Introduction Uganda and Zambia


“Technology is a major driving force of our civilization. Whether through medicines to heal the sick or products for growing food to feed the hungry, or most recently information and communication technology most accessible to the poor and disenfranchised is the mobile phone. ”Desmond Tutu




The purpose of this research paper is to determine the role that ehealth has and continues to play in HIV/AIDS prevention in Uganda and Zambia. In addition Uganda’s ehealth national strategy is part of the national ICT policy, while Zambia currently has no national ehealth policy in place, thus throughout this paper key actors such as national Governments, local NGOs, international NGOs, multilateral and bilateral organization in both Uganda and Zambia will be acknowledged and evaluated to determine what role they play within ehealth initiatives and whether a national ehealth policy is necessary. Beneficiaries will be identified, as was at the impacts ehealth has had on populations in Uganda and Zambia. Finally, current and past projects will be examined, evaluated and analyzed to determine both costs and benefits of ehealth prevention in the global south.





Assumptions and Hypothesis

–       Uganda having an ehealth policy integrated into their ICT policy, thus expecting Uganda’s government to be an active and supportive actor within sustaining ehealth strategies.

–       With a national ehealth policy in place since 2006 I was expecting a vast collection of publications to establish and compare ehealth projects within the vicinity of preventive ehealth.

–       Uganda has experienced a significant reduction in HIV/AIDS prevalence rates and I was expecting basic ICT to play a role the reduction of HIV.  Government led public health campaign was dramatically decreased HIV prevelecnce from 15% in 1991 to 5% in 2001 (Ybarra, Kiwanuka, Emenyonu, & Bangsberg, 2006).

–       Zambia with no national ehealth policy was thus expecting little supportive role by the government.

–       Personal Bis: Not currently in Zambia, and thus I am relying on publications some more reliable than others, although I am trying to filter out the work which I feel has alternative motives, for example vodaphone publications on mhealth.


What is E-health

– across published academic journals there are an abundance of unique definitions of what ehealth is. However the common factor between all the definitions is that they involve technology and health.


– During the 1990s the Internet exploded within the public, a number of e-terms began to surface and circulate. Email brought new possibilities for people as communication was rejuvenated and rapidly enhanced how individuals share experiences; e-commonerce proposed new ways of conducting business and financial transaction through the internet. The introduction of e-health presented the promise of new information and communication technologies to improve health and the health care system (Oh, Rizo, Enkin, & Jadad, 2005).


Why: ehealth is bringing to the delivery of health care around the world today, and how it is making health systems more efficient and more responsive to peoples needs and expectations.

– Globally, the application of information and communication technologies to support national health-care services is rapidly expanding and increasingly important. This is at a time when health systems face strigent economic challenges and greater demands to provide more and better care, especially those in need.


–       low income countries have focused on the use of mobile devices in ehealth care (mhealth). Mobile technologies have been expanding at rapid rates (Ibrahim, 2009). In Africa alone mobile phones grew in popularity from 49 million in 2002 to 280 million in 2007, with an expected increase to 600 million subscriptions during 2012. Mhealth applications have explored the possibility of addressing health challenges using mobile phones and other mobile devices in Africa and other regions of the developing world (Danis, et al., 2010).

–       Although internet has increase in popularity in recent years, in 2011, 26% of the people in developing countries has access, while 79% had a mobile phone subscription (Thirumurthy & Lester, 2012).


Why do we need ehealth?

Health systems around the world are faced with significant challenges in finaning and providing quality care at an affordable budget. Health systems within developing countries such as Uganda and Zambia are faced with numerous other challenges such as shortages of trained health care professionals, increasing burden of disease, poor infrastructure and unequal access to healthcare and education. Ehealth provides the health sector with a creative way to address these challenges in the developing world through multisectoral approaches to delivering health services and information to the publish and within the health sector. (The Rockefeller Foundation, 2008).


Why ehealth in the South?

–       Many of these nations are the world most vulnerable and impoverished populations faced with health financing, system and disease burdens, making the potential for ehealth to boost efficiency, equity and quality of health services even more pronounced (The Rockefeller Foundation, 2008).

–       #1: ensuring public health requires the exchange of information, and is often dependent on intensive exchanges of information and research.

–       #2: over the past two decades the global spread and advancement of ICTs, such as the internet and mobile technology have increased the feasibility of digitizing health information. The Spread of mobile subscriptions in Africa grew twice as fast as that of the rest of the world. Internet users from 2000-2008 grew by a factor of eight between 2000-2008. Despite the increase in ICT the developing world lags behind the developed world (Ibrahim, 2009).



ehealth provides the possibility to be a powerful, low-cost method to deliver health intervention and prevention programs to large numbers of young people across diverse geographic regions. Resource limited settings where cost effectiveness interventions are most needed may benefits greatly from ehealth initiatives.(Ybarra, Kiwanuka, Emenyonu, & Bangsberg, 2006)


Challenges of Ehealth

–       breakdown of technological systems can hinder the delivery of health services.

