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Swiss Centre for International Health

Health Technology and Telemedicine Unit

Practical insight into the role of free and open source software in achieving the health-related Millennium Development Goals

12e RMLL, Strasbourg, 11.07.2011

Gonçalo Castro

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History:

The Swiss TPH …

… was founded in 1943 as a public organisation

… 310 staff (Basel), 500 worldwide

… is an associated institute of the University of Basel, Switzerland

.. mandate: improving healthsystems and population health

The Swiss TPH …

… was founded in 1943 as a public organisation

… 310 staff (Basel), 500 worldwide

… is an associated institute of the University of Basel, Switzerland

.. mandate: improving healthsystems and population health

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Epidemiology&

Public Health

Swiss Centre for

InternationalHealth

Swiss Tropical &Public Health Institute

Services

Teaching &Training

Research

Clinical and DiagnosticServices

MedicalParasitology &

Infection biology

Structure of Swiss TPH

PharmaceuticalMedicine

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JordanEgypt

HungaryPolandRomaniaRussiaSwitzerlandTajikistanUkraineBelarus

Angola, Burkina Faso,Chad, Cameroon, Niger, Madagascar, Malawi, Rwanda, Sao Tomé & Principe, Senegal, Tanzania, Togo

China CambodiaVietnamLaosMyanmarNepal ThailandMongolia, Philippines

Swiss TPH projects

Benin, Ghana Mali, DR Congo, South Africa, Sudan, Kenya, Uganda, Equatorial Guinea

NicaraguaBoliviaCosta Rica

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Millennium Development Goals

• International development goals set in September 2000

• Commitment of all UN member states and many international organizations

• To achieve by the year 2015

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Millennium Development Goals

Source: United Nations

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Goal 4: Reduce child mortality rates

• Target 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Goal 5: Improve maternal health

• Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

• Target 5B: Achieve, by 2015, universal access to reproductive health

Goal 6: Combat HIV/AIDS, malaria, and other diseases

• Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS

• Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

• Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Millennium Development Goals

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ICTs for Health

eHealth

“Advances in information and communication technologies (ICT) offer

unprecedented opportunities to improve public health worldwide.“

Dr Anders Nordström

Acting Director-General World Health Organization (2006)

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eHealth

Telemedicine

eLearning

Health Information

Systems

Electronic Health Records Consumer Health

Informatics

mHealth

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eHealth “hot” topics

National & cross-border Electronic Health Records (EHR)

Interoperability & integration

• HL7, openEHR, DICOM

„Transition and developing“ countries: eHealth gainingprominence

Pilot projects shown [1]

• 50% reduction in mortality or

• 25-50% increase in productivity in healthcare system

[1] Greenberg, A. 2005. ICTs for Poverty Alleviation: Basic tool and enabling sector. Stockholm: SIDA

• reduce costs

• improve quality of care

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Some eHealth projects at Swiss TPH …

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iPath – Telemedicine in our Ukraine programme

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Ukraine

Large country (bigger than Metropolitan France)

Many disparities between regions

Economical

Quality of (health) services

Infrastructure

Mobility & knowledge transfer difficult

mitigation measure: introduction of Telemedicine

14* MCH – Mother and Child Health

iPath

FLOSS Telemedicine platform based in PHP & ADOdb

Developed by University of Basel (Switzerland)

Roll-out in 2006 in scope of Swiss-Ukraine MCH* programme

Main functionality:

1. present and discuss medical cases (second opinion)

2. information exchange

3. training: case-based learning

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iPath

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Achievements with iPath in Ukraine

Participants from 53 institutions (including foreign experts)

Moderation by Ukranian physicians

Discussions’ quality improving throughout time

Server migrated to “Ukrainian Association for Telemedicine and eHealth Development”

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openMEDIS - improving health technology management

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Background: The World of Health Technology

Multiplicity of manufacturers and devices 1

Trend: 50% of all diagnostic and

treatment methods did not exist

10 years ago 2

Medical technology in % of total expenditure for health

Avg 5 % among OECD countries 3

40 – 50 % in low-income countries 3

Broken or idle equipment in low- and middle income countries:

25 to 50%

1 The Medical Device Register 2009 , Grey House Publishing, 2 Swedish Council on HTA, 20063 World Health Organization. The World health report 2000

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Information Base on Medical Devices in Low- and Middle-Income countries

• No good data on quantity and quality of infrastructure

• Commercial SW solutions for data management not suitable

-> Made by - and made for - countries with “expensive” health systems

Decision to develop new web-app within Swiss TPH

Difficult to manage health technology

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Development of openMEDIS

• Hospital inventory management SW using FLOSS technology

– PHP / MySQL

• integration of useful databases

– UMDNS nomenclature and generic device lists

– supplier database

• localized

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Ukraine (MCH Programme)

• Used in 25 health facilities

• High interest of Local Health

Administration in FLOSS

Republic of Moldova (Perinatal Project)

• University of Chisinau hosting server, students train hospital staff

• Used in 8 hospitals

Practical Results

Egypt (Radiology Project)

• Used for registration of public hospital radiology equipment

• Extra module development locally

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Perinatal Registry (MCH-Registry)

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Motivation

Lack of real-time pregnancy information within Volyn region in Ukraine

Consequences:

1. Complications during delivery

2. Late referrals

3. High number of births at the main regional hospital

Solution:

Development of web-based pregnant women registry, in order to:

- record comprehensive and structured information

- have it available region-wide to support clinical practice

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Registry for Pregnant Women

Development in PHP/MySQL

Cooperation betweenSwiss TPH and localdevelopers

Pilot starting soon!

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iPath(2006)

openMEDIS(2009)

MCH-Registry(2011)

Main activities Configureexistingsoftware

Project design& backstopping

Developsoftware

Extra modulesdeveloped bylocalprogrammers

Challenges

eHealth evolution in Swiss-Ukraine MCH Programme

Developsoftware

Localprogrammersinvolved fromthe beginning

Health professionalslow computerliteracy

Lack of (IT) staff withinpublichealthsystem

eGovernance& eHealth on early days

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How to overcome those challenges

• Sensitize decision makers

• Collaborative attitude

• Engage local actors

• Capacity building / competence growth

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Capacity building in eHealth applications

Capacity

Today Tomorrow

LocalExperts

Internat. Experts

LocalExperts

Long run

Inter-national Experts

Develop Application

Installation & support

Define requirements

Train users

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FLOSS: key catalyst for health systems development

• FLOSS characteristics address systemic issues

• Scalability – pilot projects must be scalable

• Interoperability – different projects/organisations implement different SWs

• Affordability – financing constraints

• Effectiveness – crucial for development

• Security – key topic at the level of public administration

• Transparency – development demands increased transparency

Sustainability

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Health Millenium Development Goals in Ukraine

Source: Ministry of Economy of Ukraine. Millenium Development Goals: Ukraine – 2010: National Report, 2010.

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More information -> www.swisstph.ch

http://www.swisstph.ch/resources/ehealth-services.html