Our assessment is based on an comprehensive framework to evaluate the current eHealth ecosystem as well as international best practices.

1. Preliminary
Zambia Digital
Health Strategy
2022-26
Digital Health Conference
October 2022 – Lusaka

2. Preliminary
Develop an Implementation
Roadmap
Articulate The Strategic Vision
And Objectives For The Future
State
Develop The Review Cycle Plan
And Evaluation Framework
Define the Future Governance
Structure
Develop The Sector Strategy and
Key Activities To Reach The
Future State
100 days roadmap
1 year road map
3 years Roadmap
Develop Implementation and
Evaluation Plan
Understand the Aspiration Articulate and Detail Strategy
Take Stock Of The Existing
Strategies For The Sector
Understand Key Stakeholders
View And Perspective Of The
Sector Future State
Understand Patients Perspective
And Needs
This strategy follows a 4 staged process that engages stakeholders, enables co-
creation, and ensures pragmatic solutions
1.Engaging with patients may not be a valuable exercise for a digital health strategy – dependent on decision from Zambian team
Source: MoH; TBI
1
Approach to strategy development
1 4
3.1
3.2
4.1
3.3
3
1.1
1.2
1.3
Assess Current State and
Future Model Options
Baseline Care Provision And
Demand, And Evaluate Future
Need
Derive Lessons Learnt for Best
Practices and Tailor to Zambian
Context
Identify and Assess Future Model
Options
2
2.2
2.1
2.3 4.2

3. Preliminary
At this point in the revised timeline, we are halfway through the process and on track
to deliver by end of April
2
1. CRC – Content review committee.
Source: MoH; TBI
Mar Apr May
27. 06. 13. 20. 27. 03. 10. 17. 24. 01.
2.1 Baseline care provision, demand and evaluate future needs
(perform site visits)
CRC1 review
3.1 Articulate strategic vision and future state objectives
Project kickoff
Key Milestones
3.2 Develop sector strategy and key activities to reach future state
Develop Implementation plans and
Evaluation framework
Workshop
Understand the aspiration
CRC1 final review
Articulate and Detail Strategy
4.2 Develop review cycle plan and evaluation framework
1.1 Take stock of existing strategies (data requests & analysis)
Assess Current State and Future Options
3.3 Define future Governance structure
Activity
2.2 Derive lessons learnt from best practices and tailor to Zambian context
2.3 Identify and assess future model options
1.2 Understand stakeholders perspective and future state
(Perform interviews)
4.1 Develop implementation roadmap
1
2
4
3
CRC 1: Current state
and benchmarking
analysis. Week of April 3.
CRC 2: Vision, strategic
objectives, governance,
and roadmap
Stakeholder workshop
to present and validate
strategy, and incorporate
feedback
Proposed Project Plan

4. Preliminary
Existing studies
and previous
work on digital
health have been
leveraged to
develop this
strategy
Zambia National Health
Strategic Plan 2017-
2021
Zambia Digital Health
Strategy Status Report
Zambia Data Protection
Act 2021
Proposed Approach for
Interoperable
Architectural
Framework for Health
National Health Facility
Census Analytical
Report - 2019
MoH E Health Strategy
2017-2021
Not Exhaustive
Source: MoH; Desktop research; E4H, IHM; TBI
3
Stakeholder Interviews
& Workshops
Donor partners
Benchmark
Analysis
eHealth
Strategy
Zambia Healthcare
Transformation
1
3
4
5 Existing Studies
2

5. Preliminary
We engaged with
a comprehensive
set of Zambian
stakeholders
Source: MoH; Desktop research; E4H, IHM; TBI
4
Total
62
Overview of Zambian stakeholders engaged through workshops of interviews
Clinical
27
6
12
17
Health
Informatics
Profession
ICT
Other
62
Entity Type
24
MOH
6
7
IP 25
CP
Other
62
Workshop #2
November 2021
Individual interviews
Sept to Apr
Inputs
Workshop #1
October 2021
Workshop #3
February 2022
Donor partners
Existing Studies
Benchmark
Analysis
eHealth
Strategy
Zambia Healthcare
Transformation
2
1
4
5
Stakeholder Interviews
& Workshops
3
Workshop #4
April 2022

