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GHF2014 – PS28 – Patient-Centric Technology: Innovation for Health

10:45
12:15
PS28 THURSDAY, 17 APRIL 2014 ROOM: 15 ICON_Fishbowl
Patient-Centric Technology: Innovation for Health
MODERATOR:
Mr. Hani Eskandar
ICT Applications Coordinator, ICT Applications and Cybersecurity Division,  Telecommunication Development Bureau of ITU, Switzerland
SPEAKERS (tentative):
Dr. Oliver Harrison
Senior Vice President, Healthways International; Consultant to WHO on mHealth for tackling Non-Communicable Diseases, Switzerland
Mr. Andrés Martin
Head of Digital Strategic Planning, BUPA
Mr. Sameer Pujari
mHEALTH secretariat for WHO and ITU joint program on mHealth for Non-Communicable Diseases, WHO, Switzerland
Mr. Simão Ferraz de Campos Neto
Counsellor for ITU-T Study Group 16, Secretariat of the ITU Standardization Sector, Switzerland
OUTLINE:
With the fast pace of technology development and the demand of improved service accessibility and quality, disruptive innovation has been having the perfect environment and opportunity to show its potential. Within healthcare, this mainly took form as the now very well-known field of personalized medicine, which allowed information and services to be more accessible to patients, healthcare professionals as well as the overall public and private sectors. Due to higher interaction between stakeholders, health services accessibility and quality will improve and to meet everyone’s expectations and needs. These technology advances allowed patient’s empowerment as well as the emergence of new services and trends. Special focus has been put on wearable technologies, which with time have been widening its use and purpose besides decreasing in size. Such technologies enabled the self-management of patients with chronic diseases, the improvement of quality of life of elderly and the promotion of healthier behaviors concerning physical activity and nutrition. Smart watches or bracelets track now users’ activities, wireless sensors correct a person’s posture, ingestible sensors are used for drugs’ compliance, biosensing clothing monitor heart rate and activity among many others. Innovation within healthcare has therefore been focused more and more on each person’s unique conditions and needs.The objective of the session is to facilitate a dialog between all stakeholders involved, namely government regarding policy-making and standardization requirements, private sector regarding future technology advances and trends, healthcare providers regarding new opportunities and international organizations regarding required global actions to unlock possible bottlenecks and to address challenges that will accelerate large scale uptake of these new technologies for improved health outcomes.
PROFILES:

Hani_EskandarMr. Hani Eskandar

Mr. Hani Eskandar is the ICT Applications Coordinator at the ICT Applications and Cybersecurity Division of the Telecommunication Development Bureau of ITU. Mr. Eskandar is currently involved in providing assistance to several developing countries by advising on eApplications strategies and policies, assisting in implementing technical co-operation projects and developing guidelines and best-practices on eApplications.

Previously, Mr. Eskandar had extensive experience in the field of ICT for Development where he, through his work with the International Federation of Red Cross and Red Crescent in Switzerland and, UNDP and other NGOs in Egypt, was involved in several development projects in the fields of Health, Education, Illiteracy Eradication, Community Development, SME development and Micro Credits. This included, among others, introducing Telemedicine services in rural areas, introducing ICT in Schools, creating Community Development Portals, Community Learning Centres, developing e-Learning and training programs for Youth.

Mr. Eskandar has an educational background in Electrical Engineering (Telecommunications) and has completed an MBA from McGill University, Canada and a Master Degree in Social and Economic Development Studies from University of Paris I, France.

Oliver_Harrison_squareDr. Oliver Harrison

Dr. Oliver Harrison is a Senior Vice President with Healthways International, a global health and wellbeing company specializing in population health management based on more than 30 years of experience.  He is also a Consultant to the WHO for their joint initiative on mHealth for tackling Non-Communicable Diseases, and Co-Founder of Platform Health (www.platform-health.org), a non-profit Standards Development Organisation and ITU Sector Member.  Platform was created to help close the remaining gaps to enable secure “plug and play” health data system interoperability, including mobile.

Until 2013, as Director of Strategy at the Health Authority – Abu Dhabi, Dr. Harrison helped drive a comprehensive health system reform.  Progress was driven and tracked using data from pioneering IT systems designed/implemented by the Health Authority team (www.shafafiya.org); these systems have become the blueprint for several additional countries (http://bit.ly/1hQRSMA).  Dr. Harrison established the Abu Dhabi Public Health Department, which used these data systems as the foundation to design and implement “Weqaya” – an award-winning population health management programme targeting diabetes, hypertension, and other risk factors for cardiovascular disease (www.weqaya.ae).

Before Abu Dhabi, Dr. Harrison spent five years with McKinsey working worldwide with the healthcare practice.  He is a UK physician with US National Board Certification in Public Health, and Masters’ degrees in Public Health from Johns Hopkins and Neuroscience from Cambridge University, a Non-Executive Director of Guy’s and St. Thomas’s NHS Trust, and a member of the World Economic Forum Global Agenda Council on Behaviour and Cognitive Science.

