\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"5820",leadTitle:null,fullTitle:"Green Chemical Processing and Synthesis",title:"Green Chemical",subtitle:"Processing and Synthesis",reviewType:"peer-reviewed",abstract:'Sustainable development and alternative energy constituted urgent needs in the last decade. Renewable chemicals, energy and bio-resource use became challenging topics in the sustainable, renewable and green sciences. This encourages and turns primordial needs the works in certain fields as developing of new and green catalysts for chemical transformations, in the domains of energy, environmental, pharmaceutical, agro-alimentary and cosmetically applications; evaluation of bio-resources compounds largely available for many applications in energy or as additives to fuels and other applications, reduction and conversion of greenhouse gas as well as developing new synthesis routes by avoiding the use of toxic and environmentally damage materials. In this book, the recent sustainable and green process is presented in three sections: "Greenhouse Gas Conversion Efficiency in Microwave", "Biomass Green Process" and "Green Synthesis and Catalysis".',isbn:"978-953-51-3260-8",printIsbn:"978-953-51-3259-2",pdfIsbn:"978-953-51-4761-9",doi:"10.5772/65562",price:119,priceEur:129,priceUsd:155,slug:"green-chemical-processing-and-synthesis",numberOfPages:160,isOpenForSubmission:!1,isInWos:1,isInBkci:!1,hash:"c0ab0c8e1f6a1af3ee04ff657ce75e1d",bookSignature:"Iyad Karame and Hassan Srour",publishedDate:"July 5th 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5820.jpg",numberOfDownloads:11683,numberOfWosCitations:13,numberOfCrossrefCitations:9,numberOfCrossrefCitationsByBook:2,numberOfDimensionsCitations:25,numberOfDimensionsCitationsByBook:2,hasAltmetrics:1,numberOfTotalCitations:47,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 5th 2016",dateEndSecondStepPublish:"October 26th 2016",dateEndThirdStepPublish:"January 22nd 2017",dateEndFourthStepPublish:"April 22nd 2017",dateEndFifthStepPublish:"June 21st 2017",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"145512",title:"Prof.",name:"Iyad",middleName:null,surname:"Karamé",slug:"iyad-karame",fullName:"Iyad Karamé",profilePictureURL:"https://mts.intechopen.com/storage/users/145512/images/3352_n.jpg",biography:"Iyad Karamé, PhD.\nHe is a professor at the Faculty of sciences in the Lebanese University in Beirut. Director of the Organometallic Catalysis and Materials Laboratory, in the department of Chemistry. He got his PhD degree from Claude Bernard-Lyon 1 university in France in January 2004. He was an assistant professor and researcher (ATER) at the Ecole Normale Supérieure de Lyon, France, for one year (2004-2005). A researcher at the Leibniz Institut für Katalyse in Rostock (Germany) (2005-2006) and then at the Laboratory of Organometallic Chemistry of surface, CPE-Lyon till 2008. His principal axis of research are Organometallic Catalysis, Green Chemistry, CO2 chemistry and Synthesis of chelating macrocyles for the complexation of metals.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"Lebanese University",institutionURL:null,country:{name:"Lebanon"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"195431",title:"Dr.",name:"Hassan",middleName:null,surname:"Srour",slug:"hassan-srour",fullName:"Hassan Srour",profilePictureURL:"https://mts.intechopen.com/storage/users/195431/images/4969_n.jpg",biography:"Got his PhD degree from University of Claude Bernard Lyon 1 in France in October 2013. His principal axes of research are organic synthesis, polymer electrolytes, organometallic catalysis for different applications (energy storage systems and CO2 valorization). He is an editor of different books published by INTECHOPEN such as: “Recent Advances of Organocatalysis”, Green chemical processing and synthesis and Carbon Dioxide (CO2) Chemistry, Capture and Oil Recovery.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"496",title:"Environmental Chemistry",slug:"organic-chemistry-environmental-chemistry"}],chapters:[{id:"54677",title:"Enhancing the Greenhouse Gas Conversion Efficiency in Microwave Discharges by Power Modulation",doi:"10.5772/67875",slug:"enhancing-the-greenhouse-gas-conversion-efficiency-in-microwave-discharges-by-power-modulation",totalDownloads:1434,totalCrossrefCites:1,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Scientific interest to the plasma-assisted greenhouse gas conversion continuously increases nowadays, as a part of the global Green Energy activities. Among the plasma sources suitable for conversion of CO2 and other greenhouse gases, the non-equilibrium (low-temperature) discharges where the electron temperature is considerably higher than the gas temperature, represent special interest. The flowing gas discharges sustained by microwave radiation are proven to be especially suitable for molecular gas conversion due to high degree of non-equilibrium they possess. In this Chapter the optimization of CO2 conversion efficiency in microwave discharges working in pulsed regime is considered. The pulsed energy delivery represents new approach for maximization of CO2 conversion solely based on the discharge “fine-tuning”, i. e. without the additional power expenses. In our work several discharge parameters along the gas flow direction in the discharge have been studied using various diagnostic techniques, such as optical actinometry, laser-induced fluorescence, and gas chromatography. The results show that CO2 conversion efficiency can be essentially increased solely based on the plasma pulse frequency tuning. The obtained results are explained by the relation between the plasma pulse parameters and the characteristic time of the relevant energy transfer processes in the discharge.",signatures:"Nikolay Britun, Guoxing Chen, Tiago Silva, Thomas Godfroid, Marie‐\nPaule Delplancke‐Ogletree and Rony Snyders",downloadPdfUrl:"/chapter/pdf-download/54677",previewPdfUrl:"/chapter/pdf-preview/54677",authors:[{id:"176901",title:"Dr.",name:"Nikolay",surname:"Britun",slug:"nikolay-britun",fullName:"Nikolay Britun"},{id:"176903",title:"Dr.",name:"Thomas",surname:"Godfroid",slug:"thomas-godfroid",fullName:"Thomas Godfroid"},{id:"176904",title:"Prof.",name:"Rony",surname:"Snyders",slug:"rony-snyders",fullName:"Rony Snyders"},{id:"199224",title:"Dr.",name:"Tiago",surname:"Silva",slug:"tiago-silva",fullName:"Tiago Silva"},{id:"199226",title:"Mr.",name:"Guoxing",surname:"Chen",slug:"guoxing-chen",fullName:"Guoxing Chen"}],corrections:null},{id:"54707",title:"Role of Plasma Catalysis in the Microwave Plasma‐Assisted Conversion of CO2",doi:"10.5772/67874",slug:"role-of-plasma-catalysis-in-the-microwave-plasma-assisted-conversion-of-co2",totalDownloads:1462,totalCrossrefCites:3,totalDimensionsCites:7,hasAltmetrics:0,abstract:"Climate change and global warming caused by the increasing emissions of greenhouse gases (such as CO2) recently attract attention of the scientific community. The combination of plasma and catalysis is of great interest for turning plasma chemistry in applications related to pollution and energy issues. In this chapter, our recent research efforts related to optimization of the conversion of CO2 and CO2/H2O mixtures in a pulsed surface‐wave sustained microwave discharge are presented. The effects of different plasma operating conditions and catalyst preparation methods on the CO2 conversion and its energy efficiency are discussed. It is demonstrated that, compared to the plasma‐only case, the CO2 conversion and energy efficiency can be enhanced by a factor of ∼2.1 by selecting the appropriate conditions. The catalyst characterization shows that Ar plasma treatment results in a higher density of oxygen vacancies and a comparatively uniform distribution of NiO on the TiO2 surface, which strongly influence CO2 conversion and energy efficiencies of this process. The dissociative electron attachment of CO2 at the catalyst surface enhanced by the oxygen vacancies and plasma electrons may explain the increase of conversion and energy efficiencies in this case. A mechanism of plasma‐catalytic conversion of CO2 at the catalyst surface in CO2 and CO2/H2O mixtures is proposed.",signatures:"Guoxing Chen, Nikolay Britun, Thomas Godfroid, Marie‐Paule\nDelplancke‐Ogletree and Rony Snyders",downloadPdfUrl:"/chapter/pdf-download/54707",previewPdfUrl:"/chapter/pdf-preview/54707",authors:[{id:"176901",title:"Dr.",name:"Nikolay",surname:"Britun",slug:"nikolay-britun",fullName:"Nikolay Britun"},{id:"176903",title:"Dr.",name:"Thomas",surname:"Godfroid",slug:"thomas-godfroid",fullName:"Thomas Godfroid"},{id:"176904",title:"Prof.",name:"Rony",surname:"Snyders",slug:"rony-snyders",fullName:"Rony Snyders"},{id:"199226",title:"Mr.",name:"Guoxing",surname:"Chen",slug:"guoxing-chen",fullName:"Guoxing Chen"},{id:"199227",title:"Prof.",name:"Marie-Paule",surname:"Delplancke-Ogletree",slug:"marie-paule-delplancke-ogletree",fullName:"Marie-Paule Delplancke-Ogletree"}],corrections:null},{id:"54503",title:"Catalytic Conversions of Biomass-Derived Furaldehydes Toward Biofuels",doi:"10.5772/67805",slug:"catalytic-conversions-of-biomass-derived-furaldehydes-toward-biofuels",totalDownloads:1848,totalCrossrefCites:3,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Upgrading of biomass resources toward high-energy compounds (biofuel) is a crucial technology for sustainable development because utilizations of biomass resources can contribute to the low CO2 emission on the basis of carbon neutral concept. In this chapter, recent advances on catalytic hydrogenation and hydrogenolysis of biomass-derived furaldehydes, dehydration products of saccharides, for example, called as hydroxymethylfuran (HMF) and furfural, toward biofuels over heterogeneous catalytic system are introduced. Some approaches on mechanistic study and reactor design are also mentioned in this chapter.",signatures:"Shun Nishimura and Kohki Ebitani",downloadPdfUrl:"/chapter/pdf-download/54503",previewPdfUrl:"/chapter/pdf-preview/54503",authors:[{id:"197425",title:"Prof.",name:"Kohki",surname:"Ebitani",slug:"kohki-ebitani",fullName:"Kohki Ebitani"},{id:"204890",title:"Dr.",name:"Shun",surname:"Nishimura",slug:"shun-nishimura",fullName:"Shun Nishimura"}],corrections:null},{id:"54708",title:"Green Synthesis of Oligomer Calixarenes",doi:"10.5772/67804",slug:"green-synthesis-of-oligomer-calixarenes",totalDownloads:2768,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The synthesis of calixarenes can be conventionally done by heating at high temperature for a few hours and using various solvents in large quantities. The greener synthesis can be done with microwave-assisted synthesis and the solvent-free method, where both of these methods can reduce reaction time, energy use, solvent, and waste, with a higher percentage yield than that from the conventional synthesis method, making the synthesis of cyclic oligomer calixarenes and their derivatives more environmentally friendly.",signatures:"Ratnaningsih Eko Sardjono and Rahmi Rachmawati",downloadPdfUrl:"/chapter/pdf-download/54708",previewPdfUrl:"/chapter/pdf-preview/54708",authors:[{id:"199158",title:"Dr.",name:"Ratnaningsih",surname:"Sardjono",slug:"ratnaningsih-sardjono",fullName:"Ratnaningsih Sardjono"},{id:"199162",title:"M.Sc.",name:"Rahmi",surname:"Rachmawati",slug:"rahmi-rachmawati",fullName:"Rahmi Rachmawati"}],corrections:null},{id:"55121",title:"Environment-Friendly Approach in the Synthesis of Metal/ Polymeric Nanocomposite Particles and Their Catalytic Activities on the Reduction of p-Nitrophenol to p-Aminophenol",doi:"10.5772/intechopen.68388",slug:"environment-friendly-approach-in-the-synthesis-of-metal-polymeric-nanocomposite-particles-and-their-",totalDownloads:1830,totalCrossrefCites:1,totalDimensionsCites:4,hasAltmetrics:0,abstract:"In