Improving access to healthcare services by using information and telecommunication technologies.

1. Improving access to healthcare services by using information and telecommunication technologies. Information Session on « Digital Health for Rural Communities: Potential, Trends and Challenges » ITU, Geneva, 17 September 2010 Prof. Leonid Androuchko ITU-D Study Group 2, Q14-3/2: Telecommunications for e-Health International University in Geneva

2. Health and ITU • What are the relations between Health and ITU? • What is the role of ITU?

3. What is eHealth? (1) • The advances in medical science, biomedical engineering on one side and information and telecommunication technology on the other side are offering today wide opportunities for improving access to and quality of health care.

4. What is eHealth? (2) • eHealth is an umbrella term for health-related activities, services and systems, carried out over a distance by means of information and telecommunication technologies.

5. International Telecommunication Union(1) • The introduction of eHealth services in developing countries requires multidisciplinary collaboration, with active participation of both sectors:telecommunications and health care.

6. International Telecommunication Union (2) • ITU is active in the field of Telemedicine/eHealth from 1994, when developing countries during the time of the First World Telecommunication Development Conference in Argentina asked ITU to study this question from the angle of interest of developing countries. • From 1994 there are two streams of ITU complimenting activities: ITU/BDT Development Programs, ITU-Development Sector Study Group

7. International Telecommunication Union (3) • From 1994 till 2010, ITU implemented a lot of pilotprojects, missions, conferences and seminars in developing countries in order to demonstrate potential benefit of eHealth/telemedicine services and disseminate information on how to improve access to medical services for people living in rural areas. • Resolution 41 of ITU WorldTelecommunication Development Conference, which took place in 2002 in Istanbul, Turkey, recommended to all countries to create national eHealth Committees or Task Forces for such cooperation and coordination.

8. WHO • The World Health Assembly in May 2005 officially recognized eHealth and adopted Resolution WHA 58.28 establishing eHealth Strategy for the World Health Organization.

9. ITU, WTDC 2010 Hyderabad,India • Resolution (COM3/5) was approved on « Improving access to healthcare services by using information and communication technologies ».

10. ITU-D Study Group 2, Q-14 • The main goal of the study is how to assist developing countries in the introduction of eHealth services and solutions, covering the technical part. • This is the unique international study group in the ITU-D SG2, Q14 dealing with needs of developing countries.

11. How healthcare service in rural areas could be improved? • eHealth or Telemedicine is the one practical solution which exists today. • Access to healthcare services could be provided via telecommunication networks: fixed terrestrial network, mobile network, satellite network.

12. International Telecommunication Union • 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.

13. Mobile telecommunication in developing countries • The number of mobile phones in many developing countries is drastically increased during the last five years offering technical platform for many mobile eHealth services to be organized.

14. Mobile network coverage in selected countries (ITU, 2007) • Combodia 87%, Gambia 85%, Guinea 80%, Kenya 77%, Pakistan 90%, Rwanda 90%, Senegal 85%, Togo 85%, Uganda 80%, Zimbabwe 75%.

15. Comparison of mobile and fixed phones (Source – ITU)

16. Mobile networks in selected developing countries (Source – ITU )

17. Mobile eHealth in rural areas • There are two solutions: • Mobile phone can be used for management and consultations related to medical services. • Mobile eHealth care clinics/units traveling in rural areas from one village to another and connected to nearby hospital by wireless communication for consultations.

18. ITU-D Study Group 2, Q-14 • It was decided to prepare the questionnaire and ask the opinion of medical staff in developing countries about Telemedicine and eHealth. • It was also a question asking participants about their view with regard to the implementation of eHealth services.

19. ITU-D Study Group 2, Q-14 • The study was done in the following countries: Pakistan, Uganda, Bhutan, Sri Lanka, Saudi Arabia and recently in Mongolia.

20. How developing countries are informed about eHealth? (1) • The health care administrations in developing counreies are not well informed about potential benefit of eHealth services.

21. How developing countries are informed about eHealth? (2) • The Telemedicine Group of ITU-D SG 2 made a study among medical staff in five countries and found the following level of information: Pakistan-61%, Mexico-18%, Uganda-73%, Bhutan-31% and Malaysia-66%. • This average level is still low.

22. ITU-D Study Group 2, Q-14 • In favor of eHealth services • Uganda – 96.6% • Pakistan – 86.5% • Bhutan – 87.5% • Sri Lanka – 81% • Saudi Arabia – 90.7% • Mongolia – 77%

23. What is it nesessary to speed up the implementation?

24. What is it nesessary to speed up the implementation?

25. Why eHealth services are not implemented? • Main obstacles: • Lack of Government policy • Lack of the knowledge about eHealth successful projects • Lack of training at all levels

26. ITU Strategies for e-Health 1. Advance the establishment of ICT infrastructure 2. Provide tools for the development of national e-health strategies 3. Promote cooperation among relevant stakeholders 4. Facilitate information exchange 26