6. Preliminary 5
Materials Reviewed
International policy
and legal frameworks
Analyses,
assessments and op-
eds
National Strategies,
incl digital health,
data,
Standards,
Guidelines, Pathways
Selection Rationale
Access to available
information
International best
practices
Quality of digital
health systems
Similarities in
healthcare systems
Innovators and game-
changers
Source: MoH; Desktop research; TBI
The strategy has also been benchmarked against global leaders,
African counterparts, and rapidly growing digital economies
Selected countries for benchmarking analysis
Stakeholder Interviews
& Workshops
Donor partners
Existing Studies
eHealth
Strategy
Zambia Healthcare
Transformation
2
1
3
5
Benchmark
Analysis
4

7. Preliminary
The overall approach will result in 6 deliverables…
6
1.Current state analysis; benchmarking analysis; vision, mission, strategic objectives; governance structure; and the high level implementation plan to be completed by end of April. Project charters and evaluation plan to follow shortly thereafter.
Source: MoH; TBI
Deliverables1
Current state analysis Benchmarking analysis Vision & Strategic Objectives
– Assessment of the current state of
ehealth in Zambia against the framework
– Identification of key challenges including
gap analysis
– Derived lessons learned from global best
practices including case studies
– Articulation of the vision and strategic
objectives vetting and validated by key
stakeholders
Governance structure
– Recommended governance structure to
deliver the strategy, vetted by key
stakeholders
Roadmap Evaluation plan
– Implementation plan sequencing all
initiatives based on a set of pre-
determined criteria (i.e., impact and
feasibility)
– Detailed charters for each initiative
– Plan to routinely evaluate progress and
impact of the strategy

8. Preliminary
Our assessment is
based on an
comprehensive
framework to
evaluate the
current eHealth
ecosystem as well
as international
best practices
Source: MoH; WHO; TBI
L E A D E R S H I P & G O V E R N A N C E
I N V E S T M E N T & S U S T A I N A B I L I T Y W O R K F O R C E F O R D I G I T A L H E A L T H
S T A N D A R D S & I N T E R O P E R A B I L I T Y
L E G I S L A T I O N , P O L I C Y, &
C O M P L I A N C E
I N F R A S T R U C T U R E
S E R V I C E S & A P P L I C A T I O N S
Laws &
Regulations
(incl. privacy)
National
Networks
Data Storage National
Digital ID
HIE
Platform
Workforce
& Talent
Development
Research &
Innovation
Funding &
Support
Partnerships
Leadership Governance
Institutions
& Planning
Strategy Service
Setup &
Stakeholders
Technical
Standards
Health System
Architecture
Licensing &
Accreditation
EMRs National
Databases
Ancillary
Systems
Vendors Analytics
Security &
Access
eHealth sector strategy framework
Leadership Governance
Institutions
& Planning
Strategy
Svc
Setup+
WF&
Talent Dvp
Research &
Innovation
Tech Stds
Hlth System
Arch
Funding &
Support
Partner-
ships
Laws &
Regulations
Licensing &
Accred
EMRs
National
Databases
Ancillary
Systems
Vendors Analytics
National
Networks
Data
Storage
National
Digital ID
HIE
Security &
Access
Workforce
Stds & Inter-
operability
Inv & Sust
Leg, Policy
& Comp
Infra
Svc & Apps
L&D
7

9. Preliminary
Globally, digital
health
ecosystems
required 6 key
enablers
Source: MoH; TBI
Key digital health enablers
8
In terms of funding, three national funding models for
eHealth are typically used, with overall funding ranging
Planning and oversight of eHealth strategy is often
achieved through a dedicated eHealth body, while
implementation is done at the regional and facility levels
Four themes are consistently present in national eHealth
strategies: capacity building, interoperability, health data laws,
and access to information
Strong digital health regulatory ecosystems address 8
areas, but this is expanding
To develop the digital health workforce, countries with
advanced eHealth ecosystems typically have
comprehensive training programs
To ensure interoperability, countries typically have
dedicated standards bodies specific to digital health
Funding
Planning
and
oversight
Strategy
Regulations
Workforce
Standards
Strategic
Operational
Technical

10. Preliminary
Strong digital
health regulatory
ecosystems
address 8 areas,
but this is
expanding
Source: MoH; Desktop research; TBI
Core regulatory scheme areas
• Healthcare Act
• Personal Data Protection Act
• Medicines/Medical Devices Act
• Healthcare service providers
• Healthcare professionals
• Digital health devices
• Data protection for platform
providers
• Data sharing and analytics
Novel and not yet established Yet to be established
Core Health Regulatory Schemes Additional Regulation
• AI and machine-learning regulation • Liability issues for non-healthcare
entities
Foundational
Novel
9

