eHealth strategy

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THE UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH AND SOCIAL WELFARE
eHealth in Tanzania
National Strategic Plan

Final Draft


FOREWORD
This eHealth Strategy is intended to lay a solid foundation for making the best possible use of Information and
Communications Technology (ICT) resources in Tanzania’s Health and Social Welfare sector. This Strategy
will modernise and increase the whole sector’s performance. For example, the role of ICT in supporting
distance-education, training (both pre-service and in-service) and research, offers tangible benefits given the
remoteness of many parts of Tanzania where rural health service facilities are located. Further, eHealth will
help trigger a wealth of new opportunities through sector-wide empowerment, collaboration, research and
innovation.
The Strategy is built around the opportunities and the specific constraints of Tanzania, without blindly
imitating examples in the industrialised countries. It envisions a health system built by Tanzanians for
Tanzanians, and that must above all perform sustainably within Tanzania. For this reason, the eHealth
Strategy was crafted by local stakeholders as lead resource-persons, with consultants taking only the role of
facilitators. Also, this Strategy was developed through mapping each of the Strategic Objectives of Tanzania’s
Health Sector Strategic Plan Phase III (HSSP III, 2009-2015) against the best practices for implementing a
network of ICT systems.
While the focus of health and social welfare is on people, the focus of ICT is on technology. The
implementation plan for the Strategy builds a platform for people and technology to best complement each
other and advance together. The approach is based on 12 constituent Programme Areas, whose gradual roll
out can accommodate adjustments along the way. This allows flexibility and gradual progress, with
independent cycles of iteration within and between each of the Programme Areas, while any newly emerging
priorities may be assimilated cohesively. Thus, although an initial twelve Programme Areas are proposed,
their number is not set in stone. During the course of implementation, it is likely that these Areas will evolve
in response either to evolving sectoral or social needs on the side of people or to evolving technological
opportunities on the side of ICT. The implementation teams are mandated to take such changes into
consideration.
The aspirations of the eHealth Strategy are articulated in the National Health Policy (2007) and the Primary
Health Care Service Development Programme (known by its Swahili acronym MAMM, 2007). Both these
and other related strategies and/or programmes (including those listed under Section 2.4 of HSSP III) are
contextualised by the Health Sector Reforms of 1994, with an initial emphasis on improvement of access,
quality and efficiency of health service delivery. So this eHealth Strategy brings powerful new tools for
implementing those long-desired improvements at last. Therefore the Ministry of Health and Social Welfare
commits to implement this eHealth Strategy and urges other stakeholders to share this commitment.
ICT is basically a means of uniting people and knowledge easily, reliably and cheaply. Ultimately, the
successful deployment of this Strategy is going to depend upon improved performance in health service
delivery by people to other people, and not the numbers of shiny gadgets deployed. At the end of the day, the
thrust of the Health and Social Welfare sector is to improve the well-being of the people of Tanzania.
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ACKNOWLEDGEMENTS
This eHealth Strategy will support and accelerate ongoing reforms in the health and social welfare sector of
Tanzania. However a key challenge to reform is willingness and ability to learn and embrace new ways of
working in a collaboratively networked environment. To achieve this, it is necessary to first reject the widespread
attitudes that lead to remaining in isolated ignorance for fear of the future’s unknowns.
It is true that there are unknown risks and costs in initiating change in a broad-based manner such as this.
However, these cannot possibly outweigh the well-known risks and costs of not initiating that change, or of
allowing ungoverned change to emerge spontaneously as is happening in many areas right now. The cost of
not doing anything is measured in mortality, morbidity and lost productivity. And the cost of ungoverned
change further adds the cost of well-intended investments into numerous small-scale projects, which fail to
yield tangible results at the national level where they need to be interconnected to share knowledge, resources
and priorities. This sharing would then go beyond the projects and also embrace while receiving support
from the practitioners in the field as well as the general public, for whom the benefits can be very tangibly
perceived. We are therefore grateful to all who took part in the development of this Strategy, for introducing
change in health sector Reform.
The participatory process of developing this strategy was spearheaded by a Steering Committee of 23
members appointed by the Ministry of Health and Social Welfare. They held five formal meetings plus
numerous informal sessions and technical consultations in a process launched with an inaugural meeting in
November 2009. For the consultations, a wide variety of additional resource persons were co-opted, including
specialised local stakeholders from the Public, Private and Non-Profit sectors, who were experts in healthrelated
fields and others in ICT fields. And the Strategy drafts were finalised after receiving inputs at a
Ministerial Management Meeting consisting of senior officials from the Ministry of Health and Social Welfare.
To each of the contributors to this eHealth Strategy, as well as to those who assisted and supported them, we
send our profound appreciation.
Specific appreciation is here given to the International Institute for Communication and Development (IICD)
of The Hague for support provided and for helping to assure that the preparatory process of this Strategy was
both participatory and inclusive. Specific appreciation is also given to the eHealth Steering Committee, ably
chaired by Dr. Godwin Ndossi, Managing Director of the Tanzania Food and Nutrition Centre, for their