Andres_Martin_squareMr. Andrés Martin

Andrés Martin Diana was born in Seville, Spain, has academic background in Media and holds a MBA by the IE Business School (Madrid). He has been working in the digital arena since 1997, when he co-founded and managed a pioneering online content start-up. Passionate about healthcare disruption by innovative online services and technologies, he led the digital marketing, sales and services for Sanitas, a leading healthcare company in Spain, until 2008. After that, he was responsible for Bupa’s global digital strategy until 2013. He now leads the partnership between Bupa and the WHO and ITU for mHealth, supporting the initiative Be Healthy Be Mobile to tackle non communicable diseases globally. He has been invited as speaker in several international conferences on strategy, digital transformation and eHealth/mHealth

Sameer_PujariMr. Sameer Pujari

Currently with WHO, Sameer Pujari is part of the mHEALTH secretariat for the flagship WHO and ITU joint program on mHealth for Non-Communicable Diseases; Be He@lthy Be Mobile. With WHO, he has also provided technical advise and support to over 30 countries in the development of surveillance and management information systems. He is also a core member of the Health Data Forum at WHO and the co-chair of the WHO mHEALTH working group. Before coming to WHO, Sameer worked with the US Governments health agency helping various countries build informatics systems for immunization and vaccination programs in Asia Europe and Africa. He started his career working with WHO's National Polio Surveillance Project in India for 7 years, where he led the development and implementation of various information management systems for surveillance across the country.

Campos NetoMr. Simão Ferraz de Campos Neto

Simão Ferraz de Campos Neto joined the secretariat of the ITU Standardization Sector in 2002, and is the Counsellor for ITU-T Study Group 16 (for standardization work on multimedia services, protocols, systems, terminals and media coding, including accessibility, IoT, IPTV and Digital Signage). He organized several workshops (e.g. Multimedia in NGN, Telecoms for Disaster Relief, RFID, E-health standards; SIIT2005) and was the editor of the first version of the ITU-T Security Manual.

Prior to joining ITU in 2002, Mr Campos worked for 8 years as a scientist in COMSAT Laboratories performing standards representation and quality assessment for digital voice coding systems, and before that he was a researcher at Telebras’s R&D Center (CPqD).

A Senior Member of the IEEE, Mr Campos authored several academic papers and position papers, served in the review committee of several IEEE-sponsored conferences, and organized the first ITU Kaleidoscope Conference.

CBK-learning: new technologies for the health education of prospective and new parents.

Author(s) Christian Oberlé1, Stéphanie Blaise2,
Affiliation(s) 1Management Department, Clinique Bohler, Luxembourg, Luxembourg, 2Management Department, Clinique Bohler, Luxembourg, Luxembourg, 3
Country - ies of focus Belgium,Germany,Luxembourg,Mali
Relevant to the conference tracks Innovation and Technologies
Summary Health education and coaching represents 75% of the support given to birthing mothers during their hospital stays. The important need for information and support before and after the birth of their child convinced Clinique Bohler to invest in the development of an e-Learning platform, adapted to the lifestyles of young parents. Cbk-learning is an innovative concept in the field of women’s health education and prevention. Incorporating new multimedia technologies into health education can facilitate access to quality information tailored to the needs of the patients and help maintain remote contact with them. It is an educational tool that has a great resource sharing and co-development potential.
What challenges does your project address and why is it of importance? 1.Establish early contact with the patient base.
In Luxembourg, the future mother has the first contact with the staff of the Clinic around the 6th month of pregnancy when attending prenatal workshops. To better inform and support prospective parents throughout the pre natal period we need to make contact with them at an earlier stage.
2.Develop communication channels and innovative training
Patients are increasingly turning to the internet to find answers to their questions about health. It is important to be kept up with our patients’ lifestyles and listen to their evolving expectations.
3.Be accessible to current customers whatever their geographic distance to the Clinic
The distance between home/work and the maternity centre can be a significant barrier for the future mother in attending prenatal workshops.
4.Provide consistent information and quality education before, throughout and after the patient's hospital stay.
Health information found on the internet is not necessarily reliable. As a hospital we have the expertise to provide reliable information to future parents.
5.Anticipate patient questions, needs and concerns
The birth of a child is a major event: it requires special attention because prospective and new parents are particularly sensitive and they need responses and attention.
How have you addressed these challenges? Do you see a solution? Solutions according to challenges:1. Establish early contact with the patient base.
In the early stages of the pregnancy patients are invited by the medical secretaries to preregister for cbk-learning. It is a very simple process.2. Develop communication channels and innovative training.
The use of new multimedia technologies can enhance and facilitate access to quality information tailored to the specific needs of the patient base and help maintain remote contact with them.It is a new concept for educating and supporting pregnant women and facilitates access to information (remote exchanges).

The platform now embeds social media networks as well (interactive sessions accessible to facebook fans, possibility to share contents). It is very much in sync with the habits of younger generations who need to be connected to a community based on their particular situation or interests.

3. Be accessible to current customers whatever their geographic distance to the Clinic is.
E-learning is a solution to create the contact with these patients and offer them access to essential information and even remote access to prenatal workshops.

4. Provide consistent information and quality education before, throughout and after the patient's hospital stay.
The patients’ need for consistent and reliable information was the source of the creation of the e-learning website. The content of the platform is validated by a Committee composed of midwives, staff, management, social adviser, nurses, pediatrics, and gynaecologists.

