Geneva Health Forum Archive

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GHF2006 – PS05 – Can We Trust Medical Information Online?

Session Outline

Parallel session PS05, Wednesday, August 30 2006, 16:00-17:30
Chair(s): Antoine Geissbuhler, Switzerland, Kazem Behbehani, Switzerland
A Decade Devoted to Improving Online Health Information Quality
Celia Boyer, Quality and Ethics, Health On the Net Foundation, Geneva 14, Switzerland 
The Global Health Library: Global Access to Health Information
Yvonne Grandbois, WHO Library and Information Networks for Knowledge, World Health Organization, Geneva, Switzerland
Wikipedia: An Experiment in International Cooperation in Collecting and Disseminating Knowledge
Florence Devouard, Wikimedia Foundation, Malintrat, France

Session Documents

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Session Report

Submitted by: Marc Menichini (ICVolunteers); Contributors: Prof. Antoine Geissbuhler (HCUGE), Philippe Berset (ICVolunteers), Tatjana Schwabe (ICVolunteers)

Image: Viola Krebs, ICVolontaires.org

Access to reliable medical information, as well as ensuring its quality, validity and availability were the main issues presented in this track V session. As the chairpersons emphasized, the three speakers presented different, yet complementary ways to bridge the knowledge gap between people who have Internet access and the ones who rely on offline oral or written transmission.

This session on the accuracy of medical information online saw three speakers presenting their organisation's approaches to ensure quality in health information.

Ms. Celia Boyer presented insights into the work of the Health On the Net Foundation (HON), which is devoted to bringing more reliable online medical information. Saying that "anyone can put information on the net but this information can be misleading [...] and even harmful", she made a case for principles to ensure that websites inform in an efficient manner.

Following initiatives led by different governmental and non governmental organisations, HON implemented its own code of conducts in 1998, which do not regard the content, but rather the way information is presented online. Web sites voluntarily seeking the HON accreditation are invited to comply with its eight principles. HON will work with the web designers and content produces to make the needed modifications. The most common problem encountered are the web sites advertising policies (59% of the cases). The HON also carries out follow-up through its annual auditing.

Numerous partnerships have now been started, including one with Google in which a medical searches can be refined using tags attributed by HON on the accredited Websites, and a toolbar indicating if the web site has been accredited. Another project brings together the University of Geneva, the World Health Organisation (WHO), and a University from Bamako, Mali and investigates socio-cultural determinants in the confidence one can have in online health information.

Speaking on behalf of the WHO Library, Ms. Yvonne Grandbois presented the new Global Health Library. It aims at improving access to health information by bringing together diverse communities such as publishers, libraries, medical professionals and others, in order for them to share their knowledge. This would initiate a world wide coordinated effort to bridge the inequality gap in access to health.

The program has also developed interesting strategies to respond to the needs of people who do not have access to the internet by creating "mobile libraries" contained in boxes, which are sent to Africa and Asia. The information provided by this network is free of charge. Several comments from the floor concerned challenges this new project might face in the future, such as training consumers to use this information or including mobile phones. Ms. Grandbois mentioned the necessity of creating more partnerships and developing the fundraising strategies.

Following the first two health-focused media, a representative of the Wikimedia Foundation was invited to share their thoughts and experience on collecting and disseminating knowledge. Ms. Florence Devouard presented the philosophy and main activities of the online encyclopaedia Wikipedia. She pointed out that Wikipedia avoided financial barriers, was open to multilingual sources and worldwide editors, and relied on its editors to check and, if necessary, to correct the articles' contents. The web site aims at creating a "collaborative community" where the neutrality of point of view remains crucial. While all relevant opinions can be published on a topic, the site refuses any advocacy or philosophical content. Ms. Devouard briefly discussed limits and constraints such as the stability of the information, legal risks linked to publishing, and censorship in different countries. She also stressed that Wikipedia did not provide medical advice but general information and did not replace medical doctors.

The three presentations showed that trustworthy information already exists online and that different tools are available to improve the access to reliable medical knowledge. With the increasingly global network in the future, these services remain to be developed and optimised  further.

GHF2008 – PS27 – Biotechnology to Improve Access to Health: Can it Make a Difference?

