Executive Summary

As the Aga Khan Development Network eHealth Programme expands, progress is reflected in the increased uptake of services.

In Q2 2017, 1772 teleconsultations were conducted across all countries in South and Central Asia, as compared to 1496 teleconsultations in Q2 2016, resulting in an 18% increase in activities. The increase is mainly due to expansion of sites and services along with increased marketing activities in Pakistan. An increase in the uptake of services in Afghanistan was seen due to increase in demand. Reduced activity was experienced in Kyrgyz Republic and Tajikistan as compared with Q2 2016 due to various reasons, including electricity cuts in Naryn leading to rescheduling of teleconsultation sessions and the hiring of a radiologist at KOGH, leading to fewer cases being sent to NMC.

There was a 63% increase in the number of health care professionals trained through eLearning - from 492 in Q2 2016 to 803 in Q2 2017. The number of participants attending eLearning sessions increased notably in Pakistan as a result of marketing activities and expansion of services to include additional eLearning sites. Similarly in Kyrgyz Republic, the number of eLearning participants more than doubled as services expanded to include additional sites.

During Q2 2017, the AKDN eHRC team made monitoring and evaluation visits to eHealth sites in Gilgit-Baltistan and Chitral in Pakistan; Kyrgyz Republic; and Tajikistan and carried out various activities. Overall, an increase in the uptake of eHealth services was seen in Q2 2017 as compared with Q2 2016.

Afghanistan

947

Live
Teleconsultations

273

Store-and-Forward
Teleconsultations

24

eLearning
Sessions


 
223

eLearning
Participants

Teleconsultations


Live Teleconsultations

In Q2 2017, 947 live teleconsultations were conducted across all sites in Afghanistan compared with 624 teleconsultations in Q2 2016.

The French Medical Institute for Children (FMIC) conducted 315 teleconsultations with Bamyan Provincial Hospital (BPH) and 348 teleconsultations with Faizabad Provincial Hospital (FPH). FMIC also conducted 25 teleconsultations with Aga Khan University Hospital, Karachi (AKUH, K) in Pakistan and 56 teleconsultations with La Chaine de I’Espoir in France.

Bashore, Ishkashim and Nusai Comprehensive Health Centres (CHCs) conducted 87 teleconsultations with Faizabad Provincial Hospital (FPH) and 16 teleconsultations with Khorog Oblast General Hospital (KOGH) in Tajikistan.

FPH conducted 58 teleconsultations with Bharak District Hospital (BDH) and 42 teleconsultations with Kisham District Hospital (KDH).

 
Store-and-Forward Teleconsultations

During Q2 2017, 273 store-and-forward cases were referred across all sites in Afghanistan compared to 327 cases in Q2 2016.

FMIC offers teleradiology services to BPH and FPH and sends teleradiology cases to the AKUH, K for second opinions. Also, Bashore, Ishkashim and Nusai CHCs, BDH and KDH receive teleradiology services from FPH. In Q2 2017, 249 teleradiology cases were resolved compared to 285 cases in Q2 2016.

Telepathology cases are referred for second opinion from BPH and FPH to FMIC and from BDH and KDH to FPH. In Q2 2017, 20 telepathology cases were referred for second opinion as compared to 18 cases in Q2 2016.

Teleopthalmology services connect FMIC with AKUH, K.  Four teleopthalmology cases were referred from FMIC to AKUH, K for diagnosis as opposed to 24 cases in Q2 2016.

The graphs given below display the comparison of live and store-and-forward teleconsultations with Q2 2016.

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

Live Teleconsultations

Store-and-Forward Teleconsultations

eLEARNING


FMIC offers eLearning sessions on medical and nursing topics to BPH, FPH, Mirwais Regional Hospital (MRH) in Afghanistan and to the KOGH in Tajikistan. FPH also delivers eLearning sessions to Bashore, Ishkashim and Nusai CHCs, BDH and KDH.

In Q2 2017, 223 participants were trained through eLearning sessions, delivered by FMIC and FPH in Afghanistan, compared to 257 participants in Q2 2016.

