Executive Summary

The Aga Khan Development Network eHealth Programme is expanding rapidly, which was reflected in the increased uptake of services in Q1 2017. Reduced activity, however, was experienced in some countries as compared to Q1 2016, which led to a moderate increase in overall numbers.

In Q1 2017, 1749 teleconsultations were conducted across all countries in South and Central Asia, as compared to 1585 teleconsultations in Q1 2016. The increase is mainly due to the increased number of sites and expansion of services in Pakistan and Kyrgyz Republic. The number of sites and specialties were increased in Pakistan, whereas in Kyrgyz Republic, additional sites were added.

The number of eLearning participants increased moderately from 591 in Q1 2016 to 620 in Q1 2017. The number of participants attending eLearning sessions increased notably in Kyrgyz Republic and Tajikistan. Although sessions were offered in Pakistan, no health care professionals were available to attend courses, indicating no improvement in the motivation of health care providers to attend courses.

During Q1 2017, AKDN eHRC conducted workshops on telemedicine and mHealth innovations for health care professionals and programme managers from Afghanistan, Kyrgyz Republic, Pakistan and Tajikistan. Twenty-eight participants benefitted from the workshops, which were held in Dubai, UAE and Islamabad, Pakistan.

Afghanistan

1059

Live
Teleconsultations

392

Store-and-Forward
Teleconsultations

26

eLearning
Sessions


 
271

eLearning
Participants

Teleconsultations


Live Teleconsultations

In Q1 2017, 1059 live teleconsultations were conducted across all sites in Afghanistan compared to 710 teleconsultations in Q1 2016.

The French Medical Institute for Children (FMIC) conducted 411 teleconsultations with Bamyan Provincial Hospital (BPH) and 343 teleconsultations with Faizabad Provincial Hospital (FPH). FMIC also conducted 37 teleconsultations with the Aga Khan University Hospital, Karachi (AKUH, K) in Pakistan and 81 teleconsultations with La Chaîne de l'Espoir in France.

Bashore, Ishkashim and Nusai Comprehensive Health Centres (CHCs) conducted 107 teleconsultations with FPH and 23 teleconsultations with Khorog Oblast General Hospital in Tajikistan.

Fifty-seven teleconsultations were conducted between Bharak District Hospital (BDH) and FPH. No teleconsultations were conducted between Kisham District Hospital (KDH) and FPH. Due to resignation of head of KDH, eHealth activities had temporarily stopped there, as a result no teleconsultations were conducted.

In Q1 2017, FMIC initiated live teleconsultations in orthopedics with AKUH, K, adding a new specialty to the existing services.

The number of teleconsultations increased notably in Q1 2017 from Q1 2016 due to the increase in monthly teleconsultation targets, which were reduced by 50% in the first three quarters of 2016 as a result of budgetary constraints.

 
Store-and-Forward Teleconsultations

In Q1 2017, 392 store-and-forward cases were referred across all sites in Afghanistan compared to 417 cases in Q1 2016.

Teleradiology services are offered at BPH and FPH from FMIC and at FMIC from AKUH, K. Furthermore, FPH offers teleradiology services to patients at Bashore, Ishkashim and Nusai CHCs, BDH and KDH. In Q1 2017, 354 teleradiology cases were resolved compared to 380 cases in Q1 2016.

Telepathology cases are referred from BPH and FPH to FMIC and from Bharak and Kisham District Hospitals to FPH. In Q1 2017, 22 telepathology cases were referred for second opinion.

Teleopthalmology services connect FMIC with AKUH, K. Sixteen teleopthalmology cases were referred from FMIC to AKUH, K for diagnosis.

The graphs given below display the comparison of live and store-and-forward teleconsultations with Q1 2016

Dr Ezatullah Faiz, Orthopedic Surgeon, French Medical Institute for Children, conducting a teleconsultation with Faizabad Provincial Hospital.

Dr Sayed Sabir, ENT Consultant, French Medical Institute for Children conducts a live teleconsultation with Bamyan Provincial Hospital.

Live Teleconsultations

Store-and-Forward Teleconsultations

*Note: Cases were not referred to a consultant radiologist in Q1 2016; hence a comparison is not available.

eLEARNING


FMIC delivers eLearning sessions on medical and nursing topics to BPH, FPH, MRH in Afghanistan and to Khorog Oblast General Hospital in Tajikistan. FPH also delivers eLearning sessions to Bashore, Ishkashim and Nusai CHCs, BDH and KDH.

