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Geneva Health Forum 2014 – Conclusions of Day 1

Highlight_of_the_Day Highlights of the Day

  • Integration from the point of view of health is needed at multiple levels
    • Global: different agendas (Universal Health Coverage, Primary Healthcare, MDGs, post-MDGs, Noncommunicable diseases, etc.)
    • National: political agendas, capacity and financial resources
    • Health system: capacity to respond to political agenda in parallel to responding to the needs of the population
    • Patient: driver of the health system

Lesson_of_the_day Lessons of the Day

  • Will the push be top-down and driven by resource and financial constraints
  • Or will it be bottom-up with consumers/patients driving the agenda
  • Importance of a clear understanding of the context where integration is taking place
    • How does the context shape the response

Quote of the day1 Quote of the day2 Quote of the Day

“In order for integration to happen cultural change is necessary, but it requires politicalsupport” – B. Levrat, CEO, Geneva University Hospitals

Feedback Feedback

  • Interesting discussions
  • Practice that explains the theory
  • Lively discussion
  • Different perspectives

Unanswered_Question Unanswered Question

  • Who will drive the “integration” agenda?
  • How to empower users of the health system to truly “drive” change?
  • How can medical education play a role in improving integration of the health system and patient perspectives?

Lesson Expectations for Tomorrow

  • More lively discussions
  • Answers to some of the questions about the role of the health systems
  • How do health systems fit into the larger picture of health on a national and global level

Download here the PDF version for CONCLUSIONS of DAY1




GHF2014 – PS15 – From Technology to Impact: Focus on Diagnostic Imaging and Neonatal Incubators

PS15 TUESDAY, 15 APRIL 2014 ROOM: 13
From Technology to Impact:
Focus on Diagnostic Imaging and Neonatal Incubators

Dr. Klaus Schönenberger
CEO EssentialMed Foundation. Program Leader, EssentialTech, Cooperation & Development Center at the Swiss Federal Institute of Technology in Lausanne, Switzerland
Mr. Bertrand Klaiber
Chief Operating Officer, EssentialMed Foundation. Project Manager, EssentialTech, Cooperation & Development Center at the Swiss Federal Institute of Technology in Lausanne, Switzerland
Mr. Matthieu Gani
Scientific collaborator, EPFL’s Cooperation and Development Center (CODEV), Switzerland
The goal of this session is to mobilize the Global Health Community at the Forum to address the challenges in the process of developing, deploying and scaling-up innovative technologies. After short presentations of two existing projects, discussion will be opened regarding technical and socio-economic aspects such as maintenance, business models, logistics and training.The first project concerns access to radiography; In spite of its importance in primary healthcare, radiography is still not accessible to an estimated two thirds of humanity. This is a major issue in the fight against important diseases such as tuberculosis or pneumonia, but also for the proper diagnostic of trauma, with an ever growing burden of road traffic accidents. The project ( ) aims to entirely develop a digital x-ray system adapted to the needs of district hospitals in resource-poor settings.The second project ( ) aims to develop an affordable and appropriate neonatal incubator. Despite the fact that child mortality is decreasing sharply globally, new solutions are required because the neonatal share of that mortality appears more and more as resistant to that trend.

Dr. Klaus Benedikt Schönenberger, Program Leader & CEO EssentialMed FoundationDr. Klaus Schönenberger, Program Leader at the Cooperation and Development Center, EPFL and CEO of the EssentialMed Foundation.

Klaus Schönenberger obtained a PhD from the Swiss Federal Institute of Technology in Lausanne (EPFL), Switzerland, in 1996. After a post-doctoral research assignment at Lawrence Livermore National Laboratory (USA), he joined the medical devices industry. During 10 years, Dr. Schönenberger held various leading positions in medical devices companies, such as director of R&D and global vice-president of R&D. In his last position he was the global vice-president of Research and Technology at DJO Inc. (Vista, California) a Medical device company with annual revenue of $1bn. In 2009 he left the industry to create the EssentialMed foundation, with the goal to develop appropriate medical devices for developing countries. In 2011, he took the position of program leader at EPFL’s Cooperation and Development Center. He created and currently leads the Center’s EssentialTech programme, which aims to fight poverty through the development of appropriate technologies and implementation models.


BK-1Mr. Bertrand Klaiber, Chief Operating Officer, EssentialMed Foundation. Project Manager, EssentialTech, Cooperation & Development Center at the Swiss Federal Institute of Technology in Lausanne Switzerland.

Mr. Klaiber is an experienced business development manager with several achievements in launching innovative industrial and consumer electronic products.
After graduating in Electrical engineering at EPFL in 1994, Mr. Klaiber worked for 10 years as an engineer and project manager for Motorola Semiconductors and Logitech. In 2004, he completed an MBA with honors at the University of Lausanne and then worked as Stategy and Marketing manager at LEM, an international leader in electrical measurement products. In 2010 he was promoted Worldwide Business Development Manager for Energy Solutions at LEM.
In 2012 he joined the Swiss Federal Institute of Technology (EPFL) to launch the EssentialTech program that aims at developing appropriate technologies for impoverished countries. He is the COO of the EssentialMed foundation which he co-created in 2010.


PS15_Matthieu_GaniMr. Matthieu Gani

Mr. Gani is a scientific collaborator at EPFL’s cooperation and Development Center (CODEV). After completing an M.Sc. in Electrical Engineering, he worked on cochlear implants at the Geneva University Hospital, developing research interfaces and conducting tests with patients. He was then employed as a social worker and assistant manager at the Soup Kitchen in Lausanne, Switzerland, providing free meals and guidance to people in need. He joined CODEV’s EssentialTech team in 2013 to manage the GlobalNeonat project.



