The Urgent Need for a National Electronic Health (National eHealth) Strategy for Liberia. A Lesson from the Ebola Outbreak

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Last week I was part of a four-man delegation that attended the West Africa Regional Workshop on the Development of National eHealth Strategy in Abuja, Nigeria. The workshop was hosted by the International Telecommunications Union (ITU), the World Health Organization (WHO), ICT4Health Nigeria, and the Federal Ministry of Health of Nigeria. It (the workshop) provided participating West African countries insight into the development and implementation of a National eHealth strategy. It also allowed the Liberian delegation to network with technicians (both from the ICT and Health sectors) from other West African countries and provided an opportunity for it (the delegation) to understand the successes, challenges and failures with regards to the use of ICT in delivery of healthcare in other West African countries. In today’s article, I provide insight into what eHealth is, what an eHealth Strategy is as well as its impact on Liberia, and the compendium of stakeholders who will drive and lead the development and implementation of a comprehensive and robust eHealth strategy in Liberia.

The Ebola outbreak which began sometime in late 2014 exposed a lot of weaknesses in the health sector of West African Countries that were affected as well as those that were not affected. In Ebola infected countries (Liberia, Guinea and Sierra Leone), one of the weaknesses that led to the initial dysfunctional response toward the Ebola outbreak is the lack of a comprehensive eHealth strategy. This problem does not only exist in Ebola infected countries, but also in several other West African countries. The lack of an eHealth strategy and policy strangulates (and will continue to strangulate) efforts by governments (West African countries and other developing countries), development partners, service providers, and communities to efficiently and effectively deliver or aid in the delivery of healthcare services to citizens and residents. As a result of this, the World Health Organization (WHO), the International Telecommunications Union (ITU) and other stakeholders concerned with the delivery of healthcare through ICTs, have taken the initiative to build the capacity of West African countries and all other countries in the development and implementation of their respective countries’ eHealth strategy. Thus, the West African National eHealth Strategy workshop that was held in Abuja, Nigeria on April 26-27, 2016.

Now, what exactly is eHealth? Before I provide insight on what an eHealth strategy is, let me first define eHealth using the World Health Organization’s (WHO) definition: eHealth is “the use of information and communication technologies (ICTs) for health to, for example, treat patients, pursue research, and educate students, track diseases and monitor public health.” This definition covers a vast domain which includes the following: Electronic Health Records, Routine health management information (e.g. web-based surveillance systems, electronic disease registers, electronic district health information systems), Vital Registration (the use of computerized systems for registration of death or births), Health Knowledge Management (e.g. best practice guidelines managed and accessed electronically), mHealth (e.g. use of mobile devices such as cell-phones to share information or to collect aggregate or patient data), Telemedicine (e.g. use of ICTs to provide care at a distance), Virtual Healthcare (e.g. teams of professionals working together via ICTs), and Health Research (e.g. use of high performance computing to handle large volumes of data).

Based on the definition of eHealth, how can we define an eHealth strategy? A strategy by definition is a plan of action designed to achieve a major aim. Hence, a national e-health Strategy provides a framework and plan for national coordination and collaboration of various stakeholders to deliver quality healthcare services through the use of ICT. An eHealth strategy takes into consideration and/or leverages the existing healthcare and ICT landscape and ecosystem, manages the underlying variation in capacity across the health sector nationally, and allows scope for change as lessons are learned and technology is developed further.

An eHealth strategy must be comprehensive, pragmatic and innovative. It must define eHealth as a broad domain which I mentioned above (Health Records, Vital Stats, mHealth, telemedicine etc.) to promote, support and strengthen healthcare.

Liberia’s health information landscape is currently characterized by islands of information, many of which are paper based. And where automation exists, there is often a lack of interoperability between disparate systems. This has created significant barriers to the effective sharing of information between healthcare participants to support accessible, safe, quality healthcare, an issue compounded by Liberia’s multiple health service boundaries and geographic distances. Hence, a robust eHealth program plays a pivotal role in evolving the way in which healthcare is delivered in Liberia, empowering both citizens and professionals through better digital services and information. This will directly improve the outcomes of professional care, and at the same time provide essential support for effective self-care and health improvement by people in Liberia.

The Ministry of Health and the Ministry of Posts and Telecommunications are expected drive and lead the development of Liberia’s eHealth Strategy in collaboration with other stakeholders. The development of the strategy will involve a series of national consultations with various stakeholders including general practitioners, medical specialists, nursing and allied health, pathology, radiology and pharmacy sectors, health information specialists, health service managers, researchers, academics and consumers. The input of a diverse group of stakeholders will be critical to informing the strategy and its priorities for eHealth in Liberia over a given period.

Response to the Liberian eHealth Strategy will be coordinated through Steering committees or a Presidium and Technical Working Groups. Specific decisions about the next steps will occur in consultation with the strategic stakeholders. To ensure the best results there will be a need for ongoing communication and consultation with all stakeholders including Liberian public about a work plan to deliver on future decisions.

Finally, effective monitoring of healthcare service delivery and overall performance of healthcare systems require functional health information systems capable of producing real-time information for decision making. This real-time information is driven by Information and Communication Technology (ICT) which has emerged globally, as a critical enabling mechanism in all sectors. Therefore, the amalgam of healthcare (e.g. health information management systems) and ICT guided by a robust eHealth Strategy for Liberia will usher in a new era of optimism about the capabilities of our healthcare ecosystem.

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