The Role of Telehealth in Pacific Island Human Resource for Health (HRH) Development: An Environmental Scan of Past Experiences and Potential Developments Rieko Hayakawa, Christina Higa, Cathy Wasem The 21st Pacific Congress Okinawa Asia Pacific Telecommunity Telemedicine Initiative June 2007, Okinawa, Japan

I. Introduction  22 island economies  >25,000 islands  8.6 million people  Populations from several thousand to over 6 million  Geologically diverse – from coral atolls to volcanic high islands

1. Map of Pacific with flag of US, France, British, NZ, Au.

Political AffiliationPacific Island Economy Independent Countries:Papua New Guinea, Fiji, Vanuatu, Solomon Islands, Samoa, Tonga, Tuvalu, Nauru, Kiribati US free association:Republic of the Marshall Islands, Federated States of Micronesia, Republic of Palau NZ free association:Cook Islands, Niue, Tokelau US territory:Commonwealth of the Northern Mariana Islands (CNMI), Guam, American Samoa French Territory:French Polynesia, New Caledonia, Wallis & Futuna British Territory:Pitcairn Island

Hideaki Satoh Beliefs: Traditional & Western

Geography: small atolls and volcanic islands Hideaki Satoh

Technologies: Traditional & Modern

II. HEALTH, HUMAN RESOURCE FOR HEALTH (HRH) DEVELOPMENT IN THE PACIFIC ISLANDS AND TELEHEALTH

There is a global shortage of health workers estimated at more than 4 million doctors, nurses, midwives and others. This takes its greatest toll on the poorest and most vulnerable populations. unprecedented strain on health-care systems : -traditional diseases - malaria and tuberculosis -modern lifestyle-related diseases – diabetes & heart disease Add to this the newly emerging threats such as avian influenza The quality health care may soon be jeopardized in many countries. Dr. Shigeru Omi In Preface to the Regional Strategy on Human Resources for Health and in an article for World Health Day 2006

Pacific islands situation: Double burden of disease - tuberculosis, Hansen's disease, high infant mortality - diabetes, cardiovascular disease, cancer - rise in communicable disease - increasing alcohol and drug use Lack of Human Resource % of health workers are expatriates in the Marshall Islands Lack of training opportunities - quality education - funding - Small numbers of students

Telehealth Use of ICT to support long distance   clinical health care,   health workers and patient health related education,   public health, and   health administration

III. PACIFIC ISLANDS TELECOMMUNICATION – MONOPOLIES, ICT POLICY REFORM, TELECOMMUNICATION NETWORKS, AND UNIVERSAL SERVICE

Telecommunication Costs Long Distance Telephone Rates $.05 - $3.00 Minute $.05 - $3.00 Minute T-1 Rates Guam – Hawaii, CNMI-Hawaii Guam – Hawaii, CNMI-Hawaii $200,000 Year American Samoa - Hawaii American Samoa - Hawaii $300,000 Year Intrastate Hawaii Intrastate Hawaii $12,000-$24,000 Year Internet Republic of the Marshall Islands Republic of the Marshall Islands $10 Registration, 0-free hours, $3.50/hour Federated States of Micronesia Federated States of Micronesia $19.95 Monthly, 10-free hours, $1.95/hour Republic of Palau Republic of Palau $15.00 Monthly, 4-free hours, $2.50/hour

Regional commitment ICT policy  2005 Pacific Islands Forum “Digital Strategy” in the “Pacific Plan” “Digital Strategy” in the “Pacific Plan”  2004 UNDP funded by Japan “ePasifika” “ePasifika”  2001 Pacific Islands Forum “Regional ICT Policy and Strategic Plan” “Regional ICT Policy and Strategic Plan”

7. network chart of USPNet

E-Rate Networks

American Samoa E-Rate Network  ~$ 24+ Million in 7-Years  All Public and Private Schools Connected  Fiber Optics (4-strands)  Video Teleconferencing  High Speed Internet

CNMI Partners in Distance Learning Network  ~$12+ Million in 4-Years  20 VTC Sites Public School Systems Public School Systems Office of the Governor Office of the Governor Electronic Data Processing Electronic Data Processing Commonwealth Health Center Commonwealth Health Center 1Gpbs between schools 1Gpbs between schools

Guam Education Network  ~$12+ Million in 4.5- Years  30+ VTC Sites * Public Schools * University of Guam  High Speed Internet  On-island Fiber Gigabit Fiber Connectivity

IV. EXPERIENCES AND ISSUES IN HRH DEVELOPMENT USING TELEHEALTH

1. network maintenance and operations 2. telecommunication cost 3. collaboration within and among the POLHN sites 4. POLHN resources could be further maximized by working with other governments, health care providers and educational institutions 5. mechanisms for articulating higher education coursework and certifying continuing education

State of Hawaii Telehealth Access Network

Direct Network Connections Oahu  HHSC Corporate Offices  North Hawaii Community Hospital  Leahi Hospital  Maluhia  Shriners Hospital for Children  St. Francis Health Care System  Veterans Administration (and Network)  UH College of Tropical Agriculture  JABSOM Telemedicine Network (and Clinics)  UH Affiliated Programs Kauai  Kauai Veterans Memorial Hospital  Samuel Mahelona Memorial Hospital Maui  Maui Memorial Medical Center  Kula Hospital  Maui Community College  Lanai Community Hospital East Hawaii  Hilo Medical Center  Kau Hospital  Hale Ho`ola Hamakua Hospital West Hawaii  Kona Community Hospital  Kohala Hospital Others Connections…  Chubu Hospital, Okinawa  Etc.

Tripler Army Medical Center’s (TAMC) Pacific Rim Regional Telerehabilitation Program The Pacific Area Health Education Centre (AHEC) Pacific Association for Clinical Training (PACT)

The University of Guam has established 30 telecentres in the remote islands of the Micronesian region HF radio system

V. EXPERIENCES AND ISSUES IN ICT HUMAN RESOURCE DEVELOPMENT

Tokai University Medical School Leading telehealth in Japan and Asia Pacific 2006 – 2008 ICT training in Japan (3 month) Special designed for Pacific Islands Health workers

Pacific ICT Academy  Partners: ASG, ASCC, DOI, eCDC, DELTA, TIPG  Accredited, Professional Certificates CISCO, Microsoft, Oracle  Modality: VTC/ Local Facilitators  1-Year Program  Agreements with Employers

1. Problem in the access and cost of telecommunication services: need to increase access and lower costs by i. universal service mechanisms ii. accelerate development of ICT strategies iii. support networks eg. PEACESAT & USPNet 2. Problem – a lack of a regional coordinating body (or bodies) in this arena: improve the linkages between the health, education, and ICT sectors, and the local, regional, and international funding agencies 3. Problem – there is a small number of ICT technical personnel: need to enhance local higher education institutions to provide training 4. Problem – a lack of policies that support the articulation of coursework and the certification of continuing education : need to develop mechanisms for sharing HRH programs among higher education institutions. Conclusions

Collaboration between Okinawa and Pacific E-Health for Okinawa (Chubu Hospital) For 50 remote islands *2 Hospitals: Miyako Island and Yaeyama Islands *19 Clinics Needs: To help doctors and nurses who work in remote Is.

Mahalo, Arigatou, ViNaka, Mifaiyu, health professionals and administrators who contributed valuable information and insights regarding HRH development and ICT in the Pacific for this paper (ed.) Sumiko Ogawa (2000) 「 Public Health Nurse in Okinawa 」.Educational video. JICA