Logo_EssentialMedEcole Polytechnique Fédérale de Lausanne




Recep Akdag

RecepAkdagSquareRecep Akdag

Minister of Health of Turkey 2002 - 2013

Recep Akdag was born in Erzurum, Turkey in 1960. As a pediatrician, he has been holding a professor title from the Ataturk University School of Medicine since 1999. During his career as a medical specialist and academician, he had been involved in a number of administrative tasks. Between 1994 and 1998, he worked as the Deputy Chief Medical Director, Chairman of the Procurement Commission and Deputy Editor of the Medical Bulletin in the Research Hospital of the Medical Faculty of Ataturk University. He also co-founded the Biotechnology Research Center of the University and served as the Deputy Head of the Center from 1997 to 2000.

After being elected as a Member of Parliament from the Province of Erzurum, he had served as the Minister of Health of Turkey between 2002 and 2013. During his tenure, he has been the key figure for the implementation of the influential Health Transformation Program (HTP) in Turkey. This comprehensive program brought a people-oriented approach to healthcare service delivery and strengthened the health system with successful implementation of universal health coverage. Major aspects of this health system reform included integration of public hospitals, increased patient access to medical services and prescription drugs, invigorated primary healthcare delivery with the implementation of family medicine, improved maternal and childhood healthcare services, better quality and reach of emergency services, and establishment of a national medical rescue team.

HTP generated high access rate for essential services thru the adequate healthcare supply and universal health insurance covering the poorest. Infant mortality rate, maternal mortality ratio and catastrophic health expenditures decreased dramatically. Public satisfaction with health services increased from 39% in 2002 to 75% in 2012. Apart from leading this influential program, Prof. Akdag has edited a number of reports and contributed/co-authored academic articles about HTP. He has addressed, directed and moderated in many international conferences including of those the WHO and UNICEF. He has received the WHO’s “World No Tobacco Day” Award as a recognition of his efforts in the fight against the global tobacco epidemic and in the promotion of tobacco control initiatives and policies. He has been an advisory board member of the Ministerial Leadership in Health (MLIH) Program at Harvard University since 2012.

Prof. Akdag still serves as an MP in the Grand National Assembly of Turkey for his third consecutive term. He also is a Richard L. and Ronay A. Menschel Senior Leadership Fellow, Harvard School of Public Health.


Dr Rifat Atun

RifatAtunDr Rifat Atun is Professor of Global Health Systems at Harvard University, where he is the Director of Global Health Systems Cluster at Harvard University's School of Public Health.

In 2006-13, Dr Atun was Professor of International Health Management and Head of the Health Management Group at Imperial College London. He is an Honorary Professor at the London School of Hygiene and Tropical Medicine. In 2008-12 he served as a member of the Executive Management Team of The Global Fund to Fight AIDS, Tuberculosis and Malaria as the Director of Strategy, Performance and Evaluation Cluster.

Rifat's research focuses on the design and implementation of health systems transformations and their impact on outcomes. His research also explores adoption and diffusion of innovations in health systems (e.g. health technologies, disease control programmes, and primary healthcare reforms), and innovative financing in global health. Organization. Rifat is a co-Investigator and the joint lead for the innovation work stream at the National Centre for Infection Prevention and Management at Imperial College. He is also a co-Investigator and the Theme Lead for 'Organisational Change, Sustainability and Evaluation' at Imperial College and Cambridge University Health Protection Research Unit for Antimicrobial Resistance and Healthcare Associated Infection. He has published widely in the Lancet, PLoS Medicine, Lancet Infectious Diseases, BMJ, AIDS, and Bulletin of the World Health Organization.

Rifat has worked with several governments globally and with the World Bank, World Health Organization, and the UK Department for International Development to design, implement and evaluate health system reform initiatives in more than 20 countries. He has led research and consultancy projects for GSK, Pfizer Inc., the Vodafone Group, Hofmann La Roche,  PA Consulting, and Tata Consulting Services.

Rifat was the Founding Director of the MSc in International Health Management, BSc in Management and Medical Science, and Founding Co-Director of the Masters in Public Health Programme at Imperial College. He has been a director of Imperial College spin out companies operating in areas of health technology.

Rifat is a member of the MRC Global Health Group as the MRC Infections and Immunity Board representative. He serves as  a member of the PEPFAR Scientific Advisory Board, the Norwegian Research Council's Global Health and Vaccination Research (GLOBVAC) Board, the Research Advisory Committee for the Public Health Foundation of India, and the US Institute of Medicine USAID Standing Committee on Strengthening Health Systems. In 2006-08 he served as a Member of the Advisory Committee for WHO Research Centre for Health Development in Japan. He was member of the Strategic Technical Advisory Group of the WHO for Tuberculosis and chaired the WHO Task Force on Health Systems and Tuberculosis Control. In 2009-12 he was the Chair of the STOP TB Partnership Coordinating Board.

Rifat is a Fellow of the Royal College of General Practitioners (UK), Fellow of the Faculty of Public Health of the Royal College of Physicians (UK), and a Fellow of the Royal College of Physicians (UK).

