RepublicofUganda
Ministry of Health
UgandaNationaleHealthPolicy
November2016
i
Foreword
TheUgandanhealthcaresystem,throughitsongoinghealthsectorreforms,aimstoimprovehealthoutcomes.Aspartofthesereforms,theMinistryofHealth(MOH)developedtheHealthSectorDevelopmentPlan(HSDP)2015/16-2019/20toaddressthekeychallengesfacingUganda’shealthsystem,setoutprioritiesandkeyareasonwhichtofocushealthinvestmentinthemediumterm,forbothpublicandprivatepartners,inordertooptimallycontributetotheattainmentofboththehealthsectorgoalsandthenationalgoalsasoutlinedintheNationalDevelopmentPlanII.AlthoughimplementationofHSSPIIIpromisedtoproducemanypositiveresults,realizingthebestoutcomesinthefaceofincreasingpressuresonthehealthcaresystemrequiresafundamentaltransformationinthewayhealthcareisdeliveredandmanaged.
TheMinistryrecognizesthepotentialofinformationandcommunicationtechnology(ICT)intransforminghealthcaredeliverybyenablinginformationaccessandsupportinghealthcareoperations,management,anddecisionmaking.However,theUgandanhealthsectorischaracterizedbyafragmentedlandscapeofICTpilotprojectsandnumerousdataandhealthinformationsystem(HIS)siloswithsignificantbarrierstotheeffectivesharingofinformationbetweenhealthcareparticipants.
Althoughthegovernment,partners,andprivateinstitutionsarecontinuingtoinvestinvariousICTinitiatives,withoutsomeformofanationalplanandcoordination,thereisarealriskofcontinuedduplication,ineffectiveexpenditure,andthecreationofnewsolutionsthatcannotbeintegratedorscaledacrossthecontinuumofcare.
Toformanationalplanandcommunication,theMOHdevelopedaNationaleHealthPolicy(2013),aNationaleHealthStrategy(2013),andsubsequentlyadraftNationaleHealthPolicy(2016)toguidetheuseofICTinsupportinghealthsectortransformation.Aspartoftheseprocesses,theMinistry,throughaneHealthTechnicalWorkingGroup(eHealthTWG)supportedbyUnitedNationsChildren’sFund(UNICEF)andWorldHealthOrganization(WHO),conductedaseriesofnationalconsultationsthatincludedhealthsectorprofessionals,partners,faith-basedorganizations,Government,non-governmentalorganizations(NGOs),andotherstakeholders.
In2016,theMinistry,throughtechnicalandfinancialsupportfromUNICEFandWHOunderthestewardshipoftheeHealthTWGreviewedthedrafteHealthPolicyandstrategy,seekingareasforimprovement.ThereviewprocessalsofollowedaparticipatoryapproachdrivenbyHSDPstrategicobjectives.TheNationaleHealthPolicyandStrategyprovideanappropriatebasistoguidethedevelopmentofeHealthinUganda.Itadoptsenterprisearchitecture(EA)-drivendevelopmentapproachtodevelopingeHealthcapabilities:
• LeveragewhatcurrentlyexistsintheUgandaneHealthlandscape.• Understandwhatthenewcomponentsareandwheretheyfitinexistingstructures.• Defineinformationstructurestofitcurrentneedsandtosupportanticipatedones.• Demonstratehowtechnologyandresourceconstraintsdictatebothwhatisfeasibleandthe
pathforward.
TheimplementationofthiseHealthpolicyandstrategywillacceleratetheongoingreformsandsustainthegainswitnessedinthesectorsince2015,whenthesectorstartedtheimplementationof
ii
HSDP.Inaddition,thepolicyandstrategywilladdresssomeofthekeychallengesexperiencedduringHSDP,thatincludeashortageofqualifiedhealthcareprofessionalsatalllevelsofthehealthsystem;epidemicssuchasHIV/AIDS,tuberculosis(TB),andmalaria;andlimitedaccesstohealthfacilitiesandhealthprofessionalsduetopoorinfrastructure,inefficienciesofthehealthcaresystem,poverty,andignorance.
TheNationaleHealthPolicyandStrategywilldelivertheeventualbenefitofasafer,high-quality,equitable,efficient,andsustainablehealthsystemthatisequippedtorespondtoemerginghealthsectorcostanddemandpressures.TheUgandanhealthcaresystemenhancementswillalsodrivestrongerworkforceproductivitythatisvitaltoUganda’slong-termeconomicdevelopment.
TheNationaleHealthPolicyandStrategyisapplaudedasausefulguidetothenextstepsforUgandainitseHealthjourney.ThePolicyandStrategyarepragmatic,balancesdifferentpriorities,andwillhelptoleadUgandatowardthedeliveryofasafer,betterconnected,andmoresustainablehealthcaresystem.
Dr.JaneRuthAceng
MinisterofHealth
iii
TableofContents
Foreword.................................................................................................................................................i
TableofContents..................................................................................................................................iii
Executivesummary................................................................................................................................1
Acknowledgements...............................................................................................................................3
ListofAcronymsandAbbreviations......................................................................................................4
DefinitionsofKeyTerms........................................................................................................................9
ListofTables........................................................................................................................................11
ListofFigures.......................................................................................................................................12
PolicyDeclaration................................................................................................................................13
1. Introduction.................................................................................................................................14
1.1 eHealthBackground............................................................................................................14
1.2 eHealthServices..................................................................................................................14
2 StrategicContextforeHealth......................................................................................................15
2.1 TheInternationalPerspective..............................................................................................15
2.2 TheUgandaHealthcareSystem...........................................................................................17
2.3 JustificationofeHealthinUganda.......................................................................................19
3 SituationAnalysis.........................................................................................................................19
3.1 UgandaeHealthSituationAnalysis......................................................................................19
3.1.1 LeadershipandGovernanceofeHealth.......................................................................19
3.1.2 eHealthEnterpriseArchitecture,InteroperabilityandStandards...............................20
3.1.3 eHealthServices,InformationSharingandDataManagement...................................20
3.1.4 Infrastructure...............................................................................................................21
3.1.5 eHealthInformationAssurance...................................................................................21
3.1.6 Ethics............................................................................................................................22
3.1.7 HumanResourcesandCapacityBuilding.....................................................................22
3.1.8 MainstreamingSpecialInterestGroups......................................................................23
3.1.9 Research,InnovationandDevelopment......................................................................23
3.1.10 eHealthInvestment.....................................................................................................24
3.1.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships............24
3.1.12 BusinessProcessRe-Engineering.................................................................................25
iv
3.1.13 LegalandRegulatoryFrameworkforeHealth.............................................................25
4 FoundationoftheeHealthPolicy................................................................................................26
4.1 RationaleoftheeHealthPolicy............................................................................................26
4.2 ScopeofthePolicy...............................................................................................................26
5 Vision,Mission,GoalandGuidingPrinciples...............................................................................26
5.1 Vision...................................................................................................................................26
5.2 Mission.................................................................................................................................26
5.3 Goal......................................................................................................................................26
5.1 PolicyGuidingPrinciples......................................................................................................27
6 Pillars/priorityareasfortheeHealthPolicy................................................................................27
7 PolicyObjectivesandStrategies..................................................................................................28
7.1 LeadershipandGovernanceforeHealth.............................................................................28
7.1.1 Objective......................................................................................................................28
7.1.2 Scope...........................................................................................................................28
7.1.3 PolicyStrategies...........................................................................................................28
7.1.4 ResponsibilitiesandProcedure....................................................................................29
7.2 eHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandards..............29
7.2.1 Objective......................................................................................................................29
7.2.2 Scope...........................................................................................................................29
7.2.3 PolicyStrategies...........................................................................................................29
7.2.4 ResponsibilitiesandProcedures..................................................................................30
7.3 eHealthServices,InformationSharingandDataManagement,.........................................30
7.3.1 Objective......................................................................................................................30
7.3.2 Scope...........................................................................................................................30
7.3.3 PolicyStrategies...........................................................................................................30
7.3.4 ResponsibilitiesandProcedures..................................................................................31
7.4 Infrastructure.......................................................................................................................31
7.4.1 Objective......................................................................................................................31
7.4.2 Scope...........................................................................................................................31
7.4.3 PolicyStrategies...........................................................................................................31
7.4.4 ResponsibilitiesandProcedures..................................................................................32
7.5 eHealthInformationAssurance...........................................................................................32
7.5.1 Objective......................................................................................................................32
v
7.5.2 Scope...........................................................................................................................33
7.5.3 PolicyStrategies...........................................................................................................33
7.5.4 ResponsibilitiesandProcedures..................................................................................33
7.6 Ethics....................................................................................................................................34
7.6.1 Objective......................................................................................................................34
7.6.2 Scope...........................................................................................................................34
7.6.3 PolicyStrategies...........................................................................................................34
7.6.4 ResponsibilitiesandProcedures..................................................................................34
7.7 HumanResourcesandCapacityBuilding.............................................................................34
7.7.1 Objective......................................................................................................................34
7.7.2 Scope...........................................................................................................................34
7.7.3 PolicyStrategies...........................................................................................................35
7.7.4 ResponsibilitiesandProcedures..................................................................................35
7.8 MainstreamingSpecialInterestGroups(SIGs)....................................................................35
7.8.1 Objective......................................................................................................................35
7.8.2 Scope...........................................................................................................................35
7.8.3 PolicyStrategies...........................................................................................................35
7.8.4 ResponsibilitiesandProcedures..................................................................................36
7.9 Research,InnovationandDevelopment..............................................................................36
7.9.1 Objective......................................................................................................................36
7.9.2 Scope...........................................................................................................................36
7.9.3 PolicyStrategies...........................................................................................................36
7.9.4 ResponsibilitiesandProcedures..................................................................................36
7.10 eHealthInvestment.............................................................................................................37
7.10.1 Objective......................................................................................................................37
7.10.2 Scope...........................................................................................................................37
7.10.3 PolicyStrategies...........................................................................................................37
7.10.4 ResponsibilitiesandProcedure....................................................................................37
7.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships....................37
7.11.1 Objective......................................................................................................................37
7.11.2 Scope...........................................................................................................................38
7.11.3 PolicyStrategy.............................................................................................................38
7.11.4 ResponsibilitiesandProcedures..................................................................................38
7.12 BusinessProcessRe-Engineering.........................................................................................38
vi
7.12.1 Objective......................................................................................................................38
7.12.2 Scope...........................................................................................................................38
7.12.3 PolicyStrategies...........................................................................................................38
7.12.4 ResponsibilitiesandProcedures..................................................................................38
7.13 LegalandRegulatoryFramework........................................................................................39
7.13.1 Objective......................................................................................................................39
7.13.2 Scope...........................................................................................................................39
7.13.3 PolicyStrategies...........................................................................................................39
7.13.4 ResponsibilitiesandProcedures..................................................................................39
8 PolicyImplementation.................................................................................................................40
8.1 Framework...........................................................................................................................40
8.2 PolicyDisseminationandSensitization................................................................................40
8.3 Planning,Budgeting,ResourceMobilizationandInvestment.............................................40
8.3.1 PlanningandBudgeting...............................................................................................41
8.3.2 ResourceMobilization.................................................................................................41
8.4 Monitoring,EvaluationandComplianceAssessment.........................................................41
8.4.1 MonitoringandEvaluation..........................................................................................41
8.4.2 ComplianceAssessment..............................................................................................41
1
Executivesummary
TheNationaleHealthPolicyandStrategyaredirectionaldocumentsthatdescribeslong-termvisionforeHealth,withastrongfocusontangiblebenefitsanddeliverables.Italsodescribestheleadershipandgovernancestructure,canteredontheNationaleHealthTechnicalWorkingGroupthatwillhelpensurethetimelyimplementationofeHealthinitiatives.
