New study reveals limited eHealth regulation in sub-Saharan Africa

Greenfield led consortium concludes eHealth regulation study

A year-long study on eHealth Regulation in sub-Saharan countries shows that they have much to do to catch up with global good practices. Few have specific regulations for eHealth and rely mostly on telecommunications and data protection laws, but these only provide partial coverage. The average for a sub-Saharan country is less than half of all the eHealth regulations needed. Greenfield, a consultancy based in South Africa, and its partners Jembi Health Systems, Fraunhofer Institute and Thales Alenia España completed the study for the European Space Agency (ESA) during May.

Africans use eHealth every day to solve healthcare challenges. The time is ripe to strengthen the regulatory environment to move this forward” says Greenfield consultant and epidemiologist, Malawian Peter Nyasulu.

The study provides a comprehensive review of eHealth regulation in 48 African countries, suggests specific actions needed to implement a complete eHealth regulatory framework and identifies the most promising scenarios for implementing the fertilisation projects in the second phase of the eHSA Programme.

Study outputs include:

1.       A Reference Regulatory Model, instantiated with all types of eHealth and 64 eHealth regulatory aspects

2.       Details of regulatory environment gaps between five best-practice countries, which have specific eHealth regulations, and the study countries in Africa, which rely primarily on telecommunications, data protection legislation and cyber-security legislation

3.       Ten African countries that are shown as ready to develop eHealth regulation using a Regulatory Readiness Index that comprises each countries RRM position, their information society and eHealth maturity, using the International Telecommunications (ITU) information development index and the World Health Organization’s (WHO) eHealth survey, and healthcare spending per head of population

4.       Roadmap for the ten ready countries with a five-year horizon, the first two years assigned to developing eHealth regulation processes, organisations and resources and compliance, then expanding specific eHealth regulation from year three.

5.       Roadmap for other countries with a five-year horizon with the first four years assigned to developing eHealth regulation processes, organisations, resources and compliance, then expanding specific eHealth regulation from year five as they expand their eHealth initiatives.

The regulation study concluded with two international eHealth regulation workshops, held in Botswana and Ghana with 10 African countries represented.Key regional stakeholders such as the African Union Commission (AUC), WHO-AFRO, NEPAD-Agency, AfDB and SADC participated in the workshops. Thesevalidated study findings and provided the study team with valuable insights into eHealthdynamics, challenges and specific eHealth initiatives in the region, and enabled the countries to start setting their eHealth regulation frameworks in place.

Project advisory board member Dr Ousmane Ly remarked: “eHealth regulation is critical for all countries. I am here to take key messages home to strengthen our plans in Mali”. This was echoed by participants from many countries, particularly Rwanda, Botswana, Senegal and Ghana.

A number of countries have begun planning how to include study findings and recommendations in their on-going eHealth development work.Says Greenfield International Relations Advisor Lesley Dobson “Our team will continue supporting these countries’ efforts to embrace eHealth opportunities to strengthen healthcare”.

Greenfield CEO Dr Sean Broomhead echoes this sentiment: “Our work in Africa is far from over. During the next 12 months we will provide extensive support to non-profit TinTree International eHealth to help the NGO support countries and regional bodies such as WHO-AFRO to move eHealth, and itsregulation forward.”The eHealth regulation road maps and action plans provide detailed material to support countries’ efforts.

The study is one of four horizontal studies of the first phase of ESA’s Satellite Enhanced eHealth for sub-Saharan Africa (eHSA) Programme. The other studies deal with governance, interoperability and sustainability.

For the full summary report click here.

More information is available from Lesley Dobson, International Relations Advisor, Greenfield Management Services, Kimberley, South Africa.

Email: lesley.dobson@greenfield.org.za

Phone: +27 53 832 2655


Greenfield and partner Jembi recently hosted a eHealth Regulation Workshops in Botswana and Ghana on behalf of the European Space Agency (ESA). The focus was eHealth Regulation in sub-Saharan Africa and ESA’s (eHSA) Programme.

Most SSA countries have several eHealth initiatives underway, and eHealth regulatory aspects are beginning to receive attention. Workshop participants will set priorities to expand their action plans for eHealth regulation, including components such as the regulations and regulatory bodies needed to set out on a development path to support a fertile environment for eHealth services.

