The Benefits and Challenges of E-Health Applications in Developing Nations: A Review

ABSTRACT

This paper is presented to contribute to the benefits and challenges of the Healthcare system in
developing nations with daily increase in population, how ICT could be of important aid to the
cause. First, its argues that the health sector is best conceptualized as a ‘knowledge economy’.
This supports a broadened view health service provision that includes formal and informal
arrangements for the provision of medical advice and drugs, this is particularly important in
countries with a pluralistic health system with relatively underdeveloped institutional
arrangement. By using ICT, the quality of healthcare can be increased, or standards can be
maintained with fewer people and at lower cost. Many companies are now working on
excellent eHealth innovations, as we all know the aim of Information and Communication
Technologies (ICT) for Health (also known as eHealth) is to improve significantly the quality,
access and efficacy of healthcare for all citizens. ICT for Health describes the application of
information and communication technologies across the whole range of functions that affect
the health sector.

Keywords: eHealth, mHealth, ICT, Healthcare System, Education.

1. INTRODUCTION

In developing countries, preventable diseases and premature deaths still inflict a high toll.
Inequity of access to basic health services affects distinct regions, communities, and social
groups. Under-financing of the health sector in most countries has led to quantitative and
qualitative deficiencies in service delivery and to growing gaps in facility and equipment
upkeep. Inefficient allocation of scarce resources and lack of coordination among key
stakeholders have made duplication of efforts, overlapping responsibilities, and resource
wastage common and troublesome problems. The World Health Organization's definition of
health is not merely the absence of disease but the attainment of a state of physical, mental,
emotional and social well-being.

Information and communication technologies ,ICT is used to describe a range of technologies

for gathering, storing, retrieving, processing, analyzing, and transmitting information.
Information is seen as a key element to achieving these objectives, as is a workforce trained in
the appropriate health information skills (Berland G.K et al, 2001). It is an unfortunate reality
that healthcare is not as safe as it should be. Adverse events and preventable errors that cause
patient harm and death are commonplace in healthcare. These errors are most often not the
fault of individuals, but of a system that fails to provide safe and effective care. The cause of
preventable errors can be traced to gaps in the flow of information and communication failures
both within organizations and across different healthcare service providers. The personal cost
of these errors is immeasurable.

One very common form of ICT health (eHealth) is patient self-care and education, including
for example interactive web sites and medical devices for self-monitoring. Along with
adapting health ICT the patients are being involved more and more in their own health care
process. This also seems to be a welcomed trend from the patient side, as more and more
people are interested in their own health and proactively looking for health information in
internet.
Obviously, with modern ICT also the communication between health professionals and
patients and other actors can now be done faster than ever, even real-time. Furthermore, one of
the most commonly referred use of health IT is the electronic data storage and data sharing
across providers. This has also received attention in the European Union, and the European
Commission envisions a common health database for the European Union. In addition to the
increasing importance of self-care, modern forms of communication and electronic data
processing, there can also be very complex technologies that combine all these. These
technologies make it possible to do certain monitoring tests at home and send the data to
health care professionals to be analyzed, resulting in an intervention when needed.
(Christensen et al. 2007).
2. LITERATURE REVIEW

The rapid pace of mobile phone adoption, with its promise of universal connectivity, lends
credence to beliefs that the latest generation of information and communication technologies
(ICTs) will support substantial beneficial changes in the organization of the health sector. This
has led donor agencies and foundations to invest in many digital health interventions in low
and middle-income countries, in the hope that they will provide a way to address major
deficiencies in access to safe, effective and affordable health services, especially by the poor.
It has also stimulated large private sector investments in pursuit of niches in rapidly changing
markets.

Healthcare is an information intensive industry and healthcare professionals rely on access to

correct and comprehensive information, when and where they need it, to inform the daily
decisions they make about a person’s care. Information and communications technology is
largely absent from the way we generate, capture and share health information as we continue
our reliance on handwritten paper records. To say that this reliance on paper is inefficient,
wastes money and scarce resources and compromises patient safety and the quality of care is
an understatement (Nichols et al, 2008). In order to meet these challenges and ensure the
sustainability of healthcare, we need to change the way healthcare is funded and delivered.
Failure to do so means these challenges go unchecked, needs go unmet, and the health system
continues its downward spiral of unsustainability with resultant detrimental flow on effects for
workforce participation, productivity and economic growth. The challenges facing healthcare,
if not addressed appropriately and soon, will become overwhelming. They call into question
nation’s ability to deliver efficient, equitable, affordable, portable, universal, highly accessible
and safe, high quality healthcare.

