Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

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.

An Assessment of Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Young Adults in Tehran University of Medical Sciences

Author(s): N. Raeesi*1, H. Gharaie2
Affiliation(s): 1Research Centre, Tehran University of Medical Sciences, Iran (Islamic Republic of), 2Women’s Affairs Office, Ministry of Health and Medical Education, Iran
Keywords: Premenstrual syndrome, premenstrual disphoric disorder, life style
Background:

Menstruation is an important biological phenomenon and studies concerning menstruation need to take into account life style and cultural and psychosocial factors that define the meaning, values and behaviour associated with this phenomenon.

Summary/Objectives:

The objective of the current study was to evaluate the prevalence of a potential premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) during one menstrual cycle, in a representative sample of young medical university students of Tehran, according the Pennsylvania University criteria. On the other hand, a questionnaire, available from the author, was used to explore socio-demographic data.72 students were interviewed that the mean age of them was 21.20 years.

Results:

72 students were interviewed that the mean age of them was 21.20 years, 34 met the criteria of a potential PMS (47.21%), 20 of them showed PMDD (27.77%) and 25% of them had no complications in this area. During the premenstrual phase the following symptoms were found among the proportion with PMS and PMDD (74.98%): marked depressive mood(81.48%); difficulty of concentration (33.33%); being nervous and anxious(24.07%); irritability and angriness (75.92%) marked increase in appetite (48.14%); moodiness, sadness (48.14%); hypersomnia or insomnia 51.85%; sense of being overwhelmed (25.92%); lethargy, excessive fatigability (53.70%) and physical symptoms including breast tenderness, swelling, headache, joint or muscular pain, and a sensation of bloating and weight gain (72.22%). On the other hand, 53.70% of the sample had a disturbance in their socio-professional lives as a consequence to the psychological disturbances. Just 18.51% of these women consulted a physician, and 24.07% used drugs (mostly herbal ones). Exactly half of them experienced painful periods and 37.03% reported irregular ones. Some of these students expressed a lot of stress and tension in their study and relationships, 59.25 %. According to the questioner 40.74 %had wrong food habits. Unfortunately 83.33% of them didn’t exercise enough.

Lessons learned:

These data confirms that these disorders are common and have a bad impact on mental health and on quality of life of the women, when the mental health and quality of life at the same time affect the prevalence of these disorders.

Connecting the Global Healthcare Workforce through e-Health

Author(s): A. Panjamapirom*1, J. L. Steward1, P. F. Musa2
Affiliation(s): 1PhD in Administration - Health Services, 2Management, Marketing and Industrial Distribution, University of Alabama at Birmingham, USA
Keywords: E-Health, continuing medical education, global healthcare workforce, tele-education
Background:

Like other resources, human resources are limited. The scarcity of resources leads to a number of social and economic issues. The healthcare sector around the world is confronting the crisis of inadequate supply of healthcare providers. At the same time, the demand of medical services is skyrocketing as a result of the aging population and numerous chronic diseases. Additionally, the world population is even more intimidated by the threats of mortal infectious diseases such as HIV/AIDS, malaria, pandemic flu, hunta virus, and severe acute respiratory syndrome (SARS). From the foregoing and as the supply and demand are growing apart, the crisis of global healthcare workforce importantly merits increased attention. Despite its significance, the number of healthcare workforce is not the only concern. Quality of care is among the top priority policy issues; the skills and capabilities of these providers are therefore of critical importance. World Health Organization (WHO) and World Bank have created a collaborative framework of e-Health development, which is perceived as a promising solution to various predicaments in healthcare. One of the e-Health applications is knowledge services. Since knowledge is power, we as a society are leaning toward creating and disseminating up-to-date information and innovative knowledge across all disciplines. Healthcare knowledge is completely valuable as it is directly used to save lives and improve their quality. Healthcare providers are required to maintain their knowledge, skills, and abilities necessary to successfully perform their tasks. As a result, continuing medical education plays a major role in supplying knowledge to the providers. Through tele-education, healthcare providers around the world can share a real-time experience in numerous diagnosis and treatment procedures. As such, the medical knowledge can be rapidly enhanced and diffused, which will be greatly valuable to the population of the world.

