532 research outputs found

    Privacy and data protection in eHealth in Africa - an assessment of the regulatory frameworks that govern privacy and data protection in the effective implementation of electronic health care in Africa: is there a need for reform and greater regional collaboration in regulatory policymaking?

    Get PDF
    This thesis examines and evaluates the legal protection of privacy and personal data in South Africa and across Africa in the electronic health care industry, that is, where medical services are provided to individuals by way of networked technological platforms including mobile telephones. This thesis presents a critical understanding of, and pragmatic solution to, the questions that lie at the intersection of the following: an individual's right to privacy and data protection, cultural disparities when defining privacy, the emergence of electronic health care, the sensitivity of health related data, the need for health care in areas, where lack of resources and lack of accessibility are often commonplace, and the introduction of networked technologies within the health care system as a solution. Firstly, eHealth services and applications are described. Secondly, notions of privacy and data protection are considered. Thirdly, the prevailing legal determinants that form the basis of African and South African data protection regulatory measures are ascertained. Fourthly, selected illustrations are presented of the practical implementation of eHealth services and certain recent influencers within the digital environment, which may inform the future eHealth privacy regulatory framework. Finally, criticisms of the Malabo Convention are presented and recommendations advanced. As there is limited guidance with regard to policymaking decisions concerning privacy and data protection in the implementation of eHealth in developing countries, possibilities for reform are suggested. These will allow a more careful balance between, on the one hand, the normative commitment to providing accessible health care using electronic means and, on the other, the rights to privacy and data protection of the user, which require safeguarding within an African context. In proposing a solution, it is argued that adequate privacy regulation of electronic health must (1) be sensitive to societal and cultural differences in what is considered private, (2) be responsive to rapid technological transformation in healthcare industries, and (3) build user confidence in data protection in this context, to enable nascent electronic health initiatives to reach their potential in Africa. It is proposed that the adoption of an accepted social imperative protected by a powerful triumvirate of ethical constraints, effective legal provisions and regulations, and operational necessities, is possible. Greater regulatory collaboration across the continent is called for based on harmonised domestic and international laws, national policies, and industry codes of conduct that are sensitive to local conditions and challenges

    Telerehabilitation In South Africa – Is There A Way Forward?

    Get PDF
    South Africa, like the rest of sub-Saharan Africa, has a disproportionate burden of disease and a shortage of health professionals. Telemedicine has been identified as a possible way of overcoming part of the problem but telemedicine has not been widely adopted. In the public sector hospitals in South Africa which serve 82% of the population there are 2.5 physiotherapists and 2 occupational therapists per 100,000 people served. The extent of telerehabilitation in South Africa is unknown. A literature review of telerehabilitation found no papers from South Africa. A survey of the heads of university departments of physiotherapy, occupational therapy and speech and language pathology revealed limited knowledge of telerehabilitation. Telerehabilitation services are confined to follow-up of patients at some institutions by telephone, fax or email. There is need to raise awareness among therapists if telerehabilitation is to become a reality in South Africa.  Future actions are outlined

    Implementation barriers for mHealth for non-communicable diseases management in low and middle income countries: a scoping review and field-based views from implementers.

    Get PDF
    Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMIC). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMIC is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMIC were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 16 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies did not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients' characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowed linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMIC. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage

    Application of mHealth to improve service delivery and health outcomes: Opportunities and challenges

    Get PDF
    The use of mobile technologies for health related activities (mHealth) is a new but rapidly progressing activity with global penetration. However, few programs have been implemented at scale. The objective of this paper is to review the background and evidence on mHealth, particularly with respect to the benefits and challenges of scale-up. A comprehensive review of literature on mHealth, aspects of eHealth and the related regulatory environment was undertaken in August 2014. mHealth innovations vary broadly in purpose, delivery channel and target population. As a result of its broad applicability and geographic reach, the benefits of successfully, safely and widely implemented mHealth are numerous and promising. However, these benefits can only be realized if the associated risks are minimized and the barriers are purposefully overcome. Government stewardship and leadership is crucial in overcoming these barriers and scaling up mHealth

    Innovative Continuing Education for Maternal and Newborn Health Workers in Low-and Middle-Income Countries: A Feasibility Study

