Case Study Selection and Description

Building on our evidence review and interviews, we have identified and agreed with ESA seven case studies of telemedicine and eHealth applications which will be reviewed and considered in the course of this study. For each application, we have reviewed the application of telemedicine and eHealth derived services and data and assessed the projected economic benefit associated with the application itself. We have selected case studies which cover a range of applications and highlight the main issues and interventions which telemedicine and eHealth has been applied. The focus has been on applications which are more likely to give rise to significant socio-economic impacts rather than focusing on the commercial benefits for businesses accruing from each application. The final output of the study is to provide a reasoned and evidenced illustration of potential applications and benefits that could rise from telemedicine and eHealth derived applications in sub-Saharan Africa using the case study results as the foundation for the overall results.

Assessment of the Evidence

We pulled together our evidence and analysis from the evidence review and the consultation interviews. Using the information gathered from the research, case studies and consultations, we developed and completed our socio- economic model which highlights the key considerations and develops quantitative models for assessing the impacts. The model has been built around three key areas of impact:

 Strategic and policy benefits:these benefits arise to policy makers and regulators that use telemedicine and eHealth derived services and data to increase the effectiveness of public services and policy development, regulation and implementation. The output of these benefits would consist mostly of strategic argumentation through the usage of stakeholder views to achieve commitments that governments have made to their electorates and partners. This will require identification of the expected outcomes from these policies on people, societies and the environment.

 Public health economic benefits:these benefits arise as an outcome of space-derived services and data insofar as they facilitate improvements in public health which in turn delivers positive benefits to both individuals (e.g. treatment of their conditions and additionally to wider society (e.g. control of contagious diseases). These benefits have been projected using stakeholder views, modelling and third party sources.

 Economic activity benefits:these benefits relate to the direct commercial applications of space applications to users (e.g. commercial benefits for businesses exploiting the telemedicine and eHealth technology), the specific

development of local workers and businesses through the application of the technology; and to the wider economic benefits through the increased take-up of technology (e.g. increased computer literacy rates). Typically, these benefits manifest themselves as productivity improvements or efficiency gains which can help improve local economic performance and resources available to local communities. These benefits have been assessed in qualitative terms only.

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Baseline Evidence (including objectives and costs)

Health, social and economic impact assessment Direct impacts e.g.

policy commitments met

Direct impacts e.g. illness cured, clinician time saved

Direct impacts e.g. commercial

opportunities, worker training

Wider impacts e.g. European Union’s role in meeting global

development goals

Wider impacts e.g. reduced disease burden, improved health service efficiency

Wider impacts e.g. more skilled workforce,

improved connectivity and networks C a s e S tu d ie s S ta k e h o ld e rs , S u rv e y a n d E x p e rt s

Strategic Public Health Commercial

All three categories of benefits have been considered in this study. Whilst benefits arising in the public health categories lend themselves more readily to quantification, wider and strategic and policy benefits are more qualitative in nature. This should not to underplay the significance of these benefits, but to recognise that in applying a prescriptive appraisal framework to a study of this nature some economic benefits may be regarded as simple transfers (in economic terms) throughout the economy and as such not recognised as net economic benefits. Strategic commentary will assist us in drawing attention to these aspects of the benefit case that might otherwise not be as visible, or lend themselves to valuation only in qualitative terms.

For each case study selected, we have developed an impact pathway which shows how the intervention is expected to result in changed outcomes for individuals, the society, the economy and the environment. These include both the intended and potential unintended consequences. The impact pathways identify the objectives of the programme and the inputs (e.g. funding, labour, activities) which have been used. The impact pathway then shows how the inputs would be expected to lead to particular outputs (e.g. business advised, technology installed). The impact of these outputs on individuals, businesses and the environment would be assessed to see what the outcomes in terms of changed circumstances and behaviours would be. These are then compared to the objectives to show how well the process is aligned.

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WIDER OUTCOMES e.g. increased economic activity, better life outcomes OUTCOMES e.g. reduce mortality and morbidity rates

INITIAL OUTCOMES e.g. better skilled individuals OUTPUTS e.g. qualifications gained, completion of courses

ACTIVITIES e.g. training sessions, individual support INPUTS e.g. trainers, facilities, materials, time OBJECTIVES e.g. increase skills of health professional skills