Participants will share insights and draw knowledge from one another’s African experience – strengthening eHealth for Africa.



Successful submission of key deliverables this week, marks the half way point of the Greenfield led consortium studying the regulatory aspects of eHealth in sub-Saharan Africa. Deliverables describe the review of eHealth regulatory environments in 48 sub-Saharan African countries. Findings confirm that general regulatory environments are varied and substantial, though explicit eHealth regulatory coverage in SSA is low.

The next part of the study involves readiness assessments and the development of two generic eHealth regulatory roadmaps, one for countries assessed as ready for eHealth regulation, and one for other countries. These will support healthcare organisations and countries to move forward.

Shared values and a common vision for eHealth development work in Africa are key aspects driving the project team forward. Consortium members Jembi health Systems (South Africa), Fraunhofer IGD (Germany) and Thales Alenia España (Spain), led by Greenfield Management Solutions, have embraced the opportunity with significant investment of time and resources.

Engaging with regional stakeholders is essential. Engagement with senior officials of AUC (Addis-Ababa), WHO-Africa (Brazzaville) and the NEPAD Agency (Pretoria) has yielded important advice, comments and support. Reflecting their eHealth regulation policies and priorities continues to strengthen the project. Now, the focus is to brief the Regional Economic Councils and countries up to speed as the project progresses.



On the 12th of September 2012, Lesley Dobson presented at the South African ICT4Health conference in Cape Town. Her piece on eHealth and its International Opportunities looked at eHealth from an international relations perspective emphasising the value international learning links have for work currently underway in South Africa.

While developed countries are more advanced with regards to eHealth development and implementation, no one country can offer all the solutions, she cautioned. It is therefore important to draw information and knowledge from a number of countries and incorporate lessons learnt from abroad into the South African context.

Countries should take advantage of lessons - both successes and failures. The failures of others can help identify potential pitfalls which allow countries to put in place the necessary safety nets to mitigate certain risks.  

The tinTree eHealth knowledge base, which is based on 55 cost benefit analyses of eHealth initiatives from around the world, helps to identify these learning links. It provides comparisons and synthesis of eHealth strategies, plans and initiatives from several countries including countries with different levels of development, different health financing models and different healthcare models. It can be used to create a framework and working model that countries can adapt to help position themselves with successful eHealth strategies and plans for sustainable eHealth environments.



Last week a Greenfield team briefed senior African Union (AU) officials in Addis Ababa regarding progress on the European Space Agency ehealth program: the satellite-enhanced telemedicine and eHealth for sub-Saharan Africa (eHSA) programme.

Dr. Ademola Olajide, AU Head of Division of Health, Nutrition and Population and Dr. Janet Byaruhanga, AU Health Officer of the Department of Social Affairs met with Greenfield’s International Relations Advisor Lesley Dobson and Senior eHealth Consultant Michael Kavuma.

Greenfield provided the AU with insight into the study on regulatory aspects emphasizing the importance of the regulatory reference model, one of the outcomes of the study. The model identifies eHealth processes and services that need regulation and can be used to support implementation of eHealth in SSA to ensure sustainability and effective development.  

The AU acknowledged the study as important and timely given that the African Ministers of Health during their last Ordinary Session held in Namibia in April 2011, requested that the AU Commission, in partnership with the relevant organizations, develop an eHealth strategic framework for Africa to support the Africa Health strategy. The AU shared its vision for a continental eHealth strategy for Africa with the Greenfield team.

The AU team is enthusiastic about the study and the potential practical benefits which it has to offer. They are confident that thestudy can help advance the AU’s goals with regards to eHealth in Africa. The AU recognises the need for regulating eHealth and the importance of implementing the appropriate laws to regulate eHealth services.  

This signals the start of a fruitful relationship between Greenfield and the AU built around strengthening ehealth development and implementation opportunities on the continent.


Health consultancy Greenfield Management Solutions announced today that it has signed a contract with the European Space Agency (ESA) regarding a study on regulatory aspects for eHealth, including telemedicine and satellite services, in sub-Saharan Africa (SSA). This project is framed in the recently launched eHSA programme (Satellite-enhanced Telemedicine and eHealth for sub-Saharan Africa). Greenfield will lead a multinational consortium, comprising Jembi Health Systems (South Africa), Fraunhofer Graphishce Datenverarbeitung (Germany) and Thales Alenia Space España (Spain). The 15 professionals involved are from eight nationalities and have experience in 22 SSA countries.

