Digital Health Blueprint

Final Draft

April, 2021
MASSAGE FROM STATE MINISTER

A
MESSAGE FROM DIRECTOR (HITD)

B
C
MESSAGE FROM DIRECTOR (PPMED)

D
PREAMBLE

Cognizant of the inevitable digital revolution that has already started to happen in several fields
over many countries, the Ethiopian government has set an ambitious agenda of envisioning a
DIGITAL ETHIOPIA by 2025. In light of this umbrella initiative and based on global digital
innovation leaders’ assessment that the health sector would be the most likely sector to highly
benefit from digital revolution, the Ministry of Health decided to proactively embrace the
digital solutions and services to catch up with the booming digital era. One huge measure taken
in this regard is the preparation of the Digital Health Blueprint for Ethiopia (DHBP-E), the
guiding and parent document.

This Digital Health Blueprint for Ethiopia, the governing document of the digital health
endeavours in Ethiopia, is prepared to guide and support MOH, regions, agencies, partners,
donors and private sectors in the implementation of digital health in the coming 10 years. The
DHBP was developed in compliance to the “Digital Ethiopia 2025: A digital strategy for
Ethiopia Inclusive Prosperity” – and tailored to the technologically booming health sector. The
Blueprint will unpack – the gaps in the digital health ecosystem that are required to be tackled;
the current status of eHealth and digital health implementation in the Ethiopian health system,
and level of readiness of the sector for adopting emerging technologies; the ways the Ethiopian
health system could change and be affected in the next ten years as a result of the boom of
digital health technologies; priority focuses of the Ethiopian health sector in the digital health;
the main building blocks and enablers tailored for the Ethiopian digital health; and, strategic
priorities and considerations that should be in place to effectively embrace and transform the
Ethiopian health system through digital health technologies.

It is necessary that all digital health stakeholders refer to this Blueprint before they jump into
the investment, and adhere to the highlighted vision, goals, guiding principles, pillars, priorities
and recommendations before and during implementation of the digital health endeavours.

E
Contents

Massage from State Minister A

Message from Director (HITD) B

Message from Director (PPMED) D

Preamble E

Abbreviations iii

PART I: Digital Health Blueprint for Ethiopia 2

1.1 Ethiopia Digital Health ecosystem Analysis 2

1.2 Understanding and forecasting the future 3

1.3 Why Digital Health Blueprint for Ethiopia? And Why Now? 6

PART II: Vision, Objectives, guiding principles and prioritized initiatives 9

2.1. Vision 9

2.2. MISSION 9

2.2 OBJECTIVES 9

2.3 Guiding Principles 10

2.4 Prioritized digital health technology enabled healthcare focus areas 10

PART III: Building Blocks/Pillars of the digital health blueprint 15

3.1. Description 15

3.2. Digital Health Blueprint Conceptual Framework 15

3.3. Pillar 1: ICT Infrastructure 17

3.4. Pillar 2: Solutions and Services 18

3.5. Pillar 3: Digital Health Access and Service Delivery 19

3.5. Pillar 4: Digital Health Data Hubs 20

Part VI: Enablers of the Digital Health Blueprint 23

4.1. Description 23
i
 4.2. Standards and Interoperability 23

4.3. System Security 24

4.4. Research and Innovation 25

4.5. Digital Health Workforce 26

4.6. Governance and Leadership 27

Part V: Implementation Approaches and Strategies 29

5.1. Implementation Approaches 29

5.2 Stakeholders Mapping 33

5.3. The Blueprint Action Plan 34

5.4. Monitoring and Evaluating the Maturity Levels of Digital Health Initiatives 34

5.5. HIS Maturity Assessment Findings and Future States (Goals) 35

Appendix A: Glossary of Terms 38

ANNEX 1: DIGITAL HEALTH BLUEPRINT PILLARS ACTION PLAN 39

ANNEX II: DIGITAL HEALTH BLUE PRINT ENABLERS ACTION PLAN 44

ii
 ABBREVIATIONS
AI Artificial intelligence IRR Information revolution road map

CPD Continuous professional development ISO International standard organization

DHBP Digital health blueprint IT Information technology

eCHIS Electronic community health KM Knowledge management

information system LAN Local area network

eHA Enterprise health architecture LOINC Logical Observation Identifiers

eHMIS Electronic health management Names and Codes

information system MFR Master facility registry

EHR Electronic health record MPI Master patient index

ERP Enterprise resource planning NHDD National health data dictionary

EWS Early warning system NHWA National health workforce account

FHIR Fast health interoperability resource PHEM Public health emergency

GIS Geographic information system RIS Radiology information system

HIS Health information system RPM Remote patient monitoring

HITD Health information technology SHR Shared health record

directorate
SNOMED Systematized Nomenclature of
HSTP Health sector transformation Medicine -- Clinical Terms
plan
TMS Terminology management system
ICT Information Communication
technology UHC Universal health coverage

IR Information Revolution VPN Virtual private network

iii
VSAT Very small aperture terminal WHO World health organization

PART I: DIGITAL HEALTH BLUEPRINT

FOR ETHIOPIA

1.1 ETHIOPIA DIGITAL HEALTH ECOSYSTEM ANALYSIS

The ultimate purpose of crafting health-related policies, strategies, and blueprint is to improve
the quality of life by providing equitable, affordable, and quality health services. The
application of appropriate technologies stands tall among the interventions that influence health
delivery. In the near future, digital technologies have the potential to revolutionize how people
interact with digital health services and solutions. Therefore, all initiatives related to
digitization and digitalization of healthcare should be aligned with the digital advancement that
continues to reshape health delivery.

Digital health strategies should be aligned with the digital health blueprint for realizing the
implementation of standard digital systems that ease access to health information and data
sharing thereby improving decision-making. The ambition of any strategic plan shall be to
realize the integration of national, regional, and local level digital frameworks and
infrastructural components by sharing data across different geographic locations and health
sectors in a distributed structure.

The Ethiopian Health Sector Transformation Plan (HSTP I, 2015-20) has identified
information revolution out as one of the four transformational agendas along with 1) Woreda
Transformation, 2) Compassionate, Respectful and caring, and 3) Quality and Equity. These
four transformation agendas were continued as the transformation agendas in the second health
sector transformation plan ( 2020-25). To translate the information revolution transformation
agenda into practice, the ministry of health has issued a detailed information revolution
roadmap(IRR). As it is clearly stated in the roadmap, information revolution refers to the
phenomenal advancement in the methods and practice of collecting, analysing, presenting, and
disseminating information that can influence decisions in the process of transforming economic
and social sectors. It entails a radical shift from traditional methods of data utilization to a
systematic information management approach powered by a corresponding level of
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technology. The Information Revolution is not only about changing the techniques of data and
information management; it is also about bringing about fundamental cultural and attitudinal
change regarding perceived value and practical use of information (Information Revolution
Roadmap I/ 2016-20). The roadmap envisions connected woreda and identified two pillars for
the information revolution agenda: 1) Cultural Transformation for health data use and 2)
Digitalization and scale-up of priority health information systems. The rationale for developing
this Information Revolution Roadmap is that all functions of the health system rely on the
availability of timely, accurate, and dependable information for decision making.
Revolutionizing the availability, accessibility, quality, and use of health information for
decision-making processes, through the appropriate use of information communication
technology, can ultimately impact the access, quality, and equity of healthcare delivery at all
levels in Ethiopia.

Even though they are not formally endorsed,the Ministry of health has also been working on
the development & cascading of health information systems and digital health related national
documents. These include information revolution roadmap II ( 2020-2029?), Information
revolution strategic plan (2018 -2025), Ethiopia eHealth architecture (2019), and ICT policy
and digital health strategy (2021-29).

The Ethiopian eHealth architecture(eHA) redefines the obsoleted state and operating procedure
with a defined enterprise architecture blueprint that designates business, data, technology, and
process principles in every component and participating systems. The architecture encourages
implementers to use any technology and innovation as long as they use agreed business
processes and profiles with uniform terminology and messaging data standards. It shall also
play a vital role in making the eHA functional, realizing its goals, adding governance,
ownership, socializing it, and thereby creating government buy-in.

The draft Ethiopia Digital Health Strategy 2020-29 envisions the overall organization and
application of Information Communication and Technology for the service delivery,
application development and infrastructure improvement of the health sector to improve the
health delivery system. It involves the strategic objectives addressed by the Health sector
transformation plan II.

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The ICT policy prepared by the Health Information Technology Directorate of MOH in 2017
was significant for underlining that ICT is a fundamental component of digitalization of the
health sector as a whole. This policy sets up the basic requirements for implementing ICT-
supported health services. Also, it is supposed to provide a framework that enables Health
Information Technology Directorate (HITD), enhance security of the ICT infrastructure, make
sure regional and international standard compliances are attained, and avail efficient IT
support.

