Aga Khan Development Network
eHealth Programme
In April 2015, live teleconsultations in ENT initiated between the French Medical Institute for Children (FMIC) in Kabul, Afghanistan and the Aga Khan University Hospital, Karachi (AKUH, K) in Pakistan, making this the first live teleconsultation service between the two sites. Through this service, patients at FMIC will now be able to consult with and receive diagnosis and treatment from an ENT specialist at AKUH, K.
Q2 AT A GLANCE
TANZANIA
Joining Hands Initiative eHealth Programme Concludes
eHealth activities under the Joining Hands Initiative (JHI) concluded in March 2015. The JHI eHealth programme initiated in 2013 in Tanzania with teleconsultation services being offered in the Dodoma and Mwanza regions from the Aga Khan Hospital, Dar es Salaam (AKH, Dar). The programme expanded over time to include additional district and regional hospitals and health centres. Services were provided in the areas of Family Medicine, Internal Medicine, Obstetrics and Gynecology and Pediatrics.
The same year, eLearning services were introduced as well for health care professionals with professional development courses offered to doctors, nurses and other health care personnel.
As of March 2015, 134 teleconsultations were conducted. Of these, 107 teleconsultations (49 live teleconsultations and 58 store-and-forward cases) took place between the primary medical centres in Dodoma and Mwanza and AKH, Dar. In addition, government facilities referred 27 cases to AKH, Dar using store-and-forward technology.
For the last six months before the programme concluded, remuneration models for health care providers and uptake of eHealth technologies for teleconsultations remained a challenge. The availability of AKH, Dar specialists, working on a voluntary basis, was also often limited. In addition, the implementation of eHealth technologies decreased significantly resulting in no teleconsultations being conducted in the last six months.
Since eLearning sessions were introduced, 10 training sessions were conducted between AKH, Dar and the PMCs in Dodoma and Mwanza benefitting 200 health care providers.
eLearning services were positively received by participants at AKH, Dar and the PMCs in Dodoma and Mwanza. Distance and high speed internet connectivity posed as major challenges for health care workers at district hospitals and health centres.
eHEALTH EXPANSION PLAN
Funding for the eHealth Expansion Plan in Africa is being sought and discussions with potential funding agencies are on-going. The initiation date of the plan will be determined accordingly.
The Expansion Plan will transform health care delivery by implementing systems and eHealth services that will provide enhanced health care service availability and access as well as health education, knowledge and research to communities residing in remote areas in the region.
AFGHANISTAN
TELECONSULTATIONS
Live Teleconsultations
In Q2 2015, 820 live teleconsultations took place in Afghanistan. Bamyan Provincial Hospital (BPH) conducted 412 teleconsultations and Faizabad Provincial Hospital (FPH) conducted 297 teleconsultations with the French Medical Institute for Children (FMIC), respectively. Bashore, Ishkashim and Nusai Comprehensive Health Centres conducted 74 teleconsultations with FPH and 30 teleconsultations with Khorog Oblast General Hospital (KOGH) in Tajikistan. A breakdown of these teleconsultations is listed in the table below.
A new development was the initiation of live teleconsultations in ENT and Neurology between FMIC and the Aga Khan University Hospital, Karachi. TeleENT services initiated in April with two teleconsultations conducted during the quarter. Teleneurology services initiated between the two sites in May with five teleconsultations conducted in the quarter.
In Q2, all eHealth sites experienced an increase in teleconsultations conducted compared to Q1. Teleconsultations between BPH and FMIC increased from 266 in Q1 to 412 in Q2. Similarly, teleconsultation sessions between FPH and FMIC increased from 288 to 297. Teleconsultations from three CHCs to FPH increased from 39 to 74 and from three CHCs to KOGH also increased from 15 to 30 between Q1 to Q2 2015.