Summary/Objectives:

The issues of healthcare workforce, the number of supply and the skills and capabilities of healthcare provider, are discussed. The framework for using e-Health to address these issues is provided. The main objective of this poster presentation is to provide strategies to link global healthcare workforce through e-Health applications.

Lessons learned: 1 – E-Health applications enable the global healthcare workforce to gain new knowledge, share medical experiences, and develop higher skills and capabilities useful for their practices.
2 – The strategies provided will help accelerate the adoption of e-health applications among the content providers of continuing medical education.
3 – Both healthcare academicians and practitioners can greatly benefit from rapid diffusion of knowledge around the world.

Leveraging Tele-Health for Strengthening Health Systems and Workforce: Transition from Project Mode to a Sustainable Model with Public-Private Partnership

Author(s): P. P. Venugopalan1, M. K. Nabeel*2
Affiliation(s): 1Dean, 2Medical College, Kannur, Kerala, India
Keywords:

Tele-health, tele-medicine, informatics, technology in healthcare, health system reform, public private partnership

Background:

The Kerala Tele-health & Medical Education (TH&ME) project was initiated three years ago by the State Government with support from the Indian Space Research Organization (ISRO). An IP based system, working on satellite technology, it has got its own merits and a few demerits as well. Even prior to this project there were small initiatives within the country making use of similar technology, but this was a major leap in the roll out after identifying the potential benefits of a state-wide network.

Summary/Objectives:

Setting apart the spurts of activities in the initial days and the consistent activities from very few centres, it is found that the installations at most centres in the project are grossly underutilized. The factors affecting the adoption of this technology and its utilization were analysed and classified into technology related and non-technology related. Best Practices and value additions at some centres, which enhanced the effectiveness of the project are also documented in the full paper.

Results:

Setting apart the spurts of activities in the initial days and the consistent activities from very few centres, it is found that the installations at most centres in the project are grossly underutilized. The factors affecting the adoption of this technology and its utilization were analysed and classified into technology related and non-technology related. Best Practices and value additions at some centres, which enhanced the effectiveness of the project are also documented in the full paper.

Lessons learned:

We have identified that there are barriers to the adoption of such technologies, even though these technologies itself are brought in to overcome barriers in access to health. Contrary to popular belief, barriers not directly related to technology per-se are more important than those barriers related to technology. Another important lesson learned from this project is regarding the essentiality of a proper needs assessment and prioritization before the launch of any project. Based on the findings of this analysis, this paper further discuss about a proposed public private partnership initiative which tries to integrate public health in general and primary healthcare in particular to this already piloted project. Apart from Tele-Education & Tele-Consultations, plans have been put forward for using the network for sharing other electronic resources and also to use it for enhancing and improvising disease surveillance, health system management and epidemiological research.

More Healthcare Providers: A Crisis in Armenia’s Health System

Author(s):  G. G. Jerbashian1
Affiliation(s): 1Department of Healthcare Practice, Cardno Emerging Market, Armenia
Keywords: Health workforce distribution imbalance, planning of human resources for health, access to and quality of healthcare
Background:

Armenians continue to experience poor access to healthcare and low quality services, even though the number of physicians is 37.9 per 10,000 inhabitants compared to 24.0 in the United States and 34.0 in France (2007), the latter two having much better health indicators. Likewise, in 2005, Yerevan State Medical University alone produced 33.0 medical graduates per 1,000 practicing physicians compared to 26.5 of the USA and 17.5 in France. In reality, the situation is much more critical, as the number of medical graduates from the four private medical universities grows steadily resulting in a continuously increasing number of potentially unregulated physicians in the country. Thus, the number of graduates (from all medical universities) per 1,000 practicing physicians in Armenia was 32.6 in 2000, and reached 38.9 in 2007.The Armenian healthcare system is characterized by a well developed network of primary, secondary and tertiary level healthcare facilities and auxiliary supportive services. However the hospitals are overstaffed and the utilization rate is low (55%). The medical workforce has not decreased, despite a substantial cutback in hospital beds (49.8%) in mid 1990s. The medical workforce is inadequate distributed across the country, with 76.9 physicians (per 10,000 inhabitants) in the capital versus 17.6 elsewhere. Several household and patient surveys indicate a high level of unmet need for healthcare (39.5% of sick people report not seeking medical assistance because of financial constraints). Informal payments for many state guaranteed free-of-charge healthcare services (21.5% of women paid out-of-pocket money for state-funded pregnancy and delivery care) is still practiced despite the recent substantial increase of the state reimbursement rates for these services.