Inordertohaveapolicyandstrategythatisholisticandinclusive,thedevelopmentofthepolicyandstrategyusedaparticipatoryprocess.ThereforetheStrategyincludestheviewsofmultiplegroupsandsectorsandistheresultofmanyhoursofdebateanddeliberation.
VisionEffectiveuseofinformationandcommunicationtechnologyforbetterhealthoutcomesoftheUgandanpopulation.
MissionTotransformthehealthofthepeopleofUgandabypromotingeffectiveutilizationofinformationandcommunicationtechnology.
ObjectiveTocreateanenablingenvironmentforthedevelopment,deploymentandutilizationofsustainable,ethicallysoundandharmonizedeHealthinitiativesatalllevels.
StrategicAreasofImplementation
• LeadershipandGovernanceofeHealth• eHealthEnterpriseArchitecture,InteroperabilityandStandards• eHealthServices,InformationSharingandDataManagement• Infrastructure• eHealthInformationAssurance• Ethics• HumanResourcesandCapacityBuilding• MainstreamingSpecialInterestGroups• Research,InnovationandDevelopment• eHealthInvestment• StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships• BusinessProcessRe-Engineering• LegalandRegulatoryFrameworkforeHealth
Principles
a) ClientfocusedeHealthagendab) Equityc) User-friendlytechnologyapplicationsd) MultiSectoralApproache) HumanRightsbasedapproachf) QualityInformationgenerationg) GenerateQualityInformationbaseforstrategicplanningandpolicydevelopment
GovernanceandManagement
2
SuccessfulimplementationoftheNationaleHealthPolicyandStrategyrequiresawell-definedgovernancestructuretoprovideimprovedvisibility,coordination,andcontrolofeHealthactivitiesthatareoccurringacrossthecountry’shealthsector.Themaingoalofgovernanceistoassureallstakeholdersthatoperationswillgoasexpected—thattheresultsachievedwillbeinlinewiththedecisionsmade.
Implementation
ThefollowingpillarsrepresentthefourkeyareaswherewemustexcelinordertoachieveournationaleHealthvision:
• eHealthFoundations:ThebasicinfrastructuralbuildingblocksrequiredtoenabletheeffectiveelectronicsharingofinformationacrosstheTanzanianhealthsector
• eHealthSolutions:Thespecificcomputingsystemsandtoolstoaddressthehigh-priorityneedsofconsumers,careproviders,andhealthcaremanagersthatimproveefficiencyandeffectiveness
• ChangeandAdoption:TheactualactionsthatneedtobecarriedouttoencourageandenableparticipantsinthehealthcaresystemtoadopteHealthsolutionsandchangetheirworkpracticestobeabletousethesesolutionseffectively.
• eHealthGovernance:TheappropriatenationaleHealthgovernancestructuresandmechanismsneededprovideleadership,coordination,andoversighttoensuresuccessfulimplementationofthenationaleHealthprogram
3
Acknowledgements
Therealizationofthepolicyandstrategyhasbeenachievedthroughtremendouseffortandcommitmentofseveralindividuals,organizations,andpartnerswhohavecontributedtothedevelopmentofthisstrategydocument.
ThisstrategyhasbeendevelopedthroughaparticipatoryprocessthatwasspearheadedbytheeHealthTechnicalWorkingGroupappointedbytheMinistryofHealth(MOH).Theyheldnumerousformalmeetingsplusinformalsessions,technicalconsultations,extensiveinputfromstakeholdersthroughworkshops,discussiongroups,interviews,reviewthroughtheWorldHealthOrganization(WHO)eHealthdevelopmenttoolkit,andothersurveys
ThisprocessproducedadrafteHealthPolicyandStrategy.Toeachofthecontributorstothedraftpolicyandstrategy,aswellastothosewhoassistedandsupportedthem,wesendourprofoundappreciation.SpecificappreciationisgiventotheUNICEFandWHO.
SpecialthankstotheMOH,particularlyMinisterofHealthforhersincereencouragementandfollow-uponeHealthissues,aswellasstakeholderswhoparticipatedintheworkshopsandcontributedideasthataretheframeofthepolicyandstrategy.
MOHstaffworkedwithvigourtomakesurethattheMinistryfinalizedtheNationaleHealthPolicyandStrategy.
Allcontributionsandeffortsarehighlyappreciated.
Dr.DianaAtwineKanzira.
PermanentSecretary,
MinistryofHealth
4
ListofAcronymsandAbbreviations
AIN AlienIdentificationNumber
BC BusinessContinuity
CIS ClinicalInformationSystems
CPD ContinuingProfessionalDevelopment
CSO CivilSocietyOrganization
DR DisasterRecovery
DGHS DirectorGeneralofHealthServices
EAC EastAfricanCommunity
EGI e-GovernmentInfrastructure
eHP eHealthPolicy
EHR ElectronicHealthRecord
EMR ElectronicMedicalRecord
eTWG eHealthTechnicalWorkingGroup
GOe GlobalObservatoryforeHealth
HCI HealthCentre1
HCII HealthCentre2
HCIII HealthCentre3
HCIV HealthCentre4
HDPs HealthDevelopmentPartners
HEA-IF HealthEnterpriseArchitectureandInteroperabilityFramework
HIS HealthInformationSystem
HMIS HealthManagementInformationSystem
HPA HealthProfessionalAssociations
HPAC HealthPolicyAdvisoryCommittee
HRHIS HumanResourcesforHealthInformationSystem
HRIS HumanResourceInformationsystem
5
HSC HealthServiceCommission
HSDP HealthSectorDevelopmentPlan
HSSIP HealthSectorStrategicandInvestmentPlan
ICT InformationandCommunicationTechnology
IFMS IntegratedFinancialManagementSystems
IHRMS IntegratedHumanResourceManagementSystem
IT InformationTechnology
LIMS LandInformationManagementSystem
LSMIS LogisticsandSuppliesManagementInformationSystem
LIS LibraryInformationsystem
LOGICS LocalGovernmentInformationCommunicationSystem
LRC LawReformCommission
MDAs MinistriesDepartmentsandAgencies
MDGs MillenniumDevelopmentGoals
MoEI MinistryofEthicsandIntegrity
MoES MinistryofEducation&Sports
MoFPED MinistryofFinance,PlanningandEconomicDevelopment
MoH MinistryofHealth
MoICT MinistryofInformationCommunicationsandTechnology
MoJCA MinistryofJusticeandConstitutionalAffairs
MoLG MinistryofLocalGovernment
MoPS, MinistryofPublicService
MoSTI MinistryofScience,TechnologyandInnovation
NASH NationalAuthenticationServiceforHealth
NBI NationalBackboneInfrastructure
NDC NationalDataCentre
NDP NationalDevelopmentPlan
6
NeHP NationaleHealthPolicy
NeHS NationaleHealthStrategy
NeHSC NationaleHealthSteeringCommittee
NHP NationalHealthPolicy
NIN NationalIdentificationNumber
NISF NationalInformationSecurityFramework
NITA-U NationalInformationTechnologyAuthority-Uganda
NITP NationalInformationTechnologyPolicy
NRH NationalReferralHospitals
PDA PersonalDigitalAssistant
PHR PersonalHealthRecord
PHI PersonalHealthInformation
PI PersonalInformation
PFP Private-for-Profit
PNFP Private-Not-for-Profit
PPP PublicPrivatePartnership
RC ResourceCentre
RCDF RuralCommunicationsDevelopmentFund
RRH RegionalReferralHospitals
SMART Specific,Measurable,Achievable,RealisticandTime-bound
SOP StandardOperatingProcedure
SIGs SpecialInterestGroups
TMC TopManagementCommittee
TV Television
TWG TechnicalWorkingGroup
UCC UgandaCommunicationsCommission
UCMB UgandaCatholicMedicalBureau
7
UHI UniqueHealthcareIdentifiers
UN UnitedNations
UNMHCP UgandaNationalMinimumHealthCarePackage
VHTs VillageHealthTeams
WHA WorldHealthAssembly
WHO WorldHealthOrganization
8
9
DefinitionsofKeyTerms
BusinessContinuity(BC):isdefinedasthecapabilityoftheorganizationtocontinuedeliveryofproductsorservicesatacceptablepredefinedlevelsfollowingadisruptiveincident.(Source:ISO22301:2012)
Businessprocessreengineering(BPR):Thefundamentalrethinkingandredesignofbusinessprocessestoachievedramaticimprovementsincriticalcontemporarymeasuresofperformancesuchascost,quality,service,andspeed.
ClinicalInformationSystem(CIS):Acomputerbasedsystemthatisdesignedforcollecting,storing,manipulatingandmakingavailableclinicalinformationimportanttothehealthcaredeliveryprocess.
Disasterrecovery(DR):involvesasetofpoliciesandprocedurestoenabletherecoveryorcontinuationofvitaltechnologyinfrastructureandsystemsfollowinganaturalorhuman-induceddisaster.
Distance learning for health professionals (eLearning): eLearning services compriseeducationandtraininginelectronicformforhealthpprofessionals.eLearningimprovesthequality of education and increase access to learning resources. Examples of use includecontinuing professional development for doctors and nurses, and training on preventiveservicesatthehouseholdlevelforcommunityhealthworkers.eLearningtoolsvarywidely,andmayallowinteractionbetweenthelearnerandinstructor,accesstodigitallibrariesandonline courses, networks to share experiences, or the use of mobile devices to accessinformationtosupportdeliveryofcare.eHealth:Acost-effectiveandsecureuseofinformationandcommunicationtechnology(ICT)insupportofhealthandhealth-relatedfields,includinghealthcareservices;healthsurveillance;healthliterature;andhealtheducation,knowledge,andresearch.
ElectronicHealthRecord(EHR):AnEHRisadigitalrecordbuilttogobeyondstandardclinicaldatacollectedinaprovider’sofficeandinclusiveofabroaderviewofapatient’scare.EHRscontaininformationfromallthecliniciansinvolvedinapatient’scareandallauthorizedcliniciansinvolvedinapatient’scarecanaccesstheinformationtoprovidecaretothatpatient.EHRsalsoshareinformationwithotherhealthcareproviders,suchaslaboratoriesandspecialists.EHRsfollowpatients–tothespecialist,thehospital,thenursinghome,orevenacrossthecountry.
Electronicmedicalrecords(EMR):AnEMRisadigitalversionofthepaperchartsinclinicianoffices,clinics,andhospitals.EMRscontainnotesandinformationcollectedbyandforthecliniciansinthatoffice,clinic,orhospitalandaremostlyusedbyprovidersfordiagnosisandtreatment.EMRsaremorevaluablethanpaperrecordsbecausetheyenableprovidersto
10
trackdataovertime,identifypatientsforpreventivevisitsandscreenings,monitorpatients,andimprovehealthcarequality.
