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Search | What's New?| Site Map | Discussion Lists Regional Information Infrastructure Development in Africa : Opportunities and Challenges for the Health Sector Lishan Adam Economic Commission for Africa, P.O.Box 3001, Addis Ababa, Ethiopia Tel. +251 1 514534 Lishana@hotmail.com, adam2@un.org Abstract Information technology is being increasingly used in the health sector. Basic applications of information and communication technologies to the health sector include electronic medical records, hospital information systems, the setup of Intranet for sharing information among institutional and individual participants in health sector, the use of public networks such as Internet to distribute information, health decision-support expert systems, the provision of remote diagnostics via tele-medicine, and community health information system for local, regional and national health planning. Although the health sector is still far behind in applying new information technologies, recent developments in the Internet and WWW content have at least prompted the need for connectivity to exchange information on health in Africa. The opportunities to be gained from investment in new information and communication technologies are wide and diverse. Investment in information and communication technologies in the health sector in Africa could complement basic health services provision. Opportunities include health administration enhancement, health sector connectivity, and decision support system for curative and preventive health improved distribution and reduced cost of medical supplies, etc. However, the application of information and communication technologies in the health sector will continue to face challenges from weak infrastructure and resources and resistance due to lack of awareness. These challenges cannot be countered by the health sector alone but require coordination among various sectors and a consistent national framework that promotes the application of information and communication technologies, content development, human resources development, communications and computing infrastructure. It also demands the introduction of medical informatics to medical research institutions throughout Africa so as to build a corps of skilled champions that utilize new technologies, carry out ICT research based on local needs and act as evangelists of the new technologies. This paper reviews the opportunities, challenges and networking infrastructure needs of the health sector in Africa. I. Introduction Rapid growth has been achieved both in healthcare services and communications in developed countries in recent years. Communication has become the underlying pillar for successful healthcare delivery. Physicians and hospitals can no longer operate in isolation. The lines between healthcare delivery, research and health services use have been blurred towards achieving healthcare at any place, anywhere and anytime. Underlying this is a change in attitude from health care to the concept of health itself, including improvement on key determinants of health, such as socio-economic conditions and education about healthy lifestyles [1]. On the other hand developing countries continue to suffer from major health threats. The challenges especially in Africa are tremendous - ranging from epidemics, spread of infectious diseases, high level infant and maternal mortality, low level of life expectance and limited healthcare facilities. These have put pressures on governments to focus on increasing the availability of health care with stress on preventive medicine, training of more doctors and health attendants, constructing health facilities and promotion of national capacity in health research. These priorities of governments are rational and obvious. Indeed, such priorities are more crucial for policy makers and health administrators than investment in information and communication technologies. Although it seems insignificant compared to the massive needs in meeting health demands, investment in information and communication technologies in the health sector could complement the priorities cited above. In fact a very small amount of resources is needed to improve health communications. Computers and modems cost more than hundreds of syringes. However, the cost of not using information and communication technologies in the health sector is dramatic. The opportunities to be gained from investment in new information and communication technologies are wide and diverse. These include [2]:
However, developing countries, especially those in Africa, have not been able to benefit from new information and communication technologies in the health sector. Apart from difficulties in reconciling priorities, the technological and infrastructural development in many countries remains a great hindrance to optimal application of communications in the health sector. In many parts of Africa access to an ordinary telephone is a challenge. Africa has only 2% of the world telephones but 12% of the world population. By contrast Latin America has 5% of world's telephones and 8% of its population; Asia has 13% of the world’s lines and 57% of the world’s population. Telephone density in Africa ranges from 1 phone for 1250 people in Democratic Republic of Congo to 1 telephone for 3 persons on the small island of Reunion. Some countries such as Angola, Democratic Republic of Congo, Ethiopia, Liberia, Madagascar and Somalia have shown negative growth rates in telecommunications. The waiting lists are also disturbing. One has to queue for over ten years to get a telephone in Algeria, Eritrea, Ethiopia, Lesotho, Malawi, Mozambique, Sao Tome & Principe, Sierra Leone and Tanzania. It is safe to say that 75% of Africans have never made a telephone call. Fax and other electronic facilities are generally unavailable to the majority of health workers. Figure 1. shows the nature of network density in Africa. This excessive demand for communications in relation to supply is matched with ample interest in local and foreign private sector investment. The liberalization of the telecommunication sector is occurring in some countries