FMIC delivered nine eLearning sessions which trained a total number of 109 medical and nursing staff at BPH and FPH. No sessions were offered to MRH due to internet connectivity problems at MRH. FPH delivered 15 sessions to the CHCs in Bashore, Ishkashim and Nusai and to BDH and KDH, training 114 health care professionals.

The graph given below displays the comparison of Q2 2016 and Q2 2017.

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.

 


 

Kyrgyz Republic

17

Live
Teleconsultations

15

eLearning
Sessions


 
196

eLearning
Participants

Teleconsultations


Live Teleconsultations

The National Centre of Maternity and Childhood Care (NCMCC) and the Republican Centre for Infectious Diseases in Bishkek provide live teleconsultation services to the Naryn Oblast Merged Hospital (NOMH). With the support of the Medical Education Reforms Project, the Geneva University Hospitals, Switzerland, continues to offer teleconsultation services to the NOMH.

In Q2 2017, telesurgery services were implemented connecting the National Surgery Centre, Bishkek with the Surgery Department at the NOMH for live teleconsultations and eLearning. Furthermore, At-Bashy Territorial Hospital was connected to NCMCC for live teleconsultation and eLearning services.

In Q2 2017, 19 teleconsultations were conducted as compared to 72 teleconsultations in Q2 2017. Of these, 2 teleconsultations were conducted by Geneva University Hospitals while 15 teleconsultations were conducted by NCMCC. No teleconsultations were conducted by the Republican Centre for Infectious Diseases.

Electricity and power cuts were repeatedly encountered in Naryn which resulted in the rescheduling of teleconsultation sessions. This led to the decrease in numbers as compared with Q2 2016.

The graph given below display the comparison of live teleconsultations with Q2 2016.


A telesurgery session being conducted from the National Surgery Centre, Bishkek for health care professionals at the Surgery Department of the Naryn Oblast Merged Hospital.

Live Teleconsultations

*Note: Teleconsultation services did not exist between the sites in Q2 2016.

eLEARNING


During Q2 2017, 15 eLearning sessions were provided to 196 health care across all sites in Kyrgyz Republic as compared to 7 sessions benefitting 92 participants in Q2 2016. NCMCC offered one session, training 63 participants;  Kyrgyz State Medical Academy (KSMA) offered 2 sessions, benefitting 3 participants; Kyrgyz State Medical Institute of Continuing Education (KSMICE) delivered 9 sessions, training 119 participants; and the Ministry of Health conducted 3 sessions, benefitting 11 participants.


The graph below displays the comparison with Q2 2016.

eLearning Participants

*Note: eLearning services did not exist between the sites;.

eLearning session being conducted between the Kyrgyz State Medical Institute of Continuous Education and the Naryn Oblast Family Medicine Centre on Meningococcal Infection in Children.


MONITORING AND EVALUATION VISIT


In 2016, during a monitoring and evaluation visit to Kyrgyz Republic, it was identified that there is a need for telesurgery and eLearning services between Bishkek and Naryn.  Fortunately, in order to establish these services, Kyrgyz Republic received funding under the Central Asian Health Systems Strengthening project in the context of additional activities. In May 2017, the AKDN eHRC team visited Kyrgyz Republic to implement a comprehensive, hybrid solution that would allow health care professionals in Bishkek and Naryn to conduct eLearning sessions in surgery directly from the operating room and allow health care professionals in Naryn to obtain second opinions from surgeons in Bishkek.

As a result of such services, physicians at the National Surgery Centre are now able to record and share surgical procedures with health care professionals in Naryn.

 

Pakistan

201

Live
Teleconsultations

0

Store-and-Forward
Teleconsultations

14

eLearning
Sessions


 
179

eLearning
Participants

Teleconsultations


Live Teleconsultations

During Q2 2017, 201 live teleconsultations were conducted across all sites in Pakistan compared with 93 teleconsultations in Q2 2016.

