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Institute of Informatics, Tallinn University 2014 A framework for designing and deploying e-health systems in developing countries Abdul Wahid Samadzai PhD Student David Lamas, Vladimir Tomberg Supervisors Institute of informatics Tallinn University 2015

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Page 1: 2015-02-25-2 research seminar

Institute of Informatics, Tallinn University


A framework for designing and deploying e-health systems in developing countries

Abdul Wahid SamadzaiPhD Student

David Lamas, Vladimir TombergSupervisors

Institute of informaticsTallinn University


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Research ProblemResearch GoalResearch Questions DefinitionsChallenges DocumentPlans for this academic year


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There is a lack of the systematic framework for designing and deploying e-health systems in developing countries

Research Problem

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The goal is to develop and evaluate a systematical approach for designing and deploying e-health systems in the developing countries

Research Goal

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The main research question is:

How to support developing countries in development of health management systems, in terms of horizontal technology transfer between developed and developing countries, considering the inherent constraints and limitations.

Research Questions

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In order to answer to the main question, we need to answer to following sub-questions:

What are the main challenges and prerequisites for e-Health systems in developing countries?

What practices gathered from scenarios in developed countries can be applied for developing countries and what practices cannot?

What kind of parts designing and deploying e-health systems framework should consist of?

Research sub-questions

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The World Health Organization broadly defines

Electronic Health (E-health) as being “concerned

with improving the flow of information, through

electronic means, to support the delivery of health

services and the management of health systems”

.‣ In another word E-health is better

healthcare and a healthier life through digital technology.

Electronic Health

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Health information systems (HIS) are the systems for collecting and processing health data from different sources.

HIS have become a fundamental component for increase the health systems in developing countries.

Health Information system

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Health information system emergence has therefore lead to shifting from paper based to computer-based ways of processing health information.

This shift has increased the opportunities of manipulating patient data efficiently.

Health Information system(2)

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The field of Information and Communication Technology (ICT) combines science and technology.

Human computer interaction for development (HCI4D) provides a focus for that interdisciplinary dialogue.

Overview of Information and Communication Technology (ICT)

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This document included: 1. Short abstract 2. Introduction (defines a problem, define

questions, to write why this is important) 3. Several sections, according to the needs.

Challenges Document

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A) To collect challenges and prerequisites (what we do need in developing countries for building e-health systems, what infrastructure and other important conditions?) from literature,

B) At the end of this document to build a table with collected challenges and prerequisites.

C) To place in the document extended Concept Map.

Challenges Document

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● I read some articles about concept map to use it as a sense-making tool. I use it with purpose of summarizing the ideas from articles;

● I started a work on literature review. For this purpose I read articles about E-health system in developing countries;

● I identified a set of specific challenges in e-health system field;

Current work

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Challenge name Challenge description

Found in country


Infrastructures e-health system need for infrastructures

India, Kenya, Macpherson Yvonne and Chamberlain Sara

Economy For design good health system we need to good economy. In most developing countries the people have poor economy.

Developing countries Lewis Trevor, Synowiec Christina, Lagomarsino Gina and SchweitzerJulian

Central point The central point is necessary for e-health system. The health system manager can control the all health system.

Bangladesh, Pakistan Ouma Stella, and Herselman M.E.,

Internet connection The internet connection is necessary or good e-health system.

Developing countries MacPherson Yvonne and Chamberlain Sara

Academic staff E-Health system need to best academic staffs for good health service.

Kenya, India, Bangladesh…

MacPherson Yvonne and Chamberlain Sara

Challenge in developing countries

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Challenge name Challenge description

Found in country


Transportation Transportation is the big point for e-health system to rural area

Developing countries Roberto J Rodrigues,

Cost and time lack The cost of infrastructure and time is very important in health system sector

Developing countries Roberto J Rodrigues,

Lack of proficient

human source staff and

lack of trainings to

produce this staff

The computerized information system wants experienced people for its effective action. Training is one of the aspects for use of any new technology.

