|Parallel session PS19, Friday, September 1 2006, 11:00-12:30|
|Chair(s): Guy Olivier Segond, Switzerland, Antoine Geissbuhler, Switzerland|
|The iPath Project: Global Exchange of Medical Knowledge and Information Using Virtual Communities|
|Kurt Brauchli, Pathology, University of Basel, Basel, Switzerland|
|Hopes: Lessons from a Practical Example|
|Line Kleinebreil, Direction informatique, Hôpital européen Georges Pompidou, Paris, France|
|The Raft Network: Five Years of Distance Continuing Medical Education and Tele-Consultations via the Internet in French-Speaking Africa|
|Cheick Oumar Bagayoko, Informatique Médicale, Hôpitaux Universitaires de Genève, Geneva, Switzerland|
|The Digital Solidarity Fund|
|Alain Clerc, Secretary-General, Digital Solidarity Fund, Switzerland|
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As part of the broad topic on how to provide equal access to health, this symposium discussed how tools such as telemedicine can increase access to medical information and contribute to the reduction of the global digital gap. According to Guy Olivier Segond, former president of the State Council of Geneva and President of the Executive Committee of the Digital Solidarity Fund, information technology (IT) remains a "key tool to access health and improve the effectiveness of health systems".
In this context the four speakers presented different pilot projects to illustrate how Information Communication Technology (ICT) has positively influenced health care in rural areas.
Mr. K. Brauchli, a Swiss biologist and computer specialist, described the iPath project of global exchange of medical knowledge and information with virtual communities. He used the case of the Solomon Islands with a population of 450,000 to illustrate the challenges brought by limited resources and the shortage of trained staff and infrastructure, which lead to the lack of access to diagnosis. In this context, the telepathology service, launched in 2001, has been a successful experiment with more than 1,500 users and handling over 9,000 cases to date. Health workers are a major resource and they need access, not merely to information in general, but specifically to relevant and up-to-date information, as well as training and guidance. Mr. Brauchli argued that the key aspects of telemedicine are "its potential for sustainable transfer of knowledge, quality control and immediate feedback; the capacity to foster communication within the health system; overcoming professional isolation and, most importantly, to reduce the brain drain effect and the promotion of South-South collaboration". Telemedicine is also "accountable and transparent", and remains a useful tool as an "archive of material for later review and reference". He concluded that telemedicine can effectively contribute to strengthening health systems, because it "supports diagnosis and is timely and accurate" with a 90-97% concordance with clinical relevancy.
The second presentation, given by Dr. Line Kleinebreil of the Hôpital Européen Georges Pompidou, described another programme linked with ICTs and also using telemedicine. Health Operations Programme through Education and Sentinel networking (HOPES), originally started by Cheik Modibo Diarra in Mali, aims to contribute to the achievement of the Millennium Development Goals (MDGs) through updating and increasing the availability of training for primary care professionals. In 2003, HOPES entered into a partnership with the Université Numérique Francophone Mondiale (UNFM) based in Paris and is now essentially a North-South programme. Established in Mali and Burkina Faso since 2005, this programme sets up multi-media classrooms to create dialogue between medical students and professionals. Most of the teaching takes place at the Hôpital Européen Georges Pompidou through satellite video-conferencing. Although this technology is not new in itself, Dr. Kleinebreil stressed the programme's innovation in being linked with African universities and in giving training not only on health care but also on the use of computers. Recorded courses are also available offline on DVDs which have apparently proved very popular. This is a powerful way to disseminate information. Through re-watching the conferences, medical students and professionals are given the opportunity to discuss and comment. The programme is free of charge except for a registration fee for exams. Concerned with sustainability, HOPES shares classrooms with enterprises and aims to increase public-private partnerships. The goal is for the African centre to become independent after three years and to extend the system to other areas.
Trained in medical informatics, Dr. Cheick O. Bagayoko from Mali introduced the Réseau en Afrique Francophone pour la Télémédecine (RAFT) project, a "network for eHealth in Africa" and a key strategy in developing South-South training and links. Launched in Bamako, Mali, in 2001 the network soon expanded to reach countries like Mauritania, Senegal, Tunisia, Morocco, Burkina Faso, Niger and Madagascar. The training's main characteristic is its hybrid aspect, which encompasses "dialogue between concerned experts, the development of skills, fieldwork, collaboration with other projects and evaluation". Dr. Bagayoko emphasized the importance of telemedicine as a tool against professional isolation, which tends to discourage doctors from practicing in remote villages, where they are most needed. An important aspect of the RAFT project is the fact that the South can also share its experience with the North. For instance, some courses on tropical medicine are transmitted from Mali to the University Hospital of Geneva. On the whole the success of the project is illustrated by the 122 courses which took place between 2003 and 2006, 30% of which have been given from the South. However, challenges remain with organizational and individual problems; linked with a need for field knowledge. Dr. Bagayoko concluded his presentation by raising the question of ethics: "Is the installation of antennas and thus transmission of information more important than access to clean water?". There is no easy answer.
Mr. Alain Clerc, of the Digital Solidarity Fund (DSF), urged the information society to create a network to combine the various smaller projects involved in the same field, relating specifically to ICTs. He stressed equality of access as the main focus for spreading information. The DSF, recently inaugurated in Geneva after the two World Summits on the Information Society in Geneva and Tunis, is an organization aimed at reducing the global digital divide. The figures concerning this digital divide are striking: in developing countries only 2% of the population has access to new technologies whereas over 80% of the population does in more developed countries. The structure of the Digital Solidarity Fund is new in that it not only involves governments but also civil society and the private sector. The Fund does not operate on the ground; rather it is concerned with finding funds for local projects. It is aiming to establish an innovative financing mechanism: obtaining 1% of the value of all digital and material transactions to invest in the 80% of the population without access to new technologies. Mr. Clerc stressed that the Fund finances local projects in order to have a direct effect on the rural population and therefore help decrease or prevent brain drain. He concluded with a call to companies and hospitals which are not already doing so to invest 1% of their transaction costs according to the Fund's guidelines.
Following the presentations, important questions such as how to deal with the high cost of satellites and how to reach self-sufficiency were raised. It was noted that there is the prospect of launching an African satellite and that self-sufficiency will be boosted by communication centres funding multisectorial projects and by initiatives such as the Digital Solidarity Fund sponsoring South-South collaboration.
In conclusion, this symposium discussed the importance of IT particularly through telemedicine, and of the need for equity in the information society in order to achieve knowledge and health access for all.