Transcript HEALTHCARE TRENDS South African Medical Association

E-health solutions for healthcare
systems in developing countries Africa
“How to use Information Technology to improve Quality and Safety in
Patient Care”
Scientific Session on Health Care Information
Technology:
175th WMA Assembly in Copenhagen, Denmark 4 October 2007:
By: Dr Monwabisi Gantsho
(South African Medical Association)
Agenda item in the WMA General
Assembly: Copenhagen 2007 and
Pilanesberg 2006 (Doc.
GA/Agenda/Oct2006).
• The Danish Medical Association had proposed
“Health Care Information Technology” as the
theme for the 2007 Scientific Session
• eHealth may be described as the combined
use of electronic communication and
information technology for the health sector.
– eHealth can be considered to be the health
industry's equivalent of e-commerce.
WMA Dues Categories for 2007 is
According to
• World Bank Country Classification 2006*
• Based on Gross National Income (GNI)
• Category C: Upper-middle-income economies
(40): @ € 1,50 per member
• In Africa the following countries are in Category C:
– South Africa, Equatorial Guinea, Gabon, Libya, Mauritius,
Seychelles.
• * For complete information on the World Bank
classification refer to:
• http://www.worldbank.org/data/countryclass/countrycl
ass.html
Declaration made by the World Summit
on Information Society (WSIS) in
Geneva 2003
• challenge is to harness the potential of Information
and Communication Technology (ICT) to promote the
development goals of the Millennium Declaration,
namely:
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the eradication of extreme poverty and hunger
achievement of universal primary education
promotion of gender equality
empowerment of women
reduction of child mortality
improvement of maternal health
to combat HIV and AIDS
malaria and other diseases.
Innovation, excellence, impact &
sustainability
In a developing country it is critical to find
alternatives to conventional infrastructural
delivery in the fields of:
– Telephony
– Internet access
– Power generation
The aims are:
 Prevention is better than cure
 Early Diagnosis and accurate prognosis
 Appropriate treatment and rehabilitation
 Good quality of life at cost effective levels
Innovation, excellence, impact &
sustainability
Tools, challenges and opportunities:
1. Cost efficiencies and economic viability
2. Flexibility and mobility of the ICT
3. Political will and governments capacity
4. Among developing countries in Africa, South Africa
is relatively fortunate:
a.
b.
Small pool of technological skills
Dept of Science &Technology 10 yr plan:
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Biotechnology
Safe, clean, efficient energy generation
Social science studies to understand change in social
dynamics and climate change.
“need to balance resource based economy with
knowledge based economy”
Mpumalanga
Witbank Town
& Maputo
Province,
of
Corridor
Mangweni
Clinic
Pretoria
Mbuzini
Clinic
Tonga Hospital
E-health experiences in Africa
and Developing countries
• Physicians, obstets & gynae specialists:
sonograms examinations of rural women to reduce
perinatal & neonatal mortality rates.
• Internal medicine & dermatology specialists: study
skin & mucousal lesions, diagnosis, management
& control of various STIs.
• Ophthalmologists: examining eyes & retinas of
patients in remote rural areas
• Radiologists: receive & interpret diagnostic
radiographic studies from remote areas including
emergencies
• Pathologists: examining pap smears, blood
smears, bone marrow & other tissue smears
Infrastructure Indicators in
SA
– Electricity (71%) Top 10 African countries,
in effective teledensity, 1993 and 2004
– Radio (> 95%)
30.0
Reunion
14.2
Seychelles
– Television (70%)
South
Africa
– Telephone:
– Fixed Lines
(10%)
– Mobile ( 40%)
– Computer (10%)
– Internet access
(7%)
4.8
Tunisia
4.4
Namibia
4.2
Mayotte
3.8
Egypt
3.7
Algeria
Average
3.7
1.6
Seychelles
60.8
43.1
Mauritius
7.3
Libya
79.3
South Africa
9.3
Mauritius
Reunion
1993:
South Africa =
3rd with
teledensity 6.1
times greater
than African
average
41.4
Gabon
36.2
Tunisia
35.9
Botswana
31.4
Morocco
30.1
22.8
Mayotte
Source: ITU World
Telecommunication
Indicators Database.
Mauritania
Average
2004:
South Africa =
3rd with
teledensity 4.9
times greater
than African
average
17.5
8.8
Note: Effective
Teledensity is either
mobile or fixed-lines
per 100 inhabitants,
whichever is higher.
TELEMEDICINE and
TELEHEALTH
• Telemedicine
is the use of information
and communications technology for
delivery of healthcare services:
– Clinical: Health management: Health Educationprevention, diagnosis and treatment
– Practice of medicine over a distance where
interventions, diagnostic & treatment decisions are
based on data, documents & information transmitted
through telecommunication systems.
– All principles of medical ethics apply to telemedicine
• Telehealth is more precise because it involves all
aspects of health services using audio, visual and data
communications.
Telemedicine & Heath
Information Technology
• Patient Physician relationship & confidentiality must
be respected.
• Data obtained during these processes must be
secured through encryption and other security
precautions to avoid unauthorised access.
• Continuity of care should be guaranteed
• First contact physician using E-health or referral
should remain responsible for all decisions
• Possible weaknesses of E-health in emergencies
must be acknowledged. Available know-how and
capacity should influence advice and treatment.
• WMA and NMAs should encourage development of
national legislation and international agreements.
The CHALLENGE in Africa
• Unequal Development - Unemployment
• Poverty forms breeding Ground for Diseases HIV/AIDS, Malaria, TB.