this chapter, an environment‐friendly approach in synthesizing Au and Au@Ag metal nanoparticles using a microgel is demonstrated. Poly(N‐isopropyl acrylamide)/polyethyleneimine microgel was used as a multifunctional template to reduce metal ions to metal nanoparticles, stabilize and immobilize these metal nanoparticles, and regulate their accessibility within the template. Such multifunctional roles of microgel template were possible due to their unique properties (i.e., amino groups reducing capability, electrostatic and steric stabilizing properties, and swelling/deswelling properties). Characterizations of these metal/polymeric composite particles were also performed, such as scanning electron microscope (SEM), transmission electron microscope (TEM), Zeta‐potential, UV‐vis spectroscopy, X-ray Diffraction (XRD), and X‐ray photoelectron spectroscopy (XPS). To test the catalytic activities of both gold and gold@silver nanoparticles in the microgel template, a model reaction (i.e., reduction of p‐nitrophenol to p‐aminophenol) was performed. Results showed that bimetallic gold@silver gave 10 times higher catalytic activity compared to monometallic gold nanoparticles. With the simple one‐step synthesis, a highly scalable process is possible.",signatures:"Noel Peter Bengzon Tan and Cheng Hao Lee",downloadPdfUrl:"/chapter/pdf-download/55121",previewPdfUrl:"/chapter/pdf-preview/55121",authors:[{id:"197243",title:"Dr.",name:"Noel Peter",surname:"Tan",slug:"noel-peter-tan",fullName:"Noel Peter Tan"},{id:"197363",title:"Dr.",name:"Cheng Hao",surname:"Lee",slug:"cheng-hao-lee",fullName:"Cheng Hao Lee"}],corrections:null},{id:"55675",title:"Environmental-Friendly Catalytic Oxidation Processes Based on Hierarchical Titanium Silicate Zeolites at SINOPEC",doi:"10.5772/intechopen.68389",slug:"environmental-friendly-catalytic-oxidation-processes-based-on-hierarchical-titanium-silicate-zeolite",totalDownloads:2342,totalCrossrefCites:1,totalDimensionsCites:8,hasAltmetrics:0,abstract:"Since it was claimed by EniChem in 1983 for the first time, titanium silicate‐1 (TS‐1) zeolite presented the most delightful catalytic performance in the area of selective organic oxidation reactions. To enhance the mass diffusion property, hierarchical titanium silicate with hollow cavities within crystal was prepared by using a post‐synthesis treatment in the presence of organic template, and then, it was commercially produced and employed in many industrial catalytic oxidation processes, such as propylene epoxidation, phenol hydroxylation, and cyclohexanone ammoximation. Moreover, we also developed several totally novel oxidation reactions on hollow titanium silicate (HTS) zeolite, i.e., Baeyer‐Villiger oxidation of cyclohexanone and chlorohydrination of allyl chloride with HCl and H2O2. In all cases, HTS shows much better catalytic performance than TS‐1, attributing to the mass diffusion intensification by introducing hollow cavities. On the other hand, enormous works on synthesizing hierarchical TS‐1 zeolites with open intracrystalline mesopores have been done via silanization treatment and recrystallization. Based on them, several bulk molecule oxidation processes with tert‐butyl hydroperoxide, such as epoxidation of fatty acid methyl ester (FAME) and large olefins, have been carried out. As a consequence, hierarchical TS‐1 zeolites supply a platform for developing environmental‐friendly catalytic oxidation processes to remarkably overcome the drawbacks of traditional routes.",signatures:"Changjiu Xia, Xinxin Peng, Yao Zhang, Baorong Wang, Min Lin, Bin\nZhu, Yibin Luo and Xingtian Shu",downloadPdfUrl:"/chapter/pdf-download/55675",previewPdfUrl:"/chapter/pdf-preview/55675",authors:[{id:"182654",title:"Dr.",name:"Changjiu",surname:"Xia",slug:"changjiu-xia",fullName:"Changjiu Xia"},{id:"182925",title:"Prof.",name:"Min",surname:"Lin",slug:"min-lin",fullName:"Min Lin"},{id:"182927",title:"Prof.",name:"Bin",surname:"Zhu",slug:"bin-zhu",fullName:"Bin Zhu"},{id:"182928",title:"Prof.",name:"Xingtian",surname:"Shu",slug:"xingtian-shu",fullName:"Xingtian Shu"},{id:"187312",title:"Prof.",name:"YiBin",surname:"Luo",slug:"yibin-luo",fullName:"YiBin Luo"},{id:"200872",title:"Mr.",name:"Xinxin",surname:"Peng",slug:"xinxin-peng",fullName:"Xinxin Peng"},{id:"204876",title:"Dr.",name:"Baorong",surname:"Wang",slug:"baorong-wang",fullName:"Baorong Wang"},{id:"204877",title:"Mr.",name:"Yao",surname:"Zhang",slug:"yao-zhang",fullName:"Yao Zhang"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"2874",title:"Hydrogenation",subtitle:null,isOpenForSubmission:!1,hash:"737b7439c2b3372d6c4b34ce28a37fe4",slug:"hydrogenation",bookSignature:"Iyad Karamé",coverURL:"https://cdn.intechopen.com/books/images_new/2874.jpg",editedByType:"Edited by",editors:[{id:"145512",title:"Prof.",name:"Iyad",surname:"Karamé",slug:"iyad-karame",fullName:"Iyad Karamé"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5206",title:"Recent Advances in Organocatalysis",subtitle:null,isOpenForSubmission:!1,hash:"d06787ec7084c188686d860994f03abe",slug:"recent-advances-in-organocatalysis",bookSignature:"Iyad Karame and Hassan Srour",coverURL:"https://cdn.intechopen.com/books/images_new/5206.jpg",editedByType:"Edited by",editors:[{id:"145512",title:"Prof.",name:"Iyad",surname:"Karamé",slug:"iyad-karame",fullName:"Iyad Karamé"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6186",title:"Carbon Dioxide Chemistry, Capture and Oil Recovery",subtitle:null,isOpenForSubmission:!1,hash:"720a601cd2b5476cbeb817906a4ab2dd",slug:"carbon-dioxide-chemistry-capture-and-oil-recovery",bookSignature:"Iyad Karamé, Janah Shaya and Hassan Srour",coverURL:"https://cdn.intechopen.com/books/images_new/6186.jpg",editedByType:"Edited by",editors:[{id:"145512",title:"Prof.",name:"Iyad",surname:"Karamé",slug:"iyad-karame",fullName:"Iyad Karamé"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5768",title:"Desalination",subtitle:null,isOpenForSubmission:!1,hash:"939ab36830b6159adf8da8f9413277f3",slug:"desalination",bookSignature:"Taner Yonar",coverURL:"https://cdn.intechopen.com/books/images_new/5768.jpg",editedByType:"Edited by",editors:[{id:"32956",title:"Dr.",name:"Taner",surname:"Yonar",slug:"taner-yonar",fullName:"Taner Yonar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"7512",title:"Lanthanides",subtitle:null,isOpenForSubmission:!1,hash:"f7bcbda594eacb5a3bd7149e94628753",slug:"lanthanides",bookSignature:"Nasser S. 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\r\n\tThis book aims to explore the various management strategies for facial and dental anomalies which include both surgical and non-surgical orthopedic interventions. Treatments like craniofacial and orthognathic surgery are critical not only in addressing skeletal malocclusion but also in the management of obstructive sleep apnea, facial cosmetics, orthodontic discrepancies, cleft and craniofacial deformities, post-traumatic dentofacial asymmetry, and temporomandibular joint disorders.
\r\n\r\n\tThe craniomaxillofacial skeleton consists of multiple intricate and distinct but co-functioning units. Corrective measures are typically multi-disciplinary in approach, requiring the skills of experienced providers in plastic surgery, otolaryngology, oral and maxillofacial surgery, sleep medicine, orthodontics, and dentistry. Thus, the text itself is meant to be an inter-professional collaboration of providers from a variety of specializations.
\r\n\r\n\tWe hope to create a book that is relevant not only across medical disciplines but across ethnicities as well. To this end, we welcome experts from across the globe to help ensure that the information contained within remains universal.
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Brian Sun",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11691.jpg",keywords:"Skeletal Malocclusion, Overbite, Underbite, Orthodontics, Surgery-First, Maxillo-Mandibular Discrepancy, Congenital Facial Asymmetry, Cleft Lip, Traumatic Malocclusion, Traumatic Asymmetry, Fracture Line Osteotomy, Le Fort Fracture",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 3rd 2022",dateEndSecondStepPublish:"March 31st 2022",dateEndThirdStepPublish:"May 30th 2022",dateEndFourthStepPublish:"August 18th 2022",dateEndFifthStepPublish:"October 17th 2022",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. H. Brian Sun is a surgeon, professor, and instructor in oral and maxillofacial surgery, and a researcher with multiple chapters, textbooks, and numerous article publications. He is a Clinical Assistant Professor at the Western University of Health Sciences, and a graduate alumnus of the UCLA Center for Oral/Head & Neck Oncology Research.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"184302",title:"Dr.",name:"H. Brian",middleName:null,surname:"Sun",slug:"h.-brian-sun",fullName:"H. Brian Sun",profilePictureURL:"https://mts.intechopen.com/storage/users/184302/images/system/184302.png",biography:"H. Brian Sun, DMD, MS is an oral and maxillofacial surgeon, a Clinical Assistant Professor at the Western University of Health Sciences, a Clinical Instructor at the University of Pacific, and a graduate alumnus of the UCLA Center for Oral/Head & Neck Oncology Research. 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Mauricio Barría"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9500",title:"Recent Advances in Bone Tumours and Osteoarthritis",subtitle:null,isOpenForSubmission:!1,hash:"ea4ec0d6ee01b88e264178886e3210ed",slug:"recent-advances-in-bone-tumours-and-osteoarthritis",bookSignature:"Hiran Amarasekera",coverURL:"https://cdn.intechopen.com/books/images_new/9500.jpg",editedByType:"Edited by",editors:[{id:"67634",title:"Dr.",name:"Hiran",surname:"Amarasekera",slug:"hiran-amarasekera",fullName:"Hiran Amarasekera"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"314",title:"Regenerative Medicine and Tissue Engineering",subtitle:"Cells and Biomaterials",isOpenForSubmission:!1,hash:"bb67e80e480c86bb8315458012d65686",slug:"regenerative-medicine-and-tissue-engineering-cells-and-biomaterials",bookSignature:"Daniel Eberli",coverURL:"https://cdn.intechopen.com/books/images_new/314.jpg",editedByType:"Edited by",editors:[{id:"6495",title:"Dr.",name:"Daniel",surname:"Eberli",slug:"daniel-eberli",fullName:"Daniel Eberli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"58196",title:"The Multivariated Effect of City Cooperation in Land Use Planning and Decision-Making Processes: A European Analysis",doi:"10.5772/intechopen.72191",slug:"the-multivariated-effect-of-city-cooperation-in-land-use-planning-and-decision-making-processes-a-eu",body:'Recent changes in the European landscape introduced by geopolitical, socioeconomic and/or cultural issues have been continuously contributing to strengthen the magnetism of urban areas, increasing their capacity to change land use, thus fostering important transformations not only at the socioeconomic level but also in terms of urban morphology all over Europe [1, 2, 3, 4, 5, 6, 7]. Even though sometimes positive, these changes have reinforced the clear tendency of depopulation of rural territories—confirmed on the last decades—consequently increasing the development of progressively larger urban agglomerations [8, 9, 10].
Even if these issues are currently seen as part of countries’ evolutionary processes, it urges to develop specific strategies that might tackle this scenario, contributing to revert this situation. In this regard, it is crucial to study new ways of cooperation between smaller cities, highlighting the ways in which this type of synergic projects and strategies related to cross-border and city cooperation might revert this process contributing to city sustainability.