    Get PDF
    Purpose: The purpose of this dissertation is to explore strategies to improve maternal and newborn health workers’ clinical competence and performance, particularly among nurses and midwives, in low-and middle-income countries (LMICs), through innovative continuing educational approaches using priority evidence-based content. A feasibility trial with one such learning approach was implemented with maternal and newborn health providers in a hard-to-reach setting of the Democratic Republic of the Congo (DRC) in order to test one possible response to the continued high maternal and neonatal mortality in that country. The study contributes to the knowledge base on provision of critical continuing education to maternal and newborn health workers in hard-to-reach settings and to the global effort underway to address excess maternal and neonatal mortality in LMICs. Problems/Aims: Health worker clinical performance is often inadequate in developing countries. Substandard delivery and emergency obstetric care (EmOC) in health facilities has been widely documented as a major cause of maternal mortality in health facilities globally. Similarly, studies show that quality gaps are leading to higher rates of neonatal mortality in facility births. A basic strategy for improving health worker practice and strengthening clinical performance is through the promotion of continuing education (CE). However, there are many challenges to organizing CE opportunities for healthcare workers in hard-to-reach LMIC settings. The aims of this research were 1) to explore potential approaches to continuing education for maternal and newborn health workers in LMICs by examining the approaches that are currently available worldwide and 2) evaluating one concrete approach using a mobile phone mLearning app. We examined the feasibility and acceptability of the use of mLearning with facility-based maternal and neonatal health workers in one hard-to-reach setting of the DRC. We also evaluated the use of mLearning for a preliminary impact on facility-based health worker Basic Emergency Obstetric & Neonatal Care (BEmONC) self-confidence and clinical knowledge, and on select maternal and newborn outcome trends (as a proxy for evaluating improved health worker clinical behavior/performance). We also sought to refine intervention delivery in the DRC and strengthen study procedures required to conduct a robust future largescale trial. Design including theoretical basis: This study design is comprised of two literature reviews on the topic and a feasibility study using a convergent parallel mixed methods and community-engaged pilot cluster-randomized trial design. Our theoretical basis is comprised of complementary theoretical approaches: (1) Benjamin Bloom’s Theory of Mastery-Learning and Taxonomy of Educational Objectives; (2) Kirkpatrick’s Model of training evaluation; and (3) The Theoretical Domains Framework (TDF). Findings: Our literature reviews on CE approaches for facility-based maternal and newborn health workers in low-income countries revealed that conventional and simulation training using varied teaching methodologies can improve provider knowledge, skills, clinical practice, and patient outcomes. However, results are variable and there is limited evidence overall, with minimal use of robust study designs and validated measurement instruments, that document the association between CE and long-term effectiveness of the interventions with improved patient outcomes. Other creative interventions are being piloted in eHealth / eLearning including mobile phone learning applications (mLearning) and these have shown encouraging results in overcoming some key challenges in providing health workers with evidence-based learning in more remote settings. mLearning was found to be feasible and acceptable to health workers and key stakeholders in the DRC. A trial of one recent mLearning evidence-based app, the Safe Delivery App, increased health worker knowledge and self-confidence on the management of obstetric and newborn emergencies 3 months after introduction and indicated preliminary encouraging impacts on health workers’ practices in BEmONC. Conclusion: eLearning and mLearning show promise for improving maternal and newborn health worker practice and reducing mortality in low-and middle-income countries, particularly for health workers in more remote settings, where the challenge of maternal and neonatal mortality and quality assurance of emergency obstetric and neonatal care is greatest. Factors such as health worker motivation and self-efficacy, as well as the physical and policy environment, emphasized by Bloom and the TDF, are essential in improving practice and should be considered, along with cost, in designing scalable and comprehensive maternal and neonatal mortality programs for improved outcomes

    Designing and Implementing Health Management Information Systems

    Get PDF
    This review studies the lessons learned from what has and has not worked in designing and implementing Health Information Systems (HIS) in other countries. Reasons for success vary according to the country they are based in, and are due to a number of factors. HMISs are often also called Routine Health Information Systems (RHISs) or HISs, and relevant data using any of these terms is included in this rapid review. However, studies evaluating development of HISs in developing countries are limited. Specialists were consulted about key sources of information for this rapid review. These experts confirmed that most HMIS evidence is from single-country experiences, as well as the scarcity of comparative studies. Global evidence, taken from cross-country systematic analysis and individual country experiences, suggests that setting up a new HIS alone does not guarantee its success. Key findings are: An integrated HIS requires a long-term, high-level focus on good HMIS governance, capacity building for data management and information use, and strong commitment to change by leadership across stakeholder groups (Heywood and Booth, 2015:56). The review identifies key enablers including financial and motivational support, proper implementation and maintenance supported by good ICT. Meanwhile, there are key barriers need to be considered in the discussion, including an unclear information framework, organisational factors and hierarchical organisational structures, cost issues in high-income settings, staff with poor language skills, and capacity barriers. There are two major effective approaches to donor co-ordination in demands for data: effective strategies to influence donor involvement include all-phase involvement from design to implementation, improving governance, investment in improved data sources, and more collaborations (WHO, World Bank Group & USAID, 2015) and developing a system based on the ‘three-ones’ strategy (one database, one monitoring system, one leadership) can harmonise the efforts of donors in support of developing countries (WHO, World Bank Group, & USAID, 2015)

    SecHealth: enhancing EHR security in digital health transformation.

    Get PDF
    In the contemporary wave of digital transformation, the implementation of electronic health records (EHRs) has become a pivotal undertaking for numerous nations. However, amidst this technological advancement, a critical facet deserving heightened attention is the security and privacy of these electronic health systems. Regrettably, this crucial concern often finds itself eclipsed by other aspects of digitalization. Consequently, these oversight lapses create vulnerabilities within the EHR framework, leaving them open and exposed to an array of malicious cyber intrusions. In response to this pressing issue, our study delves into a comprehensive evaluation of security measures within the ambit of African digital health strategies. Remarkably, among the number of approximately 42 nations that have embarked on digital health strategy formulation, a mere 2 countries have taken cognizance of the imperative to integrate robust security and privacy policies into their healthcare-oriented digital transformation initiatives. In light of this disconcerting revelation, we present an actionable roadmap that endeavours to fortify EHR security, aligning with the progressive "shift-left" paradigm. By advocating for the proactive integration of security measures from the inception of EHR development, we strive to curtail vulnerabilities and enhance the overall resilience of these systems. Our proposed roadmap stands as a clarion call for governments, healthcare authorities, and technology stakeholders to collectively prioritize security in tandem with digital health advancement, thereby fostering a safeguarded and privacy-respecting electronic healthcare landscape
    • …
    corecore