Bangladesh as an example

Transcription

1 Taking ehealth & mhealth to National Scale in resource poor setting Bangladesh as an example November 2013 Prof Dr Abul Kalam Azad Additional Director General & Director, MIS DGHS, MOHFW Regional High-Level Meeting on e/mhealth Bangkok

2 As the world recognizes our current e/mhealth Impressive progress WHO Landmark Publication UN Digital Health for Digital Development Award 2011 One of top 11 Global Innovations in 2011 National Digital Innovation Awards 2010 & 2011

3 HIS -- Until 2008 Upazila District Upazila Data required Division District Upazila HQ District Division District > 1 wk > 1 wk > 1 wk < wk < wk < wk

4 Challenges Huge population (>150 mill) in small land area (pop. Density: 1,100/sq. km.) Resource constraints Competing health priorities Shortage of skilled ICT staffs Opportunities Mobile phones & Internet everywhere (110.7 mill subscribers as of Sept 2013) Plain land & good road networks Well structured & uniform distribution of health facilities & CHWs to reach every family Highest level political commitment

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6 Internet Rollout CHW 7 divisions Avg. pop. 22 mill. 64 districts Avg. pop. 2.4 mill. 485 upazilas Avg. pop mill. 4,501 unions Avg. pop. 33,400 13,503 wards Avg. pop. 11,133 SSH MCH DH UHC UHFWC CC Geolocations of CCs (18,000)

7 National Health Data Center National Health Data Repository

8 IT training of HWF No. of personnel & staffs given IT training (total 159,774) 14,927 43,584 40,662 29,701 30, (ongoing)

9 One system for all programs at source Promoting for other ministries Hospital automation GiZ WHO UNICEF

10 Building Local Information Culture Visit

11 ehealth enterprise architecture Client Standardization & Interoperability Integration with DHIS & OpenMRS Ministry of Health & Family Welfare EHR/EMR ICD-10 Asset Bangladesh National ehealth Standards & Inter-operability Framework Population Health Information Exchange Facility Health workforce National ehealth Steering Committee Geolocation Training eregistry Systems

12 Not an isolated journey of MOHFW Multi-sectoral engagement Govt. (MOLGRD, BBS, A2I, MOSCIT, BTRC); Telcos, Private sectors (ICDDR,B; BRAC; Johns Hopkins); DPs (WHO; GiZ; UNICEF; UNFPA; DFID; JICA; SAVE); NGOs: (BRAC); Media, Academia (BSMMU, BRACU, BUHS), etc. National ehealth Steering Committee To settle common standards & inter-operability; CRVS Guiding documents ehealth components of National Health Policy 2011; National ICT Policy 2009; HPNSDP Strategy & Program Implementation Plan; HIS & ehealth OP Current engagement National ehealth Strategy using WHO/ITU toolkit & National ehealth Policy Development of National ehealth enterprise architecture Software tools OpenSource software (we take/ we contribute)

13 Data are going to public website However, our ehealth is not just for data

14 Selected e/mhealth programs TV Now I know Remote Time Attendance Complaint-Suggestion Box mhealth SMS based pregnancy advice, SMS-Stat GIS Priority disease surveillance Client education elearning Telemedicine

15 Telemedicine 582 mobile phone call centers to roll out to 18,000 community clinics 28 advanced telemedicine centers for referral services Soon to launch 18,000 Skype based tele-consultation centers in community clinics

16 At least 1 mbps dedicated bandwidth Single Point Camera Tertiary Hospital Multi Point Camera E1 Connection Primary & Secondary Hospital Infrastructure ATA standards Tele-stethoscope Pulse Oximeter Tele Microscope Tele-skin camera Tele-ECG Tele-BP machine Electronic Thermometer Tele Glucometer Tele-Spirometer Tele-Ophthalmoscope Tele-Ophthalmoscope Tele- Ultrasound

17 Display boards in 800 hospitals Empowering citizens Upper part tells about mobile phone health service Lowe part about Complaint-Suggestion Box

18 Complaints/ Suggestions box Toilet not clean One dedicated staff see, talks to sender, takes action

19 Denominators to intervene Numerators Community Clinic At Community Clinic in each week HA, FWA, CHCP, NGO worker, CSG sit Review local data update 11 COIA indicators in DHIS Make intervention plan Intervene Cycle continues Shared online form We will add NCDs COIA Secretariat established Thanks to WHO - HQ & SEARO Monthly Review Meeting with DHIS Auto-Report Union Upazila District Division National DP/NGO ecodirs

20 Laptop With laptop in Community in Community Clinic Clinic Attendance monitoring Telemedicine Health education elearning / web browsing 18,000 CCs TV

21 With tablet for Community Health Worker (~25,000) What do you want? Record your location & time Send data Educate client Self-learning Android 3G Tablet with GPS Pilots of JHU

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