Considering the aforementioned opportunity and taking into account that very often the cooperation between cities occur among sovereign nations, such issues gain more emphasis not only because one-third of European population live in border areas [11, 12] but also because this fact takes the discussion to another level, associated with intricate bureaucratic procedures related to the lack of standardization practices and policies between these territories, which generally lead to a reckless attitude by the main actors/decision-makers toward city cooperation and development, facts which have a high influence not only in the development capacity of these regions but also on the overall quality of life of people leaving in these areas [7, 13].
The analysis of city cooperation multivariated effect in land use planning and decision-making processes is, in this respect, seen as a pivotal procedure that, throughout the implementation of specific planning principles and frameworks, might contribute to strengthen the development of these areas, enabling Europe to achieve a more balanced polynucleated territory, less dependent on few large metropolitan areas.
In this regard, in order to identify a set of planning principles and city cooperation frameworks, a group of the best practice case studies will be analyzed, using both Case Study Research (CSR) method [14, 15] and Territorial Impact Assessment (TIA) analysis, in turn identifying the impacts produced by this type of cooperation [16, 17, 18] and highlighting how these processes might contribute to reverse the impacts promoted by current mononucleated tendencies.
This study is considered a fundamental basis that will enable the identification of precise factors, which influence spatial planning procedures, leading to the definition of new methods and approaches to one of the main urban problems affecting Europe during the last decades, in line with the scope of the book and considering several relevant issues related to spatial planning, sustainable growth, and urban development approaches.
The European Union (EU) has no direct mandate and no clear institutional and political framework for spatial planning: according to the principle of “subsidiarity,” territorial planning is a responsibility primarily of the member states. While this is so, it is equally clear that the EU’s indirect role in spatial planning is steadily increasing, mainly through sector policies particularly in the areas of regional policy, rural development, environment, and transport. Another way in which the role of the EU is indirectly increasing in spatial planning is the principle of territorial “cohesion” [19].
In this regard, European territorial cooperation is the third objective of the EU Cohesion Policy for 2007–2013, as well as being the new umbrella under the European Spatial Development Perspective (ESDP) of 1999, such as European Spatial Planning Observation Network (ESPON), and European Territorial Cooperation (INTERREG) [20, 21].
In fact, the documents of EU from 1999 regarding spatial policy foster to promote a sustainable urban development. European Territorial Cooperation, and the EU INTERREG Initiative in particular, is one of the five main means of application identified by the European Spatial Development Perspective (ESDP). ESDP is a document approved by the Informal Council of Ministers of Spatial Planning of European Commission in Potsdam in 1999 and forming a policy framework with 60 policy options for all tiers of administration with a planning responsibility.
An entire chapter of the ESDP is in fact devoted to considering the application of its concepts and ideas. The five main means of application comprise (1) application at the European Community level, (2) application via transnational cooperation between member states, (3) application via cross-border and interregional cooperation, (4) application of the ESDP in member states, and (5) application via pan-European and international cooperation. The influence and application of the ESDP clearly have an important transnational learning dimension. As a result, the ESDP remains the most significant policy document guiding the EU’s determinations in the territorial development sphere [22].
Even though the document does not have the power of a law, it has indeed been successful in establishing a framework [20]. Once that the strategic aim achieved a balanced and sustainable spatial development strategy. In the late 1990s, the ESDP represented a “new dimension of European policy” since for the first time the EU was starting to pay explicit attention to territorial planning as an instrument to achieve broader social and economic goals [19]. A key objective of the ESDP was to facilitate better coordination of the territorial impacts of European policy: horizontally across different sectors, vertically among different levels of government, and geographically across administrative boundaries [23].
The ESDP was created to achieve three central aims of European policy: socioeconomic cohesion, conservation of natural resources and cultural heritage, and a more balanced competitiveness of the European territory. In order to achieve these goals, the ESDP highlighted three crucial spatial development policy objectives [19, 20, 21, 24]:
Development of a polycentric and balanced urban system and strengthening of the partnership between urban and rural areas. This implicates overcoming the outdated contrast between city and countryside.
Promotion of unified transport and communication concepts, which support the polycentric development of the EU territory and are an important precondition for enabling European cities and regions to pursue their integration into the Economic and Monetary Union. Equivalence of access to infrastructure and knowledge should be realized gradually. Regionally, adapted solutions must be brought into being for this.
Development and conservation of natural and cultural heritage through wise management. This contributes both to the preservation and deepening of regional identities and the maintenance of the natural and cultural diversity of the regions and cities of the EU in the age of globalization.
A significant outcome of the ESDP process was the establishment of the European Spatial Planning Observation Network [21]. The mission of ESPON is to support policy development and build a European scientific community in the field of the European territorial development [19]. The main aim is to increase the general body of knowledge about territorial structures, trends, perspectives, and policy impacts in the enlarging European Union [25].
One of the concrete offspring of the ESDP is the ESPON established in 2001 for providing data and information about spatial trends and developments in the EU. ESPON’s aim was to support spatial policy making for all territorial levels [26]. For planners, the value added of ESPON is that it supplies the technical and scientific knowledge needed to help implement the policy options in the ESDP and translates them into appropriate legal and financial instruments [27, 28].
However, the planning and execution of the specific political objectives of the ESDP should take into account the specific economic, social, and environmental situation of each area. These policy objectives for agriculture and rural development, infrastructure, and transport, as well as the environment, in a synthesized way are policy aims and options for ensuring productive and diverse rural areas, policy aims and options for promoting accessibility to transport and sustainable infrastructure, and policy aims and options aimed at preservation and development of the natural heritage [21, 29].
On the other hand, the policy priorities of the ESDP have been addressed by means of cofinancing of spatial planning projects involving partners in different countries through the INTERREG Initiative [19]. In this regard, INTERREG is the EU’s primary instrument to support cooperation across national borders, and it is financed by the European Regional Development Fund. INTERREG was launched in 1990 to overcome the disadvantages presented by administrative boundaries of adjacent regions in the emerging common market [30]. INTERREG has included three phases with spatial planning agenda: Phase II (1994–1999), Phase III (2000–2006), and Phase IV (2007–2013). There are three territorial levels: (1) cross-border projects, involving geographically contiguous border regions; (2) transnational initiatives, across large multinational spaces; and (3) interregional initiatives, among noncontiguous regions across the whole territory of the EU.
In the latest phase (2007–2013), INTERREG has been incorporated into the EU’s territorial cohesion agenda under the objective of territorial cooperation [19]. This implies cooperation on regional and spatial planning together with other economic growth issues more generally related to regional policy [30]. As for territorial cohesion in 2005, the Commission explained that territorial cohesion becomes a key element of promoting stronger integration of the territory of the Union in all its dimensions, and cohesion policy supports the balanced and sustainable development of the territory of the Union at the level of its macro-regions and reduces any barrier effects through cross-border cooperation (CBC) and the exchange of best practices [31].
The latter objective (strengthening territorial cooperation) is closely tied to the notion of European spatial planning (in INTERREG Phase III). The strong relation between cohesion policy and planning in the EU is reinforced by the work of DG Regio, the Commission Directorate-General for Regional (Cohesion) Policy which has taken the lead, with member states, on European spatial planning initiatives [30].
On the one hand, in European urban areas, the focus is on improving competitiveness through clustering, networking, and achieving more balanced development between the economically strongest cities and the rest of the urban network. Priorities are promoting entrepreneurship, local employment, and community development and measures to rehabilitate the physical environment, redevelop brownfield sites, and preserve and develop historical and cultural heritage [19, 31].
On the other hand, in European rural areas, the member states should support economic regeneration by ensuring a minimum level of access to “services of general economic interest,” with a view to improving conditions in rural areas and limiting outmigration. Priorities include building connectivity to the main national and European networks; developing an integrated approach to tourism development; investing in development poles in rural areas (e.g., in small- and medium-sized towns); and developing economic clusters based on local assets combined with the use of new information technologies [19, 31].
City-to-city (C2C) cooperation is not a novel phenomenon, through a scientific study on the matter is quite new. C2C was started, and evolved, in Europe—in wider terms: local governments in developed countries tend to determine the content of it. The first international relations between local governments in Europe were recognized after the Second World War, especially in the 1950s. The Council of European Municipalities and Regions, established in 1951, took a strong position to encourage these international contacts at the local level. The idea was to build a united Europe. Strict regulations were determined for these relations by the Council of European Municipalities and Regions and by the French-oriented Fédération Mondiale des Villes Jumelées—Cités Unies [32].
In the Western world of attention for development, cooperation was high in the 1970s, and characteristic of this development was the total absence of formal regulations. Then, a new tendency of international relations of local governments became apparent in the 1980s. In the United Kingdom, the United States, and the Netherlands—among others—local authorities united themselves against the apartheid in South Africa [32, 33].
As for Asia, China has undergone economic and political restructuring in the post-socialist era under the background of globalization. At the same time, its provincial governments have mobilized various forms of booming North-South city-to-city (C2C) cooperation within their respective jurisdictions during the last 10 years [34]. As for cross-border cooperation (CBC), during the recent decades, border areas increased great importance on the international scene concerning their potential and integrative functions such as demonstrated along the unification of Europe [12, 35, 36, 37].
The experiences of CBC, assumed not only in Europe but also all over the world, as is the case of several CBC projects between the United States and Mexico, China-India (Asia), Argentina-Chile, or Brazil-Bolivia (South America), among many other examples through the globe [38, 39], fostered the creation of a global network of relationships among people and states, which enabled the achievement of several political, economic, environmental, and sociocultural win-win situations [40, 41]. These networks have been increasingly recognized by urban planners, landscape architects, and other urban development specialists, as crucial elements which enable the introduction of recent urban development challenges and paradigms [13, 42, 43, 44, 45, 46, 47] into future planning activities [10].
As for spatial planning system, an ensemble of territorial governance arrangements that seek to shape patterns of spatial development in particular places is considered [48, 49]. In this regard, the set of systems and policies of the planning of the EU expanded planning system increasing criteria such as the extent of the planning system, the extension, and the type of planning at the national and regional level [31, 50, 51]. Also, it has redefined the role of the public and the private, maturity and integrity of the system and the distance between the intended objectives and the results actually obtained [52]. And, it divides traditional planning mainly into four types, including regional economic planning, urban planning, comprehensive planning, and land use planning [49].
In fact, the efficacy of the CBC at different scales of cooperation in planning the land use has been under discussion, through the review of CBC’s initiatives in developing countries [10, 53]. On a governmental scale normally stands as the promise of the project from the management and land use, in several cases, it contributes to overshadow the limitations of land use. For example, the extraction of natural resources and the massive agricultural exploitation. Secondly, at the regional level, the design and implementation of the CBC have overlooked often asymmetries of power within a community. This effect has been gone unnoticed at the individual level. Thus, there has been unequal access to the design, decision-making, and the intended results. It also highlights at the community, local, and national bargaining power that has taken the elites, because this has been instrumental in shaping the governance of the CBC and even in the promotion of the CBC by external agents. In fact, the adaptation of the CBC to new scenarios depends largely on the process of empowerment of the community and the construction of optimal networks with external agents [53]. In this way, as will be achieved through CBC, cross-border regions can reach (1) comparative advantages and (2) economies of scale.
Planning potentially influences and connects a wide range of issues, behind which are most diverse and conflicting interest [49]. The traditional special planning focuses on the position, intensity, form, quantity, and coordination of the development of the land in different spaces. However, the issues and challenges faced by the local areas need to be addressed by a process of socio-spatial integration through which occurs a vision, coherent actions, and means of implementation for shaping and structuring making it a place and what this place might be in the future position [54, 55]. In this sense, cooperation between cross-border cities is directed to the solution of problems arising from the dysfunctions caused by the existence of the border [56].