Integrating neuro-psychiatric disorders at the level of primary health care centres: Guinea

Author(s) Abdoulaye SOW1, Oury SY2, Amatigui DIALLO3, Abdoulaye KOULIBALY4, Mouctar DIALLO5, Binta BAH6.
Affiliation(s) 1Mangment, Medical fraternity Guinea, Conakkry, Guinea, 2Physian, Medical fraternity Guinea, Conakry, Guinea, 3Physian, Medical fraternity Guinea, Conakry, Guinea, 4Physian, Medical fraternity Guinea, Conakry,Guinea, 5Physian, Medical fraternity Guinea, Conakry, Guinea, 6research, Medical fraternity Guinea, Conakry, Guinea.
Country - ies of focus Guinea
Relevant to the conference tracks Chronic Diseases
Summary Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease. According to the World Health Report 2000 neuropsychiatric disorders (a component of mental health) are the second cause of disability-adjusted life years (DALYs), behind the infectious and parasitic diseases. Under the theme “Stop exclusion, Dare to care”, the year 2001 was dedicated by the WHO as the "Year of mental health”. Since ancient times, epilepsy has remained a controversial subject for many world populations. This is because mental illness has been perceived as socio-anthropological for many societies.
What challenges does your project address and why is it of importance? Primary health care strategy aims to make accessible to as many people as possible healthcare according to people’s needs, at an affordable cost and taking into account a country's given resources. Equity and social justice are the basic principles of this strategy.
According to the World Health Report 2002, neuropsychiatric disorders account for 13 % of the global burden of disabilities adjusted life years (DALYs). In Guinea, while significant progress has been made in primary health care programmes, little improvement has been measured in the field of mental health. The psychiatrist ratio per capita is one of the lowest in the world. A similar gap in the number of neurologists prevails throughout the country.
In order to address this gap, the Guinea Medical Fraternity (a Guinean association of doctors) opted for the integration of neuropsychiatric consultation into the daily work of the general practioners working in its health centers.
At the opening of its health centers in the 90's, one missing element was the lack of data about the number of patients who sought consultation for mental health problems. At that time, no information was available due to the lack of qualified human resources and poor access to medicines. To tackle this challenge, Guinea Medical Fraternity initiated the project SaMoa, and used 'action research.'
How have you addressed these challenges? Do you see a solution? The model of care employed is based on the three-dimensional approach used in outpatient mental health management: medical, socio-psychological and the community. These three dimensions are combined for almost all patients in our centers, without following neither a chronological nor a hierarchical order.
For the two groups of diseases described in this abstract, epilepsy and mental health disorders, a care package is offered to the patient. This includes: identification of fixed and advanced strategy for the patient, medical treatment (with antipsychotics and/or anticonvulsants), follow-up and psychosocial support (individual interview, with family members, home visits), family and community reintegration through discussion groups and reintegration workshops (graphical expression, apprenticeships) and finally social support interventions (such as supporting the recovery of a lost job or supporting patients in rebuilding a couple in crisis).
In order to ensure continuity of care, a number of materials have been developed.
These include:
• Personal health record (first visit and follow up)
• Home visit notebook
• Reintegration notebook (describing the patient personal project)
• Group workshops notebook.
• Monthly collection sheet.
• Monthly report
Regular inter-professional encounters have been established in order to promote synergies and complementarity among caregivers and has been used to foster continuous staff training. This framework is supported by:
• A joint consultation between a generalist and a specialist (neuropsychiatrist ) at the beginning of the project
• A daily joint consultation between doctors and social workers
• A weekly team meeting between doctors, social workers and community volunteers, to discuss specific cases
• A monthly coordination meeting, which brings together the heads of unit of each health center and the officials of the NGO.
How do you know whether you have made a difference? From January 2000 to June 2013, 7079 mental health problems were diagnosed among which 47 % were psychoses, 33% were epilepsy cases and the remaining 20% represented by depression, dementia, neurosis, social problems and cerebral motor deficiencies.
Among patients put under treatment, two main molecules were used for psychosis (different forms of Haloperidol and Akineton as corrector) and for epilepsy, four essential generic drugs (carbamazepine, phenobarbital, phenytoin and sodium valproate). We found a positive impact for both patients and their families, health care providers as well as for health centres.
For the patient, the impact is assessed by how much healthcare management has improved by integrating the socio-cultural context of the patient and his/her family, how much the intervention has strengthened patient-provider relationship and contributed to better adherence and how much the intervention has facilitated patients social reintegration and has strengthened their economic capacity.
At the level of health centers and providers: the impact is felt at many levels
 Improved patient-provider relationship (beyond mentally ill patients).
Indeed, GP’s trained to adopt a more holistic bio-psycho-social approach with psychiatric patients and spontaneously applied a similar approach vis-à-vis other patients, spending more time, listening and discussing with them and paying more attention to their psychosomatic problems.
 Improved relationships between health centers and the communities they serve.
Communities started to see healthcare providers and the health centres as partners and contributed to the development of the relationship.
 Improved relationships between primary health centers and referral hospitals.
Given the fact that the care package provided by the programme is not available in district hospitals, the project has reversed the usual pattern of the health pyramid that usually sees PHC centers referring their patients to a hospital. In this case, the opposite took place, hospitals sending their patients to the lower level of care.
 Implementation of several community initiatives around the health centres.
The momentum created by the project has allowed the emergence of community-led initiatives such as economic interest groups among intervention communities, involvement of young people in the village around health promotion activities and the establishment of patient support groups.
 Health centre as a training and internships for medical students in public health and community health workers. Successful health centres are coveted by academics whose students are engaged in the internships and the development of dissertations.
Have you or the project mobilized others and if so, who, why and how? The project involved several actors in different and various socio-medical fields.
In Guinea, networking is not integrated into the system. Each association operates in isolation and tries to protect its field of competencies as a private territory. Initiatives are confined to a limited territory or to a given intervention and do not benefit neither the beneficiaries nor field social workers. To break this single thought mindset, our project has created an inter-professional approach mobilizing a supportive and dynamic network of various health workers, social workers and human rights advocates in order to improve the management of heavy neuropsychiatric disorders.
Among the objectives, this initiative attempted also to demedicalize some health problems, to push healthcare providers to pay more attention to social problems and to involve other social stakeholders in medical work.
As an illustration, health centres provide care (medical consultations, nursing services and drugs) to all populations. Social centres provide services (psycho -social support, legal support, rehabilitation, social and professional reintegration) to the same populations. The interaction of these two levels of intervention can only be beneficial for patients, providers and medical-social structures.
Our methodology involves the organization of platforms for dialogue between actors, field visits, referrals of patients or target groups and the organization of joint actions.
The platforms are organized around a theme: clinical, social, results or best practice.
Field visits take place upon request in order to assess the social and/or medical situation of an identified patient, or to meet with an association that wants to share its experience and best practices or seek advice.
Social workers refer their clients to a healthcare professional for a medical condition and the healthcare professional refers their patients to social workers in order to be more effective not only in medical care but also to delegate certain activities (counseling, search of lost to follow up) in order to deal with other aspects.
Joint actions are put in place to identify, plan and agree upon a synergic mode of implementing activities that improve the quality of services offered.
When your donor funding runs out how will your idea continue to live? The project initially depended on single funding, but since its activities are integrated into health centres, it has become routine and no longer dependent on external funding. Yet, the fact that we are in the process of replicating and scaling up the programme in several other health centres, funding will be needed in order to train staff, provide a starting stock of essential generic drugs, conduct reintegration workshops and provide supportive teaching materials.

Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina.

Author(s) Ahmed Novo1, Sinisa Stevic2, Srdjan Dusanic3, Darko Paranos 4, Vera Kerleta-Tuzovic 5, Nadja Bascausevic6
Affiliation(s) 1Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina, 2ASKVA , ASKVA RS, Banja Luka, Bosnia and Herzegovina, 3Faculty of Philosophy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina, 4Mental Health Project in BiH, MHP BiH, Sarajevo, Bosnia and Herzegovina, 5Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina, 6Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina.
Country - ies of focus Bosnia and Herzegovina
Relevant to the conference tracks Health Systems
Summary Within scope of the Mental Health Project in Bosnia and Herzegovina (BIH) two BIH agencies for safety and quality improvement and accreditation in health care, AKAZ and ASKVA conducted series of training seminars in order to improve the importance, role and visibility of the Centres for Mental Health (CMH) in the health systems, as well as their relations with other relevant stakeholders in health and social systems of Bosnia and Herzegovina. Two surveys at the beginning and the end of the project activities have been performed in order to measure the successes of the training seminars. Final survey results have showed that CMH have improved their importance as well as communication.
Background Activities were conducted within the scope of the Mental Health Project (MHP) in Bosnia and Herzegovina (BIH). The Mental Health Project in BIH is a result of continuous commitment of the health ministries to continue the mental health reform in BIH. The mental health reform was launched in 1996 and focused on community-based care as a contrast to the traditional model which was mainly oriented towards hospital treatment of persons with mental disorders.The overall goal of the Mental Health Project in BIH, in the period June 2010 - December 2013, was to improve general mental health of the population and enhance the capacities of policy makers and competent institutions in complying with European standards in mental health care in BIH.Since 2008, two Agencies for quality improvement AKAZ and ASKVA were involved in training and accreditation of health centres in field of mental health with the aim to improve the quality of provided care. Therefore they were selected to perform training for representatives of relevant stakeholders in order to improve importance, role and visibility of the Centres for Mental Health, as well as their relations with other relevant stakeholders in the health systems of Bosnia and Herzegovina.
Objectives The objectives of the Mental Health in BiH Project from the period June 2010 to December 2013 were as follows:1.Improved administrative and legislative framework to enable efficient operations and processes in mental health care in both BiH entities, Federation of Bosnia and Herzegovina and Republika Srpska.
2.Persons with mental problems have access to improved and better quality services of mental health care at the community level.
3.Provision of high-quality mental health services at the community level supported as a priority of the reform process by the management structures in Community Health Centres.
4.To strengthen the capacities to fight against stigmatisation and discrimination related to mental disorders.Within the objective 3, the specific objectives include: a) Improved understanding of managers of DZs and centres for social welfare on the importance and role of mental health centres within DZ organizational structure and b) Establishment of improved cooperation between centres for mental health and other services within primary health care centres, other relevant sectors and local community.
More precisely, AKAZ and ASKVA needed to conduct a series of training seminars in order to improve the importance, role and visibility of the Centres for Mental Health in the health systems, as well as their relations with other relevant stakeholders in health and social systems of Bosnia and Herzegovina. It was also planned to perform two surveys at the beginning and the end of the project activities in order to measure the successes of the training seminars and to examine whether the training made a difference in the initial and final report, emphasising the following questions and tasks:
•Assessment of the current human resources and technical capacities of centres for mental health;
•Assessment of the cooperation established among centres for mental health and other relevant stakeholders in the sector (family medicine teams - FMT and primary healthcare centres - PHC as a whole, psychiatric clinics/wards, centres for social welfare - CSW, local community);
•Definition of the major challenges in inter-sectoral and intra-sectoral cooperation among the aforesaid stakeholders;
•Identifying the respondents’ attitudes toward mental health (centres for mental health, working professionals, individuals with mental disorders);
•Assessment of the respondents’ acquaintance with basic terms and data in the field of mental health.
Methodology Within the MHP in BiH, Agencies for healthcare quality, AKAZ and ASKVA, conducted a series of surveys on “Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina. Both Agencies have compared results of the baseline and final survey on respondents’ view and evaluation of the capacity, role and importance of the Centres for Mental Health and their relations with other relevant stakeholders. AKAZ and ASKVA applied different research methodologies. AKAZ developed five questionnaires for the survey: for mental health centres staff, for social work centre staff, for DZ management, for members of the family medicine teams and for staff from psychiatry departments/clinics. All participants completed questionnaires anonymously and questionnaires did not contain questions about the identity of respondents. Questionnaires had seven parts: data on respondent, cooperation between CMH and management of DZ, cooperation between CMH and family medicine teams in DZ, cooperation between centre for mental health and and psychiatry department/clinics, cooperation between CMH and centred for social work, cooperation between centre for mental health and