Session Outline

Parallel session PS27, Wednesday, May 28 2008, 11:00-12:30, Room 15
Chair(s): Robin Offord, Executive Director, Mintaka Medical Research Foundation and Professor Emeritus, Faculty of Medicine, University of Geneva, Switzerland
Finding Simple Solutions for Developing Countries Using Advanced Technology
Robin Offord, Executive Director, Mintaka Medical Research Foundation / Professor Emeritus, Faculty of Medicine, University of Geneva, Switzerland 
Partnerships for Malaria Eradication
Tim Wells, Chief Scientific Officer, Medicines for Malaria Venture, Switzerland 
Biotechnology and Access to Health: The Case of Diagnostics
Vinand Nantulya, Senior Policy and Implementation Officer, Policy and Communications, Foundation for Innovative New Diagnostics, Switzerland  
Accelerating Health Innovation in Africa
Ronak Shah, Research Assistant, McLaughlin-Rotman Centre for Global Health, University of Toronto, Canada 
Multipathogen Detection Using High-Density Microarrays
Stewart Cole, Global Health Institute EPFL, Switzerland

Session Documents

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Session Report

Submitted by: Jimena Lazarte (ICVolunteers)

Molecular amplification methods, multi-pathogen detection using high-density micro arrays, microbicides that protect women from HIV infection: "Biotech is poised to make an impact on access to health in developing countries." Now that the role of biotechnology as a means to health has been established, we must consider what needs to be done to extend it to developing countries.

Robin Offord, Executive Director of Mintaka Medical Research Foundation opened the session by emphasizing the responsibility of local stakeholders as the interface between innovation and local populations.

Tim Wells, Chief Scientific Officer at Medicines for Malaria Venture (MMV), believes that we need to focus on the 'technology' bit in biotechnology for the developing world and see how it can be used to make treatment both more efficient and more affordable. Effective partnerships that synergize the best from the private and public sector are essential to this project. He described how MMV was able successfully to develop antimalarials through active portfolio management (including the termination of ineffective projects), raising and allocating philanthropic and public funds to projects, integrating and coordinating world class industry with academic science and medicine under the guidance of international thought leaders, and ensuring new medicines are accessible to and meet the needs of targeted patients and medics.

Vinand Nantulya, Chief Scientific Officer at the Foundation for Innovative New Diagnostics (FIND), outlined how biotechnology can be exploited to deliver rapid, affordable, accurate and context appropriate diagnostics. For example, he noted the co-development of a molecular amplification methods in Japan that can be used to test for HIV without additional equipment (as the result is indicated by the acid's colour) within a few minutes.

Ronak Shah, a researcher from the McLaughlin-Rotman Centre for Global Health discussed the challenges that Sub-Saharan countries will face if they are to tackle their own health problems, capture the value of their own research, accelerate commercialization of their own products and enter the innovative sectors of the global economy. Following 110 interviews in Ghana, Rwanda and Uganda it was found that there is a lot of unexploited potential to commercialize innovative biomedical research and the development of traditional medicines. In order to improve inadequate financial incentives/resources as well as reduce the lack of synergy and knowledge flows between companies and actors in science and technology, the concept of convergence innovation was studied during stakeholder workshops: "In particular, the [African Development] Bank should support the development of national and regional centres of excellence in the health science [...]. These centres would facilitate and incubate innovation, supporting entrepreneurship and developing technologies."

Stewart Cole from the Global Health Institute, briefed the meeting on the initiative started by the Ecole Polytechnique Federale de Lausanne (EPFL) a few years ago to develop a chip for multipathogen detection using high-density microarrays. The chip, known as 'pathogen ID', detects select agents (at least 50 types of bacteria, 42 viruses and 619 toxins and antibiotic resistance genes), gives a predicted virulence profile and identifies GM agents. While the diagnosis of this new molecular method are in agreement with those made with the traditional antibiogram, pathogen ID is more advantageous because it yields a lot more information. It can help predict possible antibiotic resistance and give results in less time.

Finally, Robin Offord reported on the progress made by the Mintaka Medical Research Foundation in developing a local anti HIV microbicide that will empower young girls and women with the means to protect themselves from HIV. He believes that some of the proteins that are being developed at Mintaka could prevent person to person transmission. Meanwhile, the two big questions around this project are: 1) will women accept and use microbicide protection and 2) will it be affordable? While a sociologist has been called to study the first question, the answer to the second question is that it is very likely Mintaka will be able to manufacture these proteins by microbial fermentation for a significantly low cost at perhaps two dollars per gramme.

GHF2008 – PS21 – Information and Communication Technology in Support of Health Workers

Session Outline

Parallel session PS21, Tuesday, May 27 2008, 16:00-17:30, Room 18
Chair(s): Meissa Touré, UCAD, Dakar University, Senegal, Kazem Behbehani, Former WHO Assistant Director-General, External Relations and Governing Bodies, UK 
Preparing Health Professionals for Work in Isolated Settings 
Walinjom Muna, Professor of Internal Medicine and Cardiology, Chief of the Department of Internal Medicine and Subspecialities, University of Yaounde, Cameron 
African Nework of Distance Training Centres for Health Proximity Actors: A Francophone Initiative to Contribute to the Millennium Development Goals
Line Kleinebreil, Deputy Secretary General, Université Numérique Francophone Mondiale, France  
Logistics of Telemedicine: Experiences in Mali
Cheick Oumar Bagayoko, Coordinator, Réseau en Afrique Francophone pour la Télémedecine (RAFT), University Hospitals of Geneva, Switzerland 
Telemedicine at Various Levels of Health Systems: Experiences in Niger 
Ali Ibrahim Touré, Head of Internal Medicine, Cardiovascular Department, Focal Point of RAFT-UNFM, Niger 
Decision Support: Preliminary Results from a Phased Implementation Planned for the Map of Medicine in Africa 
Sylvester Yunkap Kwankam, Coordinator eHealth, World Health Organization, Switzerland

Session Documents

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Session Report

Contributors: Frances Narvaez (ICVolunteers)

One cannot deny the immense impact technology has on humankind. It enables individuals to watch over others' health from a great distance.