Methods:

The study methods were qualitative and quantitative: household (HH) and patient survey results analysis; healthcare system examination; a literature review; and national and international health data analysis. We analyzed the current situation of the Armenian healthcare system to reveal the extent to which Armenians experience lack of access to healthcare and if there is manifestation of the adverse outcomes of “excessive” healthcare. Compared international and national data to see if there is a correlation between physician supply and health outcomes (e.g. life expectancy at birth, infant mortality).

Results/Conclusions:

Our study identified oversupply of medical workforce as one of the critical factors influencing the interminable increases of prices in healthcare and spread of corruption in the system. On the basis of trends in several national health indicators, adverse outcomes of care are observed in Armenia. Reasons include but are not limited to excessive number and unbalanced distribution of medical workforce in the country. Our analysis indicates that having too many physicians does not contribute to better access to and quality of healthcare, even more, may become a burden to governments and households. Along with customizing the medical workforce skill mix to local health needs, raising public awareness on state-funded healthcare, and introducing proper incentives for the retention of health workers in underdeveloped areas, there is a need for better regulation of medical education and practice. This should include: controlling admissions to medical schools, setting up state scholarship quotas, establishing a solid licensing system, rationalizing the medical workforce, improving the referral system, and ensuring its balanced geographical distribution across the country.

Health Sector Support as a Bridge to Peace in the Northern Caucasus

Author(s): K. Dzgoev*1, V. Besolov2, S. Parizheva3, A. Avtorkhanova4, N. Lorenz5
Affiliation(s): 1Department of Surgery, State Medical Academy, Vladikavkaz, 2Republican Centre of Medical Prophylaxis, Ministry of Health of the Republic North Ossetia-Alania, Vladikavkaz, 3Republican Center of Medical Prophylactics, Ministry of Health of Republic of Ingushetia, Nazran, 4Republican Center of Medical Prophylactics, Ministry of Health of the Chechen Republic, Grozny, Russian Federation, 5Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
Keywords: Health threats and access to health at times of crisis, Health systems during conflict and recovery, peace building
Background:

The legacy of more than a decade of instability in the Northern Caucasus combined with the consequences of the disintegration of the Soviet state has left the region impoverished and burdened with health problems such as infectious diseases (TB, HIV/AIDS and Sexually Transmitted Infections), and life-style related health problems. In the aftermath of the hostilities there has been very little to no interaction between health professionals in the area of continuous medical education, or in exchanging on medical problems. This paper presents efforts to achieve concrete health outputs and promote trust and collaboration among health professionals in a post-conflict region, while addressing at the same time health problems and achieving project-specific outputs.

Methods:

In 2001, the Swiss Agency for Development and Cooperation/Swiss Humanitarian Aid, in collaboration with the health authorities of the three republics, began a medical programme which has provided support to laboratory (TB, HIV/AIDS) and health promotion services. Equipment and technical support were provided. Continuous training of health professionals in priority areas received particular attention. In a second phase activities were streamlined, and the promotion of collaboration and interaction between health professionals from the three republics became an explicit objective of the programme.