Different policy, strategy, roadmap, and directive documents were produced by the MoH at
different directorates in recent years which focused on improving eHealth. Analysis of these
documents showed that the documents are developed in line to global recommendations and
toolkits. They focus on health information systems and data use for decision making. They are
prepared for decision makers and implementers in the health sector. Most of the documents
have proposed feasible solutions to improve the existing disparate and fragmented digital
health systems and on-going implementations and scale-ups in eHealth. However, they are
either on the initial draft or unpublished to date. This created unclear implementation and scale-
up plans; a lack of binding policies and roadmaps among stakeholders; and a rework of the
same document. Furthermore, these documents do not give much attention to the rapidly
changing and booming digital health technologies.

1.2 UNDERSTANDING AND FORECASTING THE FUTURE

The Ethiopian government has already incorporated new technologies in different sectors such
as banks, security, and governance. This shows that there is an appetite and aptitude to leverage
the benefit of emerging technologies to leapfrog Ethiopia to the digital era which will realize
health system transformation. However, it will require focused leadership, innovative private
sector, committed international stakeholders, and civil society for Ethiopia to realize the
potential of the rapid rise of digital health technology.

The introduction of Digital health in Ethiopia will support different aspects of health sector
activities such as management of patients, public health data, healthcare workers capacity
building, remote health service delivery, health information provision using mobile

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technology. Mobile technology and Internet use would accelerate the implementation of the
health Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC).

Though digital health has already been proven to advance health service delivery in different
countries such as Korea, Canada, and other, in Ethiopia it is yet to be harnessed because of
several inevitable challenges such as highly fragmented initiatives, poor coordination, scarce
of prepared health workforce ready for digital health, poor power and Internet infrastructure,
lack of sustainable financing, and others. To look forward and bring about quick decisions by
the leadership for rapid, cost-effective, and sustainable development of digital health in
Ethiopia, the introduction of the digital health blueprint document will have a significant game-
changing effect on the staggering appetite and aptitude of the government to transform the
country to digital space.

From a policy-making perspective, emerging technologies are of interest as they shape future
investment. Being an early adopter in technology creates the basis of modern competitive
strategies that are destined to have a profound and long-lasting impact on existing businesses
and create opportunities for new ones. For a technology to be considered as emerging it needs
to have radical novelty, relatively fast growth, coherence, prominent impact, and uncertainty
and ambiguity. Emerging technology generally refers to a new technology or a continuing
development of existing technology expected to be available within the next ten years and
create significant social or economic effects. In healthcare, they have great potential in
transforming health service delivery. Such technologies that have a significant effect on the
digitization of health systems include but are not limited to Cloud Computing, the Internet of
things, blockchain, data science, artificial intelligence, mobile and pervasive computing. These
technologies have a disruptive effect on the way service is delivered and can be harnessed
towards productively and creating a healthy population.

Healthcare has already become dependent on technology and repurposing of health data to
bring new insights for improving health service delivery. The Application of healthcare
technologies has brought healthcare professionals and patients closer regardless of their
physical distance. This is because of emerging digital technologies and their application in
healthcare to realize better and more affordable healthcare services and personalized healthcare
services.

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Some of the Applications of emerging digital technologies as of today in healthcare are:

● Mobile Health - empowered by AI to detect or prevent health issues.

● Robot-assisted surgery - improve flexibility, control, and precision during complex

surgical procedures.

● Predictive Analytics - uses patient data, statistical algorithms, and machine learning
approaches to predict imminent diseases.

● AI-based Check-ups and care planning - with the aid of patient digital ID and digital
payment.

● Analyze and predict infectious disease using AI-based surveillance systems.

● 3D printing: impacts the healthcare in 3D-printed orthopedic implants, Personalized surgery

and Medical & Dental devices.

● Cybersecurity - Securing patient data using trusted AI models over Blockchain in

digital health.

Health service delivery has been progressing by strengthening strategic interventions, engaging
the community as a centrepiece of the process, and investing in capacity building in
collaboration with universities. The introduction of the Ethiopian eHealth Architecture (eHA)
provided a clear picture of the current state and future direction of the country’s health sector
in the digital space envisioned by the government. The eHA is designed to accommodate
existing and emerging technologies as health needs, priorities, and interventions of the country
grow and change.

Therefore, the MoH and stakeholders have an astonishing appetite to advance the healthcare
access and service that is aligned with the trends that shape the health systems of the future.
For the next 10 years, the health system will be changing under the influence of booming
technologies such as mobile technology, Artificial Intelligence, genomics revolution,
blockchain, and others. Also, the global demographic dynamics, sustainability of the health
systems, and capacity building of the healthcare workforce are determinant factors for changing
the health system.

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With the advent of the fourth industrial revolution, the health system context is not going to be
the same. The way patients and doctors interact, how diagnosis and treatment are done are all
going to be affected by technology. With patients becoming aware of their medical condition
through the support of Internet-enabled medical devices their choice for a medical professional
and the demand from the health sector is going to be vast. The health system needs to be ready
and resilient to accommodate changes. A learning health system enabled by digital health
technology should also be created to ensure continuous improvement and innovation and
provide quality, equitable and affordable health care. The Ethiopian health system shall thus
be cognizant of this global change and adapt to cope with changing needs and be ready for
national and global challenges related to outbreak and pandemic needs.

Paradigm shifts are mostly caused by the emergence of disruptive technologies or unavoidable
crises. For example, the COVID-19 pandemic has brought a significant havoc to the business
as usual globally. The pandemic overturned the conventional process in the healthcare system.
It is mandatory to understand the very nature of health care dynamics in order for the blueprint
to be fit-for-purpose. The increasing demands, constantly evolving processes, and other
influences that potentially shape how healthcare will be provided in the future are the things
the health sector needs to consider. Given the vast constraints for the health sector, the
opportunities for implementation of digital health solutions are extensive where the
appropriateness of the solution and involving emerging technologies shall be prioritized.

The digital health blueprint preserves the overarching prospect of previously crafted policies,
strategies, plans, and roadmaps. This would encourage existing and ongoing developments to
be part of the blueprint and eliminate reinventing the wheel.Digital health blueprint will lay
significant emphasis on leveraging digital technologies for improving health delivery services,
bringing cultural shifts on information use, introducing emerging technologies, and
empowering the health workforce to seamlessly shift the paradigm.

1.3 WHY DIGITAL HEALTH BLUEPRINT FOR ETHIOPIA?

AND WHY NOW?

In the digital health era, when solutions and services are being disrupted by digital health
technologies, countries need to have a way of tapping the potential of such technologies.

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Ethiopia has taken an ambitious and bold country wide flagship strategy ‘Digital Ethiopia
2025’ with the aim of benefiting from the opportunities of digital revolution and emerging
technologies such as Artificial Intelligence, the Internet of Things, Nanotechnology, Big Data,
and other cutting-edge technologies.

The health sector is one among those that are highly influenced by services leveraged by digital
technologies. Having an overarching strategic guidance that will lead the investment and
implementation of digital health is vital. Thus, the digital health blueprint would have a
paramount importance for the health sector to align its eHealth and digital health initiatives
with the country’s bold and courageous move.

Whilst the Information Revolution guided the implementation of electronic health during
HSTP-I, there are several grey areas left off, including the contribution of digital health for
health services is not bold enough to address the emerging role of digital technologies in health
care and services. Hence, this blueprint is meant as a way of adapting to local and global digital
health technological dynamics by leapfrogging to the digital health era. Given the current
situation of the health system in Ethiopia, digital health might seem to be a luxury. In practice,
countries should not reinvent the wheel and pass through all the development of digital health.

The digital health blueprint will be the guiding document from which other initiatives emanate
and expected to be aligned with. The blueprint shall not in any way replace the information
revolution roadmap or other existing eHealth policies and strategies. It rather gives a lens with
which it has to be seen i.e., from the perspective of digital health instead of eHealth. It should
inform its priorities, values, and strategies for implementation by creating alignment with the
blueprint and other policies. The blueprint shall also add patterns of implementation by
unifying initiatives and gearing them towards the desired vision. By Unpacking digital health
domains placing them in respective pillars, the blueprint will insure ignored areas are included
and bring equitable service.

The blueprint is broadly meant to harness the huge potential of digital health technologies by
building on the lesson learned and progress made through the works of the information
revolution. To be able to leapfrog and catch up with emerging and disruptive digital health
technologies, there needs to be a framework for architecting and deploying digital health
solutions along with considerations for design choices and strategic planning. It shall also

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guide digital health solution provision and transformation from the eHealth era to the digital
health era. Though the available policy documents are of paramount importance to digitize the
health information systems in the country, they needed to be forward-looking in the sense of
encompassing emerging technologies. The blueprint shall elevate those initiatives and make
them mainstream agendas in the health sector.

The blueprint has to bring fundamental cultural and attitudinal change regarding the perceived
value and practical use of digital health solutions. This can be done by bringing together the
lessons and plans put forward in the various documents stated earlier to create a national digital
health blueprint that can act as the foundation on which the national digital health ecosystem
can be built. There is also a visible demand by patients, health workers, and various
stakeholders for innovative digital health solutions. The blueprint thus intends to create a
holistic and comprehensive digital health ecosystem.