An example of an organization promoting health care access to developing regions is Université Numérique Francophone Mondiale (UNFM), represented at the 2008 Geneva Health Forum by its Deputy Secretary General, Line Kleinebreil. A variety of UNFM bases have been founded in five African towns. The organization's educational programmes centre on the issue of health, but cover a range of topics such as health decisions, HIV transmission prevention from mother to child, diabetes and chronic disease care plans, among others. Together with the Senghor University of Alexandria, the UNFM presents its 'Interuniversity diploma in care and alert decisions' to students who have successfully completed the courses. What is pivotal for the organization, however, is its promotion and effective use of e-medicine in order to make accessible secluded towns and to allow diagnosis for emergency care in remote areas. Similarly, it aims to develop various programmes geared towards answering calls from village staff, as well as planting 'cyber centres' that will enable students to self-study via the internet.

On a similar scale, the Centre d'Expertise et de Recherche en Télémedecine et E-Santé (CERTES) is& geared towards providing coordination of telemedicine applications between Mali and Francophone Africa. Cheick Oumar Bagayoko, Coordinator of Réseau en Afrique Francophone pour la Télémedecine (RAFT), presented new technologies the organization is developing, called the Ikon teleradiology project, e-learning, and teleconsultation. He said that through these, the group expects "better management of the flow of requests for teleconsultation, better orientation of health professionals and the public, validation of new applications for telemedicine, installation of solid research activities, and training of competent human resources."

According to Dr. Walinjom Muna of the University of Yaounde in Cameroon, the "adoption of technology must be 'needs-based' because the best use of already scarce resources must be made." Furthermore, he said that as health professionals take action in rural settings, they ought to use distant "experience, expertise and other resources" through the technological resources provided to them in order to promote the competence of communities in isolated areas.

Fatima Sanz de Leon of the World Health Organization explained their new project, called the Map of Medicine, which enables health workers doing field work in Africa to access information such as online journals and health care information that is specially adapted to local areas lacking in resources.

Finally, Ali Ibrahim Touré, Head of the internal medicine cardiovascular department and focal point of RAFT-UNFM Niger, discussed the partnership Niger has been holding with the UNFM and RAFT regarding cost-effective methods in using e-health technologies, as well as the steps taken in order to achieve the aim of using 'telehealth' as a 'highway' in reaching the 8th Millennium Development Goal.

GHF2008 – PS26 – Health Knowledge at the Age of Web 2.0

Session Outline

Parallel session PS26, Tuesday, May 27 2008, 11:00-12:30, Room 4
Chair(s): Antoine Geissbühler, Head of Medical Informatics Division, University Hospitals of Geneva, Switzerland & Hans Hoffmann, CERN, Switzerland 
Public Health Capacity-Building and Web 2.0: The Peoples-Uni
Richard Heller, Coordinator, Peoples-Uni, UK
Web 2.0 for Health: Tools, Hype and Perspectives
Miguel Cabrer, Independent eHealth Consultant, IRC, Spain 
Construction and Validation of Clinical Guidelines in French-Speaking Africa: Is Web 2.0 a Relevant Tool?
Didier Wernli, Division of Medical Informatics, University Hospitals of Geneva, Switzerland, Beat Stoll, Institute of Social and Preventive Medicine, University of Geneva, Switzerland
Behavioural Knowledge in Healthcare Professions
Marc-André Raetzo, Director, Onex Medical Group, Switzerland
Trustworthiness at the Age of the Web 2.0 
Celia Boyer, Executive Director, Health On the Net Foundation, Switzerland

Session Documents

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Session Report

Contributors: Jimena Lazarte (ICVolunteers), Fabio Weissert (ICVolunteers)

Wikipedia.org is one of the collaborative online resources, where volunteers generate and check contents.

Wikipedia - a website that indiscriminately allows users to contribute, edit and publish information - is only one of the most widely known champions of the Web 2.0 generation. The unprecedented social networking possibilities of Web 2.0 are opening the doors of the Information Development Industry to anyone connected to the internet. Will online collaboration in the development and dissemination of health knowledge flood the internet with false and potentially dangerous information, or can we harness the Web 2.0 spirit to improve universal access? Can we harness Web 2.0 for health knowledge and, if so, how? Are we heading towards Medicine 2.0?

