Detailed Table of Contents

Preface...... xv

Chapter 1 Records Management and Open Data in Healthcare Provision in Africa: Reflections and Lessons for ...... 1 Peter Mazebe II Mothataesi Sebina, , Botswana Balulwami Grand, University of Botswana, Botswana

Although there is recognition that open data can lead to improvements among lives in Africa arising from availability and access to healthcare data, this chapter advances that a critical element of open data which is often overlooked and little regarded most times, is records management. The chapter argues that the key elements of open data is that data must be available on platforms which are easily accessible and easy to manipulate for purposes of use and reuse; transparency of the open data process; information security; information privacy, and finally trust which could lead to acceptance, reuse of data and also emerging encouragement among citizens that data is worth accessing, using and reusing, are all made possible by good public sector records management. Records management, this chapter shows, is a clear means through which effective open data especially in healthcare may be achieved. While the chapter draws out lessons which Botswana could learn from and makes recommendations for workable open data in the country’s public health sector, these are nonetheless applicable to many African countries and others in the developing world.

Chapter 2 Big Data and Healthcare: Implications for Medical and Health Care in Low Resource Countries...... 14 Kgomotso H. Moahi, University of Botswana, Botswana

This chapter explores the concept of big data and its application to health and medical care in developing countries. It explores what big data is and how it can be applied to healthcare and medicine. To do this, the first sections address the question of what big data and data analytics are and what they encompass. An exploration of the potential benefits of big data is provided, with examples of applications, most of which are from the more developed nations of the United States and Europe. The chapter then considers what might be possible from implementing big data in low resource countries, with some examples of what already pertains. It looks at the challenges of implementing big data in health care in both developed and low resource countries.

 

Chapter 3 Open Source Technology for Medical Practice in Developing Countries...... 33 Afton Chavez, Geisel School of Medicine at Dartmouth, USA Carrie Kovarik, Perelman School of Medicine, University of Pennsylvania, USA

This chapter provides an overview of the role of open source technologies in medical practice in developing countries. First, the background and meaning of “open source” is explored. Second, several fields of open source implementation are described. Within each field, specific case studies are provided to illustrate how the technologies have been adapted to the developing world for usage in information and communication sharing, electronic data management, mobile data collection, disease mapping, scholarly publication, and education. The issues and controversies, as well as future research directions and solutions are addressed.

Chapter 4 Knowledge Sharing for Healthcare and Medicine in Developing Countries: Opportunities, Issues, and Experiences...... 60 Kgomotso H. Moahi, University of Botswana, Botswana Kelvin J. Bwalya, University of Johannesburg, South Africa

This chapter focuses on knowledge sharing by health professionals in the provision of healthcare and medicine in developing countries. It covers knowledge management and its link with knowledge sharing; the various methods of knowledge sharing in healthcare; factors that make knowledge sharing an important strategic direction for healthcare organizations; and factors and issues that affect or determine knowledge sharing behavior. Finally, examples of knowledge sharing in developing or low and middle- income countries are presented. The chapter shows that developing countries have recognized the value of knowledge sharing in healthcare systems and there are tangible signs that this is going to shape cross- pollination of ideas and innovations in the health systems in the foreseeable future.

Chapter 5 Viral Education via Mobile Phone: Virtual International Networks and Ebola Prevention in ...... 78 Julia Bello-Bravo, University of Illinois – Urbana Champaign, USA Anne Namatsi Lutomia, University of Illinois – Urbana Champaign, USA Thomas Songu, Njala University, Sierra Leone Barry Robert Pittendrigh, Michigan State University, USA

This chapter documents a strategy for the development and deployment of educational content on Ebola prevention and treatment targeted at low-literate learners speaking diverse languages in Sierra Leone. During the outbreak of Ebola in Sierra Leone, Njala University partnered with Scientific Animations Without Borders (SAWBO) at the University of Illinois at Urbana-Champaign to create educational animations on Ebola. Drawing on an international network of collaborators, these animations were then placed into multiple languages for Sierra Leone. Njala University in turn acted as the central hub for engaging local partner groups to deploy this content throughout Sierra Leone. This chapter describes the development process which occurred during the outbreaks and the ICT tools now available to the global health community. The educational animations created during the 2014 Ebola outbreak are now available in multiple languages for Sierra Leone, as well as those of other West African countries, along with a highly scalable deployment pathway that can be rapidly operationalized during future outbreaks or modeled for other outbreak or health crisis situations. 