EmergingTechnologies:Newtechnologiesthatarecurrentlydevelopingorwillbedevelopedoverthenextfivetotenyears,andwhichwillsubstantiallyalterthebusinessandsocialenvironment.
EnterpriseArchitecture(EA):EAistheprocessoftranslatingbusinessvisionandstrategyintoeffectiveenterprisechangebycreating,communicating,andimprovingthekeyprinciplesandmodelsthatdescribetheenterprise'sfuturestateandenableitsevolution.
HealthInformationSystems(HIS):Itisasystemsthatfacilitatesgathering,aggregating,analysingandsynthesizingofdatafrommultiplesourcestoreportonhealthsituationandtrends(diseaseburden,patternsofriskbehaviour,healthservicecoverageandhealthsystemmetrics).CountriesmayhaveinplaceoneormoreHISsupportingreportingondiseasesorprograms.TheymayalsohaveHISstrategiesaimedatimprovingdecision-making,policydevelopment,healthservicesmanagement,responsetoemergingthreatsandbetterallocationofhealthresources
MatureTechnologies:Thisreferrerstoatechnologythathasbeeninuseforlongenoughthatmostofitsinitialfaultsandinherentproblemshavebeenremovedorreducedbyfurtherdevelopment.Insomecontexts,itmayalsorefertotechnologythathasnotseenwidespreaduse,butwhosescientificbackgroundiswellunderstood.
Mobilehealth:mHealthormobilehealthisdefinedasmedicalandpublichealthpracticesupportedbymobiledevices,suchasmobilephones,patientmonitoringdevices,personaldigitalassistants(PDAs),andotherwirelessdevices.
Examplesincludetheuseofmobiledevicesfor:• Datacollectionforsurveillanceandpublichealth(e.g.outbreakinvestigation)• Real-timemonitoringofanindividual’shealth• Treatmentsupport,healthadviceandmedicationcompliance• Healthinformationtopractitioners,researchersandpatients• Healtheducationandawarenessprograms• Diagnosticandtreatmentsupport,communicationforhealth-careworkers.
PatientRegistry:APatientRegistryisanorganized.systemthatusesobservationalstudymethodstocollectuniformdata(clinicalandother)toevaluatespecifiedoutcomesforapopulationdefinedbyaparticulardisease,condition,orexposure,andthatservesapredeterminedscientific,clinical,orpolicypurpose(s).
Personalhealthrecords(PHR):APHRisarecordthatcontainsthesametypesofinformationasEHRs—diagnoses,medications,immunizations,familymedicalhistories,andprovidercontactinformation—butaredesignedtobesetup,accessed,andmanagedby
11
patients.PatientscanusePHRstomaintainandmanagetheirhealthinformationinaprivate,secure,andconfidentialenvironment.PHRscanincludeinformationfromavarietyofsourcesincludingclinicians,homemonitoringdevices,andpatientsthemselves.
Telemedicine:Thisisthedeliveryofhealthcareservices,wheredistanceisacriticalfactor,byallhealthcareprofessionalsusinginformationandcommunicationtechnologiesfortheexchangeofvalidinformationfordiagnosis,treatmentandpreventionofdiseaseandinjuries,researchandevaluation,andforthecontinuingeducationofhealthcareproviders,allintheinterestsofadvancingthehealthofindividualsandtheircommunities.Examplesoftelemedicineservicesareprovidedbelow.
• Store-and-forwardservices involveacquiringmedicaldata for transmission laterbythehealth-careproviderforofflineassessmentandtreatmentrecommendation.
• Remotemonitoringservicesenablehealth-careproviderstomonitoranindividual’sconditionremotely,usinginformationtechnologies.
• Interactive services enable real-time interaction between health-care providerthrough means such as telephone, web conference, video conference and otherformsofonlineandremotecommunication.
ListofTables
Notableoffiguresentriesfound.
12
ListofFigures
Notableoffiguresentriesfound.
13
PolicyDeclaration
AllMedicalPractitioners,UsersandStakeholdersSHALLbelawful,efficient,economicalandethical in theiruseof thee-Health resources,whichareprovided tocreate,preserveandexecutethemissionoftheHealthSector.
14
1. Introduction
1.1 eHealthBackground
eHealth refers to theuseof InformationandCommunicationTechnologies (ICT) inhealthcare.TheWorldHealthOrganization(WHO)hasdefinede-Healthas“thecost-effectiveandsecure use of ICT in support of health and health-related fields, including health careservices,healthsurveillance,healthliterature,healtheducation,knowledgeandresearch1”
GovernmentofUgandarecognizedtheuseof informationandcommunicationtechnology(ICT) intheNationalDevelopmentPlanII2015/16-2019/20asanenablerto improvethedelivery of services to its citizens across its sectors. The Ministry of Health too hasrecognized eHealth in the Health Sector Development Plan 2015/16 - 2019/20 as a keyenablerforsupportingthehealthsysteminordertodelivergoodhealthtothepopulation.TheNationaleHealthPolicyprovidesguidanceonhowtouseICTtofacilitateimprovementin the flow of information, through electronic means, to support the delivery of healthservicesandthemanagementofthehealthsysteminabidtofacilitateuniversalaccesstocare,healthsectorefficiency,andsocialtransformation.TheNationaleHealthPolicyhasbeendeveloped throughaparticipatoryandconsultativeprocess of engagement with multisectoral stakeholders. Stakeholder identification wasbasedontheir influence,knowledge,expertiseandinterest ineHealth.ThiswastoensureaninformednationaleHealthpolicythatisrelevantto,andsupportedbystakeholdersfrom;thehealthandICTsectorsandotherrelevantgovernmentministries,HealthDevelopmentPartners(HDPs),UNAgencies,thePrivatesector,CivilSociety,Serviceconsumers,ResearchOrganisations,LocalgovernmentsandAcademia.Healthmanagersandadministratorsfromurbanandruralareaswerealsoconsulted.ThesuccessofeHealthishingedtoproperpolicy,planning,implementationandregulation.Harmonizationoftheinitiativesto-daterequiresaholisticapproachbasedoninternationalbestpracticeandrelevancetothelocalenvironment.
1.2 eHealthServices
Theapplicationsofe-HealthhavebeenclassifiedasuseofeHealthintheprovisionofhealthservicesatadistance(telehealth),managementofclinicalandadministrativeinformation(healthinformatics),andsharinginformationandknowledgewithhealthcareproviders,patients,andcommunities(e-learning).
1WorldHealthOrganization,EasternMediterraneanRegion.AboutEHealth.2007;Availablefrom:http://www.emro.who.int/his/ehealth/AboutEhealth.htm
15
2 StrategicContextforeHealth
2.1 TheInternationalPerspective
The fifty-eight World Health Assembly in May 2005 adopted a resolution setting up a“GlobaleHealthStrategy”within theWorldHealthOrganisation.Thesameyear theWHOsetup the“GlobalObservatory foreHealth (GOe)”with the remitof studying,monitoringand promoting the role of eHealth in health services and systems globally. The GOe haspublished many documents looking at areas such as telemedicine, internet safety andsecurity,mobility,legalissuesandpatientrecords.
TheWHOhasstatedthat“eHealthischanginghealth-caredeliverytodayandisatthecoreof responsive health systems. The daily business of health relies on information andcommunicationand, increasingly,on the technologies thatenable it,atevery leveland inevery country. This is equally so in delivering care, deploying personnel, managingprogrammes or conducting research. The case for adopting these technologies has beenevident for over a decade. However, it has taken a crisis in the health sector in manycountriestomoveeHealthfromtheperipherytothecentreofstrategichealthplanning.Inanincreasinglydigitalworld,spurredbytechnologicaladvances,economicinvestment,andsocial and cultural changes, there is growing recognition that inevitably the health sectormustintegrateICTintoitswayofdoingbusiness.Thisapplieswhetherthegoalistoreachall citizens with high-quality, equitable and safe care, or to meet obligations for publichealthresearch,reportingandhumanitarianaction”.
In support of this, theWHO have published an eHealth Strategy Development Toolkit tohelpcountriesalongthepathtoeHealthmaturity.ThedocumentoutlinesarecommendedapproachtodevelopmentofanationaleHealthstrategyandincludesconsiderationssuchasstakeholderengagement,policyandgovernancemodels.
ToensurethatacountryrealizesthepotentialfromeHealth,itisimportanttoestablishaneffective governance, management and implementation structure. To support theidentification of such structure and help define its essential characteristics, a review ofinternationaleHealthexperienceshasbeenundertakentoexaminebest-practicecriteriaforsuccess. This review included Australia, England, Scotland, Northern Ireland, Denmark,Cuba,PhilippinesandCanada.ThesewereselectedastheyrepresentvariousapproachestoeHealth implementation and have shown varying degrees of success and therefore keyfactorsofbothsuccessandfailurecanbeexamined.
Inaddition,reviewlookedatAfricancountries;SouthAfrica,Nigeria,Ghana,KenyaandTanzaniatoensurethatregionalexperiencesarealsobroughtintoperspective.
Themajoroutputofthisreviewwasthedefinitionofbest-practiceguidelinesandcriteriatoidentifytheoptimumgovernanceandoperationalstructurerequiredforimplementation.ThesecriteriaareusedtoidentifyanoptimummodelforUgandaofthisstrategy.
16
ThefollowingareasummaryoftheInternationalPerspective:
(a) Governance.Stronggovernanceandleadershipisrequiredandclearoperationalmodels/roadmapsneedtobeagreedbyallearlyonintheexecutionphases.Thedeliveryentityshouldhaveoverallgovernanceforimplementationandmanagefundingallocations.Thefundingshouldbeallocatedonamilestone/deliverablestage-gatebasis,heldcentrallyandawardedtolocaldeliveryorganisationsasaninnovationincentive.
(b) DeployinPhases:Usingaphasedapproachtoimplementationbasedonnationalprioritiesandbuildinguptoscalemakesmoresensethanlarger‘bigbang’deployments.
(c) EnterpriseArchitecture,InteroperabilityandStandards:DeploymentsshouldbebasedandconformtoaneHealthEnterpriseArchitecture,InteroperabilityFrameworkandstandards.
(d) eHealthServices:eHealthServicesshouldbebasedonanapprovedeHealthEnterpriseArchitecturetoenablestandardization,interoperabilityandservicesthatarealignedtothehealthcarebusinessobjectivesinaholisticmanner
(e) Infrastructure:Developmentofasecurenetworkinfrastructureisimportantandthisshouldbesharedacrosspublicandprivatehealthcaresystems.Publicinvestmentinthese‘buildingblocks’iswarrantedandisakey‘enabler’totheapplicationsthatwillbedeployedontop.
(f) BusinessProcessRe-Engineering:eHealthdeploymentsshouldbeviewedasBusinessprocessre-engineeringandchangemanagementenablingthroughtheuseofinformationsystemsratherthanICTprojectsperse.Muchupfronteffortneedstobedirectedatorganisationalimpactanalysisandchangemanagementaspects.
(g) NationalOversight,LocalInnovation:Anationaloversightapproachforkeyaspectssuchasstandardsandinteroperabilitycombinedwithlocalinnovationandincentivesshouldbeadopted.
