for Developing Countries

Transcription

1 Global e-health Research and Training Program Health Innovation and Information Technology Centre An ehealth Strategy Framework for Developing Countries Dr. Richard E. Scott Associate Professor, Global e-health Research and Training Program, Health Innovation and Information Technology Centre; Harkness Associate; Fulbright New Century Scholar; Past-President, Canadian Society of Telehealth Med-e-Tel, Luxembourg 2 April

2 For Today -Topics- Sustainable ehealth solutions Planning for success 2

3 HSBC Advertisements - Perspective - Privilege Sacrifice Role Model Adventure Fear Debt People value the same things, but in different ways 3

4 From Here to There - Perspective - If you don t know where you are going, any road will take you there!

5 ehealth STRATEGY - Differential Diagnosis- A systematic method of diagnosing a disorder that explains a presenting signs and symptoms.

6 Sustainable ehealth Solutions - What Does the Literature Say? - Wright D, Androuchko L. Telemedicine and developing countries. JT Telemed dtelecare, 1996;2(2): Adeyinka MB. Fundamentals of modern telemedicine in Africa. Methods Inf Med., 1997 Feb;36(2):95-8. Picot J. Telemedicine and telehealth in Canada: forty years of change in the use of information and communications technologies in a publicly administered health care system. Telemed J., 1998, Fall;4(3):

7 Why are we not Sustainable? - What the Literature Says - 1. Stakeholder participation and management (cradle to grave) 2. Patient and societal needs-based solutions 3. Appropriate technology (right solution in the right place for the right reasons; simple, inexpensive) 4. Evidence-based decision making 5. Balance health opportunity costs of resources (redirect any cost savings) 6. Resource dedication (clinical, management, ehealth experts) 7. Priority setting 8. Evaluation outcomes and CBA (evidence of value ) 9. Implementation and integration plans 10. Training (technical and professional) 11. Policy and procedure (development and inter-jurisdictional collaboration) 12. Strategic intent and government support 13. Context part of an overall health system (convergence) 14. Funding transition 15. Strategic solutions (not technological imperative or clinical champion focus) 16. Change management 17. Readiness (community, organisational, and individual) 18. Business case and business plan development 19. Staged implementation 20. Cultural sensitivity (local context; local solutions; local awareness; not N/S transfer) 21. Equipment resilience (differing N/S needs; e.g. lack of environmental control) 22. Knowledge transfer for others gain 23. Data preservation 7

8 Sustainable ehealth Solutions - Sustainability ~ Do we really want it? - Sustainability The capacity to be maintained indefinitely. [To keep up or keep going; Endure; To keep in existence; Maintain; Capable of being sustained; Capable of being continued with minimal long-term effect on the environment or depletion of natural resources; to continue to exist; last: To continue in the same state without perishing; to last; to remain ] An alternative - 'viable' solutions Solutions that are practicable and workable" 8

9 Sustainable ehealth Solutions - Some Thoughts - Bruntland Commission: Sustainable development' is: "Development that meets the needs of the present without t compromising i the ability of future generations to meet their own needs."

10 Sustainable ehealth Solutions - Some Conclusions - A sustainable ehealth solution is: One that uses ICT resources to meet the health needs of the present without compromising the ability of future generations to meet their own health needs.

11 Planning for Success - My Gift to Each of You ~ $10 Million - I want you to buy an ehealth solution! How will you spend it? Why spend it as you did?

12 ehealth STRATEGY - Conceptual Framework - One of several options WHO, ITU Experience based (Asia, Africa, and LAC) and Literature based A conceptual framework: Two components: six principles and a sixstep process. Scott RE. Future proofing telehealth in developing countries. Journal of Telemedicine and Telecare Volume 13 Supplement

13 ehealth STRATEGY - Conceptual Framework ~ 6 Principles- (1) Pragmatic approach. (2) Shared cost. (3) Balance ehealth s 2 primary components. (4) Focus on technologically appropriate, and culturally sensitive solutions. (5) Clear, simple and broadly accepted vision. (6) Frequently articulated goal.

14 ehealth STRATEGY - Conceptual Framework ~ 6 Process Steps- 1. Evidence gathering. g 2. Holistic review (Differential Diagnosis approach). 3. Identifying solutions (Business Case). 4. Consider e-health solutions. 5. Setting priority. 6. Strategy development. Synthesise steps 1 to 5 into a plan of action.

15 ehealth STRATEGY - Differential Diagnosis- A systematic method of diagnosing g a disorder that explains a presenting signs and symptoms. Leads to: Treatment plan Re-assessment Prognosis

16 ehealth STRATEGY - Differential Diagnosis - Table 1. Categories for Consideration during a Differential Diagnosis for Development of an e-health Strategy Sachs (2005): Poverty Trap Economic Policy Framework Fiscal Framework and Fiscal Trap Governance Patterns and Failures Cultural Barriers Physical Geography Geopolitics Additional: Health - Status, Services, and Policy Framework e-health - Status, Services, Policy Framework, and Readiness External Factors - Projected Impact on Health of Climate Change Infostructure - Current and Planned

17 An ehealth Strategy -Why?- Many senior policy-makers have yet to fully recognise that the whilst the cost of knowledge creation and dissemination is high, the cost of ignorance and opinion in delivering poor health care to their populations is even greater. McDaid D, Cookson R, Maynard A, Sassi F. Evaluating health interventions in the 21st century: old and new challenges. Health Policy. 2003;63(2):

18 An ehealth Strategy Framework - Test Run! - Pakistan Belize

19 An ehealth Strategy Framework - Final Thouhts - Thank You