GAID White Paper On ICT4D Health

E c o n o m i c &
S o c i a l
A f f a i r s
White Paper
Information &
Communication
Technologies for
Development: Health
df
Authors:
Andrea Bordé
Charles Fromm
Farzad Kapadia
Doriana S. Molla
Eleece Sherwood
Jane Brandt Sørensen
The New School University

Graduate Program in
International Affairs
Advisor:
Ambassador Rafat Mahdi
asdf
Information & Communication Technologies
for Development: Health
A white paper commissioned by:
Authors:
Andrea Bordé, Charles Fromm, Farzad Kapadia, Doriana S. Molla,
Eleece Sherwood and Jane Brandt Sørensen
The New School University

Graduate Program in International Affairs
Advisor:
Ambassador Rafat Mahdi
New York, April 2010

ICT for Developm e n t : H e a l t h
Table of Contents:
1. INTRODUCTION.................................................................................................................................................1
2. INTERSECTION OF HEALTH AND ICTs...........................................................................................................2
3. ICTs AND THE MDGs........................................................................................................................................2
3.1 eHealth and mHealth: Challenges and Opportunities.................................................................................3
4. ROLE OF GOVERNMENTS FOR IMPROVED HEALTH..................................................................................4
4.1 National Health Plans......................................................................................................................................4
4.2 Innovative Health Plan Initiatives...................................................................................................................5
5. NATIONAL COMMITMENT TO HEALTH FINANCING..................................................................................5
5.1 Health Expenditure Analysis...........................................................................................................................5
5.2 Public-private Partnerships for eHealth........................................................................................................6
5.3 The High Cost of Access to eHealth Devices...............................................................................................7
6. ROLE OF CIVIL SOCIETY....................................................................................................................................8
6.1 Civil Society and Health....................................................................................................................................9
6.2 Involvement of Civil Society at the Program Level....................................................................................10
7. TECHNICAL AND HUMAN CAPITAL CONSTRAINTS................................................................................10
8. MONITORING AND EVALUATION................................................................................................................11
8.1 Easy Use of PDAs............................................................................................................................................12
8.2 Cracking Health Stigmas................................................................................................................................12
8.3 Shorter Wait Times for Patients....................................................................................................................12
8.4 Medical Data Collection and Country Staff Development........................................................................12
8.5 ICT for Health Education................................................................................................................................13
9. LESSONS LEARNED........................................................................................................................................13
9.1 Financial Sustainability of ICT Projects.......................................................................................................13
9.2 Lack of English Skills and Education as a Road Block to ICT...................................................................14
9.3 Effective Counseling against Stigmas.........................................................................................................14
9.4 ICT for Health, Technical and Human Capacity.......................................................................................14
9.5 Reluctance of Governments and Private Companies...............................................................................15
I C T f o r D e v e l o p ment: Health
9.6 Medical misdiagnoses Using ICT..............................................................................................................15

9.7 Role of Civil Society and Public-Private Partnerships..............................................................................15
10. RECOMMENDATIONS....................................................................................................................................15
10.1 For Governing bodies.....................................................................................................................................16
10.2 For International Organizations and Donors...............................................................................................16
10.3 For Civil Society...............................................................................................................................................16
10.4 For Private Entrepreneurs..............................................................................................................................16
10.5 When Implementing ICT for Health..............................................................................................................17
11. APPENDIX........................................................................................................................................................18
Figure 1.............................................................................................................................................................18
Figure 2.............................................................................................................................................................20
Figure 3.............................................................................................................................................................21
Figure 4.............................................................................................................................................................22
Figure 5.............................................................................................................................................................23
Figure 6.............................................................................................................................................................23
Figure 7.............................................................................................................................................................24
List of Acronyms.....................................................................................................................................................25
ENDNOTES.....................................................................................................................................................................27
1. Introduction
At the G8 Kyushu-Okinawa Summit in July 2000 member states of the industrialized countries focused
on the impact of information technologies and the growing challenges and risks of a global “digital
divide”. The summit recognized that Information and Communication Technologies (ICT) can serve as
effective tools for broad-based international development in regions where development’s traditional
toolkit has fallen short. The United Nations (UN) has paid particular attention to the role of ICT in ad-
vancing the Millennium Development Goals (MDGs) through its UN ICT Task Force and the World Sum-
mit on Information Society.
In recent years, the international community has rallied around a campaign known as Information and Com-
munication Technologies for Development (ICT4D), which aims to apply information technology solutions
toward poverty reduction goals. ICTs can be applied directly wherein their use benefits a disadvantaged
population, or indirectly where ICTs assist aid organizations, non-governmental organizations (NGO), gov-
ernments or businesses in order to improve existing socio-economic conditions.
For the purposes of this report, ICTs are defined as tools that facilitate communication and the processing
and transmission of information and the sharing of knowledge by electronic means. This encompasses the
full range of electronic digital and analog ICTs, from radio and television to telephones (fixed and mobile),
computers, and electronic-based media such as digital text, audio-video recording, and the Internet, includ-
ing Web 2.0 and 3.0, social networking and web-based communities.1
This white paper was commissioned at the request of The Global Alliance for Information and Communica-
tion Technologies and Development (UNGAID), a United Nations body launched in 2006, which remains at
the forefront of highlighting the relevance of ICT for development. The network emerged out of the 2005 UN
Summit emphasizing ICT involvement for development goals with a special focus on the MDGs.
UNGAID serves as a global forum addressing issues closely tied to ICT diffusion, relevancy, and implications
in development. UNGAIDs mission stresses the importance of a multi-stakeholder approach, following the
belief that a people-centered and knowledge-based information society is essential for achieving better life
for all. UNGAID has partnered with other UN agencies, the private sector, academia and the ICT industry to
help develop these ICT solutions.2
This report will review examples from different regions of the world where ICT programming focuses on
combating HIV/AIDS and malaria, decreasing child mortality and improving maternal health. Relevant cas-
es of ICT applications and their effectiveness in improving health services in developing countries will be
examined. The aim is to take into consideration the costs and benefits of ICT solutions in healthcare without
losing sight of long-term impact on development.
The thirteen economies selected for this work represent a broad range of developing and transitory coun-
tries chosen from various regional groupings. The countries detailed through the paper are: Albania, Esto-
nia, India, Jordan, Macedonia, Malawi, Peru, Qatar, South Africa, Tanzania, Trinidad and Tobago, Uganda
and Vietnam. See Figure 1 for detailed descriptions of the selected featured initiatives. Additionally, for an
overview of progress made on the three health MDGs in these countries refer to Figure 2.
W H I T E PA P E R | 1
2. Intersection of health and ICTs

In developing countries, lack of access to health care and inefficient delivery methods are the norm. This
shortage is exacerbated by the inability of governments to devote adequate funding to their respective
health care sectors. This is intensified by the multiple crises in finance, food and energy. Unsuccessful
reform efforts, combined with little funding, have left billions without the ability to tap into basic health
care services.
Most health ministries in developing countries are aware of the inequities between urban and rural com-
munities; however, efforts to decrease this divide have fallen short. Cost effective reform initiatives are
needed to ensure greater access and higher quality of basic health care through the use of ICTs. A number
of initiatives, detailed later in the paper, demonstrate where ICT proved critical in improving access and
health services to underserved populations.
Most solutions center on mobile solutions as personal, ubiquitous, connected and increasingly intelligent
mobile phones have become indispensable in much of the developing world: 64% of mobile users are in
emerging markets and it is estimated that by 2012, 50% of individuals in remote areas of the world will have
mobile phones.3
According to the World Health Organization (WHO), technology has always been at the backbone of im-
proving medical services to prevent, diagnose, and treat illness and disease.4 This report shows that given
the right policies, resources, and institutions, ICTs can be powerful tools in the hands of those working to
improve health.5
3. ICTs and the MDGs

In order for global poverty to decrease, definitive steps must be taken to improve health, especially among
marginalized populations. It is with this philosophy that three of the eight MDGs were designed to improve
global health. In this white paper, the focus is placed on the following three MDGs:
• Reduce child mortality (MDG 4)
• Improve maternal health (MDG 5)
• Combat HIV and AIDS, malaria and other diseases (MDG 6)
The three health-related MDGs are best achieved through a coordinated approach of public, private and
civil institutions. There is a need for ICT programs to work in synergy with any other policy initiatives or
strategies, such as national poverty reduction strategies or as part of national health policies.6
A World Bank study concluded that there is growing evidence that ICTs have the capability to provide new
and more efficient methods of production; improve delivery of information; bring previously unattainable
markets within reach of the poor; and facilitate the transfer of knowledge.7 With specific regard to MDGs
four, five and six, ICTs have the capability to increase remote access and support of specialists to caregivers
in rural locales. They also enhance basic training for healthcare workers, increasing their ability to monitor
and access information, such as statistics on disease and famine.8
2 | W H I T E PA P E R
3.1 eHealth and mHealth: Challenges and Opportunities