Results/Conclusions:

Independent national and international quality control has shown that TB and HIV diagnostics have improved in North Ossetia, Ingushetia and Chechnya since the inception of the programme. HIV/AIDS prevention has led to some improvements in the attitude of the sexually active population regarding preventative/protective behaviour particularly reflected in an, albeit modest, increase in the use of condoms. Equally important is that the health departments of the three republics collaborate regularly, for example, in sharing health education tools. More than 150 health professionals from the three republics were jointly trained in the State Medical Academy of North Ossetia and obtained recognized post graduate training certificates. In addition more than 400 professionals from North Ossetia, Ingushetia and Chechnya participated in a medical conference on current health issues in the Northern Caucasus. A high level steering committee with representatives from the three republics provides oversight on the programme. The efforts outlined above not only contribute to a better quality and harmonization of the regional health services, but they also promote peace and understanding in the region. As demonstrated in other regional settings (1) critical factors for success have been the involvement of a trusted third party. In this case, SDC provided “on the ground” activities, committed, well connected and competent professionals, a clear focus on significant clinical and public health concerns and a comparatively long term commitment of external support combined with an academic grounding. This case study from the Northern Caucasus confirms once more that the WHO’s (2) “Health as a Bridge for Peace” is a valid approach, which should be used more actively. (1) Skinner H, Abdeen Z, Abdeen H, et al: Promoting Arab and Israeli Cooperation: A Model for PeaceBuilding Through Health Initiatives. Lancet 2005, 365:1274-77.   (2) “Health as a Bridge for Peace” was formally accepted by the 51st World Health Assembly in May 1998 as a feature of the ‘Health for All in the 21st Century’ strategy.

Global Minimum Essential Standards in Medical Education Based on the Principles of Social Accountability: On the Road to Consensus

Author(s): J. ladner*1, C. Boelen2
Affiliation(s): 1Epidemiology and public health department, Rouen University Hospital, France, 2Epidemiology and public health department, Former coordinator of the WHO program of human resources for health, Sciez-sur-Léman, France
Keywords: Social accountability, Accreditation of medical schools, Standards
Background:

Expression of social accountability: An educational institution that aspires to excellence in the production of health care professionals should be granted that status not only when its graduates possess all of the competencies desirable to improve the health of citizens and society, but when they are able to use them in their professional practice. Educational institutions are increasingly requested to be more explicit about their outputs of professional practitioners and the impact of their presence on social well-being. There is also an expectation that the other partners in social accountability (policy makers, health service managers, health professionals and the public) are equally committed to anticipation, adaptation and quality assurance.
Social accountability requires that the actions of a medical school begin and be grounded in the identification of societal needs. This complex process is based on three domains professionals they produce: conceptualisation, production and usability (CPU model). The domain of conceptualisation involves the collaborative design of the kind of professional needed and the system that will utilise his or her skills. The domain of production involves the main components of training and learning. The domain of usability involves initiatives taken by the institution to ensure that its trained professionals are put to their highest and best use. As globalisation is reassessed for its social impact, societies will seek to justify their investments with more solid evidence of the impact of these investments on the public good. Medical schools should be prepared to be judged accordingly. Arguments in favour of the CPU model based on ethical, democratic, economic and political issues. Towards of global consensus on medical education standards The aim of the project is to promote quality improvement standards and processes that enable medical schools to have a greater impact on health. A major feature of the project is the holding of a Global Consensus Conference attended by representatives of principal organizations worldwide concerned with the quality of medical education (including representatives of other key stakeholders in the health sector) to reach a general agreement on such standards. The project is justified by:
-Evolution. Health systems require constant transformation in order to meet evolving social, economic and cultural realities. The same is true for the health professions and educational institutions that should foster that ongoing transformation.
- Paradigm of excellence
- Scope. New standards are needed to address the adequacy of these programs to meet the present and future health needs of society, the aspirations of the public.
- Recognition. A general framework of parameters and standards consistent with this orientation must be defined and promoted for use in evaluation and accreditation systems.