The blueprint can also lay a foundation for a strong ICT infrastructure, reliable solutions and
service, and sustainable access and delivery for patients. This would help streamline the
delivery of healthcare services and related information. It illustrates how current and emerging
technologies can be incorporated into health care delivery processes to enrich the functionality,
generate greater efficiencies, and enhance the experience for health service providers and
consumers.

The digital health ecosystem in Ethiopia is thus in need of synchronization of various initiatives
through the development of a digital health blueprint which will be acting as an overarching
guiding document to create a clear vision. Thus, this would provide guidance and insight into
the use of emerging technologies and new digital health opportunities. In a nutshell, the scope
of the blueprint is to create an overarching foundational plan for digital health in Ethiopia and
will serve for 10 years (2021-30).

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 PART II: VISION, OBJECTIVES, GUIDING
PRINCIPLES AND PRIORITIZED
INITIATIVES

2.1. VISION

To bring quality, affordable, equitable, and technology enabled health service delivery by 2030.

2.2. MISSION

To avail effective, reliable, secure, and innovative digital health systems to support policy &
strategic development, clinical decision making, patient management, healthcare provision,
education and research functions of the health sector .

2.2 OBJECTIVES

The objectives of the blueprint are to:

● Have an overarching document that should govern the fragmented initiatives

● Guide leaders to oversee ongoing progress in the digitization of the health sector
● Create alignment of initiatives and thereby avoiding duplication of effort
● Coordinate and strengthen initiatives to boost the impact
● Bring about a shared vision of current and emerging digital health solutions and services
● Foresee challenges that could come along with the application of new technologies and
prepare a mitigation scheme
● Put forward the priorities and opportunities
● Create scalable ICT infrastructure taking into account the current and future demand
with the engagement of stakeholders
● Help leapfrog to the next era while being cognizant of current challenges and harnessing
opportunities
● Improve the quality of healthcare access and service delivery using digital health
solutions.

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2.3 GUIDING PRINCIPLES

The following are the values of the blueprint which defines the core philosophy of the digital
health ecosystem:

Synergy - create combined actions among different initiatives by creating a clear vision of
current and emerging initiatives and also inform and harmonize HIS documents.

Alignment with the the sectoral objectives:- The digital health system should follow the
priority areas of the health system strategic objectives

Mainstreaming - digital health blueprint objectives shall be carried out as part of mainstream
health system activities as digital health technologies are the means, not the end.

Patient/Client centered:- Digital health priorities are geared towards the benefits of
patients/client.

Local contextualization - to realize sustainability, the digital health blueprint should be

adaptable to local contexts by providing due consideration to the human, financial, cultural
situations on the ground.

Multi Sectoral Engagement - collaboration between organizations in different sectors public

or private to achieve policy outcomes.

Leveraging Global Goods - are digital health tools that are adaptable to different countries'
context. Implementers need to start with global goods that have open architecture.

2.4 PRIORITIZED DIGITAL HEALTH TECHNOLOGY

ENABLED HEALTHCARE FOCUS AREAS

Although digital technologies bring huge and countless opportunities for transforming the
health care, all possible opportunities cannot be piloted and implemented at larger scale at the
same time because of financial and human capacity constraints. Selection and prioritization of
high impact digital health interventions considering the country’s context would be mandatory.
So far in the past couple of decades, the Ethiopian health system has been giving priority to

10
digitalization of health information. However, in the digital health era, much can be done
beyond in parallel to digitizing health data depending on the actual need of patients, health care
workers, managers and the community at large.

In this section, the potential high impact digital health investment focus areas are highlighted.
The areas have been identified by consulting the Digital Ethiopia 2025 and WHO
recommendations of digital health interventions. Consultative meetings with the national
advisory group (NAG) for digital health and representatives taken into account. Moreover, a
health system perspective of MOH was reviewed and included.

1
Health System Leadership and Governance: Digital Performance Management

One of the critical challenges in the Ethiopian health system is creating accountability
and merit-based performance evaluation. The work of healthcare managers and
healthcare workers is usually evaluated through meetings and supervisors - and they are all
paper-based. This paper-based method of evaluation often depends on the supervisor's
judgment. It doesn’t evaluate processes and outcomes as intended and it also doesn’t show the
quality of work or performance of the health worker and manager. Because of the capabilities
of digital technologies to collect real-time and objective data, having a digital health
intervention for monitoring and evaluation of the performance of health care workers and
managers would significantly improve the leadership and governance of the Ethiopian health
system.

2
. Health Service Delivery: Remote Health Care Delivery

Two of the nine WHO minimum digital health recommendations for developing
countries are client-to-provider telemedicine and provider-to-provider telemedicine.
These two digital health interventions can be effectively implemented in Ethiopia given the
right commitment and follow up are in place. In particular, provider-to-provider telemedicine
can be effectively and easily scaled up in the next ten years as almost all health care providers
own mobile phones.

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3
. Health Workforce: Digital Decision-making Support and Learning

Despite the massive improvement in access to health services, Ethiopian health care
remains to be of poor quality. This is mainly due to the poor quality of health workers
training and low level of health workers’ knowledge and skill retention, particularly, among
mid-level and frontline health care workers. To address this critical problem, the country has
been investing millions of dollars in capacity building and refresher trainings for health
workers. However, the effectiveness of these in-service trainings and sustainability of such
trainings in the absence of donor money is daunting. Supporting and partly replacing these
onsite and in-service trainings with digital decision-making support and learning tools and
approaches is commendable. By doing this, the cost for trainings and continuous professional
development can be reduced significantly and gives health workers the freedom to learn
anytime and anywhere at their own pace, need, and convenience.

4
. Healthcare Financing: Digital Health Payment

Introducing and scaling-up of digital payment is one of the highly prioritized projects
in the Digital Ethiopia 2025. The government is committed to have digital payment in
all sectors and institute e-commerce as it aspires to benefit from the digital economy. So far, in
Ethiopia, the banking sector is pioneering and has gone far in transforming its services to
electronic, including ensuring digital payment. The health sector has equal opportunities of
benefiting from introducing and scaling up of digital payment schemes. The community-based
health insurance is one mentionable service of the health sector that can be practically digitized.
Although currently the revenues that the government collects from health services is low
compared to other sectors, health care is the future industry that can generate huge revenues
for government and private companies. Thus, modernization and digitizing the payment and
revenue collection of the health system is one of the leapfrogging areas that will open several
opportunities for the private and government sectors.

5
. Digital ID

As noted earlier, most of the efforts of the Federal Ministry of Health have been in
digitalization of the health data and health information system. As a result massive
improvement has been achieved. Under the umbrella of connected woreda strategy, the

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implementation of the likes of HMIS and community-based information systems is making
promising progress. However, because of the lack of unique ID for every citizen and patient,
making the systems interoperable has been one of the areas of struggle - and as such, better use
of data collected through these platforms is greatly hampered. Having a unique digital ID for
every citizen in the country is a prerequisite for transforming the electronic health information
system. Thus, it should be a top priority digital health focus area in the health sector, as
underpinned in the Digital Ethiopia 2025. Meaningful and strong collaboration with relevant
sector offices, particularly Immigration, Nationality and Vital Events Agency (INVEA), is
necessary in this regard.

6
. Healthcare Medical Products, Vaccines and Technologies: Point of Care
Disruptive and Diagnostic Technologies

Four main manifestations of the fourth industrial revolution are autonomous vehicles,
3D/4D printing (additive manufacturing), advanced robotics, and smart materials. The
applications of these four manifestations coupled with rise of nanotechnology, artificial
intelligence and advancement of sensors opens for new disruptive medical products and
technologies. Medical technologies are expensive and are unaffordable for many developing
countries. The cost of maintenance, electricity needed and reagents for such medical equipment
is even beyond the initial cost. Thus, looking for alternative disruptive technologies is essential.
Nowadays globally there is a shift from the development of high cost and complicated medical
equipment that can be operated by highly skilled professionals to simple point of care tests that
can be operated by mid-level and frontline health care workers. In the near future, point of care
tests that would replace the current MRI, CT scan and Ultrasound would be available not only
at referral hospitals but across all levels of health facilities. A typical example is the
development of portable and mobile ultrasound which was unthinkable some years ago.
Ethiopia shall focus on the investment and development of such disruptive point of care tests
as its benefit is multiple and transformative agendas.

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. People: Digital Literacy

The ultimate purpose of technology should be to improve people’s life and serve
humanity - so do digital health technologies. From the health care perspective,
technology is a means. It is not an end by itself. Any digital health intervention shall be seen

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and judged from its usefulness to improve patient's experience, the work of healthcare workers,
healthcare mangers and improve health outcomes. On the other hand, no matter how a digital
health technology is well designed, it can’t achieve the desired outcome without adequate use
and adoption of the people in need. For this digital literacy of the whole society and users is
imperative. Needless to say, Ethiopia’s digital literacy among the general population is low.
Much has to be done to improve digital literacy of Ethiopian people.

