IP based network for eHealth applications: practical cases in Developing Countries Marco Obiso and Desire Karyabwite International Telecommunication Union November 2008

WHO The World Health Report 2006 « Working together for Health  » presented an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide.

Developing Countries How to help developing countries to improve health care services? How to help the population living in rural areas to get better access to health care services?

How healthcare service in rural areas could be improved? eHealth or Telemedicine is the only solution which exists today. Access to healthcare services could be provided via telecommunication networks.

eHealth/Telemedicine eHealth/Telemedicine is a digitalized health service supporting medical staff in routine work ensuring easiness of data transfer and on time, cost effective, time saving, 24 hours a day patient care without physical presence of patient and doctor at the same location.

WSIS The World Summit on the Information Society (WSIS), which was held in two phases: the first in Geneva, 10-12 December 2003 and the second in Tunis, 16-18 November 2005, has included eHealth in Geneva Plan of Action as one of the important ICT applications.

WSIS Promote collaborative efforts of governments, planners, health professionals, and other agencies along with the participation of international organizations for creating reliable, timely, high-guality and affordable health care… through the use of ICT…

WSIS Encourage the adoption of ICTs to improve and extend health care and health information systems to remote and underserved areas and vulnerable populations, recognizing women’s roles as health providers in their families and communities

WHO Resolution on eHealth In May 2005, the Fifty-eighth session of the World Health Assembly officially recognized eHealth and adopted Resolution WHA58.28 establishing eHealth strategy for the World Health Organization.

WHO Resolution on eHealth « …eHealth is the cost-effective and secure use of information and communication technologies in support of health and health-related fields… »

WHO Resolution on eHealth Recommended to prepare “…long-term strategic plan for the developing and implementing eHealth services in the various areas of health sector”. National eHealth Master Plan

International Telecommunication Union (ITU) The introduction of eHealth applications requires multidisciplinary collaboration, with active participation of telecommunication operators and health care professionals.

ITU/BDT Resolution 41 of World Telecommunication Development Conference, which took place in 2002 in Istanbul, recommended to all countries to create national eHealth Committees or Task Forces for such cooperation and coordination.

BDT Programme 3 (E-strategies and ICT applications) Cost-effective, interoperable and socio-economical telecommunications and information and communication technology (ICT) in health care are essential to fostering implementation of eHealth initiatives in developing countries.

BDT Programme 3 Activities (1) Preparation of eHealth Master Plan for selected developing countries. Wide promotion of the best practic in the eHealth field to developing countries be organizing regional and international workshops, seminars, conferencies.

BDT Programme 3 Activities (2) Cooperation with WHO on eHealth at different levels. Coordinate Mobile eHealth Applications for rural areas in developing countries by setting up under BDT/ITU umbrella the « Mobile eHealth Alliance ».

ITU-D, Study Group 2 Question 14-2/2 – Telecommunication in eHealth Question exists from 1994 Several reports have been prepared Latest one – Making Better Access to Health Care Services

ITU-D, Question 14-2/2 Take further steps to assist in raising the awareness of decision-makers, regulators, telecommunication operators, donors, etc. about the role of telecommunication and information technologies in supporting health-care and healthy life in developing countries

Question 14-2/2 Assist in the development of National eHealth Master Plan by providing information on the best technical solution taking into account the local telecommunication network.

Republic of Maldives (as example) eHealth Master Plan has been prepared be experts from Q14 Group and the Telecommunications Authority of Maldives (Mr. Mohamed Nasih, Director) This Document was prepared on the voluntary basis without any financial expenses from BDT/ITU.

Why eHealth Master Plan is so important?(1) Public health is the sovereign responsibility of States, that no health or eHealth project can be implemented in the field without the agreement of the competent authorities.

Why eHealth Master Plan is so important? (2) It has to demonstrate that eHealth application to be developed is beneficial: to the patient (in terms of time, quality care received; cost, etc.), to the medical staff (in terms of productivity, competencies, etc.) to the community (in terms of public health for everybody)

What is the best telecommunication technology for eHealth services in rural areas? It is a difficult question. The universal solution is not exist. Nevertheless, mobile telecommunication has a big potential to be used as a platform for eHealth services. IP advanced technologies

Mobile Technology(1) Many developing countries have already introduced 3G mobile. The mobile phone can be integrated into a computer system by a variety of means (for example, infrared) to create the integrated health care information system.

Mobile Technology (2) Mobile Technology for eHealth in rural areas can also include a mobile health care unit. There are several good examples: India – ophthalmology care Russia Indonesia

Russia. Mobile Unit

Tele-Ophthalmic Van – Aravind Eye Hospital MOBILE TELEMEDICINE To overcome the prohibitive costs of large number of terminals and reaching out to the rural areas Tele-Ophthalmic Van – Shankara Nethralaya Tele-Ophthalmic Van – Aravind Eye Hospital

Point to Point system Russia and India are using satelitte technology to connect mobile health care unit with a hospital. The system diagram is presented at the next slide.

Point to point System Patient end Doctor end 12 Lead ECG A3 Scanner SkyIp Terminal Video Conferencing Camera SkyIp or FlexiDama Terminal OR Digital Camera Switch Video Conferencing Camera Hub/Switch Doctor-End Station TV Monitor TV Monitor District Client Station

Mobile WiMAX wireless access technology Turkey. It was successful demonstration how WiMAX could be used to send information in real time from the ambulance carrying a patient to a hospitals’s emergency room. Lebanon. The telemedicine systems in Governmental Hospital in Nabatiyeh provide real-time video consultation between phisicians kilometers apart, the ability to share data and to diagnose patients from afar.

Problems (1) So far the Ministries of Health are not convinced that eHealth/telemedicine not only saves lives but saves money. The Ministries around the world still see eHealth as an expensive technology that needs to get in line far behind immunization and maternal health.

Problems (2) They know perhaps that eHealth could make a huge contribution to maternal and child health and even immunization; but the message has not been accepted so far. The solution is with National eHealth Master Plan.

ITU-D SG-2, Question 14 In order to understand how medical staff in developing countries is aware about eHealth, eHealth survey was organized in several developing countries. The majority does not know what is eHealth. As an example, on the two next slides the information received in Uganda and Pakistan are presented.

Uganda,Mulago Hospital Complex, Kampala (58 staff) What would be necessary to do in order to introduce eHealth services?

Pakistan, Medical staff in Rawalpindi and Islamabad (111) What would be necessary to do in order to introduce eHealth services?

Survey’ Conclusion Money is not a main obstacle for the introdiction of eHealth services. 15.9% Medical staff needs more information about best telemedicine practice and training. 69.7%

Conclusion (1) Telecommunication and medical professionals have to work together in order to develop eHealth Master Plan for each country. Telecommunication authority has to initiate this process. BDT/ITU is ready to provide any assistance.

Conclusion(2) Experience demonstrates that there is no single solution that will work in all settings. The complexity of technologies and the complexity of needs and demands of healthcare suggests the gradual introduction, testing and refining of new technologies.

Conclusion(3) Successful eHealth services require more than just technology. For any eHealth system to work in practice – in real clinical situation – suitable, committed personnel are essential.

Thank you for your attention For the further information please contact Marco Obiso, BDT, marco.obiso@itu.int Leonid Androuchko, Rapporteur Q14, landrouchko@iun.ch