in Africa driven by the World Trade Organization, new accounting rates and pressure of donor agencies. Undoubtedly this will improve the situation in many countries, since the telecommunication sector is often the most important sector and the major revenue base. Longstanding practices and the institutional setting of incumbent telecommunication companies have also continued to hinder the development of telecommunications sector. The obstacles to the advancement of communications in Africa are not technology or lack of investment. A considerable effort in expanding the African telecommunications is underway through a number of infrastructures building projects. The most notable one is the AT&T Africa One that aims to put fiber optics links around Africa. The South African Telekom South Africa-Far East (SAFE) in collaboration with Malaysian Telecom plans to lay fiber optic cables between the two countries with various spurs. Across the Mediterranean and Red Sea SEA-ME-WEA 3 has been laid to link Egypt and Djibouti to Western Europe and South East Asia. RASCOM has advanced plans to launch an African satellite. Cellular as well as VSAT networks are expanding. There are (menu-full) projects to chose from. The problem in African telecommunications remains the largely monopolistic and non-enabling policy environment, declining social and physical infrastructure, continuing political unrest and continuous turnover of policy makers - thus turnover of attitudes towards development. Fig. 1.Teledensity map of Africa
Based on: ITU: African Telecommunications Indicators, 1997 The low-level computerization in institutions in Africa is the second largest problem.. A typical institution has a small collection of out of date, standalone computers in different departments. The high price of equipment relative to available resources means that the majority of institutions are underdeveloped in use of computers and networks. 286 based DOS machines are still in use in many parts of Africa. Although these may be put to good use, support and maintenance are often unavailable. Many local suppliers are relatively over-taxed, thus local prices are often exorbitantly high as compared to street prices in developed countries. Obtaining high quality support and maintenance remains the major issue as technology advances and the skills to catch-up often remain the same. Other challenges facing the computing environment in Africa include:
The third major problem is lack of organized content for the health sector. The low status of health information system can generally be attributed to the socio-economic situation of the region. The World Bank classifies thirty countries in Africa as the least developed countries of the world, and 36 countries as low-income countries. Twenty countries had per capita income lower than what they had 20 years earlier, and budget deficits continue to increase. Unemployment and scarcity of jobs are prevalent in most of the countries. In some countries the literacy rate has begun to stagnate or even to drop. The Gross Domestic Product (GDP) per capita in many Africa countries reflects a situation as disturbing as that of network density. Those countries with lowest telephone densities are those with lowest GDP per capita (Fig 2. shows the GDP map of African countries). The situation in others is exacerbated by civil war. Under such conditions it is essentially difficult to build an information infrastructure for the health sector. Fig 2. HDI Map of Africa
Based on: UNDP Human Development Report, 1997 Other difficulties are pertinent to health practitioners and health institutions in Africa. First, the majority of practitioners in the health sector seem to be occupied with day-to-day activities of public health services. Remuneration in government hospitals is insufficient to sustain daily lives; often doctors and nurses spend their free time working in attending other private health services or running long hour surgeries. Second, the adoption of new information and communication technologies involves practical issues such as complexity, cost, security, confidentiality and lack of standards. Health care information systems affect the structure, functions and the traditional practices of health services and thus are prone to acceptance problems by physicians and health workers [2]. Experience with Healthnet has shown that health practitioners are more reluctant to absorb new information and communication technologies as compared to their counterparts in other fields and sectors such as pure sciences (e.g. chemists); Third is the lack of awareness of the new developments in information and communication technologies. While medical knowledge is expanding and changing at unprecedented rates, health workers often are not aware of new advances such as evidence-based medicine or medical informatics. One seldom finds workshops or awareness seminars being organized for the health community on new information and communication technologies. Coupled with the busy schedules of many health workers and the closed nature of medical practices, the concept of information and communication technology has yet to spread in health institutions in Africa. Health workers in developing countries require urgent actions to enhance the spread of medical knowledge via communications. More than 360,000 articles are published yearly in medical journals but their diffusion is very slow [3]. Health workers in developing nations require substantial amounts of information and communication to carry out a wide array of diagnosis do not have time and resources to access it. The average medical library in the United States has 3,000 journals in its collection - many African libraries often have less than 30 titles! Lack of communications is also a threat for dissemination of local knowledge. Many of the journals published in Africa are not included in larger indexes because of requirements of frequency of publication and length of time for unbroken publication. Some of these journals have not been able to meet such standards [4]. The need to increase access to communication and information technologies for health workers in Africa is becoming very urgent.
