote compliance across the region.

STRATEGIES AND GUIDELINES FOR IMPLEMENTATION /&1& )1,1%"02 "00,#1%"4,/(,#1%"4,/(01/"*4&)) "&10 &)&161,4,/("ƛ" 1&3")64&1%-,)& 6 ,ƛ& &)0&+/1+"/11"0ǽ%"4,/(01/"* + "0""+01%&+(1+(+!/"$&,+)# &)&11,/1%14,/(0&+ the service of creating a policy environment to promote digital health on behalf of EAC Partner States. It thus is essential that the workstream does not work in isolation. %"4,/(01/"*4&))#,/*+! "$2&!"! 6"$&,+),)& 6 1%1&0*!"2-,#4,/(01/"*02 '" 1 *11"/"5-"/10+!)"$)Ǿ%")1%Ǿ+!-,)& 6,ƛ& &)0#/,*/1+"/11"0Ǿ4%,4&)) 11,$"1%"/1,0 ,-"Ǿ+! /"3&"4-,)& &"0+!)"$&0)1&,+!/4+2- 61%"4,/(01/"*ǽ%" 4&)))0,-)6 ,*-)&+ "/,)"&+1%1&1 will review Partner State progress with implementation of agreed-upon policy and legislation. The following are strategic recommendations for the operationalisation of this approach: • ,+&1,/"5&01&+$Ǿ/")"3+1-,)& 6&+&1&1&3"0&+1%"1,)&$+4&1%1%"&/-/, "00"0Ǿ/1%"/1%+ 2++" "00/&)6 /"1&+$+"4+!-/))")-/, "00"0ǽ%"/"-,00& )"Ǿ*"+!+!%/*,+&0""5&01&+$ policies. • !"+1+!-/1+"/4&1%/")"3+1/1+"/11"-,)& 601ƛț"ǽ$ǽǾ!1-,)& 6Ǿ%")1%&+#,/*1&,+-,)& 6Ȝ and consult during policy development. • Actively focus on socialisation of new policies (e.g., with private and development sectors and EAC Partner States) so that policies are known and used. Create policies that are easy to understand and communicate to diverse stakeholders. • Support Partner States in adopting new policies and legislation. • /,*,1" ,*-)&+ "1%/,2$% ,+02)11&,+Ǿ!3, 6Ǿ+!0%,4 0&+$,#02 "00#2)"5*-)"0ǽ Dashboards could be created to allow Partner States to track and monitor their progress towards certain activities and commitments. • Work closely with the Leadership and Advocacy workstream to advocate for the adoption of new regional policies and legislation. If possible, these two workstreams will be physically located close to each other to ensure sharing of information. • Work in support of the Health Programme Workstream by providing technical assistance and by prioritising the development of policies and legislation based on the health programme.

73 Ǿ Ǿ

Ǿ Ǿ PARTNER STATE ROLE Key OPTIMISE THE PREVENTION, COMLIANCE PRIORITY ACTIVITIES DIAGNOSIS, AND TREATMENT OF PRIORITY HEALTH CONDITIONS

țǗǕǖǞȔǗǕǗǘȜ SUPPORT UNIVERSAL ACCESS TO HEALTHCARE

IMPROVE HEALTH WORKER 7.1 Design policy, legislation, and • Contribute to development of regional EDUCATION AND TRAINING and country policies and legislation OPTIMISE HUMAN RESOURCE regulatory frameworks around ALLOCATION AND MANAGEMENT remote data hosting (including data • Implement common policies, IMPROVE DISEASE SURVEILLANCE AND RESPONSE -/&3 6+! ,+Ɯ!"+1&)&1601+!/!0 regulations, and best practices IMPROVE SUPPLY CHAIN and requirements) EFFICIENCY • Create the regulatory and compliance 7.2 + ENHANCE PUBLIC HEALTH Develop policy, legislation, and requirements to match the regional EDUCATION AND AWARENESS regulatory frameworks to support MONITOR POPULATION HEALTH guidelines using the regional testing and STATUS data sharing in cases of disease "/1&Ɯ 1&,+1,,)0 ALL OUTCOME GOALS outbreaks and telemedicine to allow -1&"+101, "+"Ɯ1#/,* ,+1&+2&16 of care and improved health security and surveillance across the region 7.3 Establish a policy and the associated regulatory frameworks for managing public health emergencies (e.g., how to drive commitment of Partner States to mobilise resource in "*"/$"+ &"0Ȝ1,"+02/""ƛ& &"+ 6+! "ƛ" 1&3"+"00,#/"$&,+)/"0-,+0" 7.4 Develop a shared policy and supporting regulatory framework to support portability of health insurance

%"-/&,/&1&"0)&01"!%"/"4&)) "/"3&"4"!++2))6 6,/(01/"*ǖ+!&10-/1+"/0ǽ!!&1&,+) 1&3&1&"0 #,/1%&04,/(01/"*1%1 + "1/$"1"!1)1"/01$"0 + "#,2+!&+--"+!&5ǽ%"0-" &Ɯ 0(&))0+! - &)&1&"0/".2&/"!#,/1%&04,/(01/"* + "#,2+!&+--"+!&5 ǽ 2/1%"/!"1&),+1%"*+$"*"+1+!,-"/1&,+0,#1%&04,/(01/"*Ǿ&+ )2!&+$,/$+&01&,+01/2 12/"0Ǿ /"0-,+0& &)&16/"0Ǿ("6-"/#,/*+ "&+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ activities can be found in the&$&1) +&1&1&3",/(01/"*,*-"+!&2*.

74 BUILDING HEALTH WORKER CAPACITY

WORKSTREAM 8: WORKFORCE

75 WORKSTREAM 8: WORKFORCE

OVERVIEW ,1"+1&)ƛ& &"+ &"0+! This workstream focuses on establishing a workforce capable of /1+"/0%&-0ǿ acquiring, maintaining, designing, creating and implementing, customising, and evaluating research and development (R&D) Partner with academic and training and digital health programmes which are needed by the EAC institutions in the region and leverage region to enhance healthcare. Technology can play a key role curriculum and guidelines already in building this capacity and in delivering harmonised training. developed (e.g., eLearning at MUHAS Building capacity and harmonising training regionally is an and the East African CoE in Supply investment for the medium and long term, and the EAC can Chain Management, the East African be a leader in Africa in the use of technology for a transformed 2)&Ɯ 1&,+0 /*"4,/(#,/ &$%"/ +!Ɲ"5& )"%")1%4,/(#,/ "&+4601%1)0,02--,/11%" Education developed by the IUCEA) sustainability of digital health investments in the long term. ,,/!&+1"4&1%1%" +! "ƛ,/11, /"1"$), )$,,!0 GOALS curriculum and eLearning. The overall goal of this workstream is to build the capacity of /1+"/4&1%+!)"/+#/,*"5&01&+$ health workers in the region to facilitate the sharing of human Learning platforms (e.g., the World resource and evidence-based best health practices across +(ȉ0-"+"/+&+$*-20țȜ countries with the aim of harmonising and enhancing patient and the Humanitarian Leadership care and outcomes as well as overcoming the shortages of Academy. skilled health workers. By increasing digital health capacity of the EAC workforce, this workstream will also support the sustainability of the Digital REACH Initiative and its associated long-term activities. To do this, the workstream will support pre- and in-service capacity building by leveraging technology forteaching, learning, research, and clinical practice in ways that improve the continuity and quality of healthcare across the EAC. To achieve this, the Workforce workstream will: • Create a digital-ready health workforce in East Africa that has the skills to use digital health during pre- service training of new health workers and for CPD training for in- service health professionals. • &)&11"02--,/1#,/1%"/" ,$+&1&,++! /"!&11&,+,#-/"Ȓ0"/3& "1/&+&+$+! 1&3&1&"0,# healthcare credentials across the region to improve resource allocation and allow health workers to move freely from one country to another, based on demand. • Put the tools in place so that eLearning can become a mainstream way that EAC health workers 01/"+$1%"+Ǿ"5-+!Ǿ!-11%"&/0(&))0Ǿ+!0%/" "01-/ 1& "0ǽ

STRATEGIES AND GUIDELINES FOR IMPLEMENTATION The workstream will be implemented in close collaboration with professional bodies and educational &+01&121&,+0+!4&))4,/(4&1%&+"5&01&+$/"$&,+)#/*"4,/(0+!#,/2*0Ǿ4%"/"-,00& )"ǽ%&04&))&+ )2!" ,,/!&+1"!/"3&"4,#"5&01&+$!&$&1)%")1%1/&+&+$--/, %"0&+1%"/"$&,++!1%"%/*,+&01&,+ /,00 Partner States of minimum standards in teaching curricula, which include the use of digital tools and ICT as well as data sharing and security. The following are strategic guidelines for the operationalisation of this approach: • 3,&!!2-)& 1&,+4&1%,1%"//1+"/11"2+&3"/0&1&"0Ǿ1%"-/&31"Ȓ0" 1,/Ǿ,/+,+Ȓ-/,Ɯ1,/$+&01&,+01%1 /")/"!6-/,3&!&+$!&$&1)%")1%1/&+&+$Ȁ-/1+"/4&1%"5&01&+$&+&1&1&3"0ǽ • /4,++!!!1,"5&01&+$1/&+&+$ ,!&"0+!*,!")0)/"!620"!&+/1+"/11"0ǽ%" workstream will be a partner, not a new training institution. • Partner with the private sector to build training capacity by introducing new ways of training trainers and health workers.

76 • Coordinate with the IUCEA to ensure that all curriculum developed is aligned with the East African 2)&Ɯ 1&,+0 /*"4,/(#,/ &$%"/!2 1&,+ǽ • +1"$/1"4&1%"5&01&+$*"!& )+!%")1%4,/("/1/&+&+$-/,$/**"0ț"ǽ$ǽǾ%")1%Ȓ/")1"! undergraduate programmes (medicine, nursing, pharmacy, laboratory, other allied health programmes), post-graduate programmes (MSc, MMed, MPhil), introduce post-graduate programmes in digital health and promote PhD-based research programmes on digital health. • Work with the relevant regulatory bodies to conduct a needs assessment and develop eLearning demand- driven CPD courses for in-service health professionals. • "12-+!*+$",/(#,/ "/1+"/0ȉ ,/2*1%1&+3,)3"0*"!& )2+&3"/0&1&"0+!/")"3+1 professional bodies (e.g., doctor and nurse associations) to facilitate cohesive inclusion of digital health in medical training, strategise optimal delivery of eLearning content, and advise on content. • Work with the EAACH Health Programme to support workforce for community health, adapt their skills, and share best practices. • Work in support of the Health Programme Workstream by providing technical assistance and by prioritising the development of content based on health programme implementation needs.

PARTNER STATE ROLE Key OPTIMISE THE PREVENTION, țǗǕǖǞȔǗǕǗǘȜ DIAGNOSIS, AND TREATMENT OF PRIORITY HEALTH CONDITIONS

SUPPORT UNIVERSAL ACCESS TO + 8.1 Work with universities and training • Agree on credentials per health subject HEALTHCARE IMPROVE HEALTH WORKER institutions to harmonise and and develop, review, and update EDUCATION AND TRAINING make available eLearning course national training curricula to align with OPTIMISE HUMAN RESOURCE ALLOCATION AND MANAGEMENT ,+1"+1+!00&3"-"++)&+" harmonised regional digital health IMPROVE DISEASE SURVEILLANCE ,2/0"0ț0Ȝ#,/&+Ȓ0"/3& "+! curricula AND RESPONSE IMPROVE SUPPLY CHAIN pre-service health professionals ș212))6/" ,$+&0" "/1&Ɯ 1&,+#,/ EFFICIENCY

that can be shared within the East training + ENHANCE PUBLIC HEALTH African region using eLearning and EDUCATION AND AWARENESS • Create bilateral agreements and MONITOR POPULATION HEALTH telemedicine STATUS protocols to facilitate sharing of human + 8.2 ALL OUTCOME GOALS Work with universities, training resources for health, including workers institutions, and global and regional with disease specialisations; this will partners to harmonise curricula for include agreed-upon recognition of digital health and telemedicine for ".2&3)"+1 !"*& .2)&Ɯ 1&,+0 healthcare professionals and health IT professionals ș(""5&01&+$""/+&+$ ,2/0" ,+1"+1 available to be shared across the region + 8.3 Work with universities to embed digitally digital learning methods in medical and healthcare worker • Work with other Partner States to training programmes to promote develop appropriate content independent, student-centred learning 8.4 Train health care professionals on the use of digital health for health services provision (e.g. in public health emergencies)

%"-/&,/&1&"0)&01"!%"/"4&)) "/"3&"4"!++2))6 6,/(01/"*ǖ+!&10-/1+"/0ǽ!!&1&,+) 1&3&1&"0 #,/1%&04,/(01/"*1%1 + "1/$"1"!1)1"/01$"0 + "#,2+!&+--"+!&5ǽ%"0-" &Ɯ 0(&))0+! - &)&1&"0/".2&/"!#,/1%&04,/(01/"* + "#,2+!&+--"+!&5 ǽ 2/1%"/!"1&),+1%"*+$"*"+1 and operations of this workstream, including organisation structures, responsibility areas, key performance &+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ 1&3&1&"0 + "#,2+!&+1%"Digital +&1&1&3",/(01/"*,*-"+!&2*.