5. Anticipate patients questions, needs and concerns.
The e-learning site is built around the main questions and concerns expressed by the parents.
We gathered an inventory of the most frequently asked questions in prenatal classes and consults, analysed them and relied on evidence-based nursing to build the contents of the e-learning website.

The e-Learning platform developed by Clinique Bohler is:

• A unique platform for preventive healthcare and health education of women and an effective support tool for future parents through new multimedia technologies.
• A library of learning tools (educational videos, quiz, animations) in gynaecology and obstetrics.
• An internet-based broadcasting tool of live interactive sessions given by the nursing staff which allows patients to actively participate in the classes from home or during their hospital stay.
• An innovative way to ensure ongoing consistent training for the nursing staff.

How do you know whether you have made a difference? The key figures for 2012, be it the number of visits, the average time spent on the site per visitor, or the geographical origin of the visits, illustrate the relevance of this e-learning initiative
• Nearly half of the patients who gave birth at the Clinic Bohler in 2012 (2680 births) were registered on the e-learning site. The number of registration increased in 2013
• The presence of patients online for the interactive classes is constantly increasing, as is the number of patients physically present in the rooms.
• A visitor remains on average about 7 minutes on the website, which is way above the average of traditional websites.
• Other key figures (2012): 7048 Views, 3483 Unique Visitors, 47721 Page viewsThe qualitative feedback we get from our patients and the more targeted questions they raise when they come to the Clinic for the birth of their child also go a long way to validate the benefits in the area of health education of this new approach we’ve developed with our e-learning solution.
Have you or the project mobilized others and if so, who, why and how? We have implemented a series of targeted partnerships to ensure the viability, the sustainability and the successful deployment of the platform.
• Educational partnership with a Nursing school
The Clinic has achieved a close partnership with Henallux(midwifery/nursing School) for the development of pedagogical tools.The school can use cbk-learning platform for its health education courses and in return, students and teachers from the school participate in the development of the cbk-learning contents.
• Partnerships with selected clinics/hospitals
The development of professional quality content for the website is consuming both financially and in terms of human resources for a single hospital. Sharing of complementary knowledge and resources with other clinics seemed the best way to ensure the future of the platform.The idea was also to choose partners who could help making the platform multilingual, and especially in the languages spoken in Luxembourg (German, Portuguese, English).
Current status of partnerships:
• Germany is already covered by a partnership with Frauenklinik Dr Geisenhofer (Munich).
• Portugal will soon be covered with a partnership with a University Hospital from Coimbra.
• Belgium is already covered with a partnership with Clinique Saint-Vincent.
• We hope to achieve a partnership that will cover the needs of English speaking patients.
Another objective in engaging in partnerships with other hospitals would be to open the opportunity for the platform to broaden its scope to areas other than obstetrics.
• Partnerships for Corporate Social Responsibility
CBK-learning is an educational tool that can potentially be deployed in areas of the world where prenatal care and women’s health education are major public health issues. The idea is to replicate a concept that was already successfully tested in Europe, while adapting it to local contexts, needs and means as an addition to local programs. This can be done with partners with a good local knowledge and a solid regional implementation. From that perspective, we entered in a joint-project in Mali with the Fondation Raoul Follereau. The objectives are to capitalize on the contents of the existing e-learning platform to create videos and technical recommendations on various formats that local healthcare professionals can use to reinforce the training of local health personnel in the fields of obstetrics and early childhood, and increase the number of pregnant women attending prenatal consults
When your donor funding runs out how will your idea continue to live? Our project will continue to live through:- Partnerships based on co-creating contents and resources and sharing the cost of maintaining and developing the platform
- Generating revenues by developing a client-base of hospitals and healthcare professionals who wish to give their patients access to the e-learning platform and will pay a registration fee to the platform, thus financing in part the development of the new contents and the operating costs.
- European or country specific subsidies are likely to be allowed to this initiative, as the platform contributes to public health objectives and promotes European collaboration in the health sector.

The ‘Rural Surgeon’ of India: A New Paradigm in Surgical Education

Author(s): K. M. Shyamprasad*1, M. Gautham2
Affiliation(s): 1Surgical Education, National Board of Examinations, 2Public Health, Independent consultant, New Delhi, India
Keywords: Rural surgeon, innovative training, skill mix
Background:

There is a wide gap between the burden of surgical emergencies and diseases in India and the availability of appropriately skilled surgeons to manage these, especially for the country’s 700 million rural population. On the public health forefront, huge surgical needs exist for management of (1) maternal complications and emergencies that are a leading cause of India’s high maternal mortality rate (407/100,000 live births), and (2) injuries responsible for 11% of deaths, 50 million hospital care seekers, and 17 million hospitalizations. The country needs to develop greater numbers of versatile surgeons able to function independently in resource limited rural settings.

Summary/Objectives:

In a significant shift from the Euro-Western model of compartmentalized surgical education, the National Board of Examinations - the MoH’s apex body for post graduate medical education - has developed a 3 year Rural Surgery course. The syllabus emphasizes basic surgical skills and management of traumas and emergencies; it includes Obstetrics and Gynaecology, Anaesthesia, as well as Management of a Rural Health Centre. Problem solving learning principles underlie the pedagogical approach. Nodal and peripheral rural course centres, chosen for their commitment to rural surgical care, provide practical training in cost containment, economics of rural healthcare, functioning within infrastructural constraints, and also inculcate appropriate attitudes and communication skills. Student’s learning material is responsive to local disease burdens and incorporates a variety of e-learning and audiovisual material.