II. Opportunities and Challenges in the application of information and communication technology in the health sector in Africa A glance at the literature on ICT application in the African region shows that the health sector is greatly behind compared to other sectors. Recent analysis of the use of information and communication technologies in health sector in Africa by the International Development Research Center (IDRC) depicts a gloomy picture [5]. Regional initiatives are few. The majority of these are donor driven. Although donor investments have contributed to an extent, dependency did not help to sustain projects or to reap the expected opportunities for the health sector. Some feel that supports to the health sector without local involvement and local demands and long-term goals has led to a negative impact. Yet the low cost and increasing power of information and communication technologies have created opportunities in Africa to adopt them even under severe socio-economic situation. Fifty countries in Africa have already established direct Internet connections. Plans are already in place in Eritrea, Somalia and the Republic of Congo [6]. Connecting to the Internet alone does not mean much in terms of reaping benefits. First, access to the Internet requires the necessary tools and training. At the moment Internet is limited to an elite. The "net density" in many parts of Africa is about 1 access for 10,000 people (fig 3). Analysis shows that those who access Internet are generally well educated and better paid. A survey conducted in 1996 in Zambia, Senegal, Ethiopia and Uganda shows that 90% of those using the electronic mail had a university degree [7]. This raises a question as to how to democratize access to health workers. Fig 3. Net densisty
Based on: Mike Jensen’s survey , http://www3.wn.apc.org/africa There is a wide range of applications of new information and communication technologies for the health sector that could be supported by Internet connectivity. These include the set up of a health information system for health data management, development of local information access networks for the health sector and a repository for community health. The following section provides a glimpse of these ICT applications in the health sector in the region.
Healthcare information systems in Africa Advanced healthcare information systems involve a wide range of electronic medical records and hospital information systems. Electronic medical records cover areas such as electronic systems for the claims processing, imaging systems to scan documents, multimedia technology incorporating data, voices and images for the education and training of physicians, patients, remote diagnostics, speech recognition in transcription, robots in surgery, and kiosks for presenting health information to consumers and employees. Hospital information systems cover admission/discharge and transfer systems, scheduling and registration, electronic patient records, laboratory information systems, pharmacy system, and financial management systems for reporting and billing [8]. In Africa, the majority of these applications is virtually unknown and seems to be remote. Given the low level of skills, nature of focus and infrastructure, some of these technologies are premature for implementation. Besides treatment, health care services in the region have to deal with day to day problems - prevention, promotion and community engagement in health development processes. The main focus should be the provision of technical support and services to people at the village level in a variety of areas such as agriculture, income generation, literacy, fishing culture, etc in order to improve the quality of life that sustains a better health. If healthcare information systems are employed in Africa, they should not only end up holding scheduling and registration data but also support the transformation of the health conditions in rural and under-privileged areas. What is required is communication for human development. The technology that is needed in this context would largely be different from that of developed countries. A simplex two-way radio system, which allows voice communication with the communal health centers and hospitals, a rural radio that disseminate new health practices could make substantial impact on human development. A community telecentre that provides low cost access to multiple technologies (listening center, viewing center, and Internet access center) for the delivery of health services is as vital as electronic medical records and hospital information systems. Considering the current malpractice, there is urgency in creating hospital information systems in Africa. Healthcare is one of the largest industries in Africa. It is complex, cumbersome, paper-based, and fragmented with limited coordination across the board. A quick walk-through a typical African hospital or a health care center exhibits inefficient and poor quality service, that is costly for patients both in terms of life and resources. The recording procedures in most hospitals leave much to be desired. The overwhelming manual system is prone to enormous inaccuracy, hinders the flow of information and impedes the integration of healthcare delivery, research and administration. A