Improving access to healthcare
services by using information and
telecommunication technologies.
Information Session on « Digital Health for Rural Communities:
Potential, Trends and Challenges »
ITU, Geneva, 17 September 2010
Prof. Leonid Androuchko
ITU-D Study Group 2, Q14-3/2:
Telecommunications for e-Health
International University in Geneva
Health and ITU
 What are the relations
between Health and ITU?
 What is the role of ITU?
What is eHealth? (1)
 The advances in medical science,
biomedical engineering on one side
and information and
telecommunication technology on
the other side are offering today
wide opportunities for improving
access to and quality of health
care.
What is eHealth? (2)
 eHealth is an umbrella term for
health-related activities,
services and systems, carried
out over a distance by
means of information and
telecommunication
technologies.
International
Telecommunication Union(1)
 The introduction of eHealth
services in developing countries
requires multidisciplinary
collaboration, with active
participation of both
sectors:telecommunications and
health care.
International
Telecommunication Union (2)
 ITU is active in the field of Telemedicine/eHealth from
1994, when developing countries during the time of the
First World Telecommunication Development Conference
in Argentina asked ITU to study this question from the
angle of interest of developing countries.
 From 1994 there are two streams of ITU
complimenting activities:
ITU/BDT Development Programs,
ITU-Development Sector Study Group
International
Telecommunication Union (3)
 From 1994 till 2010, ITU implemented a lot of pilot
projects, missions, conferences and seminars in
developing countries in order to demonstrate potential
benefit of eHealth/telemedicine services and
disseminate information on how to improve access to
medical services for people living in rural areas.
 Resolution 41 of ITU World Telecommunication
Development Conference, which took place in 2002
in Istanbul, Turkey, recommended to all countries to
create national eHealth Committees or Task Forces for
such cooperation and coordination.
WHO
 The World Health Assembly in May
2005 officially recognized eHealth
and adopted Resolution WHA
58.28 establishing eHealth
Strategy for the World Health
Organization.
ITU, WTDC 2010
Hyderabad,India
 Resolution (COM3/5) was
approved on « Improving access to
healthcare services by using
information and communication
technologies ».
ITU-D Study Group 2, Q-14
 The main goal of the study is how
to assist developing countries in
the introduction of eHealth
services and solutions, covering
the technical part.
 This is the unique international
study group in the ITU-D SG2,
Q14 dealing with needs of
developing countries.
How healthcare service in rural
areas could be improved?
 eHealth or Telemedicine is the one
practical solution which exists
today.
 Access to healthcare services could
be provided via telecommunication
networks: fixed terrestrial
network, mobile network, satellite
network.
International
Telecommunication Union
 Experience demonstrates that
there is no single solution that will
work in all settings. The
complexity of technologies and the
complexity of needs and demands
of healthcare suggests the gradual
introduction, testing and refining
of new technologies.
Mobile telecommunication in
developing countries
 The number of mobile phones in
many developing countries is
drastically increased during the
last five years offering technical
platform for many mobile eHealth
services to be organized.
Mobile network coverage in
selected countries
(ITU, 2007)
 Combodia 87%, Gambia 85%,
Guinea 80%, Kenya 77%, Pakistan
90%, Rwanda 90%, Senegal 85%,
Togo 85%, Uganda 80%,
Zimbabwe 75%.
Comparison of mobile and
fixed phones (Source – ITU)
Mobile and fixed telephone line per
100 inhabitants
50
45
40
%
35
30
25
20
15
10
5
0
n
n
a
n
na bia nia
ta
ni
ta
ta
ha am Ke gys rita kis ikis
G G
j
r
u
P a Ta
Ky Ma
mobile
fix
Mobile networks in selected
developing countries
(Source – ITU )
Mobile Network Coverage and Telephone Penetration
100
90
80
70
Coverage
50
Penetration
40
30
20
10
e
Zi
m
ba
bw
ga
nd
a
U
To
go
am
bi
a
G
ui
ne
a
C
am
bo
di
a
M
al
aw
i
Pa
ki
st
an
R
w
an
da
Se
ne
ga
l
G
Be
ni
n
sh
Bu
ru
nd
i
0
Ba
ng
la
ge
%
60
Mobile eHealth in rural areas
 There are two solutions:
Mobile phone can be used for
management and consultations
related to medical services.