In Q1 2017, 271 participants were trained through eLearning sessions delivered by FMIC and FPH in Afghanistan and Aga Khan University in Pakistan compared to 312 participants in Q1 2016. Fifteen sessions were offered by FMIC to 203 medical and nursing staff at BPH, FPH and MRH. Furthermore, eleven sessions were delivered by FPH, benefitting 68 participants at the three CHCs, BDH and KDH.

eLearning between FMIC and KOGH was reinitiated in Q1 2017, after a year-long pause since Q4 2015. FMIC temporarily stopped the offering courses to KOGH due to the language barrier between the two sites. However, to overcome this challenge, the courses are now being translated into the local language for better comprehension and retention.

The graph given below displays the comparison with Q1 2016.

eLearning Participants

An eLearning session being conducted by the French Medical Institute for Children for health care professionals at the Bamyan and Faizabad provincial hospitals.

Capacity Building Activities


In January, eHealth training was delivered to health care professionals of the KDH in an effort to build their capacity. Participants received training on eHealth concepts and hands-on training on the usage of eHealth equipment and software. The training was held at FPH and five health care professionals were trained.


 

Kyrgyz Republic

52

Live
Teleconsultations

13

eLearning
Sessions


 
125

eLearning
Participants

Teleconsultations


Live Teleconsultations

In Q1 2017, the Republican Centre for Infectious Diseases and the National Surgery Centre were connected to the Naryn Oblast Merged Hospital as hub-sites for live teleconsultation services. Now, the National Centre of Maternity and Childhood Care (NCMCC), Republican Centre for Infectious Diseases and the National Surgery Centre provide live teleconsultation services to patients at the Naryn Oblast Merged Hospital. Additionally, the Geneva University Hospitals, Switzerland, offers live teleconsultation to patients at the Naryn Oblast Merged Hospital, with support from the Medical Education Reforms Project.

In Q1 2017, 52 teleconsultations were conducted as compared to 22 teleconsultations in Q1 2016. Of these, 12 were conducted by Geneva University Hospitals, one by The Republican Centre for Infectious Diseases and 39 by NCMCC.

Electricity outages were experienced on several occasions in Naryn, which resulted in the re-scheduling of teleconsultation sessions. Overall, teleconsultation numbers increased from Q1 2016. This is due to additional hub-sites being added as the eHealth network expanded over the year.

eHealth equipment purchase for expansion of services into surgery in Naryn and to add an additional spoke site, At-Bashy Territorial Hospital, was approved by donors and the procurement process initiated.

The graph given below display the comparison of live and store-and-forward teleconsultations with Q1 2016


Dr Kasmalieva Kalbubu Kemelovna, Head of the Infectious Diseases Department of Naryn Oblast Hospital, receiving a second opinion on a case of differential diagnosis of splenic fever through a teleconsultation.

Dr Mamyraliev Altynbek, Maxillofacial Surgeon, National Centre of Maternity and Childhood Care, performing a check-up of a patient through teleconsultation for recommendations on a follow-up surgery.

Live Teleconsultations

*Note: Teleconsultation services did not exist between the sites in Q1 2016, hence a comparison is not available.

eLEARNING


During Q1 2017, 13 eLearning sessions were delivered, benefiting 125 health professionals at the Naryn Oblast Family Medicine Centre. Kyrgyz Stated Medical Academy offered five sessions, benefitting 24 participants; Kyrgyz State Medical Institute of Continuing Education delivered seven sessions, benefitting 94 participants; and the National Hospital of the Ministry of Health conducted one session, benefitting seven participants. NCMCC primarily conducts teleconsultations rather than eLearning sessions. As a result, no eLearning sessions were conducted by NCMCC. In Q1 2016, 7 sessions were delivered, benefitting 98 health care professionals.

During the quarter, a new connection for eLearning services was established. The National Hospital of the Ministry of Health, Kyrgyz Republic was connected to the Naryn Oblast Family Medicine Centre as a hub-site for eLearning sessions. The institutions initiated the implementation of the connection. The National Hospital of the Ministry of Health, Kyrgyz Republic also expressed its readiness to support Naryn Oblast Family Medicine Centre for teleconsultations in the future. Furthermore, the Kyrgyz State Medical Academy initiated eLearning sessions for continuing medical education for clinical residents in Naryn. Similar sessions are expected on a regular basis in the future.

