WHO Collaborating Centre for Telemedicine – perspectives and programmes Dhaka, 7 January 2004

Telemedicine in the developing world: what do we know and what do we need to know?

Telemedicine, eHealth, Telehealth, Health Telematics? “Telemedicine” is the provision of health services over a distance, distance training and patient information included Telemedicine is a process where technology is only one factor Terminology varies with contexts and politics, e.g. “Telemedicine” is the adapted term in Norway, but “eHealth” when needed (EU’s 6FP)

counter arguments Can health-care workers do anything on the basis of the advice they receive? Is it an approporiate use of resources? How do you know that the advice offered was correct?

What is different from industrialized regions?

in the US 2000 There were 21.4 million medicare services, of which 179 involved telemedicine Litterature search in Medline, revealed 39 articles on telemedicine in the developing world Wootton, 2001

Telemedicine in developing countries Case studies (review articles by R. Wootten (1997, 2001) 1995, Secretary-General of ITU and the Director-General of WHO signed a MoU on cooperation in telemedicine ITU-D report (1999) D/tech/telemedicine/Doc2-166e.pdf D/tech/telemedicine/Doc2-166e.pdf WHO consultations and collaboration

What are the main uses? Educational purposes, e.g. SatelLife / HealtNet, SuperCourse Access to health information, e.g. HealthInternetwork Clinical trials, e.g. Swinfen Charitable Trust

HEALTHNET SatelLife’s computerbased telecom system that links health care professionals around the world. HealthNet-projects comprise: Physician collaboration Data collection Health care delivery Medical alerts Access to medical libraries Research

What do we know? Total number is small Few clinical trials Few evaluations conducted Few reported Bangladesh is one exception (Vasallo et.al 2001)

What do we need? More trials, e.g. more cases, to be evaluated and published Appropriate technologies Systems handling multiple communication channels Organization in place Tailored systems and software - again same prescription as for industrialized countries

international co-ordination & enthusiastic entrepreneurs

role for WHO? “However, to realize this potential a number of challenges need to be overcome. Here are some of them:... generating evidence that the technology contributes to performance improvement in health systems, helps build human capital for health and improves access to knowledge, supports decision-making, and leads to better outcomes for patients.” Dr. Gro Harlem Brundtland, Former Director General, World Health Organization, launching of the WHO CC for Telemedicine, Tromso Norway, December 2002

in other words Continuously monitor developments in relevant fields and country readiness for telemedicine advise member States when it is opportune to introduce such services strengthen the evidence base identify best practices strengthening collaboration

priority areas of work 1.Country work 2.Research and dissemination 3.Distance learning / human resources development 4.Health telematics knowledge base 5.Advisory role 6.Resource mobilization

vision Good, efficient and egalitarian health services through telemedicine

NST corporate idea We provide research, development and consulting services regarding telemedicine We work to ensure large-scale use of telemedicine services NST target group is the Norwegian public health care sector, but WHO-CC is global We are a multi-profewssional and project- based organization We cooperate with other private and public sector parties

1. Country work To provide support to WHO and its Member States, as appropriate, in the establishment, development, monitoring and evaluation of projects on application of health telematics and assessment of the telematics impact on health system performance

Country work Northwest Russia 1996-> Afghanistan pre-project Feasibility studies and consultations to Kyrgyz Republic, Cuba, Sri Lanka, Botswana, Nepal, Greenland, Bosnia and South Africa Pilot project proposal in Georgia

The first case

consultations

Guidelines to carry out feasibility studies Based on experiences from previous missions and projects Reference to litterature on the subject Collection of checklists, ”How to…” litterature To be tested in selected countries Wanted: Feedback, comments and input

3. Distance learning / human resources development …the development of a global teleeducation network of distance learning services for health professionals and communities.. a means for training and continuing education.

Distance leaning - history Major activity within the NST since the beginning Telemedicine Training Course 1998 Health Telematics Training Course for 3rd World countries 2000 Distance education programme with Russia since 1996

distance learning - perspectives Provide an overview of existing programmes and tools Recommendations of methodologies and concepts Integrated part of telemedicine projects Developing tailored courses

5. Advisory role To provide advice and answers to specific questions on health telematics and related issues to WHO and Member States through a ”hot line” and other appropriate mechanisms.

Strategies Close cooperation with existing recognized institutions and organizations International resource network National resource network Regional development focus Annual international workshops in Tromsø, TTC

what is needed? Entrepreneurs: Enthusiastic people with Real health care needs Appropriate technology Communication means (network) An organization willing to change Politics & strategic planning Economic incentives Legislation and licensing

what can we do ?