One avenue that the health sector can contribute to the improvement of digital literacy is
through the health extension program and other tailored community-based programs. Through
these community based programs, social mobilization can be done for digital literacy. Basic
and innovative trainings can be considered as part of the health extension program and school
health program to improve digital knowledge and skills of the people. In this regard, the issue
of local language shouldn’t be forgotten - as one of the critical barriers for adequate usability
and adoption of digital health technologies is language. Thus, having devices that can handle
local languages and development of digital health contents in local languages is mandatory in
terms of both improving digital literacy and enhancing effective use and adoption of digital
health interventions.

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. Research and Development: Digital Health Research and Development Centre

The Ethiopian government, through Digital Ethiopia 2025 has highlighted science,
technology, and innovation as key enablers in promoting the ability of Ethiopia to
realize its full potential in the digital space. Thus, MoH with local and international
stakeholders should focus on strengthening research on the application of emerging
technologies for realizing digital health in Ethiopia. Locally driven research outputs would help
the leaders and policymakers to understand the country’s contexts. Engaging universities,
private technology companies, donors and strategic digital health partners will have a
paramount advantage in terms of translating insights gained from research. This could be
realized by creating centres of excellence at academic institutions and technology incubation
centres at the national and regional levels.

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 PART III: BUILDING BLOCKS/PILLARS OF
THE DIGITAL HEALTH BLUEPRINT

3.1. DESCRIPTION

Building blocks/pillars of the digital health blueprint constitute the significant elements which
are crucial for the realization of the objectives of the blueprint. The main principles for the
selection of these pillars are that it should be of high impact for the success of the ecosystem,
key/critical component for the blueprint, require high focus and attention from all stakeholders.
Each Building block has a specific functional scope and that can be integrated with other pillars
and enablers to create a digital health ecosystem.

By adopting the pillars under WHO ICT and enabling environment [1] to our current needs and
also conducting a detailed review of other countries' experiences and practices, four building
blocks or pillars and five key enablers were identified. Thus, the pillars are Access and
Delivery, Solutions and Services, ICT Infrastructure, and Data Hub. These pillars more or less
match both the HSTP II’s classification of digitalization activities and WHO’s foundational
ICT environments. The classification of the interventions is based on the WHO
recommendation [2] .

3.2. DIGITAL HEALTH BLUEPRINT CONCEPTUAL FRAMEWORK

Based on the identified pillars and enablers, a conceptual framework for DHBP is designed to
demonstrate how the building blocks of the DHBP are interlinked and interact with each other.
Moreover, enablers of these building blocks are also mapped, adapted from WHO’s toolkit for
developing eHealth strategy and ITU’s toolkit for building Digital Health Platform (DHP)[ 3],
and shown as in the diagram below.

1 National eHealth Strategy Toolkit

2 recommendations on digital interventions for health system strengthening
3 Digital Health Platform Handbook: Building a Digital Information Infrastructure

(Infostructure) for Health

15
Fig 1. Conceptual framework of the Blueprint

16
3.3. PILLAR 1: ICT INFRASTRUCTURE

ICT infrastructure includes the hardware, software, networks, facilities, etc., that are required
to develop, test, deliver, monitor, control or support IT services. The ICT infrastructure here
refers to Servers, Computers, Printers, Tablets, Network Connectivity Components, Software,
Firmware and facilities, among others – that we use in the health sector to support or improve
health service delivery mechanisms with a diverse set of digital health solutions and services
to foster interaction amongst different stakeholders. This pillar allows one to facilitate, govern
and establish, secure, accessible and manageable ICT infrastructure that can run solutions,
services and access of data in the Ethiopian health sector. This includes facilitation and
governance of infrastructure establishment in public and private sectors; development and
endorsement of the policy for health ICT infrastructure; and continuous assessment and
amendment of the current and emerging ICT infrastructure technology needs.

Focus Areas

This pillar focuses on establishing, expanding and maintaining a highly secure, scalable and
compatible ICT Infrastructure that is capable of accommodating Ethiopia’s digital health
initiatives at all levels. Specifically, its concern with:

● Creating scalable ICT infrastructure, and enforcing workable implementation and scale
up approaches.

● Deploying infrastructure accommodating current and future needs;

● Establishing operational support at all levels;

● Establishing comprehensive and efficient policy, procedures and regulation for

governing ICT infrastructure;

● Establishing collaboration and support mechanisms in infrastructure development with

stakeholders – including the private sector;

● Establishing emerging technology infrastructure adoption and regulations mechanisms

for leapfrogging.

17
Recommended interventions under the Digital Health Infrastructure Pillar are further unpacked
in the “Digital Health Blueprint Pillars Action Plan” part of the Annex(Annex 1).

3.4. PILLAR 2: SOLUTIONS AND SERVICES

This pillar deals with digital health solutions and services that integrate the digital health
ecosystem participants (clients, health delivery centers, practitioners, policy makers, solution
creators and providers) through a systematic and seamless development of digital health
technologies to improve service quality and accelerate ease of access to health services. The
solutions and services will be (and should be) based on the real business requirements and
priorities of the health sector. The digital health solutions and services are categorized based
on primary target user groups: Client-oriented, Provider-oriented, Manager-oriented and Data-
services-oriented solutions and services. Strategies are proposed in a bid to implement high-
impact and sustainable digital health solutions and services.

Focus Areas

The main focus of the Solutions and Services Pillar is expediting digital health usage and
adoption through identification, classification, and prioritization of digital health solutions and
services following a holistic and principled approach so as to improve service quality and
enhance Universal Health Access (UHA). The Digital Health Solutions and Services have
mainly to do with:

● Ensuring the implementation and/or adoption of globally acceptable and contextually

tailored digital health solutions and services for the health sector;
● Adapting eHealth standards and systems architecture to ensure harmonized and
interoperable eHealth applications;
● Promoting the development and use of enterprise-class health application system;
● Promoting the development and adoption of state-of-the-art and remotely accessible
technology solutions to enhance equitable access to health services;
● Identifying and defining/setting standards and regulation mechanisms for the proper
implementation and use of digital health solutions and services;
● Defining appropriate implementation arrangements for the implementation of digital
health solutions and services;

18
 ● Conducting/Assessing the maturity of solutions and services and promoting improved
maturity status.

This can be achieved through: an integrated approach to stakeholder management and

alignment of priority initiatives; raised awareness and improved confidence for utilization of
digital health solutions and services; strong interoperability platforms to support sharing of
health information across fragmented systems, geographical and health ecosystem boundaries;
enforcement of community and human-centered design principles; and, establishment of a
platform to develop capacity and technical know-how amongst stakeholders.

Recommended interventions under the Digital Health Solutions and Services Pillar are further
unpacked in the “Digital Health Blueprint Pillars Action Plan” part of the Annex(Annex 1).

3.5. PILLAR 3: DIGITAL HEALTH ACCESS AND SERVICE

DELIVERY

Data access and service delivery pillar of the digital health Blueprint encompasses programs to
create and improve data access to various audiences and actors including public/citizens,
clients/patients, health care providers, health care managers, researchers, academic institutions,
donors, implementing partners and other health sector stakeholders. It also deals with
facilitating health service delivery by creating and deploying apps for clients /patients, and
health care workers. Accordingly, it improves client-provider interaction, increases health
literacy and decision support by health data users.

Focus Areas

The Data Access and Service Delivery Pillar mainly focuses on improving service quality and
wellbeing of citizens by making data easily accessible for decision making by all stakeholders
and enhancing the use of digital health technology by clients/patients and health care providers
to improve health service provision processes. Specific focus areas include, but not limited to:

● Identification of different data sources, pulling and integrating the data/information

from the sources and repositories and making it suitable for access by the users;

19
 ● Assessing the existing and emerging technologies used for data/information access
and service provisions to the clients;

● Proposing, adapting and framing the data, information and service delivery
technologies to suite local contexts and situations;

● Promoting the health data to be made accessible for assimilation by the tailored
audiences.

Recommended interventions under the Digital Health Access and Service Delivery Pillar are
further unpacked in the “Digital Health Blueprint Pillars Action Plan” part of the Annex(Annex
1).

3.5. PILLAR 4: DIGITAL HEALTH DATA HUBS

The Digital Health Data Hubs Pillar aims at creating interconnected health information/data
systems to support health care informed decision and service delivery. The basics of this pillar
are data transformation, exchange and integration, data archiving, data management and
analytics to generate reliable information and evidence for decision. It encompasses identifying
relevant data sources, extracting data from the sources, transforming and harmonizing data,
and making them analysable, establishing and managing data repositories and securities,
putting in place data governance standards and regulations, enhancing standards for data
exchange/sharing, and applying robust data analytical tools. The pillar functions at all levels of
the health sector and relevant actors that include government sector, non-government
institutions, donor organizations, private institutions and other relevant stakeholders. It is
concerned with all health and health related data with their respective data sources and
institutions, data standards and regulations, building state of the art data systems and capacities
to produce reliable evidence for all relevant users.

20
Fig. 2: Workflow of data exchange between multiple sources, data warehouses store massive
amounts of data generated from various sources, data processing using analytic pipelines to
provide information for access and delivery.

