The document discusses WHO's efforts to address priority challenges in health systems through eHealth initiatives. It outlines WHO's six point agenda to accelerate development, foster health security, strengthen health systems, harness research and evidence, enhance partnerships, and improve performance. It then discusses how health systems in Africa are especially weak and in need of investment. The document argues that improved surveillance and reporting through eHealth are needed to address emerging infectious disease threats. It also notes that a focus on improving health sector productivity is needed, rather than just increasing funding.
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This document summarizes healthcare market trends and internet growth in Egypt based on primary research. It finds that Egypt has a young population with over 30% under age 15. Healthcare expenditures are growing, with over half spent on medical equipment and products. There are over 180,000 licensed physicians in Egypt, most working in public hospitals. Internet usage in Egypt is also growing rapidly, with over 30 million users today compared to half a million in 2000. Mobile internet access is increasing as well, though many phones with 3G capability are not yet using mobile internet services.
State of the vitiviniculture world market 2011 - OIVWinePaper
The document summarizes global vitiviniculture trends from 2000-2011. Some key points:
- Europe dominated vineyard surface area (56.1% in 2011), grape production (41.6%), and wine production (66.5%).
- While Europe remained the largest consumer of wine, 2011 estimates showed consumption reversing a decreasing trend.
- The global wine market is dominated by the top 5 EU exporters, but southern hemisphere producers and the USA are gaining market share over time.
Presentation of UNESCO report for UNESCO's Conference on Freedom of Expression on the Internet in Marrakesh, Morocco, with support from the Morocco Internet Society, 15 February 2013.
The Role of Technology For Patient Outcomes in East Africa — Slides from East...IHS
These slides were presented by Farah Ramadan at the East Africa Healthcare Investment Summit 2012 in Kampala, Uganda on 19th April 2012.
The presentation was part of a panel discussion with government and industry representatives, examining strategies for sustained growth and profitability in the healthcare arena in East Africa.
This presentation focused specifically on the role of technology as an enabling force for better patient outcomes in East Africa.
The document discusses the impact of socioeconomic changes on health and healthcare systems. It notes that total health expenditures in Thailand have been rising but remain stable at around 4% of GDP. The poor previously spent a larger percentage of their income on healthcare than the rich, but this gap has narrowed. Upcoming changes like an aging population and the ASEAN Economic Community will present challenges and opportunities for Thailand's health system and services sector. Cross-cultural factors, emerging technologies, and lifestyle choices will also impact population health.
Protein Biomedical Corp is a Taiwanese company founded in 1992 that focuses on developing immune and growth factor products using techniques like aquatic vaccines, antibodies, and growth hormones. The company's chief scientist, Dr. Cheng-Hsien Lin, has extensive experience in areas like virology, immunology, and stem cell research. The company is developing biological alternatives to antibiotics like vaccines and antibody-like feed additives to treat and prevent diseases in animals. They are seeking funding to bring their aquatic vaccine through clinical trials and mass production to target the large and growing global market for antibiotic alternatives in animal feed.
Georgia College and State University's Global Citizenship SymposiumWorldwatch Institute
See Nourishing the Planet’s latest powerpoint presentation at the Georgia College and State University's Global Citizenship Symposium. Project director Danielle Nierenberg discussed the connection between sustainable agriculture and public health.
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The document analyzes Facebook usage in the Middle East and North Africa region. It finds that the region has over 58 million Facebook users, representing 16.8% of the population. Turkey has the most users at over 29 million. Usage is growing, with over 2.3 million new users in the last month alone. Males dominate usage at 62.9% of the total user base. The majority of users are between the ages of 18-34. While most users browse Facebook in English, over 10 million browse in Arabic.
Healthcare Market in Egypt and it's Relation to Internet GrowthOsama ElKhair
This document summarizes healthcare market trends and internet growth in Egypt based on primary research. It finds that Egypt has a young population with over 30% under age 15. Healthcare expenditures are growing, with over half spent on medical equipment and products. There are over 180,000 licensed physicians in Egypt, most working in public hospitals. Internet usage in Egypt is also growing rapidly, with over 30 million users today compared to half a million in 2000. Mobile internet access is increasing as well, though many phones with 3G capability are not yet using mobile internet services.