There is a wealth of educational resources freely available on the Internet. Professor Richard Heller described how the Peoples-Uni (Edinburgh, UK) is using these resources to help build Public Health capacity in low- to middle-income countries by recruiting volunteers to develop and deliver courses that integrate these resources into an educational context, and which are less expensive than University courses in the North.

In the collaborative spirit of Web 2.0, participating students are encouraged to partake in the development, refinement and delivery of future courses. A pilot project covering maternal mortality suggests that this method of capacity-building has considerable potential; however, generational gaps and limited Internet access are some of the obstacles that will have to be overcome if the concept of Web 2.0 is to realize its full potential.

Miguel Cabrer, an independent eHealth advisor, assessed Web 2.0's impact on healthcare. Social networking between health professionals, biomedical researchers and consumers has led to the creation of the new Health 2.0 space, which is composed of different interactive healthcare communities.

At the healthcare consumer level, early adopters of 'social tech' include the American Diabetes Association's message boards and the Revolution Health social network. Sermo, in turn, is an online community that permits physicians to "exchange clinical insights, observations, and review cases in real time". Among other projects Mr. Cabrer is running the MDPIXX portal on which physicians can "exchange medical images and videos, create clinical cases, search for content and discuss them".

Content control, health tourism and the protection of personal health records are some of the challenges faced by Health 2.0.

Marc-André Raetzo, of Group Médical d'Onex, stressed that "knowledge should be knowledge in action". While medical knowledge is principally taught in a descriptive way (diseases), the healthcare community in the field mostly handles complaints by patients, which call for practical knowledge and pragmatism.

Medical reasoning and decision analysis should therefore be part of medical teaching; they are especially important in circumstances where only limited or no diagnostic resources are available. Guidelines and tools are needed to train physicians to gather information in cases without diagnosis and to allow them to take a treatment decision.

Didier Wernli (University of Geneva Hospitals), Marc-André Raetzo, of Group Médical d'Onex and Beat Stoll, of Institute of Social and Preventive Medicine in Geneva, analysed the Web 2.0's relevancy for the construction and validation of clinical guidelines in French speaking Africa.

As medical literature is chiefly produced in rich, Western countries, where ample means for diagnosis and care are available, existing scientific data oftentimes is not accurate for African countries, given their health resource constraints. In order to help physicians to practice efficient medicine and to take appropriate decisions under so much uncertainty, Wernli and his fellow researchers decided to transpose their "Docteur j'ai..." decision tools and guidelines to the tropical context.

To create and discuss a decision tree for four frequent clinical situations, they relied on i-path, a Web 2.0 tool consisting of a discussion group with limited access for partners in Francophone Africa. Not all discussion entry points proved equally successful in initiating discussion, probably due to reticence against 'Western' guidelines and public exposure when debating online. Despite these difficulties, this Web 2.0 approach fostered debate among different experts in different continents, showed that guidelines should be adapted to specific contexts and gave an idea about the Web 2.0's potential for continuous education. Lack of internet access and insufficient computer skills to use these interactive resources remain a problem.

Célia Boyer, of the Health on the Net Foundation, addressed the question of quality control of (health) content on the Web, an 'old issue' which now faces new challenges with the advent of the Web 2.0. This enables virtually everybody to publish and edit information, and, to create websites, wikis and blogs, etc. As potentially millions of users may freely edit, add and erase information, the crucial question becomes "how can you trust the information there?"

To gauge the reliability of Web content, we therefore need to establish standards and guidelines for certification, the most recognised of which is the HONcode. However, in view of the time certification takes and the sheer volume of health-related content on the Internet, it is a good idea to complement this approach with Web 2.0 tools, such as collaborative tagging (Folksonomy) and the concept of a network of knowledge and confidence (friend-of-a-friend paradigm).

GHF2010 – PL05 – Global Access to Health: The High’s and Low’s of Technology

Session Outline

Plenary session PL05, Wednesday, April 21 2010, 9:00-10:30, Room 2
Chair(s): Najeeb Al-Shorbaji, Director, Knowledge Management and Sharing, World Health Organization, Switzerland, Jean-Michel Gaspoz, Professor and Head, Department of Community Medicine and Primary Care, Geneva University Hospitals, Switzerland
De-Isolating Care Professionals in Sub-Saharan Africa Using the Internet
Antoine Geissbühler, MD Director, Medical Informatics Division, Geneva University Hospitals, Switzerland 
mHealth: Bridging the Health Divide
Krishnan Ganapathy, President, Apollo Telemedicine Networking Foundation; President Elect, Telemedicine Society of India
Capacity Building in eHealth and Health Informatics in Developing Countries
Don Detmer, President and Chief Executive Officer of the American Medical Informatics Association, USA

Session Documents

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Session Video

This session is available to watch using Dudal. To watch it you will need to have Java installed on your computer.

