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IP based network for eHealth applications: practical cases in Developing Countries Marco Obiso and Desire Karyabwite International Telecommunication Union November 2008 WHO

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ip based network for ehealth applications practical cases in developing countries

IP based network for eHealth applications: practical cases in DevelopingCountries

Marco Obiso and Desire Karyabwite

International Telecommunication Union

November 2008

  • The World Health Report 2006 « Working together for Health  » presented an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide.
developing countries
Developing Countries
  • How to help developing countries to improve health care services?
  • How to help the population living in rural areas to get better access to health care services?
how healthcare service in rural areas could be improved
How healthcare service in rural areas could be improved?
  • eHealth or Telemedicine is the only solution which exists today.
  • Access to healthcare services could be provided via telecommunication networks.
ehealth telemedicine
  • eHealth/Telemedicine is a digitalized health service supporting medical staff in routine work ensuring easiness of data transfer and on time, cost effective, time saving, 24 hours a day patient care without physical presence of patient and doctor at the same location.
  • The World Summit on the Information Society (WSIS), which was held in two phases: the first in Geneva, 10-12 December 2003 and the second in Tunis, 16-18 November 2005, has included eHealth in Geneva Plan of Action as one of the important ICT applications.
  • Promote collaborative efforts of governments, planners, health professionals, and other agencies along with the participation of international organizations for creating reliable, timely, high-guality and affordable health care… through the use of ICT…
  • Encourage the adoption of ICTs to improve and extend health care and health information systems to remote and underserved areas and vulnerable populations, recognizing women’s roles as health providers in their families and communities
who resolution on ehealth
WHO Resolution on eHealth
  • In May 2005, the Fifty-eighth session of the World Health Assembly officially recognized eHealth and adopted Resolution WHA58.28 establishing eHealth strategy for the World Health Organization.
who resolution on ehealth10
WHO Resolution on eHealth
  • « …eHealth is the cost-effective and secure use of information and communication technologies in support of health and health-related fields… »
who resolution on ehealth11
WHO Resolution on eHealth
  • Recommended to prepare “…long-term strategic plan for the developing and implementing eHealth services in the various areas of health sector”.
  • National eHealth Master Plan
international telecommunication union itu
International Telecommunication Union (ITU)
  • The introduction of eHealth applications requires multidisciplinary collaboration, with active participation of telecommunication operators and health care professionals.
itu bdt
  • Resolution 41 of WorldTelecommunication DevelopmentConference, which took place in 2002 in Istanbul, recommended to all countries to create national eHealth Committees or Task Forces for such cooperation and coordination.
bdt programme 3 e strategies and ict applications
BDT Programme 3 (E-strategies and ICT applications)
  • Cost-effective, interoperable and socio-economical telecommunications and information and communication technology (ICT) in health care are essential to fostering implementation of eHealth initiatives in developing countries.
bdt programme 3 activities 1
BDT Programme 3 Activities (1)
  • Preparation of eHealth Master Plan for selected developing countries.
  • Wide promotion of the best practic in the eHealth field to developing countries be organizing regional and international workshops, seminars, conferencies.
bdt programme 3 activities 2
BDT Programme 3 Activities (2)
  • Cooperation with WHO on eHealth at different levels.
  • Coordinate Mobile eHealth Applications for rural areas in developing countries by setting up under BDT/ITU umbrella the « Mobile eHealth Alliance ».
itu d study group 2
ITU-D, Study Group 2
  • Question 14-2/2 – Telecommunication in eHealth
  • Question exists from 1994
  • Several reports have been prepared
  • Latest one – Making Better Access to Health Care Services
itu d question 14 2 2
ITU-D, Question 14-2/2
  • Take further steps to assist in raising the awareness of decision-makers, regulators, telecommunication operators, donors, etc. about the role of telecommunication and information technologies in supporting health-care and healthy life in developing countries
question 14 2 2
Question 14-2/2
  • Assist in the development of National eHealth Master Plan by providing information on the best technical solution taking into account the local telecommunication network.
republic of maldives as example
Republic of Maldives (as example)
  • eHealth Master Plan has been prepared be experts from Q14 Group and the Telecommunications Authority of Maldives (Mr. Mohamed Nasih, Director)
  • This Document was prepared on the voluntary basis without any financial expenses from BDT/ITU.
why ehealth master plan is so important 1
Why eHealth Master Plan is so important?(1)
  • Public health is the sovereign responsibility of States, that no health or eHealth project can be implemented in the field without the agreement of the competent authorities.
why ehealth master plan is so important 2
Why eHealth Master Plan is so important? (2)
  • It has to demonstrate that eHealth application to be developed is beneficial:
  • to the patient (in terms of time, quality care received; cost, etc.),
  • to the medical staff (in terms of productivity, competencies, etc.)
  • to the community (in terms of public health for everybody)
what is the best telecommunication technology for ehealth services in rural areas
What is the best telecommunication technology for eHealth services in rural areas?
  • It is a difficult question.
  • The universal solution is not exist.
  • Nevertheless, mobile telecommunication has a big potential to be used as a platform for eHealth services.
  • IP advanced technologies
mobile technology 1
Mobile Technology(1)
  • Many developing countries have already introduced 3G mobile.
  • The mobile phone can be integrated into a computer system by a variety of means (for example, infrared) to create the integrated health care information system.
mobile technology 2
Mobile Technology (2)
  • Mobile Technology for eHealth in rural areas can also include a mobile health care unit.
  • There are several good examples:
      • India – ophthalmology care
      • Russia
      • Indonesia
mobile telemedicine