State of the vitiviniculture world market 2011 - OIVWinePaper
The document summarizes global vitiviniculture trends from 2000-2011. Some key points:
- Europe dominated vineyard surface area (56.1% in 2011), grape production (41.6%), and wine production (66.5%).
- While Europe remained the largest consumer of wine, 2011 estimates showed consumption reversing a decreasing trend.
- The global wine market is dominated by the top 5 EU exporters, but southern hemisphere producers and the USA are gaining market share over time.
Presentation of UNESCO report for UNESCO's Conference on Freedom of Expression on the Internet in Marrakesh, Morocco, with support from the Morocco Internet Society, 15 February 2013.
The Role of Technology For Patient Outcomes in East Africa — Slides from East...IHS
These slides were presented by Farah Ramadan at the East Africa Healthcare Investment Summit 2012 in Kampala, Uganda on 19th April 2012.
The presentation was part of a panel discussion with government and industry representatives, examining strategies for sustained growth and profitability in the healthcare arena in East Africa.
This presentation focused specifically on the role of technology as an enabling force for better patient outcomes in East Africa.
The document discusses the impact of socioeconomic changes on health and healthcare systems. It notes that total health expenditures in Thailand have been rising but remain stable at around 4% of GDP. The poor previously spent a larger percentage of their income on healthcare than the rich, but this gap has narrowed. Upcoming changes like an aging population and the ASEAN Economic Community will present challenges and opportunities for Thailand's health system and services sector. Cross-cultural factors, emerging technologies, and lifestyle choices will also impact population health.
Protein Biomedical Corp is a Taiwanese company founded in 1992 that focuses on developing immune and growth factor products using techniques like aquatic vaccines, antibodies, and growth hormones. The company's chief scientist, Dr. Cheng-Hsien Lin, has extensive experience in areas like virology, immunology, and stem cell research. The company is developing biological alternatives to antibiotics like vaccines and antibody-like feed additives to treat and prevent diseases in animals. They are seeking funding to bring their aquatic vaccine through clinical trials and mass production to target the large and growing global market for antibiotic alternatives in animal feed.
Georgia College and State University's Global Citizenship SymposiumWorldwatch Institute
See Nourishing the Planet’s latest powerpoint presentation at the Georgia College and State University's Global Citizenship Symposium. Project director Danielle Nierenberg discussed the connection between sustainable agriculture and public health.
Facebook Usage in the Middle East & North Africa - July 2011Abbas Alidina
The document analyzes Facebook usage in the Middle East and North Africa region. It finds that the region has over 58 million Facebook users, representing 16.8% of the population. Turkey has the most users at over 29 million. Usage is growing, with over 2.3 million new users in the last month alone. Males dominate usage at 62.9% of the total user base. The majority of users are between the ages of 18-34. While most users browse Facebook in English, over 10 million browse in Arabic.
eHealth and Global Health: Investments Opportunities and Challenges for Indus...Adesina
This document discusses opportunities and challenges for eHealth industry investments in developing countries. It notes major health problems in developing countries like Africa, including high rates of HIV/AIDS, malaria, and lack of healthcare infrastructure. It outlines opportunities for private investment in areas like health records systems, telemedicine, and health insurance. Challenges include understanding local contexts, building sustainable business models, and developing appropriate technologies. Investors are advised to consider regional differences and focus on inclusive business models, capacity building, and collaborative innovation.
This document discusses building human resources capacity for health information systems (HIS). It notes that a competent workforce is needed to support HIS according to WHO standards. It proposes drafting competency standards for the workers required to sustain HIS from data collection through use. Producing curricula to develop these competencies is also proposed. The document highlights scoping the issue as important, including mapping current skill levels. Key roles and competencies required at different levels and for different health system domains should be identified to develop training and curricula. Building sustainable human resources is critical for effective HIS.
Cloud computing allows organizations to do new things in new ways by increasing flexibility and agility while enabling new business models and scenarios. It provides a trusted platform that can enable transformative experiences beyond just lowering the cost of IT. Cloud computing offers health organizations scenarios to innovate through a flexible platform.