clinical information system that covers patient records, bed-side data, lab reports, pharmaceutical receipts, and that caters for demographic and movements between hospitals is required to support needs of a wide range of users. A well-designed hospital information system could have a substantial impact on the cost and quality of service and the health care in the region. Development of Intranet in health institutions in Africa Health institutions in Africa, especially those oriented towards research and development require integrated information strategies built around Intranet or Web based Information Systems (WIS) to encourage knowledge diffusion. Currently the application of information technologies in research institutions is limited. Those available are scattered in small islands of automation. The implementation of Intranet in medical institutions in Africa is still a new area. Some universities and medical colleges have become part of the whole campus-wide information services. Health information is rarely converted to digital form and shared among clinicians, students and researchers. The majority of medical institutions in the region have yet to develop a nascent information system that could emerge as nation wide Web-based information systems. Intranet is an Internet technology implemented on a Local Area Network with connections to the Internet via a security firewall. Intranet would improve access to local up-to-date information resources and could integrate various information services that could be accessed from office, clinics, hospitals, ward, library and home. Building an Intranet involves appropriate technology and organization of content using Internet tools. Intranets run on Internet (TCP/IP) based networks, which typically consist of server machines and client workstations using a mix of platforms (such as Unix, Windows, and Macintosh), applications and network services. The network backbone LAN requires connections, cables, routers, repeaters, and other components. However, the art of the Intranet is not in the hardware and software or the networking protocol but rather in its applications, content and competence of the people running and using it. Medical content that could be available on the Intranet includes medical literature, journals, guidelines and drug information, expert summaries, information on medications and diagnostics testing, institutional policies, work schedules, local library, support services, etc. Much of the content on Intranet could be developed locally and more could be grabbed and cached from the Internet or a CD-ROM server. The real art of the Intranet is in its ability to integrate information from various sources to satisfy needs on various aspects of daily chores of the health workers ranging from institutional activities such as the daily menu to patient care and to advanced research in specific fields. Clearly this is easier said than done. Building a full-blown Intranet is not easy. Health professionals perform a wide variety of tasks, thinking, record keeping, advisory, teaching, research, conferences, etc. that are often difficult to accommodate within a single Intranet. A new field of medical informatics is devoted to study how to deliver well-structured high-quality content based on day to day needs of medical personnel, and is now becoming well established. Medical informatics studies the various information systems and telehealth applications, medical language, coding, standards and classification, medical imaging, simulation, communication systems and protocols for healthcare, intelligent clinical decision support systems, use of expert systems, etc. Expertise in the area of medical informatics is nonexistent in Africa. Although the branch of medical informatics is still evolving it is essential to improve awareness in the area. For Africans to participate in this growing field, it is essential to establish a center of medical informatics in the region to bring doctors close to the opportunities provided by ICTs rather than judging claims of experts on the issues that affect the health sector. International and local support in establishing medical informatics centers are crucial. Remote diagnostics via telemedicine Telemedicine refers to the practice of medicine and the delivery of health care services at a distance. It is an application that connects geographically dispersed health care facilities via communication technologies. It has become crucial to allow medical practitioners in urban areas to access patient records or films, such as magnetic resonance imaging or cat scans of patients in remote and under-served areas to perform remote clinical diagnoses and surgeries, and deliver clinical advice. Telemedicine has become an exciting subject to Africa. Given difficulties in attracting competent health professionals to remote areas and scarcity of clinicians, telemedicine lends itself to the health delivery problems in Africa. Rural communities in Africa continue to suffer from lack of primary care physicians or specialized health care professionals. The chronic shortage of doctors and mid-level practitioners in rural Africa is indisputable. Of the planned health centers in Ethiopia, the majority remained unopened or functions under capacity