Tele-Ophthalmic Van – Shankara Nethralaya

Tele-Ophthalmic Van – Aravind Eye Hospital


To overcome the prohibitive costs of large number of terminals and reaching out to the rural areas

point to point system
Point to Point system
  • Russia and India are using satelitte technology to connect mobile health care unit with a hospital.
  • The system diagram is presented at the next slide.

Point to pointSystem

Patient end

Doctor end

12 Lead ECG

A3 Scanner



Video Conferencing


SkyIp or FlexiDama



Digital Camera


Video Conferencing Camera




TV Monitor

TV Monitor

District Client Station

mobile wimax wireless access technology
Mobile WiMAX wireless access technology
  • Turkey. It was successful demonstration how WiMAX could be used to send information in real time from the ambulance carrying a patient to a hospitals’s emergency room.
  • Lebanon. The telemedicine systems in Governmental Hospital in Nabatiyeh provide real-time video consultation between phisicians kilometers apart, the ability to share data and to diagnose patients from afar.
problems 1
Problems (1)
  • So far the Ministries of Health are not convinced that eHealth/telemedicine not only saves lives but saves money.
  • The Ministries around the world still see eHealth as an expensive technology that needs to get in line far behind immunization and maternal health.
problems 2
Problems (2)
  • They know perhaps that eHealth could make a huge contribution to maternal and child health and even immunization; but the message has not been accepted so far.
  • The solution is with National eHealth Master Plan.
itu d sg 2 question 14
ITU-D SG-2, Question 14
  • In order to understand how medical staff in developing countries is aware about eHealth, eHealth survey was organized in several developing countries. The majority does not know what is eHealth.
  • As an example, on the two next slides the information received in Uganda and Pakistan are presented.
uganda mulago hospital complex kampala 58 staff
Uganda,Mulago Hospital Complex, Kampala (58 staff)
  • What would be necessary to do in order to introduce eHealth services?
pakistan medical staff in rawalpindi and islamabad 111
Pakistan, Medical staff in Rawalpindi and Islamabad (111)
  • What would be necessary to do in order to introduce eHealth services?
survey conclusion
Survey’ Conclusion
  • Money is not a main obstacle for the introdiction of eHealth services. 15.9%
  • Medical staff needs more information about best telemedicine practice and training. 69.7%
conclusion 1
Conclusion (1)
  • Telecommunication and medical professionals have to work together in order to develop eHealth Master Plan for each country.
  • Telecommunication authority has to initiate this process.
  • BDT/ITU is ready to provide any assistance.
conclusion 2
  • 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.
conclusion 3
  • Successful eHealth services require more than just technology. For any eHealth system to work in practice – in real clinical situation – suitable, committed personnel are essential.
thank you for your attention
Thank you for your attention
  • For the further information please contact
  • Marco Obiso, BDT, marco.obiso@itu.int
  • Leonid Androuchko, Rapporteur Q14, landrouchko@iun.ch