Session Report

Satellite dish in rural Mali, near Niafunke. Photo by V. Krebs, ICVolunteers.org

The benefits of Information Technology (IT) in healthcare are creating "boundless opportunities in a borderless world", according to speaker Dr. Ganapathy. Access to healthcare and support for care professionals in remote rural areas is being transformed by the internet and telecommunications. Resources are being better utilised as the need for physical mobility of equipment, care providers and patients is minimised.

This plenary session was chaired by Jean-Michel Gaspoz, as Najeeb Al-Shorbaji from the World Health Organization (WHO) was unable to attend. The main theme running throughout the session was how to overcome physical distance and lack of access to healthcare with the assistance of IT. The presenters spoke of IT being beneficial not only to the patients in remote areas of developing countries, but also to healthcare professionals practicing in such areas. The first two presenters focused on their experiences of providing access to quality healthcare for patients in rural areas and access to information to the practitioners themselves.

The goal of IT intervention in healthcare is to support care professionals wherever they are located in the world, said Antoine Geissbuhler, MD, Geneva University Hospitals. The key is to move information rather than the patients or the care professionals. The density of care professionals is very low in some areas of the world, such as Sub-Saharan Africa and Southeast Asia. The case studies of Niger and Mali were presented where de-isolation of care professionals has been implemented (professionally and socially).

These case studies were the brainchild of the RAFT network, a project run by “people of goodwill and enthusiasm”. The RAFT network consists of 30 local collaborators and a team of five collaborators in Geneva. The project started in 2001 and is now active in 15+ countries, mainly in French-speaking Africa. The network is mostly deployed in reference hospitals and in some remote sites. People in Africa now produce 75% of the content on the network. The project is still in its initial stages and more sophisticated tools are needed for it to become more robust and sustainable. Current developments in RAFT include: industrialising its deployment in district hospitals; evaluating new diagnostic tools coupled with remote support; moving towards certifying capacity development; and teaming up for the implementation of public health and clinical information systems.

Dr. Krishnan Ganapathy, gave an impassioned and energetic presentation on how a humble phone inside your pocket can be a tool to save lives. Mhealth, or mobile health, is a useful tool not only in developed countries, but also in developing countries. The speaker quoted Dr. Muhammed Yunus, “The quickest way to get rid of poverty is to provide everyone with a mobile phone”. Today’s mantra should be “anytime, anyone and anywhere”. Dr. Ganapathy mentioned three advantages of mHealth: a better utilisation of limited resources, a reduced burden on tertiary hospitals and allowing patients to remain in their communities. MHealth will make a huge difference to healthcare access, as 80% of the world’s population has mobile phone coverage potential. Literacy is not necessary at all in mHealth; images are all that are needed. The only limit is your imagination.

Following the presentation, the Chair asked Dr. Ganapathy the all-important question, “Who is paying for mhealth in India?” Dr. Ganapathy replied that insurance companies must cover the bill for the mhealth network in India. People must be encouraged to take up mhealth.

The last speaker was Dr. Don Detmer, CEO of the American Medical Informatics Association (AIMA). His presentation mainly dealt with the human capacity side of ehealth development. He identified three major themes in medical informatics: identify and support local health experts locally as well as worldwide, formalise partnerships with others and build a collaborative AMIA global partnership programme for health informatics. He spoke of moving “from silos to systems”, creating “healthy individuals and populations”. The components for his vision of an ehealth workforce are: Human factors, Information, Communication and Technology (HICT). The degree of change would be more difficult as you moved from technology to human factors. Dr. Detmar introduced Health Informatics Building Blocks (HIBBS) and mentioned that three prototypes are currently being created. Finally, he concluded by saying that a useful vision now exists, but many things still need to be done. These include creating an adequate IT infrastructure, evolving healthcare processes and taking a fresh view of the education of healthcare workers.

Finally, a very important question was addressed to all three speakers during Q&A about appropriate behaviour and the ethical framework of ehealth. Dr. Detmer said that this was a very important question, as culture is a relevant challenge today. He said “the patient is the individual in North American/European culture, while the patient is the family in Asia, Africa and south Europe”. According to Mr. Geissbuhler, it is very important to bridge language barriers and to understand the socio-economic context of the particular country involved. Finally, Dr. Ganapathy commented that breaking the face-to-face paradigm of medical care is not easy, but the past decade has shown considerable improvement in this area.