According to the World Health Organization, the life expectancy of the country is low and
about 20% of children die before the age of 5 (Health care system, Wikipedia). While the CIA
World FACTBOOK believes that the life expectancy at birth for male is 48.95 and female is
55.33 years of age (FactBook, CIA). With all this facts and figures there is no argument that
the need for improvement is needed effective immediately. With Different climate change,
there is always a different type of diseases; the common ones are malaria and fever. A country
like Nigeria with daily rising in population of over 190 million people with most of its citizen
attending a public hospital (Government owned) should have a more advanced way of
attending to people and giving them proper care, also making a move away from the paper
based approach which is commonly used in the health sector instead of the database approach
which is faster and more accurate.
2.1 ICT In Health Care
ICT in Healthcare is powerful in monitoring the outbreak and spread of disease, disseminating
health information about health-promoting and disease-preventing, training and long distance
support to health care practitioners. A specific challenge for developing countries is ensuring
that Information and Communication Technologies are effectively mobilized to develop health
outcomes and combat disease amongst the poorest and most isolated populations. The
applications of information and communications technologies in medicine are commonly
referred to as telemedicine and medical informatics. Although these terms are often used
together and confused with each other, they are separate and have their own definitions. The
Institute of Medicine (1996) defines telemedicine as the use of electronic information and
communications technology to provide health care when distance separates the participants. It
includes all forms of electronic communication between patients and providers and among
providers, starting from telephone to interactive video and web-based communication.
Medical informatics is defined by The National Library of Medicine (2001) as the field of
information science concerned with the analysis and dissemination of medical data through the
application of computers to various aspects of health care and medicine.

Medical informatics can also be referred to as the intersection of information science,

computer science and health care. For example, medical informatics includes health care
delivery processes that are supported by computers that help in analyzing electronic data.
(Christensen et al. 2007).
 Fig.1: Physician-Patient Communication in an E-Health Scenario
Source: https://ijhpr.biomedcentral.com/articles/10.1186/2045-4015-1-33

3. E-HEALTH AND M-HEALTH

The term eHealth could be described as the use of ICT in hospitals. eHealth is defined as the
use of ICT in provision of health care services. This means ICT can be used in various health
care functions such as clinical, educational, research and administrative regardless of
geographical settings. M-Health (Mobile Health) extends the efficiency and accuracy of the
already available health systems through the use of electronic devices such as PDAs and
mobile telephone networks to improve functions (such as reporting procedure) of the health
systems. ICT can be used to transform the health paradigm by shifting the provider-patient
configuration this typically can involve extending health care services to underserved areas by
use of electronic or telecommunication means (Telemedicine) such as video chat, or health
telephone hotlines. This arrangement provides patients with seamless access to doctors,
improved diagnosis and treatment around the clock. E-Health and m-Health can transform the
health systems by incorporating electronic means to deliver information and provide health
related training. For example, mobile phones can be used to disseminate information regarding
vaccination campaign and the Internet can be used to provide distance learning, share
information etc.

M-Health occur mostly through mobile provision of health care services. It occurs through
wireless telemedicine that involve the use of mobile telecommunications and multimedia
technologies and their integration with mobile health care delivery systems. M-Health
continues to mature and has been used to address health care challenges such as access,
quality, affordability, matching of resources and behavioral norms through mobile
technologies. M-Health is a network involving people and products; and the mechanisms that
connect them using digital technologies.
E-health technologies and processes such as individual electronic health records, clinical
decision support systems and intelligent, responsive buildings and equipment have enabled the
delivery of safe, high quality healthcare. The culture of healthcare has evolved substantially
from the days where mistakes, errors, omissions and duplication were common in healthcare
delivery.
This restructuring entails a two-fold paradigm shift:
a) From symptom-based to preventive healthcare and
b)From hospital-centred to person-centred health systems.
Table 1.0: Difference between the traditional model of healthcare and the new model of health
services delivery (Omotosho A. 2011)
Traditional model
of New model of health services
healthcare delivery

Disease centred
Model/Philosophy cure Citizen centred and wellness focused

Episodic , on
Interactions demand Continuously , autonomous
 Fragmente
Data Characteristics d, Integrated , distributed,
proprietary Shared , continuous update

Care giver Healthcare Citizen ,informal carers ,community ,

professiona
l healthcare professional

Care receiver Patient All citizen (independent of social ,

mental , physical capacities)

Entry into healthcare system Disease triggered Choice

Linea
Consultation delivery process r Ubiquitous , seamless , collaborative
(cottage industry
type)
Consultation receiver Hospital , GP
location Office Home , community-based