Focus Areas

The major focus of this pillar is building and strengthening interconnected data systems through
interoperability framework, governance, workforce development and capacity building. This
includes establishing a robust information exchange between actors, improving health data
quality and integrity, implementing research and innovation, applying data analytic tools and
methods (such as machine learning/artificial intelligence, and big data analytics) and fostering
health intelligence. Some of specifics include the following:

● Making data systems interoperable and interconnected, facilitating data exchange and
access for seamless data sharing between endpoints;

● Ensuring data governance through standards and regulations to enhance open data
systems and data access;

● Establishing and strengthening national and subnational data repositories with

appropriate security systems;

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 ● Applying computational techniques and methods such as machine learning/, artificial
intelligence, big data analytics and fostering health intelligence;

● Building data capacity including the workforce;

● Promoting and advocating for data use and incentives;

● Enhancing research and innovation on data systems, applications and services;

● Generating quality and reliable evidence and disseminating with different formats such
as publications, reports, dashboards.

Recommended interventions under the Digital Health Data Hubs Pillar are further unpacked in
the “Digital Health Blueprint Pillars Action Plan” part of the Annex(Annex 1).

22
 PART VI: ENABLERS OF THE DIGITAL
HEALTH BLUEPRINT

4.1. DESCRIPTION

Enablers of the blue print constitute elements which are essential for the successful
implementation of the building blocks.They are cross functional in their nature and due
emphasis is given for their consideration in each pillar. They are equally important for the
successful implementation of the blue print along with the building blocks and proper analysis
should be made when considering implementation of digital health initiatives.

The following enablers have been identified for the digital health blueprint.

4.2. STANDARDS AND INTEROPERABILITY

Healthcare applications in Ethiopia usually offer different sets of features and functionalities
with different structures and data formats. However, most of these applications do not use
common data elements or data exchange standards. There should be a mechanism to enforce a
consistent use of standards and adoption of them on a regular basis to guide the newly
developed digital health solutions. By so doing, we can address the gaps and support
interoperability and information sharing across various healthcare applications and systems.

Focus Areas

This Enablers focuses on adopting and promoting the globally recognized and nationally
adopted standards which enable interoperability among eHealth applications to meet
international norms and standards as a cornerstone for integrated health information systems
in the health sector. Specifically, this Enabler has a lot to deal with:

● Promoting a central curation mechanism for data, indicator and unique identifiers;

23
 ● Adapting an enterprise service bus layer/interoperability solution to make applications
interoperable;
● Promoting the usage of health data exchange standards;
● Developing and operationalizing a digital health inventory system/Digital Health Atlas
to be used as a clearinghouse for compliance and standards;
● Improving capacity building and creating a knowledge sharing platform;
● Defining and implementing metrics for evaluating the values added to the health system
by implementing an interoperability solution;
● Setting up a regulatory body that follows up and enforce data exchange standards.

Recommended interventions under the Standards and Interoperability enabler are further
unpacked in the “Digital Health Blueprint Enablers Action Plan” part of the Annex(Annex 2).

4.3. SYSTEM SECURITY

System Security is one of the cross-cutting enablers that should be taken into consideration in
all identified pillars and enablers of this Digital Health Blueprint. Based on ISO 27001, it is
described as vital to the business and daily operation of any organization related to research,
administration, and management. Information that is collected, analyzed, stored,
communicated, and reported upon may be subject to theft, misuse, loss, and corruption. It may
also be put at risk because of poor education and training, and the breach of security controls.
Information security incidents can give rise to embarrassment, financial loss, non-compliance
with standards and legislation as well as possible judgements being made against an
organization/institution. System security encompasses all facets of accessing information
assets from authentication, to software updates, anti-virus protection, and modifications.
System security also is a key component to a device operating at its optimum. Hence a defined
level of system security and its supporting controls, processes and procedures will be applied
to all individuals and stakeholders who access the health sector’s ICT infrastructure, solutions
and services and the data hub.

Focus Areas

The primary considerations of System Security in digital health system are:

24
 ● Identifying possible Information risks, management options and treatment procedures
in all initiatives;
● Establishing all physical, procedural, and technical control mechanisms to address the
security concerns of all the Digital Health Pillars;
● Ensuring that appropriate tracking measures are put in place for the authorized users to
securely access and share health information.
● Establishing secure information exchange across the digital health ecosystem.
● Ensuring that contractual and legal obligations relating to information security are met.
● Enabling that research, innovations, and administrative activities consider relevant
information security protocols.

Recommended interventions under the Digital Health System Security enabler are further
unpacked in the “Digital Health Blueprint Enablers Action Plan” part of the Annex(Annex 2).

4.4. RESEARCH AND INNOVATION

Digital health interventions should be supported by suitable research in all aspects, from
conception to development and deployment of new models, services and products. It also helps
to generate innovative ideas and solutions, incorporate risks and assumptions, and identify
existing best practices and challenges during implementation. Likewise, the need to monitor
and report global developments and trends in digital technologies used in health systems, public
health and data science will advise us to depend on digital health research and innovation. The
research and innovation agenda should align with the emerging needs to improve and
disseminate evidence and information on the use of digital health at all levels. It should justify
the return-on-investment of digital health and help the establishment and promotion of
accountability mechanisms. The research and innovation agenda should also address the need
for stimulating the development and testing of technologies, methods and infrastructures that
overcome obstacles to the application of digital health and health priorities. This agenda should
be closely linked with capacity-building of research teams.

Focus Areas

The overarching digital health research and innovation priorities for Ethiopia include
implementation model effectiveness studies; feasibility studies; return-on-investment studies;
25
equity and rights analyses; Big Data Analyses; Predictive Models; Data Access versus
confidentiality wrestlings; Artificial Intelligence; Business Analytics; Internet of Things, and
the like.

Recommended interventions under the Digital Health Research and Innovation enablers are
further unpacked in the “Digital Health Blueprint Enablers Plan” part of the Annex(Annex 2).

4.5. DIGITAL HEALTH WORKFORCE

The digital health workforce with appropriate education, skill mix, quality and adequate
quantity at all public health offices and facilities is crucial to keep the digital health systems
implemented and running to transform the overall health care services in the sector. The
Workforce Enabler guides the design and implementation of the human resource roadmap
(structure), appropriate curriculum (both for pre-service and in-service modalities) tailored to
the digital health workforce and the health workforce at large emanating from the needs of the
health system. There is an understanding that strengthening of the ICT health education and
training programmes at post-secondary educational institutions such as universities, vocational
training institutions and professional bodies by embedding Digital Health into their curricula
and thereby increasing the number of skilled, nationally available digital health practitioners
can enable the leapfrogging to the technological advancements used in health care delivery.
Hence, systematic efforts should be made to create and foster an environment that encourages
and supports digital health employees to remain employed. This can be done by maintaining
strategies and practices in place in the bid to address their diverse needs. It is also equally
important to create structure for the demand of digital health and assign appropriate workforce
at all levels.

Focus Areas

The main focus of this Enabler is maintaining competent digital health workforce that can
establish and maintain effective digital health systems with the aim of having resilient health
systems and to realizing digital literacy among the entire health workforce. More specifically
the Digital Health Workforce Enabler emphasizes on:

26
 ● Establishing and implementing digital health workforce standards and structures at all
levels of the public health sectors;
● Developing curriculum of up to standards for in-service and pre-service trainings for
post-secondary educational level digital health and other health workforce;
● Enhancing the capacity of the digital health workforce through development of tailored
training programs for pre-service and in-service modalities to enable them capture,
analyze and report using the digital health systems;
● Establishing digital health workforce retention mechanisms.

Recommended interventions under the Digital Health Workforce enabler are further unpacked
in the “Digital Health Blueprint enablers Action Plan” part of the Annex(Annex 2).

4.6. GOVERNANCE AND LEADERSHIP

Digital Health governance and leadership is a mechanism by which decisions related to digital
health planning, funding, implementation, monitoring, etc. are overseen augmented with
proper digital health policies, legislation, compliance, and standards – with the aim of enabling
the health system to use the digital technologies to maximize achievement of health care
services. Availing strategic policy frameworks combined with effective oversight, coalition-
building, regulation, and attention to system design and accountability is the key role of this
Enabler. Likewise, it is also vital to enhance the leadership capacity to lead the overall
execution of digital health strategic initiatives.

Focus Area

One of the major focus areas of the digital health leadership and governance is the creation and
improvement of the functionality of the various digital health governance structures and
framework at national and regional levels. This is done in light of the realization of inclusive
and transparent digital health decision-making, consensus building and accountability with the
intent of directing, implementing, enforcing, monitoring, and evaluating the digital health
initiatives.

The other focus area is the realization of digital health via active engagement of multiple
stakeholders with varied interests and priorities for the multi-stakeholder dialogues (MSDs),

27
facilitation of consensus building through collective identification of challenges, recognition
of shared goals and interests, and creation of best considered solution pathways within this
governance framework.

