Improving Chronic Disease Outcomes in Rural Areas in Africa through E-Health Programmes; an Examination of Barriers, Facilitators and State Policies (Dissertation Sample)

Improving Chronic Disease Outcomes in Rural Areas in Africa through E-Health Programmes; an Examination of Barriers, Facilitators and State Policies: A Study of Kenya.
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Abstract
The purpose of this project was to examine the possibility of improving chronic disease outcomes in rural areas in Africa through e-health programs. In this case barriers, facilitators and state policies were explored with Kenya being the area of study. The methodology used to collected information for the research covered primary and secondary data; primary data was collated through surveys, questionnaires and structured interviews. For the secondary data information was accessed from sources such as related research, books, newspapers, encyclopaedias among others. It was concluded that despite having few hospitals and limited technology, rural Africa had the potential to successfully run e-health programs and reduce the spread of chronic diseases. It was recommended that electronic health services be applied over a period of time to enable smooth integration, governments and hospital administrators work together with various stakeholders to implement electronic health in rural Africa, and local area networks, as well as wide area networks should be set to facilitate the team work between hospitals. 
Keywords: e-health, electronic, chronic diseases, barriers, state polices, and facilitators
Chapter 1: Introduction
1.1 Definition of E-Health
The term e-health (electronic health) is broadly used by many individuals, professional bodies, funding organizations, and academic institutions. Oh et al. (2005) claim the term has become an accepted neologism despite the lack of an agreed definition. Eysenbach (2001) also observes that many people are familiar with the term e-health, but only a small number have come up with a clear definition of the term. According Esyenbach (2001), the term is used to characterize not only “internet medicine”, but also virtually everything that is related to computers and medicine. Esyenbach (2001) argues that the term was first created and used by industry leaders and marketers rather than academicians; these used the term in line with other “e-words” like e-business, e-solutions, and e-commerce among others. The emergence of the internet presented opportunities, as well as challenges to the traditional healthcare information technology industry and the introduction of a new term to address these issues seemed appropriate.
According to the World Health Organization (WHO) (2015), e-health is the transfer of health resources, as well as healthcare by electronic means. WHO (2015) observes that e-health is encompassed in three main areas:
a) Delivery of health information, for health professionals and health consumers, through the Internet and telecommunication;
b) Using the power of IT and e-commerce to improve public health services; for example, through the education and training of health workers;
c) The use of e-commerce and e-business practices in health systems management. Gibbons (2007) defines e-health as the use of emerging interactive technologies such as the internet, interactive TV, interactive voice response systems, kiosks, internet-enabled cell phones and personal data digital assistants to enable the improvement of health, as well as healthcare services. Gibbons (2007) believes this definition is widely used as it accommodates e-health applications for patients and providers, and more infrastructure-related programs; for instance, the electronic medical records (EMRs) and personal health records (PHRs). Regardless of the many different definitions of e-health, its introduction represented the promise of information, as well as communication technologies with the purpose of improving health and healthcare system.
1.2 E-Health in Africa
Access to healthcare has been a major challenge for a good number of years. This is, especially, the rural regions of Africa. These regions have few available healthcare services that people can access for healthcare services. Geographic remoteness and high levels of poverty are essential factors that impact healthcare services in rural Africa. The Commonwealth (2015) claims e-health offers possibilities for addressing most of these challenges. According to The Commonwealth (2015) e-health strengthens health systems and addresses the public’s health priorities as it has the potential to increase the effectiveness of health systems, as well as improving access, especially, in the remote regions; for marginalized or excluded populations, the elderly and people with disabilities. E-health can be used to improve quality of service and reduce costs of healthcare by reducing redundancy, as well as duplication, and introducing the economies of scale (eHealth Africa, 2015). For this purpose, the Commonwealth began focusing on assisting countries to promote the exchange of e-health status, especially, among its members. In this case, a methodology and templates for the policy and strategy of e-health were developed (The Commonwealth, 2015).
As a result, e-health policy and strategy training were delivered in Eastern and Southern Africa, which resulted to the drafting, reviewing, as well as updating of policies and strategies for e-health; in addition to the development of work plans and engagement with relevant stakeholders, decision and policy makers at the regional level (eHealth Africa, 2015). The Commonwealth (2015) notes that at the national level, it resulted to the successful sourcing of additional resources from other partners with the purpose of developing e-health strategies; for example, the Kenyan Government officially launched its own e-health strategy. The Kenyan government has since worked hand in hand with the Commonwealth Secretariat to share their experience in the Southern African regions and to offer assistance for the Southern African Development Community country teams to draft and finalize their strategies and policies for e-health (The Commonwealth, 2015).
1.3 Chronic Diseases in Africa
Aikins et al. (2010) observe that Africa faces an urgent, but neglected epidemic of chronic diseases. According to Aikins et al. (2010) some African countries experience cases of hypertension, stroke, cancer and diabetes that cause great numbers of adult medical admissions, as well as deaths in comparison to communicable diseases like tuberculosis or HIV/AIDS. Aikins et al. (2010) claim Africa faces a burden of infectious, as well as chronic diseases. Infectious diseases account for about 69% of deaths on the continent; however, chronic diseases tend to have higher death rates compared to infectious diseases. Aikins et al. (2010) argue that in the coming years, there could be a significant increase in death rates from diseases such as cancer, cardiovascular disease, diabetes and respiratory diseases. In Africa, health systems are weak and national investment in healthcare service delivery and training continue to priorities parasitic, as well as infectious diseases (Aikins et al., 2010). This is because a good number of health systems in Africa are underfunded and under-resourced; these struggle to cope with the cumulative burden of infectious and chronic diseases (Aikins et al., 2010). Chronic diseases project world Health Organization (WHO) (2005) notes 23% of deaths in Africa. Estimates from WHO (2005) reveal in the next ten years the total number of deaths caused by chronic diseases in Africa will increase causing about 28 million deaths.
This means that cases of chronic diseases will increase by 27% and most deaths will be from diabetes, which will have increased by 42% (WHO, 2005). The following figure is an extract from WHO (2005) showing projected deaths among all ages in Africa caused by diseases.
Figure 1.1 Projected Deaths by Cause, WHO Africa, 2005


As observed in the figure, chronic diseases are the second major causes of deaths in Africa after communicable diseases. Examples such as respiratory disease, diabetes, cancer, cardiovascular disease among other chronic diseases make up for 23% of deaths in Africa (WHO, 2005). Populations affected by chronic diseases in Africa are urban and rural, wealthy and poor, the old and the young. According to Aikins et al. (2010), chronic diseases have been attributed by change in behavioral practices; for instance, sedentary lifestyles, diets in high saturated fats, sugar and salt. These are linked to structural factors like industrialization, increasing food market globalization, and urbanization (Aikins et al., 2010). The issue of chronic disease in Africa continues to be a matter of concern, as chronic diseases tend to increase throughout Africa. For example, South Africa showed a significant increase in chronic diseases among its provinces as observed by Adonis et al. (2013) in the South African Medical Journal, which provides an overview of their research on chronic diseases in Africa. The extract below shows provincial screening rates in South Africa of various types of chronic diseases. This is an example of the increasing rate of chronic diseases in African countries.
Figure 1.2 South Africa’s Provincial Screening Rates as of 2011


Figure 1.3 deaths caused by chronic diseases in high, middle and low-income countries


The condition of chronic diseases tends to worsen and it is estimated that by the year 2030, a great number of African individuals will be having chronic disease complications. Figure 1.3 above from CSIS (2015) shows the difference of t...