Upload
arletty-pinel
View
355
Download
0
Embed Size (px)
DESCRIPTION
Citation preview
Large Scale Capacity Development in eHealth Addressing workforce development through global
partnerships
Presentation at the High Level Working Session on the Development of economic Models and Metrics for
eHealth in Support of the Health-related Millennium Development Goals
Arletty Pinel, MD
Director, eHealth and Telemedicine - iCarnegie Geneva, 6 September 2010
1
9-‐novi-‐11
• eHealth for Health Sector Strengthening (HSS) – Educa?on and workforce development as an integral part
• Leveraging exper?se Globally: iCarnegie • Leveraging exper?se Globally: Brazil
2
Agenda
9-‐novi-‐11
ü eHealth for Health Sector Strengthening (HSS) – Educa?on and workforce development as an integral part
• Leveraging exper?se Globally: iCarnegie • Leveraging exper?se Globally: Brazil
3
Agenda
9-‐novi-‐11
• eHealth has poten?al for HSS but qualified workforce poses addi?onal strain to system
• Challenges will increase before solu?ons arise • Innova?on for large scale training of ICT and health workforce needed for cost-‐effec?ve eHealth implementa?on
• HSS for equitable health delivery and South-‐South and triangular coopera?on at core
4
eHealth: Key issues
9-‐novi-‐11
• Shortage of skilled workforce • Shortage of teachers and/or educa?onal content
• Desire by governments to invest in workforce development
• Realiza?on that this can only be met through educa?on
5
Common Themes
9-‐novi-‐11
What is needed?
• Public-‐Social-‐Private-‐Partnerships (PSPPs) at different levels (from local to regional to global)
• Strategic plan constructed in a par?cipatory fashion with key stakeholders in eHealth/ICTD
• Mul?professional team to develop content and design appropriate learning plaVorm
• Exis?ng ini?a?ves from which to build • Boldness and crea?vity to promote a paradigm shiW on delivery of capacity development
• Inspired individuals and commiXed ins?tu?ons
9-‐novi-‐11
Global South
• Start locally but secure globally: – Value developing and transi?onal countries’ priori?es, applied knowledge and crea?ve solu?ons
– Match with specific know-‐how to create high quality products
9-‐novi-‐11
Team and pla<orm
• Credibility of the ini?a?ve requires a top-‐class mul?professional and mul?cultural team as well as a tailor-‐made learning plaVorm
• Appropriateness of the approach needs to consider disparate educa?onal levels, learning processes and styles of applying knowledge
• Strength of the product is key to overcome skep?cs
9-‐novi-‐11
• eHealth for Health Sector Strengthening (HSS) – Educa?on and workforce development as an integral part
ü Leveraging exper?se Globally: iCarnegie • Leveraging exper?se Globally: Brazil
9
Agenda
9-‐novi-‐11 10
Mission
9-‐novi-‐11 11
Approach
FoundaAonal Knowledge
SoC Skills &
CommunicaAons
Experience Accelerator Projects
Problem Solving, Learn by Doing, Outcome Based and Profession Focused
9-‐novi-‐11
How Are We Different?
Scale
EducaAonal Content / InstrucAonal Quality
12
MIT Berkeley Stanford Harvard
NIIT
SENA
Learning Tree
RoseXa Stone
iCarnegie
Cisco Entrepreneurial Ins?tute
LEGO
Trade Schools
Local Community Colleges
Public Universi?es
eCornell
NGOs Industry Training
Yahoo
9-‐novi-‐11
Global Partnerships
13 13
9-‐novi-‐11 11/9/11 14
Global Presence
© iCarnegie Inc – NOT FOR DISTRIBUTION
9-‐novi-‐11
Skills Transfer
• Learning needs context • eLearning is a complement; nothing subs?tutes face-‐to-‐face interac?on
• Teaching can be relevant without sacrificing quality
• Access relies on local delivery, local languages and local costs
9-‐novi-‐11
China
16 16
• China, City government of Wuxi – iCarnegie Center for IT professionals, Wuxi China
– Training center for 5000 students in SoWware and web development
– Focused on academic and professional educa?on for the Chinese Outsourcing industry
9-‐novi-‐11
Colombia
17 17
• SENA – Training 40,000 people yearly in ICT (but not geing hired)
– Large scale 2500 hrs programs in soWware development, soWware engineering, game development and informa?on systems