The third focus area is establishing appropriate digital health policies and legislations at
national and regional levels and providing legal and policy framework for digital health
implementation and operations. It is increasingly important to establish digital health related
protocols, standards or SOPs and regulatory and formal compliance mechanisms to ensure the
risk-tolerant digital health investment and funding.

Recommended interventions under the Digital Health Governance and Leadership Pillar are
further unpacked in the “Digital Health Blueprint Enablers Action Plan” part of the
Annex(Annex 2).

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PART V: IMPLEMENTATION APPROACHES
AND STRATEGIES

The blueprint will guide implementation of national as well as regional digital health solutions
in a seamless way as an umbrella to guide the overall digital health investment and
interventions. It shall give a high-level vision of what is to be implemented in the years ahead
as part of a strategic roadmap. The planning process takes the needs and capabilities of the
different stakeholders in realizing the vision. This entails the need for stakeholder analysis and
mapping so that common understanding is created and each party knows its role and
contribution. The implementation shall be done in a coordinated way by building on the lessons
from the information revolution and other strategic initiatives underway. To be able to create a
shared vision of what shall be done and to gain acceptance at levels, the blueprint shall be
socialized and shared with all stakeholder during and after its development. The blueprint
should be supported by additional roadmaps and other policy documents which shall be
cascaded at all levels. It needs to be regularly updated periodically as part of fiscal planning. It
should be able to accommodate change in the context, capabilities or capacity of the health
system and the country at large.

5.1. IMPLEMENTATION APPROACHES

The following implementation approaches are proposed in order to harness the benefit of digital
health implementations based on the pillars and enablers and priorities in the blueprint:

Use of Standards

Health data and other standards are crucial for creating resilient and interoperable systems. The
standards are important for interoperability of the digital health systems, data exchange
between sources, data storage and analysis, data security and confidentiality and data use for
informed decision making. Health data exchanges should adhere to standards that address
different transport, content and media types. Common data and data exchange standards such
as ICD10, NCoD, SNOMED, LOINC, FHIR, and HL7, etc can be adopted as needed.

Integrated Approach
29
An integrated approach to stakeholder management and alignment of prior key initiatives shall
be followed. Collaboration between stakeholders is a key criteria to implement digital solutions
and services and achieve equitable health coverage. An integrated stakeholder management
and engagement platform is necessary for digital technology projects to succeed and for the
realization of the vision set out in the blueprint.

Community Approach

Creating a community of practice that can enhance capacity and mitigate the lack of skills for
solution provision shall be done. The community approach is key in creating shared
responsibility and creating sustainable solutions which are affordable. Successful
implementation of digital health solutions and services require community engagement that
takes the local context and situation into account. Understanding and integrating local issues
into digital health design ensures that the right technological solution can be identified and
social aspects that enable digital health technology to thrive are considered.

Government ownership

The blueprint can only be realized through appropriate leadership and governance. Higher
bodies in the health ministry shall take the primary lead in following up its realization through
creation of implementation road-maps and putting in place monitoring & evaluation
mechanisms. The leadership and governance shall also be cascaded to lower level management
to create a shared vision through socializing it via different engagement platforms. Though the
primary governing body of this blueprint shall be the ministry of health.

Adopting Human Centred Design

Digital health solutions have to be developed following human centred design. This has to be
adopted to ensure that users needs are well addressed and useful solutions are provided.
Developing technology solutions that are user-focused, user-friendly and adjust to the local
context: this strategy ensures digital health solutions and services should consider local context
and focus on the end user. Designing and implementing digital health solutions are based on
local needs and aspirations, takes work practices into account, aligns to local skill levels and
builds in incentives for the individual to use the system.

30
Building Local capacity

Initiating capacity building strategies in collaboration with universities, research institutes and
stakeholders helps in creating strong and sustainable local capacity. This strategy is aiming to
establish collaboration and ensure sustainability of these initiatives engaging local universities
for training, research and innovation. This strategy is also to establish strong coordination with
research institutes and stakeholders for their steamed contribution, resource mobilization and
overall support.

Implementation Research Oriented Approach

Implementation research is crucial in guiding the implementation of digital health initiatives

based on local practices, experiences harmonized with scientific findings, and
contextualization based on the reality on the ground. It is helpful to introduce practical solutions
into the digital health system and facilitate full-scale implementations at national and regional
levels. The intention of this approach is to provide solutions, identify challenges and best
practices, to discover new solutions, to develop knowledge management and scale up best
practices.

Competency/Incubation/innovation Centres

Establishing competency, incubation and innovation centers at national and regional levels
which will foster the development of innovative digital health ideas to ensure the sustainability
of the digital health initiatives. Such centers enable for collaboration among different
stakeholders through creation, sharing, and testing of ideas. A lack of digital skills and technical
abilities among health professionals are common cited roadblocks that impact implementation
and acceptance of digital health solutions. It is factual that the competency centers will address
skill and knowledge related issues by producing a pool of experts in digital health
implementations. This approach focuses on creating a platform for different digital health
innovators to share new ideas and experiences and dissemination of best practices.

Resource Synchronization

This strategy is to emphasize sustainable budget and resource allocation for the overall
implementation of this strategy including local financing to achieve its goals and objectives.

31
Bringing resources from multiple sources and guiding it towards the realization of the blueprint
avoids duplication effort and promotes efficient use of resources.

Contextualization

Solutions need to be contextualized to the local settings. Solutions shall not be designed in one
size fits all mentality so that they accommodate local culture, operating environment, locale
and the likes.

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5.2 STAKEHOLDERS MAPPING

The Blueprint is nothing without the engagement and consistent collaboration of stakeholders.
The following stakeholders are identified as major stakeholders that will directly take part in
the realization of what is stated in the Blueprint.

No Name Description Role Responsibilities

1 Citizens/clie People who benefit from Beneficiary / Provide the necessary information in
nts/patients the digital system. They are users identifying needs, followup of
the primary stakeholders as development progress and quality of
all the digital health services
development efforts are
done to improve health
outcomes
2 Healthcare Service providers in the Service Involve in creation of the products and
providers health sector e.g doctors, providers / services following the human centered
nurses, health extension users design principle
workers, etc
3 Higher Private and public Capacity Creating local capacity. They shall be
Institution universities and colleges building keen in understanding of current and
emerging technologies and conducting
research and development
4 Healthcare Decision making entities in leadership Endure leadership and management of
managers the health sector e.g Health digital health solution development and
Ministry, CEO, Medical services provision. Monitor quality of
directors, regional, zonal service and bring customer satisfaction
and departmental and sub-
department heads

5 Donors Source of funding and Donation Provide source of fund and follow-up
technical support and technical support in utilizing the
fund

6 Implementin Digital health solution implementer Engage in product and service

g partners developer and providers development, deployment, maintenance
and support
7 Researchers Academician who are Researcher Document lessons and propose
involved in research and recommendations for implementation
development
8 Communitie Communities of practice Contributor Development of solutions, standards
s working on digital health and identification of gaps and provision
of best practices

33
5.3. THE BLUEPRINT ACTION PLAN

The major interventions, the core of the blueprint, are identified, streamlined and scheduled so
as to ensure to guide other strategies and roadmaps to be crafted based on the blueprint.
Enhancing computing infrastructure, network connectivity and service desk are the major
initiatives as part of strengthening the ICT Infrastructure. In order to make the maximum
benefit out of digital health services and solutions, implementation of remote health care services,
mobile health care services, point of service applications, institution-based applications is of paramount
importance. Being the end user of all the digital health interventions, the clients have stake in the
outgrowing digital health technology, including access to digital health service promotion and
information dissemination, and personal health records and use of health apps to track their health
condition. Several interventions, including repositories, shared services, data warehouse
initiatives, have been identified to maintain and utilize the data generated by the health sector.
The enabling environments and initiatives, to ground the major digital health interventions,
related to standards & Interoperability, system Security, research & Innovation, Workforce,
Governance & Leadership are identified and properly scheduled. The detailed interventions
with the respective action plan are indicated in the Annex 1 & 2 within this document.

5.4. MONITORING AND EVALUATING THE MATURITY

LEVELS OF DIGITAL HEALTH INITIATIVES

Nowadays, the importance of assessing the maturity level of digital health using maturity
model-based assessment tools have grown. These methods are powerful in describing the
current maturity level of digital health systems in terms of human resources, business
processes, technology, and organizational capabilities. The methods also facilitate users’
ability to set goals for future levels of maturity and inform the development of improvement
plans to realize the next maturity level toward a stronger digital health system for a country to
meet its public health targets. The HIS maturity assessment gives due emphasis to the
institutional maturity of the digital health in its entirety (based on the concept of HIS Stages of
Continuous Improvement) as well as the maturity of individual digital health components and
interoperability maturity of those systems. Based on the current maturity status of digital health
and where we want to reach in the future, the assessment results will give information about
the areas which need special attention by the different stakeholders.

34
MOH has conducted the digital health maturity assessment with the objective of establishing
a systematic basis of measurement for describing the digital health maturity baseline (end of
2020), mid-term goals (2024 – the end of HSTP-II), and the ultimate goals (2030) through HIS
Stages of Continuous Improvement (SOCI) and to set a roadmap toward resilient and
interoperable systems, and prepare action plans for improvement.