In recent years, mHealth and telemedicine have emerged as important initiatives in the field of eHealth.
While there is no widely agreed-to definition for these fields, the public health community has gathered
around these working definitions (see Figure 3 for greater detail):
• eHealth: Using information and communication technologies (ICT)—such as computers, mobile
phones, and satellite communications—for health services and information.
• mHealth: Using mobile communications—such as PDAs and mobile phones—for providing remote
health services and information.
• Telemedicine: solutions that are designed to deliver a clinical “presence” in remote health services.9
Due to the limitations of today’s mobile technology (specifically, bandwidth and transmission speed), the
distinguishing element of telemedicine – clinical presence (imagery, video or other real time diagnostic
information) – is best delivered through fixed line or wireless networks. As both mobile technology and
bandwidth continue to evolve, the overlap between telemedicine and mHealth will continue to increase
through services like mobile broadband.
To date, serving targeted populations, such as the rural poor, has posed the greatest challenge to mHealth
projects spread throughout the globe. The ability to demonstrate scale incentivizes key players in the
mHealth value chain, for instance, a mobile network provider would need to be assured high levels of traffic
before agreeing to participate. Large numbers of unique text messages or scalable and robust behavioral
change will entice platform and application developers.10 The more scale that can be displayed, the easier
it will be to coalesce partners that are truly invested in the program.
Using new methods of delivery vastly improves the penetration of basic health services across the develop-
ing world. For this to happen, the sector needs to bolster its effectiveness - delivering care to those who
have previously received none - with partnerships rooted in business interests. The issue of scale and sus-
tainability must be emphasized here, since relationships based on profit motive are easier to sustain during
periods of economic turmoil.
Central to the success of any mHealth application is consistent funding and the ability to retain larger value
chain partners, i.e. telecommunications providers. These companies are under intense pressure from senior
management and stockholders to remain profitable and increase market share, making it difficult to justify
any venture whose sustainability has yet to be proven. Priority of mHealth developers should be based on
ensuring both sustainability and scale, as a measure of wider success in improved health care delivery.
4. Role of Governments for Improved Health

Governments play a major role in determining immediate national priorities while also working towards
long-term development plans. Healthcare remains a crucial component of development strategies under-
taken by governments requiring political capital, financial resources, and organizational capacities to be
fully invested in the process.
Under the MDGs, increased focus has been given to the role that governments play in bettering health care
delivery via their national health plans and ICTs. This section serves as a progress report, highlighting the
successful initiatives undertaken by selected country governments as well as indicating where more human
and financial capital is necessary.
4.1 National Health Plans
In terms of positive examples, Uganda’s Government has made huge strides in making ICT a priority and
using it to deliver healthcare to its populace by building considerations for ICT into its national health
plan. Uganda’s national vision is to promote development and effective utilization of ICT such that quan-
tifiable impact is achieved countrywide in line with the national Poverty Eradication Action Plan and the
MDGs. The Government has given special consideration to ICT in the 2009 Uganda Health Sector Strate-
gic Plan, which identifies the mainstreaming and integration of ICTs into health care delivery as part of
the National Health Policy.
However it remains to be seen how Uganda will strengthen its institutional capacity while simultaneously
bolstering its scarce human resources, the success of which will reveal the extent to which ICT applications
have been mainstreamed into Ugandan healthcare. Despite the complexities facing the Ministry of Health
in Uganda, the shared objective aims at a 20% increase in the use of telemedicine in all health care centers
by 2010.11 Recommendations for Governments such as Uganda, who have taken concrete steps to integrate
ICT into their national health policies, would be to keep building upon the foundations already laid, in order
to capitalize on existing achievements that utilize ICT in order to bring the maximum amount of healthcare
resources to communities that need them.
In Qatar, the Hukoomi Supreme Council of Health, the main government ministry of health, has implemented
a comprehensive health system focused on using ICT as its backbone. The mandate of the e-Health plan in
Qatar is to combat and monitor non-communicable diseases, such as diabetes and high blood pressure. The
focus towards non-communicable diseases reflects the needs of the Qatari health arena where there exists
a higher prevalence of non-communicable diseases and lifestyle conditions.
Peruvian national health plans adopted in recent years have also seen great success; the plans aim to en-
hance the quality of healthcare provided to the elderly, women, children and people with disabilities. The
Ministry of Health focuses primarily on the implementation of an integrated health insurance system to re-
duce maternal mortality, HIV prevention programs, and to make healthcare accessible to the poor.12 Peru’s
pioneering achievements in healthcare management have led it to become a model country in the region
per the health related MDGs.13 But whereas ICT is growing significantly in other sectors, this is unfortu-
nately not the case in the health sector. The country must leverage existing ICT successes to make progress
in indigenous and rural regions where child mortality and HIV/AIDS rates remain alarmingly high.
In Tanzania, there is no clearly defined national ICT plan aimed at the healthcare, even though ICT solutions
have seen increased numbers in the health sector. Thus, ongoing ICT projects in health are not consolidated
and they are managed poorly for countrywide implementation. Gradually, reliable access to Internet has
been achieved and some hospitals have taken advantage. However, the present systems are weakened
by poor maintenance of computers and network infrastructures, as well as frequent attacks of computer
viruses. It appears that currently, opportunities for web-based communication and collaboration are insuf-
ficiently used.14
While South Africa’s ICT sector continues to see growth, absence of government action in tackling the HIV
epidemic in the country has had a profoundly negative impact. Progress on the MDGs has been insufficient
and in some cases reversed. Lack of coordinated government action has seen the emergence of a multi-
drug resistant tuberculosis outbreak leading to a number of preventable deaths, and early gains on maternal
mortality have been reversed by the increasing number of pregnant women with HIV.15 It can be argued that
the South African health model could be aided by further ICT implementations like disease monitoring solu-
tions, and mobile health education campaigns against HIV/AIDS.
4.2 Innovative Health Plan Initiatives
In Tanzania, the health SWAp (Sector Wide Approach), a government-sponsored initiative, introduced in
1999, has improved access to and delivery of health interventions. An independent evaluation conducted by
the WHO found the program to have reduced infant mortalities, increased access to pharmaceuticals and
has led to improved quality of health services.16 It aims at increasing transparency, improving predictability
and allocation of financing, reduced transaction costs and reduced administrative demands placed upon
government. The SWAp Committee is the agreed overall body for dialogue among all stakeholders in health.
SWAp keeps an eye toward bringing to the table all concerned parties from civil society to government
healthcare officials.17
India’s National Rural Health Mission (NHRM) also represents a break from the status quo in financing
health care in rural geographies. A notable element of the program is the government’s commitment to in-
crease public health spending from 0.9% to 2-3% of Gross Domestic Product (GDP) over the next five years,
and introduce mechanisms to ensure funding reaches its intended recipients. Approximately US$2 billion
was allocated for the NRHM. The Ministry of Labor has supplemented the program by unveiling a national
hospitalization scheme for poor families. Families living beneath the poverty line are entitled to hospitaliza-
tion coverage of up to Rs. 30,000 for most diseases requiring hospitalization, and pay a Rs. 30 registration
fee, the balance of the costs are split between state and federal governments.18
5. National Commitment to Health Financing