Store-and-Forward Teleconsultations
Teleradiology services connect BPH and FPH with FMIC and FMIC with the AKUH, K. Telepathology cases are referred from BPH and FPH to FMIC. In Q2, 285 cases were reported and diagnosed as opposed to 241 in Q1 2015.
eLEARNING
eLearning sessions are received by BPH and FPH and Mirwais Regional Hospital (MRH), a government-owned hospital from FMIC on various topics including medical, allied health and nursing. In Q2 of 2015, FMIC offered 12 sessions to 134 medical, allied health and nursing staff at BPH, FPH and MRH. In May, FMIC telecast its first live open heart cardiac surgery to the Bamyan and Faizabad Provincial Hospitals.
KYRGYZ REPUBLIC
In March 2015, discussions between the Aga Khan Development Network eHealth Resource Centre (AKDN eHRC), Aga Khan Foundation (AKF) and the Ministry of Health in Bishkek and Naryn took place to establish an eHealth link between government facilities in the two cities.
Since then, an agreement with the Kyrgyz Republic government has been formalised and sites in Bishkek and Naryn have been assessed. In addition, funding has been approved from the Department of Foreign Affairs, Trade and Development, Canada and the Aga Khan Foundation, Canada.
Currently, the scope of the plan is being finalised and AKDN eHRC is procuring eHealth equipment. Plans are to establish eHealth connectivity between the Republican Children’s Clinical Hospital in Bishkek and the Naryn Oblast Hospital and the Naryn Oblast Family Medicine Centre in Naryn, respectively. eHealth services will focus on teleconsultations in Paediatrics and eLearning in Family Medicine. eHealth services are slated to initiate in the third quarter.
The eHealth link would enable the Bishkeke-based centre to provide second opinions on cases, i.e., teleconsultations, referred by clinicians in Naryn and to broadcast from Bishkek short courses and seminars on child health topics to residents and clinicians based at the two facilities in Naryn.
PAKISTAN
TELECONSULTATIONS
Live Teleconsultations
Live teleconsultations in Psychiatry continued as usual between Aga Khan Booni Medical Centre (AKBMC) and the Aga Khan University Hospital, Karachi (AKUH, K) and between Gilgit Medical Centre (GMC) and AKUH, K.
In Q2, 54 teleconsultations took place in Psychiatry out of which 14 teleconsultations were conducted between AKBMC and AKUH, K and 40 teleconsultations were conducted between GMC and AKUH, K. In Q1, 64 teleconsultations took place at the two sites.
Telepsychiatry services were initiated in Gilgit-Baltistan in 2014 given the lack of availability of quality services in Psychiatry in the area. Later that year, services were expanded to AKBMC as well.
eLEARNING SERVICES
In April, AKUH, K started offering weekly Continuing Medical Education sessions to health care professionals at GMC. The sessions are aimed at strengthening the capacity of the health care professionals and enable them to effectively provide health care services. Since April, 11 sessions have been offered to 94 participants at GMC.
Doctors Receive eHealth Training
In April, AKDN eHRC provided eHealth training to doctors from GMC and AKBMC. The training equipped them with the knowledge required to conduct eHealth services at AKBMC and GMC in Gilgit-Baltistan. The training was offered to two doctors, one from each health care facility.
AKDN eHRC Presents at the GCC Healthcare Innovation Congress in Dubai
AKDN eHRC was selected to present at the GCC Healthcare Innovation Congress in Dubai, UAE in May. Afroz Sajwani from AKDN eHRC presented a paper on the AKDN eHealth Programme in Asia and discussed the activities, framework, outcomes, challenges and success stories of the Programme in the target communities.
Participants at the congress found the presentation interesting and unique as it focused on teleconsultations and eLearning services – key eHealth aspects that were not discussed in any other presentation at the congress. They were very appreciative of the setting in which AKDN works, i.e. the low-resource, isolated areas of Central and South Asia that face great social and political instability and commended the AKDN agencies for working in such high-risk settings. They praised the Programme for utilising simple innovations and technologies to improve people’s life by increasing access to quality health care services and reducing the cost of seeking health care.
The congress provided AKDN eHRC an international platform to promote the AKDN eHealth Programme as well as to learn from the experiences of international implementers and experts in the field of eHealth.
