Improving health in developing countries: what can FOSS contribute? - - PowerPoint PPT Presentation
Improving health in developing countries: what can FOSS contribute? Prof. S. Yunkap Kwankam Executive Director, International Society for Telemedicine and eHealth (ISfTeH) CEO, Global eHealth Consultants, Switzerland IWEEE Las Palmas, de
Improving health in developing countries: what can FOSS contribute?
Executive Director, International Society for Telemedicine and eHealth (ISfTeH) CEO, Global eHealth Consultants, Switzerland
IWEEE Las Palmas, de Gran Canaria, Spain – February 10-12, 2010
ISfTeH – NGO in official relations with WHO 32 national societies
Health – a multi-sectorial production Where can ICT contribute? WHO eHealth priority actions areas
Mobile devices in health Organizing the eHealth profession Final thoughts – RF initiative
What produces health? Where can we bring ICT to bear on this production?
Adapted from World Bank
Focus of health investment should be on improving sector productivity, cannot just increase funding
The most effective way to improve productivity is to improve health systems
Source: Nicholas C. Petris Center on Health Care Markets & Consumer Welfare (UC Berkeley), WHO, A Handbook of Cultural Economics (James Heilbrun)
Level of HC spending is a function of GDP/capita regardless of external funding Level of HC spending is a function of GDP/capita regardless of external funding
Health spend per capita (2005) GDP PPP per capita (2005)
10 100 1000 10000 100 1000 10000 100000
R2 = 0.94
What produces health? Where can we bring ICT to bear on this production? Overwhelming focus on health care T
health:
Some ICT effort in the area of education
WHO Commission report
q Improve daily living
conditions
q T
ackle the inevitable distribution of power, wealth and resources
q Measure and
understand the
Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age. Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally
INDICATORS
q T
elephone lines per 100 population
q Internet users per 100
population
q Cellular subscribers per
100 population
Target 18: In cooperation with the private sector, make available the benefits of new technologies, especially information and communications. Global Partnership for Development
Health Education Agriculture Small business Good governance
Promote, in underserved areas, the combined development of :
Maintenance Small adaptations Cell phone charging Data collection Other services
Application areas : Examples : Ghana SIM cards ICT equivalent of William Kamkwamba, Malawian
Easy access to entitlements Information agents
Application areas : Examples :
Pakistan – health care benefits Morocco – village tele- center information agents
eHealth priority action areas identified by WHO
Access to health information
HINARI
Legal and ethical issues ICT for service delivery PPP for ICT R&D for health Intelligence on eHealth
Global eHealth survey 2005
Norms and standards
SNOME D TCP XML HL7 v2.51 IP HTTP
ICT for health promotion ICT for health workforce development
WHR 2006 eLearning Kenya
ICT and Health: a symbiotic relationship
Health needs drive development s in ICT Development s in ICT help shape health systems and service delivery Health promotion Disease prevention Diagnosis & treatment Rehabilitative care Education & training HS performance
Bioinformatics Artificial Intelligence Miniaturization Improved access Wider coverage
Countries with a critical shortage of health service providers (doctors, nurses
and midwives)
Distribution of health workers by level of health expenditure and burden of disease, by WHO region
eLearning easing healthcare HR crisis in Kenya
In Kenya, chronic shortage of highly skilled nurses In Kenya, chronic shortage of highly skilled nurses Enrolled Nurses (ENs) comprise 70% of nursing and 45% of the health workforce in Kenya
communities, but are inadequately skilled to manage new and re- emerging diseases like HIV/AIDS PPP led by the Nursing Council
Medical and Research Foundation (AMREF) and Accenture to upgrade 22,000 ENs from ‘enrolled’ to ‘registered’ level within 5 years via eLearning (distance education through ICT) methods Promising progress since start of program in Sep. 2005 Promising progress since start of program in Sep. 2005 As of Nov. 2006, 3,265 nurses upgraded 27 colleges and schools participating including AMREF’s Virtual Nursing School Over 100 computer-equipped training centers set up in 8 provinces, including remote and marginalized districts eLearning can reach goal w/in next decade versus >200 years w/ traditional classroom methods eLearning can reach goal w/in next decade versus >200 years w/ traditional classroom methods
5 10 15 20 25 2005 2007 2009 2011 2013 2015 2225
(K)
upgraded/yr
22,000 ENs to upgrade
upgraded/yr
$50M
eLearning vs. traditional methods for upgrading ENs
Traditional classroom method eLearning
Results do not just represent dramatic cost and time improvements
Source: Source: WHO, AMREF website
Daniel Masys, 2001
Knowledge Knowledge-
coupling system
PROBLEM
Body of scientific knowledge
Problem- specific filter Decision
Action SELECTION Options Relevant knowledge
Problem characteristics
Today decision support tools such as Medoctor support diagnosis with robust algorithms for differential diagnosis
q A web-based visual
representation of evidence-based patient care journeys
q q Covers 28 medical
specialties
q q Contains 393 pathways q q Used to support
clinicians; not to replace clinical judgement
Mobile devices integrate
q Communications q Computing q Media
Conceptually compelling – rather than constrain user to take their problem to where technology exists, make technology available wherever the need is.