Electronic Health Record as a Source of Information to Assess Quality of Healthcare for Hypertensives: Mexico

Author(s): Svetlana Doubova1, Ricardo Pérez-Cuevas2, Magdalena Suárez1,  Dennis Ross-Degnan3, Anita Wagner3
Affiliation(s): 1Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico, 2Ministry of Health, Mexico, 3Harvard University, United States
1st country of focus: Mexico
Relevant to the conference theme: Health information and technologies
Summary (max 100 words): The objectives of this study were a) development of quality of care indicators (QCI) for hypertensives in Mexico; b) to determine the feasibility of constructing QCI using electronic health record data; and c) to evaluate the quality of care (QC) provided to hypertensives.   Methods: The study had a mixed method approach which included 48,048 hypertensives.  Results: 14 QCI emerged by using the available EHR (Electronic Health Record) data. The study demonstrated that it is feasible to evaluate QC for hypertensives using the EHR data yet substandard quality in processes and clinical outcomes was observed.
Background (max 200 words): In low and middle-income countries (LMIC) the growing prevalence of hypertension and premature mortality from its complications is a public health problem. Blood pressure control in hypertensives reduces mortality and morbidity, however, more than half of them are untreated and only 23% -46% achieved recommended blood pressure levels. It has been reported that the higher QC for patients with hypertension is associated with better control of their blood pressure, highlighting the importance of measuring QC, in order to identify failures and implement improvement strategies. One of the tools to improve QC is the use of EHR; which is 'a longitudinal collection of information about patient’s general characteristics, medical history, healthcare received and health outcomes. The use of EHR can improve the QC through its continuous monitoring, increased adherence to clinical guidelines, decreased medication errors, and other strategies.  In order to facilitate and improve the QC, the EHR is widely deployed in developed countries but in LMIC the experiences are limited. Only a few LMIC countries like Argentina, Costa Rica and Peru introduced EHR for research in small-scale settings. Mexico introduced the EHR at institutional level in the Mexican Institute of Social Security (IMSS). The IMSS is responsible for the care of 47% of the Mexican population and has a network of 1,516 family medicine clinics (FMC). In the IMSS, hypertension and other cardiovascular diseases are among top causes of ambulatory and hospital care. Nevertheless little is know about the QC that patients with hypertension receive. Currently the EHR information is not available on a routine basis to measure QC for this population.
Objectives (max 100 words): The objectives of this study were a) development of QCI in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCI using the IMSS EHR data; and c) to evaluate the QC provided to IMSS patients with hypertension.
Methodology (max 400 words): Methods: The study had a mixed method approach consisting of: 1) Development of QCI for hypertensive patients using the RAND-UCLA method; 2) Extraction of routine EHR data and construction of predefined QCI; 3) Evaluation of quality of care for hypertensive patients who received healthcare at Family medicine clinics in 2009. Setting: 4 FMCs in Mexico City. Study Population: 48,048 patients with hypertension who received care in 2009.
Results (max 400 words): Results: We developed 20 QCI, of which 14 were possible to construct using available EHR data. QCI comprised both process of care and health outcomes. Among 48,048 patients with hypertension, 64% were women, 66.7% were ≥60 years of age; 70% were overweight or obese (BMI ≥25.0 kg/m2); 30.9% had diabetes and 7.4% arteriosclerotic diseases. 51% of patients were prescribed one antihypertensive drug, 19.2% two, 4.3% received 3 or more antihypertensive drugs and 25.5% had no antihypertensive drugs prescriptions. The most frequently prescribed drugs were inhibitors of angiotensin converting enzyme (50%). The indicators of QC showed that during 2009, only in 15% of patients with newly diagnosed hypertension (in 2009) the diagnosis was based on the records of at least three blood pressure (BP) measurements with systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg. Just 10% of them were ordered urinalysis, serum creatinine, fasting plasma glucose and total cholesterol. Regarding timely detection of complications: 39.8% of subsequent hypertensive patients without diabetes had fasting plasma glucose measurement at least once in the last 12 months; 37.8% of them had serum creatinine test; 43.2 had total cholesterol measurement and 10.0% were referred to the ophthalmologist. Regarding non-pharmacological and pharmacological treatment only 3.3% of obese hypertensive patients received nutritional counseling; 53% of patients with total cholesterol >= 240mg/dl or total cholesterol 200-239mg/dl and one or more of the following CV risk factors: smoking, diabetes or established atherosclerotic diseases were prescribed statins. 61.3% of patients with systolic BP ≥ 140 mmHg or diastolic ≥ 90 mmHg in the last 3 consultations and with 3 antihypertensive drugs were referred to the second level of care. Regarding health outcomes: 62.8% of hypertensive patients without diagnosis of diabetes and / or chronic kidney disease had blood pressure below 140/90 mmHg in the last 3 measurements; nevertheless 7.4% of  hypertensive patients with type 2 diabetes or chronic kidney disease had blood pressure below 130/80 mmHg in the last 3 measurements. Furthermore, 1.5% of patients had a cardiovascular event (myocardial infarction, cerebral vascular event, arterial thrombosis) in the last year.
Conclusion (max 400 words): The study demonstrated that it is feasible to evaluate QC for hypertensive patients using the IMSS EMR data. The results highlight the need to improve processes and clinical outcomes of guideline-based care for hypertensive patients in Mexico.