Results:

The course was launched in 2007 with 10 students. Periodic reviews are designed to improve upon the basic course design and attract increasing numbers of students.

Lessons learned:

The Rural Surgery course is an innovative, pioneering effort to align surgical education with the public health surgical burden of a low income country. It represents a paradigm shift in the evolution of Indian medical education from a Western model to a locally responsive model.

Research Ethics Training in International Collaborative Research Partnerships: Looking Back on the TRREE for Africa Project

Author(s): J. Ateudjieu*1, M. Hirtle2, D. Sprumont3
Affiliation(s): 1Division of Health Operations Research, Cameroon Ministry of Public Health, Yaounde, Cameroon, 2Centre de santé et de services sociaux de la Montagne, Montréal, Biotika, Montréal, Canada, 3Institut de droit de la santé, Université de Neuchâtel, Neuchâtel, Switzerland
Keywords: E-learning, Research ethics, Ethics evaluation, international collaborative research
Background:

TRREE-for-Africa stands for Training and Resources in Research Ethics Evaluation for Africa. It is a web-based training and capacity-building initiative primarily targeting African needs. TRREE focuses on internationally recognized ethical principles and regulations while integrating local African issues and perspectives relevant in order to promote the highest ethical standards in research ethics evaluation. Currently, TRREE provides free access to: E-Learning: distance learning on research ethics evaluation on the web; and E-Resources: a participatory web-site making available international, regional and national regulatory and policy resources.

Methods:

The training needs of actors involved in biomedical research in Africa and in Switzerland were assessed trough a needs assessment questionnaire administered to Research Ethics Committees (REC) members from Switzerland and three African countries (Cameroon, Mali and Tanzania). Based on the results of this questionnaire, TRREE for Africa developed and made free access (since June 2009) in English, French, Germany three on-line and CD-ROM training modules and other resources in research ethics evaluation for a diversified audience involved in research with human participants in Africa. Module 1 is an introduction to research ethics; module 2 deals with the roles and responsibilities of RECs and; module 3, specific to each country, provides references to applicable laws, regulations and guidelines. Subject to funding, this courses will be translated in other languages, new countries will be added (for their national module 3) and additional modules will be developed in 2010 and comming years on other topics identified as priorities in the needs assessment.

Results/Conclusions:

From June 19th to October 2009, 6503 participants visited the TRREE web site (www.trree.org ) with 574 registered participants to training courses including 155 from United-States, 82 from Switzerland, 42 from Mali, 32 from Cameroon 28 from Ghana, 24 from Nigeria, 24 from Zambia, 8 from South Africa, 21 from Tanzania, 16 from Kenya, 8 from Indonesia, 7 from Egypt and 14 from India. 185 of them completed the courses with 127 certificated issued. The TRREE project has been working on its training program since the September 2006. Since that time, it has had various impacts in participating countries – in addition to the actual e resources and training program: 1) promoted south-south and south-north learning through use of African specific case studies; 2) promoting capacity-building (Organization of internships for collaborators in research ethics in Switzerland); 3) provided an opportunity to forge new partnerships and networking; 4) provided a platform by which certain countries can make their national regulations available on the web; 5) provided publications; 6) supporting the organization of workshop in Africa. The result of the TRREE training initiative are having promising outcome in Africa and elsewhere as far as the capacity building in research ethics of key biomedical research actors is concerned; even if efforts are needed to improve its accessibility to African countries.

Bioethics & BioMedical Informatics in India: Setting an Agenda for the Synergistic Way Ahead

Author(s): M. Nabeel1
Affiliation(s): 1Solution Exchange AIDS Community, Knowledge Management Partnership Project, New Delhi, India
Keywords: Training, education, e-learning, bioethics, biomedical informatics
Background:

Emergence of digital technology had made a tremendous and dramatic influence on how we use data & information at its various stages of acquisition, processing, storage & dissemination. The Biomedical domain had been one of the frontier areas in embracing such technology and continues to act as a constant source of inspiration for the development of better systems. Medical / Health Informatics is an Interdisciplinary and Integrative Body of Knowledge using the Synergy of Informational, Computational, Cognitive and Management Sciences for enhancing the acquisition, storage and optimal use of information in all Medical Activities including education, research, clinical and preventive aspects. Like it was said of Physiology as the ‘logic of life’ and Pathology as the ‘logic of disease’, Medical Informatics is being accepted as the ‘logic of healthcare’.