Cloud computing and health care - Facing the FutureJerry Fahrni
Jerry Fahrni discusses cloud computing and its potential advantages for healthcare. Cloud computing provides on-demand access to shared computing resources over the internet and has several benefits including lower costs, flexibility, and scalability. While security concerns remain, more healthcare organizations are adopting cloud-based solutions like electronic health records and image sharing to improve care coordination and lower costs. If implemented properly, cloud computing can help make patient health information more accessible to providers and support remote monitoring of chronic conditions.
This paper aims to provide an understanding of the model and exploring options available for complementing the technology and infrastructure needs of Healthcare organizations.
An Introduction to Health Systems; An Overview of the Philippine Health Care ...Paolo Victor Medina
The document provides an overview of the Philippine health care system and health systems thinking using the WHO health systems framework. It introduces concepts of health systems, leadership and governance in the Philippines, health financing sources and challenges, and human resources for health. The Department of Health is the lead agency for health care and aims to ensure accessibility and quality, but the system faces issues of inequitable financing that relies heavily on out-of-pocket costs and a lack of incentives and uneven distribution of human resources for health.
Presentation of Top 10 eHealth & Healthcare trends presented at IDC Content Management Evolution 2014: Portals, Mobile and Social. Madrid (Spain), 11th of March 2014. www.cesaralonso.com
The document summarizes efforts to integrate TB and HIV services in Ukraine. It describes challenges including a highly vertical healthcare system, lack of cooperation between AIDS and TB services, and ensuring access to quality second-line drugs for drug-resistant TB. Methods used to address this include establishing a TB/HIV working group, training health workers, and integrating prevention and treatment services. Outcomes include signing collaboration agreements and expanding integrated care services to over 1,000 clients. Further reforms are needed to fully integrate services and ensure long-term sustainability.
AcademyHealth President and CEO Lisa Simpson's presentation for the Richard and Janet Southby Distinguished Lecutreship in Comparative Health Policy at the George Washington University Hospital on April 24, 2012
The Webinar organized by Endeavour - The Mobility Company, held on July 28, 2010 explored the increasing use in healthcare and its future.
For more information on mHealth, visit: www.techendeavour.com
This document discusses examples of public health interventions that have been effective based on evidence, including insecticide-treated nets for malaria, ivermectin for river blindness, and chemotherapy for leprosy. It then shows data on the distribution of bed nets and treatment coverage for onchocerciasis. The document proposes building incentives to reach the poorest populations and shows data on vaccination coverage and efforts to reduce child and maternal mortality. It concludes that decisions for action are often made rapidly when evidence is insufficient, so building evidence during implementation is important, and welcomes Cochrane's participation in reviewing evidence and methodology for achieving Millennium Development Goals 4 and 5.
Presentation: Health Reform in Massachusettsmasscare
The document summarizes the Massachusetts Model of Health Reform, including its origins, structure, impacts, challenges, and lessons for national reform. Key points:
- The 2006 reform law expanded insurance coverage through an individual mandate, employer requirements, and subsidizing coverage up to 300% of poverty.
- It reduced the uninsured rate from 10% to around 4-5% but increased costs for employers and individuals. Financial challenges grew for safety-net hospitals.
- While more have coverage, costs continue rising faster than income. If not addressed, the system may not be sustainable long-term. National reform efforts aim to achieve Massachusetts' coverage gains while better controlling health care spending.
Treatment and care of HIV+ patients in Croatia is centralized, with all patients treated at the University Hospital for Infectious Diseases in Zagreb. A study found the prevalence of HIV among men who have sex with men in Zagreb to be 14.2% in 2011, unchanged from 2006. While monitoring and treatment guidelines are available, fewer antiretrovirals are available compared to other EU countries. Late presentation to care remains a challenge, though the percentage of patients entering care within a month of diagnosis has increased in recent years.
The document discusses current and future challenges in global waste management. It notes that currently 70% of waste is dumped in landfills or illegally, and population growth will increase waste production dramatically by 2050. New approaches are needed that view waste management as a human right and stimulate behavioral change through technology and local solutions. Focusing on improving waste services in large cities and developing regions through mobile apps and cooperation between experts and communities could help close the gap.