How much national governments spend on health care is unlikely to provide an accurate picture of the over-
all benefits their citizens receive as a result. This section looks to provide some comparison and analysis for
the selected countries of health expenditure statistics as reported by the WHO. Countries will be analyzed
and compared across and within region. The indicators to be analyzed are general government expenditure
versus private expenditure as a % of total expenditure on health; external resources for health as a % of
total expenditure on health; and per capita expenditure on health. All percentages and figures in this sec-
tion are from 2006, unless otherwise noted. Figure 4 displays how health expenditures are prioritized in the
selected countries.
5.1 Health Expenditure analysis
The sum of general and private expenditure towards health care makes up a country’s total expenditure on
health. Government expenditure should outweigh the private percentage, so that a country’s low-income
populace will have access to subsidized health care, as privatized health care is rarely an option for low-
income individuals.
A WHO survey bolstered the claim that eHealth depends primarily upon public funding with a far lesser pro-
portion of countries also using private funding or public-private partnerships to support activities.19
Of all the selected economies, Estonia maintained the lowest ratio of private health expenditure at 26.7%
while government spending accounted for 73.3% of all healthcare financing. The Estonian eHealth Founda-
tion is primarily financed from the state budget. Estonia participates in several cross-European projects
co-financed through various EU programs. The most unfavorable balance of public to private spending was
seen by India, where private expenditure accounted for 75% while the government only mustered 25% of
total expenditure on healthcare.
The regional trends mirrored those seen in individual countries as the transition economies of Estonia and
TFYR Macedonia combined, saw their governments make up 72% of spending while private health care
spending made up 28.1% of all expenditures. Asia (Vietnam and India) lagged behind with their governments
spending only 28.7% toward healthcare, the remainder, 71.4% was financed through private channels.
External resources for health are defined as the sum of resources channeled towards health by entities
outside a nation’s borders, including donations and loans, and both cash and in-kind resources. This figure
is expressed as a percentage of total expenditure on health. The percentage provides a good indication
of the amount of external funding a country requires in meeting its health care needs. Here the standout
was Qatar, who since 2000 has not required any external financing to meet its health care needs. Estonia
and South Africa come in close seconds requiring only 0.6% and 0.9% respectively, of total expenditure on
health to come from external resources in 2006.
By contrast, Malawi acquired 59.6% of it total health expenditure via external actors. Peru and Trinidad
and Tobago saw only 1.5% and 2.4% respectively, of health expenditure being channeled in externally.
Regionally, Africa did not fare well seeing up to 33.9% of its total health expenditure, flooding in from
outside the continent.
Per capita government expenditure on health indicates the dollar amount of health expenditure a govern-
ment spends per citizen. This is not to say that every citizen receives the same proportion of health care
benefits. More often than not, the amount spent by the government far exceeds the dollar value of benefits
received by the recipient. The figure is however, a gauge for the robustness of particular health systems’
finances. For instance, Sweden, a country with arguably one of the best public health care systems in the
world spends US$ 3,245 per citizen, an impressive sum.
Of the selected countries, Qatar was again a clear frontrunner, their health expenditures per citizen amount-
ed to US$ 2,157. Trinidad and Tobago was next at US$ 103 per inhabitant, indicating the massive gap that
needs to be made up by the remainder of the selected countries. Uganda spent the least per national at
US$ 6; India too also spent a very low amount of US$ 7 per resident. This however should be considered in
context of India’s billion plus population.
Regional averages highlighted some interesting trends. Asia spent the lowest per inhabitant at US$ 11, while
the transitional European economies placed well spending on average of US$ 320 per capita. The Middle
East and Latin American countries spent US$ 265.50 and US$ 213 per capita, respectively.
5.2 Public-private partnerships for eHealth
Much of the funding for eHealth projects is derived from outside ministry of health coffers. The projects typi-
cally contain a dose of public private partnerships to finance the costs and the partnerships are supported
via technical assistance and monitoring evaluation through a number of NGOs, international corporations
and increasingly often, by universities.
Peru’s Colecta-PALM project was born out of a partnership between the University of Washington and the
Peruvian University of Cayetano Heredia. As with other projects two local partners provided valuable on the
ground insight into local conditions and customs; Asociación Via Libre and Asociación Civil Impacta Salud y
Educación. The two Peruvian health clinics were instrumental in allowing the universities to administer the
surveys to their patients along with providing staff time to support the scheme.20 21
The CA:SH project in India was made possible because of a partnership between a multitude of stakehold-
ers; including Media Lab Asia (part of India’s Ministry of ICT and a privately-held software company),and the
All India Institute of Medical Sciences.22 Given the nature of the mobile healthcare software, highly skilled
engineers and doctors are needed to make successful tools, which require tremendous financial support.
This initiative is a model example of the private sector, government and academia, working in concert to
better serve the public.
Microsoft and Boeing Corporation are among some of the private funders that have funded Jordan’s
Knowledge Stations project and the general development of Jordan’s ICT sector.23 These particular
funders have been instrumental in making sure Jordan’s ICT sector continues using the most up-to-date
health software, so that its system stays cutting edge. The Knowledge Stations and Jordan’s ICT sector
are also funded by external donors such as the People’s Republic of China, the Republic of Korea, and the
Japanese government.24
Project M in South Africa is a rather unique combination of stakeholders including private media and
design firms, NGOs and government agencies, South African foundations and leading mobile technology
companies. MTN, one of the largest telecommunication companies in the developing world with more
than 74 million subscribers across the world, is donating up to 1 million “Please Call Me” messages per
day for two years.
The project has received modest funding from individuals and capital donors and significant in-kind donations
from core project partners. Cash donations total US$ 250,000, and in-kind contributions are valued at millions
of dollars. The project is cost-effective and delivers HIV/AIDS information to the population of South Africa at
virtually no cost, because of the MTN donation of text messages. The project will continue as long as it will
receive sufficient funding to do so, currently the project is financially sustainable till October 2010.25
5.3 The High Cost of Access to eHealth Devices
The emergence of e- and mHealth applications throughout developing countries is now widely documented
and accepted. However, a critical component, the affordability of mobile services, continues to escape
those who require access to mobile technology, the global poor. As a result of price competition, the price
of a cellular handset and arguably calls, have reduced dramatically over the last decade. The International
Telecommunications Union (ITU) reports that by the end of 2008, there were more than 4 billion mobile active
mobile subscriptions.26 Figure 5 provides an overview of the numbers used below.
For the countries selected in this work, affordable ICT among the masses is not a reality and the numbers
paint a bleak picture. Trinidad and Tobago ranked 23 (highest among chosen countries), among 150 coun-
tries polled by the ITU with respect to mobile affordability. Trinidad and Tobago spends approximately US$
7.9 a month on its basic mobile basketi, per the ITU. Large disparities occurred within this region, where
P
i
rice reflects the standard basket of mobile monthly usage in US$ determined by the OECD for 25 outgoing calls per month (on-net,
off-net and to a fixed line), in predetermined ratios, plus 30 Short Message Service (SMS) messages.
Peru for instance was ranked 79 and spent 2.8% of its Gross National Income (GNI) per capita toward mobile
services.ii That being said, Latin American economies selected for this paper, scored the highest in mobile
affordability against all other selected regions.
On average, the Vietnamese spent 6.4% of their monthly GNI toward mobile services and the country placed
110 on the ITU affordability scale. Its South Asian counterpart, India, was ranked 64. India was classed by
the ITU as having the most affordable basic mobile basket, at US$ 1.60 per month. Indian’s on average spent
2.1% of their monthly GNI on mobile services compared to Vietnam’s 6.4%.
Comparable inequalities existed in Eastern Europe between Estonia and TFYR Macedonia. The region had
the highest mobile basket cost of US$ 13.6 and US$ 13.2, respectively. Estonians however, spent only 1.2% of
their monthly GNI toward mobile services as opposed to Macedonian’s 4.6%.
The data for the African group of countries shows that they are by far performing the worst. South Africa
leads the group with a ranking of 73 and 2.6% of monthly GNI per capita, but Malawi, Tanzania and Uganda
are all ranked 148, 141 and 142 respectively; each country also spent 57.4%, 33.3% and 36.8% of GNI per
capita respectively on mobile subscriptions. Despite recent drops in prices, the initial and monthly costs of
owning a mobile phone remain out of reach for the majority of Ugandan’s who need them most. Given the
data presented above, this assertion can arguably be made for Malawi and Tanzania as well.
Other forms of eHealth devices are also challenged by high costs and lack of financing is one of the biggest
threats towards the Baobab Project in Malawi, where the initial touch screens were cheap leftovers trans-
formed to the health service setting. These devices are currently not being produced anymore, and costs
have therefore increased significantly, making it difficult to expand the project.
The private sector could play a big role in helping reduce the costs of e- and mHealth, i.e. to mobile hard-
ware and monthly subscription costs. For instance a system of cross subsidization using sales in the devel-
oped world, to help subsidize the cost of phones sold in the developing world could be implemented with
great success. Similarly, many telecommunications companies are transnational in nature and maintain
presence in wealthy, emerging and developing economies. The cross subsidy model could also be applied
using revenues from higher income countries to subsidize lower income mobile subscriptions.
The lack of funding remains a major barrier to the progress of eHealth, particularly in developing coun-
tries. Public funding is by far the most common source of finance. As government budgets are continually
stretched, eHealth must compete with other public services for its share of limited resources. In order to
garner such funds, governments must be convinced that money allocated to eHealth will not only improve
health services in the short-term, but will be a solid investment in the future of their nation’s health care
system. Provision of evidence-based eHealth project success stories and best practices would inform and
assist ministries with their bids for funding.
6. Role of Civil Society

Civil society can be defined as the link between the market and the state, and is also known as NGOs, non-
profit organizations or the “social economy”. It can include a variety of entities such as health clinics, family
The ITU considers less than 1% of GNI spent on mobile services as acceptable.
ii
counseling agencies, human rights organizations, universities, and grassroots development organizations.
A list of common features that they share includes: their character structured by private efforts, their inde-
pendence from the governmental apparatus, and their overarching objective which is to serve a public or
community purpose, not simply to generate financial profits. Civil society organizations are committed to
freedoms and the right to act. The leading principle they follow is that people have responsibilities not only
to themselves but also to the communities they are part of.27
6.1 Civil Society and Health
Historically, civil society has played an important role in South Africa. The power of these institutions came to
play especially throughout Apartheid and especially in the later political battle about access to antiretroviral
medicine. Visible change in the country’s attitude towards the HIV epidemic is mostly due to the profound
pressure from non-governmental interest groups, which focus on creating a political environment that can
facilitate provision of treatments and resources as an essential response to this serious problem that has
plagued the country.28 This shows the profound potential of power civil society organizations posses.
In India civil society plays a profound role in the health sector where a booming private sector covers 80% of
total healthcare spending.29 This portrays a dire picture of the public healthcare system and it is within this
context that the role of civil society and health intersect. Ahead of general elections, in early 2009 more than
a thousand civil society organizations collaborated on designing a “health manifesto” for political parties.
The goal was to demand prioritization of pressing healthcare issues countrywide. This step undertaken by
NGOs in India was motivated by the significant inequality in health with disparities in distribution between
rural and urban, poor and rich. The Government developed a “National Rural Health Mission”, however
politicians were criticized for not allocating sufficient funding and resources towards it.30 NGOs remain
important actors in generating attention to the resource allocation for healthcare services that must be
increased to India’s disadvantaged groups.
On the same note, Peruvian civil society groups and NGOs have pushed for health, trying to improve the ex-
isting health options in the country.31 They have had measurable success in improving health conditions for
youth, but a remaining topic of concern is NGOs involvement for health improvements for rural populations;
particularly indigenous people who have been neglected persistently. For example, Amnesty International
reports show that indigenous women in Peru have a much higher maternal mortality rate than the aver-
age Peruvian women, which is a consequence of absence of health facilities and health services target-
ing women’s health in indigenous areas. This largely goes unnoticed by all parts of society, including civil
society.32 This shows the power of civil society and how it can give a voice to healthcare matters affecting
marginalized groups who are generally overlooked. At the same time, it shows limitations that civil society
doesn’t necessarily cover all marginalized populations.
In Qatar for example, the role of NGOs is very limited, especially with regards to implementing ICTs for
health. This is mainly caused by the fact that the Government has implemented a broadly based health
system that gives access to 100% of its citizens.33 Similarly, Estonian NGOs are not active participants of
decisions taken by the Estonian eHealth Foundation, but they are informed on a regular basis in order to as-
sist with awareness campaigns and implementation processes involving all stakeholders of society. NGOs
in Trinidad & Tobago34 play a comparable role where they have no say in decision-making programs. But
they are invited to participate in ICT readiness assessment projects, undertake ICT awareness campaigns
for wide usage of offered services, and encourage connectivity among different communities and different
actors in the private and public spheres. Thus, well-coordinated national health systems and widespread
access to eHealth services limit the role of civil society to one that focuses on health advocacy or national
health program monitoring.
6.2 Involvement of Civil Society at the Program Level
In some of the featured case studies civil society was included, either directly in the project or through an
exchange of views before implementing the project. In South Africa, Project M was established in partner-
ship with multiple stakeholders, including civil society organizations. Targeted text messages were devel-
oped by a local educational NGO, and another partner was a national HIV/AIDS, non-profit helpline, provid-
ing anonymous, HIV counseling and referral that text receivers were directed towards.35 Call rates from the
helpline helped determine which topics required further attention. For example, phone-counselors found
that there was a great amount of misconception about prevention measures and mother to child transmis-
sion of HIV. Findings like these were used to develop more and better targeted text messages about each
topic of interest.36
In Uganda on the other hand, the TTC project had no formal contracts with local civil society organizations;
however, they did form the basis from which TTC designs its programs. For example, a local NGO supplying
HIV/AIDS counseling and testing was instrumental in providing local context to the general awareness and
prevalence of HIV/AIDS throughout the pilot program areas. Also, the software platform used to design the
TTC quizzes was using local services that were familiar with local dialect and customs, demonstrating the
importance of listening to the voices of those TTC would be serving.37
Even though the involvement of civil society has proved useful, not all of the featured projects have included
such organizations in their scope of work. For instance, in the e-Health system, providing training for health
workers in Qatar is fully implemented by the Government. However, with the context of Qatar in mind, civil
society simply has a limited role to play. Cooperation between all stakeholders is essential, but the role of
civil society in ICT health projects is likely to be determined by the amount of government responsibility and
involvement in health issues.
7. Technical and Human Capital Constraints

