eHSA Governance - eHealth for Sub-Saharan Africa - Governance study

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The goal of the overall eHSA programme is to develop pan-African eHealth services, enabled by satellite, to benefit the sub-Saharan Africa region. These services shall be focused on providing services in the domains of education, clinical services, surveillance and management to the citizens and health workers in that region. The governance study is the first in a series of four horizontal studies performed in the eHSA programme.  The governance study will examine the basic conditions for implementing eHealth and telemedicine services in sub-Saharan Africa, whether imposed by the governments or by private parties.

Key tasks include:

  • Analysing the required interaction among all the local authorities at district, country, and regional level
  • Identifying the role and responsibility of stakeholders on various levels of the healthcare system, and, if needed, other entities.
  • Identifying and proposing a suitable governance model to manage the infrastructure from the thematic areas projects funded by the programme (those being eCare, eLearning, eGovernance, eSurveillance).

Governance generally comprises a wide range of tasks, including financial administration, aggregation and reporting of administrative data including quality, programme outcomes, informed decision making and efficient steering of multiple projects through continuous access to timely information, public relations and dissemination strategies, and advocacy for the new services.

Key tasks within the governance study will include:

  • Analysing the required interaction among all the local authorities at district, country, and regional level
  • Identifying the role and responsibility of stakeholders on various levels of the healthcare system, and, if needed, other entities.

Identifying and proposing a suitable governance model to manage the infrastructure from the thematic areas projects funded by the programme (those being eCare, eLearning, eSurveillance, eAdministration / eGovernance).

The governance study will have to examine the basic conditions for implementing eHealth and telemedicine services in sub-Saharan Africa, as imposed by the governments or by private parties.

 The governance study is the very first stage of the eHSA programme. It's purpose is to pave the way for the achievement of the overall programme - i.e. to enable the development of a satellite-enhanced eHealth and telemedicine infrastructure for the sub-Saharan African region.

Expected Main Benefits:

A key benefit of a sound governance approach is that it is deliberately designed to work in harmony with existing mechanisms and to support existing national health policy, rather than to reinvent the policy and tools already in place. The benefit of this is that the eHSA programme will  strengthen health systems, not replace them. The reason why satellites are chosen as the enabler for delivery is the benefits they bring in terms of being able to reach those in remote locations.

Users and their needs

The end users will be all those that interact with healthcare systems across the sub-Saharan African region. This will include, amongst others, patients, healthcare workers, financiers, politicians, and charities and aid/development agencies with interests in the region.

A central need that the eHSA programme is looking to address " aside for the obvious requirement for improved healthcare delivery " is the strengthening of healthcare systems. Proper governance involves recognising the substantial efforts and mechanisms already in place to support the delivery of healthcare and working in harmony with them and in a way that strengthens these existing mechanisms.

Service/ system concept

The concept of the overall eHSA programme is to deliver an enhanced satellite eHealth platform and its associated eHealth services to the sub-Saharan region. The Governance study is one of 4 precursor studies to the programme that will enable its successful later implementation.

Space Added Value

Due to the thin distribution of healthcare workers in relation to the disease burden, the doctor or nurse may often be a long distance from the patient in countries where infrastructure may be poor. Satellite enabled eHealth can therefore provide a step-change in health service capability. In addition to providing this electronic care and the associated administration, satellites can provide higher bandwidth communications for training and education (eLearning) and thus get around literacy issues, and it can help track communicable disease migration patterns (eSurveillance).

Product Features

The proposed approach for the Governance Study is based on three key pillars:

  • Pillar I: A collaborative governance model supported by Ostrom's "Governance of Commons", a branch of game theory, which has been applied successfully to create win-win outcomes where groups with differing individual interests must agree how to use common resources. This approach will help ensure that public and private health service actors can work together by identifying the reasons why previous governance models have failed before and assist in constraining adopters to accept and adhere to the agreed code of governance designed to maximise outcome for everyone.
  • Pillar II: Building on "on-the-ground" expertise. eHSA needs to build on the work already done in eHealth in Africa and needs to take account of the reality on the ground. Logica will use its second tier African partners to provide case studies and to validate the findings of the study. A Stakeholder Panel of current and future funders and adopters will also be assembled and used to provide further validation. It is intended that this panel will form the core of the future eHSA governance community.
  • Pillar III: Establishing a Governance Community - Logica will set up a web portal. This will provide a community workspace and will facilitate interaction with the second tier African participants. It will assist in the collection of questionnaire responses. It will be used as a repository for a database of country information and for the BPMN models of workflows and processes. It will act as a gateway to the tools used the project team including the Stakeholder Panel. This portal is initially intended to support the project team but will be designed to be a portal that could be expanded and used in the future by the eHSA community.

 

Key Issues

Provision of healthcare in the sub-Saharan Africa region presents a challenge for several reasons, for example the region has 25% of the world's communicable disease burden but only 3% of the world's health workforce, and 1% of global expenditures on healthcare. Furthermore the population exceeds 840 million people, and over 60% of the population lives in rural areas.

Current Status

April 2012 the following deliverables have been completed:

  • A set of governance rules to drive the execution of the study.
  • An academic background to support the analysis of stakeholders.
  • Generic models (paper and electronic) describing the governance of the relevant Health and eHealth services to assess the situation in SSA later on.
  • Generic model (paper and electronic) describing the development and operation governance of the identified Health and eHealth processes
  • The governance study website (first version)
  • A preliminary practical strategy to address stakeholders.

Project Managers

Contractor Project Manager

Herve Garcia
The Office Park, Springfield Drive
Leatherhead, Surrey
KT22 7LU
United Kingdom

ESA Project Manager

Gonzalo Martin-de-Mercado
ECSAT, Atlas Building, Harwell Science & Innovation Campus
Didcot
OX11 0QX
United Kingdom

Status Date

Updated: 25 May 2012 - Created: 15 February 2014