Eighty-two teleconsultations were conducted between Aga Khan Medical Centre, Booni (AKMC, B) and (AKUH, K) and 44 teleconsultations were conducted between Aga Khan Medical Centre, Gilgit (AKMC, G) and AKUH, K. AKMC, G conducted 30 teleconsultations with Aga Khan Family Health Centre, Chatorkhand (AKFHC, C); 35 teleconsultations with Garam Chasma Tehsil Hospital (GCTH); 2 teleconsultations with Comprehensive Health Centre, Aliabad (CHC, A) and 8 teleconsultations with Aga Khan Family Health Centre, Soust (AKFHC, S).

There is a substantial increase in live teleconsultations in Q2 2017 as compared to Q2 2016. This is due to the extension of live teleconsultation services from AKMC, G to GCTH, CHC, A and AKFHC, S which were not available in Q2 2016. Furthermore, AKDN eHRC team members visited Gilgit-Baltistan and Chitral during Q2 2017 to conduct awareness-raising activities and positively engage AKHS, P staff members in efforts to streamline eHealth activities and improve uptake of services. As a result, an increase in the uptake of services was seen during Q2 2017.

Store-and-Forward Teleconsultations

In the Q2 2017, no store-and-forward teleconsultations were conducted as compared to two cases in Q2 2016. As live teleconsultation services have been made available at various sites in Gilgit-Baltistan, patients are more willing to avail live teleconsultation services as compared to store-and-forward services.

The graph below displays the comparison with Q2 2016.

Live Teleconsultations

*Note: Live teleconsultation services did not exist between the sites in Q2 2016.

Dr Hena Khan, Aga Khan Medical Centre, Gilgit, conducting a live teleconsultation in Family Medicine with a patient at the Aga Khan Family Health Centre, Soust.

eLEARNING


The Aga Khan University (AKU) delivers eLearning services to physicians and nurses at AKMC, G; AKMC, B; CHC, A; and Singal Medical Centre (SMC). During Q2 2017, eLearning services were extended to AKFHC, S; AKFHC, C; and GCTH. Furthermore, to build capacity of local nurses, eLearning sessions were initiated for nurses as well. As a result, a remarkable increase was seen in the level of participation of health care professionals in Q2 2017. Furthermore, during the monitoring and evaluation visit made by AKDN eHRC team members, efforts to motivate health care professionals to attend eLearning sessions were also made. This contributed to higher numbers as well.

Twelve Grand Rounds and CME eLearning sessions were offered by AKU and attended by 83 health care professionals as compared to 6 eLearning sessions, attended by 7 health care professionals in Q2 2016. Furthermore, two eLearning sessions for nurses were delivered by AKMC, G which benefitted 96 nurses at AKMC, G; SMC; CHC, A; AKMC, B; AKFHC, S; and AKFHC, C. Participants at AKMC, G took part through face-to-face sessions while other sites took part through eLearning.

MONITORING AND EVALUATION VISIT

The AKDN eHRC team visited Gilgit-Baltistan and Chitral in May 2017 to assess eHealth operations. Five sites were visited, including AKMC, G and health centres in Aliabad, Chatorkhand, Singal and Soust. During the visit, eLearning sessions for nurses were initiated at AKMC, G; technical and administrative issues were identified and resolved to streamline eHealth activities; marketing activities were initiated in the community and meetings were held with health care professionals to motivate them to participate in eLearning sessions offered from AKU.  As a result, there was an increased uptake of eHealth services in Q2 2017.

The graph below depicts the comparison with Q2 2016.

eLearning Participants

*Note: eLearning services were not offered between the sites in Q2 2016.


 

Tajikistan

184

Live
Teleconsultations

148

Store-and-Forward
Teleconsultations

19

eLearning
Sessions
 

205

eLearning
Participants

Teleconsultations


Live Teleconsultations

KOGH receives teleconsultation services from National Medical Centre (NMC), Dushanbe; Dushanbe Medical and Diagnostic Centre (DMDC); and the French Medical Institute for Children (FMIC) in Afghanistan. It offers teleconsultation services to the three district hospitals, Darwaz District Hospital (DDH), IDH and RDH.