A crucial component of ICT and Health programming in the developing world is the framework of infrastruc-
ture that supports these different initiatives. This infrastructure can consist of physical technology- such as
fiber optics, cell towers, broadband or satellite connections to initiate tele-surgery or tele-consultations- or
it can be organizational, i.e. being bound by legislative, legal and/or bureaucratic constraints. They can also
be cultural, for instance if a population views ICT in a negative context and is averse to using it. Figure 6 and
7 show statistics on access and constraints regarding ICT use in the selected countries.
If this infrastructural foundation is already in place, then often the quality is inadequate or sub-standard. For
instance what is termed “high speed” internet access in much of sub-Saharan Africa is considerably slower
and more expensive than internet access in say that of India.38 In East Africa, Tanzania or Ethiopia, the cost
of ICT is a major obstacle in its implementation. Despite considerable developments in the ICT sector in
Africa over the past 10 years, the region has the world’s lowest and most expensive telephone and Internet
user penetration and quality of service.39
Malawi is a classic case of ICT in Sub-Saharan Africa. The Malawian Government is committed to using
ICT in health; however, it is plagued by infrastructural challenges such as a narrow industrial base or an
unstable and intermittent power supply. As far as human resources challenges, they are also hindered by
an insufficient amount of qualified professionals to assist in ICT integration in rural areas, unregulated ICT
training facilities and low awareness levels of ICT as a method for economic development.40
On the opposite end of the spectrum, countries such as Qatar, Uganda, Vietnam and South Africa all anchor
their respective regions in telecommunications and expansion of ICT infrastructure that can be used in
eHealth. Vietnam’s ICT growth rate was double that of average in the Asia region and triple that of the world
average in 2006.41 South African telecom company MTN provides mobile broadband throughout the entire
country of Uganda and back in its native country, 90% of South Africans have access to a mobile device.42
Qtel, which used to be Qatar’s sole public telecom company, introduced such mobile technological inno-
vations as DVBH (Digital Video Broadcasting- Handheld) service to the Middle East, delivering real-time
mobile TV broadcasts that capture satellite television channels and play them through mobile handsets.43 It
also introduced 3G mobile internet and video calling, as well as a service called TETRA (Terrestrial Trunked
Radio), which is a professional two-way radio system for companies and organizations such as government,
oil and gas, police, defense, security, public safety, paramedic and the private sector.44 It has massive po-
tential in terms of supporting eHealth initiatives.
It is as a direct result of these types of technological innovations that India leads its region in ICT and health
collaborations- which boast some of the most advanced technologies available and serve marginalized and
under-serviced communities.45
Outside of these physical, technological constraints are human capital constraints such as brain drain, skills
and existing capacity among others. In places where this technology has not yet become standard, training
in ICT is inadequate and costly to implement if people are not familiar with it. The adjustment to new technol-
ogy can be hard to implement as well as time consuming and not cost-effective.
The concept of “Brain Drain”, the emigration of individuals with advanced and/or specified technical knowl-
edge or skill-sets due to political or economic instability, can significantly contribute to this as well. Places
such as India and South Africa, have traditionally had a serious problem with keeping human resources
(highly talented, skilled, trained physicians, etc.) and those they do keep, are usually lured to private institu-
tions by larger salaries that a state-run facility could not compete with.
8. Monitoring and Evaluation

Monitoring and evaluation plays a pivotal role in any project acting as the listening device as to whether
any initiative is meeting its stated goals and objectives. In this section, it will be examined how selected ICT
initiatives have worked to complement as well as develop the health sector in featured countries.
The evaluation of the ICT projects in these countries reveal that heightened linkages in the ICT and health
sectors, in both middle-income and low-income countries, works to dismantle cultural taboos, share knowl-
edge among populations through faster dissemination of information about important health topics.
8.1 Easy Use of PDAs