5.5. HIS MATURITY ASSESSMENT FINDINGS AND FUTURE S TATES

(GOALS)

Using stages of continuous improvement (SOCI) tool, the current status and future states of the
health digital health are unpacked in terms of five domains: Governance and Leadership,
Management and Workforce, ICT Infrastructure, Standards and Interoperability, and, Data
Quality and Use. The assessment findings have shown that among the five domain areas ICT
infrastructure and Leadership and Governance and Leadership are the areas that need more
focus and attention in order to realize the objective of the digital health blueprint. Other
domains also have areas to improve in order to meet the aspired maturity level in the coming
one decade. The following matrix shows the current cumulative maturity scores (end of 2020),
future maturity level for HSTP-II period, and ultimate aspired maturity for 2030. Selected pain-
points also are highlighted to zoom-in to individual domains. Hence the ministry, agencies,
regional bureaus, and relevant stakeholders need to give more focus and priority in order to
minimize these gaps in these domain areas.

Fig. Digital health maturity status, current state (end of 2020)

35
 Table. The current and Future Maturity States of digital health in Ethiopia

Domain Name Current Future Status Aspired Pain points that need special attention …
Cumulative (HSTP-II Future
Score (End of 2024) Status (2030)
2020)

● Endorsement and enforcement of policies and

legislations;
Leadership
4.99 (out of
and 2.47 (out of 5) 4.33 (out of 5)
5) ● Structures, processes and specific mechanisms
Governance
for enforcement of policies and legislations;

● Inclusive coordination mechanisms.

● Mainstreaming the Informatics concept;

● Clear HIT structure and incentive mechanisms;

Management
4.99 (out of
and 3.37 (out of 5) 4.67 (out of 5) ● Tailored competency enhancement training and
5)
Workforce development programs;

● Assessing and deploying the digital health

workforce to meet the growing demands.

ICT 2.29 (out of 5) 4 (out of 5) 4.99 (out of ● Business continuity plan – particularly
Infrastructure 5) sustainable power sources and connectivity
infrastructure;

● Speeding up the pace of the HealthNet/VPN scale

up and maintenance; Creating a strong
collaboration with the service provider;

● Addressing the increasing hardware demands.

36
 Domain Name Current Future Status Aspired Pain points that need special attention …
Cumulative (HSTP-II Future
Score (End of 2024) Status (2030)
2020)

● Reviewing, endorsing and implementing the data

exchange and messaging standards;

● Defining the minimum national clinical data sets

based on international standards;
Standards and
4.99 (out of
Interoperabilit 2.38 (out of 5) 4.11 (out of 5)
5) ● Implementing and utilizing core registry services;
y
● Coordinating and working with agencies on
unique person identification system;

● Ensuring security standards for data exchange

and enforcement procedures.

● Regular data reviews and audits - and automating

the process;

● Dynamic data use strategy to meet the emerging

decision support needs at all levels;

● Developing and managing data repositories and

Data quality 4.99 (out of
2.99 (out of 5) 4.72 (out of 5) warehouse;
and use 5)
● Data use competency mechanisms;

● Standardizing the design, use and dissemination

of information products;

● Developing and using guidelines on data use

impact.

Based on the digital health maturity assessment results and the main findings depicted in the
above table, the digital health blueprint implementation shall take into consideration the areas
where there are strengths and those areas which need more attention by all stakeholders.
Strategic initiatives and interventions shall also first be analysed with respect to the assessment
results and the interventions shall happen accordingly. The maturity assessment will be carried

37
 out periodically, and necessary adjustments in targets of the blueprint shall be considered based
on the level of maturity of the domains at the times of assessment.

APPENDIX A: GLOSSARY OF TERMS

This section defines key terms that are crucial for understanding the digital health blueprint.

TERMS DESCRIPTION

It is an umbrella term for a wide range of digital technologies that support in

DIGITAL HEALTH solving healthcare challenges. It is a field of knowledge and practice
associated with the development and use of digital technologies to improve
health.

DIGITAL HEALTH It can act as a guide for managing complexity by directing use of various
BLUEPRINT technologies to ensure that solutions are fit-for purpose in supporting current
and emergent services and needs.

INFORMATION In the context of Ethiopian, information revolution is one of the four

REVOLUTION transformation agendas in the Health Sector Transformation Plan (HSTP). It
ROADMAP refers to the phenomenal advancement in the methods and practice of
collecting, analyzing, presenting, and disseminating information.

Refers to tools to accumulate, manage, analyze, and assimilate large

BIG DATA ANALYTICS volumes of disparate, structured, and unstructured data produced by current
healthcare systems. Areas of application in health care include providing
comprehensive knowledge discovery from the available huge amount of
data.

FAIR is an acronym for Findability, Accessibility, Interoperability, and

FAIR DATA Reusability. It intends to make data machine-readable as well as human-
readable. Machine readable is a term for data that can be found, accessed,
interoperated, and reused by computational systems or algorithms with
almost no human intervention.

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 TERMS DESCRIPTION

Blockchain is a distributed ledger technology for peer-to-peer (P2P)

networks of digital data transactions that may be publicly or privately
BLOCKCHAIN distributed to all users. It keeps a ledger of transactions that are
interconnected, tamper proof and provides ways of tracking provenance. The
potential of blockchain in healthcare is to overcome the challenges related
to data security, privacy, sharing and storage.

The Internet of Things (IoT) is the network of dedicated physical objects

(things) that contain embedded technology to sense or interact with their
INTERNET OF THINGS internal state or external environment. The Internet of Things (IoT) has been
widely applied to interconnect available medical resources and provide
reliable, effective and smart healthcare service to the elderly and patients
with a chronic illness.

The cloud offers on-demand computing by using the latest technology to

CLOUD COMPUTING deploy, access, and use networked information, applications, and resources.
It’s often less costly than having multiple computers in various medical
rooms each needing proper hardware, updated software, and network
accessibility to upload, store, and retrieve patient or other medical data.

ANNEX 1: DIGITAL HEALTH BLUEPRINT

PILLARS ACTION PLAN

Pillar I: ICT infrastructure

Intervention Short Term Medium Term Long Term
Category (1-3 Years) (3-5 Years) (5-10 Years)
● Establish facility LAN connectivity ● Engage the private sector in ● Enhance network
Enhancing Network ● Engage private institutions and small- the infrastructure bandwidth at facilities
Connectivity scale enterprises in LAN installations establishment, maintenance ● Implement aggressive
● Implement aggressive scale up of the and support scale up of the
HealthNet access across the health ● Introduce new connectivity Network connectivity
facilities and health offices alternatives for remote and access across the
under resourced sites. health facilities

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 Pillar I: ICT infrastructure
Intervention Short Term Medium Term Long Term
Category (1-3 Years) (3-5 Years) (5-10 Years)

Enhancing ● Establish dynamic data centers at ● Upgrade and expand existing ● Establish high
Computing MOH, agencies and regions for data data center and DR site standard local private
Infrastructure hosting demands – including the infrastructure to the latest cloud to serve the
backup and disaster recovery sites. state of art technologies health sector and
● Identify systems and services for ● Strengthen multi-sectoral other domain hosting
Cloud hosting, and implement as collaboration to explore and services
required. use in-country hosting ● Enhance the local
● Explore, prioritize and engage the alternatives, including cloud hosting centers
most secure, reliable and cost- domestic Clouds.
effective Cloud options ● Establish local cloud hosting
● Equip the available data center centers
infrastructure facilities with cooling
facilities, fire extinguisher and
Redundant Power Backup options
Establishing ● Establish Service Desks at national ● Strengthen logistics and ● Enhance the service
Service Desk regional, zonal and woreda levels and service desk infrastructure at desk and implement
strengthen with resources. all level integrated support for
● Strengthen technical capacity all initiatives.
building for service desk technicians
engaged in technical support

Pillar II: Solutions and Services

Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
● Enhance and scaleup Teleradiology ● Enhance the fast scaleup of ● Develop Artificial
Enhance remote service/program in public hospitals. telehealth services in public Intelligence enabled
health care services ● Establish telehealth services such as hospitals telehealth programs at
to improve access telepathology, telepsychiatry, ● Enhance Remote Patient health facilities
and equity teledermatology, RPM etc. for remote Monitoring systems (RPM)
medical consultation and health care at health facilities
rendering
Enhance mobile ● Promote and facilitate the use of ● Enhance the development ● Improve mhealth
health care services mobile and wireless technologies to and implementation of services by
to empower health support clinical decision making for personal health record access incorporating cutting
worker’s clinical health workers apps for clients edge technologies
decision-making ● Enhance the development and ● Enhance the development through research
capacity implementation of mobile apps for and implementation of
health workers that enable patient mobile apps for clients’
health tracking, intercommunication, emergency management
resources access and learning.