In April 2017, a business model was implemented in Tajikistan whereby patients are now paying for teleconsultation services. KOGH is charging patients Somonis 45 to avail teleconsultations from DMDC.

In Q2 2017, 184 live teleconsultations were conducted across all eHealth sites in Tajikistan compared to 169 teleconsultations in Q2 2016.
KOGH conducted 143 teleconsultations with the three district hospitals - 47 teleconsultations with DDH, 47 teleconsultations with IDH and 49 teleconsultations with RDH. KOGH conducted 36 teleconsultations with NMC and five teleconsultations with FMIC in Afghanistan. No live teleconsultations took place with DMDC in Q2 2017.

Store-and-Forward Teleconsultations

KOGH receives teleradiology services from the Aga Khan Health Board (AKHB), USA and NMC. Similarly, KOGH offers teleradiology services to patients at DDH, IDH and RDH. During Q2, NMC started charging patients Somonis 20 for teleradiology services.
In Q2 2017, 148 store-and-forward cases were referred across all sites in Tajikistan. The number of store-and-forward cases reduced significantly as compared to 209 cases in Q2 2016.  A radiologist was hired at KOGH for second opinions on complicated cases during Q1 2017; as a result, fewer cases are being referred to NMC.

KOGH initiated store-and-forward services to the three districts hospitals, DDH, IDH and RDH in Q1 2017. The graph below displays the comparison of store-and-forward teleconsultations between Q2 2016 and Q2 2017.

The graphs below depicts the comparison from Q2 2016.

Dr Gulayozova Sabdavlat, Ophthalmologist, Khorog Oblast General Hospital conducts a live teleconsultation with a patient at the Nusai Comprehensive Health Centre in Afghanistan.

 

Live Teleconsultations

Store-and-Forward Teleconsultations

*Note: Teleradiology services between KOGH and RDH, DDH and IDH did not exist in Q2 2016, hence a comparison is not available for the sites.

eLEARNING


KOGH provides eLearning services to DDH, IDH and RDH. Likewise, KOGH receives eLearning services from the Post-Graduate Medical Institute and FMIC in Afghanistan. In Q2 2017, 19 eLearning courses were offered to 205 participants, comprising of 97 nurses and 108 physicians, across all sites in Tajikistan as compared to 136 participants in Q2 2016.

KOGH offered 13 eLearning courses, building capacity of 145 participants at the district hospitals; four courses were offered to RDH, benefitting 48 participants; five courses to IDH, benefitting 71 participants and four courses to DDH, benefitting 26 participants. PGMI offered six eLearning sessions to KOGH, benefitting 60 participants. No eLearning sessions were conducted with FMIC in Afghanistan.

The graph below displays the comparison with Q2 2016.

eLearning Participants

*Note: AKU offered eLearning courses to KOGH temporarily in Q2 2016 for the CAHSS eLearning project.

Khorog Oblast General Hospital conducts an eLearning session on the topic of Enema for health care professionals at Ishkashim District Hospital.


 

MONITORING AND EVALUATION VISIT

The AKDN eHRC team made a monitoring and evaluation visit to Tajikistan in May 2017. The purpose of the visit was to improve delivery of eHealth services; conduct marketing activities; and monitor progress of the eHealth Programme. eHealth rooms and the waiting areas were upgraded at the district hospitals.

Plans Ahead

Afghanistan


  • AKDN eHRC team to conduct trainings in Q3 2017.

Kyrgyz Republic


  • Develop marketing videos for donors and the target population.

  • Connect National Cardiology Centre, Bishkek with Naryn Oblast Merged Hospital.

Pakistan


  • Implementation of marketing plan for eHealth services.

  • Deployment of teleradiology, telepathology and diagnostic stations.

Tajikistan


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

Get in Touch

Block 17, Gulshan-e-Iqbal,
Karachi, Pakistan

ehrc@akdn.org

(+92 21) 99244230
ext. 8179