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E-health

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Digital technologies offer great opportunities to improve health services

Modern information and communication technologies (ICTs) are becoming more and more important in the health sector. They offer solutions for electronically collecting, analysing, processing and exchanging examination results and patient data. This helps improve health services and patient care. ICT-based applications can be useful in creating well-functioning health systems, especially in developing countries and emerging economies.

The term e-health (meaning "electronic health") has emerged as an umbrella term for the broad range of ICT applications in the health sector.

This includes aspects such as telemedicine, mobile health (m-health) and computer-based learning (e-learning).

Surgery robot

Telemedicine is a modality of health care that provides services at a distance with the help of telecommunications technologies. It includes, for example, remote diagnosis, psychiatric counselling using a secured internet connection or remote-controlled robot-assisted surgery.

There is great potential for using telemedicine especially in countries that lack medical specialists and where distance, poor infrastructure and other issues hamper the delivery of health services.

Telemedicine also includes internet-based information portals aimed at promoting good health and providing patients with information. Some of the portals also have a chat or e-mail function, allowing patients to send questions to medical experts more or less anonymously. Telemedicine may also come in the form of electronic readers (e-readers) in health facilities, which staff can use to access medical publications such as reference books or the most recent medical journals.

Smartphone user

There are significantly more mobile phones in service in developing countries and emerging economies than landline telephones. The market for mobile phones has been growing rapidly in recent years, especially in Africa. According to the International Telecommunication Union (ITU), almost 80 per cent of the people in Africa had a mobile phone contract in 2017. Ten years back, it was not even 30 per cent.

Mobile phones can be used to deliver certain healthcare related services, for example text messages to remind patients of their appointments or prompt them to take their medication. The devices can also be used for disseminating health-related information, registering births and deaths and monitoring the progression of diseases.

Students in Kigali, Rwanda

Many developing countries and emerging economies are faced with staff shortages in the health sector; there is an urgent need to train and upskill health professionals. Yet, existing training facilities are often not able to meet this demand, not least because there are not enough qualified instructors. Internet-based training offers and access to medical databases can make an important contribution to upskilling staff and thus also to improving the quality of health care.

E-learning also enables continuous in-service training. The training thus offered is both inexpensive and flexible timewise. This means that professional health workers can take courses without any negative impacts on patient care.

Storage for medicines in a hospital in Nigeria

E-health in developing countries and emerging economies

The spread of digital technology gives developing countries and emerging economies the chance to develop modern management and information systems, for aspects such as hospital administration, health insurance, drug logistics and disease monitoring.

When it comes to treating diseases such as HIV/Aids and tuberculosis, it has been shown that introducing an electronic patient record system improves patient care. The number of prescribing errors is demonstrably reduced and medication needs can be assessed more precisely. This in turn can prevent drug shortages from arising.

The Global Observatory for eHealth of the World Health Organization (WHO) conducted a study on e-health applications in maternal and child health in 2014 and produced an atlas of the e-health strategies of 125 WHO member countries in 2015. The atlas highlights the potential role that e-health can play in achieving universal health coverage.

However, some questions remain open. There is still little to show, for example, how much of a positive impact various e-health applications actually have on healthcare provision. And so far there are no studies on feasibility and cost effectiveness. A question that arises in many countries with which Germany cooperates is whether investments in e-health tie up funds that would be needed more urgently for other projects and whether more impact could be achieved by investing in other areas.

Potential benefits of e-health applications

E-health applications are considered especially useful for:

  • supporting local and international data collection and providing quicker access to these data in the case of disease outbreaks; increasing transparency and accountability
  • preventing errors in diagnosis and treatment through the exchange of information; providing access to knowledge and expert support
  • helping to save funding and material, e.g. through the use of electronic patient files and by reducing the need to travel; efficiency gains, for instance through ICT-based hospital management systems
  • offering training opportunities and knowledge transfer even in remote areas without the need for frequent and/or lengthy staff absences
  • helping to prevent brain drain, because the opportunities resulting from the new technologies motivate skilled staff to stay

Challenges in developing countries

  • weaknesses in basic infrastructure, for instance with regard to power supply and the availability of internet connections, computers and other devices
  • inadequate protection of sensitive data due to insufficient system maintenance (risk of computer viruses) and the tendency for mobile phones to be shared by several people
  • IT skills shortages, particularly in the public sector
  • health personnel and decision-makers in the fields of politics and administration lack the skills needed to handle the technologies and complex IT solutions
  • problems with technical devices due to environmental factors such as heat and humidity and building-related challenges, for instance in rural health facilities
  • underfunding of health systems threatens the sustainability of investments in e-health technologies (long-term coverage of operating and follow-up costs for hardware and software and also for training measures)
  • risk of growing inequalities in the health sector: the segments of the population that could most benefit from e-health applications are often those with the least access to information and communication technologies and to the necessary training
Children's hospital in Eritrea

German activities

The Federal Ministry for Economic Cooperation and Development (BMZ) sees huge potential in cooperating with the digital industry and the health sector. The areas of health information systems, human resource development, hospital management and policy advice (development and implementation of e-health strategies), in particular, offer starting points for development cooperation interventions.

