Who Ehealth Strategy


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  • I find this strategy almost impossible to understand and some is unintelligible. Is there a coherent overview available? . Difficult to see how ehealth fits into HS needs -let alone components such as mHealth which though having a huge potential remains confused in mHealth alliance and WHO papers to date. Where is there an attempt to summarise the global requirements and see where the technologies can contribute. For example it is recognized that health promotion and primary disease prevention must be the priority for developing nations merely attempting to treat disease is not an option -thus western style services treating diseases after their onset is futile and irresponsible< there are ways of doing this which does not yet appear in ehealth or mHealth policies
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  • All professionals very well know and realize that exponential growth of medical data bases ; which e caused a great limitations in its full utilization through mind and memory applications alone ,there is urgency of deploying ICT/eHeath technologies for knowledge control , deployment ,interactive utilization for justified performance . All benefits of available knowledge must reach humanity . eHealth Support systems are no replacement of human intelligence and human touch.we can ill afford to be complacent . inventor of global diseases interactive software (Indian Patent Winner ) REGARDS drscgarg@sarrclinicsoft.com
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Who Ehealth Strategy

  1. 1. WHO eHealth initiatives: addressing priority challenges in health systems S. Yunkap Kwankam Coordinator eHealth World Health Organization, Geneva eHealth Med-e-Tel 2008 Luxembourg
  2. 2. Outline of presentation The WHO six point agenda Priority challenges in health systems The Africa Health Infoway The RF global initiative on eHealth Conclusion eHealth Med-e-Tel 2008 Luxembourg
  3. 3. WHO has a six point agenda for addressing gaps and improving public health Goal Description Accelerate Bring to life-saving and health-promoting interventions to the poorest of 1 development the poor Fundamental health needs Foster health Improve health security for all especially as it relates to emerging and 2 security epidemic-prone diseases Strengthen health Focus on capacity building, financing, systems for collecting vital 3 systems statistics, and access to appropriate technology including drugs Strategic needs Harness research, Generate authoritative health info, define standards, articulate evidence- 4 info & evidence based policy options & monitor evolving global heath situation Enhance Build partnerships with UN agencies and other international 5 partnerships organizations, donors, civil society and the private sector Operational approaches Improve Continually improve effectiveness of WHO initiatives and staff 6 performance Overall effectiveness of effort measured by impact on women’s health and health in Africa eHealth Med-e-Tel 2008 Luxembourg
  4. 4. Health systems in Africa are especially weak Births attended by skilled health personnel1 One-year-olds immunized with DTP32 % 93.3 % 93.4 93.8 88.0 100 80.9 83.5 100 83.3 80 80 68.2 66.1 58.0 60 46.5 50.9 60 40 40 20 20 0 0 AFRO AMRO EMRO EURO SEARO WPRO AFRO AMRO EMRO EURO SEARO WPRO Infant mortality rate3 Maternal mortality ratio4 Deaths per 1K live births Deaths per 100K live births 93.9 100 1000 865.4 80 60.1 800 60 50.0 600 447.6 396.4 40 21.2 400 17.5 12.4 119.6 20 200 33.8 67.8 0 0 AFRO AMRO EMRO EURO SEARO WPRO AFRO AMRO EMRO EURO SEARO WPRO More so than any other region, Africa needs to invest in its health systems eHealth Med-e-Tel 2008 Luxembourg 1. Latest year data between 1998-2006 2. Latest year data between 2004-2005 3. Latest year data 2004 4. Latest year data 2005 Source: WHO Core Health Indicators Database
