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Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010
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Large Scale Capacity Development in eHealth - WHO, Geneva, Sept 2010

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  • 1. Large  Scale  Capacity  Development  in  eHealth    Addressing workforce development through global partnerships   Presentation at the High Level Working Session on the Development of economic Models and Metrics for eHealth in Support of the Health-related Millennium Development Goals Arletty Pinel, MD Director, eHealth and Telemedicine - iCarnegie Geneva, 6 September 2010 apinel@icarnegie.com 1  
  • 2. Agenda  •  eHealth  for  Health  Sector  Strengthening   (HSS)   –   Educa?on  and  workforce  development  as   an  integral  part  •  Leveraging  exper?se  Globally:  iCarnegie  •  Leveraging  exper?se  Globally:  Brazil  9-­‐novi-­‐11   2  
  • 3. Agenda  ü eHealth  for  Health  Sector  Strengthening   (HSS)   – Educa?on  and  workforce  development  as   an  integral  part  •  Leveraging  exper?se  Globally:  iCarnegie  •  Leveraging  exper?se  Globally:  Brazil  9-­‐novi-­‐11   3  
  • 4. eHealth:  Key  issues  •  eHealth  has  poten?al  for  HSS  but  qualified   workforce  poses  addi?onal  strain  to  system  •  Challenges  will  increase  before  solu?ons  arise    •  Innova?on  for  large  scale  training  of  ICT  and   health  workforce  needed  for  cost-­‐effec?ve   eHealth  implementa?on  •  HSS  for  equitable  health  delivery  and  South-­‐ South  and  triangular  coopera?on  at  core  9-­‐novi-­‐11   4  
  • 5. Common  Themes  •  Shortage  of  skilled  workforce  •  Shortage  of  teachers  and/or  educa?onal   content  •  Desire  by  governments  to  invest  in  workforce   development  •  Realiza?on  that  this  can  only  be  met  through   educa?on  9-­‐novi-­‐11   5  
  • 6. What  is  needed?  •  Public-­‐Social-­‐Private-­‐Partnerships  (PSPPs)  at   different  levels  (from  local  to  regional  to  global)    •  Strategic  plan  constructed  in  a  par?cipatory   fashion  with  key  stakeholders  in  eHealth/ICTD  •  Mul?professional  team  to  develop  content  and   design  appropriate  learning  plaVorm  •  Exis?ng  ini?a?ves  from  which  to  build  •  Boldness  and  crea?vity  to  promote  a  paradigm   shiW  on  delivery  of  capacity  development    •  Inspired  individuals  and  commiXed  ins?tu?ons    9-­‐novi-­‐11  
  • 7. Global  South  •  Start  locally  but  secure  globally:     –  Value  developing  and  transi?onal  countries’     priori?es,  applied  knowledge  and  crea?ve   solu?ons   –  Match  with  specific  know-­‐how  to  create  high   quality  products  9-­‐novi-­‐11  
  • 8. Team  and  pla<orm  •  Credibility  of  the  ini?a?ve  requires  a  top-­‐class   mul?professional  and  mul?cultural  team  as  well  as   a  tailor-­‐made  learning  plaVorm    •  Appropriateness  of  the  approach  needs  to  consider   disparate  educa?onal  levels,  learning  processes   and  styles  of  applying  knowledge  •  Strength  of  the  product  is  key  to  overcome  skep?cs    9-­‐novi-­‐11  
  • 9. Agenda  •  eHealth  for  Health  Sector  Strengthening   (HSS)   –   Educa?on  and  workforce  development  as   an  integral  part  ü Leveraging  exper?se  Globally:  iCarnegie  •  Leveraging  exper?se  Globally:  Brazil  9-­‐novi-­‐11   9  
  • 10. Mission  9-­‐novi-­‐11   10  
  • 11. Approach   FoundaAonal   SoC  Skills     Experience   Knowledge   &   Accelerator     CommunicaAons   Projects   Problem  Solving,  Learn  by  Doing,  Outcome  Based  and   Profession  Focused  9-­‐novi-­‐11   11  