3.1 Examples of eHEALTH Benefits

The spectacular success of the use of ICT in public health is the control of river blindness or
Onchocerciasis Control Program (OCP) in West Africa [15]. The effective reliable and
appropriate information and communication system was required for collection of data critical
for surveillance of the disease (the black fly larvae living in about 50 000 km of the
waterways). OCP used sensors placed in waterways for periodic readings and transmission via
satellite to the main center in Ounagadongou, Burkina Faso. It optimized the decision making
for technical operations (e.g. aerial insecticide spraying by a small fleet of helicopters) and for
program coordination and management. U.S. Government Accounting Office studied benefits
of eHealth in 11 public and private Health Care Delivery organizations of varying sizes and
settings (rural/urban) that had invested significantly in e-Health.

They were:
50%-80% reduction in medication error rates,
>15% reduction in laboratory and diagnostic imaging tests due to online access to results,
30% increase in use of formulary and generic drugs,
Significant reduction in time to refer patients using online scheduling and communication
tools,
40% increase patient screening and preventative health care procedures,
40% increase in use of standard protocols by physicians. (Rudowski 2007)
3.2 E-Health Challenges Especially In Developing Countries
Not everyone is singing the praises of ICT in health education and practice. Coyne (1995)
argued that the implementation of ICT can lead to a widening of the gap between rich and
poor, as well as of the “digital divide”, described by World Health Organization (WHO) as
being “more dramatic than any other inequity in health or income”. According to study, there
are various challenges to eHealth implementation in developing countries which involves
various areas of Technology. Let’s have a look at some highlights of the Challenges which
includes Lack of Skilled Stakeholders, Technology and Operational, Social and Cultural,
Legal, Policymaking and Financial and so on.
Lack of Skilled Stakeholders
One of the challenges to eHealth implementation in developing countries is the lack of skilled
users. The users that lack skills in using the system are health practitioners or patients,
developers and maintainers, related ICT professionals, these maybe due to poor literacy and
poor technological skills - internet and computer literacy. The stakeholders with low level of
education are technical staff but are the primary users of the Health Information Systems in
developing countries. A major challenge is training users in patient confidentiality.
Technical and Operational
Implementation of electronic health needs strong relations between ICT and Information
Systems in various organizations, which has its own complexity. Some of the problems and
facing challenges in implementing E-health, in Developing Countries are, from the technical
and operational points of view, regarded as follows:
Lack of a proper framework for information quality
characteristics Needing suitable medical equipment
Movement and Transportability
Losing and missing electronic health records
Maintenance, supporting and updating the project
Social and Cultural
Developing electronic health in the society has its own peculiarities which are quite important
due to the cultural and social limitations in Developing Countries. Some of the problems in
this field are indicated as follows:
Lack of widespread and continuous education for public use of E-health services
The need for nationalizing the health culture in involved areas in
developing Telemedicine Cultural limitations against executing E-
health services
Resistance against changes due to habits
Inadequate knowledge levels of people with regards to using E-health services

Legal
Definitely, one of the most important factors related to allocation and development of E-health
is provision of legal aspects and balancing whole collection of laws and regulations, with this
phenomenon. Some of the legal challenges of electronic health system, in most countries
especially Developing Countries, are as follows:
Lack of following government's
ratified laws No support of national
and universal standards
Lack of existing suitable laws regarding personal rights and keeping patients'
private surroundings The need for developing a legal and lawful framework
for managing it in health care
The need for developing a framework for transmitting inhomogeneous data and unifying
them
Financials
Management limitations in using workforce, physical and financial sources and the necessity
for the managers to have systematic approach and concentrating processes productivities
during operation of most resources that they have authority upon, increase the importance of
existing Information Systems and their operating mechanisms. Hence, considering the
following challenges is a part of management responsibilities in this field:
The need for investment and allocation of regular budget in electronic health field and
using relevant technologies in health section
Unsettled increase of healthcare costs
Lack of framework for economic analysis of benefits and the results of remote health
control
Lack of consideration of financial and operative situations of each of the host countries,
separately
Cultural Hindrances
At its core, the healthcare industry is built on care providers using legacy technology and rigid
processes, tightly holding onto data to remain within the Privacy Act. Subsequently, the
largest hurdle to be faced is changing perceptions on data sharing as a whole, to foster a true
culture of integration. This means that the data generated, while managed and protected, still
needs to be shared among authorized entities. Re-orienting the healthcare system towards
improved integration and prevention of ongoing health issues costly to the industry requires a
flexible workforce enabled by technology such as e-health applications.
Table 1.1: Summary of opportunities and challenges for ICT to improve health systems

