Aga Khan Development Network
eHealth Programme


Health care providers at the three district hospitals including Roshan District Hospital (right screen) receive eLearning sessions from the Khorog Oblast General Hospital. Courses are now offered in the local languages, Russian, Shugni and Tajiki, making it easy for participants to learn and retain course content.

Q1 AT A GLANCE


AFGHANISTAN



The AKDN eHealth Programme in Afghanistan received coverage in BBC Voice of America's, ‘Karwan’. The show interviews doctors and patients at French Medical Institute for Children (FMIC) and Faizabad Provincial Hospital. It also covers eLearning sessions delivered from FMIC to health care professionals at Mirwais Regional Hospital.

TELECONSULTATIONS

Total Teleconsultations: 1127

Live Teleconsultations: 710

Store-and-Forward Teleconsultations: 417


Live Teleconsultations

In Q1 2016, 710 live teleconsultations were conducted across all sites in Afghanistan compared to 608 teleconsultations in Q1 2015.

FMIC conducted 203 teleconsultations with Bamyan Provincial Hospital (BPH) and 243 teleconsultations with Faizabad Provincial Hospital. FMIC also conducted 35 teleconsultations with Aga Khan University Hospital, Karachi (AKUH, K) and 46 teleconsultations with La Chaîne de l'Espoir in France.

Bashore, Ishkashim and Nusai Comprehensive Health Centres (CHCs) conducted 82 teleconsultations with FPH and 43 teleconsultations with Khorog Oblast General Hospital (KOGH) in Tajikistan.

Twenty-four teleconsultations were conducted between Bharak District Hospital (BDH) and FPH. Thirty-four teleconsultations were conducted between Kisham District Hospital (KDH) and FPH.

The graph below exhibits the comparisons from Q1 2015:

*Note: eHealth services did not exist at the site in Q1 2015.

During Q1 2016, the Aga Khan Health Service, Afghanistan reduced the number of teleconsultations offered between FMIC and BPH and FPH by 50% due to budgetary constraints, which is why numbers have decreased from Q1 2015. This challenge, however, has been resolved by management and teleconsultations will resume as normal in Q2 2016.


Store-and-Forward Teleconsultations

In Q1 2016, 417 store-and-forward cases were referred across all sites in Afghanistan compared to 238 cases in Q1 2015.

Teleradiology services connect BPH and FPH with FMIC and FMIC with the AKUH, K. Additionally, Bashore, Ishkashim and Nusai CHCs, BDH and KDH avail teleradiology services from FPH. In Q1 2016, 380 teleradiology cases were referred compared to 91 in Q1 2015.

Telepathology services connect BPH and FPH with FMIC. Ten telepathology cases were referred to FMIC for second opinion in Q1 2016 compared to 20 in Q1 2015. The low number of telepathology cases remains a challenge. Reasons identified include overburdened laboratory staff and the lack of complicated cases that need to be referred to FMIC. Normal cases are resolved at BPH and FPH.

Twenty-seven teleopthalmology cases were referred from FMIC to AKUH, K for diagnosis. In Afghanistan, teleopthalmology is currently only offered at FMIC.

The graph below displays the comparison from Q1 2015.


eLEARNING

eLearning Sessions: 13

eLearning Participants: 312


eLearning sessions are received by BPH, FPH, KOGH and MRH from FMIC on medical and nursing topics. Bashore, Ishkashim and Nusai CHCs and BDH receive eLearning sessions from FPH.

In Q1 2016, 312 participants were trained through eLearning sessions delivered by FMIC and FPH in Afghanistan and AKU in Pakistan. FMIC offered six sessions to 264 medical and nursing staff at BPH, FPH and MRH. Fourteen health care professionals at FMIC received Continuing Medical Education sessions from AKU whereas FPH delivered seven sessions benefitting 34 participants at the three CHCs and BDH. No sessions were delivered by FMIC to KOGH in Tajikistan.

The graph below depicts a comparison of eLearning participants from Q1 2015.

*Note: eLearning services did not exist at the site in Q1 2015.

KYRGYZ REPUBLIC


Developments


The eHealth coordinator at the Naryn Oblast Hospital visited the National Cardiology and Therapy Center and National Surgery Center in Bishkek to discuss the expansion of eHealth services. Discussions were held on possible arrangements of live teleconsultations between the Naryn Oblast Hospital and the Centers in Bishkek. Counterparts at the National Cardiology and Therapy Center and National Surgery Center expressed their willingness to support the idea, but suggested to postpone the plans until Polycom software becomes available at the Naryn site, since the institutions work with this software.

