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Improving health in the Commonwealth: the role and importance of eHealth as an enabling environment

Date: 23 Jul 2007
Author: Prof S Yunkap Kwankam Coordinator eHealth,WHO,& Prof Ricky J Richardson Vice President, International Society for Telemedicine and eHealth
Publication: Commonwealth Health Ministers Reference Book 2007

The combined use in the health sector of electronic communication and information technology, known as eHealth, is a key enabler for supporting health systems the world over, in delivering good health to citizens. But despite its significant potential, some Commonwealth countries are unable to take advantage of eHealth because they lack the capacity for its absorption, or due to the high cost of its products and services. A Commonwealth eHealth programme would make the best use of the long-standing relations among member countries and through sharing, and in partnership with the World Health Organization (WHO), make eHealth benefits, such as personalised healthcare delivery with improved outcomes and mitigating the effects of shortages in the health workforce, available to them all.

Every day, the lives of a vast number of Commonwealth citizens rely on well-functioning health systems. From safe delivery of a newborn baby to the care of the elderly, health systems have a vital and continuing responsibility to people throughout their lifespan. Information and communications technology (ICT) has introduced a profound opportunity and potential for worldwide advancement in such lifelong support to people’s health. eHealth, the combined use in the health sector of electronic communication and information technology for clinical, educational and administrative purposes, both at the local site and at a distance, is recognised as a key enabler for supporting health systems the world over to deliver on their promise of good health to their citizens. ICT has been deployed successfully in public health interventions as well. The control of onchocerciasis in West Africa and the control of the SARS epidemic are two of the best known examples of the contribution that ICT can make to public health. ICT now constitutes the third industrial pillar of the health sector.The first, in the 19th century, was chemistry which led to the pharmaceuticals industry.The second was physics in the 20th century, which gave the world imaging systems. ICT is the foundation of knowledge-based health systems. In recognition of this,Target 18 of the Millennium Development Goals urges: “In cooperation with the private sector, make available the benefits of new technologies – especially information and communications technologies.” More recently, the World Health Assembly passed a resolution at its 58th session in May 2005 calling on all countries of the world to develop eHealth strategies and policies and deployed Health services to improve health worldwide.WHO works collaboratively with identified institutions throughout the world, leveraging existing knowledge and activities and creating synergies with other actors in the field of health delivery to make the benefits of eHealth available to the largest possible audience. With the myriad of applications made possible by the implementation of eHealth, patients can have their healthcare programmes tailored for their individual needs – and thus the onus of responsibility for linking patient needs with service provision shifts into the hands of the service provider. We are truly at the dawn of the age of the citizencentric healthcare delivery model, with healthcare providers reaching out and tailoring healthcare programmes to be delivered directly into the personal space of the world citizen. This comes at a time when the pharmaceutical industry is looking at tailoring individual medications more closely to patients’ individual needs, thus bio-engineered pharmaceuticals in the future will be tailor-made to individuals rather than to disease conditions. This approach mirrors what is happening in healthcare systems worldwide.

Issues and challenges

The challenges are no longer technological, because most of the technology applications have been tried and tested in other environments such as finance or manufacturing. The challenge is to persuade the clinical community, and indeed the patients themselves, to adopt the new models of the healthcare services. Patients are presenting to the doctor’s surgery these days with strongly held opinions on what treatment they are prepared to consider, armed with a formidable array of knowledge, which they have accessed via the internet. Whereas the eHealth story began with a variety of pilot projects mostly involving small numbers of patients, which then evolved into national eHealth applications, such as NHS Connecting for Health, it is interesting to note that groups of countries are now looking seriously at utilising eHealth to share resources, thus avoiding unnecessary duplication of specialist services within each individual country. As a result of investments made by the European Commission, a number of eHealth projects, large and small, have been implemented in European countries. Europe has thus become a field laboratory for eHealth programmes, which has had major implications for global health managers, who have been looking closely at eHealth programmes in Europe with a view to selecting what elements of existing applications and services might be suitable for their own healthcare system transformation. The Baltic eHealth Exchange is a good example of this. Specialist services from one country are delivered via eHealth and made available to patients living in rural communities in several other countries. eHealth thus not only acts as an agent for reforming healthcare systems from an infrastructure-focused healthcare service into a more dispersed healthcare model, but is also enabling countries with similar heritage and interests to share resources across international borders, thus providing quality without the expense of needless duplication.

The World Health Organization as a catalyst

To overcome challenges that impede the rapid and large-scale adoption and adaptation of eHealth solutions to health challenges, WHO has identified a number of priority areas, listed in the box.They include the action areas endorsed by the WHO Executive Board in January 2006.A few of these areas are elaborated below.

Global Observatory for eHealth: WHO’s Global Observatory for eHealth is conceived as an instrument to enable better understanding of the eHealth space. It provides member states with strategic information and guidance on the application of ICT for health through a decentralised network of institutions in countries which collect and analyse data and information on ICT in the health sector in each country.The Observatory’s report on the first ever global eHealth survey was published in January 2007 and is available at www.who.int/goe/en.