–       Possible spread of poor quality health information that causes harm to patients (Ibrahim, 2009).

–       Significant challenges African countries face include, low school enrollment, high illiteracy rates, low per capita incomes, widespread poverty and weak ICT connectivity which challenge the sustainability of ehealth as an effective national strategy. ICT connectivity varies country to country and within a nation among income levels and geographic location. Per capital income and formal education level has a significant effect on telecommunication usage. (Kirigia, Seddoh, Gatwiri, Muthuri, & Seddoh, 2005).

–       Inadequate technical infrastructure, limited human skills to use available networks and services, the relatively high cost of communications equitment, and poor policy and regulatory environments. (Souter, 2010)

–       Barries range from technical to political to financing. (Various Authors, WHO, 2012)



E-health is the transfer of health resources and health care by electronic means. E-health provides a new method for using health resources – such as information, money, and medicines – and in time should help to improve efficient use of these resources (WHO, 2012).


Defined as the use of information and communications technology to improve health systems performance – represents a promising frontier. Ehealth has the potential to transform local and nation health systems by enabling improvements in efficiency, equity and quality (The Rockefeller Foundation, 2008).


e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology (Eysenbach, 2001).


–       Ehealth is changing health-care delivery and is at the core of responsive health systems. The daily business of health relies on information and communication and increasingly, on the technologies that enable it, at every level and in every country. This is equally so in delivering care, deploying personnel, managing programmes or conducting research. Ehealth is concerned with improving the flow of information, through electronic means, to support the delivery of health services and the management of health systems. ICT provides significant benefits not only in achieving health goals, but also in demonstrating what has been attained and at what cost. (WHO & International Telecommunication Union, 2012)

–       Ehealth and the case for developing technologies has been evident for over a decade. However it has taken a crisis in the health sector in many countries to move ehealth from the periphery tp the center of strategic health planning.


–        Ehealth can be applied to health systems and/or patients, as well as the interaction between the two.



Stakeholders: See National ehealth strategy toolkit. Citizens

HIV and Ehealth

– ehealth is one major and potential tool among others to respond to the HIV epidemic.


Mhealth: one of the focuses of this research paper is mhealth which is defined by the Global Observatory for e-health of the World Health Organization as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices” (van Heerden, Tomlinson, & Swartz, 2012).

– through this research paper mhealth will be investigated as one sub category to ehealth and as a tool in contributing to HIV/AIDS prevention strategies.  For example Antiretroviral therapy (ART) for people with human immunodeficiency virus (HIV) infection has increased in parallel with


– 5 billion mobile phone subscriptions in the world, with over 85% of the world covered by a commercial wireless signal. (World Health Organization, 2011). The spread of mobile phones across developing countries surpasses other infrastructure such as electricity and paved roads and the growing popularity of ICTs has meant declining costs and higher speeds of data transmission and began to transform the way health services and information are accessed, delivered, and managed.





–       Country Information: The Republic of Zambia once known as Northern Rhodesia is a landlocked country in Southern Africa with a current population according to the World Bank (2011) of 13. 4 million . Zambia achieved independence from the British in 1964 and has since experienced periods of economic mismanagement by former Presidents Kaunda and Chilumba. Zambia’s poor economic performance is also a result of the rise in global oil prices and a reduction in copper prices, one of Zambia’s primary exports.

Cell phones: 34.07 per 100 people (World Health Organization, 2011).



–       Ehealth policy within ICT policy which seeks to address national health priorities.


Current cell phone usage: Uganda ranks 87th among 222 countries in terms of mobile ownership, with an estimated 4.2 million phones owned in 2007 and costs approx 7 cents per message, but incoming sms messages are free as well as voice calls.(Mitchell, Bull, Kiwanuka, & Ybarra, 2011)

HIV prevalence rate: among 15-49 year olds the prevalence rates is an estimated 6.4%. 10-24 years of age comprise of 33% of the total Ugandan population, yet comprise of 50% of the countries HIV/AIDS cases. The main mode of HIV transmission is via heterosexual intercourse. 64% of Ugandan teens have has sexual intercourse by the age of 18 (rate are similar to US where by 19, 70% of teens have engaged in intercourse) (Ybarra, Kiwanuka, Emenyonu, & Bangsberg, 2006).