Methods:

India is yet to come up with a comprehensive legislation encompassing the areas coming under Biomedical Informatics & eHealth. The IT Act 2000 and its amendment in 2006 though not specifically address these issues, can be used in some instances as a starting point for regulation. It provides detailed guidelines to be followed for electronic documents and the use of digital signatures which is very relevant for Electronic Health Records and other similar electronic documents. The Code of Medical Ethics 2002 which is indirectly binding legally on all modern medical practitioners in India by an act of parliament, makes an appeal in section 1.3.4 that Efforts shall be made to computerize medical records for quick retrieval (http://mohfw.nic.in/code.htm). Apart from this, the code does not make any mention related to Health Informatics or Ehealth or Telemedicine. Being a general guideline for all medical practitioners across all specialties, it is obvious that a detailed account of all these issues is beyond the scope of the Code of Medical Ethics. People working in the field of Telemedicine in India had been advocating for a comprehensive telemedicine / telehealth act. Though it was taken up for consideration by the Ministry of Information Technology, till date such an act has not been passed in India. In the United States of America, the Health Insurance Portability & Accountability Act or HIPAA (http://www.hhs.gov/ocr/hipaa/) takes care of most of the issues related to Protected Health Information. The Privacy Rule and the Security Rule under HIPAA are very comprehensive, though there is criticism from providers that it is too stringent. Researchers & Providers feel that it has put extra burden on them and evidently the implementation & compliance had been very slow owing to the detailed and often cumbersome procedures. In Europe, though a counterpart for HIPAA is not existing, researchers and advocates under the banner of the European Health Management Association (EHMA) have felt that many of the existing legislations though not specific to eHealth or Informatics across the European countries, can address the issues under consideration. An EHMA study titled “Legally eHealth” emphasizes this point but adds that this should be made clear to all relevant stakeholders through extensive dissemination work. (http://www.ehma.org/_fileupload/Downloads/Legally_eHealth-Del_05-Recommendations.pdf) It also recommends that a proper impact assessment should be undertaken for framing future policy & legislations in this field.

Results/Conclusions:

It is high time that India also think of undertaking such impact assessment of Biomedical Informatics on the Health System in India and evolve appropriate strategies in addressing the ethical and regulatory concerns. While a stringent and elaborate rule like that of HIPAA may not be feasible in the Indian context, we cannot neglect the need for appropriate legislations.

GHF2006 – PS16 – Managing International Mobility of Health Professionals

Session Outline

Parallel Session, Friday, September 1 2006, 11:00-12:30
Chair(s): Manuel Dayrit, Switzerland, Peter Suter, Switzerland
Lola Dare, Exectuvie Secretary, African Council for Sustainable Health Development, Nigeria 
Nurses on the Move: International Nurse Migration
Mireille Kingma, Consultant, Nursing and Health Policy, International Council of Nurses, Geneva, Switzerland
Opportunity Knocking: Exploiting e-Health for Global Health Human Ressources Planning
Kendall Ho, Continuing Professional Development & Knowledge Translation, University of British Columbia, Vancouver, Canada

Session Document

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Session Report

Contributors: Melissa Bonnefin (ICVolunteers), Robert Strange (ICVolunteers)

Sudan, Zalingei-Garsila road, Darfur. Relief convoy. Image: © ICRC/ T. Gassmann

The global phenomena of massive migration of health professionals and the advent of e-Health solutions are evidence of the fact that significant trends in health are no longer regional. Worldwide, doctors, nurses and ancillary staff are increasingly seeking better prospects for themselves, not only in the northern economic powerhouses but also in developing countries. However, a severe lack of knowledge-sharing mechanisms and appropriate funding has meant that patients and health professionals in poor countries are still denied the opportunity to benefit from pioneering e-Health programmes now being developed in countries such as the UK and Canada.

Ms. Lola Dare from Nigeria, representing the African Council for Sustainable Health Development, referred to the work of the Global Stakeholder Alliance and the African Platform, as she emphasised that srategic responses to migration involving local stakeholders are essential to ease the burden on poorer countries of the brain drain of qualified health workers. In a similar vein, Ms. Mireille Kingma of the International Council of Nurses (ICN) in Switzerland stressed the importance of the ICN's nurse-specific reports, both in supporting individual nurses who elect to migrate and in devising measures to combat the shortfall in skilled professionals in both rich and developing nations.

The negative effect of the skills gap on the health services of countries in Africa and South-East Asia is acute. But, as Ms. Dare illustrated, budget caps imposed by international monetary institutions are critically hampering the attempts to redress the balance. In Nigeria, for example, it is estimated that current spending on health sector wages would need to increase almost four-fold, to 8.7 million dollars, in order to reach the minimum health-worker to patient threshold advocated by international experts. This is of particular importance in terms of a nation's health, since there is a direct correlation between incidence of disease and the patient to health professional ratio.

Aside from monetary concerns, both Ms. Dare and Ms. Kingma highlighted the importance of addressing the wider issues constituting the "push factor" behind the decision of professionals to migrate. Studies have revealed that improvements in working conditions, greater job satisfaction and patriotism can be key in persuading them to remain in their countries of origin. It is also important to ensure that the right type of human resource policies are in place, so that "anchor effects" can stem the migratory tide. As Ms. Kingma explained, a policy of retaining older nurses while denying employment prospects to newly qualified professionals has caused high nurse unemployment in certain African countries.

Facing such prospects, and given other contributory factors, it is hardly surprising that large numbers of health professionals choose to chance their hand abroad. Their right to professional mobility should not be denied, not only due to  the advantages migration may bring to them as individuals and to their new host countries, but also in view of the indirect benefits which almost always accrue in the supplier countries.

