IP based network for eHealth
applications: practical cases
in Developing Countries
Marco Obiso and Desire Karyabwite
International Telecommunication Union
November 2008
1
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.
2
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?
3
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.
4
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.
5
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.
6
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…
7
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
8
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.
9
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… »
10
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
11
International Telecommunication
Union (ITU)

The introduction of eHealth applications
requires multidisciplinary
collaboration, with active participation
of telecommunication operators and
health care professionals.
12
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.
13
BDT Programme 3 (E-strategies
and ICT applications)

Cost-effective, interoperable and socioeconomical telecommunications and
information and communication
technology (ICT) in health care are
essential to fostering implementation of
eHealth initiatives in developing
countries.
14
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.
15
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 ».
16
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
17
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
18
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.
19
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.
20
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.
21
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)
22
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
23
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.
24
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
25
Russia. Mobile Unit
26
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
27
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.
28
Point to point System
Patient end
Doctor end
12 Lead ECG
A3 Scanner
SkyIp
Terminal
Digital
Camera
Video Conferencing
Camera
OR
Switch
SkyIp or
FlexiDama
Terminal
Video Conferencing
Camera
Hub/Switch
TV Monitor
TV Monitor
Doctor-End
Station
District Client Station
29
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.
30
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.
31
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.
32
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.
33
Uganda,Mulago Hospital
Complex, Kampala (58 staff)
What would be necessary to do in order
to introduce eHealth services?
Uganda
30.6
28.4
21.6
19.4
financial
support
training
Series1
more
informaton on
eHealth
35
30
25
20
15
10
5
0
good will of
health
administration
%

34
Pakistan, Medical staff in
Rawalpindi and Islamabad (111)
What would be necessary to do in order
to introduce eHealth services?
Pakistan
38
30
22
Series1
financial
support
training
10
more
informaton on
eHealth
40
35
30
25
20
15
10
5
0
good will of
health
administration
%

35
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%
36
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.
37
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.
38
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.
39
Thank you for your attention



For the further information please
contact
Marco Obiso, BDT, [email protected]
Leonid Androuchko, Rapporteur Q14,
[email protected]
40