77 SETTING COMMON AND SHARED STANDARDS FOR DIGITAL HEALTH

WORKSTREAM 9: STANDARDS AND INTEROPERABILITY

78 WORKSTREAM 9: STANDARDS AND INTEROPERABILITY

OVERVIEW %1/"1+!/!0Ȅ This workstream will identify and develop common guidelines, 01+!/!0Ǿ-/,1, ,)0Ǿ ,**,+*+2)0Ǿ0Ǿ+!1"*-)1"0 Standards are common rules that 1,)61%"#,2+!1&,+#,/+"ƛ" 1&3"+!&+1"/,-"/ )"/"$&,+) information abides by in order to make digital health ecosystem. The workstream researches and sets it easier to interact with and share. This common and shared standards that enable the realisation of workstream will work to harmonise 1%"&$&1) +&1&1&3",21 ,*"$,)0ǽ%&0"ƛ,/1&+ )2!"0 1%/""!&ƛ"/"+116-",#01+!/!0ǽ developing and promoting regional principles that promote access " %+& )01+!/!0 describe to healthcare services and interoperability across the EAC region. -/"!"Ɯ+"! %/ 1"/&01& 0 ,21 how information is represented within a technology to enable GOALS "51"/+)2+!"/01+!&+$Ǿ"5 %+$"Ǿ,/ The overall goal of this workstream is to develop and implement interaction with that information (e.g., regional interoperability standards, while adhering to the diagnosis codes, disease surveillance /&+ &-)"0#,/&$&1)"3"),-*"+1+!4,/(&+$1%/,2$%"5&01&+$ alerts). $), )+!/"$&,+)"ƛ,/10Ǿ1,02--,/1-/&,/&1&0"!&$&1) ,+1"+101+!/!0 describe +&1&1&3"!1"5 %+$"20" 0"0ǽ 14&)))0,4,/(1,"+02/"1%1 0-" &Ɯ ,+1"+1ț"ǽ$ǽǾ 2//& 2)2*Ǿ best practices for interoperability, data sharing, and integration 0"!"Ɯ+&1&,+Ǿ-/,1, ,)Ȝ1%1%")1% are in place and used regionally in a way that support the workers should be taught and have realisation of the Digital REACH Initiative’s outcome goals. access to in order to support their work. STRATEGIES AND GUIDELINES FOR 101+!/!0describe rules for IMPLEMENTATION how data is described and recorded 1,"+ )""51"/+)2+!"/01+!&+$Ǿ This workstream will be responsible for developing and setting "5 %+$"Ǿ ,*-/&0,+Ǿ+!&+1"/ 1&,+ standards that support the Initiative. Primarily composed with that data (e.g., standardised ,#02 '" 1Ȓ*11"/"5-"/10Ǿ1%"1"*4&))4,/( ),0")64&1% indicators, data dictionaries). This can /")"3+1-/1+"/,/$+&01&,+0Ǿ/1+"/11",ƛ& &)0Ǿ+!,1%"/ also include protocols for ensuring workstreams, providing and soliciting input as needed. The team data is safe and secure when it is 4&))4,/(4&1%1%"1, ,,/!&+1"!3&0,/6&+-21#/,*"5-"/10 stored and shared (e.g., data security /,00)),1%"/4,/(01/"*01,"+02/"1%10-" &Ɯ "5-"/1&0",+ standards, data integrity, responsible standards is provided. data practices). The workstream will form and be guided by a Standards +! +1"/,-"/ &)&16 1%1&0*!"2-,#4,/(01/"* 02 '" 1Ȓ*11"/"5-"/10+!/1+"/11",ƛ& &)0 1&+$ together to scope and review standards developed by the ,1"+1&)ƛ& &"+ &"0ǿ 4,/(01/"*ǽ2--,/1"! 6&+1"/+)2!&1,/0Ǿ1%" 4&)) "3"/$""5&01&+$&+1"/,-"/ &)&16 also play a compliance role, in that it will review progress with assessments carried out in the implementation of agreed-upon standards across Partner State region and within Partner States and Digital REACH Initiative workstreams. (e.g., Uganda’s work on harmonising The following are strategic recommendations for the standards to support interoperability operationalisation of this approach: domestically). • "1-,)&1& ) 26Ȓ&+#,/+"401+!/!0+!-/,1, ,)0 6 $1%"/&+$&+-210#/,*/1+"/11"0+!# &)&11&+$ ,**,+$/""*"+11%/,2$% 0ǽ • Develop standards and protocols based on stakeholder inputs. • Socialise protocols and standards to ensure use and gather inputs to inform iteration over time. • Advise other workstreams on appropriate world-class digital standards and protocols (e.g., data security, design). • Conduct internal auditing to monitor compliance across workstreams to ensure that all workstreams 79 promote interoperability in all their activities. Use internal auditing as an opportunity to receive feedback periodically and to provide support. • Learn from other regions that have implemented shared standards and protocols. • Work closely with the Legislation, Policy, and Compliance workstream on relevant regulation that impacts the development and compliance of interoperability standards. • Work in support of the Health Programme Workstream by providing technical assistance and by prioritising the development of standards based on health programme implementation needs. • Work with the Infrastructure and Services and Applications workstreams to identify areas where standards can help to support interoperability in the region.

IMPROVING THE PATIENT EXPERIENCE THROUGH STANDARDS AND

PARTNER STATE ROLE țǗǕǖǞȔǗǕǗǘȜ Key OPTIMISE THE PREVENTION, DIAGNOSIS, AND TREATMENT OF PRIORITY HEALTH CONDITIONS 9.1 • Contribute to the development of Develop data sharing, security, and SUPPORT UNIVERSAL ACCESS TO management guidelines, protocols, standards, guidelines, and protocols HEALTHCARE IMPROVE HEALTH WORKER and standards • Review, adopt, and implement EDUCATION AND TRAINING 9.2 standards that are developed OPTIMISE HUMAN RESOURCE Create a regional data dictionary, ALLOCATION AND MANAGEMENT mapped to international standards, • Agree on regional reference IMPROVE DISEASE SURVEILLANCE and supporting governance process AND RESPONSE interoperability architecture and adopt IMPROVE SUPPLY CHAIN to support interoperable data best practices sharing common global EFFICIENCY "5 %+$" "14""+/1+"/11" + ENHANCE PUBLIC HEALTH $,,!0,ƞ4/" EDUCATION AND AWARENESS HIS in the region (e.g., for insurance ș,**&11,!/ƞ&+$-,)& &"0,/ MONITOR POPULATION HEALTH -/,3&!"/01,)),4 &1&7"+01,Ɯ)" STATUS )&*0Ǿ1,"5 %+$"-1&"+1/" ,/!0 regulations and passing legislation ALL OUTCOME GOALS among EAC Partner States) based on approved regional standards and guidelines 9.3 2--,/1+!-/,*,1"1%""5 %+$" of unique IDs and patient health records across EAC Partner States for "ƛ" 1&3" /"!")&3"/6+! ,+1&+2&16 of care 9.4"3"),-!1"5 %+$"01+!/!0 for portability of health insurance, to support claim submission, eligibility 3"/&Ɯ 1&,+Ǿ+!/"&* 2/0"*"+10 9.5 Provide regional guidelines for diagnosis, treatment, and standards of care to facilitate continuity and quality of care across the region

%"-/&,/&1&"0)&01"!%"/"4&)) "/"3&"4"!++2))6 6,/(01/"*ǖ+!&10-/1+"/0ǽ!!&1&,+) 1&3&1&"0 #,/1%&04,/(01/"*1%1 + "1/$"1"!1)1"/01$"0 + "#,2+!&+--"+!&5ǽ%"0-" &Ɯ 0(&))0+! - &)&1&"0/".2&/"!#,/1%&04,/(01/"* + "#,2+!&+--"+!&5 ǽ 2/1%"/!"1&),+1%"*+$"*"+1+!,-"/1&,+0,#1%&04,/(01/"*Ǿ&+ )2!&+$,/$+&01&,+01/2 12/"0Ǿ /"0-,+0& &)&16/"0Ǿ("6-"/#,/*+ "&+!& 1,/0Ǿ/&0(0+!*&1&$1&,+01/1"$&"0Ǿ+!0-" &Ɯ &*-)"*"+11&,+ activities can be found in the &$&1) +&1&1&3",/(01/"*,*-"+!&2*.

80 The Path Forward

RESOURCE REQUIREMENTS An important goal of this strategic planning process is to build support for resource mobilisation among potential funding partners. The resources required for the Digital REACH Initiative will come from a variety of sources and 4&))&+ )2!" ,1%Ɯ++ &)+!+,+ȒƜ++ &)#,/*0,#02--,/1Ǿ002**/&0"!&+1%"1 )" "),4ǽ 2/1%"/!"1&),+ each of these can be found in this section. )"ǚǽ"0,2/ ",2/ "0+!1"$,/&"0""!"!#,/2 "00

RESOURCE CATEGORIES RESOURCE SOURCES ș &++ &) ,+1/& 21&,+0ț"ǽ$ǽǾ$/+10+!),+0Ȝ • Development Partners ș" %+& )"5-"/1&0" ș ,/Ȓ-/,Ɯ1/&31"" 1,/ • Political and public support and commitment ș"$&,+)+!/1+"/11" ,3"/+*"+10 • Civil society buy-in and engagement ș, ) ")1%/,3&!"/0+!&3&), &"16 /,2-0 ș +Ȓ(&+!+!!&/" 1Ɯ++ &) ,+1/& 21&,+0 • Research Bodies and Universities

It is important to note that while this while this Strategic Plan lays out what is needed to achieve the Digital REACH Initiative, an important part of resource mobilisation and implementation will be to identify opportunities #,/"ƛ& &"+ &"01%1/"!2 "1%" ,01,#&*-)"*"+11&,+,3"/1&*"ǽ5*-)"0,#02 %"ƛ& &"+ &"0&+ )2!"1%"20" ,#/"!6*!"00"104%"/"1%"6"5&01Ǿ&!"+1&Ɯ 1&,+,#01/1"$& -/1+"/0%&-04&1%,3"/)-&+ 1&3&1&"0Ǿ+! )"3"/$&+$,--,/12+&1&"0#,/,-"/1&,+) ,0103&+$0ț02 %00%/&+$,ƛ& "0- "4&1%,1%"/2+&10Ȝǽ%"0" opportunities have been highlighted across the plan in various workstreams. %"Ɯ++ &)/"0,2/ "/".2&/"*"+10#,/1%"Ɯ/01Ɯ3"6"/0,#/2++&+$1%"&$&1) +&1&1&3"Ǿ 64,/(01/"*Ǿ /"!"1&)"! "),4ǽ 2/1%"/!"1&)&03&) )"&+1%"&$&1) +&1&1&3",01&+$1,,)ǽ

)"Ǜǿ2**/6,#"0,2/ "0".2&/"!