In Peru, the Colecta-PALM project demonstrated that using PDA’s was useful in developing countries where
individuals were not accustomed to regular usage of similar devices. The survey participants were open
to not only using the device but also to receiving follow-up messages specific to their individual cases in
order to prevent the spread of HIV/AIDS. Out of the total number of participants, 74% agreed to work with
the PDAs, each of whom completed a survey on the device.46
Current evaluation of the CA:SH system in India indicates high acceptance of the technology and reduction
in total time for entry of data. An evaluation of the five-month pilot, “indicated high acceptance of the tech-
nology and reduction in total time for entry of data…the [health workers] were satisfied with the user inter-
face and were able to depend entirely on the handheld, replacing their existing paper-based records.”47
8.2 Cracking Health Stigmas
IBM is currently analyzing the data collection for TTC in Uganda and the data and opinions are then dis-
seminated to larger health agencies across the country. One big lesson learned by TTC was that most
participants did not believe HIV/AIDS tests were accurate or anonymous. This information was rapidly com-
municated to larger health actors in hopes that they could do more to begin dispelling these public myths.
Project M in South Africa is the world’s largest field trial of mHealth and it has been designed to serve as
a scalable, high-impact model that can be replicated worldwide. Since October 2008 the project has sent
out almost 300 million SMS messages to the general public on HIV/AIDS and TB, which have resulted in
1,060,000 calls to the national AIDS hotline, representing a 0.38% average response yield. There has been a
300% increase in call center volume since the launch, and a greater increase in calls are seen when messages
are seen in vernacular languages such as Zulu, compared to when sent in English. Also, when messages
are targeted at women, a higher return call rate of women is achieved. It is especially encouraging that
more young men are responding, as they have previously been difficult to reach.48
8.3 Shorter Wait Times for Patients
In Malawi, before the Baobab system was introduced, patients would stand in line for hours, because of
the exhaustive administrative process that comes with filling out health information. With the new touch
screen based system, registration time is down to under a minute for new patients and less than 10 seconds
for returning patients. Currently, the total number of registered patients by Baobab (bar-coded patients) is
1,095,000 and the total antiretroviral patients captured under this scheme number 37,500.49
8.4 Medical Data Collection and Country Staff Development
A Baobab pilot study in the pediatric Hospital in Malawi, showed that computer-based entry can be suc-
cessfully deployed and used in resource poor settings, it can be sustained at relatively low costs and with
local resources, and has a greater potential to improve patient care in developing countries. The introduc-
tion of the system has eliminated errors in medication dosage by improving documentation.
The touch screens help improve the accuracy of clinical data gathering. The data is being used on a national
level where the electronic data reports are used to forecast and plan HIV delivery in Malawi.
In Qatar the Supreme Council of ICT monitors the progress of its e-Health system. The impact of the e-Health
system has combined all stakeholder efforts in the sector through a systematic, country wide medical cod-
ing system and online terminology database that links all regions of the country together. The e-Health
system has also produced a certified online training program that is available to all emergency room and
nursing sector health care workers, in order to encourage e-Literacy. The Qatari Supreme Council of ICT
should push to require all government health care workers to complete this e-Literacy training program.
8.5 ICT for Health Education
The Jordanian government has studied whether the Knowledge Station centers are placed in the right
areas of the country and if the financing is sustainable. The studies have concluded that the Knowledge
Stations have succeeded in targeting key marginalized populations and improving their knowledge of com-
puter literacy by training 102,324 people, 56% of them being women. Knowledge Centers have allowed dis-
enfranchised populations to access basic health ICT resources and be informed about overarching health
concerns. Statistics reveal that women outnumber the number of men trained using the Knowledge Stations
by 12%, which is an important step towards targeting gender discrimination and educating the marginalized
populations in Jordan.
9. Lessons Learned
Based on the featured ICT initiatives and individual country efforts, this segment takes a broad look at some
of the key lessons learned when implementing eHealth. The lessons here focus in particular on financial
sustainability of projects, language barriers during and after implementation, as well as the increased role
civil society can play.
Readers should note that these lessons learned are formed largely based on the experiences of the chosen
countries and technologies and do not represent an all encompassing list of challenges faced across the
sector. The following section, will attempt to harmonize these lessons into actionable recommendations to
be adopted across all initiatives.
9.1 Financial Sustainability of ICT Projects
In Jordan, the future success of the Knowledge Stations project will depend on the ability of the government
to sustainably fund the centers, without requiring an out-of-pocket expense to be paid by citizens.
Research needs to be undertaken by the government and its multitude of funders in order to see if the
health seminars and workshops offered by the Knowledge Stations are effective. To address its viability, a
nationwide rubric for rating the health education received (in partnership with station owners), and perhaps
a standard curricula, could be introduced to address the health needs of marginalized populations across
regions of the country.
In both Vietnam and India, applicable government ministries need to be able to make budget allocations
in proportion to the scale of the economies and fasttrack legislation to make eHealth initiatives legal and
lawful. Without these allocations, both monetary or political, civil society and the private sector will find
themselves powerless and ineffective as far as facilitating real change.
The Baobab system in Malawi has a financial drawback as well. The original touch screen hardware is no
longer produced and current touch screens are US$ 700 per device, which proves extremely expensive, and
could become a roadblock for the financial sustainability of the Baobab system.
Project M in South Africa made text messages free of charge; however the next step in the project – to
call the national AIDS hotline – was only free when calling from a landline. Mobile callers are charged at
standard mobile rates and with 95% of the population being on pre-paid or pay-as-you-go this is relatively
expensive. The increase of the volume of calls to the Helpline show that people are willing to pay for the
service, however, more people could be reached if the service was free. Pressure is needed on the mobile
operators to collaborate and set up a toll-free line for HIV/AIDS counseling.
9.2 Lack of English Skills and Education as a Road Block to ICT
The Baobab system in Malawi is based in English and requires the healthcare worker to have English read-
ing and writing skills. Not tailoring software to be flexible to local languages has affected take-up of tech-
nologies as not all healthcare workers have the requisite language skills.
In South Africa on the other hand, Project M’s text messages are written in local languages and therefore
reach more people. South Africa has eleven officially recognized languages, and in order to reach as many
people as possible, it is crucial that people are being targeted using a language they can understand.50 This
is a positive example that the Malawi Baobab system should try to replicate.
9.3 Effective Counseling against Stigmas
The targeted method of outreach used in Project M in South Africa is more effective than traditional methods
used when trying to convince people to get counseling. Receiving information by text messages offers a more
intimate alternative to traditional methods and thus lowers stigmatization of HIV/AIDS. This is evidenced by the
high rate of users within the Project M system. In addition, Project M is working to create health test kits that
can be used at home, so that patients can test themselves in the privacy of their homes.
It was noted in Tanzania’s e-IMCI program that not all clients who visited the clinicians were comfortable
with the doctor using a PDA rather than speaking to them directly. Though this was largely cultural and rare
given the overwhelming approval of the device, it should be noted that some experienced discomfort with
their personal data being entered into a device rather than being written down. Here again, room should be
made in the software and e-IMCI protocols to allow the health worker to set the device down and continue
the session without the PDA.
9.4 ICT for Health, Technical and Human Capacity
A challenge has been to increase the capacity of the call centers that handle the phone calls. Staff behind
Project M hopes to supplement employees at local call centers with off-site, trained HIV positive counsel-
ors, which would both create jobs and increase the capacity of the health response. This step would be
critical for the launch of the free at-home testing kits, which cannot be implemented before an easy-to-
reach network of counselors has been established.51
Patience is critical to working in Uganda and arguably, Africa. Things move at a slower pace and projects often
encounter hurdles during and after the implementation cycle. To establish a fixed line connection takes several
days in Uganda and although the timeline for acquiring a mobile line has been reduced, it is by no means quick.
Technology will not solve all issues: a lesson learnt during the e-IMCI trials. What the designers realized in
Tanzania, is the inherent need for a balance between speed and efficiency while maintaining flexibility and
allowing the physician, not the tool, to determine the best course of action.
In Albania, resource constraints, such as the lack of equipment to connect remote health clinics to urban
hospitals with greater capacity, remains unsolved. The unavailability of trained specialists cannot be ig-
nored when focusing on healthcare reforms. Government action plans aimed at strengthening resource
shortages will be in vain if the necessary funds are not made quickly available. Similarly, augmenting the
sector’s human capacity to meet the demands of healthcare services requires careful planning and alloca-
tion of resources for training and professional development programs.
9.5 Reluctance of Governments and Private Companies
There seems to be reluctance on the part of both government officials and private telecom providers to
embrace mobile health solutions in Uganda. It takes a great deal of effort for NGOs like TTC to convince
key stakeholders that there is tremendous value in operations like TTC. However, with the recent light being
shed on mHealth applications throughout the world, stakeholders cannot simply dismiss mHealth as a tool
for furthering development objectives.52
9.6 Medical misdiagnosis Using ICT
In Tanzania, there are cases when a patient is on the border of a threshold between two different classifica-
tions, i.e. a severe cough and pneumonia. A clinician familiar with the IMCI protocols measured the number
of breaths per minute as instructed by the PDA. The result, 36, was just below the threshold for pneumonia,
40 breaths per minute. Since this case is on the border, e-IMCI effectively hides the pneumonia protocol,
perhaps leading to an inaccurate diagnosis. The clinician was aware of this and instead put down the PDA
and made a clinical decision without the assistance of the device. Therefore, e-IMCI software will need to
be more sensitive to evaluate threshold cases for effective diagnoses.
9.7 Role of Civil Society and Public-Private Partnerships
Estonia’s healthcare sector is well organized as a result of collaborative partnerships between all stakehold-
ers in society. There are informative campaigns focused on raising awareness of benefits and difficulties
of ICT implementations in healthcare. Estonia’s eHealth Foundation provides the right framework for future
advancement in the country’s healthcare sector. It sets an example of how action plans are implemented
through exchange of information, coordination, and participation.
What was learned from the Albania case, on the other hand, was that if there are no widely agreed to stan-
dards, and lack of information regarding the available services and equipment, there will be little participa-
tion and few positive results in healthcare improvements. Monitoring and evaluation plans must be adapted
in order to understand the effectiveness of each action plan undertaken by the government in cooperation
with its multi-level partnerships.
10. Recommendations
Drawing from the lessons learned segment, the following section makes sector wide policy recommenda-
tions that are applicable to a broad range of stakeholders, namely, governing bodies, international organiza-
tions, civil society and the private sector.
A reoccurring theme throughout different successful ICT case studies has been the cooperation between
privately owned technology companies, public or private health facilities, non-governmental development
organizations, private development contractors, academia and the government. Obviously, all of these ac-
tors will not be a part of every ICT/Health program or initiative happening in each country, sometimes only
two or three at a time will be involved. However, each actor should make it easier for the others involved
with it, in order to facilitate maximum services rendered to the largest group of beneficiaries.
10.1 For Governing bodies
• National Governments should recognize the significant impact ICT can have on the health sector and
make reasonable allocations for the sector. A clearly defined national ICT plan aimed at the health
sector should be a key priority.
• National and local governments should encourage involvement and contributions of civil society
and private entrepreneurs. This can be done through legislation, if there are laws complicating NGO/
private partnerships, or by offering incentives, perhaps tax-based, to both parties, making partner-
ship more appealing. Governments should liberalize their ICT markets to allow competition and thus
reduce costs of ICT.
• Bridging the urban/rural divide in countries across the global South must remain at the forefront of
any government initiated health efforts. Governments must make bolder strides to ensure increased
equity and access to basic health services in the rural segments of their countries.
• Countries that are making use of ICT in other sectors should make efforts to implement and further
develop these initiatives to suit the health sector.
10.2 For International Organizations and Donors
• Some countries lack sufficient funds to make ICT their top priority and are thus dependent on exter-
nal assistance. Contributions should be earmarked to ensure that a share goes toward ICT in health.
Recipient governments should be held accountable, ensuring international dollars are wisely spent.
• International organizations should foster active participation from local civil society organizations. They
have critical on the ground insights that prove invaluable and always suited to the cultural context.
• Efforts from the international community to increase use of ICT in health are fragmented, a more
targeted and coherent approach should be developed, where the UN plays a key role in monitoring
and coordination.
10.3 For Civil Society
• Civil society should apply pressure on the state health apparatus and private sector to employ ICT
in Health initiatives. Promoting partnerships is a key point, as civil society groups have the unique
qualifications to act as interlopers between different private and state interests.
• In countries where national health systems are relatively well functioning, civil society still has a role
in advocacy and monitoring of health issues. This is especially important to ensure improvements for
rural and more vulnerable parts of a population.
10.4 For Private Entrepreneurs
• Private entrepreneurs must be encouraged to participate in introducing ICT for health in developing
and transitional countries. There are many ways in which a telecom company can facilitate eHealth
programming, most of which will cost little and will allow them to reap substantial rewards in terms
of corporate social responsibility or philanthropic standing.
• Telecommunication companies must realize there lies an immense untapped market of new custom-
ers when they partner with agencies that implement mobile based ICT applications.
10.5 For All Stakeholders
• Locals, for example through civil society, should be included in eHealth projects in order to
ensure that ICT initiatives are context specific and to develop a better targeted health improve-
ment approach.
• Projects should build on local capacity so that they can easily be handed over to local staff and thus
be sustainable.
• Technology should be cheap to buy, cheap to ship to location, and easy to maintain and customize.
• Flexibility, creativity and innovation all enable future innovation, however, implementers should try
and keep models as simple as possible.
• Embrace a user-centric “innovation process” that allows field centric activities and frequent feed-
back to ensure products address actual needs with sustainable solutions.
• Programs must be designed with scalability and sustainability. Implementers should view projects as
long term investments and not handouts.
11. Appendix
Figure 1: Featured ICT Initiatives
Albania - eHealth Policy and Legislature: Between 2001 and 2004 national mechanisms such as an
information policy, an eStrategy, and an eHealth policy were adopted to Albania’s national health plan. With
the support of the Ministry of Health, the country plans to implement procurement policies and strategies
to guide software, hardware and content acquisition in the healthcare sector. The Ministry of Health also
provides resources towards the professional development of Albania’s healthcare workforce in ICT.53
Estonia - eHealth Projects: In October 2005, Estonia’s Ministry of Social Affairs, with support by the Euro-
pean Union (EU) Structural Funds and in collaboration with a team of national partners, initiated the eHealth
Foundation. The core objective of this project incorporates: development of a structured framework for
eHealth architecture; management of electronic health records and setting the stage for digital prescrip-
tions, digital registrations, and digital images. eHealth in Estonia was created by employing existing IT infra-
structure while also conducting research for system and service improvements.54
India - Community Accessible and Sustainable Health System (CA:SH): The CA:SH program started
in 2002 and was designed to address the problems of poor data flow and logistical support for rural medical
workers in the State of Haryana, India. A handheld software application to facilitate ordered data collection,
immunization scheduling, pre-natal care for pregnant mothers and recording routine demographic changes
in the community was developed.55
Jordan - Knowledge Stations: In an effort to bridge the gap between marginalized populations and ICT,
the government started drawing plans for “Knowledge Stations” in 2001. These stations are centers where
women, children, the poor and rural populations can go to gain cheap access to Internet, computers, copy
and fax machines, as well as computer training courses. These “Knowledge Stations” facilitate learning
about and having access to a number of social needs, health information being one.56
Macedonia - Telemedicine Project: Evaluating requirements and qualifications for a basic Medical In-
formation System (MISs) was the main goal of this project. Development of a structured framework and
user-friendly interfaces made it possible for multiplatform MISs to interconnect in an integrated MIS. This
project makes it possible for Macedonian hospitals to: share knowledge, experience, and expertise to be
shared among healthcare providers; have real time consultations for patients including those in remote
areas through video streaming making access to medical information easy, quick, and affordable to all
interacting participants.57
Malawi - Baobab: To support rural health workers and lead them through treatment and diagnosis, Bao-
bab applies easy-to-use touch screen clinical workstations at Malawian hospitals and HIV clinics. By using
inexpensive, low-power touch screen computers (TCW) and applying the model of care, developed by the
Ministry of Health in Malawi, the touch screens guide low-skilled health workers through the diagnosis and
treatment of patients. Furthermore, the system allows real-time, statistical monitoring and studying of health
data, helping to focus and efficiently target HIV treatment programs. The data is being aggregated and used
at a national level for policy making and analysis.58
Peru - Colecta-PALM: The Colecta PALM program was implemented to assist people with HIV/AIDS. This
program used was an open sourced and secured web-based application in Spanish that gave surveys to
the participants. These surveys helped project administrators collect data about the participants using
Personal Digital Assistants (PDAs). The surveys monitored how the patients were using medications and
practicing safe sex to keep them from transmitting HIV/AIDS to others. The program provides feedback to
the participant to encourage responsible behavior so as not to spread the disease.59
Qatar - ictQATAR: The Qatar government has proposed modern and sophisticated financing for health
plans that are geared toward the advancement of information and communication technologies. The “e-
Health Strategy” is a health plan with an emphasis on ICTs or health that is being developed by 2010. The
goals are that users of the e-Health system will have widespread access to information, services and health
products via Internet, and the system will have the capacity to monitor chronic health situations, such as a
diabetes patient’s blood sugar levels.60
South Africa - Project Masiluleke (Project M): Project M operates by using mobile technology to bring
people with HIV and tuberculosis into the healthcare system earlier and thereby increase chances of liv-
ing longer and healthier lives. The project was started in 2008, and uses specially developed open source
software to send millions of targeted health messages to mobile phone users in the country. The messages
describe symptoms of HIV and encourage mobile users to contact existing HIV and Tuberculosis (TB) call
centers where trained operators provide health information, counseling and referrals to local testing clinics.
The project also keeps patients with AIDS connected to care by reminding them of scheduled clinic visits
and thereby ensuring they adhere to antiretroviral regimens.61
Tanzania - e-IMCI: e-IMCI was launched to overcome manual and fiscal healthcare barriers. It is a pro-
gram that essentially runs to protocol Integrated Management of Childhood Illness (IMCI) on a PDA and
guides health workers thorough the IMCI protocols. Since the software automatically guides health workers
through the IMCI algorithms, there is less human error and greater adherence.62 63
Trinidad and Tobago - Virtual Health Library (VHL): Trinidad and Tobago has implemented VHL, which
takes health information for the country and organizes it in a structured manner. Users can access the VHL
from any location with internet-access. It is easy to use, and breaks information sections into categories
such as AIDS, Asthma, Breast Cancer, etc.64
Uganda - Text to Change (TTC): In late 2008, Text to Change was launched as a tool to help spread aware-
ness about the effects of HIV/AIDS in Mbarara, Uganda. The program aimed to use mobile phones for HIV
education and encouraged the public to voluntarily seek HIV testing and counseling services. Using SMS
technology, TTC provided HIV/AIDS awareness testing via quizzes sent to 15,000 mobile subscribers during
three months of testing. As an incentive to participate, free airtime was provided to users. This proved criti-
cal since users can exchange the airtime with others as a form of mobile currency.65
Vietnam - The Remote Interaction, Consultation and Epidemiology (RICE) system: The Remote
RICE system is a cellular phone-based electronic medical record designed to facilitate remote medi-
cal consultation, epidemiological surveillance and access to medical knowledge for populations without
access to computers or the internet. Rural locals are always at an elevated risk during communicable
disease outbreaks and Southeast Asia was previously identified as a potential high-risk area for SARS
and Avian influenza transmission.66
Figure 2: Progress on the MDGs
MDG 4 MDG 5 MDG 6
Proportion of 1 Births at- Tuberculosis Children under