Mobile eHealth care clinics/units
traveling in rural areas from one
village to another and connected to
nearby hospital by wireless
communication for consultations.
ITU-D Study Group 2, Q-14
 It was decided to prepare the
questionnaire and ask the opinion
of medical staff in developing
countries about Telemedicine and
eHealth.
 It was also a question asking
participants about their view with
regard to the implementation of
eHealth services.
ITU-D Study Group 2, Q-14
 The study was done in the
following countries: Pakistan,
Uganda, Bhutan, Sri Lanka, Saudi
Arabia and recently in Mongolia.
How developing countries
are informed about eHealth?
(1)
 The health care administrations in
developing counreies are not well
informed about potential benefit of
eHealth services.
How developing countries
are informed about eHealth?
(2)
 The Telemedicine Group of ITU-D
SG 2 made a study among medical
staff in five countries and found
the following level of information:
Pakistan-61%, Mexico-18%,
Uganda-73%, Bhutan-31% and
Malaysia-66%.
 This average level is still low.
ITU-D Study Group 2, Q-14







In favor of eHealth services
Uganda – 96.6%
Pakistan – 86.5%
Bhutan – 87.5%
Sri Lanka – 81%
Saudi Arabia – 90.7%
Mongolia – 77%
What is it nesessary to speed
up the implementation?
38
30
22
Series1
financial
support
training
10
more
informaton on
eHealth
40
35
30
25
20
15
10
5
0
good will of
health
administration
%
Pakistan
What is it nesessary to speed
up the implementation?
30.6
28.4
21.6
19.4
financial
support
training
Series1
more
informaton on
eHealth
35
30
25
20
15
10
5
0
good will of
health
administration
%
Uganda
Why eHealth services are not
implemented?
 Main obstacles:
 Lack of Government policy
 Lack of the knowledge about
eHealth successful projects
 Lack of training at all levels
ITU Strategies for e-Health
1. Advance the establishment of ICT infrastructure
2. Provide tools for the development of national e-health strategies
3. Promote cooperation among relevant stakeholders
4. Facilitate information exchange
26
1. Advancing ICT Infrastructure
 Connecting the unconnected remains a challenge:
 High speed broadband connectivity, needed for key
e-health applications, is expensive or unavailable
 Insufficient local content
 Traditional business models often do not support
the needed investment
 Few trained people in the required technologies
27
Wireless Broadband Initiative
Objective :
 Ambitious ITU initiative to expand
broadband access in underserved
areas of Africa
 ITU’s initiative: ITU is working with
governments and other partners
Expected outcomes :
 Develop and deploy wireless networks
 Guarantee capacity for schools and hospitals
 Train local experts and build human capacity
 Develop ICT Applications: e-health, e-education, e-government
28
2. Providing Tools
 Practical guidelines for the development of
national e-Health strategies will developed
in collaboration with WHO and the World Bank
in 2010
 The Guidelines for National e-Health Strategies :
 Methodology to assess actual Health System Status, Needs and Action Priorities
 An integrated Action Framework covering: Infrastructure, Applications,
Financing, Governance, Legal and policy, Human Capacity, Information quality
 Guidance on how to set eHealth targets, benefits and Key Performance
Indicators
29
Providing Tools (cont.)
 Practical guidelines to map e-Health
infrastructure to desired outcomes
 Survey some of the major Tele-health initiatives
in India comprising basic information about activities
and infrastructure
 Grouping of activities across care cycle within
various services
 Map of Activities and diseases being addressed by
those activities, correlated to corresponding infrastructure being utilized
 Map the gaps between the desired and existing facilities as evidenced
by some of the efforts
 Provide insights in terms of infrastructure planning for eHealth.