after a long construction and planning period due to lack of health professionals. The solution to this problem is not easily in sight, although many means have been tried. Encouraging and sometimes forcing physicians to serve in rural communities and encouraging the private sector to provide health services to rural areas has not succeeded. The urgent need for decisions on patient condition, a high- level of anxiety and an absence of viable alternatives for patients in rural communities are day-to-day-facts. Restricted access to medical information often lead to an over-reliance on the judgment of the treating physician regarding health care options. Telemedicine could mitigate these severe conditions in rural Africa. In the developed world telemedicine has been employed in almost all clinical disciplines - in exchange of radiology images (teleradiology), pathology slides (telepathology), or videoconference regarding dermatology examination (teledermatology), and other fields such as psychiatry (telepsychhatry), emergency and trauma management as well as home care and military healthcare. Packets of information, such as patient records, X-rays, or pathology slides, can be sent over the telecommunications link to be stored digitally for review by a specialist. These data can be a simple a text, the primary care physician's notes on an initial examination, or could contain high-resolution images from CT or MRI scans. Advanced telemedicine could employ interactive videoconferencing, which allows patient and doctor to see and hear each other; new devices let physicians listen to a patient's heart, take blood pressure readings, and otherwise thoroughly examine a patient without actual physical contact. Treating more patients at home using telemedicine technologies rather than in the hospital is a new cost cutting trend. Apart from meeting shortages of experts, telemedicine is a two-way educational and diagnostic tool that reduces isolation of clinicians in the field and provides access for academic and research communities in urban areas to problems in rural and under-served areas. Although telemedicine is a well-used field in the developed world and has become cheaper and better, it has not begun to realize its potential in Africa. There have been a few attempts at using telemedicine in South Africa, Mozambique and part of North Africa. Demonstrations of some of the possibilities in tele-radiology and digital microscopic image capture and transmission for making anatomic pathology diagnoses at a distance (telepathology) using low cost technologies are available in South Africa. The implementation of full-scale telemedicine applications requires up front investment in infrastructure, especially a high quality and high bandwidth network. The initial cost of a full-fledged telemedicine application is usually high. This is often cited as the problem that has made its integration into the African health practices difficult. Although the obvious problems of its widespread use are cited as financial, infrastructural and technical, the blocking and hidden difficulties are rather human, organizational and political. These include:
These require adequate training, awareness and demonstration of best practices throughout Africa. The main cause of underdevelopment is often lack of knowledge of the possibilities, especially in the area of democratization of access to the communities. Community health information system for health planning Many of the rural community health systems in Africa suffer from a lack of consolidated, accurate, meaningful and current information on which to base appropriate strategic planning and effective resource allocation. A recent Msc study of the community health information system at Jimma Institute of Health in Ethiopia indicates an overall lack of information on the target population’s social and demographic environment, poor quality, quantity and utilization of data, and lack of timely information on community health [9]. The need for data on community health covering a wide range of subjects such as population statistics, health services and resources, healthcare financing, nutrition, environmental health, school health, etc. is very crucial for strategic planning of rural community health care. Community health information systems have yet to be developed to be integrated with hospital information systems to promote effective healthcare decision making processes in Africa. (v) Progress towards Internet connectivity in the health sector in Africa Access to basic communication facilities has become a fundamental human right. Access to communications by health workers reinforces the human right for better treatment by boosting the quality of medical care delivered to patients. Health workers can now move among office, clinic, hospital, ward, library and home, and have access to the Internet through single, common, cross-platform application. They no longer need to learn the details of Internet protocol. The currency of information on the Internet has also improved. Nevertheless, there have been limited attempts to improve access to the Internet for the health workers in Africa. Isolated cases include institutional subscriptions supported by development aid agencies and individual efforts. One of