While the latter point might seem counter-intuitive, it is not only host countries which gain from the global movement of health personnel. Nurses who have spent a period abroad are able to apply their increased expertise to their work if and when they choose to return to their native countries. More importantly perhaps, remittances sent home amount to a total of 225 billion dollars, more than the sum of all the world development aid budgets.

Given the precarious state of health infrastructures in many poor countries, it would appear that their citizens and health professionals are unlikely to benefit in the near future from the breakthroughs in e-Health. However, as Dr. Kendall Ho from the University of British Columbia in Vancouver, Canada emphasised, with the appropriate investment in new technologies and with improved access to knowledge, it would be feasible for the benefits brought by e-Health to "underserved populations" in outlying areas of British Columbia (Canada) to be replicated even in poor parts of the globe.

Health informatics and e-learning can be effective tools in providing support to doctors in rural areas and also to patients in urban environments, for example in post-operation situations. As long as appropriate networks are established and the necessary resources are put in place, the capacity of e-Health to bridge geographical gaps could become a key factor in improving access to health and support to health professionals in poor countries. Dr. Ho highlighted the urgent need for "global debate" on e-Health.

It is vital that human resource policies are adapted to take account of the new global realities. Appropriate support should be provided for workers choosing to exercise their right to professional mobility, while funding and other strategic issues clearly need to be revisited in order to alleviate the crisis situation faced by health services in many poorer countries. The debate should now focus on the full complexity of the issue, including advantages for supplier countries and non-financial measures geared to retaining health professionals. Furthermore, we must grasp this opportunity to share knowledge and transfer technology so that patients and health professionals in developing countries are not excluded from the e-Health revolution in the rich nations that is beginning to deliver on access and quality.



Opportunity Knocking: Exploiting e-Health for Global Health Human Resources Planning

Author(s): Kendall Ho1
Affiliation(s): 1Continuing Professional Development & Knowledge Translation, University of British Columbia, Vancouver, Canada
Key issues: Because of a worldwide shortage of health professionals, all levels of government and global organizations such as the World Health Organization have identified health human resources (HHR) availability and planning as a key health priority. Current international practices in health professional exchange and migration have also introduced sometimes difficult issues in the ethics of health professional recruitment and retention in different countries. The approach to HHR planning is also changing since future health professionals need to possess cross-professional core profi ciencies beyond competency in their own disciplines.
Meeting challenges:

E-Health the use of modern information and communication technologies for health is rapidly becoming a core part of the many health systems regionally and internationally, and can make significant and innovative contributions to HHR. This presentation examines key e-health literature and Canadian experiences to illuminate on how e-health can best assist HHR, especially considering the current acceleration of e-health introduction in different parts of the world.

Conclusion (max 400 words):

Based on the literature and existing body of experiences, e-health can contribute to HHR planning in three key strategic directions, including: 1) Using e-learning to create an innovative learning environment to increase capacity and improve recruitment and retention; 2) Using ICT as an unprecedented team building medium to overcome conventional practice boundaries; 3) Empowering communities and citizens to become knowledgeable health consumers. This presentation will expand on these three themes. Furthermore, the presentation will offer additional recommendations to promote national and international dialogue on HHR planning as it links to e-health. Finally, this presentation will make observations as to how the academy with the mandate to train and support health professionals, can contribute to global HHR planning through e-health so as to help respond to the global community’s needs.

GHF2008 – PS37 – Enduring Research Infrastructures in Low-income Countries

Session Outline

Parallel session PS37, Wednesday, May 28 2008, 11:00-12:30, Room 14
Chair(s): Jon-Andri Lys, Executive Secretary, Commission for Research Partnerships with Developing Countries (KFPE), Switzerland
ICDDRB as a Research Institution in the Developing World
Alejandro Cravioto, Executive Director, ICDDRB, Dhaka, Bangladesh 
Contributing to Health Research Capacity Building in Chad
Jacob Zinsstag, Department of Epidemiology and Public Health, Swiss Tropical Institute, Switzerland 
Sustainable Ethical Review Mechanisms: TRREE for Africa
Dominique Sprumont, TRREE for Africa, Institute of Health Law, University of Neuchâtel, Switzerland 

Session Documents

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[Download not found]

Session Report

Contributors: Fabio Weissert (ICVolunteers)

Truly global access to health not only includes universal access to healthcare, but also the availability of medical research infrastructure in both high- and low-income countries. However, at present, knowledge is highly concentrated in the North where science and technical expenditure amounts to roughly 200 to 500 times that of developing countries. In order to narrow this gap, enduring research infrastructures in low-income countries need to be established. Past experiences and ongoing projects can tell us what works and what does not work when it comes to constructing research infrastructures in the developing world.

Dr. Alejandro Cravioto, Executive Director of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR), a research institution in the developing world, offered insights into his institution and into the conduct of medical research in a developing country setting.

Convinced that "all people, especially the poor, can become healthier and reach their full potential through the application of new knowledge", the ICDDR aims to develop and promote realistic solutions to the most pressing health, population and nutrition problems of Bangladesh and the developing world in general.

The ICDDR, which was established almost 50 years ago, initially focused its activities on diarrheal diseases and progressively also on non-infectious diseases. Its research initiatives have, inter alia, led to the development of an oral re-hydration solution (ORS) saving millions of children's lives each year and zinc supplements to reduce diarrhea morbidity. In addition, the ICDDR is a leading training centre and runs two major hospitals (in Dhaka and Matlab), as well as several field sites.