(h) StakeholderEngagement:Frontlineandclinicalengagementiscriticalandthesestakeholdersshouldbe‘champions’ofeHealthsolutions.Engagementwithfurtherstakeholdersincludingpatientgroups,advocacyorganisationsandstandardsbodiesshouldbefactoredinearlyintheprocess.
(i) HealthIdentifier:AuniqueidentifierisacornerstoneofmosteHealthsystems.Whatneedstobedecidedistheformatthistakes.Ideallyre-useofexistinginitiativesandpublicinfrastructureisadvisable.Properlegislationneedstoaccountforprivacyandsecurityissues.
17
(j) Leverageexistinginvestments:Leverageexistinginvestmentswhereverpossible.ForexampleinIrelandtheIntegratedServicesFramework(ISF).
(k) BrandingandAwareness:Thedeliveryentityshouldbestronglybrandedandthereshouldbestrongandearlyengagementwiththepublic.Campaignsofpublicawareness,educationandbenefitsshouldbelaunched.
(l) Skills:Thedeficitofadequatehealthinformaticsskillsneedstobeaddressed.Skillsdevelopmentandtrainingarethereforenecessarypartsofanimplementationprogram.
2.2 TheUgandaHealthcareSystem
InplanningforthemoresystematicandexpandedapplicationofeHealthtothehealthsectorinUganda,itisimportanttounderstandtheorganizationofthehealthcaresystemwithinthemainland.
Ugandaasacountryisdividedinto112districtsandonecity(thecapitalcityofKampala).ThedistrictsarespreadacrossfouradministrativeregionsofNorthern,Eastern,CentralandWestern.Thedistrictsaresubdividedinto181countiesand22municipalitiesand174towncouncilswhicharefurthersubdividedinto1,382subcounties,7,138parishesand66,036villages(CensusReport2014).ParallelwiththeadministrationaretraditionalKingdomsthatenjoysomedegreeofmainlyculturalautonomy.Thedistrictsaresemi-autonomousinhealthplanningandimplementation,whichisanimportantpointtotakeintoaccountwhenplanningthedeploymentofeHealththroughoutthecountry.
TheUgandaHealthcareSystemisgovernedandsupportedthroughanumberofinstitutions:
i) TheMinistryofHealth(MoH)
ii) HealthServiceCommission(HSC)
iii) PublicServiceCommission(PSC)
iv) MinistryofLocalGovernment(MoLG)
v) NationalDrugAuthority(NDA)
vi) NationalMedicalStores(NMS)
vii) UgandaAidsCommission
viii) UgandaNationalHealthResearchOrganisation(UNHRO)
ix) CentralPublicHealthLaboratory(CPHL)
x) UgandaBloodTransfusionServices(UBTS)
xi) UgandaVirusResearchInstitute(UVRI)
18
xii) UgandaHeartInstitute(UHI)
xiii) UgandaCancerInstitute(UCI)
xiv) JointClinicalResearchCenter(JCRC)
xv) NaturalChemotherapeuticsResearchLaboratory
xvi) UgandaMedicalandDentalPractitionersCouncil(UMDPC)
xvii) PharmacyBoard
xviii) UgandaNursesandMidwivesCouncil(UNMC)
xix) AlliedHealthProfessionalsCouncil(AHPC)
xx) PharmaceuticalSocietyofUganda
xxi) HealthCommitteeofParliament
xxii) ICTCommitteeofParliament
xxiii) ICTAssociationofUganda
xxiv) UgandaManufacturersAssociation
xxv) WorldHealthOrganization(WHO)
xxvi) UNICEF
xxvii) USAID
xxviii) CDC-Uganda
TheinstitutionsabovehavebeenputintoconsiderationwhendevelopingtheeHP
TheGovernmentofUganda(GOU)hasdedicatedsignificanteffort,throughpublicandprivateproviders,todeliverprimaryhealthcareservicestoitscitizens.Allthe112districtsinUgandaeitherhaveahospitalorHCIVorboth.
Currentlythereareapproximately831clinics,2,941HealthCentreII,1,289HealthCentreIII,197HealthCentreIV,144GH,14RRH,and2NationalReferralHospital.About72%ofthepopulationliveswithinfivekilometresofaprimaryhealthfacility;however,themajorityofthepopulationlivesinruralareasatadistancefromhospitalsandthecareofspecialists.
EffortsbytheGoUandPartnershavefacilitatedrecruitmentofmuch-neededstaffincreasingtheproportionofapprovedpostsfrom56%in2010to69%in2013/2014.ThishoweverleavesUgandawithahumanresources(HR)deficit.Thiscrisis,togetherwithotherchallengesfacingtheUgandanhealthsector,callsfortheimmediateimplementationofeHealthinthecountry.eHealthdevelopmentcanbesupportedthroughtheformulationandimplementationofaneHealthpolicyasawayofsupportingprogressinthesector.
19
2.3 JustificationofeHealthinUganda
Someofthekeypressuresfacingthehealthsectorincludethefollowing:
• Shortageofqualifiedhealthcareprofessionalsatalllevelsofthehealthsystem;• Diseaseburden;• Limitedaccesstohealthfacilitiesduetopoorinfrastructure;• Fragmentationofhealthrelatedinformationandinsufficientinteroperability;• Weakhealthinformationmanagement;• Inefficienciesofthehealthcaresystem;• Underdevelopment;• Inadequatefunding;• Insufficientknowledge.
Tobeabletomitigatethechallenges,thereisneedtocontinuouslyimprovetheperformanceandcapacityofthesupplysidetomeetsomeofthegrowthindemandonhealthcareservices.TheimplementationofeHealthislookedatasoneofthesolutionstomitigatethechallengesfacedintheHealthSystem.
3 SituationAnalysis
3.1 UgandaeHealthSituationAnalysis
ThesuccessofeHealthtofacilitateimprovementofhealthservicesispremisedonbeingabletoovercomespecificICTinHealthchallenges.ThiscanbeachievedbyusingexistingopportunitiesandensuringthatthethreatsareminimisedbytakingadvantageoftheOpportunitiessuchasthe(i)theexistenceofDevelopmentPartnersupportedprograms/projects,(ii)theavailabilityofnewtechnologiessuchasmHealth,(iii)theexistenceofpublic-privatepartnershipslegalframeworktosupporteHealthdevelopmentprojects,andetc.Anassessmenttoidentifythesewascarriedoutthroughdocumentreview,keystakeholderconsultationsandphysicalobservations.TheassessmentincludedaninvestigationofthecurrentICTservicesandinfrastructureinthecountry,howdatainthehealthsystemarecollectedandmanaged,referralambiguitiesthatresultinlossofpatients’follow-up,bestpracticesformonitoringandevaluation(M&E),andtheinformationpathwayforanetworkofserviceproviderswhocouldbebettersupportedthroughICT.
InlinewiththeInternationalSituationanalysis,adetailedanalysisisgivenbelow.
3.1.1 LeadershipandGovernanceofeHealth
eHealthisincludedasoneoftheprioritiesinUganda’sNationalDevelopmentPlanIIandwellelaboratedintheHealthSectorStrategicandInvestmentPlanIIasanasakeyenablerforsupportingthehealthsysteminordertodelivergoodhealthtothepopulation.
CurrentlyeHealthleadershipandgovernancefunctionatnationallevelisexecutedbytheeHealthTechnicalWorkingGroup(eHTWG)oftheMinistryofHealth.eHTWGischairedby
20
theDirectorGeneralofHealthServices(DGHS)withtheDepartmentofHealthInformationastheSecretariat,andisresponsibleforthedevelopmentoftheNationaleHealthPolicyandStrategy.eHealthleadershipandgovernanceatthedistrictandcommunitylevelsisnotclear.Thishasledtobottlenecksininformationflowbetweenthevariouslevelsofthehealthsystemleadingtopoorperformance.
Summarily,thereislackofpropercoordinationofeHealthrelatedimplementationnationallywithinMinistries,Departments,andAgencies(MDAs),aswellasbetweenotherstakeholderssuchasthePrivateSector,DevelopmentPartners,andPractitioners.
3.1.2 eHealthEnterpriseArchitecture,InteroperabilityandStandards
Currentlythereareseveralstandards,e.g.StandardforSystemsandsoftwareengineering-SystemsandsoftwareQualityRequirementsandEvaluation(SQuaRE),StandardforStructuredCabling,etc.thathavebeendeveloped,adoptedoradaptedtofacilitateuseofInformationTechnology.ThesestandardshavenothoweverbeenreviewedspecificallyforeHealth.ThedevelopmentofaNationalEnterpriseArchitectureande-GovernmentInteroperabilityFrameworkisbeingspearheadedbyNITA-UandtobeinplaceinFY2017/18.Thereisneedtocapitalizeontheexistinginitiativestodevelopthisarea.
ThereisachallengeofseveralSilosofeHealthsolutionsthatarenotintegrated.
3.1.3 eHealthServices,InformationSharingandDataManagement
TherearesomeeHealthservicesbeingimplementedacrossthehealthsectorsuchastheHealthManagementInformationSystems(HMIS),DHIS2andHumanResourcesforHealthInformationSystem(HRHIS)amongothers.TheMoHhasaKnowledgeManagementPortal;anonlineresourcethatintegrateshealthandhealthrelatedinformationresourcesfromtheMinistryofHealthandbeyond.Thisprovidesasinglepointofaccesstovaluableinformationthatfacilitatesevidencebaseddecisionmaking.
TheaffiliatedInstitutionsincollaborationwithMoHhavesomenotableeHealthServicessuchastheWarehouseManagementSystem(WMS)andthecomputerizedLogisticManagementInformationSystem(LMIS)amongothers.OthereHealthinitiativesincludemTrac,U-Report;Inpatientandspecialtyservices,CommunityVillageHealthTeam(VHT)activitiesandroutinereportingofdatafromtheHealthFacilitiestotheNationalHealthDataBank/RC.
Therearealsoisolatedmobileapplicationsdevelopedbylocalinnovatorswhichhavenotgonefullytothemarket.SeveralTelemedicineprojectsinitiatedinthecountryovertheyearshaveseldomgonebeyondpilotphase.Thereislimitedrelevantcontentonhealthissuesinthelocallanguage.
ManyoftheexistingeHealthServicesaredevelopmentpartnerfundedprojectsandhavetendedtobeproof-of-conceptpilots,whereICTisintroduced(orimported)todemonstrateinnovativeuseoftechnologyinalimitedcontextandtheylacklocalownership,supportand
21
fundingforroll-out.Theyoftenstallwhenthedevelopmentpartnerfundingisended.Theprojectsalsofailduetothesustainabilityintermsofthesupportinginfrastructuresuchasaffordableandreliablepower,connectivityetc.;maintenance,hostingoptions,etc.
ThechallengeisthattheexistingeHealthServicesarenotbasedonstandards,nouniqueidentifierofhealthrecordsandthehealthrecordsareduplicated.
3.1.4 Infrastructure
CurrentlydataconnectivityandnetworkinginUgandacoversalmost100%ofthewholecountryincluding;urban,district,ruralandremoteareas.Thishasbeenachievedthroughfibreforthemajortownsandwireless(mobilephone)connectivityforthedistrict,ruralandremoteareasprovidedthroughthegovernmentNationalDataTransmissionBackbone(NBI),andtheprivatesectorfibreandwirelessnetworks.TheGovernmenthasalsobuiltaNationalDataCentre(NDC)hostingsomeMDAsystems.Mobilephonepenetrationisover57.6%,andinternetpenetrationof39.8%.
