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Digital Health Ecosystem for African Countries File Type Digital Health Ecosystem for African countries A Guide for Public and Private Actors for establishing holistic Digital Health Ecosystems in Africa LIST OF ABBREVIATIONS ACBF African Capacity Building Foundation ICD International Statisticall Classification of Diseases and Related Health Problems API Application Programming Interface ICT Information and Communications BMZ Federal Ministry for Economic Cooperation Technology and Development IHE Healthcare Enterprise CDA Clinical Document Architecture IVD Ischemic Vascular Disease CDA Common Document Architecture KPI Key Performance Indicators CDR Clinical Data Repository mHealth Mobile Health Applications CDW Clinical Data Warehouse MPI Master Patient Index CODL Centre for Open and Distance Learning MRS Medical Record System DATIM Data for Accountability Transparency Impact Monitoring NGO Non-Governmental Organization EAIDSNet East African Integrated Disease NHSSP II National Heath Sector Strategic Plan II Surveillance Network openEHR Open Electronic Health Record ECS Emergency Care Summary PaaS Platform as a Servcie eHR Electronic Health Record PEPFAR President's Emergency Plan for AIDS Relief eID Electronic Identification PHCIS Primary Health Care Information System eIDSR Electronic Integrated Disease Surveillance REC Regional Economic Communities and Response RRI eHealth Regulation Readiness Index EMR Electronic Medical Record System SaaS Software as a Service ePS Electronic Patient Summary SACIDS Southern Africa Centre for Infectious Disease ESA European Space Agency Surveillance ESB Enterprise Service Bus SARA Service Availability and Readiness Assessment EWS Early Warning Systems SDG Sustainable Development Goals FBO Faith-based Organisation SDI Service Delivery Indicators GIZ German Corporation for International SMEs Small- and Medium-sized Enterprises Cooperation GmbH SPA The Service Provision Assessment HIS Health Information System SPDA Strategic Partnership Digital Africa HISM Health Information Management System tMed Telemedicine HIV Human Immunodeficiency Virus Infection USAID United States Agency for International HL Health Level Development HPRS Health Professionals Registration WAHO West African Health Organization System (Kenya) WHO World Health Organisation Content EXECUTIVE SUMMARY 6 Core results 6 1. INVESTING IN A DIGITAL HEALTH ECOSYSTEM— OPPORTUNITIES AND CHALLENGES 8 Why digital health is different 9 Opportunities and challenges for digital health 10 2. TOWARDS A RESILIENT DIGITAL HEALTH ECOSYSTEM: WHERE TO START 14 Responding to policy priorities and stakeholder needs 15 Starting point: national or regional? 16 Guiding questions to assess the starting point towards a comprehensive Digital Health Ecosystem 16 3. BUILDING BLOCKS FOR IMPLEMENTING A COMPREHENSIVE DIGITAL HEALTH ECOSYSTEM: A WAY FORWARD 18 3.1. Four foundational building blocks 19 3.2. Drafting a digital health strategy (I.) 20 3.3. The road from eHealth strategy to long-term sustainability (II.) 21 Roadmap concept 21 Roadmapping framework 21 3.4. Implementation of the Digital Health Ecosystem (III.) 23 Open digital health platform 23 Core starting services and applications 24 Towards a goal-oriented digital health interoperability framework 26 The need for change management 31 Governance and legal framework 33 3.5. Assessing and measuring impact (IV.) 34 3.6. Summary: key success factors 35 The Strategic Partnership Digital Africa (SPDA) is a network of the German Federal Ministry for Economic Cooperation and Development (BMZ) and European companies, managed by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH. Its goal is to harness digitalisation opportunities to drive Africa’s development—in partnership with European companies. One of six thematic expert groups of the SPDA concerns digital health. Its experts from the private and public sector have identified integrated, interoperable Digital Health Ecosystems as an area of interest due to the widespread state of fragmentation in the digital health sector. 4. THE WAY FORWARD 36 4.1. Investment opportunities in African Digital Health Ecosystems 37 Country rankings 37 Overview of four high ranked countries 39 Kenya 39 Namibia 41 Rwanda 41 Tanzania 42 Summary 43 4.2. Vision for a cooperative investment approach 44 The “customers” 44 Development partners and financiers 45 Providers of Digital Health Ecosystems 45 4.3. An industry perspective 45 ENDNOTES 46 GRAPHS Graph 1 Key challenges on the way towards a Digital Health Ecosystem 13 Graph 2 Four building blocks for a resilient Digital Health Ecosystem 19 Graph 3 Generic open Digital Health Ecosystem architecture 23 Graph 4 Interoperability domains 30 Graph 5 Results-based evaluation management 35 TABLES Table 1 eHealth priority ranking