Steven Schwartz at Consumer Centric Health, Models for Change '11HealthInnoventions
Tackling the Double Helix: On the Road to Sustainable Behavior Change.
Sustainable health behavior change is possible.
To be successful, you must equally commit to health at the individual level and the social level.
The document summarizes a strategy meeting presentation from 2011 about opportunities for El Salvador's apparel and textile industry. It discusses how the industry has changed significantly since 2004 when trade quotas were eliminated. While China was initially the biggest winner, costs are rising in China and it is becoming a more volatile sourcing location. The presentation recommends that El Salvador can still position itself to take advantage of opportunities over the next few years if it acts immediately to improve areas like logistics, training programs, and attracting textile investment.
Electrolux Capital Markets Day 2012 - Presentation Alberto ZanataElectrolux Group
Electrolux Capital Markets Day. November 14, 2012, Stockholm, Sweden. Together with senior management, the President and CEO of Electrolux, Keith McLoughlin will present the Group’s strategy to create further sustainable economic value at today’s capital markets day.
This document provides an overview of the Software Development Security Domain topic from the CISSP Common Body of Knowledge. It discusses software development life cycle models and processes, programming languages, database and data warehousing vulnerabilities and protections, and software vulnerabilities and threats. Key frameworks covered include ISO/IEC 15288, SW-CMM, and SSE-CMM. The document also examines governance approaches like COBIT and the importance of assurance requirements.
5 tarrant-global conf on aging presentationifa2012
The document discusses the potential benefits of using video remote monitoring to manage chronic diseases. It suggests that video remote monitoring could help integrate health services, collect health data, and connect patients to social and medical support networks. The document summarizes research showing that video remote monitoring may decrease hospitalizations and emergency room visits for conditions like COPD, CHF, diabetes, and wounds. It estimates a potential cost savings of $800 per high-risk patient per month from reduced hospitalizations when using video remote monitoring for patients with multiple chronic conditions.
This is a presentation of the results of the Global Programme to Enhance reproductive Health Commodity Security (GPRHCS), coordinated by the Commodity Security Branch (CSB) of the United Nations Population Fund (UNFPA)
eHealth and Global Health: Investments Opportunities and Challenges for Indus...Adesina
This document discusses opportunities and challenges for eHealth industry investments in developing countries. It notes major health problems in developing countries like Africa, including high rates of HIV/AIDS, malaria, and lack of healthcare infrastructure. It outlines opportunities for private investment in areas like health records systems, telemedicine, and health insurance. Challenges include understanding local contexts, building sustainable business models, and developing appropriate technologies. Investors are advised to consider regional differences and focus on inclusive business models, capacity building, and collaborative innovation.
This document discusses building human resources capacity for health information systems (HIS). It notes that a competent workforce is needed to support HIS according to WHO standards. It proposes drafting competency standards for the workers required to sustain HIS from data collection through use. Producing curricula to develop these competencies is also proposed. The document highlights scoping the issue as important, including mapping current skill levels. Key roles and competencies required at different levels and for different health system domains should be identified to develop training and curricula. Building sustainable human resources is critical for effective HIS.
Cloud computing allows organizations to do new things in new ways by increasing flexibility and agility while enabling new business models and scenarios. It provides a trusted platform that can enable transformative experiences beyond just lowering the cost of IT. Cloud computing offers health organizations scenarios to innovate through a flexible platform.
Cloud computing and health care - Facing the FutureJerry Fahrni
Jerry Fahrni discusses cloud computing and its potential advantages for healthcare. Cloud computing provides on-demand access to shared computing resources over the internet and has several benefits including lower costs, flexibility, and scalability. While security concerns remain, more healthcare organizations are adopting cloud-based solutions like electronic health records and image sharing to improve care coordination and lower costs. If implemented properly, cloud computing can help make patient health information more accessible to providers and support remote monitoring of chronic conditions.
This paper aims to provide an understanding of the model and exploring options available for complementing the technology and infrastructure needs of Healthcare organizations.
An Introduction to Health Systems; An Overview of the Philippine Health Care ...Paolo Victor Medina
The document provides an overview of the Philippine health care system and health systems thinking using the WHO health systems framework. It introduces concepts of health systems, leadership and governance in the Philippines, health financing sources and challenges, and human resources for health. The Department of Health is the lead agency for health care and aims to ensure accessibility and quality, but the system faces issues of inequitable financing that relies heavily on out-of-pocket costs and a lack of incentives and uneven distribution of human resources for health.