Dr. Ilim Beishenaliev, the head doctor of At-Bashy Territorial Hospital in Naryn, expressed his interest in initiating eHealth services at the At-Bashy Territorial Hospital. He requested the Aga Khan Foundation, Kyrgyz Republic (AKF, KR) for technical support and financial assistance for the establishment of fiber-optic internet connectivity. He also stated that after the establishment of the services, operational costs for human resources, internet connectivity and equipment will be covered by his hospital. It was decided that a detailed project proposal with cost-share specifications will be prepared by the At-Bashy Territorial Hospital administration and shared with AKF, KR and AKDN eHRC.


Raising eHealth Awareness


In Q1 2016 various eHealth information sessions were offered in an effort to increase awareness of eHealth services. In February, AKDN eHRC held a session on eHealth for remote regions and shared an eHealth activities update on the Central Asia Health Systems Strengthening project for members of the AKF, KR and the Mountain Societies Development Support Programme. Eighteen participants attended the session.

The eHealth Coordinator at the Naryn Oblast Hospital offered introductory information sessions on eHealth to health authorities at seven primary health care centers (PHCs) in Naryn; one PHC in Jumgal and one PHC in At-Bashy. Furthermore, health administrators at At-Bashy and Ak-Talaa were sent emails informing them about eHealth operations in Naryn. An advertisement in a local newspaper, Kyrgyz Tuusu, was released to raise awareness about eHealth activities at Naryn Oblast Hospital.


TELECONSULTATIONS

Total Teleconsultations (Live): 22


Live Teleconsultations

Live teleconsultations are conducted in Paediatrics between the Republican Children's Clinical Hospital, Bishkek and the Naryn Oblast Hospital. In Q1 2016, live teleconsultations were also initiated in Obs/Gyn. In Q1 2016, 22 teleconsultations in Paediatrics and Obs/Gyn were conducted between the two sites.

Various challenges were encountered during the quarter. Public holidays resulted in shortage of working days for eHealth coordinators and hub and spoke site physicians. A mobile clinic, staffed with specialists from Bishkek and supported by the National Society of the Red Crescent, was operating in Naryn. This may have caused fewer patients coming to Naryn Oblast Hospital for teleconsultations.

There was a connectivity problem with VirtualDoc, the online portal to manage physician-patient and physician-physician teleconsultations. But after shifting the server of the portal from Tajikistan to Pakistan, the issue was resolved and connectivity was reinstated. eHealth coordinators continue to document eHealth activities on a paper-based system as a back-up due to lack of computer literacy. This highlights a need for training, which is planned later this year.

eHealth coordinators have limited or no English language skills. Therefore, eHealth reports are sent to the hub site in Russian and Kyrgyz. The health program officer has to translate reports, which is time-consuming. eHealth coordinators also have limited exposure to international and non-government organizations. Therefore, challenges are encountered in compliance with reporting requirements and timelines. These challenges are mitigated through on-going communication and coordination with stakeholders; constant face-to-face and online correspondence and meetings; and addressing issues on a timely basis and through discussions.

eLEARNING

eLearning Sessions: 7

eLearning Participants: 98


Seven eLearning sessions were delivered to the Naryn Oblast Family Medicine Centre. Of these, five were offered by the Republican Children's Clinical Hospital, Bishkek and two by the Kyrgyz State Medical Academy. Ninety-eight health professionals benefitted from these sessions.

Pre- and post-tests are not administered under eLearning sessions. The structure of the eLearning sessions offered in Kyrgyz Republic does not allow for the administration of pre- and post-tests, which makes the eLearning programme in Kyrgyz Republic different from those in other countries.

A challenge in eLearning encountered during Q1 was that in some cases, specialists were canceling or postponing eLearning sessions they had to offer and the given schedule was not followed. This was due to busy schedules and unexpected urgent work along with their regular duties.

The eHealth connection at Naryn Oblast Hospital was utilized for several activities in addition to routine eHealth operations:

  • Interviews of health administration staff with the Aga Khan University, Karachi for the upcoming Health Facility Management courses;
  • Teleconference of the Center of Blood Transfusion in Naryn with the Ministry of Health in Bishkek on the latest audit by the Counting Chamber of the Kyrgyz Republic;
  • Teleconference of the Naryn Oblast Family Medicine Center administration with the Ministry of Health (MoH) in Bishkek with regard to upcoming MoH meeting in Bishkek.

PAKISTAN


TELECONSULTATIONS

Total Teleconsultations: 75

Live Teleconsultations: 55

Store-and-Forward Teleconsultations: 20


Live Teleconsultations

During Q1 2016, 55 teleconsultations were conducted in Pakistan as compared to 64 teleconsultations in Q1 2015. Forty teleconsultations were conducted at Aga Khan Medical Centre, Gilgit (AKMC, G) from the Aga Khan University Hospital, Karachi (AKUH, K) whereas 15 teleconsultations were conducted at the Aga Khan Booni Medical Centre (AKBMC) from AKUH, K.