• South Africa has now introduced: Telederm
• Limited HR- One radiologist for each province or
region without Medical Schools.
• Peace Keeping Missions In Africa as Part Of
NEPAD Initiatives.
E-health competitive advantage
• Telemedicine is NOT meant to replace
strategies implemented to overcome poverty,
access to water nutrition promotion and
sanitation
• It is merely a response to scarce resources
for dealing with health problems.
• The greatest challenge to Africa and
developing world is lack of vital infrastructure
to deliver comprehensive e-health solutions.
Telemedicine Sites
Remote sites
Referral sites
Northern Province
Gauteng Mpumalanga
North West
Free State
KwaZulu-Natal
Lesotho
Northern Cape

Eastern Cape
Western Cape
MRC
Produced by: Health GIS Centre, M RC
Source: M RC Telemedicine Programme
0
150
Kilometers
300
One of the first African Telemedicine
initiatives: UNITRA & AFIP
One of the first African Telemedicine
initiatives
•
Sitting in Pretoria and locating the beating heart of a foetus in a Free
State hospital through a TV screen:
•
Tanzania and Uganda linking up with Canada in 1986
Results of early implementation
Examples in SA
• Tele-Radiology
• Tele-Ultrasound Antenatal Care
• Primary Health Care (PHC) telemedicine
research testbed
• Using a health broadcast channel as a means
of disseminating information about HIV/AIDS
in South Africa
TELERAD
• 3 Provinces: North West, Free State
and Mpumalanga provinces
• 1 Receive site: the Provincial
Tertiary Centre and 3 send sites:
the District Hospitals.
• Average distance is 200 km. Av
population is 3-4 million per
Province
The documented cases that were sent for
tele-consultation comprised:
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62.7% chest disease and Trauma
11.5% spine Trauma
7.3% upper/lower extremities trauma
6.2% bone disease
5.5% abdominal
4.2% head trauma
2.6% paediatrics
The Tele-Ultrasound
Antenatal Care
 To move the pre-natal
ultrasound services from the
provincial referral centre to the
primary care centre
 Train providers in the use of
ultrasound
 Tele-consultation
for complicated pregnancies.
The PHC Telemedicine Research
Testbed
• Nkomazi District of Mpumalanga Province
• Tonga Hospital and 3 clinics.
• Locally Designed and build Primary Healthcare
Telemedicine Workstation.
• The Research sites are linked to other institutions
• Testbed is used for clinical research and
development of new Telemedicine Technology:
• Affordable and sustainable technology that
support PHC
• And Tele-education services in Southern
Africa and Africa.
Telederm Pilot Study:
University of Cape Town
• Authors: Roy Colven, MD, Mi-Hyun Mia Shim,
and Gail Todd, PhD, FFA (Derm)
• Improvement in Primary Provider Diagnostic
Acumen Using a Teledermatology Network in
rural South Africa
• Abstract for the 13th American Telemedicine
Association meeting, Seattle, Washington, April
2008
Telederm Pilot Study
• Teledermatology as a tool for improving
delivery of scarce dermatological care
• directly reduces the burden of skin disease
and improve the quality of health-care
practice in remote areas.
• However, data that demonstrate the extent of
sustainable benefits derived from
teledermatology support are currently
insufficient
Telederm: Pilot study
• evaluating primary-care provider (PCP) satisfaction &
assessing change in diagnostic concordance
between referring providers & teledermatologists over
time.
• A network was established to link University of Cape
Town dermatology consultants to providers from six
underserved primary-care sites using asynchronous
store-and-forward technology between October 2004
and January 2007.
• RESULTS: 13th American Telemedicine Association
meeting, Seattle, Washington, April 2008
Mpumalanga
Witbank Town
& Maputo
Province,
of
Corridor
Mangweni
Clinic
Pretoria
Mbuzini
Clinic
Tonga Hospital
MRC WORKSTATION AT
TONGA HOSPITAL
Activity Between Witbank and Pretoria Academic
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36
24
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20
01
2
17
17
4
8
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8
11
10
0
JAN
FEB MAR APR MAY JUN
JUL
AUG SEP OCT NOV DEC
Head Injury CT Cases
Head Injury Telemedicine Consultations
Head Injury Telemedicine Transfers
Using a health broadcast channel as a means of
disseminating information about HIV/AIDS in South
Africa
Using a health broadcast channel as a means
of disseminating information about HIV/AIDS in
South Africa
Evaluation Results
 Access to specialist radiologist
reporting within an hour compared to
5 to 7 days
 Improves medical ability to diagnose
and manage various medical
conditions particularly those related to
trauma and chest diseases.
 Reduced professional isolation
Percentage of GDP Spent on health
Percentage of GDP Spent
16
14
12
1999
10
2000
8
2001
6
2002
4
2003
2
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Br
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s
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tin
Ar
g
So
u
th
Af
ri
ca
0
Health Financing
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Public health
expenditure as a
% of GDP
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Total health
expenditure as %
of GDP
Public vs. total health expenditure as a percentage of
GDP
Summary
• ICTs appear to hold the key to meeting some
of the challenges that face healthcare
especially in the developing countries. The
challenges are however considerable but
achievable. They include the technological,
socio-economic and political issues. Not only
is facilitating access crucial but so is ensuring
that those with access are able to derive the
greatest benefit from it.
CONCLUSION
• The most critical components of ehealth are the end users – the health
care providers and the patients.
• It is the people and not the
technology that determines the
operational success of the system.
Thank you