# YEAR 1 YEAR 2 ǘ Ǚ ǚ TOTAL ǖ Initiative Management $2,388,169 $2,993,217 $2,997,509 $3,038,247 $2,950,551 $14,367,693 2Health Programmes $2,294,869 $10,696,936 $12,682,206 $25,365,618 $36,249,356 $87,288,985 Ǘǽǖ The EAHC $ — $1,125,509 $2,379,410 $1,287,368 $771,777 $5,564,064 2.2 Regional Health Services $1,500,000 $2,832,500 $3,182,700 $3,824,545 $2,251,018 $13,590,762 2.3 READSCoR $ — $1,030,000 $2,652,250 $2,185,454 $ 5,064,790 $10,932,494 2.4 Telehealth NEAT Healthcare Services $1,500,000 $5,407,500 $3,182,700 $3,746,493 $2,894,166 $16,730,858 Ǘǽǚ EAACH $ — $1,373,333 $2,121,800 $2,185,454 $5,064,790 $10,745,377 ǗǽǛ $ — $ — $ — $5,600,226 $5,064,790 $10,665,016 Knowledge Management and Peer Ǘǽǜ $1,000,000 $2,769,910 $2,499,374 $3,067,515 $2,496,644 $11,833,444 Learning Regional Technical Assistance for Digital Ǘǽǝ $ — $ — $ — $983,454 $2,701,221 $3,684,675 Health ǗǽǞ Innovations in Health $ — $ — $ — $2,185,454 $4,502,035 $6,687,489 3 Infrastructure $ — $1,268,431 $2,370,034 $2,793,062 $4,050,790 $10,482,316 4 Services and Applications $658,050 $3,182,681 $3,117,724 $2,377,825 $2,232,499 $11,568,780 ǚ Leadership and Advocacy $594,795 $1,407,166 $2,070,775 $1,901,658 $1,714,390 $7,688,784 Ǜ Strategy and Investment $1,158,559 $2,186,374 $2,053,602 $2,150,653 $2,091,816 $9,641,004 ǜ Policy, Legislation, and Compliance $ 820,138 $1,985,290 $2,333,351 $2,579,995 $2,535,727 $10,254,501 ǝ Workforce $2,503,400 $4,119,531 $3,513,438 $3,411,082 $3,386,344 $16,933,795 Ǟ Standards and Interoperability $ 429,784 $1,802,807 $2,242,935 $2,499,781 $2,452,833 $9,428,141

T,1) ʏǖǗǾǝǙǜǾǜǛǙ ʏǘǙǾǛǗǘǾǙǜǘ ʏǘǝǾǗǚǙǾǖǘǚ ʏǙǜǾǚǜǛǾǜǙǝ ʏǚǘǾǜǛǛǾǛǖǙ ʏǖǝǜǾǕǛǝǾǜǘǙ

81 Engagement with a range of stakeholders is critical for the success of the Digital REACH Initiative. A multi- 01("%,)!"/"+$$"*"+1--/, %4&))"+02/"1%1 /&1& )&+1"/+1&,+)"5-"/1&0"&021&)&0"!+!1%11%" +&1&1&3" is structured in a way that ensures sustainability from the start. Priority will be given to partners who recognise 1%"&*-,/1+ ",#-211&+$), )"5-"/1&0"11%"#,/"#/,+1+!!!/"00&+$$-0&+1%"/"$&,+1%/,2$%(+,4)"!$" transfer and capacity building, rather than providing long-term continuous support. The development community is already involved in multiple activities related to the Initiative, and private-sector companies may be interested in !&ƛ"/"+1/"0,#02--,/1!"-"+!&+$,+1%"&//")1&3" 20&+"00*,!")0ǽ 1/1"$& --/, %1,"0,2/ ", &)&01&,+ &3"+1%"0 ,-"+!1&*")&+",#1%&0&+&1&1&3"&1&02+!"/01,,!1%1*, &)&0&+$1%"+" "00/6/"0,2/ "0#,/ &*-)"*"+11&,+4&)) "+,+$,&+$+! ,)) ,/1&3"-/, "00ǽ ,,!-/1+"/0%&-/".2&/"0+,-"+*&+!*,+$ governments, development partners, and the private sector alike, and it is in this spirit that resource mobilisation #,/&$&1) 4&)) " ,+!2 1"!ǽ 1&0"5-" 1"!1, "+&1"/1&3"-/, "00Ǿ1%14&))/".2&/"1%"&!"+1&Ɯ 1&,+,# ,*-)"*"+1/6-/&,/&1&"04&1%-,1"+1&)-/1+"/0ǽ )"ǜ "),4)60,210,*",#1%"-,1"+1&)--/, %"0#,/1%&0Ǿ 4%&)"1%" )"ǝ "),4-/,3&!"0*,/"!"1&),+1%"3)2"+!)&(")6,--,/12+&1&"0#,/-/1+"/0%&- /,00/+$",# stakeholders.

)"ǜǿ1/1"$& --/, %"01,, &)&0&+$"0,2/ "0#,/&$&1) APPROACH EXAMPLES /$"1%0"! 2+!&+$ • Take a phased approach to funding, starting with support to mobilise resources and set- up the Initiative and discreet, priority activities and quick-wins. This can be followed by funding for short-term and eventually longer-term activities "3"/$"+$,&+$+! ș/1+"/11" ,**&1*"+10ț+" ")1%Ǿ Ȝ )++"! 1&3&1&"0 ș5&01&+$!"3"),-*"+1-/1+"/ 1&3&1&"0&+1%"/"$&,+ • Partners aligned with new Principles of Donor Alignment for Digital Health 2&)! 2+!/&0&+$&+1, • Allocate resources to support ongoing fundraising for the Initiative +&1&1&3"-"/1&,+0 • Start with implementation of priority activities and use success from quick-wins and evidence generated to secure additional resources )&$+4&1% ")1%/&,/&1&"0 •Identify and articulate alignment with development partners’ and Partner States’ health $"+!01%/,2$%1%" ,2/0",#1%" +&1&1&3"+!"5&01&+$&+3"01*"+101%1 + ")"3"/$"! ,,(#,//1+"/0%&-04&1% • Identify private sector organisations that have aligned agendas and look for ways to 1%"/&31"" 1,/ structure PPPs and other partnerships

)"ǝǿ%/ 1"/&01&,+,#&$&1) +&1&1&3"/1& &-1&,+ 6" 1,/

DEVELOPMENT FOR-PROFIT REGIONAL AND LOCAL SERVICE PARTNERS PRIVATE SECTOR NATIONAL PROVIDERS AND UNIVERSITIES GOVERNMENT CIVIL SOCIETY GROUPS • International • Health multina- • EAC • Health and educa- • Local and international development part- tional corporations • Partner State tion service provid- health, education and ners with aligned (e.g., insurers, governments ers (e.g., hospitals, research institutions agendas health manage- ș1%"//"$&,+) clinics, medical *"+1Ɯ/*0Ȝ bodies (e.g., provider groups, • Pharmaceutical African Union, faith-based provid- companies European Union) "/0Ǿ 0Ȝ • Medical device • Professional health companies worker associa- ș /!4/"Ǿ0,ƞ- tions ware, and profes- • Advocacy groups sional services PRIORITY SEGMENTS OF THE SECTOR THE OF PRIORITY SEGMENTS Ɯ/*0 ș0Ǿ), )"+1/"- preneurs/SMEs, and private sector forums 82 DEVELOPMENT FOR-PROFIT REGIONAL AND LOCAL SERVICE PARTNERS PRIVATE SECTOR NATIONAL PROVIDERS AND UNIVERSITIES GOVERNMENT CIVIL SOCIETY GROUPS • Support of activi- • "+"Ɯ1#/,*"+- • Progress towards • Support of activities • +,4)"!$""5 %+$"+! ties that align with abling environment national health that align with "5-"/1&0" 2&)!&+$ organisational and market entry agendas and organisational goals • + /"0"!"5-,02/"#,/ goals and agendas • Market development targets and agendas published research • Direct funding or • Potential for in- • Potential for • Increased pool of academic loss guarantees /"0"!&+Ɲ2"+ " &+ /"0"!&+Ɲ2"+ " talent from development (e.g., replication of (e.g., opportunity to partner community EU regional coop- lobby governments VALUE FOR THE SECTOR • Capacity building of eration models) or development 01ƛ&+1%"/",# • Capacity building partners) digital health ,#01ƛ&+1%"/" • Capacity building of of digital health 01ƛ&+1%"/",# digital health • Direct funding or • Direct funding or • Direct funding or • In-kind support and • In-kind support and con- investment (e.g., investment (e.g., investment contributions tributions (e.g., research grants, loans, grants or equity • Political support • Provision of techni- support, training support) private-sector loss investments) and technical cal assistance • Participation in advisory guarantees) • Participation in "5-"/1&0"+! • Participation in bodies • In-kind support and PPPs and advisory assistance advisory bodies • !3, 6"ƛ,/10 contributions (e.g., bodies • In-kind support • !3, 6"ƛ,/10 technical assis- • In-kind support and and contributions tance) contributions (e.g., (e.g., seconded • Participation in provision of airtime 01ƛȜ advisory bodies 60Ǿ/"!2 "! • Participation in • !3, 6"ƛ,/10 or highly subsidised advisory bodies (e.g., lobbying) -/& &+$Ǿ0,ƞ4/" • !3, 6"ƛ,/10 licences)

POTENTIAL TYPES SUPPORT OF • !3, 6"ƛ,/10Ǿ speaker bureaus, thought leadership "5-,02/"Ǿ+! access to networks +!&+Ɲ2"+ "

PRIVATE SECTOR ENGAGEMENT IMPLICATIONS FOR DIGITAL REACH 11/ 1&+$-/&31"0" 1,/&+3"01*"+14&))/".2&/" ,+ "/1"!"ƛ,/1 /,001%"&$&1) +&1&1&3" workstreams and activities. Workstream team should work together to see how best to attract investment +! ,,/!&+1""ƛ,/10+!-/1+"/0%&-0ǽ %4,/(01/"*4&))-)6("6/,)"&+01&*2)1&+$-/&31"0" 1,/ investment. The Strategy and Investment workstream will lead the overall engagement of the private sector but it will be the responsibility of each workstream team lead to identify areas where the private sector can be brought in and engaged to support activities. The table below details the opportunities in each workstream to engage the private sector.

83 )"Ǟǿ,)",#1%"/&31"" 1,/&+&$&1) /,00+ )&+$+3&/,+*"+1,/(01/"*0 HOW THE PRIVATE SECTOR CAN SUPPORT THIS INVESTMENT ș)2 )""5-"/1&0"Ǿ1" %+& )00&01+ "Ǿ+! ș ,2+!1&,+)&+#/01/2 12/" /"1"0+,--,/- 02--,/11%/,2$%0" ,+!*"+1,#01ƛǾ-/"#"/"+1&) tunity for additional value-added services and -/& &+$#,//".2&/"!0,ƞ4/")& "+ "0+!%/!- applications to be created. ware, and design and R&D assistance. ș 2/1%"/!"3"),-01" %+& )"5-"/1&0"&+1%" • Direct investment for technical or commercial region. pilots. ș5*-)"/"$&,+)1" %+& )&*-)"*"+11&,+0 ș210,2/ &+$,# 1&3&1&"0&+ )2!&+$1%" 2&)!&+$ signals clear, unambiguous opportunities to INFRASTRUCTURE and maintenance of platforms and the technical create other regional and national services and call centre or tiered technical support for the applications. region. • Better connectivity infrastructure makes it eas- ș5-+0&,+,# ,++" 1&3&16&+#/01/2 12/"&+1%" ier for the private sector to invest and function region through strategic PPPs. and creates opportunities for new products to enter the market.

ș)2 )""5-"/1&0"Ǿ1" %+& )00&01+ "Ǿ+! ș5-+!01%",--,/12+&1&"0#,/-/1+"/&+$4&1% 02--,/11%/,2$%0" ,+!*"+1,#01ƛǾ-/"#"/"+1&) the private sector from potential in-house tech- -/& &+$#,//".2&/"!0,ƞ4/")& "+ "0+!%/!- nical assistance to wholly outsourced develop- ware, and design and R&D assistance. ment of services and applications. • Direct investment for technical or commercial • Creates an opportunity for additional val- SERVICES AND pilots. ue-added services and applications to be APPLICATIONS ș210,2/ &+$,# 1&3&1&"0&+ )2!&+$1%"!"0&$++! created. implementation of services and applications. ș 2/1%"/!"3"),-01" %+& )"5-"/1&0"&+1%" region. • Better connectivity creates opportunities for new products. ș5-"/1&0"+!1" %+& )00&01+ "ț"ǽ$ǽǾ1%/,2$% ș" %+,),$& ))6Ȓ0336ǾȊ/"!6#,/ 20&+"00ȋǾ0"- 0" ,+!*"+1,#01ƛȜ#,/1%"!"3"),-*"+1,# +&,/")" 1"!,ƛ& &)0+!$,3"/+*"+1!" &0&,+ harmonised standards and best practices on makers who want to support a business-friend- LEADERSHIP AND interoperability. ly environment will encourage investors to ADVOCACY • Lending their brand through sponsorship of enter the region. regional events and making introductions within their network. ș5-"/1&0"+!1" %+& )00&01+ "#,/#"0& &)&16 • Bulk purchasing increases market size and studies that make the case for private investment makes the region more attractive to investors. and strategy development for private sector ș5*-)"0 +"+ ,2/$"1%"-/&31"0" - engagement. tor to replicate successful models in the region. STRATEGY AND • In-kind contributions through preferential pricing • Better connectivity creates opportunities for INVESTMENT for insurance products, bulk SMS for health new products. education messaging, and medical devices and ș "0& &)&16012!&"0&+!& 1&+$-,0&1&3",--,/- equipment. tunities and making the case for private sector ș01,"5-+!+"14,/(&+#/01/2 12/"+! ,+- investment. nectivity in the region. ș5-"/1&0"+!1" %+& )00&01+ "ț"ǽ$ǽǾ ,+02)- • Companies will have a clearer and more har- Ǿ tation services) for policies that support private monised policy and regulatory environment Ǿ sector investment for the development of digital that is conducive to business and encourages COMPLIANCE health in the region. -/&31"0" 1,/&+3"01*"+1ț"ǽ$ǽǾ151&,++! Ɯ0 )-,)& &"0Ȝǽ ș5-"/1&0"+!1" %+& )00&01+ "ț"ǽ$ǽǾ1%/,2$% • A well-trained workforce that is technically 0" ,+!*"+1,#01ƛȜ#,/1/&+&+$ ,+1"+1ǽ literate and skilled in the use of digital health • Provision of services (e.g., as provider of eLearn- &+ /"0"01%"-,,),#.2)&Ɯ"!4,/("/0+! ing platforms or curator of digital health short !"*,+01/1"01%" "+"Ɯ10,#1%"$,,!0+! courses and continuous professional develop- services they provide. ment (CPD) courses). • Build training capacity by introducing new, innovative, and tested ways of training trainers and health workers.