• Min of EducaAon – Middle-‐school/High-‐school STEM using Robo?cs
• Min of Commerce – Human Capital Development Programs and Industrial ‘Competency’ commiXees
9-‐novi-‐11
India
• B-‐Tech/M-‐Tech aren’t producing needed talent
• Industry creates ‘bridge courses’, ‘finishing schools’ and expensive campuses to train new-‐hires
• iCarnegie looking at increasing quality of formal training
18
9-‐novi-‐11
Kazakhstan
19 19
• Government of Kazakhstan – Large investments in overseas educa?on
• Crea?ng a world class mul?versity in Astana to develop the research and management talent for the country
• iCarnegie developing academic and professional based cer?ficate programs (e.g., soWware engineering, IT management)
9-‐novi-‐11 11/9/11 20
Timeline
• Assessment • Vision (where we want to go)
• Gap Analysis (where we are currently)
3 Months
6 Months
4 years
• Program development
• Industry involvement • Integra?on and Customiza?on
• Instructor Training • Course delivery • Course Evalua?on • Enhancements and process improvement
© iCarnegie Inc – NOT FOR DISTRIBUTION
9-‐novi-‐11
• eHealth for Health Sector Strengthening (HSS) – Educa?on and workforce development as an integral part
• Leveraging exper?se Globally: iCarnegie ü Leveraging exper?se Globally: Brazil
21
Agenda
9-‐novi-‐11
Brazil Telehealth
Acknowledgement Ana Estela Haddad (Ministry of Health) and Beatriz de Faria Leão
9-‐novi-‐11
Brazil
• Population: 190,000,000 • States:26 + 1 Federal District • Municipalities: 5,563 (40% in metropolitan areas)
• 220 native ethnicities (0,2% of the population) • 185 languages
9-‐novi-‐11
Unified Health System
• The Unified Health System (Sistema Único em Saúde – SUS) has the following principles:
– Universal Care – Equitable Care – Comprehensive Care
– Unified Care – Regionalized Services Network – Social Par?cipa?on
9-‐novi-‐11
•
Primary Health Care
• Family Health Strategy – started in 1994 – Family health team (FHT): 1 Medical Doctor (MD), 1 Registered Nurse (RN), 1 Den?st
– 2 technical-‐degree nurses and 4 to 6 Community Health Workers
– 30.000 FHT covering 90 million people in 60% of the Brazilian municipali?es
– major impact in the reduc?on of children mortality in the last decade
9-‐novi-‐11
Family Health Strategy
1998 5% coverage
FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind
9-‐novi-‐11
Family Health Strategy
FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind
2009 90% coverage
9-‐novi-‐11
Brazilian Telehealth
Brazil Telehealth Program - remote assistance and continuing education Pilot Project: 9 states and 900 points www.telessaudebrasil.org.br
Open University of Unified Health System - provides in-service training for thousands of health care providers www.universidadeabertadosus.org.br
Telemedicine University Network - RUTE, initially about 80 University Hospitals in collaborative research and education across all federal states – http://rute.rnp.br
9-‐novi-‐11
Telehealth Program Coverage:
9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants
9-‐novi-‐11
9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants
Expansion states (3 + Federal District) Priority: Northeast region and Brazilian Amazon
Coverage:
Telehealth Program
9-‐novi-‐11
9 Centers – June 2010
1.209 Points
890 Municipalities
5.900 Family Health Teams
17.786 Formative Second Opinion
14.302 Complementary Exams
Telehealth Program
9-‐novi-‐11
A Telehealth Center R$ 200.000,00 ((±US$100,000)
A Telehealth point of care R$ 2.800,00 (±US$1,400)
Telehealth Program
9-‐novi-‐11
1º Phase 2007 – 2008 2º Phase 2009 – 2010
R$ 14.831.778,35 US$ 7 M
R$ 21.830.720,00 US$ 11 M
Total: R$ 36.662.498,35 (±US$ 18,400,000)
MoH investments
9-‐novi-‐11
Maintenance of teleconsultants of a center/month for 100 points of Telehealth
R$ 31.560,00 (±US$15,500)
Maintenance costs of Human Resources by center/month for 100 points of Telehealth
R$ 29.560,00 (±US$15,000)
Maintenance costs
9-‐novi-‐11
• Evalua?on of 33 pilot municipali?es at North and Northeast of Minas Gerais:
– Referral costs in Primary Health Care were 8x more expensive than Second Opinion offered by TeleHealth.