30
3. Promoting Cooperation
 The introduction of e-Health applications requires
multidisciplinary collaboration
 ITU facilitates the establishment of public-private
partnerships
 All countries to create national e-Health committees
or Task Forces for cooperation and coordination
 Based on Resolution 41
World Telecommunication Development Conference
(Istanbul, 2002)
31
Cooperation:
Digital He@lth Initiative (DHI)
 ITU is co-chairing the DHI, a unique, multi-stakeholder
collaboration between the ICT and healthcare sectors :
 Harness digital health care solutions for scaling up
Interventions in even the most resource poor settings.
 Map the current state of play in this field
 Develop an economic model for policy-makers and practitioners
 Put in place a partnership platform for fast and high impact
country-specific projects of regional importance
 Put in place a partnership platform for fast and high impact
country-specific projects of regional importance
32
Cooperation:
ITU Study Groups on e-Health
 Study Groups (SG) dedicated to e-Health related issues :
 ITU-D SG 2 Question 14-2/2: Telecommunications for e-Health
 ITU-T SG 16 Question 28/16: Multimedia Framework
for e-Health Applications
 ITU-T SG 17 Question 9/17: Telebiometrics
 These Study Group Questions bring together ITU diverse
members (government, industry, academics, other
stakeholders) to lead the work (studies, recommendations,
best practices) on diverse aspects of e-Health
33
Cooperation : SG2/Q14-2/2 m-Health support
 Goal:
Promote the coordinated introduction of
cost-effective mHealth applications
in developing countries
 ITU Study Group 2, Q14 is discussing with
members of industry and Research organizations to assit
developing countries introducing mHealth solutions:
 Mobile phones can be integrated into a computer system
to create an integrated health care information system
 mHealth technology for rural areas can also include
mobile healthcare units
 Provide tailored support to developing countries to transfer
knowledge, build local capacities, implement feasibility studies
and support elaboration of project proposals to deploy
large-scale, simple and cost-effective mobile solutions for Health
34
Cooperation :SG2/Q14-2/2 m-Health support
Mobile Health Information Services
Mobile clinics &
Health Education (Health awareness campaigns, tips,
quizzes, games, etc.)
Portable eHealth terminals
Telemedicine services in remote areas
(Telediagnostics, Teleconsultations,
Telecare, etc.)
Emergency Telemedicine services
Health Data gathering (surveys, disease surveillance,
research trials, etc.)
Training for Health Workers
Remote Patient Management & Monitoring (helpline,
alerts, reminders, access to patient record, history,
medication plan, tracking, Remote sensors, etc.)
Dignostics and Treatment Decision Support Systems
(2 ways SMS,
, DSS software)
35
Remaining Challenges
Need for improved evidence of the economic and
social benefits of e-Health
Problems achieving interoperable e-Health applications and
standardization
Many pilots for e-Health projects exist, but scalability is an issue
Improved communication between telecom and health sectors
36
Conclusions (1)
 The telecommunication and health care sectors
have to work together in developing national
e-Health strategies
 Successful e-Health services require commitment to
promote national strategies and facilitate capacity
building
 Developing countries urgently need a strategic
document – eHealth Master Plan and a Roadmap
37
Conclusion 2
 Effective governance of eHealth
requires codes, regulations, and
standards to ensure satisfactions
of the consumers.
 Issues include legal liability, ethical
standards, privacy protection, and
cultural and social standards.
Additional Resources
 ITU statistical database of ICT indicators per
country and region
(www.itu.int/ITU-D/ict/index.html)
 Expert aid in drafting and implementing
national e-Health projects
(www.itu.int/ITU-D/projects/index.html)
 Training opportunities
(www.itu.int/ITU-D/hrd/tc/index.asp)
 Policy and regulatory reports and symposia
(www.itu.int/ITU-D/treg/index.html)
 Regional office in Addis Ababa to support
Member States in Africa
(www.itu.int/ITU-D/afr/CMS/index.asp)
39
Thank You!
For more information on
ITU’s e-Health Activities
visit the website at:
www.itu.int/ITU-D/cyb/app/e-health.html