4. CONCLUSION

The use of ICT within the field of healthcare is becoming an increasingly important aspect of a
clinicians professional practice, improving the delivery of health services and communication
between HealthCare workers, as well as enhancing the decision making process through the
efficient flow of information. Other important benefits include facilitating Evidence Based
Practice (EBP) through access to information for research, allowing Continuing Professional
Development (CPD) in rural areas and diminishing the advantages of geographical and
professional isolation. While there are barriers to widespread adoption of ICT in healthcare,
such as the high cost of equipment, and concerns about the credibility of information, these
obstacles are not prohibitive.However, it is recommended that further investigation into the
use of ICT and its specific implementations in healthcare System and professional practice are
carried out in order to better inform clinicians and educators with regards the beneficial
potential of technology in healthcare.
View publication stat

REFERENCES
1. Ashly D. Black, Josip Car et al (2011): The Impact of eHealth on the Quality and
Safety of Health Care: A Systematic Overview
2. Christensen M. C. & Remler D. (2006): Information and Communications Technology
in Chronic Disease
Care: Why is Adoption so slow and is slower better? National Bureau of Economic
Research Working Paper 13078. http://www.nber.org/papers/w13078 (visited
2.3.2010)
3. Coyne R.D (1995): Communication systems and development: the pragmatic
approach. Development Bulletin, 35, 4-7.
4. Enock Yonazi, Tim Kelly, Naomi Halewood and Colin Blackman (2012)
“eTransform Africa: The Transformational Use of ICTs in Africa.”
5. Gerald Bloom, Evangelia Berdou et al (2017): ICTs and the challenge of health system
transition of Low and middle-income countries. “Bloom et al. Globalization and
Health (2017) 13:56 HARRY FULGENCIO (2014): eHealth for Developing
Countries: a theoretical model grounded on literature “M.Sc. ICT in Business Leiden
institute of advanced computer science Niels Bohrweg 1 leiden, 2333ca, the
Netherlands”
6. Kerry McNamara [infoDev] (2007): Improving Health, Connecting People: The
Role of ICTs in the Health Sector of Developing Countries
7. Lekan Oyegoke (2013): Adoption and Utilization of ICT in Nigeria Hospitals
(Government Owned) “Bachelor’s Thesis Degree programme in Business IT
University of Applied sciences”
8. Lucas Mimbi, Felix Bankole (2015): ICT and Health System Performance in Africa: A
MultiMethod Approach “26th Australasian Conference on Information Systems”
9. M Rowe (2008): Information and Communication Technology in Health: A Review
of the Literature “JCHS Volume 3 No. 1 2008 Pp 68-77”
10. Marike Hettinge: ICT innovations in Healthcare “Windeshein university of Applied
Sciences”
11. Mulusew Andualem Asemahagn (2015): Challenges of ICTs Utilization among
Health Professionals: The Case of Public Hospitals in Addis Ababa, Ethiopia
“Research article School of Public Health, College of Medicine and Health
Sciences, Bahir Dar University, Ethiopia”
12. Omotosho A , Emuoyibofarhe O.J , Adegbola O (April 2011): ICT in Health care
delivery system: A Framework for developing nations “International Conference on
ICT for Africa (ICT4A), Covenant University and Bells University of Technology,
Ota , Nigeria , 23 – 26,March 2011. Vol III. Pp 95 - 100”
13. Peter Elliot Borketey (2017): A literature review on the challenges of eHealth
implementation in developing
countries among rural folks: A case of Ghana
14. Paula Ranta (2010): Information and Communications Technology in Health Care
15. P. J. Toussainta, J. Verhoefa,b,c, T.P.M. Vliet Vlielandc, J.H.M. Zwetsloot-
Schonk : The impact of ICT on communication in Healthcare
16. Robert Rudowski (2007): Impact of Information and Communication Technologies
(ICT) on Health Care “Department of Medical Informatics and Telemedicine,
Medical University of Warsaw, Poland”
17. Sayed Nasir Khalifehsoltani, Mohammad Reza Gerami (2010): E-Health
challenges, opportunities and experiences of developing countries “2010
International Conference on e-Education, e-Business, e-Management and e-
Learning Pp 264-268”
18. The Challenge of Integrated ICT in Healthcare
“https://vitaenterprisesolutions.com.au/new-ideas/articles/challenge-
integrated-ict-healthcare”