A key factor is to ensure that the selected technologies and contents match the needs of the target groups and the conditions in the individual countries, and suit the infrastructure that is available. Follow-up costs, for instance for system maintenance and software updates must also be taken into account. This applies in particular for solutions offered by companies from industrialised countries that cost little upfront but for which maintenance and repair are expensive. Stand-alone solutions which use technology that is incompatible with existing systems are to be avoided.

A set of digital investment principles that Germany helped to develop can provide a general framework for guidance.

  • Working at a computer
    Cooperation in action

    Universal health coverage – special software provides the technical basis

    OpenIMIS is an open source software for managing social health protection systems which can be adapted to the specific needs of individual countries.

Working at a computer
The case of openIMIS

Universal health coverage – special software provides the technical basis

Goal 3 of the 2030 Agenda for Sustainable Development calls for action to "ensure healthy lives and promote well-being for all at all ages." A number of partner countries with which Germany engages in development cooperation have launched reform processes in order to achieve this objective. The focus of these reforms is on efficient funding for an effective healthcare system.

Many models - one common problem

Different countries use different models - some are based on tax-funded systems, others on social insurance, community-based health insurance, micro-insurance or even health-related social transfers. However, there is one challenge they all face: for a system to work efficiently manner and on a large scale, complex data processing (management of client data and contracts, processing of applications and payment procedures...) must be carried out using digital technologies.

This means that governments need to decide whether they want to commission tailor-made software solutions requiring regular - and often very costly - maintenance, adjustment and updates. Or whether they prefer to purchase a commercial licence for an existing programme. This would come with regular automatic updates; but it would not be tailored to the specific needs of an individual administration. In addition, there is the risk that the new programme might not be compatible with the existing system or that it cannot be used for other purposes.

Patients waiting in a hospital in Tanzania

Flexible, efficient, transparent, cost-effective

This is where the openIMIS initiative, co-funded by the BMZ and the Swiss Agency for Development and Cooperation (DEZA), comes in. OpenIMIS is an open source software for managing social health protection systems.

OpenIMIS is a tool that can be used to link patient, provider and payer data. This way patients can be more easily identified and electronic hospital invoices that are sent automatically can be verified and paid more speedily. This ensures reliable cash flows in health care systems. The software offers on-line and off-line options as well as applications for mobile phones and can thus also be used in rural settings.

It is an open-source application, which means that a large international community of software developers is working together to develop the product. The software can be adapted to the specific needs of individual countries; at the same time, users can benefit from improvements made in other countries.

Building up from a Swiss project

OpenIMIS is based on an information management system for insurance providers that was developed by the Swiss Tropical and Public Health Institute and successfully deployed in Tanzania in 2012. Later on, the licence holder, Switzerland, made the system available to Cameroon and Nepal as well.

There is huge demand in developing countries and emerging economies for reliable and cost-effective digital solutions for social insurance systems. That is why the BMZ and DEZA pooled forces and developed the system further into the openIMIS application. In 2017, GIZ took charge of coordinating the openIMIS initiative. The initiative helps interested countries introduce the software.

Cooperation with the private sector

On behalf of the BMZ and in cooperation with partners from Germany and from partner countries, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) is developing digital models to improve healthcare services.

Under the framework of its event series "lab of tomorrow" GIZ is collaborating, for instance, with the science and technology company Merck. Merck hosted two three-day workshops, one in Darmstadt and one in Nairobi in May and in November 2016. The focus of these workshops was on logistics solutions to improve access to medicine and diagnostics in Kenya. Some 50 participants, including representatives from 31 companies, developed nine solutions – ranging from a loyalty point system via an online marketplace for pharmacies and clinics to using drones to deliver medicines. Seven of these models are currently being implemented.

In spring 2017, another lab of tomorrow focusing on the prevention of chronic diseases in Kenya took place. This is where the idea of "Health.Games.Org" originated. An on-line quiz lets users explore information on healthy lifestyles in a playful manner. An initial version was presented in Eschborn and Nairobi on World Diabetes Day on 14 November 2017.

Logo: lab of tomorrow
Documents and links

Further information

BMZ glossary

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