As for sovereign and cooperation problems, nation-states are under pressure to find innovative ways to redefine their relationships with space. The traditional understanding of the state, as the ultimate repository of sovereignty over a bounded portion of the Earth’s surface and the society that inhabits it, is at odds with the current world of cross-border flows of capital, goods, people, and ideas [57]. At the same time, there is a reterritorialization of economic and political activity that transcends the spatial framework of the nation-state [58].
Border, cross-border regions, and CBC studies address state territorial restructuring at the subnational level. They have primarily examined the reterritorialization of state power and institutions across borders, documenting the emergence of cross-border governance networks and power relations [57, 59, 60, 61, 62, 63, 64, 65]. In this regard, CBC should be placed in the context of the emergence of multilevel and participative governance, which requires an active involvement on behalf of, on the one hand, different tiers of government (from the EU institutions to local governments) and, on the other, civil society and private actors working alongside public authorities [66]. The diversity of arrangements existing in the field of CBC includes the fact that Euroregions may be established according to either private or public law [67]. The geopolitics of Euroregions suggest that cross-border reterritorialization across the latest EU borders is driven by a scalar conflict of territorial logics [57]. The border-induced territorial logic of the nation-state conflicts with the border-bridging territorial logic of CBC [68].
In political and institutional terms, the emergence of CBC and the setting-up of cross-border frameworks such as Euroregion and European Grouping of Territorial Cooperation (EGTC) can be seen as an expression of broader developments in the field of European governance, including the subsidiarity principle and its adaptation to a borderless Europe, the increasing centrality of regions as spaces combining a political, economic, social, and cultural dimension [69].
A “territoire de project” amounts to a bottom-up process, which in turn can contribute to moving from a vertical, interlocked approach to regional development and multilevel governance to the one characterized by shared responsibilities and by horizontal, interdependent relationships among different regions and tiers of government [70]. Besides, the added value of EGTCs lies in their ability to fulfill cross-border tasks by common decisions on the regional/local level and to reinforce the ability of local and regional authorities to contribute to bottom-up regional development [71]. But public authorities on the regional/local level need an EGTC; otherwise, a bottom-up approach in territorial cooperation is very difficult [66]. Also, in comparative terms, the adoption of the EGTC Regulation also serves to highlight the relevant role played by CBC within the European integration process, since the sovereignty of the state ends at its borders, but the differences and problems of these borders continue to exist and require sustainable solutions [66]. Against this background, they cannot allow their borderland to follow special rules without compromising the theoretical model of the territorial container that the nation-state follows [72]. Euroregions for their part need exemptions from national regulation in order to be able to function meaningfully across state borders [57]. Indeed, the degree of cross-border integration can be a result of political will and the benefit perceived by the communities involved in the collaboration, but it can also be interpreted as resulting from the prevailing tension between the aim to supersede traditional borders and the ongoing weight of national traditions and structures [66].
In this regard, research has gained additional momentum considering current developments, such as the recent situation in Crimea (Ukraine) with Russia, the Greek-German frictions, the rise of terrorism in European continent (leading to an increasingly fractious debate about free movement in Europe as well as the resurgence of nationalist and extremist sentiments among European citizens), the economic fallouts in Europe, or even the recent Brexit scenario [3, 7, 73, 74, 75]. Due to the fact, other factors to ensure the sustainability of experiences include political will, i.e., political commitment and transparency, and the integration of a “cross-border awareness” or “cross-border culture” in the standard design and management of policies and legislation, i.e., common objectives and Master’s Plans [10, 66].
In the inception of the twenty-first century, especially in a European and Western context, it is almost given that borders are just lines drawn on a map. For this, the establishment of the European Union has contributed as a catalyst [76], almost vanishing borders and promoting CBC and city border cooperation, i.e., as is the case of the establishment of the Euro-cities. Still, as abovementioned, the recent developments going on European territory are threatening such relationships among European nations and even with other continents, leading to the necessity to rethink some of the EU policies.
In this regard, four European CBC case studies (Figure 1) focused from different aspects and perspectives will be exposed, analyzed, and assessed, enabling a multivariated effect analysis of city cooperation in land use planning and decision-making processes. Thus, the case studies need to meet the following criteria:
Cities must present a historic of city cooperation.
Countries should present CBC projects toward the integration of environmental, sociocultural, and economic development goals.
The distance between cities should be no longer than 100 km.
Selected case studies. (A) Vienna-Bratislava-Brno-Györ, (B) Copenhagen-Malmö, (C) Oradea-Debrecen, and (D) Ruse-Giurgiu.
The institutional relations between the cities of Bratislava, Vienna, Brno, and Györ are driven, mainly, by the desire to promote economic development. With the end of the transitional period—limiting the right of Slovak workers to enter the labor market in the European Union in 2011—the cooperation levels between the cities have considerably increased. Nowadays, the leading entity, regarding CBC, is the Centrope Strategy 2013—which includes territories of Hungary, the Czech Republic, Austria, and Slovakia. In this regard, one of the main goals of such strategy is to foster a coordinated approach toward a sustainable regional planning to improve connectivity and the movement between cities, in this large region, regarding accessibility and transportation infrastructure and services [77]. All the regions present great results; however, it should be highlighted that the city of Bratislava once is perhaps one of the best examples of urban growth in the globalization
The cooperation around the Øresund Strait mainly focuses on cross-border economic development based on knowledge and innovation—several clusters in life sciences and clean technologies. Projects as the Øresund Bridge, the train or the freeway, are just some example that have enabled an increase on accessibility standards and improving border functional integration among regions, which have led to the development and construction of new urban districts, i.e., Ørestad, in Copenhagen, and Hyllie, in Malmö, through this transboundary linkage. Being peripheral cities normally seen as a handicap, however, in this case, it has turned into an advantage thanks to the great relationships among these territories and the commitment demonstrated by the main actors of the common regional planning processes and the decision-makers.
If the cooperation between these two cities is still young and also poorly developed, the possibilities for growth through new cooperations and synergies are considerably high, once these two cities perform one of the major urban agglomerations of the region—leading to a significant amount of human resources. By the other hand, the existence of a Hungarian minority in the Romanian side contributes to a stronger regional cohesion. Still, both cities are inserted in the Euroregion Hajdu-Bihar Bihor, where one of the pre-established goals of the Euroregion is fostering a better integration of the projects carried out by the public regarding: health, culture, education, and economic development. The distance between these two cities, about 65–70 km, should also be taken into account. So, their territorial success depends on well-developed connectivity between cities; so, the
The cities of Ruse and Giurgiu constitute the largest border urban agglomeration between Bulgaria and Romania, separated by the Danube River, which is in itself a reason for cooperation since a long time, i.e., common urban planning due to extreme flood phenomena. Along with the previously identified reason for cooperating, also exists the need for the rehabilitation of accessibility infrastructures promoting a transboundary integration avowing infrastructural duplication in CBC [7]. Also, in this case, the area is inserted within a Euroregion—
In this regard, general settings including statistical data for the population of the cities and the corresponding region or influenced area (Table 1), as well as data for the distance-time between the cities of these border areas (Table 2), were analyzed. Through that analysis, it is possible to understand their spatial configuration, i.e., different spatial configurations and different urban patterns and dynamics, concurring with previous researches and studies as the one conducted by ESPON regarding Urban Functions [78], among many other studies and works developed in the same context.
Case study | Country | Area (km2) | Spatial structure | Population |
---|---|---|---|---|
Vienna-Bratislava-Brno-Györ (Centrope region) | AT SK CZ HU | 48,200 | Cross-border polycentric metropolitan region | 6,500,000 |
Copenhagen-Malmö | DK SE | 21,800 | Cross-border polycentric metropolitan region | 3,800,000 |
Oradea-Debrecen | RO HU | 13,600 | Cross-border polycentric metropolitan region | 1,134,255 |
Ruse-Giurgiu | BG RO | 195 | Cross-border agglomeration | 204,297 |
Case study | Country | Between main cities | Travel time (min) | ||
---|---|---|---|---|---|
By public transport | By car | By bus | |||
Vienna-Bratislava-Brno-Györ (Centrope region) | AT | Vienna-Bratislava | 83 | 54 | / |
SK | Vienna-Györ | 116 | 81 | ||
Vienna-Brno | 137 | 103 | |||
CZ | Bratislava-Györ | 91 | 55 | ||
Bratislava-Brno | 87 | 78 | |||
HU | Brno-Györ | 248 | 122 | ||
Copenhagen-Malmö | DK SE | Copenhagen-Malmö | 34 | 48 | / |
Oradea-Debrecen | RO HU | Oradea-Debrecen | 54 | 69 | / |
Ruse-Giurgiu | BG RO | Ruse-Giurgiu | / | 15 | 15 |
Connectivity and accessibility-movement between cities (source: [80]).
AT, Austria; SK, Slovakia; CZ, Czech Republic; HU, Hungary; DK, Denmark; SE, Sweden; RO, Romania; and BG, Bulgaria.
Also, an indicator which allows that to analyze the economic dynamics of the territories, i.e., GDP per capita in terms of purchasing power parity, is presented in Table 3, covering both sides of the border. Analyzing Table 3, it is possible to understand the socioeconomic dynamics of the urban areas under study, i.e., GDP per capita for each case study region for the 3 years 2000, 2006, and 2011, where in all cases, the GDP per capita has increased in absolute terms but with very different rates. For an easy reading, in the last column, the information is synthesized using signs which allow seeing whether GDP has increased at rates, which are:
Still below the average increase for European regions in NUTS 3 (−), which was 5500 €.
Between 5000 € and 10,000 € above the EU average growth (+).
Very above (++), over 10,000 € elation to the population.
Case study | Country | GDP per capita | Evolution (2000/2011) | ||
---|---|---|---|---|---|
2000 | 2006 | 2013 | |||
Vienna-Bratislava-Brno-Györ | AT | 30,263 | 34,547 | 36,562 | + |
SK | 12,400 | 17,200 | 19,000 | + | |
CZ | 12,803 | 16,139 | 18,652 | + | |
HU | 15,652 | 26,855 | 34,357 | ++ | |
Copenhagen-Malmö | DK | 22,100 | 25,700 | 27,100 | — |
SE | 29,161 | 33,419 | 36,667 | + | |
Oradea-Debrecen | RO | 7600 | 10,900 | 12,500 | — |
HU | 4700 | 9300 | 10,100 | — | |
Ruse-Giurgiu | BG | 4700 | 7100 | 8700 | — |
RO | 2700 | 4800 | 9000 | + |
Notes: (−) means that the evolution of the GDP per capita is below 5.500 € (EU NUTS 3 average growth) between 2000 and 2011; (+) means that the evolution of the GDP per capita is between 5.500 and 10.000 € between 2000 and 2011; (++) means that the evolution of the GDP per capita is higher than 10.000 € between 2000 and 2011; The threshold values have been calculated based on the average and standard deviation in all the NUTS 3 regions in the EU. AT, Austria; SK, Slovakia; CZ, Czech Republic; HU, Hungary; DK, Denmark; SE, Sweden; RO, Romania; and BG, Bulgaria.
It is a well-documented fact that labor market can play a critical role through the impact on cross-border integration [81]; so, throughout Table 4, it is possible to analyze the differences in unemployment levels and where cross-border cooperation can potentially allow a higher fluidity of the labor market for the benefit of both sides of urban regions [80, 81].