ICT R&D for health: Although health has benefited greatly from developments in ICT, health is not simply an area of application of ICT. There should be a symbiotic relationship between the two. Health sector needs – health promotion, disease prevention, diagnosis, treatment, protection against health threats – should also drive the ICT R&D agenda. ICT for human resources for health: There is global shortage of health workers. This shortage is particularly acute in 57 countries (16 of them in the Commonwealth) with a health worker density below a critical minimum necessary to provide effective basic health services. eLearning and other forms of ICTmediated learning can help alleviate the situation. Kenya, for example, is upgrading the skills of 22,000 nurses using eLearning, at a fraction of the cost and time it would have required using traditional methods of educational delivery.

One area of WHO focus is the interaction between ICT and health systems – the development, deployment and use of the technology to support health system functions. It is thus concerned with solutions from the policy and practice environment within which ICT is operated to support capacity building, and to provide services that improve health outcomes – an environment defined by socio-economic, financial and institutional policy; human and material resources; and organisational and managerial models. The work covers: 

• Capacity building, through access to affordable sources of reliable and current information, and educational opportunities and training materials that develop individual competence, institutional capacity, and support an informed and empowered public
• Support to health service delivery and system performance, addressing: improved effective coverage through better access to and availability of interventions; increased technical quality of services; and effective and efficient management of human, financial and physical resources 
• Monitoring, evaluation and assessment of impact in the above areas.

A Commonwealth eHealth programme Despite the call of the World Health Assembly, and the significant potential of eHealth, many Commonwealth countries, especially in the developing world, are not able to enjoy the benefits of eHealth because they lack the capacity to systematically evaluate developments in ICT and make informed decisions about potential applications, adaptation to country-specific needs, and country readiness for their adoption. These countries look to others for joint action. Other members of the Commonwealth are unable to take advantage of eHealth developments because they do not have access to the proprietary products and services through which ICT adds value to health. However, a number of organisations are willing to donate/share the intellectual property rights to their eHealth products and services to WHO, in an effort to make these products and services available, as appropriate, to all peoples of the world. Building on the long-standing multilateral relations which exist among its members, the history and common traditions which constitute the Commonwealth factor, and in partnership with WHO, these countries could be part of the eHealth revolution. Resource-challenged countries could share through a WHO pilot initiative on Sharing eHealth Intellectual Property for Development (SHIPD).

There are also significant gradients in eHealth application among Commonwealth countries – between, for example, Canada, the UK, and Australia on the one hand, and many of the African member countries on the other – which facilitate eHealth technology transfer. Common action at country, regional and international levels is needed as investments in ICT infrastructure are multisectoral in nature. A Commonwealth eHealth programme could thus leverage trade agreements and other forms of bi- and multi-lateral agreements to maximise synergies among sectoral initiatives.

The Commonwealth: a vehicle for sharing

A number of key documents such as the World Health Assembly resolutions on eHealth, on human resources for health, the Crisp Review, an unpublished report of the Global Health Workforce Alliance, and the WHO report of the global eHealth survey, not only highlight the importance of bringing ICT to bear positively on health challenges in countries, but also give examples of how this could be achieved. A common theme which runs through these reports is the value of sharing.The Commonwealth offers a vehicle for such sharing. It is hoped that developments in eHealth will not only herald an era of personalised healthcare delivery with improved outcomes, but together they will do something to reduce the cost burden of the delivery of quality healthcare, which is becoming financially unsustainable. Perhaps most importantly with the change in demographics, which is unmasking huge numbers of patients with chronic disease, we are establishing the building blocks of a citizen-centric healthcare system of the future which will be of immeasurable benefit to our children and grandchildren, who will inherit the benefits of forward thinking leadership being articulated today in the Commonwealth and throughout the world.

Portions of this article have appeared in eHealth in Europe, published by the European Pharmaceuticals Journal. Professor S Yunkap Kwankam is Coordinator eHealth at WHO, Geneva Switzerland, where he is responsible for coordination of eHealth work across the Organization. He oversees programmes on the use of ICT in health, including coverage of development of frameworks and tools to support policy and practice in ICT-based knowledge  management and sharing in countries; assistance to countries in building national capacity for effective and efficient use of ICT in health systems; and development of the evidence base and best practices in eHealth. He also directs the development and implementation of WHO eHealth policies, and provides authoritative advice on eHealth to countries.

Professor Ricky J Richardson, BSc, MBBS, MRCP (UK), FRCP, FRCPCH, DCH, DTM&H, is a Consultant Paediatrician. He sees patients at the Great Ormond Street Hospital for Children and the Portland Hospital for Women and Children, London. He is Clinical Director, Healthsystems Group, and Visiting Professor in eHealth, Imperial College, London. He was founding Chairman of the UK eHealth Association, and he is now Life President. He served as Chairman of the Pan European eHealth Working Group of the European Health Telematics Association (EHTEL) from 1999 to 2003. He was elected Vice-President of the International Society for Telemedicine & eHealth in September 2003. He is Group Clinical Director of HealthSystems Group of companies. The World Health Organization is the United Nations specialised agency for health. It was established in 1948.  WHO’s objective, as set out in its Constitution, is the attainment by all peoples of the highest possible level of health.

World Health Organization
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Email: kwankamy@who.int
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