27. 1.Advancing ICT Infrastructure Connecting the unconnected remains a challenge: • High speed broadband connectivity, needed for key e-health applications, is expensive or unavailable • Insufficient local content • Traditional business models often do not support the needed investment • Few trained people in the required technologies 27

28. Wireless Broadband Initiative Objective : Expected outcomes : • Ambitious ITU initiative to expand broadband access in underserved areas of Africa • ITU’s initiative: ITU is working with governments and other partners • Develop and deploy wireless networks • Guarantee capacity for schools and hospitals • Train local experts and build human capacity • Develop ICT Applications: e-health, e-education, e-government 28

29. 2. Providing Tools • Practical guidelines for the development of national e-Health strategies will developed in collaboration with WHO and the World Bank in 2010 • TheGuidelines for National e-Health Strategies: • Methodology to assess actual Health System Status, Needs and Action Priorities • An integrated Action Framework covering: Infrastructure, Applications, • Financing, Governance, Legal and policy, Human Capacity, Information quality • Guidance on how to set eHealth targets, benefits and Key Performance • Indicators 29

30. Providing Tools (cont.) • Practical guidelines to map e-Health • infrastructure to desired outcomes • Survey some of the major Tele-health initiatives • in India comprising basic information about activities • and infrastructure • Grouping of activities across care cycle within • various services • Map of Activities and diseases being addressed by • those activities, correlated to corresponding infrastructure being utilized • Map the gaps between the desired and existing facilities as evidenced • by some of the efforts • Provideinsights in terms of infrastructure planning for eHealth. 30

31. 3. Promoting Cooperation • The introduction of e-Health applications requires multidisciplinary collaboration • ITU facilitates the establishment of public-private partnerships • All countries to create national e-Health committees or Task Forces for cooperation and coordination • Based on Resolution 41 World Telecommunication Development Conference (Istanbul, 2002) 31

32. Cooperation: Digital He@lthInitiative (DHI) • ITU is co-chairing the DHI, a unique, multi-stakeholder • collaboration between the ICT and healthcare sectors : • Harness digital health care solutions for scaling up • Interventions in even the most resource poor settings. • Map the current state of play in this field • Develop an economic model for policy-makers and practitioners • Put in place a partnership platform for fast and high impact • country-specific projects of regional importance • Put in place a partnership platform for fast and high impact • country-specific projects of regional importance 32

33. Cooperation: ITU Study Groups on e-Health • Study Groups (SG) dedicated to e-Health related issues : • ITU-D SG 2 Question 14-2/2: Telecommunications for e-Health • ITU-T SG 16 Question 28/16: Multimedia Framework for e-Health Applications • ITU-T SG 17 Question 9/17: Telebiometrics • These Study Group Questions bring together ITU diverse members (government, industry, academics, other stakeholders) to lead the work (studies, recommendations, best practices) on diverse aspects of e-Health 33

34. Cooperation : SG2/Q14-2/2 m-Health support • Goal: Promote the coordinated introduction of cost-effective mHealth applications in developing countries • ITU Study Group 2, Q14 is discussing with members of industry and Research organizations to assit developingcountries introducingmHealth solutions: • Mobile phones can be integrated into a computer system to create an integrated health care information system • mHealth technology for rural areas can also include mobile healthcare units • Provide tailored support to developing countries to transfer • knowledge, build local capacities, implement feasibility studies • and support elaboration of project proposals to deploy • large-scale, simple and cost-effective mobile solutions for Health 34

35. Cooperation :SG2/Q14-2/2 m-Health support Mobile Health Information Services Mobile clinics& Portable eHealth terminals Telemedicine services in remote areas (Telediagnostics, Teleconsultations, Telecare, etc.) Emergency Telemedicine services 35

36. Remaining Challenges Need for improved evidence of the economic and social benefits of e-Health Problems achieving interoperable e-Health applications and standardization Many pilots for e-Health projects exist, but scalability is an issue Improved communication between telecom and health sectors 36

37. Conclusions (1) • The telecommunication and health care sectors have to work together in developing national e-Health strategies • Successful e-Health services require commitment to promote national strategies and facilitate capacity building • Developing countries urgently need a strategic document – eHealth Master Plan and a Roadmap

38. Conclusion 2 • Effective governance of eHealth requires codes, regulations, and standards to ensure satisfactions of the consumers. • Issues include legal liability, ethical standards, privacy protection, and cultural and social standards.

39. Additional Resources ITU statistical database of ICT indicators per country and region(www.itu.int/ITU-D/ict/index.html) Expert aid in drafting and implementing national e-Health projects (www.itu.int/ITU-D/projects/index.html) Training opportunities (www.itu.int/ITU-D/hrd/tc/index.asp) Policy and regulatory reports and symposia(www.itu.int/ITU-D/treg/index.html) Regional office in Addis Ababa to support Member States in Africa (www.itu.int/ITU-D/afr/CMS/index.asp) 39

40. Thank You! For more information on ITU’s e-Health Activities visit the website at: www.itu.int/ITU-D/cyb/app/e-health.html