of Sub-Saharan African countries 38 Table 2 Sub-Saharan African countries ranked according to eHealth regulation readiness 39 EXECUTIVE SUMMARY Core results Digital technologies will influence the future of well-being The study results are summarised in seven key and economic growth worldwide. African economies are messages and recommendations: well-positioned to benefit from this accelerating techno- logical change that will help to overcome limitations and Seven Key Messages the costs of physical infrastructure in important areas 1. Digital health supports the Sustainable Development of economic life. Goals and Universal Health Coverage. To meet the health targets of the Sustainable The health sector is benefitting from this trend, in particu- Development Goals by 2030, progress must be acceler- lar in Africa. Substantial investment in digital solutions ated, in particular in regions with the highest burden in recent years have already improved health services of disease. When implemented appropriately, digital in Africa. African leaders who gathered at the African health is a great enabler towards better health care and Ministerial Dialogue on digital health leadership at the health coverage. May 2017 World Health Assembly affirmed their commit- ment to digital health and identified the pathway towards 2. The establishment of a national Digital Health Ecosystem realising strong Digital Health Ecosystems in their coun- should be based on an integrated framework. tries. A Digital Health Ecosystem is the holistic application A sustained transformation of health systems requires of Information and Communication Technologies (ICT) to a holistic vision, driven by priorities and a unifying support and improve health care delivery, its coordination approach that ensures that all eHealth applications are and integration across providers. integrated through a national digital health infrastruc- ture platform—a Digital Health Ecosystem. In this study, framework conditions, requirements and options for the successful, sustainable implementation of 3. There is no one-size-fits-all solution for digital health. Digital Health Ecosystems in Africa are analysed with the Implementing and sustaining digital applications goal to create an action-oriented framework for digital in the health sector is demanding, complicated and infrastructure and services, based on a well-founded time-consuming. There is no one-size-fits-all platform health policy context. Relevant partners include decision solution. Instead, each solution has to be tailored to makers, health system operators and industry in African local needs, circumstances and resources. countries, development partners and companies with expertise in Digital Health Ecosystems and applications. 4. Instead of developing individual pilots, governments and development partners should focus on integration. The study provides a basis for these actors to jointly devel- Stand-alone eHealth implementations and pilot op Digital Health Ecosystems that address the respective projects that rarely reach scale or sustainability needs and technical requirements of African countries. should be avoided. Focus on a few health care and/or public health priorities to guide nation-wide investments. Ensure coordination and integration of all stakeholders. “ A Digital Health Ecosystem is the holistic application of Information and Communication Technologies (ICT) to support and improve health care delivery, its coordination and integration across providers.” 6 5. There are four building blocks for successfully kkAs implementing a national Digital Health Ecosystem implementing a National Digital Health Ecosystem: is a multi-year endeavour, put in place careful planning a strategy, roadmap, implementation elements and processes, including risk and change management, evaluation. from the beginning. Drafting an eHealth strategy will not do the job. Three kkFocus first on low-hanging fruit and early benefits for additional building blocks are needed: An actionable, health care delivery, particularly health professionals realistic roadmap on how to move from strategy to and patients. Build on and integrate what is already implementation and long-term sustainability, six there—do not start yet another isolated project. implementation elements (national platform, core kkEnsure coordination, adequate infrastructure services, interoperability guidance, leveraging the processes and organisation, e.g. through an eHealth “open” approach, change management, governance Division in the Health Ministry or a competent and legal framework) and measuring impact to guide eHealth Authority. further development. kkEnforce mandatory coordination among all core stakeholders who invest in digital health applications, 6. Fostering a Digital Health
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