Case study | Country | NUTS2* | Active population 2006/2013 (%) | Unemployment rate (%) | Employment 2006/2013 (%) | ||
---|---|---|---|---|---|---|---|
2006 | 2013 | Difference (%) | |||||
Vienna-Bratislava-Brno-Györ | Burgenland | 3.5 | 5 | 4.7 | −1 | 4.7 | |
AT | Niederösterreich | 6.2 | 4 | 5.6 | 0.5 | 5.6 | |
SK | Wien | 7.4 | 8.8 | 7.8 | −0.4 | 7.8 | |
CZ | Jihovýchod | 3.7 | 7.1 | 4.1 | −0.3 | 4.1 | |
HU | Nyugat-Dunántúl | −0.7 | 5.7 | −2.7 | 2.1 | −2.7 | |
Bratislavský kraj | 0.3 | 4.6 | −1.7 | 1.8 | −1.7 | ||
Copenhagen-Malmö | DK | Sydsverige | 9 | 8.2 | 6.8 | 1.7 | 6.8 |
SE | Hovedstaden | 8.8 | 5 | 3.8 | 2.4 | 3.8 | |
Sjælland | −2 | 4 | −5.6 | 2.8 | −5.6 | ||
Oradea-Debrecen | RO | Észak-Alföld | 5.7 | 11 | 1.7 | 3.4 | 1.7 |
HU | Nord-Vest | 0.6 | 5.9 | 2.7 | −1.8 | 2.7 | |
Ruse-Giurgiu | BG | Severen Tsentralen | −9.1 | 13.5 | −11.1 | 1.8 | −11.1 |
RO | Sud-Muntenia | −8.8 | 9.4 | −9 | 0.5 | −9 |
Table 5 shows the identified factors for territorial success on the case studies.
Identified factors | Case studies | |||
---|---|---|---|---|
Vienna-Bratislava-Brno-Györ | Copenhagen-Malmö | Oradea-Debrecen | Ruse-Giurgiu | |
Access to European funds | x | x | ||
Common objectives and Master’s Plans | x | x | ||
Connectivity-Movement between cities | x | x | x | x |
Increasing life’s standards | x | |||
Stronger economy | x | x |
Identified factors.
The performed multivariated analysis of the case studies enabled us to identify critical factors for territorial success through CBC projects. Nevertheless, similar studies have already been developed, i.e., [7, 10, 32, 66], among many others, however, not through a multivariated analysis focusing on the addressed case studies. Thus, the present study allowed to define specific factors for these cases as well as to establish a correlation with land use, urban planning, city cooperation, and CBC.
So, from an individualized perspective, two rhythms of development and consequently two groups of factors and objectives can be defined; in order words, through the analysis of the case studies, it is verified that the cases located in Central and North Europe, Bratislava-Vienna-Brno-Györ, and Copenhagen-Malmö, have similar objectives, i.e., common objectives, Master’s plans, and stronger economy, while in the cases of Eastern Europe, Oradea-Debrecen, and Ruse-Giurgiu, the factors and objectives are access to the EU funds and increase in life’s standards, demonstrating significant disparities in the development levels within the European continent. However, one of the identified factors is common to all case studies: connectivity-movement between cities, showing unequivocally its relevance to achieve territorial success as well as the so desired sustainable development. In this regard, to achieve a sustainable, well-developed and abiding CBC project, all the critical factors, even the ones that have been assigned only for some of the cases, should be considered and not be underestimated [6]; such statement is valid not only for the planners but mainly for the decision-makers.
The historical and social evolution that European territories have felt through time should also be focused; along with the land use, changes as well as territorial landscapes, urban and rural, are the outcome of policies and administrative actions leading to strengthen urban agglomerations giving them the consistency that they present as a result of the application of regional strategies, i.e., the plurality of Europe [41]. In fact, the reality of the twenty-first century is increasingly the change tendency in the urban landscapes of these “new times,” i.e., technological, and socioeconomically, where city cooperation is not an exception.
In fact, throughout history, territories have always sought an approach to the more developed/avant-garde nations of their time. Nowadays, and based on the results of the present study, economies and countries of Central and Northern Europe, along with the United States, continue to be references to good practice, formatting the urban agglomerations and their landscapes in the demand for such standards.
The authors would like to acknowledge the financial support given by the Junta de Extremadura/FEDER for the support to the research Group ARAM - Environmental Resources Analysis Research Group (GR15149).
Access to healthcare means having “the timely use of personal health services to achieve the best health outcomes. It consists of four components:
Coverage: facilitates entry into the healthcare system. Uninsured people are less likely to receive medical care and more likely to have poor health status.
Services: Having a usual source of care is associated with adults receiving recommended screening and prevention services.
Timeliness: ability to provide healthcare when the need is recognized.
Workforce: capable, qualified, culturally competent providers [1].
In 2001 Gulliford, et al. [2] provided a description of access to health services in which they said “Facilitating access is concerned with helping people to command appropriate healthcare resources in order to preserve or improve their health. There are at least four aspects, they said:
If services are available, in terms of an adequate supply of services, then a population may ‘have access’ to healthcare.
The extent to which a population ‘gains access’ to healthcare also depends on financial, organizational and social or cultural barriers that limit utilization. Thus, utilization is dependent on the affordability, physical accessibility and acceptability of services and not merely the adequacy of supply.
The services available must be relevant and effective if the population is to “gain access to satisfactory health outcomes”.
The availability of services, and barriers to utilization, have to be evaluated in the context of the differing perspectives, health needs and the material and cultural settings of diverse groups in society
The Institute of Medicine (IOM) defined access to healthcare “as having timely use of personal health services to achieve the best possible health outcome [3]. According to The Agency for Healthcare Research and Quality’s (AHRQ) [4] “access requires gaining entry into the health-care system, getting access to sites of care where patients can receive needed services, and finding providers who meet the needs of patients and with whom patients can develop a relationship based on mutual communication and trust”. The National Academies of Sciences, Engineering, and Medicine [5] suggested that “People use healthcare services to diagnose, cure, or ameliorate disease or injury; to improve or maintain function; or to obtain information about their health status and prognosis”. Anderson and Newman [6] presented a framework (4th phase) of health-care utilization that includes predisposing factors, enabling factors, and magnitude of illness. The framework suggests that an individual’s access to and use of health services is considered to be a function of three characteristics:
Predisposing Factors: The socio-cultural characteristics of individuals that exist prior to their illness:
Social Structure: Education, occupation, ethnicity, social networks, social interactions, and culture
Health Beliefs: Attitudes, values, and knowledge that people have concerning and towards the healthcare system
Demographic: Age and Gender
Enabling Factors: The logistical aspects of obtaining care:
Personal/Family: The means and know how to access health services, income, health insurance, a regular source of care, travel, extent and quality of social relationships
Community: Available health personnel and facilities, and waiting time
Possible additions: Genetic factors and psychological characteristics
Need Factors: The most immediate cause of health service use, from functional and health problems that generate the need for healthcare services.
“Perceived” need will better help to understand care-seeking and adherence to a medical regimen,
“Evaluated” need will be more closely related to the kind and amount of treatment that will be provided after a patient has presented to a medical care provider.
People go, or more important they do not go to healthcare services for different reasons. Three overarching categories of reasons emerged based on the necessity, availability, and desirability of care-seeking [7]:
low perceived need to seek medical care;
traditional barriers to medical care, in which people may want to seek care but are limited in their ability to do so; and
unfavorable evaluations of seeking medical care, in which people may perceive care-seeking as necessary and an available option, but not desirable.
Some of these reasons relate to the human nature of the people while others relate to the health facilities themselves. People go to these services to seek methods of prevention, protection, diagnosis, treatment, palliative care, education, research and a multiple of other reasons. Healthcare services may be provided in different ways and locations including hospitals in tertiary services, clinical and other professional services, dental services, home healthcare services which are at the increase as more patients move from hospital care to home care, nursing care services at the hospital or at home], pharmaceutical and medication dispensing services in addition to other over the counter medicines.
eHealth is one of the enablers of “access to healthcare services” along with a number of other factors. Social determinants of health represent a collection of factors that interplay in their influence of the health of people and therefore their ability to access health services using digital health technologies. It has become imperative to design and deploy such technologies in the communities to reduce inequity and improve ability to access health services. eHealth has been described as the “… use of information and communications technologies (ICT) in support of health and health-related fields, including healthcare services, health surveillance, health literature, and health education, knowledge and research” [8]. eHealth includes the ICT-enabled components of health informatics, healthcare informatics, medical informatics, biomedical informatics, mobile health (mHealth), and telehealth and telemedicine, as well as the human and non-electronic components which are essential for these systems to function. Digital health has been extensively used to mean all concepts included in eHealth plus the use of digital devices to capture, monitor and report health data images, and vital signs: body temperature, pulse rate, respiration rate and blood pressure) from individuals and the relevant signs from the environment. The World Health Assembly (WHA) adopted a resolution in 2017 [9] and then a global digital health strategy in 2020. The description provided by the two documents of digital health extensively referred to eHealth as the core component in national eHealth planning, integration of eHealth in health systems, application development, monitoring and evaluation. In a review of definitions of eHealth in 2005, [10] the reviewers found that technology was viewed both as a tool to enable a process/function/service and as the embodiment of eHealth itself. They expressed pleasure to note that technology was portrayed as a means to expand, to assist, or to enhance human activities, rather than as a substitute for them.
A diversified range of areas in which eHealth can be used as many studies indicate [11, 12, 13]. Some of these are directed to service providers while others are directly linked to patients. In all cases the ultimate benefit goes to the citizen.
This range of areas may include:
Improving access and exchange of information and data;
Improve the quality of care;
Reduce costs of healthcare;
Support research by academic and other researchers;
Building evidence for possible policy setting;
Safeguard patient empowerment and safety;
Health worker training and supervision: Pre-service and in-service and both remote and in-person mixed media training; mobile supervision checklists and observation data collection forms;
Data collection and reporting: At the household, community, facility, district, and national level; longitudinal patient tracking (electronic health records), patient registries, disease surveillance, contact tracing, vital events tracking, civil registration;
Supply chain management: Cold chain management, commodity tracking, counterfeit detection and prevention, equipment maintenance;
Financial transactions: Health savings accounts, insurance payments, provider reimbursements, salaries, per diems, conditional cash transfers, performance-based incentives, electronic vouchers;
Health workforce management: Tracking of training, certification, deployment and retention, provider work planning and scheduling;
Clinical care: Point-of-care intelligent diagnostics, remote clinical care, remote monitoring of patient compliance and status, clinical decision support (guidelines, algorithms, checklists);
Real-time communications: Between managers and providers (e.g., treatment guideline updates, routine health reporting), providers and providers (e.g., referrals, consultations), and clients and providers (e.g., symptom notifications, post-referral follow-up);
Public health information and behavior change: Public health education messages, appointment and treatment reminders, health provider point-of-care job aids, health information hotlines.
In a review of definitions of digital health [14], the findings showed that digital health, as has been used in the literature, is more concerned about the provision of healthcare rather than the use of technology. The reviewers added that “Wellbeing of people, both at population and individual levels, have been more emphasized than the care of patients suffering from diseases. Also, the use of data and information for the care of patients was highlighted. A dominant concept in digital health appeared to be mobile health (mHealth), which is related to other concepts such as telehealth, eHealth, and artificial intelligence in healthcare”. Improving access to healthcare services: especially in rural and deprived areas with low (or no) availability of healthcare services, eHealth tools can enable remote consultations, therapies and rehabilitation [15].
eHealth and digital health will be used in this chapter interchangeably to mean the “use of information and communication technology in health”. They are considered true interdisciplinary sectors that bring knowledge and practices from the fields of computer and information sciences, telecommunications, social sciences, health sciences (medicine, public health, pharmaceutical, dentistry, health management], health services research, communication, law and engineering. Success of eHealth depends on the extent and ability to integrate and function as an interdisciplinary system. Elements and applications of digital health have become an integral part of health services and information delivery. One cannot imagine a health service without the use of one or more of a digital health device or an eHealth application. eHealth is contributing to achieving Universal Health Coverage (UHC) and the Sustainable Development Goals [16]. eHealth has shown to enable national health system that use ICT to ensure that the people are aware of the availability of and accessibility to health services, that people are happy (satisfied) with the services they receive and that a monitoring and evaluation system is in place [17, 18, 19, 20].
WHO (2013) [21] describes the goal of UHC as to ensure that all people obtain the health services they need- prevention, promotion, treatment, rehabilitation and palliation without risk of financial ruin or impoverishment, now and in the future. eHealth empowers patients and make services and providers more transparent and providers are become more efficient when they use eHealth technologies to manage or deliver healthcare services.