ICThardwareismainlycomprisedofelectronicmedicaldevices,computerhardwareandmobiletelephones.Howeverthecostofinternetisstillhighcompoundedbyunreliableorunavailablepowersupplyespeciallyinlowerhealthunitsandruralcommunities.InadditionICThardwaresuchascomputersarefew,poorlymaintainedandunderutilizedparticularlyinruralandremotehealthfacilities.Currentlythereisrelianceonimportedhardwareandsoftwareinthefaceoffastchangingtechnology.Thishasledtotheproliferationofhardware,softwareandcommunicationequipmentusedinthenumerousfragmenteddonor-fundedprojects,whichdonotshareinformationandprovidelimitedinformationtohealthcareprofessionalsformanagingpatientseffectively.
Currently,thereisachallengeofcomplementaryinfrastructuresuchasgreenandaffordablebackuppowertosupporteHealth.ThereisneedstoconsideroptionslikeSolarEnergyandInverterSystemstosupporteHealth.
TherearematuretechnologiesthatareembracedinUgandasuchasCloudComputing,BigData&OpenData,DataAnalytics,SmartSystems,DigitalServicesandInternetofThings.Thesetechnologieshavebeenadoptedbutnotinanorganizedway.Thereisneedtoformalizetheiradoptionandutilizationtogaintargetedbenefitsfromthem.Therearealsosomecontinuouslyemergingtechnologiesthatareupcomingandusedinanisolatedmannerandneedtobeexploredforutilization.
Althoughsomeinfrastructureexists,itremainsinsufficienttosupporttheeffectiveandefficientimplementationofe-Health.
3.1.5 eHealthInformationAssurance
ANationalInformationSecurityFramework(NISF)wasdevelopedandadoptedbytheGOUandithasattendantpolicies,standardsandguidelines.Itsimplementationhasnotbeen
22
commencedintheHealthSector.ThereisneedtoreviewandimplementtheNISFintheHealthSectorandalsodevelopattendantmechanismstoenhanceinformationassurance.
ThereisalsoaDataProtectionandPrivacyBillbeforeParliamentforapprovalintolaw.ThisshallsupporttheimplementationofprivacyforeHealth.TheDataProtectionandPrivacyBillincludes;PrinciplesofDataProtection,DataCollectionandProcessing,SecurityofData,RightofDataSubjects,DataProtectionRegister,ComplaintsandOffences.Thereisalsoneedtoreviewitandensurethatittakescareofalltherequisiteprivacyissuesrelatedtohealthcare.
3.1.6 Ethics
TheUgandaMedicalandDentalPractitionersCouncil(UMDPC),PharmacyRegulatoryBodies(PharmacyBoardandPharmacySocietyofUganda),UgandaNursesandMidwivesCouncil(UNMC)andAlliedHealthProfessionalsCouncil(AHPC)areinplacetoensurethatethicsareadheredtooinhealthcare2.Inaddition,theMinistryinchargeofEthicsandIntegrityisalsomandatedtosetstandardsfortherebuildingandpromotionofethicsandintegrityinsociety3.TheexistenceoftheaforementionedrolesprovidesgenericprovisionsforethicsandintegritythatmightnotapplyinanICTenvironment.ThereisneedtoreviewimplementationandsufficiencyofthecodesofethicsandintegritytoensurethattheICTenvironmentapplicabilityisfullytakencareof.
ThereisalsotheNISFandtheDataProtectionandPrivacyBilldevelopedtocaterforTrust,Privacy,Ownership,Dignity,Equity,andProportionalityofICTrelateddata.Thesearenothealthspecific.Thereisneedtoreviewthesufficiencyoftheexistinginitiativesforcompletenessanddevelopsupplementarypoliciesforahealthenvironment.
3.1.7 HumanResourcesandCapacityBuilding
eHealthcapacitybuildingreferstothecreationofanenvironmentthatfosterstechnology-enabledimprovementstohealthsystemsanddelivery,includingorganizational,policyandtechnicalinterventions.
HumanresourcesforeHealthcompriseoftwocomponents;healthworkforceandhealthICTworkforce.HealthconsumerswhoareindividualsorcommunitiesalsorequireknowledgeandskillstouseITequipmentandsystems.Oneofthebiggestissuesfacinghealthcareorganizationsistheabilitytotrain,attractandretaineHealthandITprofessionals.
MostHealthworkersandconsumersarenotcomputerliterate.Inaddition,mostnursesanddoctorsfeeloverwhelmedbytheirroutineworkandfeelthatICTisanextraburdenthatwilldrawthemawayfromtheircoreduties.However,insomehealthinstitutions/facilitieswherehealthworkersarecomputerliterate,computersarenotusedforroutineofficial
2http://health.go.ug/affiliated-institutions/professional-councils3http://www.dei.go.ug/
23
work.Insummary,thereisachallengeofinsufficienteHealthskillsandtrainedhumanresource.
ITprofessionalstomanageandmaintaintheITequipmentandsupportthehealthworkersintheuseofITequipmentandsystems,arenotavailable.TheaboveconstraintshavehamperedtherealizationofthebenefitsofeHealthinimprovingthehealthsystemandhealthoutcomesthroughelectronic;
• Collection,management,storageandtransmissionofroutineHMISdata.• managementofpatientrecordsbecausethepaperrecordsgetmisplacedormay
notbeavailablewhenapatientreportsinanotherhealthfacilityawayfromhome• Followupofpatientsinthecommunityandprovidingrelevantinformationtothe
healthworkerinthelowerhealthunit.• Consultationonpatientmanagementandreferralofpatientsamonghealthworkers
atadistance.• Managementofprocessessuchasprocurementandsupplychainmanagement.• Planning,policyformulationandanalysis,monitoring,evaluationanddissemination,
reporting.
TheHumanResourcesituationiscompoundedbythenon-existenceofaneHealthWorkforceStructureandaneHealthSkillsFrameworktoguidecurriculumdevelopmentforeHealth.
3.1.8 MainstreamingSpecialInterestGroups
TheneedformainstreamingSpecialInterestgroupsforICTutilizationisincludedintheNationalICTPolicyandintheNationalICTSectorStrategyandInvestmentPlan.ThisexistencethoughisnotspecifictoeHealth.ThereisneedtodevelopaspecificStrategyformainstreamingSpecialInterestGroupsforeHealthbasedonthenationalguidanceandInternationalbestpractice.
3.1.9 Research,InnovationandDevelopment
ThereisgrowingrecognitionamongtheGovernment,DevelopmentsPartners,PrivateSector,AcademiaandtheCivilSocietyabouttheimportanceofResearchandInnovationanditspotentialforthetransformationofthecountryaswellastheassociatedeconomicbenefits.ThishasbeenmanifestedintheNationalDevelopmentPlan,HealthSectorStrategicPlan,theNationalHealthPolicy,andtheNationalICTPolicyamongothers.
Inaddition,therearemanyeHealthInnovationsthathavecomeupthroughamultiplicityofInnovationHubs.SeveralICTInnovationincubationsandHackathonshavebeingconductedinthecountry(e.g.ACIA,MarieStopesHealthAppChallenge,andVodafone2016HealthAppChallenge).
Althoughseveralstrideshavebeentaken,eHealthrelatedInnovationisfacedwiththefollowingchallenges;
24
• NostructuredandcentralizedfundingforeHealthResearch,InnovationandDevelopment;
• FragmentedeffortsineHealthResearch,InnovationandDevelopment;• InsufficientcollaborationbytheInnovatorswiththeHealthexpertsandother
disciplinescomplementarytotheHealthSector;• MosteHealthInnovationsdonottranslateintomarketableproducts;• Insufficientresearchsupporttools(highcostofinnovationspace,computing
resources,accesstoonlinematerial,internetbandwidth,etc.)
Thechallengesabovearecompoundedwiththelackofstandardstosupportinnovation,insufficiententrepreneurshipskillsamongstinnovatorsandInsufficientnationaloversightforlocalinnovation.
3.1.10 eHealthInvestment
TheGovernmentandthePrivateSectorhaveinvestedinInfrastructurethatcanbeusedtosupporteHealth,liketheNationalBackboneInfrastructure(NBI),theNationalDataCentre(NDC),andothercomputinginfrastructure.TheseinvestmentsstillremainfragmentedandInvestmentineHealthismainlyintheformofdonorfundedfragmentedeHealthprojects.TheGovernmenthasalsoinvestedinmedicalequipmentthatiscomplementarytoeHealth.ThePrivateSectoronitssidehasalsoinvestedsubstantiallyinisolatedsystemscomplementarytoeHealthwithoutproperguidance.Theinvestmentsarenotbasedonanystandardandthusnotproperlyguided.ThishasresultedinnumerousfragmentedverticaleHealthprojects/initiativeswhichdonotshareinformationandarenotaccountabletotheMinistryofHealth.ThereisneedtodevelopaneHealthArchitectureandInteroperabilityFrameworktoguideallinvestmentsineHealth.
3.1.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships
ANationalPolicyonPublic-Private-PartnershipinHealth4wasdevelopedtoprovideguidancetomainstreaming,establishing,implementing,coordinating,monitoringandevaluatingpartnershipsbetweentheGovernmentofUgandaandtheprivatehealthsectorwithinexistinglaws,policiesandplans.
Thereareexistingpartnerships5buttheyareisolated6andnotSMART.ThereareopportunitiesforpartnershipineHealththatneedtobeexploited7.ThereisaneedtoreviewtheNationalPolicyonPublic-Private-Partnership(PPP)inHealthtoensurecoverageintermsofeHealthPPPwithmeasurableoutcomesandalsodevelopandimplementa
4https://www.usaid.gov/sites/default/files/documents/1860/Uganda-National-Policy-on-PPPH-2012.pdf5http://www.swecare.se/Portals/swecare/Documents/Uganda-Health-Sector-and-Partnership-Opportunities-final.pdf6http://www.ictworks.org/2012/02/22/ugandan-mhealth-moratorium-good-thing/7http://www.swecare.se/Portals/swecare/Documents/Uganda-Health-Sector-and-Partnership-Opportunities-final.pdf
25
specificanddeliberatePartnershipandRelationshipManagementStrategyforeHealth.ThereisinsufficientawarenessofeHealthanditsbenefits.
3.1.12 BusinessProcessRe-Engineering
TherearecurrentlyisolatedeffortsintheHealthSector(PrivateandPublic)toreviewtheirBusinessProcessesinordertoembraceeHealth,however,theyremain.ThereisneedtocomeupwithadeliberatestrategyforBusinessProcessRe-engineeringspecifictoeHealthledbytheMOHandthisshouldbecompliedtobyallstakeholders.
