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World healthcare conference madu-v3


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World healthcare conference madu-v3

  1. 1. APPLICATION OF TECHNOLOGY IN HEALTHCAREA MODEL FOR RESPONSE TO HEALTH CRISIS IN DEVELOPING COUNTRIES Ernest C. Madu, MD, FACC, FRCP (Edin) Professor of Cardiovascular Medicine and Imaging Technology University of Technology, Kingston, Jamaica Chairman and CEO, Heart Institute of the Caribbean, Kingston, Jamaica Washington DC, USA, April 2012
  2. 2.  Noncommunicable diseases in developing countries are a major public health and socio-economic problem The major challenge to development in the 21st centurySource: WHO
  3. 3. Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million Deaths from noncommunicable diseases in developing countries: 28 million Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated 14 millionSource: WHO
  4. 4. Noncommunicable Diseases Projected Deaths in 2015 and 2030 30 Intentional injuries Other unintentional 25 Road traffic accidentsDeaths (millions) Other NCD 20 Cancers 15 10 CVD Mat//peri/nutritional 5 Other infectious HIV, TB, malaria 0 2004 2015 2030 2004 2015 2030 2004 2015 2030 High income Middle income Low income Source: WHO
  5. 5. Noncommunicable Diseases Death trends (2006-2015) 2005 2006-2015 (cumulative) Geographical Total NCD NCD Trend: Death Trend: Death regions (WHO deaths deaths deaths from infectious (WHO Chronic Disease Report, 2005) from NCD classification) (millions) (millions) (millions) disease Africa 10.8 2.5 28 +6% +27% Americas 6.2 4.8 53 -8% +17% Eastern 4.3 2.2 25 -10% +25% Mediterranean Europe 9.8 8.5 88 +7% +4% South-East Asia 14.7 8.0 89 -16% +21% Western Pacific 12.4 9.7 105 +1 +20% Total 58.2 35.7 388 -3% +17% WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in developing countries.Source: WHO
  6. 6. Noncommunicable Diseases Macro-economic Impact: Lost National Income Lost national income from premature deaths due to heart 2005 2006-2015 (cumulative) (WHO Chronic Disease Report, 2005) disease, stroke and diabetes Lost national income Lost national income Countries ((billions ((billions Brazil 3 49 China 18 558 India 9 237 Nigeria 0.4 8 Pakistan 1 31 Russian Federation 11 303 Tanzania 0.1 3 WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic growth"Source: WHO
  7. 7. Progress Is Not Uniform• Gaps in health between the rich and poor are as wide as they were half a century ago and are becoming wider still• Between 1975 and 1995, 16 countries with a combined population of 300 million experienced a decline in life expectancy• By the year 2025, while life expectancy at birth in 26 countries will be above 80 years, in many low resource countries it will be less than 55 years• Even more experienced a decline in DALE
  8. 8. A New Approach Needed• the worsening indices of health status in developing countries demand a fresh look at the way health systems are organized
  9. 9. Donors are not responding to requests for technical assistance * ODA = Official Development Assistance provided by 24 OECD/DAC donor countries, as well as the EC Official Development Assistance for Health (2006, in US$ Billions, total is US$21 billion) STD & HIV/AIDS Control $4.75 Infectious Disease Control $2.10 Health Policy/Management $1.93 Basic Health Care $1.80 Reproductive Health Care $1.30 Basic Health Infrastructure $0.70 Medical Research $0.60 Medical Services $0.20 Family Planning $0.20 Basic Nutrition $0.10 Health Training $0.08 Health Education $0.00 Water supply/sanitation-large systems $2.70 Water Policy/Management $2.00 Basic drinking water supply & sanitation $1.00 River development $0.30 Waste management/disposal $0.20 Water resources protection $0.10 Water Education/Training $0.00
  10. 10. Health and Foreign PolicySource:
  11. 11. Shift from Foreign Aid to Sustainable DevelopmentSource:
  12. 12. The Technological LagAdvances in technology not applied to healthcare delivery in low resource nations – Low public awareness of appropriate technology options (demand drives supply) – absence of appropriate technology transfer and access to technological advances – Lack of infrastructure and expertise in new technological advances – Deficit in capacity building – High cost of capital and limited organized private sector involvement in healthcare service – Absence of favorable policies to support and attract investment in healthcare and mitigate against the risk
  13. 13. Misconceptions about Technology in Healthcare Myth Reality– Increase healthcare cost – Technology improves healthcare – Cost-effective/improves access– Widens inequalities – Improves workflow efficiency– Reduces access – Improves patient information management– Does not improve quality of care – Improves reliability and patient safety– Unaffordable – Opportunity to extend quality care to rural settings– Only fit for the western world – Expand the reach of limited expertise– TOO GOOD FOR THE DEVELOPING WORLD – Saves lives……..improves QOL….makes life better
  14. 14. Intervention Through Appropriate Technology Transfer adapted from Chris Madu et. al Factors Determined by the Country Aquisition Factors Identif y & Implement Appropriate Technology Stable Capabilities Gov ernment & Political Sy stem Ef f ectiv e Needs & Objectiv es Success of Technology Transf ers Management Structural Factors Educate & Train (Culture Value Sy stem) R&D Inf rastructure Resources Figure 1. Critical Factors for Successful Technology Transfer Madu CN: Long Range Planning, Vol 22(4), 115-24, 1989
  15. 15. Case Studies • HIC • DOCS • EMS
  17. 17. Our Model • Smart, efficient and cost effective use of appropriate technology anchored on knowledge and expertise.• Leveraging advances in technology to improve access, quality and affordability• Focus on training, research, development and innovation