84 ș5-"/1&0"+!1" %+& )00&01+ "ț"ǽ$ǽǾ1%/,2$% • Companies will have a clearer and more har- 0" ,+!*"+1,#01ƛȜ#,/1%"!"3"),-*"+1,# monised standards environment in which to do harmonised standards and best practices on business. STANDARDS AND interoperability. • Better data that can be compared regionally to INTEROPERA- support better health products and services. • Interoperability increases the opportunity for new value-added products and services to enter the market.

Looking across all workstreams, there is a clear opportunity for the private sector to ,1",+2 )& Ȓ/&31"/1+"/0%&-0 provide investment in the form of expertise Public-private partnerships (PPPs) are agreements and technical assistance through seconded between two or more public and private entities. PPPs 01ƛǾin-kind contributions like preferential present the opportunity to utilise private sector re- pricing, and implementation support in the sources for sustainable development through access to form of commercial or technical pilots and /")"3+1"5-"/1&0"+!*/("1Ȓ 0"!0,)21&,+0ǽ0 the provision of services for the Initiative. The can be formed with local and international companies Initiative should place a strong focus on these who share common interests and values, leveraging types of support to reduce the cost of running the strengths and assets of each partner and mitigating the Initiative and ensuring the sustainability of implementation risks. its activities in the region. PPPs can facilitate the introduction of private-sector In the way the success of M-PESA has created a technology and innovation to strengthen public goods !&$&1)Ɯ++ &)0"/3& "0&+!201/6&+01#/& and services. Local private- and public-sector capacity by creating jobs and attracting investment, can also be increased through involving international there is an opportunity for the Digital REACH parties. Initiative to plant the seed for the development of a new digital industry in the region with There are multiple models for how to structure a PPP, regards to health. The Digital REACH Initiative such as USAID’s premier model, ), )"3"),-*"+1 has the potential to create a digital health hub Alliance (GDA), which partners with corporations, local in East Africa by building the capacity and 20&+"00"0ǾƜ++ &)&+01&121&,+0Ǿ&+3"01*"+1Ɯ/*0Ǿ+! infrastructure of the region to support greater foundations to drive development outcomes globally. investment and sustainability in the long-term.

85 %"Ɯ$2/" "),4)60,211%"&**"!&1"+"5101"-01,0" 2/&+$02--,/1+!#2+!&+$#,/1%"&$&1) +&1&1&3"ǽ &$2/"ǖǖǿ **"!&1""511"-0#,/"0,2/ "0, &)&01&,++! +&1&1&3"2+ % FORMAL LAUNCH AND SET-UP • 5" 21"$&+011 1& )-)+ • Set up entity • /$"10-" &Ɯ ,/$+&01&,+0Ǿ • Hire all Workstream Leads events, and activities LAY THE FOUNDATIONS • Schedule and hold launch • Host a development partner • Launch the website • /"1"ǘǕȒǛǕȒǞǕȒ!6 roundtable as a co-design • 01 )&0%+,ƛ& " 1 1& )-)+#,/ǖǗǕǖǞ opportunity to identify • /"1"Ɯ++ &) ,2+1&+$ • Establish the governing strategic linkages between mechanisms and foundations for EAC APPROVAL bodies development partners’ ,/(01/"*ǖ • • Begin recruiting process and current and future priorities EAC approval • Identify independent M&E and %&/"-/&*/6,/(01/"*ǖ and the Digital REACH processes for research partners 01ƛ Initiative strategic plan • Identify health programmes for • Create a blueprint for the • Secure domestic and and further immediate implementation infrastructure, services, and international commitments socialisation • Coordinate and hold subject-matter applications that will be built in time for launch with key regional "5-"/1 ,+3"+&+$01,$1%"/&+-210 Ɯ/01ț"ǽ$ǽǾ Ȝ • Tailor resource mobilisation stakeholders for workstreams strategy to priority areas, demonstrating synergies, where possible 5" 21&,+ --/,3) /"-/"1,2+ % +!2+ % Q4 2018 Q4 2018 - Jan 2019 Q1 2019

"0,2/ ", &)&01&,+ (ongoing)

Strategic Plan +!,01&+$ Q1 - Q3 2018

,)),4&+$#,/*))2+ %,#1%" +&1&1&3"&+1%"Ɯ/01.2/1"/,#ǗǕǖǞǾ" %4,/(01/"*4&))+""!1,.2& ()6 !"*,+01/1"-/,$/"004%&)")0, 2&)!&+$1%" /&1& )#,2+!1&,+0#,/),+$Ȓ1"/*02 "00ǽ%"Ɯ$2/" "),4 &!"+1&Ɯ"01%"-,01Ȓ)2+ %01"-0ǽ &$2/"ǖǗǿ **"!&1"1"-0 ,)),4&+$1%" +&1&1&3"ȉ02+ %

IDENTIFY AND MANAGEMENT • Build and utilise the Ȓ • ")" 101ƛ+!#2+! governance structure, immediate opportunities *&+1&+Ɲ"5& &)&160+""!"! INITIATE PRIORITY HEALTH to demonstrate progress in • Develop basic PROGRAMMES • Develop tactical plans based 1%"Ɯ")! 0"!,+/"0,2/ "0 communications and • Secure appropriate on priority activities secured at launch messaging strategy and start • Secure appropriate • leadership and partnership Identify and support key "5" 21&+$,+ 0& -2 )& for priority health leadership and partnership Partner States activities relations programmes according to implementation that align with workstream • Build and implement • Conduct baseline model selected priorities foundational management • Conduct baseline • assessments of ongoing Utililse quick wins for tools and processes with a activities that can be assessments of ongoing "ƛ" 1&3" ,**2+& 1&,+0 particular focus on driving leveraged to support priority activities that can be and awareness raising of a conscious organisational implementations leveraged to support priority Initiative culture • activities • Identify implementation Test out management • "Ɯ+"--/, %1,ǔ quick-wins to showcase • Set-up Technical Working structure and adjust as and integrate across and garner support for the /,2-01,02--,/1 needed workstreams Initiative workstreams, where relevant

,01Ȓ2+ % ,/(01/"*ǖ ,/(01/"*Ǘ ))1%"/,/(01/"*0 +!5" 21&,+ Organisational Formation Health Programmes Q1 and Q2 2019 and Management

/&1& )2 "00 1,/0

Strike a balance between building Engender common themes that each foundations (long-term output) and workstream will embrace, such as a Secure further buy-in and commitment of establishing quick wins towards progress common philosophy that is embraced resources by EAC Partner States and impact (short-term output) internally and spoken about externally

&+1&+Ɲ"5& )"-/&,/&1&"0 0"!,+ Coordinate across workstream to ensure Conduct ongoing partnership building and resources available at launch; set up priorities remain aligned regardless of awareness raising to continuously mobilise governance structures accordingly funding available resources and socialise Initiative goals and outcomes

86 APPENDICIES

APPENDIX A: FULL ACKNOWLEDGEMENTS APPENDIX B: EAST AFRICA SITUATION ANALYSIS APPENDIX C: EAC DIGITAL REACH INITIATIVE SUPPORTING DOCUMENTATION APPENDIX D: EAC PRIORITIES AND DIGITAL REACH INITIATIVE GOALS APPENDIX E: ADDITIONAL WORKSTREAM ACTIVITIES APPENDIX F: SKILLS AND CAPABILITIES ACROSS WORKSTREAMS APPENDIX G: EAHC IMPLEMENTATION ACTIVITIES

87 Appendix A: Full Acknowledgements The Strategic Plan was developed in a highly consultative and collaborative way and involved inputs from key decision makers in East Africa. The following are members of the EAHRC who oversaw and lead the creation of this document.

NAME DESIGNATION INSTITUTION /,#ǽ & 0,+& &(& 5" 21&3"" /"1/6 EAHRC /ǽ "+!"&"2$&/ "$ "-2165" 21&3"" /"1/6 EAHRC Dr. Novat Twungubumwe /&+ &-) ")1%ƛ& "/ EAHRC /ǽ &+0%2/& /&+ &-) ")1%ƛ& "/ EAHRC The EAHRC would like to thank the multiple stakeholders who have been engaged throughout the process ,#!"3"),-&+$1%" ,01"!&$&1) 1/1"$& )+ǽ-" &)1%+(0/""51"+!"!1,1%" ,+1/& 21,/0)&01"! below. ǾǙ Ȓǝ ǗǕǖǝǾ Ǿ

PARTNER STATE/ NAME DESIGNATION INSTITUTION COUNTRY /,#ǽ & 0,+& &(& 5" 21&3"" /"1/6 EAHRC EAHRC - EAC /ǽ "+!"&"2 "-2165" 21&3"" /"1/6 EAHRC EAHRC - EAC Ngirabega

Dr. Novat /&+ &-) ")1%ƛ& "/ EAHRC EAHRC - EAC Twungubumwe /ǽ &+0%2/& /&+ &-) ")1%ƛ& "/ EAHRC EAHRC - EAC Betty Nankya Senior Personal Secretary EAHRC EAHRC - EAC

Dr. Asmini Hassan Director of HMIS Ministry of Health Republic of Burundi

Dr. Ntibazomumpa HMIS/DHISR Ministry of Health Republic of Burundi "+/&" )& "+$2& &1%2* & Assistant Chief Health Ministry of Health Republic of Kenya !*&+&01/1&3"ƛ& "/ "+&"//" ,,/!&+1,/ Rwanda Biomedical Centre Republic of Rwanda Musabyimana $"+7& ,0"-%2+" Academic Associate of CEBE University of Rwanda Republic of Rwanda

Dr Isaac Kadowa /&+ &-) ")1%ƛ& "/ Ministry of Health Republic of Uganda Dr. Elias M Kwesi EAC Coordinator Ministry of Health United Republic of Tanzania David Edward Lenga Statistician Ministry of Health United Republic of Tanzania Dr. Mary B Charles Public Health Specialist Ministry of Health and United Republic of Muhimbili National Hospital Tanzania )&*/)& Public Health Epidemiologist Ministry of Health - Zanzibar United Republic of Tanzania

/ǽ 00+2! 2* ƛ& "/ Ministry of Health - Zanzibar United Republic of Tanzania Brendan Smith ,#/,#"00&,+)"/3& "0 &1)3"Ǿ + ǽ USA +! &)&11,/ Katherine de Tolly "!+)601+! &)&11,/ &1)3"Ǿ + ǽ USA

"% 11 Director of Professional &1)3"Ǿ + ǽ USA "/3& "0+! &)&11,/

88 Ǿ ǗǕǖǝ

2/&+$1%"*,+1%0,# 2)6+!2$201ǗǕǖǝǾ1%" 1/3")1,/1+"/11"0&+,/!"/1,*""14&1%("6 01("%,)!"/0+!$1%"/&+-210#,/1%"1/1"$& )+ǽ-" &)1%+(0/""51"+!"!1,1%"#,)),4&+$&+!&3&!2)0 or their contributions.

