Overcoming the Information Divide in HealthPanel on Bridging the Technology Gap Between and Within Countries: Overcoming the Information Divide in Health Panel on Bridging the Technology Gap Between and Within Countries Dr Joan Dzenowagis World Health Organization United Nations Commission on Science and Technology Development Rabat, Morocco 10-12 November 2005


World Health Organization: World Health Organization Specialized agency of the United Nations Public health mandate, founded 1948 6000 staff across headquarters (Geneva), regional offices and 192 countries Major initiatives for combating infectious diseases (HIV/AIDS, TB, malaria, influenza, polio); improving maternal and child health; tobacco control, others


Outline: Outline Perspective on ICT and health in developing countries ICT diffusion: measurement and challenges Country example Conclusions


Technology has gone from unimaginable to indispensable...: Technology has gone from unimaginable to indispensable... Drivers from health care and industry Telecom and IT developments wireless and satellite systems fiber optics and cable better services, lower costs processing power and storage capacity


Slide5: Source: ITU 2000 Canada & US Europe Latin America Australia, Japan, NZ Developing Asia-Pacific Africa Inequity is our greatest challenge Distribution of Internet hosts


Spending on health, ICT and education, % GDP: Spending on health, ICT and education, % GDP EDUC Health ICT Private Public Indonesia GDP 172 970 700 000 USD Canada GDP: 724852500000 USD 10 5 2.5 0 7.5 10 5 2.5 0 7.5 10 Health ICT EDUC Source: WHO, UNESCO, World Bank 2005


Attitudes are changing (?): Attitudes are changing (?) ICT has limited role or there are other priorities in low-income countries 'Either/or' scenario: unacceptable tradeoffs in health development investments New technologies 'not appropriate' for poor countries and institutions


Tuberculosis care: DOTS coverage : Tuberculosis care: DOTS coverage


Improving health: ICT is fundamental at all levels : Improving health: ICT is fundamental at all levels Education & training Immunization School health Water & sanitation Monitoring public health Work force planning Health policy & financing Diagnosis & treatment School health Immunization


Seizing the opportunities : Seizing the opportunities Increase workforce and workplace efficiency Quality and safety: avoid medical mistakes, reduce costs and improve care Networks and tools for learning and practice, research and development, innovation Access to information, products, advice and tools for prevention and management


Death by cause in SE Asia: Death by cause in SE Asia World Health Report 2004 - WHO Low-income, high mortality countries Low-income, low mortality countries


Example: Complex emergencies: Example: Complex emergencies Earthquake in Colima, Mexico, January 2003 A daily monitoring and reporting system ensured that aid and services from different sectors were deployed to the neediest areas


Slide13: no change (impact of ageing) -2% decrease +1% increase Source: WHO Number of deaths Year Example: Projected stroke deaths based on annual rate of change (%), China, 1990-2030


Example: Mapping malaria: Example: Mapping malaria www.mara.org


Effects of globalization: Epidemics affect travel and trade: Effects of globalization: Epidemics affect travel and trade Source: WHO 2005


Model of ICT in health systems: Model of ICT in health systems Characteristics of use


UNCTAD ICT index: UNCTAD ICT index ICT is not a single innovation, but a cluster of related technologies Diffusion of ICT in a country consists of an index of these summary measures: Connectivity Access Policy


Connectivity in 2 countries: Connectivity in 2 countries UNCTAD Handbook of Statistics 2004


Connectivity in 3 countries: Connectivity in 3 countries UNCTAD Handbook of Statistics 2004


Growth of mobile technologies: Growth of mobile technologies


Measuring 'access': Measuring 'access' UNCTAD Handbook of Statistics 2004 World health statistics 2005, WHO UNCTAD Handbook of Statistics 2004 World Bank, World development indicators 2005


Urban – rural population, SE Asia (2002): Urban – rural population, SE Asia (2002) UNCTAD Handbook of Statistics 2004


ICT diffusion in 3 countries: ICT diffusion in 3 countries


Making ICT work for health: Health InterNetwork: Making ICT work for health: Health InterNetwork One of four major initiatives of the UN Millennium Action Plan, Sept 2000 Supports public health programs and priorities Content: relevant, high quality, affordable Connectivity: improving Internet access Capacity: training to use information effectively Policy: creating a facilitating environment