  18. 18. Our Model: Niche Focus and Delivery• Organization and Strong Management Team• Capital Formation and Access• Shift from Aid to Sustainable Development• Specialization and Economies of Scale• Innovative Use of Technology• Strategic Partnerships• Internal Capacity Development• Evolving Vision and Direction
  19. 19. Jamaica 2005 • Population; 3 million• #1 Cause of Death and Disability: CVD • Access to CVD Care limited – No Cardiac Center of Excellence – Few Cardiologists with limited availability – Waiting time for Stress Test 3-6 months– Waiting Time for Echocardiograms 3-6 months
  20. 20. • The HIC Solution
  21. 21. Our Model: Making Technology Work• Technology applications relevant to low resource economies• Sustainable international partnerships rather than the current “dumping ground” approach• Global Telemedical services to expand access to health care.• Cost effective and clever use of health care resources• Specialization and “niche” positioning for more efficient service delivery• Creating value at competitive price• Private-Public Sector Partnerships
  22. 22. Improving Healthcare through Telemedicine• Implementation of web based image management portal and electronic medical reporting• Training of CV Techs for diagnostic studies• Engagement of Telecardiologists in different countries• Web based interpretation of cardiovascular diagnostic studies to improve access and outcomes• Rapid turn around time with improvement in healthcare• Cost-effective• Opportunity to extend quality care to rural settings• Expand the reach of limited expertise
  23. 23. Universal Access to Medical Expertise
  24. 24. Universal Accessto Patient Information and Reporting Just a click away
  25. 25. Impact of Technology in Healthcare Jamaica 2005 Jamaica 2012– Echo waiting time: 3-6 months – Echo waiting time; Same Day– ETT waiting time: 3-6 months. – ETT waiting time: Same Day– Cardiology Consultation: 2-3 – Cardiology Consultation: Same Day months – Reduced healthcare cost– Increased healthcare cost – Equality of care and expertise– Wide inequality in care – Open access to many– Reduced access to many – Opportunity to extend quality care– Limited access to quality care widely and to rural settings – Improved Quality of Life
  26. 26. NIGERIA 2012 PROBLEM SOLUTION– Limited access to timely – Open access through 24 healthcare or reliable hour medical hotline health information (DOCS)– Limited access to – DOCS Telemedicine Clinics Specialist Opinion – Introduce EMS service run– Absence of emergency by medical professionals medical response system
  27. 27. Looking to the Future Electronic and Mobile Health PlatformsUniversal Access to Medical Advice and Healthcare Information
  28. 28. Launching July 2012• Access to Doctors 24/7 from anywhere• Medical advice, drug information, clinic and hospital information• Internationally approved protocols• Aimed at improving access and reducing cost of accessing healthcare – Physician and hospital visits – Transportation costs and Forgone earnings• Earlier intervention = better outcomes• Invaluable “peace of mind” 24/7
  29. 29. DOCS Nigeria Medical Hotlines• Innovative healthcare delivery model aimed at improving access – Will make widespread infrastructure accessible at low cost – Leverage 60-90 million unique mobile phone accounts to disseminate healthcare services – Circumvents lacking infrastructure – Improves quality of care and will yield better outcomes – Will drastically reduce overall cost of healthcare by delivering accurate information at the right time – Reduction in healthcare spending and productivity loss
  30. 30. Real World Examples – Call AnalysisTelehealth Service Ontario, Canada • Data collected demonstrates that 43% of healthcare inquires can be resolved by self-administered care • 35% resulted in the need for physician consultation • An even smaller 16% resulted in the need for emergency care
  31. 31. DOCS TELEMEDICINE CLINICS• Real Time Audiovisual Telemedicine• Direct connection to US based Specialists• Virtual diagnosis and treatment• VOIP based solution• Flexible access from smart phones, tablets and laptops
  32. 32. • “an emergency medical service - contains 3 words that are critical; 1. It must be available and accessible in emergencies. 2. It must be led by medical professionals. 3. It must be a service - integrated from the point of patient collection, to the nearest hospital with all the emergency care facilities i.e a fully functional surgical theatre” – Source; • March 13, 2012
  33. 33. • “So far in 2012, 52 years after independence there is no functional "Emergency Medical Service" in Nigeria. Terms like ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that define Emergency Medical Services all over the world are practically irrelevant in Nigeria. EMS is an essential part of the overall healthcare system as it saves lives by providing care immediately”. – Source: • March 13, 2012
  34. 34. • Launching in Enugu, Nigeria, July 2012• Will be readily and widely available and accessible at minimal cost• Led by experienced medical professionals with experience in emergency medicine• Fully equipped EMS vehicles and trained personnel to respond to emergencies• Will be integrated with key participating hospitals in Enugu• Model will be replicated in other cities nationwide
  36. 36. SUSTAINABLE SOLUTIONS• Anticipate, adapt and respond• Develop cost effective multidimensional technology transfer policy and action plan• Build and maintain relevant infrastructure• Build internal capacity• Open up access to capital• Bridge socio-economic inequalities• Embrace new and emerging technology solutions
  37. 37. Take Home• Good healthcare is possible everywhere• The Developing World can and should leapfrog using advances in technology