PAKISTAN HOW TO SPEED UP THE INTRODUCTION OF EHEALTH SERVICES IN DEVELOPING COUNTRIES

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1 HOW TO SPEED UP THE INTRODUCTION OF EHEALTH SERVICES IN DEVELOPING COUNTRIES V. Androuchko¹, Asif Zafar Malik² ¹International University in Geneva, Switzerland ² Rawalpindi Medical College, Pakistan 1

2 Introduction Creation of the Islamic Republic of Pakistan in 1947 Pakistan is the 6 th most populous country in the world 150 million people 65% of the population lives in rural areas Ration of the number of doctors to population is 1:1555, and for the case of specialists it gets worse, 1:

3 Introduction Difficult to get quick & easy access to medical services Strategically situated in the heart of Asia Developing country with large amounts of natural & human resources Government of Pakistan considers the improvement of health services for all citizens as one of the highest priority area 3

4 Health Sector Policy All citizens in Pakistan will have access to affordable health care. Emphasis will be given to prevent health of women, children and other vulnerable groups in the society. Priority will be given to health promotion through information, education and communication for a healthy life style for all. 4

5 Health Sector Policy The Ministry of Health has announced the following goals: 1. Provision of quality health services that are accessible and affordable to all citizens. 2. Enhanced quality of life of all citizens by preventing and promoting health and curing diseases. 3. Management of the health system is streamlined in order to deliver services effectively. 4. Development of a sustainable health system by mobilizing resources, developing human resources and utilizing them effectively 5

6 Health Sector Policy The Government considers that the enjoyment of the highest attainable level of health is a basic right of every citizen. Many improvements in the health status have to be achieved through disease prevention and health promotion 6

7 Role of ehealth Health authorities in many countries have come to recognize that computerized information system, when established at appropriate levels, can assist in meeting the challenge of improving health care delivery and organizational efficiency. The term ehealth refers to the practice of medicine over a distance. The diagnostic and treatment decisions and recommendations are based on medical information transmitted through telecommunication systems. 7

8 Role of ehealth The introduction of ehealth/telemedicine will help to improve access to medical services and better use available resources. ehealth solutions and services require multidisciplinary collaboration, with the active participation of telecommunication operators and health care professionals. 8

9 Role of ehealth The platform for any ehealth services is telecommunication infrastructure in the country. International Telecommunication Union (one of the main supporters of ehealth services worldwide ) World Telecommunication Development Conference in the year 2002 in Istanbul recommends that 9

10 Role of ehealth that ITU Member States consider establishing a national committees/task forces comprising representatives from telecommunication, health sector and other interested parties. The Telemedicine Association of Pakistan, (was set up in March 2005), can play the very important role in the implementation of ehealth services and provide an umbrella for all telemedicine activities in the country. 10

11 Role of ehealth ehealth projects in developing countries offer an opportunity for people living in underserved and rural areas to obtain improved health care services. Various private and government organizations have already participated in implementation of telemedicine in Pakistan [1, 2]. Nevertheless the spread and acceptance of ehealth services are still moving very slow. For this reason it was decided to organize ehealth survey and check the opinion of medical staff. 11

12 ehealth Survey The study was done in Rawalpindi and Islamabad. Therefore the opinion was checked among doctors working in urban area and in particular in big cities. Interview method was used. 111 answers were received. The majority (86%) supported the idea of ehealth. 12

13 ehealth Survey However, there is no so far any policy in their hospitals on the introduction of ehealth services in medical practice Who participated in this study? The information is presented in Table 1. The majority of respondents were doctors, six of them have PhD degree. It was good representative sample of medical staff. 13

14 ehealth Survey (Table 1) Frequency Percent Cumulative Percent doctor radiologist head of clinic medical teacher medical student nurse Technical staff Total

15 ehealth Survey At the beginning of the survey two questions were asked: 1. Have you heard of ehealth prior to this survey? The positive answer was 61%. 2. Where have you heard about ehealth? The results are presented in Table 2. The medical training and continuous medical education (CME) play so far a small role, only 26.12% together. 15

16 ehealth Survey 72% of medical staff has heard about ehealth. The comparison with the first question and the difference in 11% is due to the fact, that these people have heard about ehealth but they did not understand it well. In conclusion the level of awareness about ehealth is very low in spite of several telemedicine activities implemented already in Pakistan. 16

17 ehealth Survey (Table 2) Frequency Percent Cumulative Percent during medical training CME medical journals newspapers TV Conferences/seminars colleagues from this survey others internet no response Total

18 ehealth Survey The next question was the following: According to your opinion, what would be necessary to do in order to introduce ehealth services in medical practice? 68% of participants recommended strongly informing medical staff and in particular health administrations at different level about potential benefit of ehealth services and provide more information about successful experience in this field. 18

19 ehealth Survey The key position of the medical nurse in the introduction of information technology into medical practice is not recognized yet. The lack of information is one of the main obstacle today. Based on successful stories and experience it is necessary to develop guidelines on how to use ehealth facilities. Because ehealth is so broad definition; it is important to have guidelines accompanied by good training for each application. 19

20 ehealth Survey Conclusions The local ehealth policy must be in agreement with any overall informatics policies in force in a country as well as with its overall health sector policy. It is important to develop ehealth Master Plan of Pakistan. This is a national ehealth policy document which will guide and coordinate all ehealth projects and activities helping to eliminate interoperability problems between different telemedicine systems. 20

21 ehealth Survey Conclusions Based on the ehealth Master Plan approved by the Government, it is important to provide the strategic planning for the implementation of ehealth services and solutions at the level of each hospital and any other medical institutions. These documents will guide the health administration to organize the implementation of ehealth in well coordinated manner. Gaps in legislation and the uncertainty of rules applying ehealth services pose a legal risk for both the doctors and their patients. The code of conduct for the practice of ehealth have to be urgently developed. 21