Infant mortality Children under Maternal
year old chil- tended by People living death rate 5 sleeping un-
rate (0-1 year) five mortal- mortality ratio
dren immu- skilled health with HIV, 15-24 per year per der insecti-
per 1,000 live ity rate per 1,000 per 100,000 live
nized against personnel years (%). 100,000 popu- cide-treated
births. live births. births
measles (%). (%). lation bed nets (%).

1990 37 1990 46 1990 88 N/A 2000 99 N/A 1990 4 N/A
Albania
2007 13 2007 15 2007 97 2005 92 2005 99 N/A 2007 3 N/A
1990 14 1990 18 1993 74 N/A 1992 99 2001 0.5 1990 4 N/A
Estonia
2007 4 2007 6 2007 96 2005 25 2006 100 2007 1.3 2007 6 N/A
1990 83 1990 117 1990 56 N/A 1993 34 2001 0.5 1990 42 N/A
India
2007 54 2007 72 2007 67 2005 450 2006 47 2007 0.3 2007 28 N/A
1990 33 1990 40 1990 87 N/A 1990 87 N/A 1990 1 N/A
Jordan
2007 21 2007 24 2007 95 2005 62 2007 99 N/A 2007 1 N/A
1990 33 1990 38 1993 98 N/A 1990 89 N/A 1990 11 N/A
Macedonia
2007 15 2007 17 2007 96 2005 10 2006 99 N/A 2007 5 N/A
1990 124 1990 209 1990 81 N/A 1992 55 2001 13 1990 62 2000 3
Malawi
2007 71 2007 111 2007 83 2005 1100 2006 54 2007 12 2007 102 2006 23
1990 58 1990 78 1990 64 N/A 1992 53 2001 0.4 1990 34 N/A
Peru
2007 17 2007 20 2007 99 2005 240 2006 71 2007 0.5 2007 16 N/A
1990 20 1990 26 1990 79 N/A 1996 98 N/A 1990 6 N/A
Qatar
2007 12 2007 15 2007 92 2005 12 N/A N/A 2007 7 N/A
1990 49 1990 64 1990 79 N/A 1995 82 2001 17 1990 78 N/A
South Africa
2007 46 2007 59 2007 83 2005 400 2003 92 2007 18 2007 230 N/A
1990 96 1990 157 1990 80 N/A 1992 44 2001 7 1990 43 1999 2
Tanzania
2007 73 2007 116 2007 90 2005 950 2005 44 2007 6 2007 78 2007 57
Trinidad & 1990 30 1990 34 1990 70 N/A 1997 99 2001 1.4 1990 2 N/A
Tobago 2007 31 2007 35 2007 91 2005 45 2006 98 2007 1.5 2007 2 N/A
1990 40 1990 56 1990 88 N/A 1997 77 2001 0.3 1990 33 2000 16
Viet Nam
2007 13 2007 15 2007 83 2005 150 2006 88 2007 0.5 2007 24 2006 5
1990 106 1990 175 1990 52 N/A 1995 38 2001 8 1990 69 2001 0.2
Uganda
2007 82 2007 130 2007 68 2005 550 2006 42 2007 5 2007 93 2006 10
Source: Millennium Development Goals Indicators: The Official United Nations Site for the MDG Indicators, retrieved from:
http://millenniumindicators.un.org/unsd/mdg/Default.aspx, November 2009
Figure 3: Positioning eHealth, mHealth and telemedicine
Low Complexity of eHealth applications High
Monitoring/ Data Disease / Health Diagnosis /

Education/
Emergency Information
Awareness Compliance Access Tracking Systems Consultation
mHealth Telemedicine
Definition
The delivery of health-related services via mobile Health-related services delivered remotely with clini-
communications technology cal participation
Distinctions
mHealth implies the use of solutions and services de- Implies technology to provide patient/clinician interac-
signed to be accessed and delivered via cellular or tion real-time using multiple ICT (i.e. video, IP, voice)
wireless broadband networks
Examples
Mobile access to health records Patient monitoring Remote health clinics