3.1.13 LegalandRegulatoryFrameworkforeHealth
CurrentlythelegalandregulatoryframeworkscompriseofseverallawsandregulationswhichsupportbutarenotspecifictoeHealth,including:
Laws
(a) TheNITA-UAct,2009(b) TheComputerMisuseAct,2010(c) TheElectronicTransactionsAct,2011(d) TheElectronicSignaturesAct,2011(e) NationalDatabankRegulations,2015(f) TheRegistrationsofPersonsAct,2015(g) TheUgandaCommunicationsCommissionAct,2013(h) TheUgandaNationalCouncilforScienceandTechnologyAct,1990(i) CopyrightsandNeighbouringRightsAct,2006,(j) NationalRecordsandRetentionAct,2001
Policies(k) NationalDevelopmentPlan(NDP)II(l) NationalICTPolicy,2015(m) RuralCommunicationsDevelopmentPolicy,2001(n) UgandaNationalCouncilforScienceandTechnology(UNCST)Nationalguidelinesfor
researchinvolvinghumansasresearchparticipants,2007Strategies
(o) NationalDevelopmentPlanII(p) HealthSectorDevelopmentPlan2015/16-2019/20(q) ICTSectorStrategyandInvestmentPlan
ThereisneedtoreviewindetailthecurrentlegalandregulatoryframeworktoestablishwhetherthesetakecareofalleHealthregulatoryareas.ThereisalsoneedtoputinplacealegalandregulatoryfunctionforeHealthtooverseethereviewaswellascoordinationoftheenforcementandcompliancetothelegalandregulatoryframework.
26
4 FoundationoftheeHealthPolicy
4.1 RationaleoftheeHealthPolicy
Advancements in ICT, as awhole, and the internet in particular, and the convergence oftelephony,computingandmediahaveresulted inmanydevices includinghand-heldones.Thesedevicesarewidelyusedforaccessinghealthinformationandcarewherebybreachofsecurity, confidentiality, and privacy of personal information is a big threat. Uganda hasdeveloped the national Health Sector Policy and the Health Sector Development Plan IIwhich provide for the principles and action in health in the country and the national ICTPolicy framework which provides for appropriate laws and guidelines for the planning,development, implementation, utilization, maintenance, monitoring and evaluation anddisposalofICTsfornationaldevelopment.ThereisaneedforthedevelopmentofaNationaleHealthPolicytoaddressthechallengesuniquetotheutilizationofICTsforhealth.InthisscenarioICTsareusedforaccessinghealthservicesandsharinghealthinformation,inordertoachievelongtermgoalsofuniversalhealthcoverage.
4.2 ScopeofthePolicy
ThePolicyshallapplytoPublic,Private,andDevelopmentPartner,Non-Governmental,Academic,andCivilSocietyInstitutions.Itwillalsocoverfullrangeofhealthcareservicesfromoperational,preventive,curative,rehabilitation,researchandlearning.Thecoverageofthescopeshallincludetheentirecountry.
5 Vision,Mission,GoalandGuidingPrinciples
5.1 Vision
Effectiveuseof informationandcommunicationtechnologyforbetterhealthoutcomesoftheUgandanpopulation
5.2 Mission
To transform the health of the people of Uganda by promoting effective utilization ofinformationandcommunicationtechnology.
5.3 Goal
To create an enabling environment for the development/deployment and utilization ofsustainable,ethically soundandharmonizedeHealthapproaches/initiativesatall levelsofthehealthsystemstopromotehealthandimprovehealthservicesdelivery.
27
5.1 PolicyGuidingPrinciples
a) ClientfocusedeHealthagendaEstablisheHealthagendathatisclientfocusedandwithstrongleadership,thatisdrivenbycountryhealthneedsandpriorities
b) EquityProvidingequitableaccesstoappropriateelectronichealthinformationandserviceswithrespecttogender,ageandemphasisonvulnerablegroupsandindividuals.
c) User-friendlytechnologyapplicationsAdopttechnologyapplicationsandsystemsthatareuser-friendly,affordable,sustainableandbasedonappropriatenationalstandards.Thestandardsshouldensureconfidentiality,privacy,security,quality,safetyandintegrityofhealthinformation
d) MultiSectoralApproachHarnessexistinginitiativesthroughpublicprivatepartnershipandcollaborationwiththerelevantstakeholders
FostereHealthresearchanddevelopmentincludingresearchonthesocialdeterminantsofhealthandtheimpactonthehealthoftheUgandanpopulatione) HumanRightsbasedapproach
ObserveHumanRightsthroughouttheeHealthpracticesandupholdingHumandignity.f) QualityInformationgenerationg) GenerateQualityInformationbaseforstrategicplanningandpolicydevelopment.
6 Pillars/priorityareasfortheeHealthPolicy
ThefigurebelowshowsthepillarswhichrepresentthekeyareaswherepolicymustgivedirectioninordertoachieveoureHealthVision.Foreachpillar,thescope,responsibilitiesandprocedurehavebeendescribed.
28
Figure1-UgandaNationaleHealthPillars
7 PolicyObjectivesandStrategies
Tocreateanenablingenvironmentforthedevelopment,deploymentandutilizationofsustainable,ethicallysoundandharmonizedeHealthinitiativesatalllevels,thefollowingarethepolicyobjectivesandstrategies:
7.1 LeadershipandGovernanceforeHealth
GovernanceforeHealthincludesinstitutionalframeworksforpolicyoversight,coordinationandcollaboration,advocacyandpartnership,clinicalsafety,managementandoperation,programmanagement,strategicarchitecture,monitoringandevaluation
7.1.1 Objective
ToprovideeffectiveoversightleadershipandgovernanceforthedevelopmentandprogressionofeHealthinUganda.
7.1.2 Scope
ThispolicyappliestoallHealthpractitioners,HealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Employees,Management,StudentInterns,andVolunteers.ThescopeshallcoverInter-AgencyPolicyGovernance,Inter-AgencyTechnicalGovernance,eHealthManagementwithintheMinistryofHealth,RegulatoryGovernance,EnterpriseArchitectureGovernance,PractitionerandUserGovernance.
7.1.3 PolicyStrategies
PolicyStrategy1:Design,establishandoperationaliseGovernanceandManagementStructurestolead,oversee,coordinateandmanagethenationaleHealthprogramatall
29
levelsofthehealthsystem,takingintoaccountexistingmandates,roles,relationshipsandresponsibilities.
PolicyStrategy2:Defineandformalizerelationshipandgovernanceinteractionswithrelevantexistingnational,andlocalgovernancebodies.
PolicyStrategy3:EstablishandimplementmechanismsforcompliancetonationaleHealthregulatoryframeworkstakingintoaccountrelationshipsandinteractionswithexistingregulatorybodiesandfunctions.
7.1.4 ResponsibilitiesandProcedure
• TheMinisterofHealthShallConstituteaSteeringCommitteewithappropriateTermsofReference
• TheSteeringCommitteeshallestablishotherrequiredGovernanceStructuresandconstitutetheStructureswithappropriateTermsofReference
• MoHshallensurethatallGovernanceandManagementcompliestotheTermsofReferenceandreportappropriatelytotheappointingauthority
7.2 eHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandards
7.2.1 Objective
ToestablishaprocessandblueprintfortransformingthehealthsectorbusinessvisionandstrategyusingICTintoeffectiveenterprisechangebycreating,communicatingandimprovingthekeyprinciplesandmodelsthatdescribetheentity’sfuturestate.ThisactsasthedesignofhoweHealthshallbeimplemented.
7.2.2 Scope
ThispolicyappliestoallhealthstakeholdersincludingallHealthpractitioners,HealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Developmentpartners,Clients/Patients,researchersandVendors.
TheEnterpriseArchitecturespellsouttheBusinessArchitecture,DataandInformationArchitecture,ApplicationsandeHealthSolutionsArchitecture,TechnologyArchitecture,theInformationSecurityArchitectureandthePrivacyArchitectureandattendantstandards.
7.2.3 PolicyStrategies
PolicyStrategy1:Plan,designanddevelopmenteHealthEnterpriseArchitectureandInteroperabilityFrameworktoguidetheimplementationofalleHealthServicesandInfrastructureinthecountry
PolicyStrategy2:DevelopandimplementcomplianceandreviewmechanismfortheeHealthEnterpriseArchitectureandInteroperabilityFramework.
30
PolicyStrategy3:eHealthServicesshallbeestablishedandimplementedinlinewiththeeHealthEnterpriseArchitectureandInteroperabilityFramework
7.2.4 ResponsibilitiesandProcedures
(a) TheeHealthSteeringCommitteeshallsteertheestablishmentoftheeHealthEnterpriseArchitectureandInteroperabilityFramework
(b) TheMinistryofHealthtogetherwithNITA-UandotherestablishedGovernanceStructuresshalldeveloptheeHealthEnterpriseArchitectureandInteroperabilityFramework
(c) TheMoHshallensurecompliancetotheeHealthEnterpriseArchitectureandInteroperabilityFramework
(d) TheMoHshallputinplaceperiodicreviewmechanismfortheeHealthEnterpriseArchitectureandInteroperabilityFramework
7.3 eHealthServices,InformationSharingandDataManagement,
7.3.1 Objective
ToestablisheHealthservicesandtoolsthataddresstheprioritybusinessneedsandtofacilitatetheestablishmentofaprocessofauthorization,sharingandmanagingelectronicdata,information,knowledge,andpracticesbetweenorganizationsandstakeholdersinthehealthindustryincludingpatients/clients,healthcareproviders,andhealthcaremanagers.
7.3.2 Scope
Thispolicyappliestoallhealthstakeholdersincludingpractitioners,HealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Employees,Management,Clients/Patients,StudentInterns,researchers,vendorsandvolunteers.
7.3.3 PolicyStrategies
PolicyStrategy1:Establishaunique,standardized,comprehensiveandcomprehensibleElectronicMedicalRecord(EMR),ElectronicHealthRecord(EHR)andPersonalHealthRecord(PHR).
PolicyStrategy2:Establishacomprehensivehealthfacility,provider,andclientregistrieswithcompleteandcurrentinformationthatmeetsstakeholders’needs.
PolicyStrategy3:Establish,prioritizeandimplementeHealthServicesinlinewiththeeHealthEnterpriseArchitectureandInteroperabilityFramework
PolicyStrategy4:DevelopandoperationalizeaneHealthDataManagementandUtilizationSystemacrossalllevelsofhealthcare.
PolicyStrategy5:AligneHealthDataManagementandUtilizationtootherexistinggovernmentlawsandregulations.
31
7.3.4 ResponsibilitiesandProcedures
(a) TheeHealthSteeringCommitteeshalloverseetheeHealthServices,InformationSharingandDataManagementProgramwhileensuringBusinesscontinuity,Disasterandriskmanagement.
(b) TheMinistryofHealthtogetherwithMoICT,NITA-UandotherestablishedGovernanceStructuresshalldevelopandimplementtheeHealthServices,InformationSharingandDataManagementProgramthatpreservesdataqualityincompliancewiththeeHealthEnterpriseArchitectureandInteroperabilityFramework
7.4 Infrastructure
7.4.1 Objective
TofacilitateestablishmentandsustainabilityofICTInfrastructureandconnectivitytosupporttheeffectivedeliveryandmonitoringofeHealthasanenablerofbetterhealthcareservices.Thisshallincludeallthecomponentsofinfrastructurewhicharecomputinginfrastructure,databases,directoryservices,infrastructuredevelopment&management,connectivityandstorage.Thisalsoincludescomplementaryinfrastructurelikepowerandbuildings.
7.4.2 Scope
ThispolicyappliestoallHealthpractitionersandeHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs).
7.4.3 PolicyStrategies
PolicyStrategy1:ConnectallpriorityhealthfacilitiestotheNationalBackboneandtheNationalDataCentrewithaviewofhavingsecure,reliableandaffordabledataconnectivityandinternetservices.