  • 12. How  Are  We  Different?  EducaAonal  Content  /  InstrucAonal  Quality   Harvard   iCarnegie   MIT   Stanford   LEGO   Berkeley   Yahoo   Cisco  Entrepreneurial   RoseXa  Stone   Ins?tute   eCornell   Public  Universi?es   Learning  Tree   NGOs   Industry  Training   SENA   Trade  Schools   NIIT   Local  Community  Colleges   9-­‐novi-­‐11   Scale   12  
  • 13. Global  Partnerships  9-­‐novi-­‐11   13  
  • 14. Global  Presence    11/9/11  9-­‐novi-­‐11   ©  iCarnegie  Inc  –  NOT  FOR  DISTRIBUTION   14  
  • 15. Skills  Transfer  •  Learning  needs  context  •  eLearning  is  a  complement;  nothing   subs?tutes  face-­‐to-­‐face  interac?on  •  Teaching  can  be  relevant  without  sacrificing   quality  •  Access  relies  on  local  delivery,  local  languages   and  local  costs  9-­‐novi-­‐11  
  • 16. China  •  China,  City  government  of   Wuxi   –  iCarnegie  Center  for  IT   professionals,  Wuxi  China   –  Training  center  for  5000   students  in  SoWware  and  web   development   –  Focused  on  academic  and   professional  educa?on  for  the   Chinese  Outsourcing  industry  9-­‐novi-­‐11   16  
  • 17. Colombia  •  SENA   –  Training  40,000  people  yearly  in  ICT  (but   not  geing  hired)   –  Large  scale  2500  hrs  programs  in  soWware   development,  soWware  engineering,  game   development  and  informa?on  systems  •  Min  of  EducaAon   –  Middle-­‐school/High-­‐school  STEM  using   Robo?cs  •  Min  of  Commerce   –  Human  Capital  Development  Programs   and  Industrial  ‘Competency’  commiXees  9-­‐novi-­‐11   17  
  • 18. India  •  B-­‐Tech/M-­‐Tech  aren’t   producing  needed  talent  •  Industry  creates  ‘bridge   courses’,  ‘finishing  schools’  and   expensive  campuses  to  train   new-­‐hires  •  iCarnegie  looking  at  increasing   quality  of  formal  training     9-­‐novi-­‐11   18  
  • 19. Kazakhstan  •  Government  of  Kazakhstan   –  Large  investments  in  overseas   educa?on  •  Crea?ng  a  world  class  mul?versity   in  Astana  to  develop  the  research   and  management  talent  for  the   country  •  iCarnegie  developing  academic   and  professional  based  cer?ficate     programs  (e.g.,  soWware   engineering,  IT  management)  9-­‐novi-­‐11   19  
  • 20. Timeline   •  Assessment   6  Months   •  Vision  (where  we   •  Instructor  Training   want  to  go)   •  Program   •  Course  delivery     •  Gap  Analysis   development   •  Course  Evalua?on   (where  we  are   •  Industry  involvement   •  Enhancements  and   currently)   •  Integra?on  and   process   Customiza?on   improvement   3  Months       4  years  11/9/11  9-­‐novi-­‐11   ©  iCarnegie  Inc  –  NOT  FOR  DISTRIBUTION   20  
  • 21. Agenda  •  eHealth  for  Health  Sector  Strengthening   (HSS)   –   Educa?on  and  workforce  development  as   an  integral  part  •  Leveraging  exper?se  Globally:  iCarnegie  ü Leveraging  exper?se  Globally:  Brazil  9-­‐novi-­‐11   21  
  • 22. Brazil  Telehealth   Acknowledgement Ana Estela Haddad (Ministry of Health) and Beatriz de Faria Leão9-­‐novi-­‐11  
  • 23. Brazil  • Population: 190,000,000• States:26 + 1 FederalDistrict• Municipalities: 5,563 (40%in metropolitan areas)• 220 native ethnicities(0,2% of the population)• 185 languages 9-­‐novi-­‐11  
  • 24. Unified  Health  System  •  The  Unified  Health  System  (Sistema  Único  em   Saúde  –  SUS)  has  the  following  principles:     –   Universal  Care   –   Equitable  Care   –   Comprehensive  Care   –   Unified  Care   –   Regionalized  Services  Network   –   Social  Par?cipa?on    9-­‐novi-­‐11  
