Health professionals are the cornerstone of any health system. Yet the world is facing a global shortage of health workers. A scarcity that - along with the global epidemic of non-communicable diseases - is one of the most critical obstacles to the achievement of the sustainable development goals. Shared solutions are needed that involve extensive changes in global health education and health practitioners’ training.
In developing countries, the health workforce crisis is even more concerning with only 0.2 doctors and 1.2 nurses or midwifes per 1,000 people in Sub-Saharan Africa.[1] In 2013, the WHO estimated a global shortage of over 17 million healthcare workers, mostly in Africa and Southeast Asia.[2]
The underlying problem is a lack of resources and a huge shortfall in educating health workers. In 2014, fifty per cent of all medical schools in the world were located in ten countries. In America, there is one medical school per 1.2 million people; whereas Africa has only one per 5 million.[3]
One of the key recommendations of the “Health professionals for a new century: transforming education to strengthen health systems in an interdependent world” report by the Lancet Commission is “exploiting the power of Information Technology (IT) for learning.”
With Africa, for example, reaching 80% of mobile penetration in 2016,[4] ICTs undeniably represent powerful tools in facilitating access to health workers’ education.
One of the main benefits of digital training is that boundaries do not limit access or participation. A teacher in Kenya can teach the same material in any English-language school. This is why institutions can increase the number of course offerings and the number of students or teachers reached thanks to video and audio streaming of lectures, mobile-based multiple-choice questionnaires, or Q&A for distance training. Open-source learning materials and social networking learning approaches are thus becoming the basis of mobile education.
These mobile tools can be used also for short-term training such as when facing an emergency. To face an epidemic, health professionals must know how to act appropriately.During Ebola, Liberia’s Ministry of Health and Social Welfare partnered with UNICEF and Intrahealth International to provide health workers with online materials that demonstrated the correct practices to avoid infection.[5]
But implementing long-term training programsthat provide health practitioners with consistent and replicable education is most important. The Indian government has recently launched a nationwide mHealth program that aims to train one million community health professionals to reach 10 million pregnant women. As of today, 258,241 of these community health workers have started this training course in nine states, and 147,177 have already graduated.[6]
Amref in Africa is another organization well versed in using ICTs for medical training as they have trained to date 20,000 nurses in Africa using eLearning. Over the last four years, Amref Health Africa has developed a mobile learning solution in partnership with the Ministry of Health, M-Pesa Foundation, Accenture, and Safaricom and used mLearning to educate over 3,000 community health volunteers, thus providing over 300,000 community members with much-needed health education and basic health services.[7]
Training and educational digital-health approaches have the potential to empower health workers in remote areas, improve quality of care at the frontline, and reinforce health systems, as well as alleviate the workload at overburdened health facilities.
[1] “World Development Indicators: Health systems”, World Bank, 2017 (link).
[2] World Health Organization, Atlas of eHealth Country Profiles 2015 (link).
[3] Duvivier RJ, Boulet JR, Opalek A, Van Zanten M, Norcini J, 2014, “Overview of the world's medical schools: an update” (link).
[4] GSMA Intelligence, 2016.
[5] O’Donovan James, Bersin Amalia, “Controlling Ebola through mHealth strategies”, The Lancet, January 2015, Volume 3, No.1, e22.
[6] “BBC Media Centre, Government of India and BBC Media Action Launch Free Mobile Health Education to Millions of Women”, 2016.
[7] Link.
The world was caught unprepared when Ebola struck West Africa in late 2013. The aftermath: over 30,000 Ebola cases, including more than 11,000 dead, and billions of lost dollars. The Ebola crisis showed us the critical importance of strong health information systems, including the use of digital information and communication technologies (ICTs), to enable resilience to disease outbreaks.
USAID has recently published a remarkable report that demonstrates the role of digital health in responding to viral diseases as fatal as Ebola: Fighting Ebola with Information: Learning from the Use of Data, Information, and Digital Technologies in the Ebola Outbreak Response. The report discusses how data collection and analysis was critical to stopping the spread of disease, and for communities how digital communication tools (as simple as an SMS) were used to provide the population with much-needed information. To contain Ebola, national and international actors needed precise and timely data to provide effective relief. Yet the response initially struggled to fully leverage the power of digital technology to rapidly gather, transmit, analyze and share Ebola-related data in large part because technical, institutional, and workforce capacity were not robust enough.
Releasing the full benefit of digital technologies requires investing in human capacity, institutional policies and procedures, as well as the physical infrastructure that extends digital connectivity. Along with these structural changes, “quick wins” can be considered. Recommendations of the report suggest - among others - the more consistent use of machine-readable forms, the use of digital data collection tools with the ability to capture data in both online and offline environments, and performing rapid communications assessments after emergencies to understand and address gaps in access to digital communications.
Among the challenges cited in the report is the lack of standards and interoperability, a topic of the recently released digital health report from the Broadband Commission working group “Digital Health: A call for Government Leadership and Cooperation between ICT and Health”, and data silos, whereby information is not recognized from one system to the next, contributed to unclear and asynchronous information in the Ebola outbreak, complicating the response. Government leaders have a significant role to play in setting standards to solve part of this fragmentation, as do the international donors who historically have funded competing and non-interoperable data systems. We see one path toward enabling greater harmonization of digital health investments in a recent initiative discussed by the heads of USAID’s global health bureau and development lab in this blog: Digital Health: Moving from Silos to Systems.
I just recently attended Mobile World Congress (attended by 100 000 people this year) where I am happy to say we released an important report for accelerating digital health: “Digital Health: A call for Government Leadership and Cooperation between ICT and Health”.
I was involved in this work from its inception all the way to contributing this fall to its writing and I am feeling very grateful to the Novartis Foundation and also Nokia for having co-chaired and supported what turned out to be a major collaborative effort with key actors and policymakers of the global digital health ecosystem. One of the reasons I believe this report will have an impact is that it is being released by the Broadband Commission for Sustainable Development which is a highly influential body established in 2010 comprised of more than 50 leaders from across a range of government and industry sectors.
In brief, as the cycle of digital health evolves, there is a growing realization of the fundamental role governments have to play in advancing the use of technology for health. Fragmentation, data interoperability and lack of appropriate legislation and laws are still prevalent, and many of these challenges will not be overcome without stronger government leadership and improved cooperation and coordination between health and ICT authorities (typically ministries of Communication and eGovernment agencies). To give you a striking example of what we mean by fragmentation; there are eleven different mobile health initiatives for maternal and child health funded by different institutions in Mali. Most of these institutions use their own tools and systems which are not interoperable with the current systems used by the national eHealth agency.
For anyone interested in scaling digital health, I therefore highly recommend the read of this report: “Digital Health: A call for Government Leadership and Cooperation between ICT and Health”. Beyond its key recommendations, the report developed case studies in 8 countries that managed to effectively advance the digital health agenda. Those countries are: Canada, Estonia, Malaysia, Mali, Nigeria, Norway, the Philippines and Rwanda. They all provide key insights and lessons which other countries can leverage from. Although not many countries have yet analyzed the impact of digital health on their systems, it is notable for other governments to see that Canada recently estimated that their investments in digital health generated savings of $15 billion since 2007. ITU and WHO established a very comprehensive National eHealth Strategy Toolkit back in 2012 which many governments have already used around the world. Let’s hope this report will do both: motivate countries that have not yet developed such strategies, and support those countries that already developed their strategies and are moving towards the complex task of implementation.