Significant penetration in Latin America and select Sub-Saharan African countries
0 - 50 50 - 100 100 -150 150 -200 200+ No data available
Internet users (per 1,000 people)
Note: Data taken from 2005 Source: World Bank WDI
Significant penetration in Latin America and select Sub-Saharan African countries
0 - 50 50 - 100 100 -150 150 -200 200+ No data available
Personal computers (per 1,000 people)
Note: Data taken from 2001-2005, depending on availability for each country Source: World Bank WDI
Mobile phones widely diffused beyond developed countries to many countries “Global South”
0 - 50 50 - 100 100 -150 150 -200 200+ No data available
Mobile phone subscribers (per 1,000 people)
Source: ITU World Telecomm unication indicators database
l 30 RC volunteers trained l 2400 surveys in 3 days l 200 for pen and paper system l Survey report to MoH same day after
synchronized with PC for data transfer
programmed on Palm Pilot
collection with handheld unit
and production
HealthMapper
A trial of the Mobile Map in 2007 had already proved very popular with Kijabe Hospital Kenya The Map of Medicine
recommended by participants in the Kenya pilot
RapidSMS is an information tracking tool that
collects data over “SMS” or “T ext Messages” from mobile users
RapidSMS allows data to be collected in real
time to enable LGA, State, Federal, and partners to collect, analyze, and react to data more quickly.
Slide by Emmanuel Onyefunafoa
RapidSMS has
been used in:
States
Slide by Emmanuel Onyefunafoa
mHealth – Mobile Communication for Health
ECOSOC Africa Regional Ministerial Meeting on eHealth
Claire Thwaites 11 June 09
mHealth for Development Report The report is one of the most extensive surveys of the use of mobile technology to advance public health in the developing world, with over 50 examples of projects providing health- related services via mobile technology. Found at: www.unfoundation.org/vodafone
Slide by Claire Thwaites
Broad Array of mHealth Applications
Education & Awareness
SMS/text messaging in support of public health and behavioral change campaigns.
Remote Data Collection
Applications using mobile devices to collect real-time patient data,
Remote Monitoring
Maintain care giver appointments
adherence via one-way or two- way communication on mobile devices.
Disease & Epidemic Outbreak Tracking
Use mobile devices to send and receive data on disease incidence, outbreaks and public health emergencies.
Diagnostic & Treatment Support
Use the mobile phone as point-of- care device.
Programs by Application Area Communication & Training For Health Care Workers
Connect health workers with sources of information via mobile technology.
Slide by Claire Thwaites
Extending data networks to include people
Early detection and response of emerging diseases can prevent potential epidemic spread
Source: WHO World Health Report 2007
A general model for disease emergence and spread A general model for disease emergence and spread
“This could be the stethoscope of the 21st century”
Jeffrey Immelt, CEO GE
To be marketed early 2010 Builds on: qminiaturization techniques qlaptop-sized interfaces qfour-dimensional ultrasound
GE Vscan – phone-sized ultrasound
Service delivery Financing SYSTEM BUILDING BLOCKS GOALS OF THE HEALTH SYSTEM
Health
Financial protection Responsiveness Information Medical products, technologies Health workforce Leadership / governance
Building blocks combine to meet health system goals
Coverage Provider performance
Quality, safety, efficiency
Equitable distribution Service delivery Financing SYSTEM BUILDING BLOCKS GOALS OF THE HEALTH SYSTEM
Health
Financial protection Responsiveness Information Medical products, technologies Health workforce Leadership / governance
Building blocks combine to meet health system goals
Coverage Provider performance
Quality, safety, efficiency
Equitable distribution Service delivery Financing SYSTEM BUILDING BLOCKS GOALS OF THE HEALTH SYSTEM
Health
Financial protection Responsiveness Information Medical products, technologies Health workforce Leadership / governance
Building blocks combine to meet health system goals
Coverage Provider performance
Quality, safety, efficiency
Equitable distribution Service delivery Service delivery Financing Financing SYSTEM BUILDING BLOCKS GOALS OF THE HEALTH SYSTEM
Health Health
Financial protection Financial protection Responsiveness Responsiveness Information Medical products, technologies Health workforce Leadership / governance Leadership / governance
Building blocks combine to meet health system goals
Coverage Provider performance
Quality, safety, efficiency
Equitable distribution
Satellite connection in Pakistan near a rural health care center – courtesy of WHO
A Canadian TeleCare pilot project (Credits: March Networks Corporation) First integrated circuit and modern day IC.
A stylized replica of the first transistor
SPIDER workshop March 30-31, Stockholm eHealth Corps eHealth Steering Committee eHealth Center/Network of Excellence - Resource Ctr
National eHealth Council
N a t i o n a l e H e a l t h S o c i e t y
SPIDER workshop March 30-31, Stockholm
Health professionals ePractitioners eHealth savvy citizens The public e H e a l t h C o r p s Advocacy Awareness Training Information
Develop and promote a global eHealth agenda - strategies to address common policy, organizational, technical, legal, financing and sustainability challenges identified through conference track and keynote sessions; Promote the importance of interoperability and open, standards- based platforms to donors, countries and technology companies Catalyze the formation of new collaborations around thematic areas and explore establishment of national platforms and a self-sustaining global eHealth coalition.
Summer Bellagio series July 14-Aug 8, 2008
World eHealth Collaborative Action Network
Project level Component System level
Collaboration at various levels
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