The Illness of “Pilotitis” In mHealth – Early Lessons from the KimMNCHip Partnerships in Kenya

 

Author(s): Stefan Germann1, Amer Jabry2, Judy Njogu3, Ronald Osumba3
Affiliation(s): 1World Vision International, Geneva, Switzerland, 2e-merge consulting, Twickenham, United Kingdom, 3Safaricom, Nairobi, Kenya
Name your project or intiative: The illness of pilotitis in mHealth - Kenya KimMNCHip brokering partnerships for national scale up early lessons
1st country of focus: Kenya
Relevant to the conference theme: Health information and technologies
Tags:
Summary: Currently there are a proliferation of mHealth pilots. It is time to stop with new pilots as the field suffers from the contagious disease of 'pilotitis'. What is needed to move the mHealth space ahead, is solutions at national scale that are cost effective and use evidence based approaches for health outcomes. In Kenya, a partnership brokering process started 18 months ago to bring together the largest mobile phone provider and NGOs to work with government aimed at scaling up mHealth for Community Health Workers and pregnant women at a national scale.
What challenges does your project address and why is it of importance?: mHealth solutions are promising to enhance health outcomes at scale, especially when integrated with mobile financial services for social protection and other measures to enhance demand creation to access essential health services, especially in the context of reproductive, maternal, neonatal and child health. Currently most mHealth approaches are project based, most often of a pilot character. Hence we term this the illness of 'pilotities' in mHealth. There is urgent need to move from this stage to national mHealth solutions that are cost effective and evidence based in terms of health benefits. Brokering multi-stakeholder partnerships towards creating convergence and new business models is needed to bring solutions to scale.
How have you addressed these challenges? Do you see a solution?: KimMNCHip is a national-scale mHealth initiative to offer pregnant women in Kenya more choice, control and care during their pregnancy, and improved medical care for them and their babies during and after delivery.  In 2008, the (adjusted) maternal mortality rate in Kenya was 530 per 100,000 live births, while the infant mortality rate was 56 per 1,000 live births.  These figures place Kenya in the highest 15% of countries for maternal mortality, and the highest 20% for infant mortality (source: data.worldbank.org).  As part of its commitment to the UN Global Strategy for Women’s and Children’s Health, Kenya will recruit and deploy an additional 20,000 primary care health workers; establish and operationalize 210 primary health facility centres of excellence to provide maternal and child health services to an additional 1.5 million women and 1.5 million children; and will expand community health care, and decentralize resources. KimMNCHip aims to support this commitment through one integrated system, providing women with mHealth support along the continuum of care from pre-pregnancy to post-natal stages.  It will  initially offer three complementary services:  1. Public information via an MNC mHealth advisory service for pregnant women who register and provide their due date.  They will receive a mix of “push” SMS and voice messages, and access to call-in advisory hotlines and information data bases for MNCH issues.  These will provide the women with timely health information scheduled in accordance with the national MNCH plan.   SMS/voice charges to be covered by private partners (funded via txt/voice message advertising – following advertising code). 2. mFinancial services for health that provide pregnant women with electronic vouchers to redeem in a collaborating clinic of their choice.  The vouchers act as an incentive for clinics to enhance the quality of their services and attract more pregnant women, through a results-based payment system.  The voucher also includes a social protection cash transfer to support the women with the costs of delivery.  We will explore other uses of mPayments to support maternal and newborn care. Funding of the vouchers will be sourced from social protection funds and contributions from donors and the private sector. 3. Primary care via mSupport services along the continuum of care, for mothers and for primary health care workers (PCHWs). These will be based on access to electronic medical records, appointments, reminders, and checklists to deliver better community health services, and monitor and respond to MNCH indicators.  The initial partners of this national scale initiative are Safaricom, World Vision, the mHealth Alliance, CARE International and NetHope.  They are developing, in collaboration with other strategic mobile health partners, the preliminary enterprise and technical architectures necessary to support the continuum of care.  This initiative will represent a model implementation of the Maternal mHealth Initiative’s Global Framework.  Members of the KimMNCHip consortium will participate in developing the Framework, and the project will seek to apply the Framework.
How do you know whether you have made a difference?: The recognition of the power of multi stakeholder partnerships is well documented, especially when convergence is achieved among the various partners. KimMNCHip has both a partner brokering monitoring framework in place and an operational research is being currently designed to measure the mHealth solutions effectiveness with scientific rigor.
Have you or the project mobilized others and if so, who, why and how?: The partnership is mobilizing the government and across the world is sharing this approach via NetHope and mHealth Alliance. The CEO of Safaricom was speaking at the UN Secretary General's Every Women Every Child event sharing about KimMNChip in New York during the September 2011 UN General Assembly.
When your donor funding runs out how will your idea continue to live?: The project is not donor funded at present and Safaricom is developing a business case for affordable mHealth solutions for all Community Health Workers in Kenya. Safaricom with MPESA, banking for the unbanked, demonstrated its ability to create business models that are affordable for all. World Vision is using its own resources to support the partnership brokering process.