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

  • eLearning sessions on neurosurgery from the Novosibiksk Neurology Centre in Russia for health care professionals at NCMCC. Fifteen health care professionals were trained through two sessions

  • Ten teleconferences with the Ministry of Health and other district health departments

  • A major health forum, conducted online and chaired by the Ministry of Health, Kyrgyz Republic. Thirty-two health care professionals participated in meetings from Naryn.
 

The graph below displays the comparison with Q1 2016.

eLearning Participants

*Note: eLearning services did not exist between the sites; hence a comparison is not available.

Clinical residents at the Naryn Oblast Family Medicine Centre, receiving an eLearning session on pneumonia from the National Hospital of the Ministry of Health, Kyrgyz Republic.


 

Pakistan

156

Live
Teleconsultations

0

Store-and-Forward
Teleconsultations

9

eLearning
Sessions


 
0

eLearning
Participants

Teleconsultations


Live Teleconsultations

During Q1 2017, 156 live teleconsultations were conducted across all sites in Pakistan compared to 55 teleconsultations in Q1 2016. Fifty-seven teleconsultations were conducted between the Aga Khan Booni Medical Centre (AKBMC) and the Aga Khan University Hospital, Karachi (AKUH, K) and thirty-six teleconsultations were conducted between Aga Khan Medical Centre, Gilgit (AKMC, G) and AKUH, K. AKMC, G conducted twenty-six teleconsultations with Chatorkhand Health Centre; twenty teleconsultations with Garam Chasma Tehsil Head Quarter (GCTH) and seventeen teleconsultations with Aliabad Extended Family Health Centre. The notable increase in numbers is due to live teleconsultation services being extended to Chatorkhand Health Centre, GCTH and Aliabad Extended Family Health Centre from AKMC, G, which were not available in Q1 2016.

 
Store-and-Forward Teleconsultations

In Q1 2017, no store-and-forward teleconsultations were conducted in Gilgit-Baltistan and Chitral. In Q1 2016, twenty store-and-forward teleconsultations were conducted. Since live teleconsultation services have been made available at various sites in Gilgit-Baltistan, patients are not availing store-and-forward teleconsultations.

The graph below displays the comparison with Q1 2016.

Live Teleconsultations

*Note: Live teleconsultation services did not exist between the sites in Q1 2016, hence a comparison is not available.

A live teleconsultation in psychiatry being conducted from the Aga Khan University Hospital, Karachi to the Aga Khan Booni Medical Centre, Chitral.

eLEARNING


In Q1 2017, the Aga Khan University (AKU) delivered 9 eLearning sessions to AKMC, G; AKMC, B; and Singal Medical Centre (SMC), however, none of these sessions were attended by health care professionals. In Q1 2016, AKU delivered three eLearning sessions, attended by 8 health care professionals at these sites. Staff was not able to attend any eLearning sessions due to their unavailability.

AKDN eHRC Conducts Training Activities in Gilgit-Baltistan and Chitral

In February, AKDN eHRC conducted training in Gilgit-Baltistan, Pakistan on eHealth concepts, benefitting 23 health care professionals. It delivered training of trainers for master trainers, who further provided training to eHealth staff at their respective sites.

The training session, eHealth Training: Training of Trainers in eHealth Concepts, was delivered over a period of three days at AKMC, G in Gilgit-Baltistan in March 2017. The training was designed to build the eHealth capacities of professionals in the health sector and help them understand eHealth concepts and the marketing of teleconsultation services. Participants of the training further provided training to the eHealth staff working at Aliabad Comprehensive Health Centre, Singal Medical Centre and Soust Health Centre.

Participants included eHealth coordinators, field health officers, social mobilizers, lady health visitors and community health nurses among others.

The graph below depicts the comparison with Q1 2016.

eLearning Participants


 

Tajikistan

156

Live
Teleconsultations

156

Store-and-Forward
Teleconsultations

18

eLearning
Sessions


 
224

eLearning
Participants

Teleconsultations


Live Teleconsultations

Khorog Oblast General Hospital (KOGH) provides live teleconsultation services to three district hospitals – Darwaz District Hospital (DDH), Ishkashim District Hospital (IDH) and Roshan District Hospital (RDH). KOGH also receives teleconsultations from the National Medical Centre (NMC), Dushanbe and the French Medical Institute for Children (FMIC) in Afghanistan along with the Dushanbe Medical and Diagnostic Centre (DMDC).