other services and part seven was for comment, suggestions and questions in an open end format. The first survey was conducted in January-March 2012 and the second was conducted in February 2013. Questionnaires were sent by e-mail to the survey participants who filled it in and sent it back in electronic format or as hard copy. ASKVA conducted interviews in two different phases, at the beginning of the first round of seminars and at the end of project implementation, during the third round of seminars. There were four rounds of trainings and seminars in whole, organised regionally (Banjaluka region, Herzegovina region and Teslic region). The baseline survey was conducted in December 2010 and the final survey was conducted in November 2011. The same respondents participating in the survey, fulfilled questionnaire both at the beginning and at the end of the survey and their responses were compared. The interviews were conducted by the RS Agency’s staff. The survey was quantitative, since it was questionnaire based. Respondents needed approximately 30-45 minutes to fill in the survey questionnaire. Data processing was completed in SPSS statistical software. Responses to the survey questions were presented in form of frequencies, percentages and arithmetic averages.
Results In Federation of BIH AKAZ conducted two surveys in the period from January 2012 till March 2013. 40 organisations participated in the first survey from primary health care level (12 DZ, 14 CMH and 14 FMT), 16 CSW and 6 hospitals. 60 organizations from primary health care level (19 DZ, 24 CMH and 17 FMT), 9 CSW and 5 hospitals participated in the second survey.
Analysis of the results of cooperation between CMH, FMT and management of DZ shows obvious progress in cooperation. Significant contribution provided CMH with improved service through the use of accreditation standards and development of cooperation protocols, working procedures and better communication with management of DZs and FMTs. Furthermore, cooperation between CMH and CSW was also improved. Analysis of the results shows the progression of attitudes of both institutions. Improvement is especially noticeable in the area of general cooperation and frequency and quality of communication. Cooperation between
CMH and psychiatry departments/clinics are also ameliorated (efficiency of the referral system, role and importance of CMH and psychiatry departments, etc.). None of the results from all stakeholders and participants in the survey show that disagreement in general cooperation, frequency in communication and definition of mutual relationships are still present.
In RS, ASKVA conducted the first survey in December 2010, using the sample of 77 respondents and the second was conducted in November 2011 with the sample of 61 respondents. Results show that the capacities of the Centres for mental health (CMH) are improved when compared to the initial survey and respondents are more pleased with cooperation they have between CMH and other institutions. The biggest impacts are related to regular communication and signed protocols of cooperation. The following challenges are recognized in inter-sector cooperation: development of better communication, organization of meetings within healthcare centres, better positioning of CMH within health centre, development of procedures and work standards, more intensive work and better cooperation in smaller communities.
Challenges in the intra-sectoral communication are as follows: better communication and information, defining and realization of protocol on cooperation, provision of more education/training for all employees. Participants have positive relations towards mental health and there are no open signs of stigmatization.
Conclusion Summarized conclusions in regards to the survey on “Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina” are as follows:
• CMH capacities are improved when compared to the initial survey. Respondents are satisfied with premises, furniture and technical equipment as well as professional instruments and additional education.
• Respondents are mainly satisfied with cooperation of CMH and other institutions in the final survey. They are the most pleased with the cooperation with organizational units within healthcare centres and the least happy with cooperation with associations of beneficiaries.
• The biggest leap forward was made in the final survey with regard to more regular communication and signed protocols of cooperation between CMH and CSW. Besides, there is a progress in regular communication between CMH and family medicine teams.
• There is a positive attitude of participants towards the mental health, CSW and psychiatric clinics.
• At the end of project, the number of those who think they knew the Strategy of Mental Health Development increased. Besides, participants evaluated that the Strategy was better implemented in practice.
• Challenges in intra-sector cooperation are: development of better communication and organization of more meetings within healthcare centres, better positioning of CMH within healthcare centres, development of work procedures and standards, intensified work and cooperation in smaller communities.
• Challenges in inter-sector cooperation are as follows: development of better communication and information, defining and realization of protocols on cooperation, provision of better education for employees.A complex organisational health care structure and the complex political structure in BIH may jeopardise the project implementation in the planned timeframes. Different understanding of roles and functions by mental health authorities at different levels could be also be one of the risks. Through the intra- and inter-sectoral cooperation, the Project should develop clear allocation of responsibilities between the institutions and stakeholders involved. Clear commitment of the BIH health care authorities to the sector reform and kind support and joint efforts of Donors (SDC and the Swiss Cantons) and the ensured domestic ownership of the project should guarantee the sustainability of the reform process.

ICT Model delivers integrated Primary Healthcare and Allied Services in Developing Countries? Evidence from India