NAME DESIGNATION INSTITUTION

Dora Simbare "+&,/ƛ& &) ")1% &+&01/6,#ƛ&/0 Aimable Nkurunziza "+&,/ƛ& &) ")1% &+&01/6,#ƛ&/0

Dr. Isaac Minani ")1%0"/3& "0 Ministry of Health Dr. Asmini Hassan Director of HMIS Ministry of Health Dr. Pierre Claver Kazihise Institut National de Sante Publique 3,++"!6&("7 Director of Training Institut National de Sante Publique Dr. Pontien Ndabashinze Director Kamenge Teaching Hospital Claude Ndayishimiye Head of ICT Kamenge Teaching Hospital Prof. Nyongabo Aloys Coordinator East African CoE Nutrition, Kamenge Teaching Hospital Dr. Claver Nijimbere Coordinator East African CoE Nutrition, Kamenge Teaching Hospital /,#ǽ+$&/&+* /"!"/& &/" 1,/,# &"+1&Ɯ "0"/ % Ministry of Higher Education and &"+1&Ɯ "0"/ % $"+!(2/&6, ,3&1% Director of Promotion of Science, Ministry of Higher Education and Technology and Innovation &"+1&Ɯ "0"/ % Dr. Peter Cherutich Director of Preventive and Promotional Ministry of Health Programs

Mwangi Sammy Senior Assistant Director Regional &+&01/6,#ƛ&/0+!"$&,+) Integration Development

",/$"1&"+, /&+ &-) +1"$/1&,+ƛ& "/ &+&01/6,#ƛ&/0+!"$&,+) Development

/ǽ (0,+&,(, Director of Medical Services Ministry of Health

Dr. Anthony Were Deputy Director EAKI East African Kidney Institute

Winfred Chitene Administrator EAKI East African Kidney Institute

Dr. Cyrus Kamau Deputy Director of ICT

/ǽ *"0&*,1%, Head of Production Department Kenya Medical Research Institute Anthony Kamigwi ICT Department Kenya Medical Research Institute

*"0/&2(& "+&,/"0"/ %ƛ& "/ Kenya Medical Research Institute /ǽ ,0-%16+$4"0, Director of Research, Innovation and +1"/+1&,+)+&3"/0&16ȡ Consultancy ")1%#/&

+"0*20*2 Head of e-Health Development Ministry of Health Professor Peter Wagajo Head of Health ICT Project University of Nairobi

Raphael Pundo eHealth University of Nairobi

89 Ǿ ǗǕǖǝțȆȜ

NAME DESIGNATION INSTITUTION ,+1%+&/ , "+&,/ƛ& &) ")1% &+&01/6,#ƛ&/0 Dr. Zuberi Muvunyi ")1%"/3& "0 Ministry of Health

Michelle Kayiganwa " ")1%"$2)1,/ƛ& "/ Ministry of Health

Edith Munyana Director of ICT Ministry of Health

Dr. Albert Tuyishime M&E Division Manager Rwanda Biomedical Centre

Clarissa Musanabaganwa Director of Medical Research Center Rwanda Biomedical Centre

Dr. Alne Umubyeyi Dean School of Public Health University of Rwanda

Prof. Kayumba PC & ""+ %,,),#"!& &+" University of Rwanda

"+!ȉ*,2/ $20"+$ Coordinator East Africa CoE for Health Supply Chain Management, University of Rwanda $"+7& ,0"-%2+" Academic Associate East Africa CoE for Biomedical Engineering and eHealth, University of Rwanda Alpha Marara Director of ICT Kigali Teaching Hospital

Dr. Martin Nyundo Director of Clinical Services Kigali Teaching Hospital

"/1/2!"$ &/+, 5" 21&3"" /"1/6

Dr. Saidi Kibeya "-2165" 21&3"" /"1/6

Moses Ndahiro /&+ &-) ƛ& "/

,/12+1"26* & /&+ &-)ƛ& "/Ǿ ++,31&,+Ǿ Technology, Adaptation and Development

Dr. Paul Kazyoba Chief Research Scientist National Institute for Medical Research (NIMR) Dr. Khadija Malima Director of Life Sciences Tanzania Commission for Science and Technology Prof. Muhammad B. K. %&"#"!& )ƛ& "/ Ministry of Health

/,#ǽ2+20ǽ$6 &/" 1,/ "+"/) National Institute for Medical Research (NIMR) /ǽ ")&52(2*0 Director of ICT Muhimbili University of Health and Allied Sciences MUHAS /,#ǽ)&$&20 ǽ26*26 Professor in the Department of Muhimbili University of Health and Microbiology and Immunology Allied Sciences MUHAS Dr. Pilly Chillo Coordinator East African CoE for Cardiovascular Sciences Dr. Doreen Mloka Director, Directorate of Continuing Muhimbili University of Health and Education and Professional Allied Sciences MUHAS Development

90 Ǿ ǗǕǖǝțȆȜ

NAME DESIGNATION INSTITUTION "+!ȉ*,2/ $20"+$ Coordinator East Africa CoE for Health Supply Chain Management, University of Rwanda $"+7& ,0"-%2+" Academic Associate East Africa CoE for Biomedical Engineering and eHealth, University of Rwanda Alpha Marara Director of ICT Kigali Teaching Hospital

Dr. Martin Nyundo Director of Clinical Services Kigali Teaching Hospital

"/1/2!"$ &/+, 5" 21&3"" /"1/6

Dr. Saidi Kibeya "-2165" 21&3"" /"1/6

Moses Ndahiro /&+ &-) ƛ& "/

,/12+1"26* & /&+ &-)ƛ& "/Ǿ ++,31&,+Ǿ Technology, Adaptation and Development

/ǽ (0,+/"* Director Uganda Cancer Institute 2)&200)& ICT Manager Uganda Cancer Institute

Alfred Bagenda Head of ICT Ministry of Health

Caroline Kyozira Head of eHealth and Acting Assistant Ministry of Health Commissioner for HMIS /ǽ*(4/" &/" 1,/ "+"/)

Dr. Henry Mwebesa $ǽ&/" 1,/ "+"/) ")1%"/3& "0 Ministry of Health

/ǽ,0*%4+$ ,0"-% %&"#/&+ &-)Ǿ2)&16002/+ "+! IUCEA 2)&Ɯ 1&,+0 /*"4,/( *0,+'"0& ǔƛ& "/#,/ IUCEA

Alvin Masko ƛ& "/ IUCEA

/ǽ ,+1%+ǽ(,4* , Regional Coordinator for ACE II IUCEA

91 *""14&1%0"+&,/,ƛ& &)0#/,*1%"*&+&01/&"0/"0-,+0& )"#,/ƛ&/0Ǿ+!*&+&01/&"0/"0-,+0& )" for health for inputs into the mid-term review of the EAHRC strategic plan and inputs into the EAHRC strategic programmes and initiatives.

ǖǘ ȔǖǙ ǾǗǕǖǝ

INSTITUTION/ MINISTRY AND NAME DESIGNATION PARTNER STATE Dr. Minani Isaac &/" 1,/ "+"/) Ministry of Health, Burundi

/ "+-1&01"7,/&/,+(+(27" Permanent Secretary Ministry of Health, Burundi

Ms. Dora Simbare &/" 1,/,#, &)ƛ&/0 &+&01/6,#ƛ&/0Ǿ2/2+!&

Aime Nkurunziza Technical Advisor &+&01/6,#ƛ&/0Ǿ2/2+!& "-/1*"+1,#, &)ƛ&/0 Dr Charles M. Nzioka Senior Deputy Director Ministry of Health, Kenya Medical Services Dr Evans Amukoye Assistant Director Research Admin/ Kenya Medical Research Institute, Kenya /ǽ)& " ǽǽ)) Director &+&01/6,#ƛ&/0Ǿ"+6

Samuel Mwangi Kahenu Senior Assistant Director &+&01/6,#ƛ&/0Ǿ"+6

Walimbi Aliyi Senior Health Planner Ministry of Health, Uganda

Dr Isaac Kadowa, /&+ &-)"!& )ƛ& "/ Ministry of Health, Uganda

Edward Sebina Commissioner &+&01/6,#ƛ&/0Ǿ$+!

",/$"4"3,,) /&+ &-) +1"$/1&,+ƛ& "/ &+&01/6,#ƛ&/0Ǿ$+!

Bernard P. Mtuta Deputy Director of Administration Zanzibar Health Research Institute, Tanzania Dr Mohamed A Mohamed &/" 1,/Ȕ Ministry of Health, Tanzania

/!"(6/&6, &/" 1,/Ȕ National Institute for Medical Research, Tanzania Edward A. Komba Health Coordinator &+&01/6,#ƛ&/0Ǿ+7+&

92 %+(0/")0,"51"+!"!1,1%"*"* "/0,#1%"&$&1) 1""/&+$,**&11""Ǿ4%& %40#,/*"! 61%" EAHRC to support the process and provide inputs. who provided key inputs into the Strategic Plan.

NAME DESIGNATION INSTITUTION Adele Waugaman Senior Advisor, Digital Health USAID, DC

Brooke Partridge +!5" 21&3"3"/0&$%1 &1)3"

Carl Leitner "-216&/" 1,/Ǿ ), ) ,,!0#,/ USAID, DC Digital Square Henry Mwanyika Regional Director, Africa PATH

Ishrat Husain Senior Health Advisor USAID, DC

"+!/ &3"+0 Program Assistant PATH / Digital Square

Kristina Celentano Digital Health Advisor USAID, DC

"% 11 Director, Professional Services and &1)3" Engagement Manager Lesley-Anne Long Strategist

Magnus Conteh 5" 21&3"&/" 1,/Ǿ,**2+&16 ")1% Last Mile Health Academy Merrick Schaefer "3"),-*"+1 +#,/*1& 0"!Ǿ ), ) USAID, DC Development Lab Peter Arimi Senior Regional Health Specialist - Care USAID / Kenya and East Africa and Treatment ǽ(6" &) "/1 Deputy Director, Digital Health PATH / Digital Square Solutions Tim Wood "+&,//,$/*ƛ& "/ &))+!")&+! 1"0 ,2+!1&,+

93 The roadmap that preceded this Strategic Plan and determined the areas of work for the Digital REACH Initiative was also developed through inputs from key decision makers through conferences and smaller 4,/(0%,-0ǽ-" &)1%+(0/""51"+!"!1,1%" ,+1/& 21,/01,1%&0/,!*-)&01"! "),4ǽ

Ǜ Ǘǝ ȔǘǕ ǗǕǖǜǾ Ǿ

PARTNER STATE/ NAME DESIGNATION INSTITUTION COUNTRY /ǽ *)!* EAHRC Commissioner Zanzibar Medical Research United Republic of Taib &/" 1,/ "+"/)+!%&/ Council Tanzania /ǽ ,0"-%6+!4& EAHRC Commissioner University of Burundi, Republic of Burundi Lecturer & Researcher 2)16,#"!& &+" Dr. Pierre Claver EAHRC Commissioner National Institute of Public Republic of Burundi Kazihise &/" 1,/ "+"/) Health Dr. Isaac Minani EAHRC Commissioner Ministry of Public Health Republic of Burundi &/" 1,/ "+"/) +! &$%1$&+01 /ǽ "/)!(,'& EAHRC Commissioner Kenya Medical Research Republic of Kenya &/" 1,/ "+"/) Institute (KEMRI) /ǽ (0,+&,(, EAHRC Commissioner Ministry of Health Republic of Kenya Director of Medical Services /,#ǽ &+0*& EAHRC Commissioner Moi University College of Republic of Kenya Professor of Child Health Health Sciences and Pediatrics /ǽ*(4/" EAHRC Commissioner Uganda National Health Republic of Uganda &/" 1,/ "+"/) "0"/ %/$+&71&,+ ț Ȝ Prof. Pauline EAHRC Commissioner Makerere University College Republic of Uganda Byakika-Kibwika Associate Professor of Health Sciences /,#ǽ2+20$6 EAHRC Commissioner The National Institute for United Republic of &/" 1,/ "+"/) Medical Research (NIMR) Tanzania /,#ǽ)&$&20 /+ &0 EAHRC Commissioner Muhimbili University of United Republic of Lyamuya "-216& "%+ ")),/ Health & Allied Sciences Tanzania Academics, Research & (MUHAS) Consultancy Prof. Dr. Mohamed EAHRC Commissioner Ministry of Health United Republic of Bakari Kambi %&"#"!& )ƛ& "/ Tanzania /ǽ,%**"! ǽ EAHRC Commissioner Zanzibar Medical Research United Republic of Dahoma Director of Hospitals and Council Tanzania Member of the Zanzibar Research Council

94 ǾǛ Ȓǝ ǗǕǖǜǾǾ

PARTNER STATE/ NAME INSTITUTION DESIGNATION COUNTRY

HONORARY GUEST

,+ǽ-"+!& %&"+$ Ministry of Health Chair EAC Sectoral Council of Republic of Uganda Sarah Health Minister of State for Health ț "+"/)21&"0Ȝ