WHO (2016) [22] confirmed that “It has become increasingly clear that UHC cannot be achieved without the support of eHealth.” The results of the Global eHealth Survey conducted by WHO in 2015 in which a total of 125 countries participated provided some key findings based on the themes that were covered in the Survey. These included:
More than half of WHO Member States now have an eHealth strategy, and 90% of eHealth strategies reference the objectives of UHC or its key elements. It is becoming mainstream for countries to have policies for managing information.
A large number of countries reported at least one mHealth initiative (83%). Despite the rapid growth, however, very few Member States reported evaluations of government-sponsored mHealth programmes, thereby limiting knowledge of what works well and what mistakes to avoid.
By offering care at a distance, telehealth services enable greater equity in health coverage. The use of telehealth continues to grow, and teleradiology is the most widespread (77%). Other services, such as telepathology, remote patient monitoring, and tele-dermatology, are also in use in nearly half of countries.
eLearning, which encompasses a variety of interventions in terms of tools, content, learning objectives, pedagogical approaches, and setting of delivery, is used for medical students’ and doctors’ education in over 84% of countries. Implementation of eLearning is associated with a number of challenges. For example, there is a lack of robust and comprehensive health science eLearning evaluation standards, leading to haphazard evaluation and accreditation of eLearning programmes.
National electronic health record (HER) systems are now reported in 47% of countries.
In total, 78% of countries reported legislation protecting the privacy of personal information, and 54% reported legislation to protect the privacy of electronically held patient data.
Nearly 80% of countries reported that healthcare organizations use social media for the promotion of health messages.
17% of countries already report having a national policy or strategy regulating “big data” use in the health sector.
As healthcare itself is data and information intensive sector it simply means that for this sector to achieve its objectives, it has to collect, exchange and utilize high quality data. Health data has a number of characteristics including:
Critical patient data and information remains scattered across different departments and systems;
Data is not accessible and handily available in times of need. Too much data, little information;
Multiple service providers (public, private, army, charities, etc.) in the system do not have a system in place for smooth process management;
Very little or no exchange (sharing) of information on patients, diagnosis, treatments, etc.;
Privacy, confidentiality and ownership of personal health data are compromised;
The above has led to potential misuse, no use or underuse of health data. Digital health strategies have become integral parts of the overall public health and healthcare delivery system in many parts of the world as health and digital technology seamlessly integrate. Planning, monitoring and evaluation of digital health have become essential to the health systems strengthening process. These have become part of the health system’s resilience and learning. A country cannot afford to have a resilient health system that is responsive to current and future demands without using digital health technology to predict, protect, diagnose, educate and treat. Adopting digital health strategies carries the promise to improve the quality of health services, reduce costs, improve equity of access, and empower citizens in a person-centered healthcare system [23]. Evidence, to prove that all these are attainable at the same time, is still being built. Digital health technologies vary in form and utilization, but have a number of commonalties:
They are all made to help/assist healthcare professionals to better collect data, diagnose, educate and treat individuals;
They represent serious attempts to replace healthcare professionals in performing tasks that look tedious or dangerous, especially when a disease is difficult to diagnose or treat using traditional means;
They may work together to perform a task for the sake of both the healthcare provider and the patient. This simply means more than one technology functions with others to perform the same task of data collection, diagnosis or treatment.
Digital health has adopted a number of other “new” technologies that were not originally designed for the health sector. This has shown that this sector is in a real need for such technologies to enable safe, secure, affordable, timely and equitable access to health services.
The range of technological solutions that are used to enable access to healthcare services is endless. The attempt here is to provide details of the eHealth/digital health types of applications that are more used rather than the list of technologies themselves. These include:
Electronic health record (EHR) is a repository of information regarding the health status of an individual in computer processable form which is collected primarily to support the provision of integrated holistic healthcare to that individual but may also be used, subject to legislation and consent, for secondary purposes that benefit the health of the wider community [24].
The EHR has been one of the most persistent and yet changing technology in healthcare. It’s the cornerstone of any electronic health system which influences the rate of success of the digital health services in an institution or even a country. EHR systems come in different forms and sizes aiming at collecting, storing, sharing and utilization of health data by healthcare providers, the patient and other third-party players as the legal and ethical frameworks permit. The complexity of the record’s structure, compliance with both semantic and syntactic standards, the interface, open vs. commercial suppliers, language version and many other issues pose challenges to implementation of EHR systems to enable access to health services.
Healthcare institutions may avoid implementing of such systems due to a number of issues they face, which automatically limit access to healthcare services by people (patients and non-patients):
Inaccurate patient identification in a record makes it extremely difficult and impractical to offer health services. Absence of a unique number for each patient may cause not only delay in provision of health services but could cause medical errors;
Lack of standard terminology and standard data exchange format hamper the efficiency of data exchange due to lack of semantic interoperability. This will cause both delay in service provision, inability to report, cost and more important medical errors;
Healthcare professionals, patients and the community have expressed concerns about privacy, confidentiality and the quality and accuracy of electronically generated information. The better secure technology, blockchain for example, legal and ethical awareness may reduce anxiety;
Patients may not trust the EHR due to both hardware and software reasons. Interrupted electrical (power) supply, wrong algorithms, lack of training on the system, etc. are all reasons limiting access to healthcare services.
Despite all these challenges, benefits of an EHR system to collectively enable fast and reliable access to healthcare services have been documented. These can be:
Health information and data. Immediate access to key information. This would improve caregivers’ ability to make sound clinical decisions in a timely manner;
Result management. Ability of all providers participating in the care of the patient across multiple settings to quickly access new and past test results. This would increase patient safety and effectiveness of care;
Order management. Ability to enter and store orders for prescriptions, tests, and other services in a computer-based system. This should enhance legibility, reduce duplication, and improve the speed with which orders are executed;
Decision support. Using reminders, prompts, and alerts to improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments;
Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients. This would improve continuity of care, increase timeliness of diagnoses and treatments, and reduce the frequency of adverse events.
Patient support. Tools that give patients access to their health records. This would provide interactive patient education and help them carry out home monitoring and self-testing, which can improve control of chronic conditions.
Administrative process. Computerized administrative tools such as scheduling systems. This would improve hospital and clinic efficiency and provide more timely service to patients;
Reporting. Electronic data storage that employs uniform data standards. This will enable healthcare organizations to respond more quickly to personal, federal, state, and private reporting requirements.
Telemedicine is not a new concept but the technology has been extensively used in the last two years due to the corona virus (COVID-19) pandemic. This is not the place to enlist the history of telemedicine as a technology and as a method to enable access to healthcare services remotely. The World Health Organization [2009] defines telemedicine as “the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities” [25]. Telemedicine and telehealth are two concepts that are exchangeable despite the fact they differ as telemedicine focuses on provision of health services to an individual while telehealth focusses on provision and assessment of healthcare services to a population. In their systematic review, Monaghesh and Hajizadeh (2020) they indicated that “telehealth can become a basic need for the general population, healthcare providers, and patients with COVID-19, especially when people are in quarantine, enabling patients in real time through contact with healthcare provider for advice on their health problems” [26]. The promise and potential of telemedicine have been to provide timely, safe, and less expensive care, where the patient/individual does not need to be in the same place/room with the healthcare provider. This simply means that access to healthcare services does not have to move from where the patient is to get into the point of care. During COVID-19 social/physical distancing, has resulted in radical increase in the use of telemedicine services in all countries. This mode of service was provided to avoid contact between patients and healthcare providers who might have been diagnosed as positive COVID-19 and to ensure continuity of primary or secondary healthcare services and in some case tertiary care. Telemedicine services have been provided to ensure timely access to high quality information and care, including prevention and protection services, provision of public health support, provides a form of patient engagement with other patients, family members and healthcare providers, the more advanced form of support includes screening for diagnosis and disease discovery and supports eLearning for both care providers and recipients [27, 28, 29].
A number of concepts are being used to mean information accessed and delivered through the use of the Internet. Among these is the web, which has been defined as “a techno-social system that allows individuals to interact on technological networks, thus improving individual’s cognition, communication and cooperation” [30]. Other applications on the Internet include email services and social media platforms. Consumers of health information have found these applications in multilingual forms, easy to access and many of them have been found to be useful and relevant to their needs. The move from Web 1.0 to Web 4.0 has resulted in providing the end user with more power to control what is being posted and searched on the web using natural language processing. Consumer health, where web developers or owners directly reach out to people poses a challenge of quality of health information, timelessness and possible abuse by predators on the internet [31]. Eysenbach, and Diepgen, [32] provided a number of important issues emerging as a result of failure to control the quality of health information on the internet. They concluded:
The quality of information on the internet is extremely variable, limiting its use as a serious information source;
A possible solution may be self labelling of medical information by web authors in combination with a systematized critical appraisal of health-related information by users and third parties using a validated standard core vocabulary;
Labelling and filtering technologies such as PICS (platform for internet content selection) could supply professionals and consumers with labels to help them separate valuable health information from dubious information;
Doctors, medical societies, and associations could critically appraise internet information and act as decentralized “label services” to rate the value and trustworthiness of information by putting electronic evaluative and descriptive “tags” on it;
Indirect “cybermetric” indicators of quality determined by computer programs could complement human peer review.
The perceived value of information, the quality, usefulness, the level of trust and the language of the site are factors that influence the level of attraction to use a website to search for health information. The emerging quality management sites such as “Heath On the Net- HON” [33], that provides 8 principles (in 38 languages) to make a judgment of the web site is a good example of how health infuriation consumers may get guidance on quality of health information on the Internet. Meeting these principles will result in a certificate provided by HON to the website. It’s important, however, to make sure that searching the web for health information, especially for self-diagnosis is no alternative to consulting ad as specialized healthcare professional as “the immediate and widespread sharing of medical and other scientific information outside of expert circles before it has been thoroughly vetted (eg, preprints) can be dangerous, especially in a pandemic [34].
As early as 1997 [35], the use of health information on the internet has been a major issue for consideration as a way to get information that may lead to further use of healthcare facilities and qualified health workforce personnel, while for others, it has been used as the sole source of information resulting to what has been described by WHO (2020) [36] as the “infodemic” being too much information including false or misleading information in digital and physical environments during a disease outbreak. It causes confusion and risk-taking behaviors that can harm health. It also leads to mistrust in health authorities and undermines the public health response. An infodemic can intensify or lengthen outbreaks when people are unsure about what they need to do to protect their health and the health of people around them. With growing digitization – an expansion of social media and internet use – information can spread more rapidly. This can help to more quickly fill information voids but can also amplify harmful messages.” The use of social media has aggravated the situation due to availability and finding unvetted information.
There are different uses of health information on the web such as:
Education and awareness for both healthcare providers and citizens;
Self-diagnosis with all the disadvantages related to this;
Access to diagnostic result reporting for clinical staff;
Searching for healthcare sites location, profiles, personnel, services, etc.;
Searching for health and medical products and services;
Electronic ordering of laboratory services (pathology, radiology services);
Patient event history via special forms or email services;
Discharge letter production;
Attending an appointment on the internet;
Searching for health and medical information in books, journals and other information sources.
mHealth is a medical and public health practice supported by mobile devices, such as mobile phones, smart phones, the Internet, patient monitoring devices connected to mobile phones, personal digital assistants (PDAs), and other wireless devices. mHealth support includes patients, care-takers, pharmacists, or other healthcare providers making use of any digital technology in addition to the devices mentioned above specialized applications called APPs [37]. The top six areas of using mobile phones for health, according to the WHO global survey, include: toll-free emergency, health call centers, appointment reminders, community mobilization, information delivery, mobile telehealth and emergency management systems and mHealth applications [38]. Mobile APPs are software programs that run on smart phones and other mobile communication devices. They can also be accessories that are attached to a smartphone or other mobile communication devices, or a combination of accessories and software [39].