Author(s) Atanu Garai1.
Affiliation(s) 1Odisha Modernising Economy, Governance, and Administration (OMEGA), IPE Global, Bhubaneswar, India.
Country - ies of focus Global, India
Relevant to the conference tracks Innovation and Technologies
Summary Various functional units of a health system depend on data and communication generated by its peer units and stakeholders for effective planning, implementing, and assessing its own functions. Currently, functional units maintain aggregated MIS data that does not provide the peer units and stakeholders any option to plan, deliver, and assess requirements, access, and usage of health services for individual beneficiaries. Effectiveness of planning, delivery, and assessment of health system functions depends on data and communication from other units. With practical examples from India, this paper designs an ICT model for better data communication by healthcare systems in order to improve outcomes.
Background Providers remain handicapped in delivering patient (beneficiary)-centric care due to the fragmentation of their functional operations. In primary and secondary care in promotional, preventive, curative, and rehabilitate health areas, providers and beneficiaries perform and access eight functions – i) planning, monitoring, and supervision, ii) service delivery (including medical and clinical aspects), iii) information and communication, iv) human resources management, v) financial management, vi) procurement and supply chain management, vii) asset and facility management, and viii) transport services management (Figure 1: Eight health system functions). Different units of health providers, sometimes different organizations, perform these functions with limited or no coordination among themselves. As a result, access and use of healthcare often remains unavailable due to actions by different agencies separated by time and space. Aggregated MIS data does not provide the peer units and stakeholders any option to plan, deliver, and assess requirements, access, and usage of health services for individual beneficiaries. This drawback can be overcome by using data on individual beneficiaries and the data can be used by all peer units for undertaking various functions.
Objectives WHO (2000) in its report “World Health Report 2000: Health systems: Improving performance” demonstrated the linkages of functional services with health system outputs and outcomes (Figure 2: Relations between functions and objectives of a health system). This paper identifies eight different functions that providers and beneficiaries access, perform, or use in various promotional, preventive, curative, and rehabilitative health areas in Indian health system. Discussions with select providers show that their organizational units have been performing their allocated functions with limited or no coordination. Besides, they do not get or use data from their peer units in planning and performing their activities. Therefore, providers disregards need, ability, and health status of the beneficiaries in the delivery of those services. This paper explores the linkages and impact across these eight functions and their sub-activities to intended health system outcomes.To improve access, delivery, and usage of health services, different units, organizations, and stakeholders shall plan, manage, and evaluate their respective functions by communicating data on beneficiaries. ICTs can effectively record, retrieve, and communicate data. This paper explores how ICT helps providers in primary and secondary care settings in India are using in these eight functions. This paper uses the functional relationships to explore the role of ICTs providing responsible functional units coordinate with other units in promoting coordination. It is argued that coordination among different functional units leads to integrated service access and delivery to achieve patient-centric integrated service delivery.
This paper has following objectives:
a) To establish causal linkages of different health system functions with outcomes, showing the dependency of different functional units within providers in promoting access and usage of health services.
b) To assess the status of limited coordination among peer units in planning, performing, and evaluating health services and its suboptimal impact on the health outcomes.
c) To assess the role and effectiveness of ICTs in allowing different units to plan, perform, and evaluate their functions to provide beneficiaries integrated and planned access to health services.
d) To evolve a patient-centric ICT model which allows the multiple units and stakeholders of providers leverage data and communication.
Methodology A literature review provides data to support analysis. The literature review uses systematic review method to search major databases including Academic Search Complete, Econlit, Google Scholar, MEDLINE, PubMED, SocINDEX, among others. Then, we screen the title and abstracts to examine their relevance for the key questions. It is likely that most literature shall use qualitative methods to examine the questions of linkages of health system functions and outcomes.
On the issue of the effect of limited coordination on the effectiveness of the functions carried out by different organizational units and stakeholders, we shall conduct interviews with select practitioners in the health sector in India.There is a growing body of literature examining the effectiveness of ICTs in various health system functions. This paper only shows the applicability and effectiveness of ICTs for specific functions. We shall use case studies showing projects implemented in India or other developing countries to show the applicability and relevance.
We shall analyze the data gathered through literature review and interviews to extrapolate key findings. Based on those findings, we shall develop a model which demonstrates the use of ICTs to generate useful data and communication for planning, management, and assessment of various health system functions.
Results This paper expects to show that the ICT applications can be effective in improving eight health system functions: i) planning, monitoring, and supervision, ii) service delivery (including medical and clinical aspects), iii) information and communication, iv) human resources management, v) financial management, vi) procurement and supply chain management, vii) asset and facility management, and viii) transport services management (Figure 1: Eight health system functions).It also shows that the data and communications from ICT applications used for planning, monitoring, and supervision can  improve the seven functions. Similarly, data and communications from service delivery can help program managers improve their monitoring and supervision.Until now, the responsibility of information and communication was delegated to mass and media organizations. The emergence of ICTs among populations has now enabled the service providers to communicate directly with their beneficiaries. Besides, data and communication from applications managing human, finances, and transport services can help improving various services.
Conclusion This paper helps the stakeholders underline the usage of data and communication by multiple functional units generated by their peer units. For generating data and communication, functional units shall use appropriate ICTs. This discussion on appropriate ICTs and their role in providing data and communication for various functional units plan, manage, and implement actions can help health providers implement a patient-centric integrated delivery.

Communications Platform for Tuberculosos to Supplement Mainstream Media: India

Author(s) Bharathi Ghanashyam1, 2, 3, 4, 5, 6, 7, 8
Affiliation(s) 1Journalists against TB, Journalists against TB, Bangalore, India, 2, , , , 3, , , , 4, , ,, 5, , , , 6, , , , 7, , , , 8, , ,
Country - ies of focus Global
Relevant to the conference tracks Advocacy and Communication
Summary Journalists against TB (JATB) is a communications platform created to supplement the information put out by the mainstream media on TB and to bring sharper focus to the issue by inviting participation from multi-stakeholders. Six journalists who have been active in the media have come together to create the space, which affords opportunities for dissemination of news on TB to focused audiences across the world. In the two years since inception, JATB has visibly demonstrated the need for such a platform and created good impact. This is evident from the response and participation, all of which is available to read on JATB is completely unfunded.
What challenges does your project address and why is it of importance? JATB addresses knowledge gaps on TB, a disease shrouded in ignorance and misconceptions. It also complements mainstream media spaces by bringing various stakeholders together on one platform, exploiting the potential of new media. Consider these little known facts about TB.TB is completely preventable and curable. TB can be eradicated. And yet, in 2011, there were an estimated 8.7 million new cases of TB (13% co-infected with HIV) and 1.4 million people died from TB, including almost one million deaths among HIV-negative individuals and 430000 among people who were HIV-positive.Control of TB is governed by one V and two Ds – Vaccines, Diagnosis and Drugs. And as experts say, all three are outdated. The BCG Vaccine recently celebrated its 90th anniversary; the smear microscopy test, which is still the most widely used diagnostic tool is 125 years old and the most used TB drug is over 40 years old. And now we have MDR, XDR and XXDR TB which defy treatment and diagnosis.