RAFT: Telemedicine in Africa

The RAFT-Network provides telemedicine in African Francophone countries. The main challenge adressed is the de-isolation of care professionals working in remote areas of developing countries. The core activity of RAFT is the webcasting of interactive courses targeted to physicians and other care professionals. Courses are webcast every week, freely available, followed by hunderds of professionals who can interact directly with the teacher.


Project/Initiative Outline:

First Name
Antoine
Last Name
Geissbuhler
Name of project or intiative RAFT: de-isolation of care professionals in developing countries
1st country of focus Mali
Additional countries of focus Sub-Saharan Africa and Latin America
Relevant to the conference theme Health information and technologies
Summary Continuing education of healthcare professionals and access to specialized advice are keys to improve the quality, efficiency and accessibility of health system. In developing countries, these activities are usually limited to capitals, and delocalized professionals do not have access to such opportunities, or even to didactic material adapted to their needs. This limits the interest of such professionals to remain active in the periphery, where they are most needed to implement effective strategies for prevention and first-line healthcare.

In order to address these needs, the Geneva University Hospitals have developed a telemedicine network in Africa (the RAFT, Réseau en Afrique Francophone pour la Télémédecine), first in Mali, then in Mauritania, Morocco, Cameroon, and, since 2004, in Burkina-Faso, Senegal, Tunisia, Ivory Coast, Madagascar, Niger, Burundi, Congo-Brazzaville, Algeria, Chad, Benin, Guinea and DRC.
The core activity of the RAFT is the webcasting of interactive courses targeted to physicians and other care professionals, the topics being proposed by the partners of the network. Courses are webcast every week, freely available, and followed by hundreds of professionals who can interact directly with the teacher. 70% of these courses are now produced and webcast by experts in Africa. A bandwidth of 30 kbits/second, the speed of an analog modem, is sufficient, and enables the participation from remote hospitals or even cybercafés.
Other activities of the RAFT network include medical tele-expertise, tele-ultrasonography, and collaborative development of educational on-line material.
The network is currently organized and run by more than 40 national coordinators throughout Africa, and by a coordination team based in Geneva. In each of the partner countries, the RAFT activities are supervised by the focal point, a medical authority (usually a university professor) that links the project to the national governmental bodies (ministry of health, ministry of education). A local medical coordinator (a junior physician) and a technical coordinator take care of the day-to-day operations, including communication with the care professionals, identification of training needs, technical training and support of the various sites within the country.
Key partnerships include the Université Numérique Francophone Mondiale (UNFM) and the World Health Organization (WHO). The RAFT is recognized as an official WHO collaborating center for eHealth and Telemedicine.
The current priority is the large-scale deployment of these telemedicine tools along with IT-enabled diagnostic devices such as portable echography, to the regional and district hospitals in Africa. These infrastructures could also be used to facilitate public health activities including the collection and communication of surveillance and healthcare indicators to the ministries. The usefulness of these tools to support isolated care professionals has been demonstrated, as well as the sustainability of the implementation in large hospitals who can integrate the recurring connection costs in their operational budgets. Given the high costs of satellite connections (about 500 USD per month), which are the only options in remote areas, it has been evaluated that sustainability can currently be achieved down to the district-level hospitals who usually serve populations of 50’000 to 200’000, and operate as the first level of reference for dispensaries and rural hospitals.
In parallel, the network is extending to other linguistic areas: educational sessions have been produced in English since October 2008, and are available to hospitals in English-speaking Africa and the Middle East. Since 2011, the project is being implemented in Latin America.
What challenges does your project address and why is it of importance? The main challenge addressed is the de-isolation of care professionals working in remote areas of developing countries. In most countries, remote areas are understaffed, with a suboptimal use of existing resources, while main cities retain most of the skilled professionals and have overcrowded care facilities.
How have you addressed these challenges? Do you see a solution? The RAFT network provides distance education and tele-expertise services to isolated care professionals, by establishing South-South collaborations between reference hospitals and regional/district hospitals.
How do you know whether you have made a difference? We have many anecdotes showing that these tools are effective both for professional and social de-isolation, and help maintain skilled and motivated professionals in remote areas, thus strengthening thelocal health systems.
Have you or the project mobilized others and if so, who, why and how? The RAFT network has many partnerships in order to provide quality contents and mutualize technical and organizational resources. These include WHO (HUG is a WHO collaborating center for eHealth and telemedicine), UNFM (Université Numérique Francophone Mondiale), AUF (Agence Universitaire de la Francophonie), UNESCO (University of Geneva has a UNESCO chair for distance education), Université Senghor...
When your donor funding runs out how will your idea continue to live? In most countries, the network is supported by the MoH or hospitals within two to three years of the initial deployment in that country.

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