1. ICT for Development e-Health: telemedicine and health information initiatives ICT4D Lecture 9 Tim Unwin

2. Lecture 9 Outline The global health agenda E-health Information Delivering practices Examples Global organisations Information and prevention Telemedicine

3. Lecture 9 Health related MDGs Goal 4: reduce child mortality Target 5: reduce by two-thirds (1990-2015) the under- five mortality rate Goal 5: Improve maternal health Target 6: reduce by three-quarters (1990-2015) the maternal mortality ratio Goal 6: Combat HIV/AIDS, malaria and other diseases Target 7: halted by 2015 and begun to reverse the spread of HIV/AIDS Target 8: halted by 2015 and begun to reverse the incidence of malaria and other major diseases

4. Lecture 9 ICTs and the health agendas Three core areas Health management systems Information and prevention Medical practices Key drivers Experiences from north America and Europe Particularly in telemedicine initiatives Pharmaceutical industry: the money in medicine Expanded markets But also a concern to use the potential benefits for greater good

5. Lecture 9 ICTs and the health agendas Long experience of ICTs in health Theatre, dance, film, video in health education Traditional telemedicine Australian flying doctor service in 1920s Potential of new technologies Very high cost of medical diagnosis equipment Samples and images can be sent digitally Use of consultants contacted by phone/digitally Saves time at a distance Making information relevant and appealing Managing large amounts of data

6. Lecture 9 E-health Information Managing health information Hospitals Diseases Maximising health benefits for populations Disseminating information on health care and prevention Health workers General public Delivering medical practices Telemedicine initiatives

7. Lecture 9 Global Health Initiatives and ICT World Health Organisation The Global Fund to fight AIDS, Tuberculosis and Malaria Roll Back Malaria

8. Lecture 9 e-Health initiatives Africa: Health Information Systems (HIS) http://www.afro.who.int/his/index.html http://www.afro.who.int/his/index.html But not particularly active South-east Asia Telematics and IT programmes Americas Telemedicine initiatives As yet, mainly pilot schemes Little evidence of ability to deliver initiatives at scale

9. Lecture 9 The Global Fund http://www.theglobalfund.org/en http://www.theglobalfund.org/en A financial instrument created in 2002 $3 billion committed in 128 countries (Feb 2005) Nothing on ICT or e-Health on site!

10. Lecture 9 Malaria kills 1 million people a year RBM Partnership Launched in 1998 by WHO, UNICEF, UNDP and World Bank Now has more than 90 partners ICT based work Multimedia online resources http://www.rbm.who.int/cgi-bin/rbm/rbmportal/custom/rbm/home.do Mainly use in information dissemination

11. Lecture 9 Information disssemination Soul City, South Africa Imfundos support for fight against malaria and HIV/AIDS

12. Lecture 9 Soul City South Africa Soul City: Institute for Health and Development Communication http://www.soulcity.org.za http://www.soulcity.org.za A South Africa NGO Established 1992 Especial focus on HIV/AIDS Different media Television Six series, each of 13 episodes Radio Six series, each of 45 episodes in 9 languages Print

13. Lecture 9 Soul City South Africa Evaluations 47% of people in SA say it is main source of info about HIV/AIDS on TV Strong positive correlation between behaviour and exposure to Soul City Soul City is as well known as Coca Cola in South Africa Materials used in 11 African countries

14. Lecture 9 Imfundo support for malaria Imfundo agendas Seeking relevance Tanzania Personal connections Dr. Alasdair Unwin working on malaria in suppport of Tanzanian Ministry of Health CD-ROM on malaria In partnership ICT4D web-solution http://www.gg.rhul.ac.uk/ict4d/Mal aria.html http://www.gg.rhul.ac.uk/ict4d/Mal aria.html

15. Lecture 9 Imfundo and the Interactive Health Network - HIV/AIDS Database on digital information on HIV/AIDS Ready access to a wealth of digital materials Searchable by types of user and types of information Users can provide comments on the resources Developed through partnership http://hivaids.digitalbrain.com/hivaids/homepage/hom e/ http://hivaids.digitalbrain.com/hivaids/homepage/hom e/

16. Lecture 9 Delivering medical practices Telemedicine in South Africa Jiva teledoc in India Satellite link to rural hospital in Mali www.satexpo.it/en/ news-new.php/3?c=42700

17. Lecture 9 Telemedicine in South Africa Telemedicine Research Centre Established by Medical Research Council in 1999 Designed to evaluate relevance of international expertise for Africa Findings: telemedicine enables Access to specialist radiologists within hours rather than days Improved diagnosis by community service doctors Local treatment of some patients, thus reduced transfers Reduced professional isolation of doctors in rural areas

18. Lecture 9 Telemedicine in South Africa University of Transkei http://telemed.utr.ac.za http://telemed.utr.ac.za Open Source telemedicine initiative Web-links Pathology Pathopic (Basel) http://alf3.urz.unibas.ch/pathopic/e/intro.htm http://alf3.urz.unibas.ch/pathopic/e/intro.htm Telemedicine Health information Online teaching resources Potential is there But not much evidence of high usage

19. Lecture 9 Jiva: sustainable healthcare in rural India Jiva Institute Non-profit Research and Development Institute founded in 1992 Health, Education and Social Enterprise Health activities Ayurveda website - the worlds first Holistic, healing science Ayunique - online consulting Teledoc - healthcare for all Ayurbuyer - online store Jiva College of Ayurveda

20. Lecture 9 Jiva Teledoc Based in village in Haryana Won World Summit Aware Practice Healthcare workers record diagnostic data Use Java enhanced mobile phones to transmit data Ayurvedic doctors diagnose and prescribe treatment Medicines are then delivered by field workers to patients Costs 70 rupees ($1.50 per consultation)

21. Lecture 9 Jiva Teledoc social returns Patients have affordable treatment Women are treated by women Wider healthcare is promoted by field workers Local workers speak local languages Provides some employment in rural areas

22. Lecture 9 Conclusions Much is technically feasible High cost end: telemedicine Lower cost: considerable health information Importance of combining multi-functional access points for information The role of Telecentres Yet, the potential of e-Health has still to be realised Why is this?