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Jun 21, 2019

On the subject of e - governance in the health sector: the only game changer (Post 5 / 2019)

Just today, I read one OPED with the title "Reimagining the future" talking about the "changing" landscape of social, economic and political fabric as a result of Information Communication Technology (ICT) revolution everywhere. One paragraph did definitely connect to me to what I have been thinking since a few days earlier about the pervasive influence of ICT on our daily lives for good or bad. The paragraph says, "For Nepali leadership across the government, the bureaucracy, the development community and the private sector who are used to the status quo, it will be a challenge to really wake up to the reality that change (as a result of ICT) is inevitable. Time for a lot of reimagining." The author himself, a dynamic personality, is exploring a better way of doing business along with serious policy studies and continuous dialogue on such issues through Nepal Economic Forum. It is certain, my best guess, he is signaling to Nepalese leadership and thought leaders all across that there are big changes bound to happen in all sphere of our life. With rapid innovations such as automation, AI, big data, cloud platform, and IOT in the field of IT, this is already a reality of which we are starting to see its effects in our day to day activities.

With this thought-provoking article, I did dwell upon the rapid changes in our daily work life, our office spaces or home and the communities all around us. Nowadays, internet service using wireless frequency (Wifi) has become so common that it is in a trend to become a free commodity. Example, we go to a restaurant, the first thing we ask for is wifi internet services and that too free. If the service is not there, then we tend to look for another restaurant. This has become a phenomenon up to a point that the free wifi service is being available even in some remote villages. There was a time when we did not have electricity, TV or even telephone services. Having a radio in a village was such a wealth that we all used to get awestruck. Now, we have all these services at our doorstep and in each office and home. So, ICT is a game changer for rapid transformation in every sector, provided we utilize for efficiency and improve governance in our institutions as well.

With this thought, I browsed our own Nepal Telecom's website to understand what is the state of our telecommunication coverage and its service. We know that the Internet and Communication Technology (ICT) is one area in the field of development in Nepal that has leapfrogged in terms of growth and quality of services. I think this is not an over exaggeration since we can now browse the internet in Mugu or Humla and talk to a friend in the USA. It seems, therefore, Nepal Telecom is working hard to achieve its overall goal "to assist in the socio-economic development of the urban as well as rural areas, as telecommunications is one of the most important infrastructures required for the development." As proof of their goal achievement (below graph), mobile penetration has reached 119 % in 2018 when we compare with 21 % in 2009. We can safely say that ICT is one and the only area that has leapfrogged in terms of achievement compared to other developmental sectors in Nepal.


In a similar rate, internet penetration has risen at a faster rate, which is at 57 % in the year 2017 from 21 % in the year 2012. In addition; Nepal is expected to reach around 79 % internet penetration by the year 2025. In the year 2017, 2.25 million new internet users were added and this means 250 new internet users per hour (Source: 2018 Digital Nepal Framework). However, we need to be cautious that social media use is diverted into productive areas that somehow would contribute in the nation building.




Digital Framework Nepal: 1 - 8 - 80 
With such a strong ground-based on ICT platform, our Digital Nepal framework owned by Government of Nepal has encompassed 8 sectors with 80 digital initiative to speed up socio-economic transformation.  Therefore, I often say that we are in the best time to accelerate the rate of development and lift us from chronic socio-economic stalemate. However, it is wise to say that all these sectors are interrelated and interdependent with each other. One of the fundamental approaches to success in what we do should be "Whole Of Government"  in every effort, rather than a fragmented approach. In that case, Digital Nepal framework (as below) is principally the conceptual framework we need to build on and strive for the best in everything we do now on.



Among these 8 sectors, I would now focus on the health sector. Definitely, we need to first develop technology infrastructure and supplement this platform with a talented and skilled workforce. For this, we need to encourage youths to enter public services and contribute to the nation-building effort. We also need to remember that public services have to evolve and create an enabling environment to retain and attract the younger generation in this sector. Although we have a long way to go before we built a robust health system, there are few efforts already in use such as Health Management information system (HMIS), Logistic Management & Information System (LMIS)Transaction Accounting Budget and Control System (TABUCS). Also, EDCD has subsystem that includes ongoing surveillance for key VBDS such as Malaria Disease Information System (MDIS), EWARS and Kala-azar tracker. In the Family Welfare Division, there is also another ongoing Maternal and Perinatal Deaths Surveillance and Response (MPDSR) activities. In the National TB center, there is too separate dedicated information systems such as Master e - TB registere - TB register for private practitioners and DRTB patient tracking and TB laboratory system. Also, National Health Training Center (NHTC) has established online national training resources.   However, it is also noted by all responsible authorities that we need to activate 2 important information system (1) Human Resource Development Infomation System (HURDIS) and another (2) e - Annual Work Planning and Budgeting (e - AWPB). Among all these separate but interrelated platforms, the most important would be the Smart Health Technology initiative undertaken at MoHP and the key dashboards like Health Facilities Registry, NHSS Result Framework, Routine DQA system and Health Dashboard _ monitoring of health indicators. Now, putting aside all kind of lethargy and procrastination, we need to work together to make the health information system - integrated, robust and efficient. This is one key element in our health system strengthening effort that we need to invest and give the highest priority since a system is bound to get paralyzed (sooner or later) without a nervous system functioning properly.


National E-Health Strategy 2017
The Government of Nepal (GoN) is committed to Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). In order to achieve these goals, there is no option other than to integrate our information system all across our government that includes our currently much-fragmented health information platform. To address this gap, the Ministry of Health and Population (MoHP) formulated the National E-Health strategy in the year 2017, one of the key larget goals is to create and innovate for cost-effective, standard, efficient, interoperable and user - friendly e-health services and applications (see below). All these efforts should be guided by the National ICT policy (2015), the National e-Governance  Interoperability Framework (2010), Telecommunication Policy (2004), Nepal Health Sector Strategy_NHSS (2015 - 2020), National Health Policies (2015 and 2018 draft) and Nepal Constitution (2015).


Future and its positive consequences
With such rapid uptake of ICT related services and its pervasive use everywhere from online shopping, payment, appointment, tracking and so on based on automation, cloud services, and IoT, we have an excellent opportunity never before in the history of the humankind to catch up with the rest of developed countries. It looks like we are in the best moment of history. We have a young population with rapid infrastructure development in ICT. Also, the changing socio-political landscape allows us to rapidly improve our state of affairs for our wellbeing, peace, and prosperity. Forgetting the possible negative consequences (lesser the better), we see all positive consequences in terms of value for money and its long term impacts. All these ICT based technologies are based principally on the idea of efficiency, the maximum utility of your valuable time and money. Thereby saving our time, the only consequence that we badly need is the good governance and discipline that our political leadership, as well as bureaucracy, are tightly kept accountable and transparent to what public servants are supposed to deliver as promised during the election. Finally, now is the time to deliver, no time is left for preaching !!

21 June 2019
Hetauda

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Anuj in Himalayas

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