Due to harsh weather conditions, rain and landsliding, only 20 of the 30 scheduled teleconsultation clinics were conducted during the quarter, resulting in the decreased number of live teleconsultations.

Implementation activities were carried out to initiate live teleconsultations at Garam Chashma Tehsil Hospital from AKBMC. Plans are to initiate live teleconsultations in various specialities at the hospital.

The graph below depicts the comparison from Q1 2015.


Store-and-Forward Teleconsultations

In Q1 2016, 20 store-and-forward teleconsultations were conducted in various specialities across all connections in Gilgit-Baltistan. During Q1 2015, store-and-forward teleconsultations had been temporarily discontinued at all sites and therefore no cases was referred. Various reinforcement, training, monitoring and implementation activities were carried out that resulted in services reinitiating and increasing in 2015.

The graph below depicts the comparison from Q1 2015.

*Note: The Chatorkhand Health Centre and Yasin Health Centre connections did not exist in Q1 2015.


eHealth services at Yasin Health Centre and Civil Hospital, Gupis were discontinued in February due to low volume of patients. Communities in the Ghizer District can access eHealth services at Singal and Chatorkhand Health Centres.

Challenges encountered in Q1 2016 included technical difficulties at Chatorkhand Health Centre, Soust Health Centre, Yasin Health Centre as well as staff being away on leave and training. Harsh weather conditions posed a challenge as well for patients.


eLEARNING

eLearning Sessions: 3

eLearning Participants: 8


eLearning courses help build capacity of health care professionals working in remote locations. Nurses, physicians and eHealth coordinators at AKBMC, AKMC, G and Singal Medical Centre (SMC) receive Continuing Medical Education (CME) sessions from the Aga Khan University. In addition to the CME sessions, AKU broadcasts Grand Rounds, structured online conferences, to the three sites in Gilgit-Baltistan. AKU also broadcasts CME sessions to Bamyan Provincial Hospital, Faizabad Provincial Hospital and the French Medical Institute for Children in Afghanistan.

In Q1 2016, AKU delivered three CME sessions. Eight participants at AKBMC; AKMC, G; and SMC attended these sessions. In 2015, AKU started offering credit hours to participants who attended the sessions for the Pakistan Medical & Dental Council renewal of licenses. This saw an increase in the uptake of eLearning sessions. In 2016, however, the Pakistan Medical & Dental Council relaxed the requirements of credit hours and announced that it will be enforced in 2017 instead.

TAJIKISTAN


TELECONSULTATIONS

Total Teleconsultations: 361

Live Teleconsultations: 172

Store-and-Forward Teleconsultations: 189


Live Teleconsultations

In Q1 2016, the eHealth network in Tajikistan grew with the addition of a new site. Dushanbe Medical and Diagnostic Centre (DMDC) was connected to Khorog Oblast General Hospital (KOGH) as a hub site to provide live teleconsultations in various specialities as well as eLearning services.

In Q1 2016, 172 live teleconsultations were conducted across all sites in Tajikistan compared to 67 teleconsultations in Q1 2015. Live teleconsultations more than doubled from Q1 2015.

133 teleconsultations took place between KOGH and the three district hospitals, with Darwaz District Hospital (DDH) conducting 41 consultations, Ishkashim District Hospital (IDH) conducting 44 consultations and Roshan District Hospital (RDH) conducting 48 consultations with KOGH. This is considerably higher than the 45 consultations conducted between KOGH and these three district hospitals in Q1 2015.

Thirty-three teleconsultations took place between National Medical Centre (NMC), Karabolo and KOGH in Q1 2016 compared to 19 teleconsultations in Q1 2015. No teleconsultations were conducted between KOGH and the French Medical Institute for Children. Four teleconsultations were conducted between the sites in Q1 2015.

Six teleconsultations took place between DMDC and KOGH, the newly established connection.

The increase in uptake of services was due to a focal coordinator appointed at each of the three district hospitals in January 2016.

Implementation of new equipment and training sessions for coordinators were planned in March at the three district hospitals and Khorog, but due to harsh weather conditions, the activities were postponed to April.

The graph below depicts the comparison from Q1 2015.

*Note: KOGH-DMDC connection did not exist in Q1 2015.

Store-and-Forward Teleconsultations

189 store-and-forward cases were referred from KOGH to NMC and the Aga Khan Health Board, USA (AKHB, USA) in Q1 2016. Of these, 183 cases were referred to NMC whereas six cases were referred to AKHB, USA for second opinion and diagnosis. In Q1 2015, 138 cases were referred by KOGH to the two sites.