  5. 5. As threats to global public health mount, stronger country- and district-level surveillance and reporting needed Threats to global public health security: • Smallpox Selected emerging and re-emerging infectious diseases: 1996–2004 • Poliomyelitis caused by a wild-type poliovirus • Human influenza caused by a new virus subtype (e.g. avian flu) • SARS Diseases of documented, but not inevitable, international impact, e.g.: • Cholera • Pneumonic plague • Yellow fever • Viral haemorrhagic fevers (Ebola, Lassa and Marburg) • West Nile fever Drug resistance in existing threats: • Tuberculosis • Diarrhoeal diseases • Hospital-acquired infections • Malaria • Meningitis • Respiratory tract infections • Sexually transmitted infections • HIV/AIDS eHealth Source: WHO World Health Report 2007 Med-e-Tel 2008 Luxembourg
  6. 6. Other infectious disease outbreaks have incurred massive economic costs to countries This economic cost is particularly difficult for poorer countries to bear eHealth Med-e-Tel 2008 Luxembourg
  7. 7. In the past, weak health systems have failed to stem rapid emergence and spread of disease Example: Failure to detect and curb spread of HIV/AIDS early on has led to massive human and financial costs eHealth Source: WHO World Health Report 2007 Med-e-Tel 2008 Luxembourg
  8. 8. Sub-Saharan Africa eHealth Med-e-Tel 2008 Luxembourg
  9. 9. Focus of health investment should be on improving sector productivity, cannot just increase funding Level of HC spending is a function of Healthcare is an inefficient sector, can GDP/capita regardless of external funding improve productivity through technology 10000 Baumol's cost disease: Labor intensive R2 = 0.94 services, such as health care, face Health spend per capita (2005) productivity lag - cannot substitute capital for labor as efficiently as the general 1000 economy, so the cost of producing them goes up faster than general inflation 100 5 ways to improve productivity: 1) Increase capital per worker 10 2) Improved technology 100 1000 10000 100000 3) Increased labor skill GDP PPP per capita (2005) 4) Better management Source: Nicholas C. Petris Center on Health Care Markets & Consumer Welfare (UC Berkeley), WHO, A Handbook of Cultural 5) Economies of scale as output rises Economics (James Heilbrun) The most effective way to improve productivity is to improve health systems eHealth Med-e-Tel 2008 Luxembourg
  10. 10. Effectiveness of health spending widely variable Health outcomes not tightly linked to income level Log GDP/Capita (PPP) vs Childhood (<5) Mortality 300 Childhood (<5) Mortality (per 1000) 250 200 Rwanda Cote d'Ivoire Countries with similar profiles with 150 very different health outcomes Togo Kenya 100 R2 = 0.60 50 0 100 1000 10000 100000 GDP PPP per capita (2005) Variation in health outcomes highlights considerable room for improvement of inefficient and ineffective health systems Source: WHO eHealth Med-e-Tel 2008 Luxembourg
  11. 11. Countries with a critical shortage of health service providers (doctors, nurses and midwives) eHealth Med-e-Tel 2008 Luxembourg
  12. 12. Distribution of health workers by level of health expenditure and burden of disease, by WHO region eHealth Med-e-Tel 2008 Luxembourg
  13. 13. Challenges of scaling the health workforce in Africa Assuming 20 years to scale up workforce Need to train 2.8 million (140 thousand/year) 77 thousand trained/country 3,800 workers per year for 20 years 10 workers per day! Current estimates of training output for Africa range from 10% to 30% of what's needed Costs of scale-up – training and salaries – adds about $10/capita minimum to health spending by year 2025. eHealth Med-e-Tel 2008 Luxembourg
  14. 14. Africa Health Infoway is a vital part of WHO’s eHealth effort The Africa Health Infoway (AHI) is district-based public health information network for African health It is an investment in health systems to: – support the collection of sub national health data and statistics for analysis, dissemination and use to support decision making in Health – strengthen capacity of African countries to use information in decision making This will include: – data for epidemiological research – indicators for monitoring and evaluation – financial and cost reporting for clinic management – drug, equipment, supply stock reporting for supply management eHealth Med-e-Tel 2008 Luxembourg