Presentation of Top 10 eHealth & Healthcare trends presented at IDC Content Management Evolution 2014: Portals, Mobile and Social. Madrid (Spain), 11th of March 2014. www.cesaralonso.com
The document summarizes efforts to integrate TB and HIV services in Ukraine. It describes challenges including a highly vertical healthcare system, lack of cooperation between AIDS and TB services, and ensuring access to quality second-line drugs for drug-resistant TB. Methods used to address this include establishing a TB/HIV working group, training health workers, and integrating prevention and treatment services. Outcomes include signing collaboration agreements and expanding integrated care services to over 1,000 clients. Further reforms are needed to fully integrate services and ensure long-term sustainability.
AcademyHealth President and CEO Lisa Simpson's presentation for the Richard and Janet Southby Distinguished Lecutreship in Comparative Health Policy at the George Washington University Hospital on April 24, 2012
The Webinar organized by Endeavour - The Mobility Company, held on July 28, 2010 explored the increasing use in healthcare and its future.
For more information on mHealth, visit: www.techendeavour.com
This document discusses examples of public health interventions that have been effective based on evidence, including insecticide-treated nets for malaria, ivermectin for river blindness, and chemotherapy for leprosy. It then shows data on the distribution of bed nets and treatment coverage for onchocerciasis. The document proposes building incentives to reach the poorest populations and shows data on vaccination coverage and efforts to reduce child and maternal mortality. It concludes that decisions for action are often made rapidly when evidence is insufficient, so building evidence during implementation is important, and welcomes Cochrane's participation in reviewing evidence and methodology for achieving Millennium Development Goals 4 and 5.
Presentation: Health Reform in Massachusettsmasscare
The document summarizes the Massachusetts Model of Health Reform, including its origins, structure, impacts, challenges, and lessons for national reform. Key points:
- The 2006 reform law expanded insurance coverage through an individual mandate, employer requirements, and subsidizing coverage up to 300% of poverty.
- It reduced the uninsured rate from 10% to around 4-5% but increased costs for employers and individuals. Financial challenges grew for safety-net hospitals.
- While more have coverage, costs continue rising faster than income. If not addressed, the system may not be sustainable long-term. National reform efforts aim to achieve Massachusetts' coverage gains while better controlling health care spending.
Treatment and care of HIV+ patients in Croatia is centralized, with all patients treated at the University Hospital for Infectious Diseases in Zagreb. A study found the prevalence of HIV among men who have sex with men in Zagreb to be 14.2% in 2011, unchanged from 2006. While monitoring and treatment guidelines are available, fewer antiretrovirals are available compared to other EU countries. Late presentation to care remains a challenge, though the percentage of patients entering care within a month of diagnosis has increased in recent years.
The document discusses current and future challenges in global waste management. It notes that currently 70% of waste is dumped in landfills or illegally, and population growth will increase waste production dramatically by 2050. New approaches are needed that view waste management as a human right and stimulate behavioral change through technology and local solutions. Focusing on improving waste services in large cities and developing regions through mobile apps and cooperation between experts and communities could help close the gap.
Steven Schwartz at Consumer Centric Health, Models for Change '11HealthInnoventions
Tackling the Double Helix: On the Road to Sustainable Behavior Change.
Sustainable health behavior change is possible.
To be successful, you must equally commit to health at the individual level and the social level.
The document summarizes a strategy meeting presentation from 2011 about opportunities for El Salvador's apparel and textile industry. It discusses how the industry has changed significantly since 2004 when trade quotas were eliminated. While China was initially the biggest winner, costs are rising in China and it is becoming a more volatile sourcing location. The presentation recommends that El Salvador can still position itself to take advantage of opportunities over the next few years if it acts immediately to improve areas like logistics, training programs, and attracting textile investment.
Electrolux Capital Markets Day 2012 - Presentation Alberto ZanataElectrolux Group
Electrolux Capital Markets Day. November 14, 2012, Stockholm, Sweden. Together with senior management, the President and CEO of Electrolux, Keith McLoughlin will present the Group’s strategy to create further sustainable economic value at today’s capital markets day.