11. Preliminary
…and three
organizational
models are
typically used
Within the Health
Ministry
Countries
Name
Within a related
government body for
health or data
Independent Entity
Where is the standards body located?
Source: MoH; Desktop research; TBI
Organizational models for dedicated standards bodies
A department within the health
ministry or associated agency
reporting directly to the health
ministry
A standards organization that is
already responsible for other
standards
(such as computing, trade etc.)
Usually located in the Ministry of
Trade / Industry / Computing
A federally-accepted but
independent non-profit with an
interest in public health
Description
10

12. Preliminary
…resulting in 32
initiatives along 7
key areas
List of Strategic Initiatives and Themes
11
Enhance leadership governance
Develop performance assessment tool
Develop financing plan for digital health
Coordinate donor funding
Enhance leadership capabilities
Enhance current workforce capabilities
Develop workforce competency framework
Develop certification programs
Develop undergraduate programs
Develop graduate programs
Improve access to online education
Develop partnerships for R&D
Develop national WF plan
Implement standards and change mgmt framework
Develop policy roadmap
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Leadership &
Governance
Workforce
Policies &
Regulations
16
Investment &
Sustainability
Develop security policies
Develop local skills transfer policy
Develop interoperability framework
Develop national health systems architecture
Develop and implement data governance model
Implement national ID for healthcare
Ensure all healthcare facilities have adequate internet
connectivity
Ensure consistent power access to all healthcare facilities
Develop healthcare cloud infrastructure
Develop national EHR product roadmap
Develop and implement a sunset program
Enhance reporting and analytics capabilities
Enhance clinical decision support (CDS)
31
30
29
28
27
26
25
24
23
22
21
20
19
18
Policies &
Regulations
Standards &
Inter-
operability
Infrastructure
Develop eHealth standards and accreditation body
Develop an integrated supply chain in healthcare
32
Services &
Applications
Source: MoH; TBI
Address policy gaps
17
Enhance change management competencies

13. Preliminary
Initiatives were
then mapped and
re-assessed to
ensure all
challenges are
tackled ….
Sample - Mapping of Sector Challenges to Strategic Initiatives
12
All identified sector challenges were mapped to the 32 strategic initiatives to
ensure comprehensiveness
Challenges
Digital Health Workforce
There are inadequate training
programs in the areas of digital health
within Zambia, and the current
workforce does not have the formal
capabilities to meet the current and
future demand
Enhance current workforce capabilities
Enhance current workforce capabilities
Develop certification programs
8
7
6
Enhance leadership capabilities
5
Interoperability
There is no standards entity in place to
1) select official national standards,
and 2) enforce standards by vendors,
government entities, and Third sector
Develop eHealth standards and accreditation body
19
Governance
Digital Health governance is still not
complete and requires additional work
to become more efficient and effective
Enhance leadership governance
1
Corresponding Strategic Initiatives
Illustrative
Source: MoH; TBI

14. Preliminary
Based on the
identified themes,
7 key strategic
objectives can be
extracted
Overview of Strategic Objectives
13
Reform digital health governance
Improve sustainability of the digital health
ecosystem
Develop digital health workforce capacity
and capabilities
Strengthen policy foundations in digital
health
Enable integration of systems
Scale up digital health infrastructure
Strategic Objectives
Enhance digital health solutions
Source: MoH; TBI
Leadership &
Governance
 Enhance leadership governance
 Develop performance assessment tool
1
2
Policies &
Regulations
 Implement standards and change mgmt framework
 Develop policy roadmap
 Address policy gaps
 Develop security policies
 Develop local skills transfer policy
19
15
16
17
18
Investment &
Sustainability
 Develop financing plan for digital health
 Coordinate donor funding
3
4
Standards &
Inter-
operability
 Develop eHealth standards body
 Develop interoperability framework
 Develop national health systems architecture
 Develop and implement data governance model
 Implement national ID for healthcare
 Develop an integrated supply chain in healthcare
24
23
20
21
22
Infrastructure
 Ensure all healthcare facilities have adequate internet connectivity
 Ensure consistent power access to all healthcare facilities
 Develop healthcare cloud infrastructure
26
27
28
Services &
Applications
 Develop national EHR product roadmap
 Develop and implement a sunset program
 Enhance reporting and analytics capabilities
 Enhance clinical decision support (CDS)
28
29
30
31
Workforce
 Enhance change management competencies
 Enhance leadership capabilities
 Enhance current workforce capabilities
 Develop workforce competency framework
 Develop certification programs
 Develop undergraduate programs
 Develop graduate programs
 Improve access to online education
 Develop partnerships for R&D
 Develop national WF plan
6
7
8
9
10
11
5
12
13
14
25