Developing countries Hanson K, Ranson MK, Oliveira-Cruz V, Mills A

Patient education The patient education and skill is necessary of e-health system

Developing countries James G. Kahn, Joshua S. Yang and James S. Kahn

Challenge in developing countries (2)

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Challenges identified up to now Infrastructures


Central point

Internet connection

Academic staff


Cost and time lack

Lack of proficient

human resource staff

Lack of trainings

Patient education

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To submit a paper “Challenges and Opportunities in eHealth: the Afghan Scenario”

To conference The Fourth International Conference on e-Technologies and Networks for Development (ICeND2015)

Plans for this academic year

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The proposed structure for the chapter:

◦ ICT4D (ICT for development) (overview of the concepts);

◦ e-Health (overview of the concepts);◦ Examples of success cases;

Plan Introduction Chapter

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◦ Challenges (1. Literature review; 2. Initial field research - Afghanistan related challenges);

◦ Potential transforms (analysis of possibilities in Afghanistan context);

◦ Selected case study

Plan Introduction Chapter(2)

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Qualitative research is about finding out not just what people think but why they think it. It’s about receiving people to speak about their opinions so we can know their motivations and feelings.

Face-to-face interviews and group discussions are the good way to receive this type of in-depth feedback.


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Qualitative research can be important when we are developing new products (e-health system for Afghanistan) or coming up with new marketing initiatives and we want to test reactions and improve our approach.

In this research we used the survey qualitative research for data collection from hospitals in Afghanistan. The survey is a best approach of data collection in this research.


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The word of survey is used most often to describe a method of collecting information from a sample of individuals.

The purpose of this survey was collecting information about problem and challenges are exist in health system in Afghanistan.


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Surveys can be divided into two broad categories:

the questionnaire and the interview. Questionnaires are usually paper-and-pencil instruments that the respondent completes.

Interviews are completed by the interviewer

based on the

Types of Surveys

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The qualitative research interview search for describe and the meanings of central subjects in the life world of the subjects.

Interview is the oral conversation between two people with the objective of collecting relevant information for the purpose of research.


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Focus groups could provide information about a range of ideas and feelings that individuals have about certain issues, as well as helpful the differences in perspective between groups of individuals.

Focus group

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We used the focus group interview for achieving data from the groups of doctors, nurses, managers and patients. We had a questionnaire for collecting data about the health system challenges and problem in Afghanistan.

Hospitals Focus Group

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The important step in preparing the focus group interview for collecting information about the challenges and problems in health system in Afghanistan is the development of a set of questions which encourage participants to respond and request the information needed from the group.

Focus Groups question methods

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There are five general types of questions used in focus group interviews. We have these types of questions for interview.• Opening questions are used to get people talking

and feeling comfortable. They should be easy to answer, but should not emphasize differences among group members.

• Introductory questions are used to get the group to start thinking about the topic at hand. They help focus the conversation.

Types of questions

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• Transition questions provide a link between the introductory questions and the key questions. They typically ask participants to go into more depth than introductory questions.

• Key questions focus on the major areas of concern. The majority of the time is devoted to discussions of these questions.

• Ending questions bring the session to closure.


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This research used the opening questions for focus group interview. The purpose of design this type of questions is collecting data from the respondents about some challenges are exist in Afghanistan heath system.

Focus group health system question method

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A sample is a limited component of a statistical population whose properties are studied to achieve information about the whole.

Purposive sampling was selected for this research

The sampling has different types, we used the typical case sampling in this research.


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The typical case sampling imports taking a sample of what one would call typical, normal or average for a specific phenomenon.

The typical case sampling in this research focuses on what is typical, normal, and/or average (doctors, nurses, manager, and patients)

Typical Case Sampling

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To cluster challenges by type, e.g. financial, infrastructure, etc.;

To prioritize challenges by criteria of reach ability and amounts of resources that they needed to invest (money, time, people, etc.);

To map these results to situation in Afghanistan and identify, which challenges are the most critical for Afghanistan

Immediate planned tasks

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Thank you!