According to Dr. Cravioto, there are two key factors accounting for the ICDDR sustainable research infrastructure: first, its unique standing as an international centre with diversified funding resources, open to different people from all over the world and benefiting from the necessary operational independence; secondly, its full financial accountability confirmed by up to twenty audits from different donors every year.

The biggest challenge for the ICDDR's long-term sustainability remains the volatility of donor funds which is exacerbated by the fact that many donor agencies do not provide funds for medical research outside developed countries.

Jakob Zinsstag, of the Swiss Tropical Institute (STI), argued that "what makes research sustainable in developing countries depends much on the approach you take". For well over two decades, the STI has been involved in Chad with nomadic pastoralists who are excluded from the traditional healthcare system. Professor Zinsstag and his fellow researchers had to adapt their research capacity building to the particular characteristics that define Chadian nomadic pastoralists (mobility imposed by environmental conditions, a highly patriarchal society, close coexistence with livestock, etc).

First, they adopted the "one medicine" concept uniting human and veterinary medicine. Additionally, they relied on a transdisciplinary approach "combining scientific knowledge with the know-how of lay people", linking local communities, scientists from different disciplines and authorities. This paradigm permitted them to look at health not merely from a medical, but also from an anthropological, sociological and geographical perspective, which added considerable value to their undertaking, enabling them to provide "culturally validated health education" for example.

Long-term North-South research partnerships yield an added value of knowledge generation by amalgamating highly technical and specific local knowledge, one of which on their own both parties lack. They should adopt an intervention-based perspective, rather than concentrating on a merely descriptive approach. Community involvement, relying on a triangular connection between authorities/decision makers, concerned populations and scientists, is crucial to success.

Many challenges for health research capacity building in the South remain: the absence of critical mass, the brain drain to other sectors/jurisdictions, politics paralysing research activities and a lack of South-South networks in the developing world.

Dominique Sprumont, of the Institute of Health Law (at the University of Neuchâtel) is the coordinator of TRREE for Africa, a "web-based training and capacity building initiative on the ethics of research involving humans conducted in Africa countries". Bringing together partners from both African and developed countries, it aims to promote "high quality research" and "protection of research participants in Africa".

TRREE capacity building relies on e-Learning (distance learning modules) and on e-Resources (a participatory web-based collection of international, regional and national regulatory and policy resources).

The TREEE for Africa initiative is an interesting illustration of how in our globalised world ideas can travel not only from North to South, but also increasingly from the South to the North: a first assessment of top training priorities and objectives in African and a subsequent one in Switzerland revealed that participants in both continents largely coincided in their preferences. Thus, a concept developed with, by and for African countries is now being taken up in Switzerland and other Western countries.

While universal access to e-Learning and e-Resources is virtually guaranteed in the North, in the South limited internet access and insufficient computer skills to use these interactive resources remain a problem.

Sustainable Ethical Review Mechanisms: TRREE for Africa

Author(s): D. Sprumont*1, J. Ateudjieu2
Affiliation(s): 1Institute of Health Law, University of Neuchâtel, Neuchâtel, Switzerland, 2Faculty of Medicine, University of Yaoundé I, Cameroon
Key messages: 1 – Efficient ethical review mechanisms are central to the protection of human participants in research.
2 – Research Ethics Committee (REC) members need specific and accurate training to fulfil their responsibilities adequately.
3 – Basic training in this field is therefore essential. It can be provided through on-line or CD-ROM program in South - North partnership such as TRREE for Africa.
Summary (max 100 words):

Training and Resources in Research Ethics Evaluation for Africa (TRREE-for Africa, www.trree.org) is a web-based training and capacity building initiative on the ethics of research involving humans conducted in Africa countries. This bilingual (French-English) initiative will make available, free of charge: e-Learning - distance learning on research ethics evaluation available on the web and on CD-Rom; and e-Resources - a participatory web-site making available international, regional and national regulatory and policy resources. Promoting bi-directional learning, TRREE-for Africa focuses on internationally recognized ethical principles and regulations while integrating local African issues and perspectives that are relevant to all those who must ensure the protection of research participants and who promote highest ethical standards. TRREE for Africa has three general objectives; 1. First, to increase knowledge as well as practical skills of those involved in the management and conduct of ethics evaluation and research partnerships. 2. Second, to create a participatory process that will nourish lasting partnerships with and amongst African partners. 3. Third, to create a resource that will facilitate the dissemination of knowledge in European and African countries. Overall, this will strengthen the research ethics evaluation capacities in African countries. Target Audience: TRREE-for Africa will provide training and resources that relevant to the work of all those who must ensure the protection of the interests and well-being of human subjects participating in research conducted in Africa as well as the promotion of the highest ethical standards. While some modules may focus on more specific training needs of research ethics committee members, or research teams including investigators, nurses, or study coordinators, the training is open to all and may be of interest to health authorities, funding agencies and universities, as well as to political authorities, patients and the media. Target Timeline: This project started in November 2006 and expects to deliver the training and capacity building material by November 2008. During this time, a significant period of time (approximately 9 months) will be allocated to the identification of training needs of the African research community. In parallel, existing resources will be identified and made available on the web-site on an ongoing basis. The next step will be the drafting of the content of training modules. Following a period of pilot testing, the e-learning web-site will be open for general use.