EAHRC

/,#ǽ & 0,+& &(& 5" 21&3"" /"1/6 EAHRC EAHRC - EAC

/ǽ "+"&"2 "-2165" 21&3"" /"1/6 EAHRC EAHRC - EAC Ngirabega / &+0%2/& /&+ &-)" ")1%ƛ& "/ EAHRC EAHRC - EAC

Nankya Betty Senior Personal Secretary EAHRC EAHRC - EAC

Dr. Novat /&+ &-)" ")1%ƛ& "/ EAHRC EAHRC - EAC Twungubumwe

EAC

Daniel Murenzi EAC Principal Information Technology EAC ƛ& "/ "/1/2!"$ &/+, East African Science and 5" 21&3"" /"1/6 EAC Technology Commission țȜ Stanley Sonoiya Department of Health /&+ &-) ")1%ƛ& "/ EAC

EAHRC COMMISSIONERS

/ǽ (0,+&,(, EAHRC Commissioner Director of Medical Services, Republic of Kenya Ministry of Health /ǽ *)!*& EAHRC Commissioner &/" 1,/ "+"/)+!%&/,# United Republic of the Zanzibar Medical Research Tanzania Council /ǽ ,0"-%6+!4& EAHRC Commissioner & ""+Ǿ 2)16,#"!& &+"Ǿ Republic of Burundi University of Burundi Dr. Leon Mutesa EAHRC Commissioner School of Medicine and Health Republic of Rwanda Sciences, University of Rwanda /ǽ,%**"! ǽ Director of Hospitals and Zanzibar Medical Research United Republic of Dahoma Member of the Zanzibar Council Tanzania Research Council Dr. Pierre Claver EAHRC Commissioner &/" 1,/ "+"/)Ǿ +01&121 Republic of Burundi Kazihise Nationale de Santé Publique /ǽ*(4/" EAHRC Commissioner &/" 1,/ "+"/)Ǿ$+! Republic of Uganda National Health Research /$+&71&,+ Prof. Muhamad Bakari EAHRC Commissioner %&"#"!& )ƛ& "/Ǿ&+&01/6,# United Republic of Kambi Health Tanzania Prof. Pauline Byakika EAHRC Commissioner College of Health sciences, Republic of Uganda Makerere University

95 ǾǛ Ȓǝ ǗǕǖǜǾǾ țȉȜ

PARTNER STATE/ NAME INSTITUTION DESIGNATION COUNTRY

EXPERTS FROM PARTNER STATES

Alpha Marara University Teaching Hospital of Director of ICT Republic of Rwanda Kigali Andrew Musiime Ministry of East African Director Republic of Uganda ,**2+&16ƛ&/0Ȓ$+! Dr. Anna Nswilla /"0&!"+1ȉ0ƛ& ""$&,+) Representative of Deputy United Republic of Administration and Local Permanent Secretary, Health Tanzania ,3"/+*"+1Ǿ+7+& Dr. Benedict Mtasiwa Inter-University Council for East %&"#/&+ &-)5 %+$" Republic of Uganda Africa (IUCEA) Links & Partnerships Carol Kyozira Ministry of Health Principal Biostatistician Republic of Uganda

Dr. Celestin Twizere "$&,+)"+1/",#5 "))"+ " Director Republic of Rwanda in Biomedical Engineering and eHealth Claudette Irere Ministry of Information &/" 1,/ "+"/) Republic of Rwanda Technology and Communications Claver Nijimnbere Ministry of Information, &/" 1,/ "+"/),# &"+ "Ǿ Republic of Burundi Communication Technology Technology and Research (ICT) Cyrus Kamau National Commission for Head of ICT Unit Republic of Kenya Science, Technology and ++,31&,+ț Ȝ David M Waititi East African Kidney Institute Project Coordinator Republic of Kenya (EAKI) | College of Health Sciences (CHS) /ǽ3&!,(,,1& Ministry of Health Head Department of Republic of Kenya Preventive and Promotive Health Eric Beda Southern African Centre for ICT Specialist United Republic of Infectious Disease Surveillance Tanzania (SACIDS) /& ( '2 Ministry of Health Head of e-health / EMR unit Republic of Rwanda

",/$"(2/21 New Mulago Hospital Head of ICT Republic of Uganda

Hermes Sotter Ministry of Health Director of ICT United Republic of Rulagirwa Tanzania Dr. Isaac Kadowa Ministry of Health /&+ &-)"!& )ƛ& "/ Republic of Uganda

"+)2!" Kamenge University Hospital, ICT Administrator Republic of Burundi Ndayishimiye Burundi "+)2!" Ministry of Public Health and IT Specialist Republic of Burundi Nshimirimana &$%1$&+01 /ǽ "+2)&6,6&1 University of Rwanda Head of Department, Health Republic of Rwanda Bioinformatics Department "++& (2!,/,$, +&3"/0&16,#2/2+!&Ǿ 2)16 Head of ICT Republic of Burundi of Medicine

96 ǾǛȒǝǗǕǖǜǾ Ǿ țȉȜ

PARTNER STATE/ NAME INSTITUTION DESIGNATION COUNTRY ,!,2 6" Muhimbili National Hospital Director of ICT United Republic of Tanzania Dr. Nabudeere Harriet Uganda National Health "-216&/" 1,/ "+"/) Republic of Uganda "0"/ %/$+&01&,+ Patrick Kibaya Uganda Chartered HealthNet Head Republic of Uganda

Dr. Peter Cherutich Ministry of Health Head Division of Strategic Republic of Kenya Health Information Dr. Pilly Chillo Muhimbili University of Health & Lecturer United Republic of Allied Sciences (MUHAS) Tanzania Richard Tumwesigye Uganda Cancer Institute Coordinator Republic of Uganda

Dr. Simon Langat National Commission for CS Republic of Kenya Science, Technology and ++,31&,+ț Ȝ /,#ǽ1"3"!")&ƛ National Commission of Chair Republic of Burundi Science and Technology Steven Wanyee +1"))& Director Republic of Kenya

Dr. Zacharia Mtema Digital Health Ifakara Health In-charge of Health United Republic of Institute Informatics Tanzania

DEVELOPMENT PARTNERS AND PRIVATE SECTOR

Adam Lane Huawei Technologies Senior Director of Public Republic of Kenya ƛ&/0 /ǽ$+"0 1,*"Ȓ Abt Associates ")1%/" &++ " Republic of Kenya Munyua Advisor, CB-HIPP Dr. Amit Thakker East Africa Healthcare Director Republic of Kenya "!"/1&,+ Prof. Barend Mons European Commission, Chair of the High-Level The Netherlands Belgium/Leiden University 5-"/1 /,2-,+1%" Medical Centre, The Netherlands 2/,-"+-"+ &"+ " Cloud Bissyande Tegawande ++&3"/0&16,#25"* ,/$ ICT Specialist/Research 25"* ,2/$ /+ ,&0Ȇ00&0" Scientist Boniface Kitungulu ǘǛǕ Director of Research Republic of Kenya

Charles Kuria &,,/-,/1&,+ Regional Director Republic of Kenya

Chris Seebregts RAD Consortium South Africa

Doroty Muroki ǘǛǕ Chief of Party, CB-HIPP Republic of Kenya

),/"+ " 2!/6Ȓ Novartis/Digital Health Representative Novatis/ /+ " Perkins Partnership ,2+!"/ /ǽ / "&%"0, USAID, Kenya and East Africa Senior Regional Maternal Republic of Kenya and Child Health Specialist

97 ǾǛȒǝǗǕǖǜǾ Ǿ țȉȜ

PARTNER STATE/ NAME INSTITUTION DESIGNATION COUNTRY

DEVELOPMENT PARTNERS AND PRIVATE SECTOR

+ &+" &,,/-,/1&,+ %&"#" %+,),$6ƛ& "/ Canada

*"0!,& ǘǛǕ Systems Analyst Republic of Uganda

"ƛ"&0"/ RAD Consortium Deputy Chief of Party South Africa

2!62$,6 Uganda Health Care Board Member Republic of Uganda "!"/1&,+ Lesley-Ane Long PATH Director of Digital Square USA

Lillian Nabunya HealthEnabled Digital Health Programme Republic of Uganda Manager Merrick Schaefer ), )"3"),-*"+1 Ǿ Lead, Development USA USAID Informatics /ǽ& %") /""+ "/$ &,,/-,/1&,+ %&/*++! USA

/,#ǽ&/'*+ Leiden Unversity Center for Director The Netherlands Reisen Data Science &00&"&+!, ǘǛǕ Senior Health Systems Policy Republic of Kenya Analyst Moses Bagyenderaa Health Informatics Republic of Uganda

/ǽ6&/&+(46 "+ 4+! ")1% /" "!"/1&,+ Chairman Republic of Rwanda Chrysostome Peggy D'Adamo USAID IT and Knowledge USA Management Advisor Dr. Peter Arimi USAID, Kenya and East Africa Senior Regional Health Republic of Kenya Specialist Dr. Peter Benjamin HealthEnabled 5" 21&3"&/" 1,/ South Africa

Peter Nganga ǘǛǕ &++ "+$"/ Republic of Kenya

Prince Bahati +1"/+1&,+) &+" Director Republic of Kenya +&1&1&3"ț Ȝ Sam Wambugu MEASURE Evaluation Health informatics Advisor USA

Sean Blashke Health Systems Republic of Uganda Strengthening Specialist Sherri Haas K4Health Project Technical Advisor, Digital USA Health and Health Economics Sionhan Coreen Sonjara, Inc. USA

Dr. Stephen Kinoti &,,/-,/1&,+ & "/"0&!"+1 USA

Dr. Subhashini HealthEnabled Consultant USA Chandrasekharan Tim Wood &))+!")&+! 1"0 "+&,//,$/*ƛ& "/ USA ,2+!1&,+

98 ǾǛȒǝǗǕǖǜǾ Ǿ țȉȜ

PARTNER STATE/ NAME INSTITUTION DESIGNATION COUNTRY

DEVELOPMENT PARTNERS AND PRIVATE SECTOR

&/&*2 (2, USAID, Kenya and East Africa Regional Deputy Chief Republic of Kenya

Dr. Wale Akinyemi Powertalks International Republic of Kenya

"+.&+$&+ Leiden Unversity Center for Data Digital Health PhD The Netherlands Science candidate

Ernest Rwagasana Director Republic of Rwanda

,!)&01"+,0%& Christian Social Services Manager United Republic of Commission (CSSC) Tanzania &+121"$& Kenya Conference of Catholic 1&,+)5" 21&3" Republic of Kenya Bishops (KCCB) Secretary "+/!1 6,12$&/ Uganda Catholic Medical Bureau IT Manager Republic of Uganda

/ǽ ,0"-%&+")1& Christian Social Services Director United Republic of Commission (CSSC) Tanzania Nathan Nshara /01#/& Consultant Republic of Uganda

Dr. Samuel Mwenda Christian Health Association of "+"/)" /"1/6 Republic of Kenya Kenya (CHAK) Dr. Tonny Tumwesigye Uganda Protestant Medical 5" 21&3"&/" 1,/ Republic of Uganda Bureau (UPMB)

FACILITATORS

Brooke Patridge &1)3"Ǿ + ǽ USA

Chris Lukolyo &1)3"Ǿ + ǽ Consultant Republic of Uganda

Derek Treatman &1)3"Ǿ + ǽ Director of Technology USA Solutions "% 11 &1)3"Ǿ + ǽ Director of Research USA

99 ǾǗǜ ȒǗǝ ǗǕǖǜǾ Ǿ

PARTNER STATE/ NAME DESIGNATION INSTITUTION COUNTRY Daniel Murenzi /&+ &-) ƛ& "/ EAC EAC

Betty Nankya Senior Personal Secretary EAHRC EAHRC - EAC

/ǽ &+0%2/& ")1%ƛ& "/ EAHRC EAHRC - EAC

/,#ǽ & 0,+& &(& 5" 21&3"" /"1/6 EAHRC EAHRC - EAC

/ǽ "+"&"2 "-2165" 21&3"" /"1/6 EAHRC EAHRC - EAC Ngirabega Dr. Novat ")1%ƛ& "/ EAHRC EAHRC - EAC Twungubumwe Bukuru Pamphile Head of Communications Ministry of Public Republic of Burundi Department ")1%+! &$%1 Against AIDS "+)2!" Head of eHealth and ICT Ministry of Public Republic of Burundi Nshimirimana Specialist ")1%+! &$%1 Against AIDS Dr. Ndagijimana Medical Director Ministry of Public Republic of Burundi Benjamin ")1%+! &$%1 Against AIDS Dr. Peter Cherutich Head of HMIS Ministry of Health Republic of Kenya