guidance, inputs and intense efforts throughout the process of developing this Strategy. All members of the
Steering Committee were instructed to participate in person, while being free to co-opt further resources as
needed, which they are hereby also congratulated for doing. This was necessary to ensure that the resultant
Strategy is fully owned by its key stakeholders, and thereby receives unequivocal commitment towards
implementation. It is this ownership and commitment that the Ministry now takes forward to prioritise and
budget the implementation of the eHealth Strategy, while establishing its institutional prerequisites and
subsequently to ensuring that appropriate monitoring and evaluation of its execution will be performed.
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EXECUTIVE SUMMARY
(and key messages)
The Health Sector Strategic Plan Phase Three (HSSP III, 2009-2015), currently being implemented,
aims to reinforce the health and social welfare systems in Tanzania. It deploys twelve Strategic
Objectives that also include a set of cross-cutting issues. Together, these Strategic Objectives
contextualise this eHealth Strategy, which has as its primary purpose to accelerate the delivery of all
the Strategic Objectives, while also laying a foundation for future progress in the structured use of
science and technology to improve health and social welfare services in Tanzania.
HSSP III explicitly recognises that Information and Communications Technologies (ICT) can greatly
contribute to the success of its own implementation. There is no question that ICT helps to relieve
problems that are currently difficult to solve by continuing to rely exclusively on past methodologies.
Many examples exist across the world of successful ICT applications that have helped
overcome problems in a structured manner, yielding spectacular improvements in performance. In
Tanzania, a number of ICT applications in health have already shown great potential, especially
now as connectivity through mobile phones is available, as the costs of computers are still going
down, as the Government is actively promoting the deployment of ICT across the country, and as
off-grid energy sources become easier to find and afford.
In particular, at section 4.12.3, the HSSP III states “ICTs have a positive impact on health care if
applied effectively”, as being justification to formulate an ICT strategic framework and implementation
plan. That statement succinctly underlines the need to carefully structure and stimulate the
development of ICT in the health and social welfare systems, as of an early stage, in order to ensure
that the wide array of required systems may be of the right standards while all being able to
interface appropriately with each other at different levels – for example linking together health
facilities, insurance schemes, pharmacies, research centres, and Local Government Authorities.
It is noteworthy that Tanzania is preparing to implement an eHealth strategy in an environment
characterised by a scarcity of key resources. The strategic adoption of ICT tools will necessarily be
shaped neither to replace nor to overwhelm, but rather to support and extend the capacities of the
preciously few existing resources, be they human, financial or technical. In the unique context of the
health sector, ICT is increasingly becoming used as a all-round tools for carrying out diagnosis,
analysis, therapy and research, in addition to being a generic tool for administration and
management, as occurs elsewhere.
At present, Tanzania has the unique comparative advantage of being able to define in advance how
those tools will function and interact, thereby ensuring reliable efficiency for the service providers
and beneficiaries alike. This, in the long run, is a considerably cheaper approach than that of later
on having to integrate a long legacy of stand-alone tools - as is happening in the more advanced
countries. The future cost of integrating would come to be counted among the costs of continuing to
not have a strategy for eHealth, in addition to what it may cost society and the economy by failing to
accelerate the desired quality improvements of health service delivery.
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The eHealth Strategy therefore addresses the challenge of creating a conducive environment for
cost-effective ICT solutions in health and social welfare services, targeted to HSSP III’s performance
goals and aimed at generating substantial benefits in alignment to the principles and priorities of the
policies behind it. And as HSSP III is action-oriented, the eHealth Strategy also has to provide clear
guidelines and indicate the mechanisms for its own implementation. Therefore, in a broad
participatory process, the main stakeholders, guided by a Steering Committee, have defined all the
main courses of action based on HSSP III Strategic Objectives, and have derived from it a shared
vision on eHealth and Social Welfare as follows:
Health workers and beneficiaries empowered with ICT to leverage
change and performance of the health and social welfare systems
The immediate result areas agreed upon for that vision are as follows:
· Institutionalize decision-making based upon reliable data;
· Facilitate and capacitate health and social welfare workers through ICT applications;
· Empower health clients (patients, communities and providers) with health information
and knowledge;
· Interlink all stakeholders and different levels to enable better ways of working and
sharing of information (by evolving information infrastructure
· based on open standards and interoperability).
The future is in small hand-held devices that are increasing being used for all kind of applications
(data collection, tele-medicine, eLearning etc.), with both decentralised services and centralised data
warehouses and support points. The main courses of action are organised in 12 programme areas
which focus on the following intended outcomes:
1. Negotiation of low-cost connectivity, the gradual expansion of infrastructure, and the
development of the ICT support structure addressing the needs of eHealth.
2. Generation of reliable data by health facilities and other organizations to improve their own
management and compilation of data for the HCCP, including disaster management.

East Africa Public Health Networking Project

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