such attempts is the Healthnet project implemented by SatelLife based in Cambridge, Massachusetts, funded by the IDRC and NEC corporation. Healthnet is being implemented in 20 countries throughout Africa. It was conceived as a means of combating the isolation of health practitioners in the less industrialized world and the lack of information that impedes their work. The network provides email, electronic medical publications, and access to medical databases and conferences. Access to these sources is provided through telephone lines where this is viable. In countries/areas where the telephone infrastructure is unreliable or non-existent, Healthnet uses satellite ground stations. Through a combination of telephone infrastructure and low earth orbit satellite technology, Healthnet has endeavored to facilitate rapid and low-cost communication between health workers in Africa, and between them and their counterparts in the rest of the world. Although its efforts are commendable, Healthnet had encountered considerable difficulties in meeting its broad objective. The lessons from Healthnet applications in some countries in Africa shows that lack of a strategy to train a wide range of users, lack of local champions, inherent technical difficulty of the system, inadequate training of technical personnel, inadequate content for health practitioners, and ownership related issues could hinder health connectivity as much as shortage of funding to implement plans. These problems aside, the introduction of Healthnet in the region could be regarded as a novel first-hand approach to address the problem of communications in the health sector in Africa. Given growing connectivity in Africa, the opportunities are much clearer - thus any connectivity-movement similar to Healthnet would have a better chance of impacting health practitioners in the region. The discussion above shows that the application of information and communication technology in the health sector can be as wide as the sector itself. Neither telemedicine nor Internet connectivity is sufficient. Access to local medical information, community health information, local Intranet as well as advanced application of ICTs such as imaging are all required to provide better health care service in Africa. Improved communication and information access cannot take place without access to information and communication technologies by other sectors such as agriculture, industry, environment, population development, trade and education. On a wider scale this cannot be achieved without overall national networking infrastructure development.
II. Need for Development of national and regional networking infrastructure in Africa Development of a national information infrastructure (NII) is a somewhat an overused term and has become a new area of government attention. It refers to a grand strategy as to how governments harness information and communication technologies for socio-economic development - health being one of the major areas of attention. After the International Telecommunication Union World Telecommunications Development Conference in Buenos Aires in March 1994, the American Vice-President Al Gore proposed the formation of a global information infrastructure. Since then many initiatives and theoretical frameworks have emerged, including in Africa the African Information Society Initiative (AISI). NII requires two important steps - putting NII infrastructure in place and a strategy formulation process. The groundwork for putting NII infrastructure in place involves telecommunications services reform to increase penetration of both multimedia and narrow-band networks, increasing access to computer technology, developing IT skills and knowledge, and strengthening sectoral strategic information systems (applications of ICTs in health falls within sectoral strategic information systems). Strategy formulation processes often involve interesting government and stakeholders, convening workshops to raise awareness, defining priority areas of informatization, securing commitments, and implementation of priority projects. Recent experience of developed and developing countries has made the strategy formulation process in Africa less difficult. African countries have yet to make substantial efforts in infrastructure development to build a working national information infrastructure. Some countries have already begun the strategy formulation process without adequate attention to communication networks and strategic information systems development. It is not clear whether too much strategy could lead to the necessary infrastructure for NII. The focus on formulation of strategies is often prompted by advancing information and communication technology, globalization, development aid agencies and regional initiatives such as African Information Society Initiative. Clearly much groundwork is required to improve infrastructure development while defining strategies. The path to NII strategies in Africa could provide a glimpse on how a combination of infrastructure development and strategies are both essential. NII initiatives in Africa to date could be grouped into three themes:
Table 1. lists progress being made in terms of national information strategy formulation in some countries in Africa.