Dr. Harriet Principal Research Scientist Uganda National Republic of Uganda Nabudere Health Research /$+&01&,+ Dr. Isaac Kadowa /&+ &-)"!& )ƛ& "/ Ministry of Health Republic of Uganda

Hermes Sotter Director of ICT Ministry of Health, United Republic of Rulagirwa Community Tanzania "3"),-*"+1Ǿ "+!"/Ǿ Elderly, and Children /ǽ!"(6/&6, Principal Research Scientist National Institute for United Republic of Medical Research Tanzania (NIMRI) Brooke Partridge +!"! &)&11,/ &1)3"Ǿ + ǽ USA

"% 11 Director of Research and &1)3"Ǿ + ǽ USA Engagement Manager Merrick Schaefer ), )"3"),-*"+1 Ǿ Lead, Development USA USAID Informatics

100 ǾǘǗǕǖǜǾ Ǿ

PARTNER STATE/ NAME DESIGNATION INSTITUTION COUNTRY Daniel Murenzi /&+ &-) ƛ& "/ EAC EAC

Betty Nankya Senior Personal Secretary EAHRC EAHRC - EAC

/ǽ &+0%2/& /&+ &-) ")1%ƛ& "/ EAHRC EAHRC - EAC

/,#ǽ & 0,+& &(& 5" 21&3"" /"1/6 EAHRC EAHRC - EAC

/ǽ "+!"&"2 "-2165" 21&3"" /"1/6 EAHRC EAHRC - EAC Ngirabega "+)2!" Head of eHealth and ICT Ministry of Public Health Republic of Nshimirimana Specialist +! &$%1$&+01 Burundi /,#ǽ1"3"!")&ƛ Chair National Commission of Republic of Science and Technology Burundi Dorothy Muroki Chief of Party for CB-HIPP ǘǛǕ Republic of Kenya Dr. Evans Amukoye Ag Deputy Director Research Kenya Medical Research Republic of and Development Institute Kenya /+ &0!2,/ Assistant Director ICT Ministry of Health Republic of 2* Kenya Dr. Peter Cherutich Head HMIS Ministry of Health Republic of Kenya /& ( '2 Head of eHealth Ministry of Health Republic of Rwanda "+&"//" "+&,/ƛ& "/Ȓ)&+& ) Rwanda Biomedical Center Republic of Musabyimana Research Rwanda Alfred Bagenda Head of HMIS Ministry of Health Republic of Uganda Caroline Kyozira Principal Biostatistician, HMIS Ministry of Health Republic of Uganda Dr. Harriet "-216&/" 1,/ "+"/) Uganda National Health Republic of Nabudere "0"/ %/$+&01&,+ Uganda Dr. Khadija Malima %&"#"0"/ %ƛ& "/ Tanzania Commission for United Republic Science and Technology of Tanzania /ǽ!"(6/&6, Ag. Director for Research National Institute for United Republic Medical Research of Tanzania Brooke Patridge +!"! &)&11,/ &1)3"Ǿ + ǽ USA

"% 11 Director of Research and &1)3"Ǿ + ǽ USA Engagement Manager Sherri Haas Technical Advisor, Digital MSH, K4Health Project USA Health and Health Economics

101 Appendix B: Partner State Situation Analysis %"Ɯ$2/" "),4-/,3&!"0+,3"/3&"4,#1%" 2//"+1011",#!&$&1)%")1%-/,$/*0+!0601"*0&+" % EAC Partner State. It describes the strategies in place, as well as services and applications that support 1%,0"01/1"$&"0ǽ 1)0,-/"0"+101%" %))"+$"01%1" % ,2+1/6&0# &+$#,/"5-+!&+$!&$&1)%")1% &*-)"*"+11&,+0ǽ%))"+$"04"/"&!"+1&Ɯ"! 6&+&01/6,# ")1%+!&+&01/6,# 01ƛ&+" % ,2+1/6ǽ %&0&0+,+Ȓ"5%201&3")+!0 -",3"/3&"4ǽ!"1&)"!)+!0 -"00"00*"+14&)) " ,+!2 1"! 6" % 4,/(01/"*,+ "1%" +&1&1&3"&00"12-1,&!"+1@%100"10)/"!6"5&01&+" %,#1%"/1+"/11"01%1 can be utilised for the Digital REACH Initiative.

Ǟǽ

Current Status of Digital Strategy and Illustrative ")#Ȓ !"+1&Ɯ"! Health Services and Applications Challenges %""-2 )& Strategy in early Strategy in Place • Poor infrastructure and ,#2/2+!& implementation stages • National Heath Policy unreliable connectivity • Recently implemented DHIS2 • National Development Plan on ș +02ƛ& &"+11" %+& )0(&))0 scaled to health centre level Health Informatics • Low levels of computer • In a stage of country-wide • National Plan for the Development )&1"/ 6*,+$01ƛ&+ program adoption of eHealth some health facilities • Implementation plan for Illustrative Services & • Lack of ICT coordination eHealth in place Applications by MoH • Implementation of a • DHIS2 • Numerous initiatives Laboratory Information ș-"+)&+& in place, mainly run by System (Labware) ș-"+%/* 6 development partners • eHealth Learning Portal • -"+ 601"* %""-2 )& Plans to expand digital Strategy in Place ș /$*"+1"!0601"*0+! ,#"+6 health implementations • Kenya National eHealth Policy interoperability over coming year ǗǕǖǛȔǗǕǘǕ • Poor support and • Nationwide implementation Illustrative Services & maintenance of ICT of DHIS2 Applications infrastructure in remote • No governance structure • DHIS2 areas in place, but proposed • EMR • Low levels of computer Health Sector Coordination literacy Committee • ICT, interoperability, and EMR standards developed and implemented • Plans to implement Unique ID %""-2 )& Comprehensive strategy Strategy in Place ș /$*"+1"!0601"*0+! ,#4+! with strong governance ș*/14+!*/1)+ǗǕǗǕ interoperability structures in place • eHealth Policy and Strategic Plan • Poor support and • Nationwide implementation ș4+!" ")1% /*"4,/( maintenance of ICT of DHIS2 • ICT Security Policy infrastructure in remote • Comprehensive digital health Illustrative Services & areas strategy Applications • Low levels of computer ș" %+& ),/(&+$ /,2- • RHMIS (using DHIS2) literacy /"3&"40"5&01&+$+!+"4 șț-"+Ȝ • Electricity and ICT initiatives and provides • ERP infrastructure /" ,**"+!1&,+01, ș ")1% +#,/*1&,+5 %+$" • High coordination between • Alert system (Rapid SMS) MoH and MITECH ș &++ &)+$"*"+1601"*0 ș-"+ #/*"4,/( implemented

102 Current Status of Digital Strategy and Illustrative ")#Ȓ !"+1&Ɯ"! Health Services and Applications Challenges %""-2 )& 1DVFHQWVWUDWHJ\ Strategy in Place • Political instability ,#,21% ,PSOHPHQWDWLRQSODQVWLOO ș1&,+) ")1%,)& 6ǗǕǖǛȒ • Poor infrastructure 2!+ under formulation ǗǕǗǚ • No clear eHealth strategy • Nascent strategy and DHIS2 Illustrative Services & in place implementation Applications ș ,3"/++ "01/2 12/"2+ )"/ • DHIS2 partial implementation

%"+&1"! Ambitious digital strategy Strategy in Place • Inadequate coordination "-2 )& ,# and clear roadmap in place ș" ")1%1/1"$6ǗǕǖǘȔǗǕǖǝ in MDAs +7+& • Nationwide implementation (being reviewed) ș /$*"+1"!)+!0 -",# of DHIS2 ș , ) & 6 2 & ! " ) & + "#,/ ")1% pilot projects • Health facility registry in place • Digital Health Investment • Inadequate infrastructure • eHealth Steering Committee ,!*-ǗǕǖǜȔǗǕǗǘ and unreliable with several technical working • Standards and guidelines connectivity groups for integrated health facility • I n a d e q u a t e f u n d i n g • Implementation of electronic management system • Inadequate knowledge telemedicine ț& "Ȝ and skills on digital health ș *-)"*"+11&,+,#-"+ Illustrative Services & currently ongoing (Health Applications Information Mediator and • DHIS2 Data Repository, client ș& "ț&+ )2!&+$Ȝ registry, Shared Health • EMR Records) • Health training institutions information system (TIIS) • Human resources for health information system (HRHIS) • Medical and dental practitioners register and licensing system (MCTIS) %""-2 )& Early adopter seeking Strategy in Place • Hiring and retaining ,#$+! organised approach to • National eHealth Strategy eHealth and IT implementing digital health • National eHealth Policy professionals technologies ș" ,3"/+*"+1,)& 6 /*"4,/( • Lack of interoperability • Nationwide implementation Illustrative Services & and standardisation of DHIS2 eHealth Technical Applications "14""+"5&01&+$0601"*0 ,/(&+$ /,2-Ȕ*""10 • DHIS2 • Infrastructure and monthly and reports to MoH • RapidPro unreliable connectivity policy and decision makers ș-"+ • Lack of digital health • Consolidation of various ș$+!ț-"+Ȝ curriculum and health systems (ongoing) • iHRIS education content for local • Development of eHealth • Community HW Registry (Pilot in languages and cultures enterprise architecture and ǖǖ!&01/& 10Ȝ • Poor support and HIE framework (ongoing) • MTrac (essential medicines maintenance practice of monitoring) ICT infrastructure • Laboratory Information System • Noncompliance to (LIS) national and international • Pharmacy Information Portal regulations; data (PIP) management, security and • Logistics Management privacy Information System (LMIS) • Knowledge Management Portal (KMP) • Doctors registration status with the Uganda Medical and Dental Practitioners Council through mobile SMS

103 Appendix C: EAC Digital REACH Initiative Supporting Documentation ǖǚ

104 105 106 107 The 35th Extra-Ordinary Meeting of the Council of Ministers

108 109 ǖ7

110 111 112 Appendix D: EAC Strategic Priorities and Digital REACH Outcome Goals

# Digital REACH Initiative Outcome Goal Associated EAC Regional Health Sector Investment Health-Focused Outcomes Priorities ǖǽ-1&*&0"1%"/"3"+1&,+Ǿ&$+,0&0Ǿ+!/"1*"+1,# ș5-+0&,+,# "001,0-" &)&0"!%")1% /"and cross /&,/&16 ")1%,+!&1&,+0 border health services • Improve quality of care across countries (e.g., by improving • Upgrading of %")1%&+#/01/2 12/"and equipment in priority communication of diagnosis/treatment best practices, national and sub national health facilities/hospitals providing clear and monitorable harmonised guidelines, • Establishment of strong -/&*/6+! ,**2+&16%")1% and allowing for collaboration and sharing of information.) 0"/3& "0 as a basis for health promotion and diseases ș *-/,3""ƛ& &"+ 6,# /" /,00 ,2+1/&"0ț"ǽ$ǽǾ 6 prevention and control improving management of care while carefully tracking of ș5-+0&,+,#%")1%&+02/+ " coverage and social health results/outcomes, harmonised drug treatment protocols) protection • Improve continuity of care across countries (e.g., by ensuring the patients and their histories remain at the centre of care regardless of location of that care) • Improve access to healthcare services Ǘǽ2--,/1+&3"/0) "001, ")1% /" ș5-+0&,+,# "001,0-" &)&0"!%")1% /" and cross • Provide universal health insurance to anyone in the region border health services ș5-+0&,+,#%")1%&+02/+ " coverage and social health • Identify everyone with a right to quality healthcare (full protection registration)