15. Preliminary
For each initiative,
project charters
will be produced
to outline crucial
information for the
implementation
team
Example charter
Source: MoH; TBI
Illustrative

16. Preliminary
General
considerations in
every
transformation
are also
instrumental to
turn the digital
health strategy
into effective
actions
Source: MoH; TBI
Engaged Third Party
Dedicated Funding
Efficient Change & Project
Management
Phased-out Pilots Right Incentive Scheme
Empowering NGOs and
encouraging private sectors to
participate in certain areas can
accelerate the transformation
process without wasting public
resources
Separating funding for digital
health initiatives to
institutionalize digital health
services and prevent efforts from
being distracted or deprioritized
Identifying a strong project lead
and an engaged PMO team is
essential to ensure each initiative
to be delivered according to plan,
and issues / risks to be
addressed on time
Establishing pilots before
rolling out the initiatives
nationally is a quick way to
gather learnings without risking
too much time and resources
Creating effective incentives
schemes, both positive and
negative, can fight systematic
inertia and accelerate changes in
workforce development,
organizational changes and
service provision

17. Preliminary
Governance set
up is critical for
the successful
implementation of
the digital health
strategy and
should address 5
key areas
Source: MoH; TBI
Key governance areas for consideration specific to the strategy
1
3
2
4
Ownership &
Accountability
Delivery &
Change Mgmt
Oversight
Stakeholder
Engagement
Leadership is supportive of digital health at the most
senior level with concerted efforts to transform the
healthcare system
Responsible for the planning and delivery of
specific strategic initiatives (i.e., project and
change management activities) while
collaborating with the appropriate stakeholders
Regular meetings to oversee the delivery of the
strategy and provide guidance, council, and
direction. Able to identify the key stakeholders
to engage with when necessary, and facilitate
introductions, particularly cross-ministerial
Ensuring consistent and constant
communications with relevant stakeholders to
ensure that transformation agenda is well
managed and change management activities
are coordinated
Reporting specifically on the progress of the
strategy including KPIs and progress reports
Monitoring &
Evaluation
5 16

18. Preliminary
Ministry of Health Leadership
Technical Working Group
• Reports on progress of
DH Strategy
• Gives National Coordinator mandate
to oversee digital health related
activities & execution of DH strategy
• Advises on DH execution
• Supports execution of
strategy
• oversight & planning for
ehealth initiatives
Digital Health TWG
The Planning &
Consultations Group
Vested Stakeholders
Donors & Implementing
Partners
Department of ICT
Provision of
Infrastructure & Support
Manage DH Operations
Ministry of
Finance &
National
Planning
National Steering Committee
Department of Clinical
Services & Diagnostics
Key User of Digital
Health Interventions
Provision of clinical
health services
Monitoring & Evaluation
(M&E)
Measure Impact &
performance of
Implementations
• Work together to Implement DH
solutions
• Co create with implementors on DH
solution
Act as change agents for adoption
of DH solutions
• Provide timely and
appropriate advice to
support the delivery of
projects
Source: MoH; TWG Terms of reference; TBI
Governance setup of eHealth in Zambia
Provides funding for
HR and Infra
resources for MoH
17
Public Health
Community Health,
Immunization
ZNPHI, surveillance
Building on the
governance
model of the
previous strategy,
we suggest
several
adjustments
Detailed on next slide

19. Preliminary
Source: MoH; TWG Terms of reference; TBI
18
With this new
governance
model, all key
areas of
consideration are
addressed
Ownership,
Accountability
Delivery &
Change
Management
Oversight
Stakeholder
Engagement
Monitoring &
Evaluation
National
Steering
Committee
Department of
ICT
TWG M&E
Sr. level ownership of
the digital strategy
Limited oversight
through reporting from
TWG
Limited role but can
connect to other Sr.
level stakeholders as
required
Reviews high level
KPIs and progress
Provides guidance to
project delivery teams
Routine oversight and
tracking of progress
against the strategy
Supports with
engagement as
required
Routinely reviews
progress reports and
KPIs
Overall responsibility
for delivery of
initiatives through a
proj. and change
mgmt. team
Limited ICT-specific
oversight and direction
Engages heavily with
key stakeholders
relevant to each
initiative
Provides status
reports to M&E and
TWG
Generates all reports
required for evaluation
Governance roles and responsibilities