TB is not a disease that is confined to the poor. TB spreads more rapidly among economically weaker people living in congested areas without access to good nutrition and healthcare, but it is airborne and spreads easily to attack anyone who is immune compromised. It can kill if left untreated.

How have you addressed these challenges? Do you see a solution? JATB has identified key challenges to the control of TB and created a platform that can discuss better ways to disseminate this information among stakeholders. Among the needs and solutions that JATB has identified for more effective TB control are greater awareness on its preventable and curable nature, far greater political will towards eradication and most importantly, larger investments for prevention, diagnosis and treatment. Framing these issues in a manner that get public attention becomes equally important. Failing this, discussion around TB can remain confined to academic and research groups, and the medical fraternity.In several countries such as India, TB control programmes are government led and run. While India has become known for a very effective programme, there is also a highly unregulated private sector at work which hampers TB control efforts through the use of inaccurate diagnostic tools such as serological tests and wrong treatment protocols. There is evidence that at least 1.5 million serological tests are performed in India every year. At $10-$30 per test, the cost of testing, plus the cost of TB drugs wasted on treating hundreds of thousands of patients with false-positive results, rival the entire Indian TB control program annual budget of $65 million. These tests are available in at least 17 of 22 highest TB burden countries, from China to South Africa to Afghanistan. This situation needs to be addressed and requires stronger advocacy. JATB has worked actively towards this as well.Recognizing social media as a powerful tool for advocacy, JATB has used it to complement the mainstream media to spread awareness around the curable and preventable nature of TB. This is based on an assumption that greater awareness by default will increase demand for treatment, thereby driving higher investments for the development of newer vaccines, better drugs and new diagnostic tools. JATB does this by publishing and disseminating expert opinion, real life incidents, discussion, debate and news on the latest advancements. JATB is a space dedicated solely to furthering debate on TB and does this by actively connecting decision makers and planners together. It has also been actively advocating for greater investments in media advocacy by the TB sector. JATB has worked actively to advance the debate around TB and make it relevant to the general public, policy makers and other stakeholders.
How do you know whether you have made a difference? JATB, within the first year of being founded found wide ranging acceptance among stakeholders, be it agencies working on the ground, governments or others. This acceptance and support has been on the rise since then. JATB, owing to the position it enjoys in the community as a voluntary space that affords opportunities for unbiased debate, has also pursued specific causes – such as advocating against the use of ineffective diagnostic tools for TB. This has included interfacing with the company that manufactures such tools and publishing their responses for the public to see, as also forwarding these replies to relevant government departments for action. Directly or indirectly it has achieved impact. That it makes a difference is evident from the fact that some of the most renowned experts on TB in the world have written for it.A story published on the blog won the WHO Stop TB Award for Excellence in writing on TB in 2011. In the same year, JATB was invited to present a session Lessons that can be learnt from a Health Journalist at the Childhood TB Conference held by European Centre for Disease Prevention and Control. This is clear evidence of the fact that such a platform is needed in the TB sector. Needless to say if this media platform can work for TB, it can work for most any other issue.As proof that JATB is making a difference, two documents are uploaded through the option later in this application. This further strengthens the value of the initiative. JATB has actively advocated for investment in the mainstream media for training and fellowships and this is also beginning to make a difference. Wider acceptance and knowledge among the mainstream media will increase visibility for TB.

The most important factor is probably that JATB is completely voluntary and unfunded. Despite the complete lack of any financial compensation, contributors have come forward to be part of JATB, enriching it with credible and useful content. This clearly points to the need for such initiatives as well as to the impact.

Have you or the project mobilized others and if so, who, why and how? There is definite evidence that JATB has mobilized the TB sector at several levels. At one level it has brought academicians, researchers and experts together. At another, there is demand from activists and community members for information as is evident from the readership of various blog posts. JATB primarily set out to provide an alternative space to the mainstream media, which did not find TB a worthy enough topic to give space to.
JATB is now a part of several important discussions around TB in the country as well as internationally. JATB has been invited to either speak at, or contribute to the debate in each of the segments it addresses. Notable among these are JATB’s representation at media events, TB conferences or consultations. JATB is now considered a valuable partner in the fight against TB.By publishing his story on the blog, JATB has mobilized some funds for the treatment of an HIV+ boy who has suffered multiple attacks of TB. JATB also set aside a portion of the award it received for the treatment of the child.The very fact that JATB was considered worthy of the WHO Stop TB Award for Excellence in writing on TB, on par with publications such as the New Yorker, is irrefutable evidence of its acceptance of and value in the TB sector.
When your donor funding runs out how will your idea continue to live? This question is not relevant to JATB as it has not sought or accepted funding from any organisation or individual to keep it going. This adds strength and sustainability to the space. It is however important to say here that the one challenge JATB faces is its inability to exploit the full potential it affords for becoming an even more powerful vehicle for advocacy on TB. This is owing to the fact that it does not get full time attention from the members of the group who are all contributing on a voluntary basis. While its biggest strength comes from the fact that it can be completely unbiased, owing to its voluntary status, this also becomes its biggest challenge as it becomes difficult to give it the attention it deserves. JATB is giving serious thought to how this challenge can be overcome without having to ally with one group or the other, should it become necessary to seek or generate funds to make it more vibrant and useful.

