Healthcare

GLOBAL INVESTOR 2.12 — 33
cluster of villages go around the community
and attend to patients. If they encounter a
problem that they are unable to solve, they
call a nurse or a midwife, or eventually a
doctor for advice about what to do.
How do mothers find out
about these things?
S. Yunkap Kwankam: With SMS you can
broadcast a message to every subscriber
on your network. For example, the MAMA
project (Mobile Alliance for Maternal
Action) provides free health messages to
new and expectant mothers around the
world. Mothers register for the service by
indicating the expected due date or the
birthday of their infant.
But communication is just one
of theadvantages you mentioned.
S. Yunkap Kwankam: Yes, the other is
capturing and analyzing good data to make
informed decisions. An example of that is
SMS for Life, which was trialed in Tanzania
using text messages and electronic
mapping technology to solve a problem
of stockouts of antimalarial drugs.
Before that, central planners did not
know what medicines were available
in what centers.
Cell phones for health!
S. Yunkap Kwankam: Yes and no. The
World Health Organization (WHO) Commission
on Social Determinants of Health
has pointed out clearly that you cannot just
focus on improving the health system.
If you look at what produces health, it is
water and sanitation, food and nutrition,
housing and education. In actual fact, you
have to fix entire economies. You have to
fix governance. You have to fix agriculture.
You have to fix communications.
The major problem faced in many
developing countries used to be that
of communicable diseases.
S. Yunkap Kwankam: That was then.
Now, as life expectancy increases, chronic
diseases are beginning to make up a
greater share of the disease burden. Moreover,
there are huge shortages of health
workers. A WHO report published in 2006
listed 53 countries worldwide where the
number of doctors, midwives, nurses and
pharmacists, per capita, was insufficient
to provide basic services. Thirty-three of
those countries were in sub-Saharan Africa.
Which implies what, in terms of ICT?
S. Yunkap Kwankam: We have to
explore what ICT can do for these other
pathways to good health. We have to shift
the emphasis from ICT for health to ICT
“We have to shift the emphasis from ICT
for health to ICT for development because
many of the challenges that these countries
face are really problems in development,
and not just health alone.”
for development because many of the
challenges that these countries face are
really problems in development and not just
health alone. Another compelling reason
for the shift is that many of the decisions
about investing in infrastructure for ICT in a
country are out of the purview of a health
minister. But health considerations need to
be part of the thinking when that infrastructure
is being put in place.
In the West, we take infrastructure
for granted.
S. Yunkap Kwankam: When I talk about
telemedicine, I always cite the example
of Medgate, out of Basel. Medgate is very
successful. The service currently handles
around four thousand or five thousand
patients a day: people call in either by
phone or the Internet. Statistics show that
half of the people who call in get the
problems resolved. And that’s terrific! But
behind the simple technology of using
a cell phone to call a doctor in the Medgate
center lies a lot of infrastructure, including
payer systems (i.e. insurance schemes),
electronic prescribing and a stable supply
of electricity. In an African country, there
is no guarantee. The infrastructure adds a
layer of complexity to the problem.
Setting aside for a moment the broader
issue of development, what are
some of the limitations of ICT itself?
S. Yunkap Kwankam: One of the biggest
limitations that the technology faces
has to do with legal and regulatory issues.
When you carry out an intervention that
spans several jurisdictions – or countries –
knowing which laws to apply and who has
responsibility can be quite murky. The
regulatory environment has not kept pace
with the advances in technology. Digital
signatures are a case in point. In the end,
you need a paper signature to validate
the electronics. It’s a real bottleneck. So
is interoperability of systems. Cyber abuse
is another obvious problem.
You have constructed a list of six eHealth
“grand challenges” (see box). Could
you share one or two of them with us?
S. Yunkap Kwankam: One is what I call
going to scale. In other words, ICT interventions
have to be commensurate with the
size of the problem. Another is to anticipate
where the health system is going, and use
technology to stay ahead of the game.
The power of ICT is staggering if you think
of it in terms of people, processes and
technology. Leveraging that power can do
Six eHealth
grand challenges
1. Creating a “knowledge commons” for
eHealth, a widely available repository
of information on eHealth that is global
in scope.
2. Scaling up eHealth interventions,
based on evidence, to a size
commensurate with the magnitude of
the problems to be addressed.
3. Creating integrated eHealth systems
to resolve the perennial issues of siloed
systems and lack of interoperability.
4. Transforming health workers into
ePracti tioners and building individual
and institutional capacity to use
eHealth tools and services.
5. Developing information and
communications technology (ICT) for
health by viewing health as a production
function, and investigating where
ICT can support it.
6. Building ICT for the health system
of the future by anticipating future
needs, thereby reducing the time lag
intervention to seeing the impact.
Source: S. Y. Kwankam, “Bulletin of the World Health
Organization,” vol. 90, 2012, pp. 395–397.