  15. 15. Interoperable HIS in countries with data communicated and merged across several dimensions Across district mediated initiatives Across geographies Surveys Registration Registration • Homes and and • Facility census census • District Disease Health surveillance service Across programs statistics Census Malaria TB HIV/AIDS Across points of care Across technologies Hospital Health clinic Community health worker eHealth Med-e-Tel 2008 Luxembourg
  16. 16. 2 eLearning easing healthcare HR crisis in Kenya eLearning can reach goal w/in next In Kenya, chronic shortage of Promising progress since start of decade versus >200 years w/ highly skilled nurses program in Sep. 2005 traditional classroom methods Enrolled Nurses (ENs) comprise eLearning vs. traditional methods 70% of nursing and 45% of the for upgrading ENs health workforce in Kenya • First point of contact for (K) 25 communities, but are 22,000 ENs to upgrade inadequately skilled to manage 20 new and re-emerging diseases like HIV/AIDS 15 PPP led by the Nursing Council of As of Nov. 2006, 3,265 nurses • ~2,800 ENs Kenya (NCK), the African Medical upgraded/yr upgraded and Research Foundation 10 • Cum. cost ~ $2.5M (AMREF) and Accenture to • ~$114/nurse •~100 ENs 27 colleges and schools upgrade 22,000 ENs from upgraded/yr participating including AMREF’s •Cum. cost ~ $50M ‘enrolled’ to ‘registered’ level 5 Virtual Nursing School •~$2,273/nurse within 5 years via eLearning (distance education through ICT) Over 100 computer-equipped methods 0 training centers set up in 8 05 07 09 11 13 15 25 provinces, including remote and 20 20 20 20 20 20 22 marginalized districts eLearning Traditional classroom method Results do not just represent dramatic cost and time improvements over status quo, they are nearly impossible without use of ICT eHealth Source: Source: WHO, AMREF website Med-e-Tel 2008 Luxembourg
  17. 17. 3 “On Cue” SMS reminders for TB patients in South Africa illustrates potential improvement in compliance... “On Cue”: 2002 project in South Africa sending SMS reminders to TB patients for Potential impact of SMS reminders for TB patients drug regimen compliance % 100 Assuming 99% Evidence suggested that TB patients often Died 7.4 compliance 7.4 rate with SMS do not take their medication simply 90 Unable to be Do not have 10.6 reminders 10.6 because they forget evaluated cell phones 80 3.1 3.1 Most widely used treatment method Non-compliant 10.8 7.7 7.7 Directly Observed Treatment, Short-course 70 Have cell (DOTS), involved direct observation of phones patient taking medicine to ensure 60 compliance – an HR-intensive method that is still not 100% successful 50 On Cue Compliance Service designed to 40 78.9 improve compliance at lower cost: 71.2 Compliant database of 138 patients taken at pilot 30 clinic, SMS messages sent out every half hour to remind patients to take medicine 20 As of Jan. 2003, the city of Cape Town 10 paid $16/patient/yr for SMS reminders 0 In pilot, only 1 patient out of 138 was DOTS Treatment Non-compliant Non-compliant DOTS treatment non-compliant (99.3% compliance rate) Outcomes patients with cell "converted" to outcomes with phones compliant with SMS reminders SMS eHealth Med-e-Tel 2008 Luxembourg Status quo Source: Bridges.org, WHOSIS, WHO Global Tuberculosis Control report Potential impact
  18. 18. 3 ...which could result in significant TB mortality reduction over time in South Africa Cost is low, cost- One benefit: Potentially significant TB mortality reduction effectiveness ratio favorable # people 50% of untreated • ~242,000 DOTS patients/year 12,000 patients eventually 10,673 die from TB • ~$16 per patient per year for 10,000 SMS messages 72% of South 99% compliance 8,000 Africans have rate with SMS cell phones • Country cost of ~$3.9M per reminders in pilot 5,337 year for South Africa 6,000 3,842 3,804 • This equates to ~$1000 per 4,000 death averted 2,000 • One TB death equates to ~20 0 DALYs Non-compliant DOTS Deaths due to non- Patient cell phone Deaths averted patients compliance coverage • Thus, cost-effectiveness In steady state, this represents an 11% decrease in annual ratio of the intervention, mortality due to TB in South Africa (currently ~34,000/year) without considering other benefits, is ~$50/DALY Other benefits include increased efficiency due to lower cost of treatment, reduced morbidity and building of capacity and infrastructure for other SMS-based interventions eHealth Med-e-Tel 2008 Luxembourg Source: Bridges.org, WHOSIS, WHO Global Tuberculosis Control report, Disease Control Priorities Project, Journal of Epidemiology and Community Health