The above indicates the uniqueness of circumstances of countries. It is apparent that all the countries listed are on a developmental path where they realize the need for NII to advance economic, social, cultural, and political situations. But each country is on its own path of development, and different countries are at different points along their respective developmental path. A combination of the three approaches that emphasize overall national information infrastructure development using the AISI model with private sector playing the leading role, and emphasizing partnership and communication for human development seems to be ideal to meet African countries self-interest wrapped in democratization of access to the poor, children and women. Such emphasis could accommodate the needs for increasing access to health workers and health service users – whose majority constitutes the poor, children and women. IV. Conclusion – need for a national and regional health informatics strategy The foregoing discussion identified challenges and opportunities of the applications of information and communications technologies in the health sector in Africa and argued for overall national information and communications infrastructure development. The status quo approach to development of telemedicine separate from national information strategy may not become successful. Instead, decision-makers need a holistic perspective on a national information infrastructure that can adapt to ever-changeable social realities. Besides a full national ICT strategy, African countries should emerge with a national telehealth strategy to enhance effectiveness and efficiency of the delivery of diverse dimensions of health services. The strategy should cover issues of applications such as telemedicine, improved access to global medical information, medical informatics education, health informatics policy, capacity building and resources mobilization. Since demonstration of best practices is important, the national telehealth strategy should be built on experiences in the region and help to disseminate success stories to others. Thus establishment of national telehealth centers is a necessity. These creation of such centers should be based on availability of seed funds, local support, network infrastructure, content and innovative national plan for telehealth applications. Regional telehealth centers would encourage the emergence of framework collaboration at a regional level. Cooperation in the form of exchanging experience, sharing the cost of new technologies and collaboration on standards has no substititute in Africa. The current climate of regional cooperation in Africa is discouraging. A good example is a survey carried out at Columbia University (USA) http://www.comet.columbia.edu/~nemo/netmap/ that shows that except in South Africa, Tunisia and Egypt, the majority of connections to the Internet are either via Europe or North America. In addition to regional cooperation, the regional centers could contribute to the following:
Although regional centers are important it is essential to mount vigorous actions towards democratizing access to health sector via community centers. Progress to date has shown that community connectivity could lead to culturally informed, stable and prosperous society. Telemedicine is one of the applications that could be integrated into community center applications. Telehealth could contribute to educated and informed population that could maintain their own health. Bringing telehealth to Africa needs reliance on local champions. The Experience of donor-funded projects has shown that technology fails when the applications are only for technology’s sake instead of solving fundamental health problems. Technologies are the agents of change. But activities of people remain the same. Thus telehealth should not be seen as a panacea but as a tool for accomplishing the delivery of improved health services. Using new information and communication technologies to deliver better health services will remain a grand challenge and opportunity for Africa. Reference: CANRIE Inc. (1997). "Telehealth in Canada,". CIEUM, (1997). "Towards Information Society in Mozambique," Anderson, James (1997). Clearing the way for physicians’ use of clinical information system. Communications of the ACM. 40(8) 83-90 Detmer, William and Edward Shortliffe (1997). Using Internet to improve knowledge diffusion in medicine. Communications of the ACM. 40(8) 101-108 Lydia, Levin. The Use of Information and Communication Technologies in the Health sector in Sub-Saharan Africa http://www.idrc.ca/acacia/studies/ir-hlth.htm Jensen, Michael. (1998). Connectivity Status in Africa. http://www3.wn.apc.org/africa/afstat.htm#countries The World Bank. (1998). "Economic Toolkit on the Internet in Africa." Raghupathi, (1997). Health Care Information Systems. Communications of the ACM. 40(8) 81-82 Getachew Hailemariam. (1998). Prototype Community Health Information Retrieval System for Jimma Zone: A Case study of the Jimma Institute of Health Sciences. Unpublished Msc. Thesis. Silvia Balit. (1997). Towards National Communication-for-Development Policies in Africa. http://www.fao.org/waicent/faoinfo/sustdev/CDdirect/CDan0001.htm
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