Speakers from various countries including India, KSA, Lebanon, Pakistan, Qatar, Switzerland, UAE and UK presented different health care innovation solutions implemented in their respective countries. The presentations focused on thematic areas such as: exploring the future of health care innovation in the Gulf region; implementing innovations to advance patient care; ensuring patient safety through innovation and technology; facilitating health care management through ICT; among others.
TAJIKISTAN
TELECONSULTATIONS
Live Teleconsultations
In Q2 2015, 119 teleconsultations took place across all eHealth sites. 86 teleconsultations took place between the three district hospitals – Darwaz, Ishkashim and Roshan – and Khorog Oblast General Hospital (KOGH) with Roshan referring 34 cases, Darwaz referring 22 cases and Ishkashim referring 30 cases, respectively. Teleconsultations between KOGH and the three district hospitals increased from 45 in Q1, 2015 to 86 in Q2 2015.
32 teleconsultations took place between KOGH and National Medical Centre (NMC) and one teleconsultation took place between KOGH and the French Medical Institute for Children (FMIC) in Afghanistan.
Store-and-Forward Teleconsultations
In Q2 2015, 217 store-and-forward consultations were conducted with 194 cases referred from KOGH to NMC and 23 cases referred from KOGH to the Aga Khan Health Board, USA. In Q1 2015, 138 store-and-forward teleconsultations took place.
eLEARNING
In Q2, 10 eLearning courses were offered to 148 participants. Four eLearning courses were offered from FMIC to KOGH benefitting 67 nurses. KOGH offered four courses to RDH, benefitting 61 nurses and two courses to DHH, benefitting 20 nurses. In Q1, six courses were offered to 82 participants across all sites.
Since 2012, eLearning courses have been offered from FMIC to KOGH. Over time, this has built the capacity of health care providers at KOGH to offer courses to the district hospitals. A reason of the uptake in courses delivered from KOGH to the district hospitals is that the courses are offered in the local language and not in English, making it easy for the local health care staff to better understand the topics, and learn and retain the course content. Therefore, moving forward, the Post Graduate Medical Institute in Dushanbe has agreed to offer eLearning sessions for KOGH doctors on a bi-monthly basis.
PLANS AHEAD
AFRICA
- The eHealth Expansion Plan 2015-2019 will be implemented in the region once funding has been procured. eHealth services under the plan will provide enhanced health care service availability and health care access as well as health education, knowledge and research to communities residing in remote areas in the region.
ASIA
AFGHANISTAN
- Initiate live and store-and-forward teleconsultations and eLearning sessions between Bharak District Hospital and FPH and between Kisham District Hospital and FPH.
- Initiate eLearning sessions between Bashore, Nusai and Ishkashim CHCs and FPH.
KYRGYZ REPUBLIC
- Procure and install eHealth equipment.
- Recruit and train two eHealth coordinators in Bishkek and Naryn.
- Launch teleconsultations and eLearning sessions.
PAKISTAN
- Shift eHealth services from GMC to GMC’s new Al-Azhar campus.
- Initiate live teleconsultations in dermatology between AKBMC and AKUH, K and between GMC and AKUH, K.
- Initiate live teleconsultations between Garam Chashma Tehsil Hospital and AKBMC.
- Initiate teleconsultations between Civil Hospital, Gupis and GMC.
- Shift teleconsultation services from Thoi and Immit to Yasin and Chatorkhand Health Centres.
- Procure eHealth equipment for Garam Chashma, Singal and Aliabad.
- Install eHealth equipment at sites in Aliabad, Chatorkhand, Garam Chashma, Gilgit, Gulmit, Singal, Soust and Yasin.
TAJIKISTAN
- Initiate teleradiology services between KOGH and FMIC. Through this service, KOGH will be able to share CT scans, MRIs and mammography images with FMIC for reporting and diagnosis.
- Upgrade connectivity and infrastructure at Darwaz, Ishkashim, Khorog and Roshan.
- Connect KOGH with AKUH, K for follow-up consultations.
- Develop business model for teleconsultations to ensure sustainability for activities.
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 (ICT) 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.