HIN Access to Research Initiative: HIN Access to Research Initiative First HIN success: major breakthrough in making content available – still growing Partnership between WHO and journal publishers Delivers 2900+ biomedical journals online, free or at low cost, to health institutions in 113 low-income countries Addition of agriculture (FAO) & environment (UNEP) to partnership, collections


HIN India: Establish and analyze the use of ICT in primary health centers: HIN India: Establish and analyze the use of ICT in primary health centers Karnataka Orissa


HIN India: HIN India Selected because of programs, resources and skills in India 40+ partners coordinated through WHO: national and state government departments local UN agency offices nongovernmental organizations research institutions, health facilities, universities private sector


Slide28: Approach: build on existing strengths Focus on public health priorities Improve information access and use Community health workers, Karnataka Rural


Lessons: Connectivity: Lessons: Connectivity It is feasible and useful to provide computers and Internet even in remote settings Infrastructure and services (electricity, phone) present a major challenge to establishing, using and maintaining the connections Challenge of working beyond the health sector: electricity, phone providers and govt admin departments


Slide30: New and old record-keeping systems side by side at a primary healthcare center, Orissa Connectivity: Establishing the foundation


Lessons: Content: Lessons: Content Content is an important motivator for Internet use Improve access to locally relevant content - statistics, program and policy documents, national scientific publications (Indian Journal of Tuberculosis)


Slide32: Consortium to share e-journals: a first in India One full-text journal article costs US$12 to obtain online, or a wait of 4 months by surface mail


Lessons: Capacity: Lessons: Capacity Skills to use and manage connectivity and content are essential HIN India contracted with local institutes to train over 300 public health personnel Effective use of Internet in public health requires specific skills- training is essential HIN Clubs (fee-for-use basis) were a local solution to generating resources and managing sites and training


Slide34: Capacity: Improving skills to use and manage information in work environment “I ‘Googled’ it.” PHC nurse, Orissa, explaining how she looked for information


Lessons: Policy: Lessons: Policy National and international coordination can optimise use of limited resources Ex: HIN workshop resulted in reallocation of funds for training, instead of duplicate hardware Essential to identify project champions, for sustainability and local involvement Planning for equity in the local context Ex: HIN computer installations in women’s quarters at medical colleges


Slide36: PHC doctor at a typical HIN installation, Orissa Policy: coordinating efforts, identifying local champions, ensuring equity


Slide37: Success: Providing immediate tangible benefits, meeting real needs is key to adoption “All you wanted to know about Tuberculosis could be just a click away” Headline on the NHIC, Indian Express, Bangalore edition 4/03


What’s needed 1: What’s needed 1 Infrastructure affordable, reliable, high-speed connectivity Technology and tools designed, developed and deployed cheap and rugged access devices people who can install and support them Education skills to find, use and manage information


What’s needed 2: What’s needed 2 Policies and standards for information representation and exchange affordable rates, tariffs and services Evaluation evidence & experience to guide development Coordination vertical systems impede real progress interaction: what is used in one place should work in another


Role of health institutions: Role of health institutions Commitment to informing research and clinical practice using ICT Interconnection of scientists and clinicians at all levels of care – globally Strive to incorporate ICT into public health methods and networks Collaboration with national and international networks for funding and implementing health R & D


Cross-border health policy issues in a networked economy: Cross-border health policy issues in a networked economy Legal framework limits innovation, services Who pays and who is accountable for cross-border services Consumer protection and involvement Who owns the electronic medical record Internet trade in pharmaceutical and medicinal products: quality, availability and cost Governance and jurisdiction


Role of countries: ICT, education and health policy : Role of countries: ICT, education and health policy Incentives for competition, better rates and services, consumer protection Infrastructure build-out to the last mile Incorporate ICT training into professional and continuing education, licensure renewal Commitment to: using local expertise, adopting standards, ensuring interoperability Plan for equity in the local context Each sector must be ‘outward looking’


Slide43: “Without computers and the Internet we are fighting 21st century problems with 19th century tools.” Tuberculosis field officer, India


Slide44: Joan Dzenowagis dzenowagisj@who.int With thanks to Gael Kernen for assistance with data and graphs