Enhance the ● Establish clinical decision support ● Enhance application features ● Accelerate the
development and systems and job aid tools like and functionalities in the implementation of

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 Pillar II: Solutions and Services
Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
implementation of Electronic Health Record (EHR) and different digital health comprehensive health
point of service eCHIS at public health facilities solutions based on gaps record system by
applications that aid ● Establish Lab and Diagnostic identified and feedback given including more
health workers to Imaging Management Systems from users. modules that exist
deliver quality ● Establish Referral Coordinating separately as ancillary
health service ● Promote the effective use of
Systems for managing point to point systems
e-learning systems by health
referrals, emergency responses and
workers and further improve ● Expand the
transports.
the content administration implementation of an
● Establish electronic Prescription and
and localization features. online e-prescription
Medication Management Systems to
system in private
generate and transmit a prescription
pharmacies
order directly from a healthcare
provider to a patient's pharmacy of
choice
● Enhance eLearning and knowledge
management (KM) systems for health
care provider’s capacity building
Enhance the ● Enhance electronic Health ● Explore, accommodate and ● Improve system
development and Commodity Management Systems implement the need for features and
implementation of ● Enhance the development and scaleup further enhancement or functionalities based
institution-based of electronic Health Workforce change on the existing on user experiences
applications to Management information systems to eHMIS platform. and innovative ideas
enhance health Plan, develop, Administer and Certify from technological
system ● Enhance the fast scaleup of
the workforce advancements.
administration, institution based digital
● Enhance Evidence-based healthcare
planning, health solutions at public
monitoring and planning, monitoring and decision
health facilities
regulation making by strengthening electronic
health management information
systems
● Develop and implement operations
and assets management systems
● Enhance the implementation of
electronic Health systems and
services regulations at institutions and
facilities
● Enhance the development and
implementation of Health financing
and insurance management systems
● Enhance the development and
implementation of Public Health
Emergency Management System
(PHEM)

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 Pillar II: Solutions and Services
Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
● Enhance the development and
implementation of Enterprise
Resource Planning(ERP) system

Pillar III: Access & Delivery

Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
● Strengthen Social media presence and ● Promote and enforce the ● Establish initiative
Establish digital alternatives to communicate the development of patient specific development
health service efforts of the health sector. portals accessed by clients. of multimedia
promotion and ● Assess the health information needs contents for
information ● Promote, and enforce
of different interest groups audiences
dissemination electronic systems for open
(communities) and develop Health
systems to promote data access
Wikis and blogs platforms for
healthy behavior
knowledge and experience sharing.
● Promote use of corporate email
communication system among the
health workforce
● Strengthen Digital Health Call
Centers and help desk systems for
effective support of digital health
systems, users and the general public
(clients/ citizens)
● Ensure the availability of display
boards at institutions and/or
department levels
Establish client’s ● Promote, design and share ● Promote, design and ●
access to personal contextualized wellness apps (mobile implement Wearable Sensors
health records and application programs that offer in order to help monitor
use of health apps to health-related services on health and/or provide
track their health smartphones, tablet PCs and other clinically relevant data for
condition communication devices). care of priority diseases
● Promote electronic access to shared
medical records by the patients

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 Pillar IV: Data Hubs
Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
● Promote and support the development ● Promote and update ● Enhance the usage of
Establish digital of Master Patient Index (MPI), Terminology management MPI, MPL, MFR, and
registries to provide Master Provider List (MPL), Master system (TMS) as an integral NHDD
shared health data Facility Registry (MFR) that stores part of interoperability
services for digital unique patient, suppliers and facility solutions.
health systems information respectively
● Enhance and use the National Health
Data Dictionary (NHDD) with all
priority health domains included
Establish health ● Build and strengthen national and ● Update and use the GIS ● promote the use of
data repositories for subnational data repository systems geodata files for geospatial Picture archiving and
centralized data such as Shared Health Record (SHR) analysis communications
storage, archival and other ancillary Health data system (PACS)
and retrieval repositories
● Collect, avail, update and use the GIS
geodata files for geospatial analysis
● Enhance and implement the available
picture archiving and
communications system (PACS)
Enhance ● Follow a Use-Case approach with ● Build data analytic capacities ● Promote Cloud-based
implementation of priority health domains to ensure the such as machine learning/ data services as
data warehouse, comprehensive data warehouse artificial intelligence, big necessary
data analytics and progressively data analytics
business ● Build analytic platforms and execute ● Promote data discovery and
intelligence to at different levels trend analysis with data from
support better
different sources
decision support
and research

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 ANNEX II: DIGITAL HEALTH BLUE PRINT
ENABLERS ACTION PLAN

Enablers: Standard & Interoperability, System Security, Research & Innovation, Workforce, Governance &
Leadership
Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
● Define and maintain data standards ● Establish local data standards ● Enhance the digital
Enhance standard locally by giving due considerations health architecture
and system ● Establish international data
to local policies, guidelines and blueprint.
interoperability to structure and messaging
legislation frameworks
accelerate health ● Adopt international data structure and standards. ● Maintain and update
information the interoperability
messaging standards like LOINC, ● Enhance the digital health
exchange and messaging
SNOMED, FHIR, etc. as applicable architecture blueprint.
standards.
for different health domains
● Promote the customization and use of ● Enhance the implementation
open-source digital health of OpenHIM components for
applications for easy integration interoperability between
among systems. disparate information
● Revisit the current eHA and upgrade systems.
it to come up with a resilient Digital
Health Architecture Blueprint
● Implementing the Open Health
Information Mediator (OpenHIM) as
a middleware component designed to
ease interoperability between
disparate information systems.

Enhance system ● Establish digital health data ● Establish security ● Enhance physical and
security to save protection mechanisms by defining safeguarding mechanisms for logical cyber-security
guard digital health role-based access control for all all infrastructure and safeguard
systems and digital health interventions solutions mechanisms at all
patients data from ● Implement physical and logical ● upgrade security mechanisms levels
unauthorized access cyber-security measures and tools to the state of the ● update the digital
and attacks.
● Establish secure Network art. health infrastructures
Infrastructure and hardware (from ● update and implement and solutions
end-device to Data Center equipment) security policies measures documentation
● Establish operational documentations
for use on the network infrastructure
and hardware security at all levels

Enhance digital ● Foster digital health researches to ● Enhance the adoption of ● Assess and adopt new
health research and guide and support decision-making, emerging digital and innovative
innovation for policy, and practice technologies and establish cutting-edge digital

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 Enablers: Standard & Interoperability, System Security, Research & Innovation, Workforce, Governance &
Leadership
Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
better health care ● Enhance the adoption of emerging innovation centers at health technologies
/service rendering digital technologies and establish subnational levels (like AI, block chain,
innovation centers at national level to Big Data, wearables,
promote digital health innovations in Internet of Things,
the health sector etc.) for use in the
health sector
Strengthen digital ● Explore the existing ICT health ● Establish digital health ● Enhance the digital
health workforce workforce allocation and propose the workforce structure at all health workforce
capacity on system required skilled professionals and levels and deploy required curriculum for pre-
use and technical structure supporting the digital health workforce. service and in-service
support initiatives. training
● Revise/update the digital
● Create/Revise the digital health
health workforce curriculum ● Enhance the digital
workforce structure and deploy the
for pre-service and in-service health education and
required workforce at all levels.
training training programs at
● Design and implement digital health
all levels.
staff retention and motivation ● Enhance the digital health
mechanisms. education and training
● Revise/update the education and programs at all levels.
training curricula of the pre- and in-
service training based on research or
gap analysis findings
● Strengthen and mainstream the digital
health education and training
programs at post-secondary health
educational institutions.
Enhance digital ● Ensure bold representation of Digital ● Document/Model data ● Scaleup capacity
health governance Health in health proclamation and standards on representation, building programs for
health policies. format, definition, leadership at all levels
● Prepare/update digital health domain structuring, tagging, to enable define,
specific policies/directives including transmission, manipulation, direct, execute,
data management and sharing policy use, and management of enforce, monitor and
(that enables data sharing to data, including data privacy evaluate the digital
secondary users including online and security standards. health ecosystem
open access, external repository and ● Establish digital health
managed access via applications), leadership and governance
organization level ICT policy mechanisms.
(roadmap for ICT implementation), ● Maintain and establish
social media policy (which advises investment and funding
the health sector on the use of social framework.
media), regulations, directives and
guidelines(such as telehealth
guideline), frameworks, and standard
operating procedures (SOPs)

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Enablers: Standard & Interoperability, System Security, Research & Innovation, Workforce, Governance &
Leadership
Short Term Medium Term Long Term
(1-3 Years) (3-5 Years) (5-10 Years)
● Adopt or create a framework for the
Digital Health Leadership and
Governance including informal
structures at all levels of the health
sector.
● Design capacity building programs
for leadership to enable define, direct,
execute, enforce, monitor and
evaluate the digital health ecosystem
● Device collaboration
framework/platform at the national
and regional levels, aligned with
health goals and political support, and
awareness and engagement from
stakeholders
● Prepare investment and funding
framework to guide the digital health
financing and ensure the digital health
interventions are properly financed.

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