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February 02, 2010
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Caroline Broder
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Sue Ducat

Global E-Health: Benefits And Challenges For The Developing World

Health Affairs Thematic Issue On Health Information Technology In Developing Countries Explores Key Issues In Long-Term Investment And Financing, Policymaking, Interoperability, And Workforce Training And Development

Bethesda, MD - The promise of modern information and communications technologies, often dubbed e-health, to transform health care in developing nations is a central focus of the February 2010 edition of Health Affairs. As these nations struggle to address seemingly intractable health care issues, global experts discuss the potential role of e-health, covering urgent issues such as the need for long-term investment strategies to fund effective e-health implementations, interoperability standards so that various information systems can work together both within and among developing countries, and trained health informatics workforces with competencies tailored to various nations or regions.

The articles constitute a broad review of the multiple e-health applications already in use in Asia, sub-Saharan Africa, and Latin America, known collectively as the Global South, as well as the challenges facing their widespread use. Highlights include the following:

• A report on a 2008 conference sponsored by the Rockefeller Foundation, Making the eHealth Connection: Global Partnerships, Local Solutions, describes next steps for using e-health to improve health in developing countries. Ariel Pablos-Mendez, Ticia Gerber and colleagues summarize conference participants' recommendations for global partnerships, health technology solutions based on local needs, cross-border interoperability, leveraging current open source networks and shared informatics systems, and developing a shared understanding or convention on e-health.

• How can e-health technologies best support health and health care in developing countries? According to a systematic review of evaluations of e-health implementations by Joaquin A. Blaya and colleagues, the greatest potential for e-health may lie in systems that improve communication between health care institutions, support medication ordering and management, and help monitor and improve patient compliance with care regimens. In addition, evaluations of personal digital assistants and mobile devices demonstrate high effectiveness in improving data collection time and quality. Future implementations should include funding for rigorous evaluations, the authors say.

• What can proponents of global e-health learn from the field of social entrepreneurship as they work to create viable business models for expansion? Kevin W. Crean writes that a combination of specialized financing techniques and sustained investor support that has benefited various social entrepreneurial initiatives can also accelerate the global impacts of e-health. E-health investments could benefit substantially from a number of other lessons, including frank, strategic risk reassessment by funders; a long-term investment horizon; greater support for developing integrated systems that can deliver care to large numbers of people; and increased focus on systems-level learning.

Mobile health or m-health - the use of cell phone technologies to improve health - is the subject of three papers. Because m-health is relatively cheap and accessible - even to many poor people in developing countries - it holds huge potential for communicating important health information to patients, including reminders to take their medications and keep their doctors' appointments. Lester Feder describes how the Carso Health Institute is testing m-health approaches in Mexico to combat a variety of conditions, including HIV/AIDS and diabetes.

Despite the great promise of m-health, there is a need for solid evaluation of its use in developing countries, according to a review from James G. Kahn and colleagues at the University of California, San Francisco. The authors call for ongoing evaluation of specific initiatives to guide m-health growth, including a mix of randomized controlled trials, natural experiments, and other study designs.

In addition, Walter H. Curioso and Patricia N. Mechael recommend expanding m-health collaborations in the Global South. Most South-South collaborations have not gone beyond the pilot stage and have not been properly evaluated. Funded primarily by private philanthropies and bi-lateral donors, such initiatives need to be reviewed and evaluated to identify those that show promise and provide the evidence to attract investment, the authors contend.

The current state of global e-health policy is parochial and nation-centric, and threatens to create permanent and counterproductive e-health silos, according to a review by Maurice Mars of the University of KwaZulu-Natal in South Africa and Richard E. Scott of the University of Calgary in Canada. They argue for a "glocal" e-health policy approach that engages the experience of stakeholders at both the global and local levels, is tailored to the needs of a given locality and population, and designed to overcome problems such as health care worker shortages. William M. Tierney of Indiana University and co-authors advocate partnerships between academic and government institutions in high- and low-income countries to help establish health informatics programs in developing countries. Such programs, they say, can in turn capture and manage data that are useful to all countries.

• How can e-health systems in developing nations exchange data and work together effectively? W. Ed Hammond and colleagues highlight issues in implementing interoperability standards - what is needed, who needs to do it, and how the work might be sustained. It's important, they note, to recognize the e-health priorities of the Global South: first, to create national databases on the prevalence of disease, regionalization of disease, and outcomes; and second, to build demographic databases of local environments. New interoperability systems need to be flexible and loosely organized to accommodate the needs of different audiences in different countries, while using shared terminology throughout.

• In the developed world, it is estimated that tens of thousands of trained health informatics professionals are needed to use and deploy e-health technologies effectively. But in the developing world, questions about health informatics workforce needs haven't been asked, let alone addressed. William Hersh of Oregon Health and Science University in Portland and co-authors present a framework for developing estimates of the size and scope of the workforce that may be needed. It will be important, they note, to develop in each country a workforce with the skills, training and competencies that are needed to fully realize the benefits of e-health and that are consistent with local culture, languages and heath systems.

The cluster of e-health articles grew out of a Rockefeller Foundation conference, Making the eHealth Connection: Global Partnerships, Local Solutions, held in the summer of 2008 that convened some of the world's leading thinkers in e-health. Publication of this set of articles in Health Affairs is supported by a grant from the Rockefeller Foundation.

This edition of Health Affairs also features an interview by Editor-in-Chief Susan Dentzer with Mark D. Smith, President and CEO of the California HealthCare Foundation. Since 1997, the California HealthCare Foundation has served as a catalyst for advances in health care access, delivery, and technology. Here, Smith contemplates health system challenges facing both the nation and California during a time of economic instability. He sees the next several years as "a period of great uncertainty and, hopefully, great experimentation," with health care providers and policymakers working together "to examine an alternative to our current path."

To access a full table of contents from this issue, please click here: http://www.healthaffairs.org/Media/2010_february_toc.pdf


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org. Address inquiries to Sue Ducat at (301) 841-9962 or sducat@projecthope.org.


©2010 Project HOPE-The People-to-People Health Foundation, Inc.