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eHealth: Global perspective

eHealth: Global perspective. S. Yunkap Kwankam Coordinator eHealth World Health Organization, Geneva. Outline of presentation. Six point agenda and health system framework WHO eHealth priorities WHO collaboration mechanisms Conclusion.

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eHealth: Global perspective

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  1. eHealth: Global perspective S. Yunkap Kwankam Coordinator eHealth World Health Organization, Geneva

  2. Outline of presentation • Six point agenda and health system framework • WHO eHealth priorities • WHO collaboration mechanisms • Conclusion

  3. WHO has a six point agenda for addressing gaps and improving public health Goal Description Accelerate development Foster health security Strengthen health systems Harness research, info & evidence Enhance partnerships Improve performance Bring life-saving and health-promoting interventions to the poorest of the poor Improve health security for all especially as it relates to emerging and epidemic-prone diseases Focus on capacity building, financing, systems for collecting vital statistics, and access to appropriate technology including drugs Generate authoritative health info, define standards, articulate evidence-based policy options & monitor evolving global heath situation Build partnerships with UN agencies and other international organizations, donors, civil society and the private sector Continually improve effectiveness of WHO initiatives and staff Fundamental health needs 1 2 Strategic needs 3 4 Operational approaches 5 6 Overall effectiveness of effort measured by impact on women’s health and health in Africa

  4. WHO eHealth priority action areas SNOMED HL7 v2.51 XML HTTP TCP IP Norms and standards Legal and ethical issues Access to health information HINARI Global Observatory for eHealth PPP for ICT R&D for health Global eHealth survey 2005 ICT for health workforce development ICT for health promotion ICT for service delivery eLearning Kenya Health Academy WHR 2006

  5. Interoperable HIS in countries with data communicated and merged across several dimensions Across district mediated initiatives Across programs Across geographies • Surveys • Homes • Facility • District Registration and census Registration and census Census Malaria Disease surveillance Health service statistics TB HIV/AIDS Across points of care Across technologies Community health worker Hospital Health clinic

  6. ICT & Health: a symbiotic relationship Health promotion Disease prevention Diagnosis & treatment Rehabilitative care Education & training HS performance Health needs drive developments in ICT ICT HEALTH Developments in ICT help shape health systems and service delivery Bioinformatics Artificial Intelligence Mobile computing Improved access Wider coverage

  7. Countries with a critical shortage of health service providers (doctors, nurses and midwives)

  8. Distribution of health workers by level of health expenditure and burden of disease, by WHO region

  9. Decision support: preliminary results from a phased implementation planned for the Map of Medicine in Africa Prof. S. Yunkap Kwankam1 Fatima Sanz de Leon1 Craig Rhodes2 Jon Conibear 2 Pam Nicklin2 1= World Health Organization, Geneva 2= Hearst Corp (Informa), UK

  10. What is the Map of Medicine? • A web-based visual representation of evidence-based patient care journeys • Covers 28 medical specialties • Contains 393 pathways • Used to support clinicians; not to replace clinical judgement

  11. Mobile Map A trial of the Mobile Map in 2007 had already proved very popular with Kijabe Hospital Kenya The Map of Medicine on PDA was recommended by participants in the Kenya pilot

  12. Mobile

  13. Mobile device with GPS Operating frequency Imaging - 2M pixel Messaging Multimedia Memory – 2 MB, 2GB SD GPS Voice features

  14. The future of eHealth is mHealth / uHealth

  15. Where people get their health care (USA) 1000 persons 800 report symptoms 327 consider seeking medical care 217 visit physician’s office; 113 of them primary care 65 visit complimentary care or alternative med care 21 visit hospital OP clinic 14 receive home health care Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM. NEJ M 344:26 2001 13 visit an emergency dept. 8 are hospitalized <1 is hospitalized in an AMC

  16. The Health Academy Investing in people, especially the younger generation Bringing together technology, health information, and education for the benefit of human development

  17. Global Observatory for eHealth (GOe) 112 countries responded 10 additional countries included in profiles Survey • 112 countries responded to extensive questionnaire • Acquired detailed national data on existing foundation and enabling policies and strategies and eHealth applications • Have heard that process of completing survey was a catalyst for bringing stakeholders together and fostering discussion and debate Report • Report distributed to 192 Member States and affiliated organizations • Paper, disc, and web versions widely available • However interviews indicate report not widely read due to need for greater promotion (e.g. through associations)

  18. Diffusion of the Internet: A Cross-Country Analysis∗; Luis Andrés, David Cuberes; Mame Astou Diouf; Tomás Serebrisky

  19. Diffusion of the Internet: A Cross-Country Analysis∗; Luis Andrés, David Cuberes; Mame Astou Diouf; Tomás Serebrisky

  20. Diffusion of the Internet: A Cross-Country Analysis∗; Luis Andrés, David Cuberes; Mame Astou Diouf; Tomás Serebrisky

  21. Exponential growth in information UC Berkley, 2003

  22. An early model of partnerships in health • The Second World Health Assembly (1949) laid down the policy (followed since then) that WHO should not consider the establishment, under its own auspices, of research institutions. Instead, it was agreed that research in the field of health is best advanced by coordinating and making use of existing institutions. • Thus, the concept of WHO Collaborating Centre (WHOCC) was developed. • Definition: the WHOCCs are institutions designated by the Director-General to carry out activities in support of the Organization's programmes at the country, regional and global levels.

  23. Currently there are 930 WHOCCsin 99 Member States

  24. Number of WHO collaborating centers by Region

  25. WHO Collaborating Centers by country

  26. The RF eHealth global initiative Develop and promote a global eHealth agenda - strategies to address common policy, organizational, technical, legal, financing and sustainability challenges identified through conference track and keynote sessions; Promote the importance of interoperability and open, standards-based platforms to donors, countries and technology companies Catalyze the formation of new collaborations around thematic areas and explore establishment of national platforms and a self-sustaining global eHealth coalition. Summer Bellagio series July 14-Aug 8, 2008

  27. Conclusion • Promoting a global vision and local insights • Human resources are key • People, processes and technology • Partnerships are the model • Major opportunities for collaboration

  28. Global Health ICT Spend USD74B Source: IDC 2007 30

  29. Focus of health investment should be on improving sector productivity, cannot just increase funding Level of HC spending is a function of GDP/capita regardless of external funding Healthcare is an inefficient sector, can improve productivity through technology Baumol's cost disease: Labor intensive services, such as health care, face productivity lag - cannot substitute capital for labor as efficiently as the general economy, so the cost of producing them goes up faster than general inflation R2 = 0.94 Health spend per capita (2005) • 5 ways to improve productivity: • Increase capital per worker • Improved technology • Increased labor skill • Better management • Economies of scale as output rises GDP PPP per capita (2005) The most effective way to improve productivity is to improve health systems Source: Nicholas C. Petris Center on Health Care Markets & Consumer Welfare (UC Berkeley), WHO, A Handbook of Cultural Economics (James Heilbrun)

  30. Effectiveness of health spending widely variableHealth outcomes not tightly linked to income level Log GDP/Capita (PPP) vs Childhood (<5) Mortality Rwanda Cote d'Ivoire Childhood (<5) Mortality (per 1000) Countries with similar profiles with very different health outcomes Togo Kenya R2 = 0.60 GDP PPP per capita (2005) Source: WHO Variation in health outcomes highlights considerable room for improvement of inefficient and ineffective health systems

  31. A Pierre de Fermat – like conjecture an + bn = cn €1 invested in eHealth = 1 DALY saved?

  32. THANK YOUkwankamy@who.int

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