These APPs:
Help patients/users self-manage their disease or condition without providing specific treatment suggestions;
Provide patients with simple tools to organize and track their health information;
Provide easy access to information related to health conditions or treatments;
Help patients document, show or communicate potential medical conditions to healthcare providers;
Automate simple tasks for healthcare providers; or
Enable patients or providers to interact with Personal Health Records (PHR) or Electronic Health Record (EHR) systems.
A very wide range of mobile health APPs is available right now, which helps patients (and non-patients) to access healthcare services and information on their own convenience. There are infrastructural, cultural, legal and ethical challenges. In general, these APPs have been used in areas such as: sports and fitness activity tracking, diet and nutrition, weight loss coaching, pharmacy; sleep cycle analysis, stress reduction and relaxation, meditation, symptom checkers, access to personal health records, digital imaging, electronic chart review, laboratory results review, life scan for patients with diabetes, remote heart monitoring, ECG viewer, oxygen level remote check, telehealth services, prescription management, appointment reminders, International Classification of Diseases (ICD) reference guide, evaluation and management coding, specialized medical reference material, pregnancy and baby development, exercise and fitness, remote dictation, surgery scheduling and interoffice communication.
“Big data in health refers to large routinely or automatically collected datasets, which are electronically captured and stored. It is reusable in the sense of multipurpose data and comprises the fusion and connection of existing databases for the purpose of improving health and health system performance. It does not refer to data collected for a specific study” [40]. Leveraging big data to find patterns and predict diseases which helps both medical researchers and health leaders to better understand the disease distribution in a country or a community, which if properly used can contribute to building sustainable healthcare systems, collaborate to improve care and outcomes and eventually increase access to healthcare. It is to be noticed that the major bulk of medical data unstructured and is clinically relevant, that data resides in multiple places like individual electronic medical records (EMR), laboratory and imaging systems, physician notes, medical correspondence, claims, etc. [41]. Accompanied with big data concept is data analytics which is evolving into a promising field for providing insight from very large data sets and improving outcomes while reducing costs. The potential of big data to transform healthcare has been identified [42]. The study of data science and the emerging importance of data as a resource in health have influenced the way that healthcare is being studied and its cost-effectiveness, efficiency, disease prevalence and accessibility are predicted.
Among the major challenges to accessing healthcare services is lack of knowledge of their existence, lack of knowledge of the distance between the place of residence and the healthcare centre and unaffordability to transport to the centre. Brown [43] enumerated five potential benefits of integrating GIS in healthcare IT: identifying health trends, tracking the spread of infectious disease, utilizing personal technologies, incorporating social media and improving (health) services. Brown concluded that “GIS is a powerful tool that has been successfully implemented to help address a number of significant health issues ranging from disease management to improved services”. Geolocation technologies for health have made it easier to locate the nearest healthcare centre, provision of the full profile of the centre and the best method to reach it. Integration of geographic data elements (locations) and the thematic data in a database utilizes the best of the two worlds as it has become possible to locate the place where a specific type healthcare services exists. “GIS plays a critical role in determining where and when to intervene, improving the quality of care, increasing accessibility of service, finding more cost-effective delivery modes, and preserving patient confidentiality while satisfying the needs of the research community for data accessibility [44].
Blockchain in healthcare which has been described as “a distributed system which records and stores transaction records. “… a shared, immutable record of peer-to-peer transactions built from linked transaction blocks and stored in a digital ledger” [45]. It allows to securely transfer the ownership of units of value using public key encryption and proof of work methods [46]. Security and data privacy have been among the major reasons for not trusting a system by the patients. Not trusting a system is one limiting factor to access to healthcare system. Increasing security and trust would encourage more people to come forward to use healthcare systems. For patients, in particular, block chain allows payments through cryptocurrencies, which is becoming a trend in the money market. Patient safety is being monitored through drug traceability, especially tracing of counterfeit medicine. Patient data management as personal health data is growing at a very high rate and from multiple sources, many patients became more conscious that data about them needs to be more secure and less accessible by unauthorized parties.
The IoT is described as a network of physical devices that uses connectivity to enable the exchange of data [47, 48, 49]. The Internet of Medical Things (IoMT) has allowed patients to stay at home or anywhere and yet provide health data about themselves to specialized centers for monitoring purposes. This amalgamation of medical devices and applications that can connect to healthcare information technology systems using networking technologies meant that patients can still access healthcare services enabled by technology without them leaving their places. Wearable devices for health monitoring are technologies that can be worn on the human body. This type of devices has become a more common part of the tech world as companies have started to evolve more types of devices that are small enough to wear and that include powerful sensor technologies that can collect and deliver information about their surroundings. A wearable device is often used for tracking a wearer’s vital signs or health and fitness related data, location, etc. These may include continuous glucose monitoring devices, smart bandages, smart pills and remote patient monitoring, monitoring of patient’s movement, dietary system, etc. Adherence to medication helps patients to take medications on time and even inform medical professionals if the patient fails to adhere to medications. In addition to the many advantages to patients, wearables aid healthcare providers in many ways, by simply improving access to healthcare services while having real time health data collection and time saving. Home care and monitoring are provided to many of the aging patients, patients with chronic diseases and those that are for economic or logistic reasons they are advised to stay at home while access to health services is enabled by digital health tools. Hospital to Home Healthcare (H2H) has become the solution of choice and is an integral part of health service delivery system. These technologies have been used to:
Reduce unnecessary hospital visits and the burden on healthcare systems by connecting patients to their physicians;
Allowing the transfer of medical data over a secure network;
Empowering individuals to better control their healthy lifestyle, well-being and fitness;
Landers, et al. [50] suggested four pillars as the key characteristics of the home health agency of the future: patient and person centered, seamlessly connected and coordinated, high quality of care and technology enabled that allows patients to more easily connect with healthcare professionals and receive more intensive services in new settings.
The mobile device (smart phone or an internet connection) connected to a medical device at home and linked to health centre provides the opportunity to send signals related to vital signs of the patient. The functionality of these devices depends on the type/reason for which this device is provided. These may include measuring body temperature, blood pressure, glucose level in the blood, heart beat rate, respiration and air flow in real-time mode, for patients that need kidney dialysis machines.
Medical wearables with artificial intelligence and big data are providing an added value to healthcare with a focus on diagnosis, treatment, patient monitoring and prevention. Access to healthcare is enabled by wearables as these provide a number of advantages. Wearable devices applied to healthcare offer multiple advantages to healthcare professionals as well as the patients [51]:
Premature diagnosis. Wearable devices allow the early detection of symptoms thanks to more precise medical parameters;
Personalization. The doctor, with the help of a software can quickly create a program based on the needs of the patient;
Early diagnosis. Precise medical parameters in the wearable devices allow early detection of symptoms;
Remote patient monitoring. Healthcare professionals can monitor patients remotely and in real-time through the use of wearable devices;
Control and monitoring of the patient: the medical professionals can monitor the patient’s evolution in real time and, if necessary, make changes in the treatment remotely. In addition, patients can also control their health status by connecting the device whenever and wherever they want.
Adherence to medication. Wearable devices help patient to take medications on time and even inform medical professionals if the patient fails to adhere to medications;
Information registry. The data are stored in real-time, allowing a more exhaustive analysis of the information. This results in a more complete and precise report on the patient’s medical history, which can be shared with other medical specialists;
Optimum decision by the doctor. The doctor is able to compare and analyze data to make a sharper clinical decision to enhance the patient’s quality of life;
Saving healthcare cost. Remote healthcare via wearable devices mean saving time and mobility, as it removes the need for the patient to be continuously transferred to the medical center.
It is recognized that some patients require multiple technologies which resulted in the emerging of the technology that tends to streamline data collection, delivery and use. The Internet of Medical Things (IoMT) is an amalgamation of medical devices and applications that can connect to healthcare information technology systems using networking technologies.
According to a World Health Organization’s survey (2017) [52], there are still 400 million people who do not even get essential healthcare support and services. Although artificial intelligence (AI) can reduce this number, the only hurdle is its implementation is the need for huge financial support. Among the reasons for this state of affairs is that patients cannot access healthcare services due to a number of social determinants of health. AI provides an opportunity for many of those who cannot access health services to be reached out “virtually” through image recognition and interpretation, diagnostic assistance, generating reminders and alerts and therapy planning. AI brings a number of benefits to the healthcare system, including to patients. It provides fast and accurate diagnostics, it reduces human errors, it contributes to cost reduction as the patient can get doctor’s assistance without visiting hospitals/clinics which results in cost cutting. AI assistants provide online care and assist patients to add their data more frequently via online medical records, etc. and it supports the Virtual Presence of patients through telemedicine services which allow specialists to assist their patients who live in remote locations. Using a remote presence robot, doctors can engage with their staff and patients in hospitals or clinics and assist or clear their queries. More recently, WHO released its guidance on “Ethics and Governance of Artificial Intelligence in Health” [53]. The guidance provided the areas of application of AI in healthcare delivery as it has been used in:
Diagnosis and prediction-based diagnosis. AI is being considered to support diagnosis in several ways, including in radiology and medical imaging. Such applications, while more widely used than other AI applications, are still relatively novel, and AI is not yet used routinely in clinical decision-making.
Clinical care. Clinicians might use AI to integrate patient records during consultations, identify patients at risk and vulnerable groups, as an aid in difficult treatment decisions and to catch clinical errors.
Emerging trends in the use of AI in clinical care. The reports indicated that several important changes imposed by the use of AI in clinical care extend beyond the provider–patient relationship. Four trends described in the report are:
the evolving role of the patient in clinical care;
the shift from hospital to home-based care;
the use of AI to provide “clinical” care outside the formal health system; and
use of AI for resource allocation and prioritization.
The guidance also provided other areas in which AI has been contributing including health research and drug development, supporting health systems management and planning and in public health and public health surveillance that includes Health promotion, disease prevention and outbreak response.
Monitoring is the periodic and ongoing operation to ensure that the healthcare services are on track while evaluation is designed to measure the relevance, efficiency and effectiveness of healthcare services and their impact on the health of people. In both cases quality data is essential and require setting the baseline by which progress or lack of it can be measured. A data system, usually computer-based health information system, that routinely collects and reports information about the delivery and cost of health services and patient demographics and health status. The major purpose of monitoring and evaluation (M&E) is to measure progress aiming at learning and improving the services. Reeve, Humphreys and Wakerman [54, 55] in the Australian context indicated that Integral to improving rural and remote health outcomes is the provision of appropriate, accessible and effective healthcare services relevant to the needs of communities, which requires a mechanism to monitor and evaluate the impact of health services on improving health outcomes for communities.
M&E requires data collection, its storage and analysis which transforms it into information, knowledge and evidence that can be used for making evidence-based policies, decisions and actions. M&E is based on a set of indicators and measurable targets, which makes it necessary to use ICT tools to fulfill these requirements of data collection, its storage, trends analysis, comparison of achievements with targets, evidence creation and application.
Quality of health services is generally understood to mean that, at all levels of a health system, there is an inherent and explicit recognition of the value of efforts to improve the quality of health services provided – and such efforts are systematically promoted within an enabling environment that encourages engagement, dialog, openness and accountability [55].
Fundamental success factors for provision of quality health services [56] were widely considered to be prerequisites for quality health services include: essential infrastructure, health workers and health management information systems and data systems (e.g. availability of quality measures and data collection templates to generate data, computer hardware/software to analyze data and synthesize the findings into actionable information for further improvement).