PolicyStrategy2:Ensureallhealthpractitioners(includingpublicandprivate)develop,utilizeandmaintainICTInfrastructure.TheInstitutionalICTinfrastructureshallconformtothee-HealthEnterpriseArchitectureandInteroperabilityFrameworkandNationalITStandards.
PolicyStrategy3:Ensureallhealthpractitioners(includingpublicandprivate)implementaseamlessconnectedICTnetworksystem(LocalArea/WideAreaNetwork)ofembeddedobjects/devices,withidentifiersandsupportforsensors(InternetofThings(IoT)).TheInstitutionalNetworkshallconformtothee-HealthEnterpriseArchitectureandInteroperabilityFrameworkandNationalITStandards.
PolicyStrategy4:TheMOHincollaborationwiththeMinistryinchargeofWorksshalldevelop,enforceandmonitorMedicalFacilityBuildingStandardsandArchitecturereadyfore-HealthinconformitywiththeBuildingControlAct.
32
PolicyStrategy5:EnsurethatallMedicalPractitionerscomplywiththeMedicalFacilityBuildingInfrastructureStandardsandArchitecturereadinessfore-Health.
PolicyStrategy6:Ensurethatallhealthpractitioners(publicandprivate)develop,utilizeandmaintaingreenandaffordablebackuppowersysteminconformancewiththeRenewableEnergyPolicyofUganda
PolicyStrategy7:EnsurethatallHealthPractitionersutilizematureandemergingtechnologieswhileadheringtotheeHealthEnterpriseArchitectureandInteroperabilityFrameworkwiththeguidanceoftheMinistryofHealth,MoICTandNITA-U.
PolicyStrategy8:EnsurethatICTInfrastructureisestablishedinacoordinatedmannerandmeetsthestandardswithguidancefromMoHinconjunctionwithMoICTandNITA-U.
7.4.4 ResponsibilitiesandProcedures(a) MinistryofHealthinconjunctionwithMoICTandNITA-Ushallensurethe
connectivitytotheNBIandNDCandprovisionofaffordableInternetBandwidthtoHealthFacilitiesandrelatedinstitutions
(b) MoHandMinistryofWorksandTransportshallensurethattheeHealthreadyBuildingInfrastructureisinplaceinconformancewithestablishedguidelines
(c) MoHandtheMinistryofEnergyandMineralDevelopmentshallensurethatrenewableenergyeHealthreadyBuildingsinconformancewithestablishedregulatoryframework
(d) TheMinistryofHealth,MoICTandNITA-Ushallensureutilizationofmatureandemergingtechnologiesinlinewithestablishedguidelines
(e) TheaboveministriesshalldeveloptherelevantguidelinesforeHealth,securefundingforeHealthactivitiesandalsocarryourM&E.
(f) PractitionersofeHealthatalllevelswillberesponsibleforadherencetotheeHealthEnterpriseArchitectureandInteroperabilityFrameworkandstandardsintheprocessofprocurement,implementationanddecommissioningofeHealthinfrastructureattheirrespectiveinstitutions.PractitionersshallputinplacetheoptimalstaffwithskillsmixnecessarytoexecuteeHealthinhealthcaredelivery.
7.5 eHealthInformationAssurance
7.5.1 Objective
Thepurposeofthispolicyistoensuretheeffectiveutilizationofsecure,confidential,qualityandauthenticelectronichealthinformation,togetherwithmechanismsofdisasterrecovery.
33
7.5.2 Scope
ThispolicyappliestoallHealthpractitionersandHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),ClientsandotherstakeholdersthatwillgovernorutilizeinformationthrougheHealthplatforms.
7.5.3 PolicyStrategies
PolicyStrategy1:InformationSecurityisobservedtoensureconfidentiality,integrity,qualityandavailabilityofinformationwhendesigning,procuring,implementing,maintainingandretiringeHealthInfrastructureandSolutionsbyallHealthPractitionersandstakeholdersinlinewiththeNationalInformationSecurityFramework(NISF)andtheeHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandardswithguidancefromMoH,MoICTandNITA-U.
PolicyStrategy2:EnsurethatInformationProtectionandPrivacyismaintainedbyallhealthpractitionersandstakeholdersinlinewiththeDataProtectionandPrivacyLaw,internationalprotocols&conventionsandwithguidancefromtheMOH,MoICTandNITA-U.
PolicyStatement3:EnsurethatallHealthPractitionersdevelop,implementandenforceaBusinessContinuityandDisasterRecoveryPlanforeHealthinlinewiththeNationalInformationSecurityFramework(NISF)andtheeHealthEnterpriseArchitectureandInteroperabilityFrameworkandStandardswithguidancefromMoHinconjunctionwithMoICTandNITA-U
7.5.4 ResponsibilitiesandProcedures
(a) HealthPractitionersshalldevelop,operationalizeandmaintainanInstitutionaleHealthInformationPrivacyProtectionProgramthatcomprisescomprehensiveandalignedInformationsecuritysafeguards,andprograms,practices,processes,toolsandtechniquesinconformancewiththeNISFwithguidancefromMoH,MoICTandNITA-U.
(b) HealthPractitionersshalldevelop,operationalizeandmaintainanInstitutionaleHealthInformationSecurityProgramthatcomprisescomprehensiveandalignedInformationsecuritysafeguards,andprograms,practices,processes,toolsandtechniquesinconformancewiththeNISFwithguidancefromMoH,MoICTandNITA-U.
(c) MoH,MoICTandNITA-Uconducttraining,awarenessandsensitizationrelatedtoInformationSecurity,PrivacyandBusinessContinuityandDisasterRecovery.
(d) MoH,MoICTandNITA-UshallmonitorcompliancetoInformationSecurity,Authenticity,PrivacyandBusinessContinuityandDisasterRecovery.
34
(e) MinistryofHealthinconjunctionwithotherrelevantMDAsshallensurethateHealth-readyBuildingInfrastructureisinplaceinconformancewithestablishedregulatoryframework.
(f) MoH,MoICTandNITA-UshallensureauthenticityoftheinstitutionaleHealthInformationprivacyprotectionprogram
7.6 Ethics
7.6.1 Objective
Thepurposeofthispolicyistoensurethatallstakeholders(Patients,clients,Institutions,allserviceprovidersanddevelopmentpartners)conformtoallprinciplesofethicalbehaviorinmanaging their own health and the health of those in their care while utilizing eHealthservices.
7.6.2 Scope
The policy applies to all eHealth Stakeholders including practitioners both public andprivate,GovernmentMDAs,healthcaremanagersandclients.
7.6.3 PolicyStrategies
PolicyStrategy1:PutinplaceeHealthEthicalStandardsandguidelinesinconformancetoculturalandreligiousvaluesaswellasinternationalbestpractice.PolicyStrategy2:PutinplaceandenforceaneHealthCodeofEthics
7.6.4 ResponsibilitiesandProcedures
The MoH in conjunction with MoEI, MoICT, NITA-U, UNBS and the Health ProfessionalCouncils and other related bodies shall develop and enforce eHealth Ethical Standards,GuidelinesandCodeofEthics.TheMoHthroughtheeHealthregulatoryfunctionshallmonitorcompliancetotheeHealthEthicalStandards,GuidelinesandCodeofEthics
7.7 HumanResourcesandCapacityBuilding
7.7.1 Objective
ThepurposeofthispolicyistofacilitatetheestablishmentandbuildingasufficientskilledeHealthHumanResourcetoensurethesustainedimplementationoftheeHealthinthecountry.
7.7.2 Scope
ThispolicyappliestoallHealthpractitionersandHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),ClientsandotherstakeholdersthatgovernorutilizeinformationthrougheHealthplatforms.
35
7.7.3 PolicyStrategies
PolicyStrategy1:EvaluatethecurrentreadinessoftheHealthWorkerstoembraceandsupporttheimplementationofeHealthandestablish,enforceandmonitoraneHealthWorkforceStructureforallMedicalFacilitiesandGovernmentMDAs.
PolicyStrategy2:EmbedeHealthtrainingandcertificationatalllevelsofeducationandtraininginthecountry.
PolicyStrategy3:PromoteaccesstocontinuousprofessionaldevelopmentbyHealthpractitioners,throughe-learninganddigitalresources.
7.7.4 ResponsibilitiesandProcedures
(a) TheMoHincollaborationwithlineMDAsshall:
I. EvaluatethecurrentreadinessoftheHealthWorkerstoembraceandsupporttheimplementationofeHealth
II. Establish,enforceandmaintainaneHealthWorkforceStructureforallHealthFacilitiesandotherrelevantinstitutions.
III. PutinplaceamechanismtoembedeHealthtrainingandcertificationatalllevelsofeducationandtraininginthecountry.
(b) HealthPractitionersshallconformtotheWorkforceStructure,TrainingandCertificationrequirementsforeHealth
7.8 MainstreamingSpecialInterestGroups(SIGs)
7.8.1 Objective
ThepurposeofthispolicyistoputinplaceamechanismtomitigatethebarriersthatmighthampertheutilizationofeHealthbySpecialInterestGroup-specificbarriers;suchasSIG-relevantcontentanddigitalservices,safetyissuesandculturenorms.
7.8.2 Scope
ThispolicyappliestoallHealthpractitionersandHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Vendors,Clientsandotherstakeholdersthatwillprocure,governorutilizeinformationthrougheHealthplatforms.TheSIGsincludebutarenotlimitedtoWomen,theDisabled,theAgedPersons,theIlliterate,etc.
7.8.3 PolicyStrategies
PolicyStrategy1:Supportandenhancetheaccessto,acceptanceandutilizationofeHealthbySpecialInterestGroups(SIGs)byputtinginplacemechanismstomitigatechallengesanticipatedbytheSIGs.
36
7.8.4 ResponsibilitiesandProcedures
(a) TheMoHtogetherwithMoICT,NITA-UshallsupportthesetupandinstitutionalizationofaSpecialInterestGroupForumundertheeHealthUsersForum
(b) TheMoHtogetherwithMoICT,NITA-Uandotherrelevantinstitutions/regulatorsshalldevelop,enforceandevaluateconformancetoStandards,PoliciesandGuidelinesforeHealthforSIGs
(c) AllHealthPractitioners(Public,PrivateandNGOs)shallconformtotheStandards,PoliciesandGuidelinesforeHealthforSIGs
7.9 Research,InnovationandDevelopment
7.9.1 Objective
Thepurposeofthispolicyistopromoteresearch,innovationanddevelopmentineHealthinordertooptimallyaddressthecountry’sevolvingneedsinthehealthcarelandscape.
7.9.2 Scope
ThispolicyappliestoallHealthpractitioners,Innovators,andHealthrelatedGovernmentMinistries,DepartmentsandAgencies(MDAs),Vendors,Clientsandotherstakeholdersthatprocure,governorutilizeinformationthrougheHealthplatforms.
7.9.3 PolicyStrategies
PolicyStrategy1:EnhanceHealthResearchandInnovationusingInformationandCommunicationsTechnology.
PolicyStrategy2:EstablishanopenmultidisciplinaryapproachtoResearch,InnovationDevelopment,TranslationandCommercializationofeHealthforhealthproviders,academia,andthegeneralpublic.