In Q1 2017, 156 live teleconsultations were conducted across all sites in Tajikistan as compared to 166 teleconsultations in Q1 2016. One-hundred and twenty-six teleconsultations took place between KOGH and the three district hospitals, with RDH referring 47 cases, DDH referring 38 cases and IDH referring 41 cases, respectively. Thirty teleconsultations took place between NMC and KOGH. KOGH did not conduct any teleconsultations with FMIC or DMDC in Q1 2017.

 
Store-and-Forward Teleconsultations

NMC and the Aga Khan Health Board (AKHB), USA, provide teleradiology services to patients at KOGH. Likewise, KOGH offers teleradiology services to patients at the district hospitals in Darwaz, Ishkashim and Roshan. In Q1 2017, 156 store-and-forward cases were referred across all sites as compared to 189 cases in Q1 2016. Despite the expansion of teleradiology services to district hospitals, the number of store-and-forward cases decreased considerably. Because a radiologist has been hired at KOGH, only complicated cases are being sent to AKHB, USA and NMC for second opinions, resulting in the decline. Previously, all cases were being referred to KOGH.

The graphs below depicts the comparison from Q1 2016.

A live teleconsultation in neurology being conducted between the National Medical Centre and the Khorog Oblast General Hospital.

A live teleconsultation being conducted between National Medical Centre and the Khorog Oblast General Hospital

Live Teleconsultation

In Q1, 2017 no teleconsultations were conducted between KOGH-DMDC due to the high price, i.e., 75 Somoni, being charged for consultation.

Store-and-Forward Teleconsultations

Note: Teleradiology services between KOGH and RDH, DDH and IDH did not exist in Q1 2016, hence a comparison is not available for the sites.

eLEARNING


KOGH offers eLearning services to DDH, IDH and RDH and receives eLearning services from PGMI and the French Medical Institute for Children (FMIC) in Afghanistan.

In Q1 2017, 18 eLearning courses were offered benefitting 224 nurses and physicians in Tajikistan as compared to 173 participants trained through 17 eLearning sessions in Q1 2016. KOGH received 11 eLearning courses from PGMI, which benefitted 89 participants. KOGH offered 7 eLearning courses to the district hospitals, benefitting 85 participants. Of these 3 courses were offered to RDH, benefitting 45 participants; 2 courses to IDH, benefitting 21 participants and 2 courses to DDH, benefitting 19 participants. FMIC delivered courses to KOGH, benefitting 50 participants.

eLearning sessions resumed between KOGH-FMIC in Q1 2017 after a long pause from Q4 2015 due to the language barrier between the countries. The sessions were translated into the local language so that participants are better able to understand and retain information.

eLearning Participants

An eLearning session being conducted between the Khorog Oblast General Hospital and the French Medical Institute for Children in Afghanistan


 

Plans Ahead

Afghanistan


  • Equip cardiology and dental clinics at the French Medical Institute for Children with eHealth modalities in Q2 2017.

  • AKDN eHRC team to conduct trainings in Q3 2017.

Kyrgyz Republic


  • Develop marketing videos for donors and the target population.

  • AKDN eHRC team to Install and implement new eHealth equipment at the National Surgery Centre, Naryn Oblast Merged Hospital and At-Bashy Territorial Hospital for the expansion of services.

  • Initiation of telesurgery services.

  • Expand live teleconsultation services to At-Bashy Territorial Hospital.

  • Visit of team members of donor agencies, i.e., Global Affairs Canada and the Aga Khan Foundation, Canada.

Pakistan


  • Implementation of marketing plan for eHealth services.

  • Deployment of teleradiology, telepathology and diagnostic stations.

  • Reinstate telehealth services at Civil Hospital, Gupis.

Tajikistan


  • Link Khorog Oblast General Hospital with Moscow and initiate live and store-and-forward teleconsultations.

  • Initiate a charging mechanism to charge patients for live and store-and-forward teleconsultations.

Get in Touch

House G3-a, Block 17, Gulshan-e-Iqbal,
Karachi, Pakistan

ehrc@akdn.org

(+92 21) 99244230
ext. 8179