A number of country studies have listed challenges and opportunities of using digital health solutions from legal, ethical, infrastructural, human and material resources, training, education, attitude, organizational, cultural and behavioral points of view [57, 58, 59, 60, 61, 62, 63, 64, 65, 66]. These challenges may include:
Infrastructure. Stable electric power supply, place to put computers, air conditioning, local area networks, and other logistics to host computers and their programmes;
Availability of ICT info-structure including computers, programmes, applications and internet that were designed with users in mind;
Connectivity (Internet, telephone lines, or else) represents a major constraint not only at the national level but could be at the local and even community and household level. The Internet penetration rate at global level is 59.5%. Major parts of Africa, for example, the major part of the continent needs access to the internet which creates a considerable obstacle in developing digital infrastructures. The very limited bandwidth in many communities makes it very difficult to download or even to properly access the Internet (web, email, social medial platforms, etc.);
Lack of financial incentives and priorities in countries where priority setting in the health field focusses on building hospitals, delivering drugs, caring of people during the pandemic and focusing of health workforce rather than investing in eHealth to serve the sector in a more cost-effective manner. It is believed in many countries that ICT in health is costly and investing in this area might not be the priority and a cost saving measures. The organizational financial, logistic and legislative support coupled with changes in the workflow of patient care may have a real impact of acceptance of technology as more investment in time and resources is being provided;
Difficulty in using the ICT for health to provide the necessary support of patients. System operators and patients alike have a sense that technology has potential to improve and is not really doing what it is supposed to do. If that technology is a little bit more user-friendly it could have a better chance of penetration and utilization in the healthcare setting;
Lack of well-trained workforce to manage eHealth programmes and projects. Human resources include not only the technicians who should be trained to operate ICT services but also policy-makers, managers and the public at large. Literacy rate that limit acceptance of digital tools to help in managing health resources hampers the progress in this area;
ICT professionals are, to a great degree, are disconnected from healthcare professionals. They both work in silos which limits the understanding and disagreement in the common objectives of helping people to get access to and having better healthcare services. Cultural barriers that exists between the ICT professionals, ICT investors, developers, and practicing physicians do exist and limit the potential to make full use of ICT resources for health. The lack of time from the healthcare staff point of view limits the ability to give feedback and utilize the technology;
The culture of monitoring, evaluation, creation and use of evidence are missing. The absence of these put a lot doubt in the minds of policy-makers, funders and even the community to accept ICT in health applications. In fact, a number of studies were developed which some of them call for development of M&E frameworks while others call for building and using evidence for eHealth;
Seamless integration of technology is health systems at the higher level and the implementation level where, for example the electronic health record or the mobile health application is not an integral part of health services provision. The absence of integration creates silos and a sense this technology is being for the “elite”, for “testing” purposes, to comply with a donor wish or even “to enable data collection about patients for use in research and other purposes;
Sustainability of eHealth solutions where people get used to a service and then it is stopped as a result of shortage of funding, lack of enthusiasm by managers and lack of leadership and shortage of human resources to manage the investment. Lack of interest by people due to distrust and not meeting their expectations;
Data integration supported by interoperability standards is constraints that has been recognized not only by operators but also by patients. The question is why do operators have to fill in the same data more than once in the same healthcare facility? Why do patients have to provide even demographic information in multiple settings? More vicious than this the inability to share data about the same symptom with different codes being assigned to the same disease?
Ethical and legal constraints that hamper access to health information including privacy, confidentiality, data ownership and digital divide. The context in which eHealth is being implemented by individuals, communities and countries provides a better understanding of these constraints. Ethics and legal frameworks differ from one culture to the other making the accepted practices in one society not accepted in another which makes it more difficult to generalize among cultures. In their scoping study, James et al. [67] found that “Of greatest challenge to eHealth systems are ethico-legal factors, particularly privacy and research ethics concerns, such as informed and broad consent, secondary uses of data and return of results”. The WHO guidance on ethics and governance of AI [68] addressed three parties: Healthcare providers (Ministry of Health and others, the manufactures of AI solutions and the Universal Declaration of Human Rights [69] provides an excellent framework for countries to use as ethical principles are laid down, which strongly promote the concept of “All human beings are born free and equal in dignity and rights.” Privacy, confidentiality and personal information are all protected. Digital divide is persisting not only at global level as countries do have access to ICT resources, while others do not enjoy the same privileges. The same divide exists at the community level and at the gender level. All these issues have a serious impact of access to healthcare. One would not expect an individual or a community to have access to health resources if this person or community is deprived from basic human rights and suffers from a digital divide.
Over 85 countries have developed their national eHealth plans, strategies or policies [70]. It is noted that some of the these are for ICT in general and health is part of that. The toolkit provides a road map for eHealth applications development and services to enable secure, relevant and cost-effective utilization of ICT in health. The national eHealth strategies aim to help the healthcare sector to improve the health outcomes using the ICT resources at the national level while considering fundamental elements in terms of regulatory, governance, standards, human capacity, financing and policy contexts and more important it aims at ensuring coordinated effort by the two sectors: Health and ICT in the country to produce seamless integration of ICT in health sector. This integration results from defining the common threads and links between national health strategies and national ICT strategies, where coordination, compatibility and interoperability of national, sub-national and local plans are considered and the provision of a platform for integration and joint work to develop shared solutions and systems. The national eHealth strategy seeks high level of transparency, accountability and return on investment to allow for meager resources in a country to be fully used as it supports the rationale and basis for investment in eHealth by the different stakeholders. In most cases the Ministries of Health have a lead role in the development with ministries of ICT and other stakeholders taking part. Other stakeholders may include:
The community (patients and no-patients)
Healthcare providers in the private sector, non-government organizations and other healthcare providers;
Ministry of Information and Communication;
Departments of civil registration and national statistics;
Legislative bodies and legal authorities;
Ministry of Planning/Finance;
Academic institutions and research centers;
The relevant civil society organizations.
While countries should focus on a range of structured activities that lead to the progressive development of a national eHealth strategy, WHO and the International Telecommunication Union developed the National eHealth strategy toolkit [71] as a tool to be used y countries that already have strategies in place or those that have embarked on development of new strategies. The way forward as provided by the Toolkit suggests:
identifying the key health and non-health sector stakeholders who will need to be involved in the development of a national eHealth vision and plan and its subsequent implementation, and engaging with them;
establishing governance mechanisms to provide improved visibility, coordination and
control of eHealth activities;
establishing the strategic context for eHealth. This provides the foundation for the eHealth vision and plan, and enables the government to assess and make informed decisions on whether to pursue opportunities that present themselves from the ICT industry and other stakeholders;
assessing the current eHealth environment in terms of the eHealth components that already exist as well as existing programmes or projects that will deliver eHealth capabilities.
eHealth and digital health have been in use for many years. COVID-19 pandemic has accelerated the use of information and communication technology. Enabling access to healthcare during the pandemic has provided an opportunity not only to test the capabilities of health information systems and their delivery mechanisms but also to test their cost-effectiveness, efficiency, acceptance by healthcare providers and patients, compliance with international standards, interoperability and the ethical and legal principles that they use.
New innovations will continue to emerge and the healthcare sector will continue to make full use of these and has its own innovative approaches. All these innovations aim to support the health system to be more resilient and more capable of meeting the demands of people for more cost-effective and secure solutions. The dependence on data for policy development, decision-making and actions in the health sector will be strengthened as more data is being translated into information and knowledge for action.
We believe financial barriers should not prevent researchers from publishing their findings. With the need to make scientific research more publicly available and support the benefits of Open Access, more and more institutions and funders are dedicating resources to assist faculty members and researchers cover Open Access Publishing Fees (OAPFs). In addition, IntechOpen provides several further options presented below, all of which are available to researchers, and could secure the financing of your Open Access publication.
",metaTitle:"Waiver Policy",metaDescription:"We feel that financial barriers should never prevent researchers from publishing their research. With the need to make scientific research more publically available and support the benefits of Open Access, more institutions and funders have dedicated funds to assist their faculty members and researchers cover the APCs associated with publishing in Open Access. Below we have outlined several options available to secure financing for your Open Access publication.",metaKeywords:null,canonicalURL:"/page/waiver-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"At IntechOpen, the majority of OAPFs are paid by an Author’s institution or funding agency - Institutions (73%) vs. Authors (23%).
\\n\\nThe first step in obtaining funds for your Open Access publication begins with your institution or library. IntechOpen’s publishing standards align with most institutional funding programs. Our advice is to petition your institution for help in financing your Open Access publication.
\\n\\nHowever, as Open Access becomes a more commonly used publishing option for the dissemination of scientific and scholarly content, in addition to institutions, there are a growing number of funders who allow the use of grants for covering OA publication costs, or have established separate funds for the same purpose.
\\n\\nPlease consult our Open Access Funding page to explore some of these funding opportunities and learn more about how you could finance your IntechOpen publication. Keep in mind that this list is not definitive, and while we are constantly updating and informing our Authors of new funding opportunities, we recommend that you always check with your institution first.
\\n\\nFor Authors who are unable to obtain funding from their institution or research funding bodies and still need help in covering publication costs, IntechOpen offers the possibility of applying for a Waiver.
\\n\\nOur mission is to support Authors in publishing their research and making an impact within the scientific community. Currently, 14% of Authors receive full waivers and 6% receive partial waivers.
\\n\\nWhile providing support and advice to all our international Authors, waiver priority will be given to those Authors who reside in countries that are classified by the World Bank as low-income economies. In this way, we can help ensure that the scientific work being carried out can make an impact within the worldwide scientific community, no matter where an Author might live.
\\n\\nThe application process is open after your submitted manuscript has been accepted for publication. To apply, please fill out a Waiver Request Form and send it to your Author Service Manager. If you have an official letter from your university or institution showing that funds for your OA publication are unavailable, please attach that as well. The Waiver Request will normally be addressed within one week from the application date. All chapters that receive waivers or partial waivers will be designated as such online.
\\n\\nDownload Waiver Request Form
\\n\\nFeel free to contact us at funders@intechopen.com if you have any questions about Funding options or our Waiver program. If you have already begun the process and require further assistance, please contact your Author Service Manager, who is there to assist you!
\\n\\nNote: All data represented above was collected by IntechOpen from 2013 to 2017.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'At IntechOpen, the majority of OAPFs are paid by an Author’s institution or funding agency - Institutions (73%) vs. Authors (23%).
\n\nThe first step in obtaining funds for your Open Access publication begins with your institution or library. IntechOpen’s publishing standards align with most institutional funding programs. Our advice is to petition your institution for help in financing your Open Access publication.
\n\nHowever, as Open Access becomes a more commonly used publishing option for the dissemination of scientific and scholarly content, in addition to institutions, there are a growing number of funders who allow the use of grants for covering OA publication costs, or have established separate funds for the same purpose.
\n\nPlease consult our Open Access Funding page to explore some of these funding opportunities and learn more about how you could finance your IntechOpen publication. Keep in mind that this list is not definitive, and while we are constantly updating and informing our Authors of new funding opportunities, we recommend that you always check with your institution first.
\n\nFor Authors who are unable to obtain funding from their institution or research funding bodies and still need help in covering publication costs, IntechOpen offers the possibility of applying for a Waiver.
\n\nOur mission is to support Authors in publishing their research and making an impact within the scientific community. Currently, 14% of Authors receive full waivers and 6% receive partial waivers.
\n\nWhile providing support and advice to all our international Authors, waiver priority will be given to those Authors who reside in countries that are classified by the World Bank as low-income economies. In this way, we can help ensure that the scientific work being carried out can make an impact within the worldwide scientific community, no matter where an Author might live.
\n\nThe application process is open after your submitted manuscript has been accepted for publication. To apply, please fill out a Waiver Request Form and send it to your Author Service Manager. If you have an official letter from your university or institution showing that funds for your OA publication are unavailable, please attach that as well. The Waiver Request will normally be addressed within one week from the application date. All chapters that receive waivers or partial waivers will be designated as such online.
\n\nDownload Waiver Request Form
\n\nFeel free to contact us at funders@intechopen.com if you have any questions about Funding options or our Waiver program. If you have already begun the process and require further assistance, please contact your Author Service Manager, who is there to assist you!
\n\nNote: All data represented above was collected by IntechOpen from 2013 to 2017.
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