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INTERVIEWThe E-Health Connection: Information And Communications Technology And The Developing World
PROLOGUE: Sophisticated information and communications technology in health care—sometimes dubbed "e-health"—is no longer a futuristic fantasy for the developing world. In low and middle-income countries, there’s growing use of everything from electronic health records to mobile phone–based systems of ensuring drug adherence. The challenge is to optimize the use of these technologies in ways that translate into gains in fighting disease and improving population health. For four weeks at its famed conference center in Bellagio, Italy, last summer, the Rockefeller Foundation convened representatives from nearly forty countries—international policymakers, private-sector players like Intel and Microsoft, and donors—to draw up a roadmap for meeting that challenge. By the conference’s end, they had contributed to a Call to Action in the areas of e-health policy and agenda setting, fostering collaborative networks, and building capacity and knowledge. Participants agreed on key objectives, including the creation of a global compact on e-health; promoting person-centered, integrated, and interoperable systems; establishing a "virtual" entity to test e-health applications; and fostering many more public-private partnerships to push e-health applications forward in the developing world. As one enthusiastic participant, Merceline Dhal-Regis, chief medical officer of the Ministry of Health, Bahamas, put it: "E-health provides a vehicle for delivering on the promises of the [Declaration of ] Alma Ata thirty years ago"—where primary health care was identified as a critical means of advancing health worldwide. At the foundation’s invitation, Health Affairs’ editor-in-chief Susan Dentzer participated in the final week of the conference. The special guest that week was President Paul Kagame of Rwanda, the East African nation that is still recovering from the horrific 1994 genocide. President Kagame spoke of his nation’s accomplishments in e-health to date, including its success in using TRACNet, a mobile phone–based system that allows tracking the use of anti-AIDS drugs through text messaging. President Kagame also identified future goals for his nation, where per capita annual income is an estimated $260 and growing. Both broadband wireless coverage and a national fiberoptic network are set to be in place throughout Rwanda by the end of 2009. The nation also plans to be the first among the countries participating in the U.S. Global AIDS Initiative, or PEPFAR (the President’s Emergency Plan for AIDS Relief ), to create a national HIV-AIDS patient registry. Dentzer sat down with President Kagame and Rockefeller Foundation president Judith Rodin to discuss the future of e-health in the developing world and the foundation’s role in moving it forward. The following contains excerpts from that conversation.
Susan Dentzer: President Kagame, welcome. You’ve said that Africa cannot defeat poverty unless it addresses the precarious state of health across much of the continent. How will e-health enable Rwanda to address HIV, AIDS, malaria, and other preventable diseases, as well as a probably increasing amount of other chronic disease in the future?
President Paul Kagame:
Information and communication technology is an "enabler"—it provides an enabling environment for efficient delivery of social and economic services. It makes a lot of sense to therefore focus on e-health. An example of an e-health technology we are already using is TRACNet, developed as a partnership with Voxiva and Dentzer:Kagame:Dentzer:Kagame:
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