1. Geneva, Switzerland, 26-27 April 2012 Barriers & opportunities to adoption: perspectives from Bangladesh Dr Sultan Shamiul Bashar, Medical Officer Management Information System DGHS, MOHFW, Bangladesh e-mail: dr.bashar@mis.dghs.gov.bd Joint ITU-WHO Workshop on e-Health Standards and Interoperability (Geneva, Switzerland, 26-27 April 2012)

2. Geneva, Switzerland, 26-27 April 2012 2 Introduction In our view, adoption of standards & interoperability framework in eHealth needs consideration from 2 perspectives: 1. National 2. Global Before explaining these perspectives, please allow me to give a brief overview of: health care infrastructures & eHealth in Bangladesh

3. Health Care Infrastructures Geneva, Switzerland, 26-27 April 20123 Geographic unit No. Average Population Health Facility Bangladesh-150 millSuper-sp. Hospitals Division723 mill Tertiary Hospital/ Medical College Hospital District642.5 mill District Hospital/ Medical College Hospital Sub-district4830.3 millSub-district hospital Union4,50135,500Union Health Center Ward13,50312,000 Community clinic – one for 6,000 population 18,000 community clinics ~600 hospitals ~24,000 day-care facilities ~150,000 health workforce

4. ehealth found phenomenal change in 3 years from 2009 Digital Bangladesh 2021 5-yr HPNSDP 2011-2016 with ambitious ehealth plan National Health Policy 2011 with ehealth as a major component Geneva, Switzerland, 26-27 April 20124 ehealth vision 2016

5. Internet Connectivity Currently 1,000 places, national to sub-district To scale to 20,000 places (USCs to CCs) by 2 yrs DHIS v2.7 Currently collecting data for >5,000 health facilities (national to union level) To be scaled soon to >20,000 health facilities Tele-medicine 8 centers with quality video Web camera in all district & sub-district hospitals Soon to be scaled to CCs Geneva, Switzerland, 26-27 April 20125 ehealth found phenomenal change…

6. Geneva, Switzerland, 26-27 April 20126 Databases HRM, PDS, Field Staff Info Supply Chain Management Health Facility Database Others mhealth Pregnancy care advice by SMS Complaint-suggestion box Health Statistics Distribution System Bulk SMS for health staffs Geneva, Switzerland, 26-27 April 20126 ehealth found phenomenal change… Hospital automation with OpenMRS 1 yr 3 hospitals (all modules) All district & sub- district hospitals (2 modules) 5 yrs All hospitals (all modules)

7. Recognition Geneva, Switzerland, 26-27 April 20127 United Nations Digital Health for Digital Development Award 2011 One of top 11 Global Innovations in 2011 The Manthan Award South Asia National Digital Innovation Awards 2010 & 2011

8. Barriers & Opportunities: National Perspective Problem Databases flourishing both within & outside health sector They lack uniform coding system for locations, common fields & options Opportunity of interoperability is being missed Hardware & network choice also often lack standardization Geneva, Switzerland, 26-27 April 20128 Barriers Lack of knowledge among database developers about standardization & interoperability Lack of knowledgeable & skill staffs in public sector Policy makers want quick solutions Inadequate communications & TAs from DPs Inadequacy of freely available standards

9. ehealth in preliminary stages - Still have time The Highest level Policy Support – Digital Bangladesh 2021 The country started initiative to develop Common National Coding System & Standards Geneva, Switzerland, 26-27 April 20129 Barriers & Opportunities: National Perspective MoH initiative to form multi- sectoral & GO-NGO-DP National HIS Steering Committee for interoperability & standardization issue A HL7 committee exists We prefer OpenSource SW (compatible with IMR, SDMX-HD, ICD-10, HL7 (e.g., DHIS, OpenMRS) Hardware choice follows ministry-wide approach Opportunities

10. Conclusions & Recommendations 1. Improve availability knowledge & practice of ehealth standards & inter-operability in developing countries 2. Ensure free & easy accessibility of ehealth standards 3. Improve DP coordination for ehealth 4. Increase ehealth TA for developing countries 4. Increase TA to developing countries with advancing situation of ehealth for generating global ehealth knowledge for replication 5. Consider geo- locations & common demographics to include for standards development Geneva, Switzerland, 26-27 April 2012 10

11. Geneva, Switzerland, 26-27 April 201211 Thank you! Woman receiving prescription from from Union Information & Service Center given by doctor at our office