  • 25. Primary  Health  Care   •  Family  Health  Strategy   –  started  in  1994   –  Family  health  team  (FHT):    1  Medical  Doctor  (MD),   1  Registered  Nurse  (RN),  1  Den?st   –   2  technical-­‐degree  nurses  and  4  to  6  Community  •  Health  Workers   –   30.000  FHT  covering  90  million  people  in  60%  of   the  Brazilian  municipali?es   –   major  impact    in  the  reduc?on  of  children   mortality  in  the  last  decade   9-­‐novi-­‐11  
  • 26. Family  Health  Strategy   19985% coverage FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind 9-­‐novi-­‐11  
  • 27. Family  Health  Strategy   200990% coverage FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind9-­‐novi-­‐11  
  • 28. Brazilian  Telehealth   Brazil Telehealth Program - remote assistance and continuing education Pilot Project: 9 states and 900 points www.telessaudebrasil.org.br Open University of Unified Health System - provides in-service training for thousands of health care providers www.universidadeabertadosus.org.br Telemedicine University Network - RUTE, initially about 80 University Hospitals in collaborative research and education across all federal states – http://rute.rnp.br9-­‐novi-­‐11  
  • 29. Telehealth  Program   Coverage: 9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants9-­‐novi-­‐11  
  • 30. Telehealth  Program   Coverage: 9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants Expansion states (3 + Federal District) Priority: Northeast region and Brazilian Amazon9-­‐novi-­‐11  
  • 31. Telehealth  Program   9 Centers – June 2010 1.209 Points 890 Municipalities 5.900 Family Health Teams 17.786 Formative Second Opinion 14.302 Complementary Exams9-­‐novi-­‐11  
  • 32. Telehealth  Program   A Telehealth point of care A Telehealth Center R$ 2.800,00 (±US$1,400) R$ 200.000,00 ((±US$100,000)9-­‐novi-­‐11  
  • 33. MoH  investments   1º  Phase  2007  –  2008     2º  Phase  2009  –  2010     R$  14.831.778,35   R$  21.830.720,00   US$  7  M   US$  11  M   Total:  R$  36.662.498,35  (±US$  18,400,000)  9-­‐novi-­‐11  
  • 34. Maintenance  costs   Maintenance  costs  of  Human  Resources  by     center/month  for  100  points  of  Telehealth   R$  29.560,00  (±US$15,000)   Maintenance  of  teleconsultants  of  a  center/month  for  100   points  of  Telehealth   R$  31.560,00  (±US$15,500)  9-­‐novi-­‐11  
  • 35. Savings  •  Evalua?on  of  33  pilot  municipali?es  at  North  and   Northeast  of  Minas  Gerais:   –  Referral  costs  in    Primary  Health  Care  were    8x  more   expensive  than  Second  Opinion  offered  by  TeleHealth.   –  Savings  was  about  5  referrals/municipali?es/month;   avoiding  1.5%  of  referrals  is  enough  to  cover  telehealth   costs  9-­‐novi-­‐11  
  • 36. Workforce  retenAon   Low importance No important 2% 4%Minas Gerais – ClinicalHospital: survey with 105 Mediumprofessionals of PHT from 32 27% Importantmunicipalities: 67%67% of the respondents felt thataccess to training at theworkplace was a major factor into stay in their hometowns 9-­‐novi-­‐11  
  • 37. SIGA  Saúde   City  of  São  Paulo’s  Health   InformaAon  System     Acknowledgement Heloisa Helena Andreetta Corral, Maria Aparecida Orsini (Director Paulistana Mother Program) and Beatriz de Faria Leão9-­‐novi-­‐11  
  • 38. SIGA  Saúde   São Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area. SIGA  Saúde  is  the  city  of  São  Paulo’s   Integrated  and  Distributed  System  for   Managing  the  Public  Healthcare  System.   The  system  belongs  to  the  city  of  São   Paulo,  which  is  willing  to  share  it  with   SIGA Saúde is present in 100% (704) of other  ci?es,  states  and  countries.     theSIGA  Saúde  has  bPaulo’spublic health care providers city of São een   developed  using   free-­‐soWware  open-­‐code  concepts.  9-­‐novi-­‐11  