Chapter 6 Mobile Phones and Expanding Human Capabilities in Plural Health Systems...... 93 Steven Sam, The University of Queensland, Australia

This chapter explores the integration of mobile phones into the local health culture in Sierra Leone to advance healthcare delivery to marginalised communities. It draws on Amartya Sen’s capability approach to conceptualise the mobile phone as a potential technology to expand healthcare capabilities in an environment of scarce healthcare resources. It builds on ethnographic data collected through mixed- methods from rural and urban communities in Sierra Leone to analyse the different actors, dynamics and practices of healthcare behaviours in a plural healthcare system. The analysis shows increasing trends towards mobile phone usage to ease healthcare communication and information poverty. Mobile phones enable marginalised publics to collapse distance and reduce time and health infrastructural constraints to seek healthcare within their abilities. It, however, concludes that to fully harness and maintain sustainable mobile phone-enabled healthcare in Sierra Leone requires the need for an appropriate institutional configuration to foster an integrated healthcare information system management and service delivery.

Chapter 7 Implementation of Mobile Health Initiatives in : Current Status, Issues, and Challenges...... 115 Donald Flywell Malanga, University of Livingstonia, Malawi

This chapter reviews the mHealth initiatives being implemented in Malawi by drawing on two case studies: Chipatala Cha Pa Foni (CCPF) Project for improving Maternal, New born, and Child Health (MNCH) and Rapid SMS Project for improving the Child Nutrition Surveillance. The chapter also examines the success stories experienced in the implementation of the projects; and identifies the challenges that hampered the adoption and scalability of the mHealth projects. Based on the challenges, the chapter makes recommendation that Malawi and other developing countries may adopt for scaling up or replicating similar mHealth programmes.

Chapter 8 Telemedicine in Low Resource Settings: A Case for Botswana...... 129 Kagiso Ndlovu, University of Botswana, Botswana Kabelo Leonard Mauco, Boitekanelo College, Botswana Ryan Littman-Quinn, Botswana- UPenn Partnership, Botswana

This chapter focuses on telemedicine practices in low resource settings, referencing key telemedicine initiatives in Botswana. Telemedicine is highly practiced in the developed world, and recently there is an increasing interest in the developing world. Current literature suggests telemedicine as an important tool for improving healthcare delivery for low resource settings, hence the authors’ interest in exploring the current status of telemedicine practices with reference to telemedicine projects from low resource settings such as Botswana. The chapter reveals that telemedicine in such settings is mainly implemented through mobile phones, also known as mobile health (mHealth). In this chapter, the authors discuss factors influencing successful implementation of telemedicine solutions in Botswana. Furthermore, the chapter discusses telemedicine implementation challenges for each of the projects and presents possible mitigation strategies. The chapter concludes by affirming the feasibility of successfully practicing telemedicine in low resource settings, notwithstanding challenges such as lack of legal and eHealth frameworks in most developing countries. 

Chapter 9 Telemedicine and Electronic Health: Issues and Implications in Developing Countries...... 149 Kijpokin Kasemsap, Suan Sunandha Rajabhat University, Thailand

This chapter provides an overview of telemedicine enabled through electronic health technology that includes electronic health records (EHR), health information exchange (HIE), mobile health technologies, and social network sites (SNSs). These are modern technologies that are focused on improving quality of care and increasing patient safety. They provide opportunities for the exchange of medical information from one site to another site via electronic communications. In this way, they help healthcare organizations share data, help reduce the cost of health care, and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and shorter hospital stays. The chapter argues that utilizing telemedicine has the potential to enhance health care performance and reach strategic goals in developing countries.

Chapter 10 Next Wave of Tele-Medicine: Virtual Presence of Medical Personnel...... 168 Kelvin J. Bwalya, University of Johannesburg, South Africa

This chapter presents a development projectile of healthcare systems and explores interventions and current trends in pervasive healthcare delivery systems and makes a prognosis of what is to come in the future. The first part of the chapter presents concepts about telemedicine. The chapter is based on literature and document reviews focusing on innovations in telemedicine and gives a commentary on what needs to be done to achieve true ubiquity in healthcare delivery systems both in the developing and developed world contexts. The chapter posits that pervasiveness will be highly enshrined into healthcare systems to a point where physicians will not have to leave their working space to provide a service. The design of the Defibrillator Drone, for example, provides an opportunity for healthcare application developers to develop information system applications which do not only carry medical supplies from one place to the other, but are able to reason and prescribe medications. With acute advances in the science of robotics and ICTs in general, this is a reality in the foreseeable future.