Increasing Access to Surgical Services in Resource-constrained Settings

Author(s): J. von Schreeb*1, S. Luboga2, S. Macfarlane3, M. Kruk4
Affiliation(s): 1Division of International Health, Karoliniska Institute, Stockholm, Sweden, 2Department of surgery, Makere University, Kampala, Uganda, 3Global Health Sciences, University of California San Francisco, 4Health Management and Policy, University of Michigan, School of Public Health, Michigan, United States
Keywords: Surgery, district, hospitals, training

Surgical services provide important preventive and life-saving strategies. Contrary to prevailing opinion, essential surgical procedures can be provided in district hospitals at a cost per DALY equivalent to other well-accepted preventive procedures. An international group of health professionals met last year at the Rockefeller Foundation’s Bellagio Center to develop strategies to raise the profile of surgery and increase access in resource-constrained settings in Africa. The group agreed that the major limiting factor in providing access is the shortage of suitably skilled health workers at district hospitals. The presentation is compiled on behalf of the Bellagio Essential Surgery Group.


 The objectives of the presentation are to: 1) outline what is known about the unmet need for surgical services in Africa and gaps in our knowledge; 2) layout obstacles to access; 3) examine alternative strategies to increase appropriate workforce skills; and 4) call for wider partnerships to integrate surgery within primary healthcare and develop training strategies.


The results are based on a literature review conducted prior to the Bellagio Conference and a synthesis of experiences of participants from Eritrea, Ghana, Kenya, Mozambique, Southern Sudan, Sweden, Tanzania and Uganda, and USA. A significant burden of disease is attributable to surgical conditions in sub-Saharan Africa but that much more evidence needs to be generated in order to better target interventions. A major proportion of these conditions can be treated or prevented cost-effectively at the first referral level but that this will require investments in facility infrastructures and in the training of non-surgeons to perform basic life saving general and obstetrical surgery. Preventive and curative programmes to address basic surgical conditions could strengthen health systems in resource-constrained settings and every effort should be made to develop these programmes in an integrative manner. Preventive and curative surgical interventions are essential to health systems and should to be integrated into primary healthcare strategies.

Lessons learned:

More effort is required to raise the profile of surgery on national and international agendas. In the first instance, there is need for: 1) more research to fill gaps in knowledge; 2) demonstration models of provision of surgical services at district level; and 3) sharing, through partnerships, of country experience in training non-surgeons in basic surgical procedures.

The Zimbabwean Experience with Primary Healthcare in the Period 1981-2000: Which Factors Shaped this Success Story?


B. Criel*1, P. Bossyns2, T. Hoeree1, J. Macq3, B. Vander Plaetse4, A. Van Geldermalsen5, E. Mabiza6, G. Mhlanga6, C. Tshuma7, A. Chimusoro8


1Department of Public Health, Institute of Tropical Medicine, Antwerp, 2Medical Department, Belgian Technical Cooperation, 3School of Public Health, Free University of Brussels, Brussels, Belgium, 4Health Section, Alafa project, Maseru, Lesotho, 5Health Services Support Programme, 6Department of Public Health, Ministry of Health & Child Welfare, Harare, 7Provincial Medical Office, Ministry of Health & Child Welfare, Bindura, 8Provincial Medical Office, Ministry of Health & Child Welfare, Gweru, Zimbabwe

Keywords: Primary healthcare, district health systems, strengthening health systems, Zimbabwe

Zimbabwe succeeded, after its independence in 1981, in dramatically transforming its health system. During the 80s and 90s, the Zimbabwean health services gradually evolved into one of the best performing systems of Sub-Saharan Africa.


We believe that the Zimbabwe experience constitutes a major learning opportunity for our understanding of how to organize Primary Health Care (PHC). We analyse the factors, both internal and external to the health system, which contributed to the success at the time. The current crisis in the health sector does not necessarily invalidate lessons from the past.


We distinguish between factors internal and external to the health system.

Internal factors:

1 – A clear operational model on how to organize PHC based on the development of integrated district health systems with networks of decentralized health centres staffed by small teams of versatile health workers, supported by district hospitals acting as back-up facilities for patients in need of more specialized nursing and medical care. Specific disease-control activities were largely integrated in the district health care delivery system.
2 – Multidisciplinary district health teams (doctors, nurses, health administrators, environmental workers, pharmacists) heading the district health services system and operating in a managerial environment with room for local decision-making and resource allocation.
3 – Significant support from provincial health teams for the district teams. The availability of true specialized care at the level of provincial hospitals and the existence of functional referral systems enhanced the health system’s overall credibility.
4 – Well-trained frontline health workers operating in a culture of rationalization of diagnostic and therapeutic behaviour and quality control.

External factors: 1 – Strong national political (and financial) commitment towards social sectors in general, and the health sector in particular. The rights-based approach of the Alma Ata philosophy found fertile soil in the postrevolution period.
2 – Support from the international donor community, including the provision of expatriate health workers integrated in the Zimbabwean public service system.
3 – Good basic transport and communication infrastructure inherited from the Rhodesia regime.
4 – Presence of economic development (commercial farming, tourism) in the 80s and early 90s.
5 – A bureaucratic but functional State apparatus: fulfilment of its normative role, payments of decent salaries to civil servants, punitive action in case of professional misconduct of health workers, etc.
Lessons learned:

In the case of Zimbabwe, in the period 1981-2000, a conjunction of elements, both internal and external to the health sector, led to an environment conducive to the development of equitable and effective PHC systems. With the increased attention for the strengthening of low-income countries’ health systems, the Zimbabwe experience provides a valuable source of inspiration.