Public health alerts, monitoring Remote diagnostics and consultation
Nutrition awareness programs Remote support for local health care provider
Training and support for rural health workers
Medication monitoring
Outbreak tracking and reporting
Behavior change, education and awareness program
Source: Vital Wave Consulting, mHealth in the global South – Landscape Analysis, 2008.
Figure 4: Country health expenditures
General govern- Per capita
Total expendi- Private expen- External re-
ment Out-of-pocket Per capita government
ture on diture on sources for
expenditure on expenditure as % government expenditure
health as % of health as % of health as %
health of private expenditure on health
gross total of total
as % of total expenditure on on health at average ex-
domestic expenditure expenditure on
expenditure health (PPP int. $) change
product on health health
on health rate (US$)
2000 2006 2000 2006 2000 2006 2000 2006 2000 2006 2000 2006 2000 2006
Albania 6.4 6.5 36.3 37.3 63.7 62.7 6 3.5 99.9 94.9 87 142 27 70
Estonia 5.3 5.2 77.5 73.3 22.5 26.7 0.9 0.6 88.5 93.3 404.0 702.0 169.0 464.0
India 4.3 3.6 21.8 25.0 78.2 75.0 0.6 1.0 92.1 91.4 14.0 22.0 4.0 7.0
Jordan 9.4 9.7 46.5 43.3 53.5 56.7 4.6 4.7 74.7 75.9 141.0 188.0 77.0 103.0
Macedonia 7.6 8.0 70.9 70.6 29.1 29.4 3.2 1.1 100.0 100.0 334.0 444.0 96.0 176.0
Malawi 6.1 12.9 43.8 69.0 56.2 31.0 26.9 59.6 42.4 28.4 17.0 43.0 4.0 14.0
Peru 4.7 4.4 53.0 58.3 47.0 41.7 2.0 1.5 79.4 77.5 123.0 184.0 52.0 87.0
Qatar 2.3 4.3 68.8 78.2 31.2 21.8 0.0 0.0 84.5 88.2 866.0 … 454.0 2157.0
South Africa 8.1 8.0 42.4 37.7 57.6 62.3 0.3 0.9 18.9 17.5 220.0 270.0 100.0 160.0
Tanzania 3.9 6.4 40.4 57.8 59.6 42.2 26.7 43.9 80.0 54.3 12.0 42.0 4.0 13.0
Trinidad and Tobago 3.9 4.4 42.8 56.5 57.2 43.5 4.7 2.4 86.3 88.0 … … 104.0 339.0
Uganda 6.6 7.0 26.8 25.4 73.2 74.6 28.3 31.2 56.7 51.0 12.0 18.0 4.0 6.0
Vietnam 5.4 6.6 30.1 32.3 69.9 67.7 2.5 2.2 91.7 90.2 23.0 49.0 6.0 15.0

Sweden 8.2 9.2 84.9 81.7 15.1 18.3 0.0 0.0 91.1 87.9 1938.0 2853.0 1936.0 3245.0
United States 13.2 15.3 43.7 45.8 56.3 54.2 0.0 0.0 26.6 23.5 1997.0 3076.0 1997.0 3076.0

Averages 5.7 6.7 46.2 51.1 53.8 48.9 8.2 11.7 76.5 73.1 187.8 191.3 84.7 277.8

Asia 4.9 5.1 26.0 28.7 74.1 71.4 1.6 1.6 91.9 90.8 18.5 35.5 5.0 11.0
Africa 6.2 8.6 38.4 47.5 61.7 52.5 20.6 33.9 49.5 37.8 65.3 93.3 28.0 48.3
Mid-East 5.9 5.9 57.7 57.7 42.4 42.4 2.3 2.3 79.6 79.6 503.5 503.5 265.5 265.5
East Europe 6.5 6.6 74.2 72.0 25.8 28.1 2.1 0.9 94.3 96.7 369.0 573.0 132.5 320.0
Americas 4.3 4.4 47.9 57.4 52.1 42.6 3.4 2.0 82.9 82.8 123.0 184.0 78.0 213.0
Developed Regions 10.7 12.3 64.3 63.8 35.7 36.3 0.0 0.0 58.9 55.7 1967.5 2964.5 1966.5 3160.5
Source: World Health Organization, World Health Statistics 2009, retrieved from: http://apps.who.int/whosis/data/Search.jsp?countries=[Location].
Members, October 2009.
Figure 5: ICT basket prices
ICT Price Basket Mobile Sub-basket

Mobile sub-basket as a Mobile sub-basket
Value 2008 out of 150 ranking 2008 out of 150
% of monthly GNI (US$)
countries countries
Albania 7.1 115 8.3 22.7
Estonia 2 42 1.2 13.6
India 4.7 64 2.1 1.6
Jordan 6.1 60 1.9 4.5
Macedonia 4.2 99 4.6 13.2
Malawi 57.8 148 57.4 12
Peru 6.9 79 2.8 8
Qatar N/A N/A N/A N/A
South Africa 4.2 73 2.6 12.3
Tanzania 55.4 141 33.3 11.1
Trinidad and Tobago 1.1 23 0.7 7.9
Uganda 60.4 142 36.8 10.4
Vietnam 11.9 110 6.4 4.2
Source: International Telecommunication Union, Measuring the Information Society - the ICT Development Index, 2009.
Figure 6: Ranking according to the ICT Development Index of 154 countries
2002 2007
Albania 93 85
Estonia 31 26
India 117 118
Jordan 65 76
Macedonia 53 65
Malawi 141 141
Peru 71 74
Qatar 47 44
South Africa 77 87
Tanzania 138 145
Trinidad and Tobago 58 56
Uganda 143 140
Vietnam 107 92
Source: International Telecommunication Union, Measuring the Information Society - the ICT Development Index, 2009.
Figure 7: ICT Access, Usage and Skills ranking
2002 2007 2002 2007 2002 2007

Albania 78 96 130 78 92 78
Estonia 37 24 20 27 18 21
India 124 129 57 44 118 118
Jordan 66 78 70 75 50 60
Macedonia 72 55 46 50 64 63
Malawi 145 138 143 144 132 136
Peru 94 85 59 61 51 56
Qatar 41 39 57 44 84 79
South Africa 77 84 67 92 80 80
Tanzania 121 140 144 143 139 142
Trinidad and Tobago 50 47 55 67 87 92
Uganda 150 142 132 126 134 133
Vietnam 118 90 105 74 95 102
Source: International Telecommunication Union, Measuring the Information Society - the ICT Development Index, 2009
List of Acronyms
AIDS Acquired Immune Deficiency Syndrome
CA:SH Community Accessible and Sustainable Health System
DVBH Digital Video Broadcasting- Handheld
EU European Union
eHealth Healthcare Service by Electronic Devices & Information Exchange
e-IMCI Electronic Integrated Management of Childhood Illness
FYROM Former Yugoslav Republic of Macedonia
GDP Gross Domestic Product
GNI Gross National Income
HIV Human Immunodeficiency Virus
IBM International Business Machines Corporation
ICT Information and Communication Technologies
ICT4D Information and Communication Technologies for Development
IT Information Technology
ITU International Telecommunication Union
MDGs Millennium Development Goals
mHealth Mobile Health
MIS Medical Information Systems
MMR Maternal Mortality Ratio
MTN South African Telecom Company
NGO Non Governmental Organization
NHRM National Health Rural Health Mission in India
OECD Organization for Economic Cooperation and Development
PDA Personal Digital Assistant
Project M Project Masiluleke
Qtel Qatar Telecom Company
RICE Remote Interaction Consultation and Epidemiology System
SMS Short Message Service or Silent Messaging Service
SARS Severe Acute Respiratory Syndrome
STDs Sexually Transmitted Diseases
SWAp Sector Wide Approach
TB Tuberculosis
TCW Touch Screen Computers
TETRA Terrestrial Trunked Radio

TFYR Macedonia The former Yugoslav Republic of Macedonia
TTC Text to Change
UN United Nations
UNGAID Global Alliance for ICT and Development
VHL Virtual Health Library
WHO World Health Organization
End Notes
1
McNamara, K. 2007. Improving Health, Connecting People: The Role of ICTs in the Health Sector of
Developing Countries. infoDev Working Paper No. 1 2007. Washington, DC, infoDev.
2
Global Alliance for ICT and Development. 2009. What is GAID? New York. Posted at: http://www.un-
gaid.org/About/tabid/861/language/en-US/Default.aspx
3
Vital Wave Consulting. 2008. mHealth in the Global South – Landscape Analysis. Palo Alto, Vital Wave
Consulting.
4
World Health Organization. 2004. eHealth for Health-care Delivery: Strategy 2004-2007. Geneva, World
Health Organization. Posted at www.who.int/eht/en/EHT_strategy_2004-2007.pdf
5
Daly, J. 2003. Information and Communications Technology Applied to the Millennium Development
Goals. Washington, DC, Development Gateway Foundation. Posted at: http://topics.developmentgate-
way.org/ict/sdm/previewDocument.do~activeDocumentId=840982
6
Ministry of Foreign Affairs Denmark. 2005. Good ICT Practice – Lessons Learned in Health Sector. Co-
penhagen. Posted at: http://goodictpractices.dccd.cursum.net/client/CursumClientViewer.aspx?CAID=2
14113&ChangedCourse=true
7
World Bank. 2003. ICT and MDGs: A World Bank Group perspective. World Bank Working Paper No.
27877. Posted at: http://www-wds.worldbank.org/external/default/main?pagePK=64193027&piPK=64
187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityI
D=000090341_20040915091312
8
Mingues, M. 2003. Information and Communications Technologies & the Millennium Development
Goals. Geneva. Posted at http://www.itu.int/ITU-D/ict/publications/wtdr_03/material/ICTs%20&%20
MDGs.pdf
9
Vital Wave Consulting. 2009. mHealth for Development: The Opportunity of Mobile Technology for
Healthcare in the Developing World. Washington, DC and Berkshire UK, UN Foundation-Vodafone
Foundation Partnership.
10
Vital Wave Consulting. 2008. mHealth in the Global South – Landscape Analysis. Palo Alto, Vital Wave
Consulting.
11
Ministry of Health, Uganda. 2009. Health Sector Strategic Plan II. Uganda, Ministry of Health. Posted
at: http://www.who.int/rpc/evipnet/Health%20Sector%20Strategic%20Plan%20II%202009-2010.pdf
12
United Nations Population Fund. 2009. Peru. New York, NY. Posted at: www.unfpa.org/webdav/
site/global/shared/CO.../Peru_b2_9.23.doc
13
Ibid.
14
The United Republic of Tanzania Ministry of Health and Social Welfare. 2008. Health Sector Strategic
Plan III 2009-2015, Partnership for Delivering the MDGs. Tanzania, Ministry of Health. Posted at: http://
www.moh.go.tz/documents/Health_Sector_Strategic_Plan_III.pdf
15
Chopra, Mickey, et al. Achieving the Health Millennium Development Goals for South Africa: Challeng-
es and Priorities. The Lancet, 374(9694):1023-1031.

