Bellagio — Developing countries in the Global South, which have already introduced innovative technology such as mobile banking, need to drive the development of "eHealth" – the harnessing of Internet-enabled technologies to improve public healthcare, says Karl Brown, associate director of applied technology of the Rockefeller Foundation. He was interviewed by AllAfrica's Boakai Fofana, at a conference on the subject in Bellagio, Italy, which has been sponsored by the foundation.
What is the idea behind the eHealth initiative?
The idea is that technology is at a turning point. In the industrialized countries – i.e. the United States and Europe – there has been long experience with using communication technology in health care. There have been a lot of lessons learned, a lot of mistakes, but also a lot of successes. We feel that in the developing world there is now an opportunity to use information technology in a more integrated way in health-care systems.
The time is now, because we feel that health care systems are undergoing a process of enormous change. There's been a change in the burden of disease in many countries. There are increasing numbers of patients entering the health care system. There's more money being spent on health care in developing countries.
The other reason we think that now is the time for "eHealth" is that there are a thousand flowers blooming. There are a thousand different eHealth pilots around the world. But the space is still fragmented, and there has been a lot of reinvention of the wheel. Now, people are learning from the experience of countries which have moved further.
The other issue that I think is important is interoperability. You have a lot of countries where donors will come and build a database, for instance, to track the HIV program. And then another donor will come in and build a database to track the TB program. And then another donor builds a database to track the malaria program. And none of these databases can talk to one another.
Speaking of the African context, what are you hoping to achieve at the end of this conference?
One of those things we are hoping to achieve is a consensus amongst the participants on the value of eHealth and on the vision for eHealth for the world. Underneath that vision, we would like to work with the participants in achieving a road map for how to bring that about.
Since the focus of this conference is eHealth in the South [developing counties], we have brought a lot of participants from the South to this conference. At the Rockefeller Foundation, we believe the vision, the strategy and the road map should all be driven by the countries who are going to be impacted by this technology. It's not a northern [developed countries] initiative, where we will define the standards and the solutions and then give them to Africa.
Innovations are coming from different places in the world. If you look at innovations in mobile banking, what are the best mobile banking systems in the world? Kenya and South Africa. They are way more advanced than anything we have in the United States. I think innovation is coming from new quarters, so we need to find a way to engage the IT [information technology] sector in Africa and elsewhere in the world in support of better health.
Are you considering the fact that you might face some structural problems in Africa – for instance, where you have health systems that have collapsed in post-war situations in Liberia and Sierra Leone? Or even the huge challenge of unemployment and illiteracy?
We have to speak in terms of the appropriate technology for the situation that you are dealing with. Take, for example, Sierra Leone. It's one of the poorest countries in the world. But we had a guy from the ministry of health in Sierra Leone here last week, and what Sierra Leone is doing, with the help of the Health Metrics Network and the World Health Organization and other partners, is building an integrated health information system. Sierra Leone has decided that this is a priority for their country – they are making a huge investment.
In a low-resource setting like Sierra Leone, you have to make every dollar go as far as you possibly can. That's where we think the leveraging power of eHealth can bring about a transformation in the way health systems are organized. They can make health systems more efficient. They can increase access to care for people who are not living in the urban areas, using telemedicine to reach people in the rural areas [where] the people are concentrated.
So short of sending the doctors out there, another solution is to use communication technology so that doctors can provide care remotely. Probably every African country is already experimenting with eHealth in one way or another.
Coming out of this conference, we are hoping to produce a longer-term vision on what eHealth could become and provide tools and resources to African countries who are interested in the field. For instance, if the minister of an African country wants to develop an eHealth policy, where does she go to understand: how do I build an eHealth policy?
Maybe we can develop templates for policies, depending on the structure of the health system. And then that could be downloaded off the Internet and used as a start. That wouldn't get her 100 percent of the way there, but it might get her 70 percent of the way. It will save her a lot of time. And it's been provided by the best-thinking experts in the North and South. There are 190 countries in the world. You don't need 190 different architectures; we don't need to do it 190 times. We could do this maybe three or four times and then share it with the world.
So after this what next? Will you start writing out grants to institutions, to see the idea taken far and wide and implemented?
Sure. One of the themes of this conference is partnerships and collaborations. In addition to inviting lots of participants from the South, we have also tried to bring donors to this conference from various donor institutions. One of those things I would hope comes out of this conference is that new partnerships are formed in support of developing countries that are interested in eHealth, and then those partnerships will help provide resources, technology, training etc.
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One of the things we are going to do here at the Rockefeller Foundation, after this conference, is to be elaborating our own internal strategy. Then, if we get approval for that initiative, we will have a larger budget, and we will start making grants to organizations working in this field.
Would you describe this initiative, this conference, as being successful?
Yes. This is only the second week, and there are a number of new ideas that have come out – which is what we expected. Some of the ideas were very innovative. There have already been new seeds of partnerships that are formed. So we have a group from South Africa, a group from Brazil and a group from the United Kingdom who are looking at the various pieces of what we already have to develop a framework of an eHealth system in Africa. That's just an example of one of the ideas that have sparked out of this conference.
Read more about Rockefeller's eHealth initiative
Read about AllAfrica's eHealth initiatives, HealthAfrica.org and HealthLiberia