PolicyStratgey3:PromoteResearch,InnovationDevelopment,TranslationandCommercializationofeHealthforinnovators,Providers,AcademiaandtheGeneralPublic.
7.9.4 ResponsibilitiesandProcedures
(a) MoHincollaborationwithlineMDAsshall:I. DesignandoperationalizeaNationalHealthCareWebPortalII. DevelopaResearchand InnovationStrategy (includinganAgenda forpriority
ResearchandInnovation)foreHealth
III. IdentifyandmaintainarecordofallplayersintheeHealthInnovationEcosystemwiththeirstakeandresponsibilities;
IV. PutinplaceaneHealthInnovationGovernanceandPartnershipmechanism
37
7.10 eHealthInvestment
7.10.1 Objective
Thepurposeofthispolicyistoestablishasustainable,affordable,robustfundingmechanisms,rationalselection,acquisitionanddeploymentofcosteffectiveeHealthsystemsinthecountry.
7.10.2 Scope
ThepolicyappliestoallGovernmentMDAs&LocalGovernments(LGs),DevelopmentPartners,CSOs,NGOs,PrivatePractitionersandcommunities.
7.10.3 PolicyStrategies
PolicyStrategy1:MainstreamandintegratefundingforeHealthprogrammesandProjectsintothenationalHealthandICTplansandbudgets
PolicyStrategy2:LeverageavailableresourcesthroughPublic-Private-Partnerships(PPP)tosupporteHealthProgrammesandProjects
PolicyStrategy3:Develop,implementandmonitoreHealthInvestmentPlantoguideallinvestmentsrelatedtoeHealth
PolicyStrategy4:CoordinateDevelopmentPartnerSupporttoeHealthprogrammesandprojects
7.10.4 ResponsibilitiesandProcedure
(a) Develop guidelines for developing, planning and implementing eHealthprojects aswell asmainstreaming theprojects in theGovernmentPlanning,ProcurementandReportingsystem.
(b) Developandimplementamechanismforeffectivecollaborationandpartnershipinthe planning, organization and management of all eHealth PPP projects andprograms
(c) DevelopandensureimplementationofaneHealthInvestmentPlan.
7.11 StakeholderEngagement,Collaborations,AdvocacyandSmartPartnerships
7.11.1 Objective
ThepurposeofthisPolicyistoensureeffectivestakeholderengagementandcollaborationinordertoimproveinformationexchange,mobilizationofsupport,identificationofopportunities,highlightingpriorities,managingandmitigatingrisk.
38
7.11.2 Scope
ThepolicyappliestoalleHealthStakeholdersincludingpractitionersbothpublicandprivate,GovernmentMDAs,academia,civilsocietyorganizations,developmentpartnersandclients.
7.11.3 PolicyStrategy
PolicyStrategy1:IdentifyandengageappropriatelyalleHealthStakeholdersatNational,RegionalandInternationalleveltoensureownership,participationandcontributiontothenationalstrategy.
7.11.4 ResponsibilitiesandProcedures
(a) TheMoHshalldevelopandregularlyupdateStakeholderRegisterincludingbutnotlimitedtohealthconsumers,healthcareproviders,health-servicemanagers,GovernmentMDAs,DevelopmentPartners
(b) TheMoHshalldevelop,implementandcontinuouslyreviewtheStakeholderandPartnershipEngagementPlan
7.12 BusinessProcessRe-Engineering
7.12.1 Objective
ThepurposeofthispolicyistoencourageandenableparticipantsinthehealthsystemtoadopteHealthsolutionsandchangetheirworkpracticestobeabletousethesesolutionseffectively.ItfurthermorefocusesonhowtomanagetherapidchangesintechnologywhileimplementingeHealth.
7.12.2 Scope
ThepolicyappliestoalleHealthStakeholdersincludingpractitioners,GovernmentMDAs,healthcaremanagersandpatients/clients.
7.12.3 PolicyStrategies
PolicyStrategy1:DevelopandimplementacomprehensivechangeandadoptionstrategytopromoteandenforcethedevelopmentanduseofeHealthsolutionsforbothpublicandprivateinstitutionsatalllevels.
PolicyStrategy2:DevelopandimplementacomprehensiveBusinessProcessRe-EngineeringstrategytotaketofacilitatetheuptakeofeHealth.
PolicyStrategy3:DevelopandimplementacomprehensiveeHealthTransitioningstrategytotakecareofrapidchangesintechnology.
7.12.4 ResponsibilitiesandProcedures
(a) TheMoHinconjunctionwithMoICT,NITA-UandHealthProfessionalCouncilshalldevelopandenforceeHealthChangeandAdoptionStrategy.
39
(b) TheMoHshalldevelopandenforceaneHealthBusinessProcessRe-EngineeringGuidelines
(c) MedicalPractitionersandManagersshallchangetheirBusinessProcessesinlinewiththeguidelines
(d) TheMoHinconjunctionwithMoICT,NITA-UandtheHealthProfessionalCouncilsshallconductcomplianceassessmenttotheBusinessProcessRe-EngineeringGuidelines.
7.13 LegalandRegulatoryFramework
7.13.1 Objective
Thispolicyaimsatputtinginplacetherelevantrules,laws,regulationsandproceduresthatshall facilitate the smooth implementation of eHealth together with mechanisms ofenforcingthem.
7.13.2 Scope
ThepolicyappliestoalleHealthStakeholdersincludingPractitionersbothprivateandpublic,CSO,GovernmentMDAs,HealthcareManagersandClients.
7.13.3 PolicyStrategies
PolicyStrategy1:AlegalandregulatoryfunctionshallbeestablishedintheMOHtooverseethelegalandregulatoryrole,enforcement,audit,complianceassessmentandreviewworkingcloselywithrelevantministriesandRegulatoryBodies.
PolicyStrategy2:TheexistinglegalandregulatoryframeworkrelatedtoeHealthshallbereviewedandmakerecommendationsonrequisiteimprovements.
7.13.4 ResponsibilitiesandProcedures
(a) TheMoH,MoICT,NITA-UMoJCAandtheHealthProfessionalCouncilshallensurethattherelevantlawsandregulationsareinplacetoenabletheimplementationofeHealth.
(b) TheMoHshallenforcethenationallawsandregulationsforlicensure,liabilityandreimbursementforeHealthpracticeandeHealthsystemsandapplications.
(c) TheMoHshallDevelopandimplementappropriatemonitoringandevaluationguidelinesforlegalandregulatoryframeworkforeHealth.
(d) TheeHealthRegulatoryFunctionasestablishedbyMoH,shallmonitorcompliancetotheLegalandRegulatoryFramework
40
8 PolicyImplementation
8.1 Framework
RecognizingthemultifacetednatureofICTinHealthissuesandthefactorsthatimpactsonthem,theMoHisconsciousthatthesuccessfulimplementationofthispolicyandachievementofitsobjectivesisthroughpartnershipwithotherMDAs,thePrivateSector,CivilSociety,academiaandDevelopmentPartners.Consequently,theparticipationandinvolvementofallkeystakeholdersiscrucial.Inaddition,theMOHandkeyStakeholdershastocontinuetodevelopthenecessarycapacityandinstrument,suchasindicators,tomonitortheimpactofthepoliciesonsocialandeconomicdevelopment.MindfulofthefactthattheICTindustryitselfisoneofthemostdynamicsectorsnecessarymechanismswillhavetobeputinplacetoensurethatthepoliciesarereviewedfromtimetotime.Enhancingofknowledgeandinformationflowsisoneoftheeffectivetoolsthatwouldbeusedtostimulateinnovationandfacilitatefine-tuningofthepoliciesforthemaximumimpactandresponsivenesstochangingtechnologicalandcompetitiveconditions.TheNationaleHealthPolicyimplementationshallbealignedwithtotheNationalHealthPolicyandNationalHealthSectorDevelopmentPlan.TheimplementationshallbethroughtheeHealthStrategyandeHealthInvestmentPlan.TheseplansshallbeimplementedthroughintegratedeHealthprojects/programswhichshallbebasedontheeHealthEnterpriseArchitecturenationalstandardsandshallconstitutetheNationaleHealthProgram.
8.2 PolicyDisseminationandSensitization
TheDisseminationandsensitizationshallbetheresponsibilityoftheauthor.ThedisseminationisaimedatensuringthatallStakeholdersknowthepolicyandtheirrespectiveresponsibilities.ThePolicyshallbedisseminatedthroughthefollowingchannels
(a) ThePolicyshallbesharedwithshareholderselectronically(MoH,GovernmentPortal,MoICT,NITA-Uportalsandwebsites.)
(b) ThroughWorkshopsandAwarenesscampaignsandothercommunicationchannels
8.3 Planning,Budgeting,ResourceMobilizationandInvestment
ThePlanningforpolicyimplementationshallbethroughtheeHealthStrategyandeHealthInvestmentPlan.
41
8.3.1 PlanningandBudgeting
a) Establish and enforce mechanisms for effective collaboration and partnership in theplanning, organization and management of all eHealth projects and programs at alllevelsofthehealthsystem
b) Promote public private partnerships, pooling of resources by all partners andinternationalcollaborativeprojectsinresearch,educationandtraining,ineHealth
c) DevelopandimplementeHealthinvestmentplan
8.3.2 ResourceMobilization
a) IntegrateeHealthbudgetintothenationalhealthplansandbudget.b) Mobilize resources for thedevelopmentand implementationof standardizedeHealth
systems and solutions for electronic health information sharing and electronic healthservicesdelivery.
8.4 Monitoring,EvaluationandComplianceAssessment
MonitoringandevaluationwillbeperformedtheextenttowhicheHealthhasbeenimplementedandspecificallytocheckforcompliancetothesetstandardsandregulations.
8.4.1 MonitoringandEvaluation
SystematicmonitoringandevaluationoftheeffectivenessofthenationaleHealthpolicyshallbeconductedtoensureitisreallydealingwithproblemsitwasdesignedtosolve.Learningfromexperienceofwhatworksandwhatdoesnotandbuildingonthelessonsbackintothepolicyreview.MonitoringandevaluationshallbeplannedandexecutedwithintheexistingoverallMOHnationalmonitoringandevaluationarrangement.ThespecificmonitoringandevaluationprocessesforeHealthactivitiesshallbealignedwiththenationalapproachandshallincludeeHealthsubjectexperts
Themonitoringandevaluationframeworkshallfocusontheoutcomes,impact,andlevelofchangeanticipatedusingamixtureofquantitativeandqualitativeindicators.M&EeHealthindicatorsandtargetstobemeasuredshallbedeveloped.Theyshallensuremonitoringandevaluationofprogressoverthedurationoftheimplementationplan.Monitoringandevaluationtimeframesshallbealignedwiththeimplementationphasesdefinedintheimplementationplan.HoweverperiodsofveryhigheHealthactivitymayrequireclosermonitoringofparticularindicators.Indicatorsshallalsobelinkedtotimeframesformeasuringotherhealthoutcomeswherepossible(forexample,inthenationalhealthsystemreportingprocesses)toshowthecontributionofeHealthtotheseoutcomesandavoidcreatingseparatereportingprocesses
8.4.2 ComplianceAssessment
AComplianceAssessmentMechanismshallbedeveloped,communicatedandcompliedto.FurthermorethecompliancestallbedonethroughtheeHealthStrategy.
42