Many policy-makers see investment in eHealth as an opportunity to help alleviate some of the challenges facing health care in SSA, such as lack of medical staff, infrastructure, finances and available and accessible clinics and hospitals. The region, consisting of over 840 million people suffers 25% of the world’s communicable diseases, but supported by only 3% of the world’s health workforce and 1% of the total spending on global healthcare.

The eHSA programme was launched by ESA in collaboration with the Luxembourg Agency for Cooperation and Development with the co-funding of the Government of Luxembourg and European Union Africa Infrastructure Trust Fund (ITF). It aims to facilitate the development of satellite-enhanced eHealth and Telemedicine infrastructure and services for the benefit of SSA, including clinical care, surveillance, healthcare management and health education.

Greenfield’s CEO Sean Broomhead, clinician and health informatics expert, emphasises that ESA’s goal to support improved performance and long-term sustainability of health systems in SSA is a key motivator for his organisation’s interest in the programme.  “The study on regulatory aspects provides a critical foundation to support the success of the eHSA Programme” he says, “and thereby contributes to strengthening healthcare in the region”.

The study on regulatory aspects is the second study of the eHSA programme. There will be two further studies taking place in 2012, before a second phase, which involves implementing projects around specific themes such as electronic care, learning epidemic, surveillance and administration. Besides the social benefit it provides, the eHSA programme intends to contribute to several of the United Nations’ Millennium Development Goals in a manner that supports SSA and the local social, political or medical equilibrium.

For more information on this project please contact Navashni Singarum at eHSA@greenfield.org.za.


Nkosanzana Dlamini-Zuma’s surprising win over Jean Ping of Goban, for her new post as commission head of the African Union (AU) has been hailed a victory for South Africa (SA), for Southern African Development Community (SADC) and for women.  

Dr Dlamini-Zuma’s victory is certainly likely to bolster South Africa’s standing in Africa. The campaign signals South Africa’s ambition for greater political influence in multilateral organizations and confident assertion of its place as an African powerhouse. Dr Dlamini-Zuma’s victory is also a big triumph for the ANC, who strives to be recognized as a strong force on the continent.  

South Africa has not always enjoyed favour in AU circles, but Dr Dlamini-Zuma’s position in the organization could rectify this. Dr Dlamini-Zuma is an astute politician known for her competent management and stern personality.

"She may have more guts to break through some constraints for the African Union Commission to become a more efficient and effective organization” said Xu, an expert on African studies at the China Institutes of Contemporary International Relations.

SA’s International Affairs Minister, Nkoana Maite-Mashabane shared Xu’s sentiment saying, “there will be more accountability and fast-tracked implementation of decisions taken by the heads of state.”

Her personally together with her past experience in creating efficient administrations will move the organisation forward and will also ensure that the AU becomes more SA “friendly.” The way Dr Dlamini-Zuma thinks, operates, organizes and manages stakeholders are all infused with a South African consciousness, which may encourage the commission to become more accepting of SA civil servants and their way of doing things. 

“Having Dlamini-Zuma as AU commissioner for South Africa would be able to make the organization, which is somewhat Francophone-dominated, not just in language but also in its methods of operating, its culture and administration, more friendly to South African civil servants,” said Paul Graham, Executive Director of the Institute for Democracy in Africa.

While Dr Dlamini-Zuma will not be pushing a South African agenda as the new commission head of the AU, her position and interaction with the 54-heads of state and other international stakeholders could prove very valuable for SA position in the international community. SA is still pushing for a permanent seat on the United Nations Security Council (UNSC) and while this is by all means a “long shot” a South African as head of the AU could increase the chances of reaching that dream in the future.

Having Dr Dlamini-Zuma occupy the most powerful position in the AU, will surely have positive repercussions, and produce new opportunities for SA and SA businesses working in Africa alike.



Lesley Dobson is the latest member to join the Greenfield team. She joins as International Relations Advisor and will focus on Greenfield’s international eHealth engagements. Her background in Political Science and her interest in Africa are a unique combination providing a valuable new perspective to Greenfield teams. 