  • 39. SIGA  IT  model   Management SMS-SP (Surveillance, Auditing and Billing) Dept of Health Internet Patient Flow Organization & Mngmnt (Specialties, Beds, Exams) Electronic Health Record Access Control SP City Datacenter9-­‐novi-­‐11  
  • 40. Paulistana  Mother  •  Program    created  by  the  city  of  São  Paulo’s   Health  authority  in  2006,  that  extended  the  SUS   Maternal  Health  Program.  •  The  Paulistana  Mother  is  an  integrated  program     to  assist  and  monitor  ALL  pregnant  women  of   the  city  of  São  Paulo.       9-­‐novi-­‐11  
  • 41. We’re going to keep calling you until the name of your baby is in our list…9-­‐novi-­‐11   Source: Diario de São Paulo, July 25th Pg. 53
  • 42. Paulistana  Mother  The  program:  •   Monitors  all  pregnancies  within  the  public  system,  •   Establishes  the  referrals  to  hospitals  and  emergencies,     –  High  risk  pregnancies  ate  treated  separately  by  special  alerts   in  the  system  •  Guarantees  bed  alloca?on  for  deliveries  •  Follows  up  mother  and  child  un?l  the  baby  is  one  year  old  •  Recharge  of  the  transport  card  at  each  prenatal  visit  •  Provides  counseling  on  breast  feeding  and  baby  care  •  Mother  receives  a  full  bag  with  products  for  the  baby  at  delivery  9-­‐novi-­‐11  
  • 43. Results  •  Free  access  to  all  pregnant  women  •  Registra?on  done  in  any  of  the  409  primary  care   units  •  36  hospitals    •  25  specialized  outpa?ents  clinics  •  80,000  pa?ents  in  program  •  10,000  deliveries  /  month  •  74%  of  paAentes  with  7  or  more  prenatal   consultaAons  9-­‐novi-­‐11  
  • 44. EVOLUÇÃO DOS COEFICIENTES* DE MORTALIDADE INFANTIL NO MUNICÍPIO DE SÃO PAULO, 1980 A 2008. ANO 1980 1990 2000 2002 2004 2006 2007 2008 COEFICIENTES MORT. INFANTIL GERAL 50,62 30,90 15,80 15,10 13,96 12,86 12,54 11,99 MORT. INF. POS-NEONATAL 25,31 11,87 5,49 4,97 4,73 4,59 4,36 4,00 MORT. NEONATAL TOTAL 25,31 19,03 10,30 10,13 9,23 8,27 8,18 7,98 MORT. NEONATAL PRECOCE 18,29 15,36 7,70 7,27 6,31 5,74 5,46 5,60 MORT. NEONATAL TARDIA 7,03 3,67 2,60 2,86 2,91 2,53 2,72 2,38 MORT. PERINATAL 30,46 23,80 17,41 16,51 14,00 12,60 11,67 12,72 NATIMORTALIDADE 12,40 8,57 9,78 9,31 7,73 6,90 6,24 7,16 TAXA DE NATALIDADE** 28,23 20,71 19,90 17,56 17,19 16,07 15,77 15,89 NASCIDOS VIVOS 239.262 196.985 207.462 185.417 183.883 173.901 171.602 173.799 FONTE: Fundação Sistema Estadual de Análise de Dados (SEADE). * Coeficiente por 1.000 nascidos vivos (NV). **Por mil habitantes9-­‐novi-­‐11  
  • 45. SIGA’s  evaluaAon  9-­‐novi-­‐11   http://vitalwaveresearch.com/healthit/
  • 46. SIGA evaluation9-­‐novi-­‐11  
  • 47. Ana Estela Haddad aehaddad@gmail.com Heloisa Helena Andreetta Corral hcorral@PREFEITURA.SP.GOV.BR Maria Aparecida Orsini Maria.aparecida@uol.com.br Beatriz de Faria Leão bfleao@gmail.com9-­‐novi-­‐11  
  • 48. Paradigm  shiC  •  Boldness  and  innova?on  (technological,  human,   social)  at  core  of  the  ini?a?ve:  it’s  a  transforma?onal   process      •  Poten?al  goes  beyond  developing  a  product  to  work   towards  a  paradigm  shiW  in  capacity  development   using  eHealth  and  ICTD  as  an  entry  point    •  No  quick  fixes:  investment  in  educa?on  takes  ?me  9-­‐novi-­‐11  
  • 49. Thank  you.   Ques?ons?  11/9/11  9-­‐novi-­‐11   49  

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