Lessons learned:

TRREE for Africa has conducted a needs assessment concerning training in research ethics and regulation in Africa and Switzerland. The concept developed first with, by and for African countries is now being used to build program in Switzerland and possibly other European countries. This demonstrates the potential collaboration in true partnership between the South and the North.

GHF2008 – PS13 – Developing In-House Capacity in Applied Research: Lessons Learned

Session Outline

Parallel session PS13, Tuesday, May 27 2008, 16:00-17:30, Room 17
Chair(s): Don de Savigny, Professor and Head, Interventions & Health Systems Research Unit, Department of Public Health and Epidemiology, Swiss Tropical Institute, Switzerland
A Comprehensive Framework for Capacity Strengthening in Research for Health and Development
Sylvia de Haan, Head, Projects and Programmes, COHRED, Switzerland  
EVIPNet (Evidence-Informed Policy Network): Building Capacity for Evidence-Based Policy Development
Ulysses Panisset, Scientist, Research Policy and Cooperation, WHO, Switzerland 
TRREE for Africa (Training and Resources in Research Ethics Evaluation of Ethics in Research): Developing e-Learning Tools to Bring Universal Ethical Review across Cultures and Disciplines
Jérôme Ateudjieu, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon  
Participatory Research Approaches and Community Empowerment in Health 
Rene Loewenson, Director, Training and Research Support Centre / Equinet, Zimbabwe

Session Documents

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Session Report

Contributors: Alessandra Sauven (ICVolunteers)

Bringing together participants from a range of contexts and backgrounds, the session provoked an exciting and varied discussion on the important role capacity-building plays within research and the ways to achieve common goals. This session highlighted both the challenges and opportunities of working together to rethink research paradigms.

Ms. Sylvia de Haan, Head of Projects and Programs, Council on Health Research for Development (COHRD), Switzerland, considered some of the issues and challenges associated with forming a comprehensive framework for capacity-strengthening in research for health and development. In particular, she highlighted the need for a more structured approach to capacity development. Increasingly, frameworks have shifted away from a purely individual focus towards an emphasis on the wider picture in which country ownership and leadership play an important role in effectively identifying gaps and needs. The idea is that frameworks should include not only individual, institutional and environmental contexts, but also recognition of the importance of capacity-building. Ms. de Haan stressed the importance of both the research system level, in order to set agendas and policies that ensure needs are met; and the socio-economic level, to ensure that civil societies have the capacity to influence research agendas and become equal partners in the process.

Dr. Ulysses Panisset, Scientist in the Research Policy and Cooperation department at WHO, (WHO), re-emphasized the importance of including civil society in capacity-building for evidence-based policy development. He highlighted the strong demand by policy-makers in low income countries for ways and mechanisms to make better use of research evidence in policy-making processes. These countries urgently need to bridge the gaps between decision making and scientific research. Within the context of the Evidence-Informed Policy Network (EVIPNet), an innovative initiative developed to promote the systematic use of health research evidence in policy-making, he stressed the need to promote partnerships between policy-makers, researchers and civil society at the country level. This would facilitate policy development and implementation by utilizing the best scientific evidence available. In particular, Dr. Panisset, emphasized the importance of learning by doing, producing, evaluating and working together.

Dr. Jérôme Ateudjieu, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon, and Coordinator of the Training and Resources in Research Ethics Evaluation for Africa (TRREE-for Africa) Team, considered similar issues within the context of training and resources in research ethics evaluation. TRREE is a web-based training and capacity-building initiative which uses e-learning and e-resources to bring universal ethics reviews across cultures and disciplines. Dr Ateudjieu noted the need to consider existing resources not to duplicate efforts, and to identify training objectives based on specific local needs. For example, he stressed the importance of working with other existing training programs, among others, to build and strengthen a network of institutions and experts in research ethics and evaluation.

Dr. Rene Loewenson, Director of Training and Research Support Centre, Equinet: The Network on Equity in Health in Southern Africa, Zimbabwe, spoke of Equinet's experiences in carrying out participatory action research, and the importance of recognizing and investing in people as the central pole for health systems. She considered how research can play a role in promoting health equity. Research should consider both the global context as well as the social and political context; thereby identifying different levels of exposure and vulnerability. Participatory action research involves working together with communities and systemizing local experience to link analysis to community voice and action. Social empowerment helps to coordinate health actions, but also aids the recognition and earlier community level detection of health problems by considering the social determinants of health. Power relations within communities and households, for example, significantly impact the uptake of health services. The approach, however, is not without its challenges, as Ms. Loewenson and several participants of the session pointed out. As a people-driven and participatory research method, it is very specific to the locality. Consequently, it is not always easy to generalize findings and make them accessible elsewhere; in journals, for instance. One of the major challenges is therefore to build capacity in order to create networks through which research paradigms can be rethought.

All participants stressed the need to move towards a wider, more holistic approach to research. The session highlighted the importance of involving communities in research agendas and empowering them to become equal partners in the process. Despite a diverse range of approaches and contexts, aims and methodologies often overlapped, yet everyone agreed on the common goal of finding new ways and means of working together.