Practical insight into the role of free and open source software in achieving the health-related Millennium Development Goals

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1 Swiss Centre for International Health Health Technology and Telemedicine Unit Practical insight into the role of free and open source software in achieving the health-related Millennium Development Goals 12 e RMLL, Strasbourg, Gonçalo Castro 1

2 History: The Swiss TPH was founded in 1943 as a public organisation 310 staff (Basel), 500 worldwide is an associated institute of the University of Basel, Switzerland.. mandate: improving health systems and population health 2

3 Structure of Swiss TPH Swiss Tropical & Public Health Institute Research Teaching & Training Services Medical Parasitology & Infection biology Clinical and Diagnostic Services Pharmaceutical Medicine Epidemiology & Public Health Swiss Centre for International Health 3

4 Swiss TPH projects Jordan Egypt Hungary Poland Romania Russia Switzerland Tajikistan Ukraine Belarus Benin, Ghana Mali, DR Congo, South Africa, Sudan, Kenya, Uganda, Equatorial Guinea Nicaragua Bolivia Costa Rica Angola, Burkina Faso, Chad, Cameroon, Niger, Madagascar, Malawi, Rwanda, Sao Tomé & Principe, Senegal, Tanzania, Togo China Cambodia Vietnam Laos Myanmar Nepal Thailand Mongolia, Philippines 4

5 Millennium Development Goals International development goals set in September 2000 Commitment of all UN member states and many international organizations To achieve by the year

6 Millennium Development Goals Source: United Nations 6

7 Millennium Development Goals Goal 4: Reduce child mortality rates Target 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Goal 5: Improve maternal health Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Target 5B: Achieve, by 2015, universal access to reproductive health Goal 6: Combat HIV/AIDS, malaria, and other diseases Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases 7

8 ICTs for Health ehealth Advances in information and communication technologies (ICT) offer unprecedented opportunities to improve public health worldwide. Dr Anders Nordström Acting Director-General World Health Organization (2006) 8

9 ehealth elearning Telemedicine mhealth Electronic Health Records Health Information Systems Consumer Health Informatics 9

10 ehealth hot topics National & cross-border Electronic Health Records (EHR) Interoperability & integration HL7, openehr, DICOM reduce costs improve quality of care Transition and developing countries: ehealth gaining prominence Pilot projects shown [1] 50% reduction in mortality or 25-50% increase in productivity in healthcare system [1] Greenberg, A ICTs for Poverty Alleviation: Basic tool and enabling sector. Stockholm: SIDA 10

11 Some ehealth projects at Swiss TPH 11

12 ipath Telemedicine in our Ukraine programme 12

13 Ukraine Large country (bigger than Metropolitan France) Many disparities between regions Economical Quality of (health) services Infrastructure Mobility & knowledge transfer difficult mitigation measure: introduction of Telemedicine 13

14 ipath FLOSS Telemedicine platform based in PHP & ADOdb Developed by University of Basel (Switzerland) Roll-out in 2006 in scope of Swiss-Ukraine MCH* programme Main functionality: 1. present and discuss medical cases (second opinion) 2. information exchange 3. training: case-based learning * MCH Mother and Child Health 14

15 ipath 15

16 Achievements with ipath in Ukraine Participants from 53 institutions (including foreign experts) Moderation by Ukranian physicians Discussions quality improving throughout time Server migrated to Ukrainian Association for Telemedicine and ehealth Development 16

17 openmedis - improving health technology management 17

18 Background: The World of Health Technology Multiplicity of manufacturers and devices 1 Trend: 50% of all diagnostic and treatment methods did not exist 10 years ago 2 Medical technology in % of total expenditure for health Avg 5 % among OECD countries % in low-income countries 3 Broken or idle equipment in low- and middle income countries: 25 to 50% 1 The Medical Device Register 2009, Grey House Publishing, 2 Swedish Council on HTA, World Health Organization. The World health report

19 Information Base on Medical Devices in Low- and Middle-Income countries No good data on quantity and quality of infrastructure Difficult to manage health technology Commercial SW solutions for data management not suitable -> Made by - and made for - countries with expensive health systems Decision to develop new web-app within Swiss TPH 19

20 Development of openmedis Hospital inventory management SW using FLOSS technology PHP / MySQL integration of useful databases UMDNS nomenclature and generic device lists supplier database localized 20

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23 Practical Results Ukraine (MCH Programme) Used in 25 health facilities High interest of Local Health Administration in FLOSS Republic of Moldova (Perinatal Project) University of Chisinau hosting server, students train hospital staff Used in 8 hospitals Egypt (Radiology Project) Used for registration of public hospital radiology equipment Extra module development locally 23

24 Perinatal Registry (MCH-Registry) 24

25 Motivation Lack of real-time pregnancy information within Volyn region in Ukraine Consequences: 1. Complications during delivery 2. Late referrals 3. High number of births at the main regional hospital Solution: Development of web-based pregnant women registry, in order to: - record comprehensive and structured information - have it available region-wide to support clinical practice 25

26 Registry for Pregnant Women Development in PHP/MySQL Cooperation between Swiss TPH and local developers Pilot starting soon! 26

27 ehealth evolution in Swiss-Ukraine MCH Programme ipath (2006) openmedis (2009) MCH-Registry (2011) Main activities Configure existing software Project design & backstopping Develop software Extra modules developed by local programmers Develop software Local programmers involved from the beginning Challenges Health professionals low computer literacy Lack of (IT) staff within public health system egovernance & ehealth on early days 27

28 How to overcome those challenges Sensitize decision makers Collaborative attitude Engage local actors Capacity building / competence growth 28

29 Capacity building in ehealth applications Today Tomorrow Long run Develop Application Installation & support International Experts Internat. Experts Local Experts Local Experts Define requirements Train users Capacity 29

30 FLOSS: key catalyst for health systems development FLOSS characteristics address systemic issues Scalability pilot projects must be scalable Interoperability different projects/organisations implement different SWs Affordability financing constraints Effectiveness crucial for development Security key topic at the level of public administration Transparency development demands increased transparency Sustainability 30

31 Health Millenium Development Goals in Ukraine Source: Ministry of Economy of Ukraine. Millenium Development Goals: Ukraine 2010: National Report,

32 More information ->