ǘǽ *-/,3" ")1%,/("/!2 1&,++!/&+&+$ ș5-+0&,+,# - &161,-/,!2 "0(&))"!+!-/,#"00&,+) • Provide standardised and recognised healthcare training 4,/(#,/ " for health in the region based on harmonised and capacity building for health workers regional training and practice standards and guidelines Ǚǽ *-/,3"&0"0"2/3"&))+ "+!"0-,+0" • Strengthen the +"14,/(,#*"!& )/"#"/"+ ") ,/1,/&"0 • Strengthen regional health security by building capacity and the r"$&,+)/-&!/"0-,+0"*" %+&0* to protect the #,/"ƛ" 1&3"!"1" 1&,+Ǿ-/"3"+1&,+Ǿ+!/"0-,+0"1,%")1% region from health security threats including pandemics, bio- threats (e.g., disease emergencies, outbreaks) terrorism and common agents • Improve continuous disease surveillance across the region and in cross-border areas ǚǽ *-/,3"2--)6%&+ƛ& &"+ 6 • Increase access to 0#"Ǿ"ƛ& &,20+!ƛ,/! )" ș *-/,3"02--)6 %&+"ƛ& &"+ 6 *"!& &+"0Ǿ3 &+"0Ǿ+!,1%"/%")1%1" %+,),$&"0 #, 20&+$,+-/"3)"+1!&0"0"002 %0*)/&ǾǾ ȡ • Improve management of procurement and supplies, and other high burden conditions including the ability to monitor and evaluate quality of health products • Upgrading of %")1%&+#/01/2 12/" and equipment in priority national and sub national health facilities/hospitals • Achieve economies of scale through bulk purchasing ș &)&11"),$&01& 01/ (&+$ Ǜǽ-1&*&0" 2*+"0,2/ ")), 1&,++!+$"*"+1 ș5-+0&,+,# "001,0-" &)&0"!%")1% /" and cross ș-1&*&0"%")1%4,/("/*, &)&01&,++!!"-),6*"+1Ǿ border health services especially in rural and remote areas* • Establishment of strong -/&*/6+! ,**2+&16%")1% ș &)&11"4,/(-)++&+$+!%2*+/"0,2/ "1/ (&+$ 0"/3& "0 as a basis for health promotion and diseases prevention and control ǜǽ+%+ "2 )& ")1%!2 1&,++!4/"+"00 • Improvement of .2)&16,#%")1% /", health sector • Improve community health-related knowledge (e.g., "ƛ& &"+ 6+!%")1%011&01& 0 awareness, drive demand for services and care, knowing when to seek care) • Provide patient education for preventive care and behaviour change (e.g., health promotion services prevention education, adherence) ǝǽ,+&1,/,-2)1&,+ ")1%1120 • Improvement of .2)&16,#%")1% /", health sector • Support the creation of evidence-backed health policies "ƛ& &"+ 6+!%")1%011&01& 0 • Support health research and use of evidence to promote • Strengthening of Health Research and development health agenda • Elevating and prioritising contemporary population health issues into the health research agenda

113 Appendix E: Additional Workstream Activities The table below lays out additional activities by workstream that can be targeted for implementation once progress has been made on the priority activities. ADDITIONAL ACTIVITIES

ǘǿ +#/01/2 12/" ș,/(4&1%1%"1/1"$6+! +3"01*"+11"*1,&!"+1-/&,/&16/"0#,/"5-+!"! network connectivity in the region based on priority use cases • Development of further digital foundational technologies (e.g., regional facility registry, shared health record) Ǚǿ"/3& "0+!--)& 1&,+0 • Work with the Workforce team to support linking regional knowledge management platforms to content in national knowledge repositories and eLearning systems that support the regional mission • Develop tools to support decision planning, tracking, and decision support for supply %&+Ǿ 2!$"1Ǿ+!Ɯ++ &)+)60&0 • Improve and integrate human resource information systems to improve human resource allocation • Implement a communications system to reach subgroups of the patient population with targeted public health messaging ǚǿ"!"/0%&-+!!3, 6 • Advocate to support better governance structures • Advocate to facilitate inclusion and recognition of digital health in curricula to ensure all health workers are trained and knowledgeable on digital health • Advocate for messaging services to public and private facilities to improve public education and awareness • Advocate across countries for bulk purchasing of medical supplies to reduce cost of healthcare to providers and patients Ǜǿ1/1"$6+! +3"01*"+1 ș"3"),- 20&+"00 0"0#,/+"$,1&1&,+4&1%0#,/ƛ,/! )" +!4&!1%+! improved network connectivity to support other implementations • Manage and negotiate bulk purchasing of supplies across states to reduce cost of provision of health ǜǿ"$&0)1&,+Ǿ,)& 6Ǿ+! • Create manpower policies to improve health worker productivity ,*-)&+ " • Achieve accreditation and recognition of eLearning courses provided by the Initiative (e.g., by nursing and doctors associations and Partner States) to allow health workers to travel in the region and to ensure patient receive the same standard of care ǝǿ,/(#,/ " • Promote eLearning as means of reaching a broader group of healthcare professionals that in the long run reduces training cost and time away from duty stations • Share best practices on digital methods including use of social media platforms for public health education and awareness • Build capacity of health professionals for areas of Digital REACH Initiative activities (e.g., data sharing, supply chain management tools, public health messaging tools, monitoring of population health trends). Prioritise according to needs.

Ǟǿ1+!/!0+! • Create standards for compensation across region to ensure fair premiums and +1"/,-"/ &)&16 repayment • Harmonise regional data standards for health insurance to support the insurance market • Create a common standardised template to collect Partner States’ supply needs to support demand aggregation • Create nonbinding guidelines on the recognition of prescriptions across borders to allow EAC citizens to access necessary medication • Create minimum data set for diagnostic algorithms and clinical referral guidelines to support continuity of care ș"Ɯ+"-/,1, ,)0#,/-2 )& %")1%*"00$&+$ț1,&+ )2!"1&*&+$+! ,+1"+1Ȝ1,"+02/" 2+&Ɯ"!0&+$)"*"00$"&0/" "&3"! 6 &1&7"+01,3,&! ,+#20&,++! /"1" #/*"4,/(0+!1"*-)1"01,&+ /"0"0-""!+!"ƛ& &"+ 6,# ,**2+& 1&,+0 • Develop guidelines for cross-border health research with regional universities and research bodies to encourage and support regional research • Set service delivery standards and harmonise service delivery guidelines

114 Appendix F: Skills and Capabilities Across Workstreams

ADDITIONAL ACTIVITIES

ǖǿ +&1&1&3" • Leadership • Communications and public relations +$"*"+1 • Management • Knowledge management • Project coordination ș5-"/1&0"&+$), )%")1%Ǿ!&$&1)%")1%Ǿ • Stakeholder and partnership management and regional policy • Change management • M&E ș-"/1&,+0țƜ++ "Ǿ Ǿ)"$)Ǿ Ȝ Ǘǿ ")1% • Management and oversight ș2 )& %")1%"5-"/1&0" /,$/**"0 ș-"/1&,+)02--,/1 ș" %+,),$6"5-"/1&0" • M&E ǘǿ +#/01/2 12/" • Management and oversight • Database administration ș-"/1&,+)02--,/1 • Server administration • Product ownership ș,ƞ4/"!"3"),-*"+1 • Enterprise IT management • Human-centred design • Partnership management • IT security • IT system architecture • M&E Ǚǿ"/3& "0+! • Management and oversight • Public health --)& 1&,+0 ș-"/1&,+)02--,/1 • Medical informatics • Product ownership • Requirements gathering • Partnership management ș0"/&+1"/# "ȡ20"/"5-"/&"+ "ț ȡȜ design ș,ƞ4/"!"3"),-*"+1 • Human-centred design • M&E ǚǿ!3, 6 • Management and oversight ș,+02)11&,++!+"$,1&1&,+"5-"/1&0" ș-"/1&,+)02--,/1 ș5-"/1&0"4,/(&+$3& %++")0+! • Stakeholder management structures • M&E Ǜǿ1/1"$6+! • Management and oversight ș"5-"/1&0" +3"01*"+1 ș-"/1&,+)02--,/1 • Business analysis • Negotiation • M&E ǜǿ"$&0)1&,+Ǿ • Management and oversight of workstream by health ș,)& 6+!)"$&0)1&,++)60&0+!!/ƞ&+$ ,)& 6Ǿ+! professionals with both managerial and technical "5-"/1&0" ,*-)&+ " skills • Digital health, particularly at the policy ș-"/1&,+)02--,/1 level • Stakeholder management • M&E ǝǿ,/(#,/ " • Management and oversight ș ")1%-/,#"00&,+)"!2 1&,+"5-"/1&0" ș-"/1&,+)02--,/1 ș2 )& %")1%"5-"/1&0" • Coordination across all workstreams ș&$&1)%")1%"5-"/1&0" • Partnership management • Capacity building, training, CPE and ,+1"+1 /"1&,+"5-"/1&0" • M&E Ǟǿ1+!/!0+! • Management and oversight • Public and clinical health +1"/,-"/ &)&16 ș-"/1&,+)02--,/1 ș "5-"/1&0" • Stakeholder management • Standards deͰelopment • Implementation • Solution development • Research and analysis • M&E

115 Appendix G: EAHC Implementation Activities %&0--"+!&5-/,3&!"0#2/1%"/!"1&),+1%"&*-)"*"+11&,+ 1&3&1&"01, " //&"!,21 61%" +#/01/2 12/" workstream and the EAHC Health Programme. To realise the EAHC, three sub-workstreams will be employed. %"0"1%/""02 Ȓ4,/(01/"*04&))#2+ 1&,+&+-/))")ǽ%"1 )" "),4-/,3&!"0*,/"!"1&),+1%"0-" &Ɯ activities in each sub-workstream. Ȓ ACTIVITIES

+0&$%10+!,+1"+1 • Advocate for buy-in from all the EAC Partner States for the EAHC • Create shared vision for EAHC ș 1&+#""! (#/,*/1+"/11"0,+4%11%"6+""!1,,-1&*&0"1%"&/3)2" from the EAHC (e.g., what data to include, what database views to make available, how 1,"+02/""06 "00#,/--/,3"!/"0"/ %"/0Ǿ !"*& 0Ǿ+!$,3"/+*"+1,ƛ& &)0Ȝ • Analyse EAHC data to create common goods (e.g., algorithms to trigger outbreak alerts, /,21&+"+)60"0,+ ,*-/1&3""ƛ" 1&3"+"00,#%")1%-/,$/**"0Ǿ01+!/!&0"! tools for data collection and use) ș&&0" "14""+1%"/1+"/11"0+!1%" +&1&1&3"ȉ0/"$/!&+$1%,2$%1 leadership and implementation learnings " %+,),$6 • Implement and manage the EAHC, its data, and the database views that are accessible 6/")"3+120"/0ț"ǽ$ǽǾ/"0"/ %"/0Ǿ !"*& &+0Ǿ+!$,3"/+*"+1,ƛ& &)0Ȝ ș01 )&0%+!*&+1&+0" 2/"+!/")& )"Ɲ,40,#!1#/,* ,+1/& 21&+$/1+"/ • State systems into EAHC and then out to users in the proper format ș01 )&0%0+!!1ȡ)"/1&+$4,/(Ɲ,40#/,*1%" 1,/1+"/11"0 • Support the design and deployment by EAC Partner States and other health programmes of standardised tools and standards for data collection and use, directly linked to the EAHC architecture ș--)6&+!201/601+!/!0#,/!10" 2/&16Ǿ&+1"/,-"/ &)&16Ǿ+!"ƛ& &"+ 6 -"/1&,+0 • Agree on location of EAHC • Identify opportunity for PPPs for the build and maintenance of the EAHC • Establish and enforce security protocols for accessing system data • Establish a user support system for accepting, tracking, and resolving requests for support, system issue reports, and new feature requests • Monitor system usage and data access • Inform users of any new system features or data sets, changes to access protocols, or disruptions to service • Maintain a public roadmap of current and planned feature development

The Infrastructure team will be responsible for ensuring that all health programmes that are dependent on EAHC to operate will feed into the functional requirements so that they are able to store the data they need in the cloud. %""!"/0%&-+!!3, 64,/(01/"*1"*Ǿ4,/(&+$4&1%1%" +#/01/2 12/"1"*+!1%"0 needed, will familiarise the EAC Partner States on EAHC for better understanding among countries of the +""!+!3)2",#&10"01 )&0%*"+1ǽ 2/1%"/*,/"Ǿ1,$&+ 26Ȓ&+#/,*/1+"/11"0+!01("%,)!"/0Ǿ "*-%0&04&)) "-21,+-/, "00"0+! ,+1/,)0/")1"!1,!10" 2/&16Ǿ-/&3 6Ǿ ,+Ɯ!"+1&)&16Ǿ+! management of the information. This programme’s implementation approach will be as much about advocacy and buy-in as it is about generating knowledge, research insights, and building the technology. Success will also require working closely with the Legislation, Policy, and Compliance workstream to ensure the right policies are in place for sharing data securely and safely. ,2+1/6Ȓ 6Ȓ ,2+1/6--/, %Ǿ20&+$ 0+! ,+02)11&3"*""1&+$0Ǿ4&)) "1("+1,")& &1 ,+ "/+0Ǿ&+-21Ǿ and approval for the programme. Early adoption from select countries will aid the EAHC’s full adoption across the EAC by providing a subgroup of intensively reviewed and evaluated implementations to inform further "5-+0&,+ǽ%" 4&))+""!1, "!"0&$+"!1, " ,*-1& )"4&1% ,2+1/60601"*0ǽ

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