16
OECD, World Health Organization and The World Bank. 2008. Effective aid, better health. Geneva, World
Health Organization.
17
The United Republic of Tanzania Ministry of Health and Social Welfare. 2008. Health Sector Strategic
Plan III 2009-2015, Partnership for Delivering the MDGs. Tanzania, Ministry of Health. Posted at: http://
www.moh.go.tz/documents/Health_Sector_Strategic_Plan_III.pdf
18
Rashtriya Swasthya BimaYojna. 2009. Health Insurance for the Poor. Ministry of Labor and Employment,
Government of India. Posted at: http://www.rsby.in/about_rsby.html
19
World Health Organization. 2006. Building Foundations for eHealth: Progress of Member States. Ge-
neva, World Health Organization.
20
Via Libre. 2009. Peru. Posted at: http://www.vialibre.org.pe
21
Impacta. 2009. Socios y Colaboradores. Posted at: http://www.impactaperu.org/Portal/content.
aspx?pid=14
22
Dimagi Inc. 2009. Ca:sH. Massachusetts. Posted at: http://www.dimagi.com/content/cash.html
23
Ministry of ICT, Jordan. 2008. Knowledge Stations: A Sustainable Approach. Jordan. Posted at: http://
www.ks.jo/KS_sustain_EN.htm
24
Ibid.
25
Project Masiluleke. 2009. Project Masiluleke Internal Evaluation Report. South Africa, Project Mail-
uleke.
26
International Telecommunications Union. 2009. Measuring the Information Society. Geneva, ITU.
27
Salamon, L, Wojciech Sokolowski, S. & List, R. 2003. Global Civil Society – an Overview. The Interna-
tional Journal of Not-for-Profit Law, 6(1).
28
Chopra, Mickey, et al. 2009. Achieving the Health Millennium Development Goals for South Africa: Chal-
lenges and Priorities. The Lancet, 374(9694): 1023-1031.
29
PriceWaterhouse Coopers. 2007. Healthcare in India- Emerging Market Report, 2007. McLean, VA,
PriceWaterhouse Coopers.
30
Ians. 2009. Civil Society Organizations Issue Health Manifesto. Thaindian News, 23 March. Posted
at: http://www.thaindian.com/newsportal/politics/civil-society-organisations-issue-health-manifes-
to_100170271.html
31
Rosen, JE. 2005. Peru: Civil Society Key to Youth Policy Implementation. USAID Policy Brief. Washing-
ton, DC, USAID. Posted at: http://www.policyproject.com/abstract.cfm/2476
32
Amnesty International. 2009. Hundreds of Peru’s Poor, Rural and Indigenous Pregnant Women Die in
Health Service Lottery. Amnesty International. New York, NY. Posted at: http://www.amnesty.org/en/
news-and-updates/report/hundreds-peru-poor-rural-indigenous-pregnant-women-die-health-service-
lottery-20090709
33
World Health Organization. 2009. Qatar Coverage with Primary Health care Service Indicators, 2009.
Geneva. Posted at: http://www.emro.who.int/emrinfo/index.asp?Ctry=qat
34
Fast Forward TT. 2009. ICT Agenda. Trinidad & Tobago. Posted at: http://www.fastforward.tt/ICT_agen-
da/default.aspx
35
LifeLine. 2007. Our Story. South Africa. Posted at: http://www.aidshelpline.org.za/default.aspx?link=our_
story
36
Project Masiluleke. 2009. Project Masiluleke Internal Evaluation Report. South Africa, Project Mail-
uleke.
37
Kapadia, F. 2009. Interview with Eric Cantor, Grameen Foundation – App Lab. mHealth in Uganda. 16
October 2009. E-mail communication.
38
Smith, A. 2008. High-Speed Internet Coming to Africa. Time Magazine, 15 September. Posted at: http://
www.time.com/time/business/article/0,8599,1841175,00.html
39
Wilfred, E. 2008. Tanzania: World Bank’s $100 million to Lower ICT Cost. allafrica.com, 6 June. Posted at:
http://allafrica.com/stories/200907061437.html
40
Chigalu, S. 2006. ICT for Sustainable Rural Development Telecenter Project. ICT Malawi, Malawi.
Posted at: http:// www.ictmalawi.org
41
Connect World. 2008. Vietnam Telecomp 2008. World Info Comms Ltd. United Kingdom. Posted at: http://
www.connect-world.com/articles/e-promo.php?e_promos_id=45
42
Pop!Tech. 2009. Project Masiluleke. Pop!Tech. New York. Posted at: http://poptech.org/project_m/
43
International Telecommunications Union. 2007. 3G International Video Calling launched in Qatar by
Q-tel. Geneva, ITU. Posted at: http://www.itu.int/osg/spu/newslog/PermaLink,guid,d30768c0-7b10-4388-
836d-9d4e6e0f5c5f.aspx
44
Tetra-Products and Services. 2009. Qtel. Qatar. Posted at: http://www.qtel.com.qa/Tetra.do?prodtype=2
45
46
Ibid.
47
Anantraman, V, et al. 2000. Handheld computers for rural healthcare: Experiences from research con-
cept to global operations. Dimagi, Boston. Posted at: http://kaash.sourceforge.net/doc/dyd02.pdf
48
Brandt Soerensen, J. 2009. Interview with Leetha Filderman, Director, Pop!Tech Accelerator. 10 No-
vember 2009. E-mail communication.
49
Brandt Soerensen, J. 2009. Interview with Sabine Joukes, Director, Baobab. 20 October 2009. E-mail
and telephone communication.
50
Ibid.
51
Reuters. 2009. Research and Markets: An Overview of the South African Healthcare Industry. Reu-
ters. New York, NY. Posted at: http://www.reuters.com/article/pressRelease/idUS175920+29-May-
2009+BW20090529
52
Kapadia, F. 2009. Interview with Eric Cantor, Grameen Foundation – App Lab. mHealth in Uganda. 16
October 2009. E-mail communication.
53
World Health Organization. 2006. Building Foundations for eHealth. Geneva. Posted at: http://www.who.
int/goe/data/country_report/alb.pdf
54
Tiik, M. 2008. Estonian Residents Are in Favor of Implementing the Electronic Health Record. Estonia.
Posted at: http://eng.e-tervis.ee/news/est-residents-in-favor-of-implementing-the-ehr.html
55
Dimagi Inc. 2009. Ca:sH. Massachusetts. Posted at: http://www.dimagi.com/content/cash.html
56
Ministry of ICT, Jordan. 2008. Knowledge Stations: A Sustainable Approach. Jordan. Posted at: http://
www.ks.jo/KS_sustain_EN.htm
57
Chorbev, I, Madzarov, G and Mihajlov D. 2009. Wireless Telemedicine as Part of Integrated Systems for
E-Medicine. Posted at: http://www.ieee.org/portal/cms_docs/iportals/education/standards/Chorbev_
Wireless_Telemedicine.pdf
58
Baobab Health. 2009. About Us - Baobab Health. Malawi. Posted at: http://baobabhealth.org/?page_
id=2.
59
60
ictQatar. 2009. National Programs – eHealth. Qatar. Posted at: http://www.ict.gov.qa/output/page6.asp
61
Frog Design. 2008. Pop!Tech Unveils Project Masiluleke. Amsterdam. Posted at: http://www.frogdesign.
com/press-release/poptech-unveils-project-masiluleke.html
62
World Health Organization. 2009. Integrated Management of Childhood Illness (IMCI). Geneva. Posted
at: http://www.who.int/child_adolescent_health/topics/prevention_care/child/imci/en/index.html
63
DeRenzi, Brian, et al. 2008. e-IMCI: Improving Pediatric Health Care in Low Income Countries. Florence,
Italy. Posted at: www.cs.washington.edu/homes/bderenzi/Papers/chi1104-bderenzi.pdf
64
Virtual Health Library. 2009. VHL – Information Sources. Trinidad & Tobago. Posted at: http://www.vhl.
org.tt/html/en/home.html
65
66
Ibid.
Printed at the United Nations, New York
09-67282—April 2010—500
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9.6 Medical misdiagnoses Using ICT..............................................................................................................15

2. Intersection of health and ICTs

3. ICTs and the MDGs

3.1 eHealth and mHealth: Challenges and Opportunities

4. Role of Governments for Improved Health

5. National Commitment to Health Financing

6. Role of Civil Society

7. Technical and Human Capital Constraints

8. Monitoring and Evaluation

8.1 Easy Use of PDAs

MDG 4 MDG 5 MDG 6

Proportion of 1 Births at- Tuberculosis Children under

Figure 3: Positioning eHealth, mHealth and telemedicine

Low Complexity of eHealth applications High

Monitoring/ Data Disease / Health Diagnosis /

Mobile access to health records Patient monitoring Remote health clinics

Figure 5: ICT basket prices

ICT Price Basket Mobile Sub-basket

Figure 6: Ranking according to the ICT Development Index of 154 countries

Figure 7: ICT Access, Usage and Skills ranking

2002 2007 2002 2007 2002 2007

TETRA Terrestrial Trunked Radio

es and Priorities. The Lancet, 374(9694):1023-1031.

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