Chapter 11 Use of Information and Communication Technology by Health Care Providers for Continuing Professional Development in Botswana...... 181 Wananani. B. Tshiamo, University of Botswana, Botswana Mabedi Kgositau, University of Botswana, Botswana Mabel Magowe, University of Botswana, Botswana

This chapter aims to elaborate the importance of continuing professional development (CPD) to health and medical care, and how ICTs can be used as a platform for CPD. Focusing on Botswana as a case study, the chapter explores challenges and issues faced by health care providers in using ICTs to access CPD and includes solutions and recommendations. Challenges identified included underdeveloped ICT infrastructure and limited use of available ICT resources by health care providers. 

Chapter 12 “It Has Been Quite a Journey”: Experiences and Evolution in Health Information Systems in ...... 193 Njabulo Bruce Khumalo, National University of Science and Technology, Zimbabwe

This chapter describes the challenges faced in Zimbabwe’s health information management and how the Ministry of Health and Child Care and its partners responded to these challenges. The chapter also highlights success stories in health information management in the country.

Chapter 13 Case Study: The Health Facility Registry...... 208 Niamh Darcy, RTI International, Tanzania Sriyanjit Perera, CTS Global Solutions, Tanzania Grades Stanley, National Institute for Medical Research, Tanzania Susan Rumisha, National Institute for Medical Research, Tanzania Kelvin Assenga, RTI International, Tanzania Faustin Polycarp, RTI International, Tanzania Angelina Sijaona, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania Esther Msechu, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania Marcos Mzeru, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania Claud Kumalija, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania Michael Kambenga, University Computing Centre, University of Dar es Salaam, Tanzania Benjamin Mayala, National Institute for Medical Research, Tanzania & University of Notre Dame, USA Mturi Elias, University Computing Centre, University of Dar es Salaam, Tanzania Paul Biondich, Regenstrief Institute, Indiana University, USA Zaharani Kalungwa, U.S. Centers for Disease Control and Prevention, Tanzania Japhal Mwamafupa, President’s Office Regional and Local Government, Kibaha District Council, Tanzania Nseya Kipilyango, RTI International, Tanzania Scott Teesdale, InSTEDD, USA

This chapter presents the Tanzanian case study describing the work and lessons learned in building the Tanzanian health facilities registry (HFR), focusing on software development, introducing geographic positioning systems and harmonizing MFL data. The Ministry launched the HFR public portal in September 2015. 

Chapter 14 Health Information Systems, eHealth Strategy, and the Management of Health Records: The Quest to Transform South Africa’s Public Health Sector...... 237 Shadrack Katuu, International Atomic Energy Agency, Austria & University of South Africa, South Africa

This chapter describes the efforts in transformation made through the promulgation of the National Health Act in 2003 and the eHealth Strategy in 2012. The chapter explores the utility of maturity assessment in evaluating transformation goals through an analysis of five maturity models: Digital Preservation Capability maturity model, eHealth maturity model, Enterprise Content Management maturity model, Health Normative Standards Framework maturity model, and Records Management Capacity Assessment System. South Africa is already using two of the five models demonstrating that is not just reliant on technology but has developed strategies and principles to guide the transformation process. The chapter argues for more expansive adoption of maturity assessment to cover the full records lifecycle.

Chapter 15 Developing and Measuring the Business Case for Health Information Technology...... 262 Duncan Wade Unwin, Griffith University, Australia Louis Sanzogni, Griffith University, Australia Kuldeep Sandhu, Griffith University, Australia

The chapter examines the adoption of information technology and information systems to support the clinical process. It explores popular models of information systems adoption and success, and relates these to the healthcare context. Successful technology adoption should manifest itself through improved performance in health care delivery. However, measuring performance is complex so various approaches to performance measurement are discussed. As one of the challenges in predicting the outcomes of adoption is the lack of a consistent taxonomy relating adoption to expected outcomes, a solution is proposed. The chapter concludes by looking at IT projects evaluation and considers what factors may affect health IT adoption and benefits in developing health care systems.

Compilation of References...... 291

About the Contributors...... 341

Index...... 347