The graph below depicts the comparison from Q1 2015.

eLEARNING

eLearning Sessions: 17

eLearning Participants: 173


Health care providers at KOGH receive eLearning sessions in English from the FMIC in Afghanistan. However, participants are more comfortable with sessions delivered in local languages such as Russian, Shugni and Tajiki. This language barrier makes it hard for them to understand and retain information. To mitigate this challenge, KOGH has limited the number of eLearning courses received by FMIC and is instead receiving sessions from DMDC.

From Q1, DMDC started offering eLearning sessions to physicians at KOGH twice a month. Courses are offered in Russian, Shugni and Tajiki, instead of English, making it easy for health care professionals to learn and retain course content.

In Q1 2016, 17 eLearning courses were offered benefitting 173 nurses and physicians. Three eLearning courses were offered from DMDC to 33 participants at KOGH. KOGH offered six courses to 60 attendees at RDH; four courses to 47 attendees at IDH and four courses to 33 attendees at DDH. No courses were offered from FMIC to KOGH.

The graph below depicts the comparison from Q1 2015.

*Note: eLearning services were not offered between the connections in Q1 2015.

PLANS AHEAD


AFGHANISTAN


  • Shift eHealth services from Faizabad Provincial Hospital to the new Essential Hospital Services Unit building in Q2 2016.
  • Aga Khan Health Service, Afghanistan to conduct an eLearning needs assessment at Kisham District Hospital in Q2 2016.
  • The first eLearning session of the Central Asia Health Systems Strengthening eLearning research project, aimed to assess the efficacy of the eLearning programme at French Medical Institute for Children, to be conducted in Q2 2016.

KYRGYZ REPUBLIC


  • Create awareness about eHealth services in health care providers at the Naryn Oblast Hospital.
  • Establish partnerships with other governmental and non-governmental entities to promote eHealth in Kyrgyz Republic.
  • Explore possibilities of connecting Republican Children’s Clinical Hospital, Bishkek to health facilities in Tajikistan.
  • Add adult cardiology and adult surgery specialties to teleconsultations.

PAKISTAN


  • Initiate live teleconsultations between Garam Chashma Tehsil Hospital and Aga Khan Booni Medical Centre.
  • Initiate live teleconsultations between Chatorkhand Health Centre and Singal Medical Centre; Chatorkhand Health Centre and Aga Khan Medical Centre, Gilgit; Soust Health Centre and Aliabad Extended Family Health Centre and Soust Health Centre and Aga Khan Medical Centre, Gilgit.
  • Implement a business plan in the second quarter.

TAJIKISTAN


  • Explore possibilities to connect Dushanbe Medical and Diagnostic Centre with a group of doctors in Moscow, Russia for teleconsultations.
  • Initiate telepathology services between Khorog Oblast General Hospital and French Medical Institute for Children for second opinion and diagnosis.
  • Develop business model for teleconsultations to ensure sustainability of the programme.

Success Story


Anara was born with myelocele, a protrusion of the spinal cord through a defect in the vertebral column. When she was a month old, she received treatment at the Republican Children’s Clinical Hospital in Bishkek and was discharged with a recommendation to continue the medicines and return for a surgery after three months. Her parents returned with her to their home in Naryn, four and a half hours away.

Soon after returning, Anara’s condition began deteriorating. She was constantly crying and sleeping a lot. Worried, her parents took her to Naryn Oblast Hospital with the discharge record from the Republican Children’s Clinical Hospital. Because the two hospitals share an eHealth connection for live teleconsultations, a quick coordination between the two eHealth coordinators led to the tracking of Dr Bakyt Karachev, the Neurosurgeon in charge of Anara’s case. He was updated on her condition and called for a teleconsultation to be arranged with her. Dr Karachev examined Anara through the consultation and advised a different treatment regimen. The treatment worked and Anara’s condition soon stabilised.

Her family was delighted that they were able to consult the same specialist and receive the same quality treatment while in Naryn, without having to travel to Bishkek in an emergency situation.

The family is now back in Bishkek for further check-ups in preparation for the planned surgery.

Name of patient has been changed to respect privacy.

AKDN eHealth Resource Centre


The Aga Khan Development Network eHealth Resource Centre (AKDN eHRC) was established in 2011 to provide strategic eHealth support to the AKDN health agencies and their partner health institutions that are managing eHealth operations. AKDN eHRC employs Information and Communication Technologies to support the assessment, development and implementation of eHealth initiatives and activities of its clients in Asia and Africa.

The mission of AKDN eHRC is to make health care accessible to communities with reduced access, increase the quality of health care provision, build the capacities of health care professionals and ultimately strengthen health systems.

Stadium Road
P.O.Box 3500
Karachi, Pakistan

ehrc@akdn.org

(+92 21) 9924-4230