“For more information about Lesley’s view on the rise of eHealth in international relations, see http://www.tintree.org/development/




Dr Broomhead and Prof Mars co-authored a paper published in Telemedicine and e-Health January 2012. They show how the addition of electronic treatment adherence support technology can help to improve Tuberculosis outcomes and lower average cost per patient by reducing treatment failure and the associated higher cost and burden on limited resources.

CMA is an appropriate initial analysis for health planners to highlight options that may justify more sophisticated methods such as Cost Effectiveness Analysis or full Cost Benefit Analy-sis where a preferred option is immediately revealed. CMA is proposed as a tool for use by public health planners in low resource settings to evaluate the return on investment of treatment adherence technology post pilot and prior to implementation.


Greenfield welcomes the opportunity to work with USAID and PEPFAR to develop and implement a TB train-the-trainer program to support PEPFAR-funded NGOs working with OVCs. The training will be implemented in all nine provinces of South Africa and will strengthen existing community based TB support programs.

We look forward to getting in touch with your NGO to tell you more about the initiative.

For more information contact our project manager Shinaaz Bhana at shinaaz.bana@greenfield.org.za or +27 53 832 2655.

This project was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Greenfield and do not necessarily reflect the views of USAID or the United States Government.


When the Department of Education needed a service provider to deliver computer training to five districts in the Northern Cape, at short notice, Greenfield and our BEE partner Pioneer Healthcare were quick to respond. Within weeks we had designed and delivered high quality training to 357 learners.

This training was part of an innovative initiative to provide capacity building activities during school holidays. The Greenfield-Pioneer training was well received with positive feedback from learners, service providers and our client, the Department of Education.  We look forward to further opportunities to work the Department, who demonstrate caring, responsibility and passion for the education sector, putting in the hard work required to improve services in the Northern Cape Province.

By Navashni Singarum


In August 2011 we launched our N2K (Need to Know) campaign, aligning the kick-off with a two day workshop to develop facilitator skills of people leading Support Groups for people living with HIV.

The Pioneer-Greenfield N2K campaign will provide ongoing support to people living with HIV, delivered through innovative social media applications.

Try out our N2K Facebook group. Ask a question and allow one of the group’s members the chance to answer you.

Support groups come into contact with people from different walks of life.  We wish to salute these community leaders and look forward to continuing to work with them for a better life for us all.

By: Shinaaz Bhana   


During October Greenfield trained 28 HIV counsellors in the Karoo town of De Aar on behalf of the Department of Health.

Participants were motivated to develop their knowledge and skills to function well in this challenging and complex area of work. It was a pleasure working with them and we wish them well with their ongoing work.

By Shinaaz Bhana


Travelling with the team that provides support to our Home Based Care learners has brought home to me how critical it is that these care givers are supported to continue their important work in the communities of the Northern Cape.

In Holpan, for example, one caregiver provides support to eight to ten families per day. The caregivers meet at one another’s homes since they do not have a facility from which they work and they have to find their own cash to pay for transport to visit patients and to collate the information that has to go to Kimberley on a monthly basis.

They are driven to do this work by a passion to help people. We should acknowledge, care for and support them. They should inspire us to be better than we are. And to be grateful for what we have.

By Navashni Singarum


The Greenfield-Pioneer partnership welcomed the opportunity to provide services to tireless social services NGO Age and Action in the Northern Cape.

The 3-month Greenfield Home Based Care training program was delivered to 50 carers from Age and Action during the first few months of 2011. Training was completed uneventfully and site visits were conducted to provide the necessary support, to ensure skills transfer was achieved and that the training resulted in strengthening of these carers daily activities.

In the words of one learner “you have brought more light to us as carers”. On behalf of our communities, Greenfield-Pioneer can say the same to each home based carer out there! Thank you for your devotion and your caring for those who need it most.

By Shinaaz Bhana


Greenfield Management Solutions has been proud to participate in the audit work awarded by the Department of Social & Population Development (DOSD) in the Northern Cape

Working closely with our BEE partner Pioneer Healthcare and auditing firm Preece & Associates we have interacted with 23 NGOs from across the province.

Greenfield has played a unique role, coordinating activities and facilitating communication between NGOs and auditors, to ensure a streamlined process and to support effective skills transfer and capacity development in these important community based service delivery organisations.

NGOs have acknowledged the value that the additional support has provided and the potential this growing relationship has to improve their audit outcomes while strengthening services rendered.

By Grace September