GHF2010 – PS02 – ICT: Improving Access for Health Professionals in Remote Settings

Session Outline

Parallel session PS02, Wednesday, April 21 2010, 11:00-12:30, Room 3
Chair(s): Ramesh Krishnamurthy, Manager, Information Systems and Framework, Health Metrics Network (HMN), World Health Organization, Switzerland
Antoine Geissbühler
, MD Director, Medical Informatics Division, Geneva University Hospitals, Switzerland
Summary: This session will explore the challenges of supporting isolated health professionals and the potential role of information and communication technologies. Real-world projects will be presented, including a nationwide training needs assessment in Senegal, a disease-specific training programme to enhance capacity for diabetes management in Africa, a coordinated, collaborative programme to facilitate the access to post-graduate training courses for physicians in French-speaking Africa, the adaptation of a virtual patient simulator for developing operational patient management skills for care professionals in remote hospitals, and the deployment and evaluation of the impact of telemedicine services in isolated healthcare settings in Mali.
Needs Assessment for Distance Continuing Education of Physicians: A Nationwide Survey in Senegal 
 Meïssa Touré, Professor, Cheikh Anta Diop University, Dakar, Senegal
Building Capacity for Diabetic Patient Management in Africa: The eDiabète Project
Line Kleinebreil, Deputy Secretary General, Université Numérique Francophone Mondiale, France 
A Federated and Structured Curriculum for Online Post-Graduate Training in French-Speaking Africa
Vincent Djientcheu, Professor, Department of Neurosurgery, Central Hospital Yaoundé, Cameroon
Using a Virtual Patient Simulator for Improving Decision-Making Skills of Care Providers in Remote Settings: A Feasibility Study in Cameroon and Mali
A'hed Assaly, Medical Student, University of Geneva, Switzerland
Deploying Telemedicine Services and Evaluating their Impact in Isolated Healthcare Settings in Mali: The EQUI-RhesHus Project 
Cheikh-Oumar Bagayoko, Mali eHealth and Telemedicine Network (REIMICOM), Switzerland

Session Documents

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Session Report

Photo by John Brownlee, ICVolunteers.org

Submitted by: Laura Mathew (ICVolunteers)

Information and Communication Technologies (ICT) play an important part in modern medicine. However, in rural African communities, the ability of medical professionals to access these new technologies is limited. The purpose of this session was to present the methods and findings of several recent projects in rural Africa and to identify ways of improving access to telemedicine services in future.

In Senegal, 90% of physicians work in the capital, Dakar. In a vast country with limited road infrastructure and isolation of peripheral structures, distance education is therefore an important consideration for care professionals. Meïssa Touré, Professor, Cheikh Anta Diop University, Dakar, described how a recent survey in Senegal compared the results of questionnaires from healthcare providers in University Hospitals in Dakar with physicians practicing in regional locations.

Over 70% of regional physicians responded to the survey, compared with 63% of medical professionals in University Hospitals. The results showed a strong interest in using technology: all respondents have a mobile phone and at least one email account; 90% have a computer at home; 87% have access to the internet and 98% can use Power Point, as well as several other well known programmes.

Significantly, 90% were found to participate actively in distance medical education, even suggesting topics for study, from surgical and obstetrical emergencies to infectious diseases.

Mr. Touré highlighted the activities of RAFT Senegal, set up in 2006 in partnership with the Ministry of Health and the faculties of medicine, pharmacy and dentistry at Dakar and Geneva university hospitals. As well as a national distance education programme, the organisation has become a member of the National Committee for the Coordination of Telemedicine and is recognised by the Ministry of Health as a tool for distance education and telemedicine.

Line Kleinebreil, Deputy Secretary General of the Université Numérique Francophone Mondiale, France, said that leaders of African countries affected by a shortage of healthcare professionals in rural areas have found that technology is an important factor in meeting this challenge.

Diabetes and other non-communicable diseases are a growing problem in Africa despite being preventable in many cases. As this is a relatively new situation, many doctors lack medical training in this area and would therefore benefit from updates which could be delivered through online lectures.

Since 2009, the eDiabète Project has been delivering a lecture once a month via the RAFT network, featuring speakers from as far afield as Brazzaville, Yaounde, Geneva and Grenoble.

Future developments include extending the internet network to more hospitals in more countries and the addition of East African countries and Haiti.

According to neurosurgeon Vincent Djientcheu, Central Hospital Yaoundé, Cameroon, education in Cameroon is hampered by a lack of lecturers, educational material, library resources and scientific journals, although the implementation of an online postgraduate training programme has gone some way to alleviating this problem.

Lectures are either pre-recorded or delivered directly over the internet with minimal equipment, allowing lecturers to reach many more students than would otherwise be possible and enabling students to access lectures from many countries, covering different areas of medicine.

The success of this programme, however, depends on students’ awareness of lectures taking place, so communication still needs to be improved.

A’hed Assaly, a medical student from the University of Geneva, spoke about a Virtual Patient Simulator (VIPS), created in 1989 to simulate medical consultations.

Doctors can use this system to generate a set of questions based on the patient’s symptoms. While the practitioner still makes their own decision, the programme can suggest other courses of action such as alternative examinations.

When VIPS was introduced as part of a study in Cameroon and Mali, medical professionals showed a generally positive response, citing its simplicity, logical presentation and variety of cases. However, internet connection was often poor, questions were missing, it is not suitable for use by some older doctors and it is only available in French.

The EQUI-RhesHus Project in Mali was principally set up to evaluate the role of ICT in medical education and to test the role of computer simulators in clinical reasoning and medical decision making.

Among the positive results mentioned by Cheikh-Oumar Bagayok, of the Mali eHealth and Telemedicine Network, Switzerland, was the increased use of teleultrasound and telecardiology and improved knowledge among users.

During the question and answer session, Ramesh Krishnamurthy, Manger of Information Systems and Framework, Health Metrics Network, World Health Organization, asked whether these projects could be achieved on a national level. Mr. Touré referred back to the Senegalese example, pointing out that the Ministry of Health in that country now recognises the importance of distance education and remote assistance and it is now involved in the coordination of the project.

When asked whether mobile phone technology could be used in distance education, Mr. Bagayoko said that although the potential exists, rural areas still lack access to more advanced 3G capabilities.

The session ended with a discussion about the high failure rate of ICT projects in Africa. Ms. Kleinebreil suggested that failure often occurred as result of projects being too technological and lacking expertise in the right areas, while Mr. Krishnamurthy highlighted the lack of coordination among donors, in turn leading to fragmentation of money and lack of communication between projects.

Antoine Geissbühler, MD Director, Medical Informatics Division, Geneva University Hospitals, warned against imposing strict frameworks that could restrict the ability of projects to react to political and technological changes.

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