– Savings was about 5 referrals/municipali?es/month; avoiding 1.5% of referrals is enough to cover telehealth costs
Savings
9-‐novi-‐11
Minas Gerais – Clinical Hospital: survey with 105 professionals of PHT from 32 municipalities: 67% of the respondents felt that access to training at the workplace was a major factor in to stay in their hometowns
Important 67%
Medium 27%
Low importance 2% No important
4%
Workforce retenAon
9-‐novi-‐11
SIGA Saúde
City of São Paulo’s Health
InformaAon System
Acknowledgement
Heloisa Helena Andreetta Corral, Maria Aparecida Orsini (Director Paulistana Mother Program) and Beatriz de Faria Leão
9-‐novi-‐11
SIGA Saúde
SIGA Saúde is the city of São Paulo’s Integrated and Distributed System for Managing the Public Healthcare System. The system belongs to the city of São Paulo, which is willing to share it with other ci?es, states and countries.
SIGA Saúde has been developed using
free-‐soWware open-‐code concepts.
São Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area.
SIGA Saúde is present in 100% (704) of the city of São Paulo’spublic health care providers
9-‐novi-‐11
Electronic Health Record
Patient Flow Organization & Mngmnt (Specialties, Beds, Exams)
Management (Surveillance, Auditing
and Billing)
Internet
SP City Datacenter
SMS-SP
Dept of Health
Access Control
SIGA IT model
9-‐novi-‐11
• Program created by the city of São Paulo’s Health authority in 2006, that extended the SUS Maternal Health Program.
• The Paulistana Mother is an integrated program to assist and monitor ALL pregnant women of the city of São Paulo.
Paulistana Mother
9-‐novi-‐11 Source: Diario de São Paulo, July 25th Pg. 53
We’re going to keep calling you until the name of your baby is in our list…
9-‐novi-‐11
The program: • Monitors all pregnancies within the public system, • Establishes the referrals to hospitals and emergencies,
– High risk pregnancies ate treated separately by special alerts in the system
• Guarantees bed alloca?on for deliveries • Follows up mother and child un?l the baby is one year old • Recharge of the transport card at each prenatal visit • Provides counseling on breast feeding and baby care • Mother receives a full bag with products for the baby at delivery
Paulistana Mother
9-‐novi-‐11
• Free access to all pregnant women • Registra?on done in any of the 409 primary care units
• 36 hospitals • 25 specialized outpa?ents clinics • 80,000 pa?ents in program • 10,000 deliveries / month • 74% of paAentes with 7 or more prenatal consultaAons
Results
9-‐novi-‐11
ANO 1980 1990 2000 2002 2004 2006 2007 2008COEFICIENTESMORT. INFANTIL GERAL 50,62 30,90 15,80 15,10 13,96 12,86 12,54 11,99
MORT. INF. POS-NEONATAL 25,31 11,87 5,49 4,97 4,73 4,59 4,36 4,00
MORT. NEONATAL TOTAL 25,31 19,03 10,30 10,13 9,23 8,27 8,18 7,98
MORT. NEONATAL PRECOCE 18,29 15,36 7,70 7,27 6,31 5,74 5,46 5,60
MORT. NEONATAL TARDIA 7,03 3,67 2,60 2,86 2,91 2,53 2,72 2,38
MORT. PERINATAL 30,46 23,80 17,41 16,51 14,00 12,60 11,67 12,72
NATIMORTALIDADE 12,40 8,57 9,78 9,31 7,73 6,90 6,24 7,16
TAXA DE NATALIDADE** 28,23 20,71 19,90 17,56 17,19 16,07 15,77 15,89
NASCIDOS VIVOS 239.262 196.985 207.462 185.417 183.883 173.901 171.602 173.799FONTE: Fundação Sistema Estadual de Análise de Dados (SEADE).* Coeficiente por 1.000 nascidos vivos (NV).**Por mil habitantes
EVOLUÇÃO DOS COEFICIENTES* DE MORTALIDADE INFANTIL NO MUNICÍPIO DE SÃO PAULO, 1980 A 2008.
9-‐novi-‐11 http://vitalwaveresearch.com/healthit/
SIGA’s evaluaAon
9-‐novi-‐11
SIGA evaluation
9-‐novi-‐11
Ana Estela Haddad [email protected] Heloisa Helena Andreetta Corral [email protected] Maria Aparecida Orsini [email protected] Beatriz de Faria Leão [email protected]
9-‐novi-‐11
Paradigm shiC
• Boldness and innova?on (technological, human, social) at core of the ini?a?ve: it’s a transforma?onal process
• Poten?al goes beyond developing a product to work towards a paradigm shiW in capacity development using eHealth and ICTD as an entry point
• No quick fixes: investment in educa?on takes ?me
9-‐novi-‐11
Thank you. Ques?ons?
11/9/11 49