Evaluating Industry-Sponsored Educational Events Attended by Physicians in Pakistan

Author(s): I. Masood*1, M. Mohamed Ibrahim2, M. Hassali2, M. Ahmad3
Affiliation(s): 1Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Penang, 2Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia, 3Faculty of Pharmacy and Alternative Medicine, The Islamia University Of Bahawalpur, Bahawalpur, Pakistan
Keywords:

Pharmaceutical, Pharmaceutical marketing, Pharmaceutical promotion, Pharmaceutical industry, sponsored educational events , promotional tools, promotional practices, Continuous medical education, CME, Regulations, code of conduct

Background:

In context continuous medical education (CME), pharmaceutical companies are sponsoring medical educational events both in developed and developing countries. This study, a first of its nature, tried to demonstrate the validity of sponsored medical educational events in Pakistan.

Methods:

Study Objectives: General objective: To identify and document various medical educational events attended by physicians in Pakistan. Specific Objectives: 1. To explore and document all the sponsored educational events attended by physicians in Pakistan; 2. To explore and document the organizers and types of expenses paid to attend the educational events by physicians in Pakistan. Methodology: A cross sectional study using structured questionnaires were undertaken with a representative sample of physicians in 4 major cities (Bahawalpur, Lahore, Loralai and Quetta) of Punjab and Balochistan respectively (2 from each province) on the bases of equal representation (125 physicians from each province). All the data were analyzed by using SPSS version15. Both descriptive (basic and cross tabulation) and inferential statistics (Chi-square test) were used. A p value of <0.05 is considered statistical significance in all the analyses.

Results/Conclusions:

The main finding of the study indicates that most of the physicians (practicing as GP, GP/specialist and specialist) attended industry sponsored events (n=173, 69.2%; p=<0.001) out of which GPs (n=41, 51.9%), GP/specialist (n=33, 71.7%) and specialist (n=99, 79.2%). The total attended events by 173 physicians during one year were 727 out of which scientific conference was (n=207, 28.47%), training courses (n=38, 5.23%), lectures (n=222, 30.54%), seminars (n=58, 7.98%), workshops (n=61, 8.89%), discussion forums (n=29, 3.99%) and drug launching ceremonies (n=112, 15.41%). Most of the educational events were organized by professional organizations of the medical community (n=115, 46%; p=0.001), and pharmaceutical companies (n=27, 10.8%). Pharmaceutical industry was the largest disclosed individual sponsor source for physicians (n=123, 49.2%; p=0.025). The type of expenses paid were airfare (n=96, 38.4% p=<0.001), accommodation (n=118, 47.2% p=<0.001), taxi fare (n=75, 30%), event registration fee (n=118, 47.2% p=<0.001) and the expense which most of the participants enjoyed was meal (n=162, 64.8%). Interestingly most of the respondents (94.8%, n=237) were unaware of any regulation controlling pharmaceutical marketing, 98% (n=245) did not new about any self regulatory code by pharmaceutical industry to control marketing and promotion matters and 73.6% (n=184) had no information about any guidelines for doctors to interact with pharmaceutical industry. Conclusion and recommendations: The results show that physicians are in very strong financial relation with the pharmaceutical industry, it is alarming sign, indicating weak or non regulatory enforcement and at large it can be reason of increase in irrational and over prescribing of medicine, this may lead to increased risk of patient health and economy which necessitates strict enforcement of well defined regulations and codes of conduct for both companies and medical community.

Training Healthcare Providers in Reproductive Health in Armenia

Author(s): K. S. Qutub1
Affiliation(s): 1Healthcare, Emerging Markets Group, Arlington, United States
Keywords: Armenia Reproductive Health Family Planning Training
Background: The population of Armenia is decreasing due to a birth rate of less than 2 births/female, leading Parliament to identify infertility, significantly as a result of excessive abortions, as a national security threat. In June 2009, Parliament organized a hearing on RH/FP, unheard of in the history of Armenia, demonstrating that Family Planning is a critical issue for the national government.
Methods:

RH reform in Armenia has been challenged by Family Medical Doctors (FMDs) who have been practicing for decades without ongoing training and are set in their ways. For those receptive to training, the training materials used often use terminology which the FMDs do not understand. In-service training for doctors occurs at marz level every three to five years, complicated by the challenge of pulling doctors away from their posts. For nurses, training is much easier because there are nurse training centers all over the country and at the marz level.
In March 2009 USAID/Armenia Project NOVA, implemented by Emerging Markets Group, Ltd and partners from September 2004-November 2009, initiated trainings for Pediatricians covering basic family planning information with an emphasis on postpartum FP, benefits of healthy timing and spacing of pregnancies and referral protocols. Observations under Project NOVA confirmed that providers who received training and other support from NOVA offered FP counseling services to their clients, mastered key FP counseling skills, conducted FP referrals, and in some instances provided a method of FP within their scope of practice.
Project NOVA materials are being used for the Armenia National Institute of Health (NIH) in its medical residency training and continuing medical education of healthcare professionals. NOVA training materials are approved by the Ministry of Health (MOH) and the NIH Training and Methodological Board before used for training students. The MOH must approve clinical protocol, which is then reviewed by the Academic and sent to the Ministry of Education and Science for approval. It was easier to institutionalize Project NOVA materials for the nursing college than for the medical school in Armenia. Nurses are being trained on global standards and contemporary treatment protocols whereby their position holds significant importance in healthcare delivery and is no longer overshadowed by medical doctors. Working Groups consisting of OB/GYN and Family Medicine faculty were been established under Project NOVA. Working Groups meet regularly to discuss the Family Planning in pre-service medical education, with Project NOVA providing technical guidance and leadership. Project NOVA found that OB/GYN faculty were not familiar with contraceptive technologies and have not mastered the use of the WHO Medical Eligibility Criteria for Contraceptive Use that was modified for use in Armenia. Teaching faculty demonstrated poor knowledge in the initiation of use for hormonal methods, natural methods, and IUD insertion. Project NOVA provided a Contraceptive Technology Update workshop for the OB/GYN faculty members that included presentation of and discussion on modern methods as well as demonstration and practice of IUD insertion.

Results/Conclusions:

Donors must continue to simultaneously educate the community and healthcare providers on modern FP methods to ensure that pregnancies are undesired pregnancies are avoided rather than terminated by abortion. It cannot do so without recognizing the cultural myths of misinformation that surround hormonal contraceptives and the financial gains physicians now receive from performing abortions. Key to the battle of reforming provider behavior is addressing the immediate profitability of abortions to OB/GYNs versus long term revenue streams created by women who access Family Planning services and products through a regular provider.

Taking Stock of an Ambitious Tele-Health and Medical Education Project

Author(s): M. Nabeel1
Affiliation(s): 1Solution Exchange AIDS Community, Knowledge Management Partnership Project, New Delhi, India
Keywords: Tele-medicine, Tele-health, Tele-education, Kerala, India.
Background:

The Kerala Tele-health & Medical Education (TH&ME) project was initiated five years ago by the State Government with support from the Indian Space Research Organization (ISRO). The present paper is taking stock of how the project is performing currently and tries to analyse the factors affecting it.

Methods:

The project is working on an Internet Protocol based system, utilising satellite technology. It has got its own merits and a few demerits as well. Through papers presented previously at this forum, the issues faced by this author as a nodal officer in implementing this project statewide were discussed. A detailed account of the project from its planning stage to the implementation stage was narrated, while the author was working with this project.

Results/Conclusions:

This paper specifically analyses the utilisation of the technology in various teaching and non-teaching hospitals. Setting apart the spurts of activities in the initial days and the consistent activities from very few centres, it is found that the installations at most centres in the project were grossly underutilized. The factors affecting the adoption of this technology and its utilization were analyzed and classified into technology related and non-technology related. Best Practices and value additions at some centres, which enhanced the effectiveness of the project are also documented in the full paper. There are barriers to the adoption of such technologies, even though these very technologies are bought in to overcome barriers in access to health. Contrary to popular belief, barriers not directly related to technology per se are more important than those barriers related to technology. Based on the findings of this analysis, this paper further discuss about a proposed public private partnership initiative which tries to integrate public health in general and primary health care in particular to this already piloted project. This paper also suggests a logical next step in taking this project forward which holds tremendous potential.