Stephen Settimi Sr. Fellow & Technical Advisor -USAID Global Health, ICT/Knowledge Management

1. Mini University Presents A Basic Operational Framework for eHealth and Telemedicine: How to Get Started 05 Oct 2007 Stephen Settimi Sr. Fellow & Technical Advisor -USAID Global Health, ICT/Knowledge Management SSettimi@usaid.gov http://www.usaid.gov/our_work/global_health/ United States Agency for International Development 1300 Pennsylvania Avenue, NW 3.6.35 Washington, DC 20523-3600 Tel.  (202) 712-1292  Fax: (202) 216-3485 Cell: 619-507-8311 "We are today where we planned to be yesterday."

2. Let's get started!

3. Vocabulary for Discussion  • eHealth • Telemedicine • ICT (Information & Communication Technology) • Informatics • Databases • Resources • Stakeholders • Intellectual Capital • Capacity Building • Public Goods • Frameworks A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

4. Getting the Right Framework to Fit Right

5. Country Focus How do we put into place a Framework within the context of Country Z? A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

6. Steps to Developing a Framework… • STEP #1 Identify opportunity inroads • STEP #2 Determine Probability of Success • Identify the Stakeholders • Determine interest level of stakeholders • STEP #3 Assess the resource base • STEP #4 Develop tactics and strategy for success A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

7. Identify Opportunity Inroads-or the Working Ecology • Resource challenged environments • Low Doctor to Client ratio (e.g., 1: 1555 Pakistan) • High Rural Populations Levels (50% to 75%) • Low educational Level • Lack of Infrastructure • Policy Supportive • Civil Society Supportive • Population Supportive • Private Sector Support A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

8.  Determine Probability of Success   > Identify Stakeholders> Assess the strength of the working relationship Assess likelihood of success by using Social Network Mapping for any given initiative: e.g., an eHealth Telemedicine program. Narrower gap = High reliance factor: USAID = high importance USAID = high closeness ARBEF WHO CAMERWA USAID CHK UNFPA CNJ Wider gap = Under Utilization: HIS-SIS = high importance HIS-SIS = low closeness CNLS CPLS FHI MINEDUC GTZ FP Priority MINALOC HIS -SIS Closest Entities MIGEPROF IntraHealth A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

9. Update:Status Report Stop • STEP #1 Identify opportunity inroads • STEP #2 Determine Probability of Success • Identify the Stakeholders • Determine interest level of stakeholders • STEP #3 Assess the resource base • STEP #4 Develop strategy and tactics for success A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

10. 4 Requisite Resources • Material • Capital • Human • Informational A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

11. Material • Information • Human • Capital Remember these 4 Requisite Resources Remember Resources are interdependent • 4 Requisite Resources • Material • Capital • Human • Informational A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

12. Information Resources • Evidence that supports eHealth and Telemedicine programs • Data that can drive processes • Social Networks • Other informational resources? • Resource challenged environments • Low Doctor to Client ratio (e.g., 1: 1555 Pakistan) • High Rural Populations Levels (50% to 75%) • Low educational Level • Lack of Infrastructure • COUPLED WITH…. • High infant mortality • High maternal mortality • Low vaccination rates • Malnutrition • Frequent or extreme Epidemiological events • What processes can we drive with these data? • Mother’s DOB and Natal Status • Child’s DOB • Location of Client (Patient) to nearest services What are Social Networks? Why are they informational resources? A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

13. Challenges toAcquiring Information Resource A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

14. Human Capital Resource ARBEF Key Stakeholders MIGEPROF CAMERWA ARBEF HSI MINALOC MOH MINEDUC * A hypothetical listing WHO CAMERWA USAID CHK UNFPA CNJ CNLS CPLS FHI MINEDUC GTZ MINALOC HIS -SIS MIGEPROF IntraHealth A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

15. Challenges toAcquiring Human Capital • Educational attainment level • Money for salaries • “Brain Drain” (attrition / retention) • Competing industries • Other? A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

16. Update:Status Report Stop • STEP #1 Identify opportunity inroads • STEP #2 Determine Probability of Success • Identify the Stakeholders • Determine strength of relationship • STEP #3 Assess the resource base • Information • Human • Capital • Material • STEP #4 Develop tactics and strategy for success A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

17. Capital Resource$ • Is Public Health a “Public Good”? • Who’s the public? • Does the public pay for this good? • Will those who pay for the good get value for the good? • What if you can’t pay for the good? • What sources of finance are available to pay for public goods? A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

18. Material Resources What physical resources would be required to implement eHealth or telemedicine programs? • a facility (building or virtual) • computer • telephones (land-lines or cell phones) • electricity • other devices A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

19. Update:Status Report Stop • STEP #1 Identify opportunity inroads • STEP #2 Determine Probability of Success • Identify the Stakeholders • Determine strength of relationship • STEP #3 Assess the resource base • Information • Human • Capital • Material • STEP #4 Develop tactics and strategy for success A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

20. ARBEF WHO CAMERWA USAID CHK UNFPA CNJ CNLS CPLS FHI MINEDUC GTZ MINALOC HIS -SIS MIGEPROF IntraHealth One Tactic: Create a Task Force from Stakeholders (both Current and Desired) TASK FORCE A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

21. ARBEF WHO CAMERWA USAID CHK UNFPA CNJ CNLS CPLS FHI MINEDUC GTZ MINALOC HIS -SIS MIGEPROF IntraHealth Tactic: Create a Task Force from Stakeholders (Current and Desired) Task Force A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

22. ARBEF WHO CAMERWA USAID CHK UNFPA CNJ CNLS CPLS FHI MINEDUC GTZ MINALOC HIS -SIS MIGEPROF IntraHealth TASK FORCE Tactic: Create a Task Force from Stakeholders (Current and Desired) A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

23. ARBEF WHO CAMERWA USAID CHK UNFPA CNJ CNLS CPLS FHI MINEDUC GTZ MINALOC HIS -SIS MIGEPROF IntraHealth TASK FORCE Tactic: Create a Task Force from Stakeholders (Current and Desired) A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

24. POLICY-MAKERS DR or NURSE POLICY-MAKERS CLINIC OR HOSPITAL DR or NURSE PATIENT or CLIENT CLINIC OR HOSPITAL PATIENT or CLIENT Task Force Models CLINIC OR HOSPITAL DR or NURSE POLICY-MAKERS PATIENT or CLIENT A B DR or NURSE POLICY-MAKERS CLINIC OR HOSPITAL PATIENT or CLIENT C D A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

25. SUMMARY Steps toward an eHealth Telemedicine Framework • STEP #1 Identify opportunity inroads • STEP #2 Determine Probability of Success • Identify the Stakeholders • Determine strength of relationship • STEP #3 Assess the resource base • Information • Human • Capital • Material • STEP #4 Develop tactics for success Develop a tactics and strategy for success A Basic Operational Framework for eHealth and Telemedicine: How to Get Started

26. Thank you! Stephen Settimi Sr. Fellow & Technical Advisor -USAID Global Health, ICT/Knowledge Management SSettimi@usaid.gov http://www.usaid.gov/our_work/global_health/ United States Agency for International Development 1300 Pennsylvania Avenue, NW 3.6.35 Washington, DC 20523-3600 Tel.  (202) 712-1292  Fax: (202) 216-3485 Cell: 619-507-8311 "We are today where we planned to be yesterday." A Basic Operational Framework for eHealth and Telemedicine: How to Get Started