  19. 19. 4 MMRS improving healthcare personnel capacity in Kenya... Mosoriot Medical Record System (MMRS), In resource-constrained Kenya, these electronic HIV/AIDS medical records for rural improvements could translate to dramatic clinics in Kenya, improved clinical operations benefits for HR capacity Improved time efficiency of clinical care • Patient visit time reduced by 22% Physicians and Nurses per 1,000 • Patient waiting time reduced by 38% 12 Nurses 11.2 • Provider-patient time reduced by 58% 10 Physicians Potential total with eHealth • Clinical personnel-patient time reduced by 50% • Clinical personnel interactions with each other 8 reduced by 66% 6 Monthly reports for the Kenyan MoH, which 4.5 previously took 2 weeks to prepare are now 4 3.1 2.6 2.6 routinely prepared in an hour 1.5 2 1.3 • MoH now ranks Mosoriot center first among all Kenyan health centers in terms of speed, 0 accuracy and completeness of monthly reports Kenya Low Lower mid Upper mid High income income income income Lower cost of administration relative to other programs Assuming similar results at all other healthcare • Cost per MMRS HIV/AIDS patient = $250/yr facilities in Kenya, transitioning from paper to • Cost per PEPFAR HIV/AIDS patient = $1500/yr electronic medical records could effectively double healthcare HR capacity eHealth Med-e-Tel 2008 Luxembourg Source: Informatics in Primary Care (2005), Journal of the American Medical Informatics Association (2003), WHO, interview with Bill Tierney
  20. 20. 4 ...and allowing transformation to evidence-based management of health MMRS EHR data allowed for Kenya lags others in vital Kenyan vaccine coverage proactive care delivery childhood immunizations has declined and stagnated Two patterns of care noticed DTP3 vaccine coverage (2005) Historical vaccine coverage, Kenya % 100 on MMRS reports: 90 80 70 88 93 92 % 100 60 69 75 50 90 • Cluster of STDs in one Kenya Low Lower Upper High 80 village team of nurses middle middle ? 70 dispatched to investigate Income level averages 60 • Team was able to Measles vaccine coverage (2005) % 100 50 identify and treat 90 80 40 individual that was 70 60 76 76 88 92 95 30 responsible for 50 Kenya Low Lower Upper High 20 spreading disease middle middle DTP3 10 Measles Income level averages HepB3 0 • Lack of child HepB3 vaccine coverage (2005) 84 87 90 93 96 99 02 05 immunizations in another % 100 19 19 19 20 19 19 19 20 90 80 village nurses 70 85 94 90 76 79 dispatched to village, 60 60 50 Potential for EHR system to children immunized for Potential Kenya Low Lower Upper High catalyze increase in vital broader middle middle childhood immunizations Income level averages implications MMRS has since been expanded to an open source EMR platform, OpenMRS eHealth Med-e-Tel 2008 Luxembourg Source: Informatics in Primary Care (2005), Journal of the American Medical Informatics Association (2003), WHO, interview with Bill Tierney
  21. 21. Sharing eHealth IP4D (SHIPD) Healthcare in the developing world Vision is improved by sharing eHealth Intellectual Property SHIPD phase 1 in 6 countries Cameroon Kenya Nigeria Tanzania Uganda Zambia eHealth Med-e-Tel 2008 Luxembourg
  22. 22. Disease surveillance: early detection and response of emerging diseases can prevent potential epidemic spread... A general model for disease emergence and spread eHealth Source: WHO World Health Report 2007 Med-e-Tel 2008 Luxembourg
  23. 23. The RF eHealth global initiative 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 Summer Bellagio series platforms and a self-sustaining global July 14-Aug 8, 2008 eHealth coalition. eHealth Med-e-Tel 2008 Luxembourg
  24. 24. Conclusion Promoting a global vision and local insights Human resources are key People processes and technology Partnerships are the model AHI - Global Health Infoway Major opportunities for ISfTeH and IMIA eHealth Med-e-Tel 2008 Luxembourg
  25. 25. THANK YOU kwankmy@who.int eHealth Med-e-Tel 2008 Luxembourg