This document provides an overview of the Software Development Security Domain topic from the CISSP Common Body of Knowledge. It discusses software development life cycle models and processes, programming languages, database and data warehousing vulnerabilities and protections, and software vulnerabilities and threats. Key frameworks covered include ISO/IEC 15288, SW-CMM, and SSE-CMM. The document also examines governance approaches like COBIT and the importance of assurance requirements.
5 tarrant-global conf on aging presentationifa2012
The document discusses the potential benefits of using video remote monitoring to manage chronic diseases. It suggests that video remote monitoring could help integrate health services, collect health data, and connect patients to social and medical support networks. The document summarizes research showing that video remote monitoring may decrease hospitalizations and emergency room visits for conditions like COPD, CHF, diabetes, and wounds. It estimates a potential cost savings of $800 per high-risk patient per month from reduced hospitalizations when using video remote monitoring for patients with multiple chronic conditions.
This is a presentation of the results of the Global Programme to Enhance reproductive Health Commodity Security (GPRHCS), coordinated by the Commodity Security Branch (CSB) of the United Nations Population Fund (UNFPA)
Importance of Ethics, Bio-security and Good Practices for Better Scientific C...UNESCO Venice Office
Workshop on Higher Education and Professional Responsibility in CBRN Applied Sciences and Technology across the Sub-Mediterranean Region
3-4 April 2012. Palazzo Zorzi, Venice
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121010_Mobile Banking & Payments for Emerging Asia Summit 2012_Agri-Fin Mobilespirecorporate
This document provides an overview of Mercy Corps and their Agri-Fin Mobile program. It discusses how Mercy Corps uses an ecosystem approach to promote uptake of mobile services among rural customers in emerging Asia. This involves building partnerships between financial institutions, mobile network operators, and application providers. The document then shares findings from research conducted with smallholder farmers in Indonesia on their mobile phone use, financial access, and information needs. It identifies opportunities to bundle financial and information services via mobile to address gaps farmers face around access to credit, pricing data, and farm management tips.
Indonesia represents a growing market opportunity in healthcare due to its large and growing population, expanding middle class, and underserved healthcare sector. With 235 million people and over 80 million in the growing middle class, consumer spending and confidence are rising. This creates demand for quality healthcare as the population ages and chronic diseases become more prevalent. Private healthcare expenditures also continue to increase steadily. The growing and resilient economy makes Indonesia an attractive target for healthcare investments focused on mid-market consumer products and services, corporate healthcare, and digital health applications.
Anyanwu keynote developing knowledge for africa's ec. advancementJohannes Phaladi
This document is a keynote address delivered by Prof. John C. Anyanwu at the 2nd International Conference on African Digital Libraries and Archives in Johannesburg, South Africa in 2011. The address discusses Africa's economic performance and the role of knowledge in economic advancement. It provides an overview of Africa's competitiveness compared to other regions, highlights concepts of knowledge and its acquisition, and examines the state of knowledge in Africa. It recommends steps to improve knowledge in Africa to support economic growth.
John Macaskill-Smith: General practice models in New ZealandNuffield Trust
The document provides an overview of the New Zealand health system and discusses some of its key challenges and drivers for change. It notes that the NZ population is 4.2 million served by a largely devolved system including a central ministry, 20 regional health boards, and private providers. While performance is generally good compared to other OECD countries, challenges include an aging population increasing demands, rising costs, and fragmentation across the system. Key drivers for change include addressing these population trends, workforce needs, financial sustainability, and improving facilities.
John Macaskill-Smith: General practice models in New Zealand
Who Ehealth Strategy
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. 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. 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. 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. 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. 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. 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
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. 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. Countries with a critical shortage of health service
providers (doctors, nurses and midwives)
eHealth Med-e-Tel 2008 Luxembourg
12. Distribution of health workers by level of health
expenditure and burden of disease, by WHO region
eHealth Med-e-Tel 2008 Luxembourg
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. THANK YOU
kwankmy@who.int
eHealth Med-e-Tel 2008 Luxembourg