AKDN eHRC visited various sites in Gilgit-Baltistan as part of on-going efforts to monitor and strengthen eHealth services in Pakistan. Included in these efforts were capacity building trainings offered to health care professionals to further improve their eHealth service delivery. New eHealth equipment was procured and installed and current infrastructure was improved as sites were upgraded. Existing eHealth services were monitored and priority health issues were identified.
AKDN has plans to expand eHealth services in East Africa. The expansion plan will impact health care delivery in the region by offering 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.
The AKDN eHealth expansion plan in East Africa will initiate once funding has been secured.
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During Q3 2015, 732 live teleconsultations were conducted across all sites in Afghanistan as opposed to 820 in Q2. French Medical Institute for Children (FMIC) conducted 365 teleconsultations with Bamyan Provincial Hospital (BPH) and 235 with Faizabad Provincial Hospital (FPH). Twenty-six teleconsultations took place between FMIC and the Aga Khan University Hospital, Karachi (AKUH, K) in Pakistan. Bashore, Ishkashim and Nusai Comprehensive Health Centres conducted 48 teleconsultations with FPH and 18 teleconsultations with Khorog Oblast General Hospital (KOGH) in Tajikistan.
In August, live teleconsultations initiated between Bharak District Hospital (BDH) and FPH. In Q3, 40 teleconsultations were conducted between the two sites. An eHealth link was established between the two sites in July.
A breakdown of these teleconsultations is listed in the table below:
In July, FMIC started conducting live teleconsultations in paediatric teleneurology with AKUH, K. Live teleconsultations initiated between the two sites in May with neurology consultations. Additionally, Kisham District Hospital was connected to FPH in September. Teleconsultations have yet to commence between the two sites.
Internet connectivity at Faizabad and Bamyan was also upgraded from 1 Mbps to 2 Mbps in Q3.
In Q3, 252 teleradiology and telepathology cases were referred. Teleradiology services are offered at BPH, FPH and FMIC. BPH and FPH take consultations from FMIC and FMIC takes consultations from AKUH, K. In Q3, 221 teleradiology cases were reported and diagnosed at the three sites.
Telepathology services are offered at BPH and FPH, with consultations taken from FMIC. In Q3, 31 cases were referred from the two sites to FMIC for consultation.
The overall decrease in teleconsultations was due to the reduced patient inflow during Ramadan and Eid holidays in Q3.
FMIC offers eLearning sessions on various medical, allied health and nursing topics to BPH, FPH and Mirwais Regional Hospital (MRH), a government-owned hospital.
In Q3 2015, FMIC offered 15 sessions to 139 medical, allied health and nursing staff at BPH, FPH and MRH. In Q2, FMIC offered 14 sessions to 141 health care professionals at BPH, FPH and MRH.
Plans to initiate eHealth services in Bishkek and Naryn are well underway.
In March 2015, discussions took place between AKDN eHRC, Aga Khan Foundation (AKF) and the Ministry of Health in Bishkek and Naryn to establish an eHealth link between government facilities in the two cities.
Since then, an agreement with the Kyrgyz Republic government has been finalised and funding has been approved from the Department of Foreign Affairs, Trade and Development, Canada and the Aga Khan Foundation, Canada.
Currently, Kyrgyz Republic telecom is installing high-speed internet connectivity in the Naryn sites. Once complete, AKDN eHRC will install eHealth equipment and train local staff to provide teleconsultations and eLearning services.
The Republican Children’s Clinical Hospital in Bishkek will be connected to 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.
The eHealth connection between these sites will enable the Bishkeke-based centre to provide second opinions on cases, i.e., teleconsultations, referred by clinicians in Naryn and to broadcast short courses and seminars on child health and family medicine topics from Bishkek to residents and clinicians based at the two facilities in Naryn.
In Q3, 25 live teleconsultations took place in Psychiatry. Nineteen of these teleconsultations were conducted between GMC and AKUH, K and six teleconsultations were conducted between AKBMC and AKUH, K. In Q2, 54 teleconsultations were conducted between the two sites. There has been approximately a 45% decrease in the uptake of teleconsultation services since the last quarter.
The decline is due to eHealth activities being shifted to a new health care facility. In July, eHealth activities started shifting from GMC to the new Al Azhar campus. While the shift was completed in August, the disruption in routine activities resulted in overall eHealth activities declining in Q3. The Al Azhar campus, located in Chilmissdass, Gilgit-Baltistan, is at a driving distance of 15 minutes from GMC.
Furthermore, in Booni, transportation and people’s access to the AKBMC was severely affected by a flood. This resulted in the decline of teleconsultations conducted at the facility.
Store-and-forward teleconsultations resumed in Q3 after being on a hiatus since the start of the year. Currently, store-and-forward teleconsultations are conducted between Soust Health Centre and Aliabad Extended Family Health Centre; Chatorkhand Health Centre and Singal Medical Centre; and Yasin Health Centre and Civil Hospital, Gupis.
Thirty-four store-and-forward cases were resolved in various specialties including Dermatology, ENT, Family Medicine, Internal Medicine, Obstetrics/Gynecology, Orthopedics, Pediatrics and Psychiatry.
The resumption in activities was a result of the following training, reinforcement, monitoring and implementation activities performed by AKDN eHRC in Gilgit-Baltistan:
The objectives of the visit were multi-fold: monitor the existing eHealth services and to identify priority health issues and gaps which can be addressed by connecting AKHS, P facilities; define the equipment, network, technology support and trainings required to implement and manage a well-functioning eHealth system in the identified health centres; and identify potential new resources in AKHS, P facilities to support teleconsultation activities.
Additionally, AKDN eHRC offered training to AKUH, K dermatologists on how to use VirtualDoc and Dermascope. The purpose of this training was to prepare them for the new teledermatology service that will soon initiate between GMC and AKUH, K.
AKUH, K offers Continuing Medical Education sessions to health care professionals at GMC. The aim is to strengthen the capacity of health care professionals and enable them to effectively provide health care services. In Q3, 11 sessions were offered, which were attended by 11 health care professionals. Although the number of sessions remained the same from last quarter, participant attendance decreased considerably. Attendance in Q3 was low because participants were not receiving credit for Continuing Medical Education hours from AKUH, K. This matter, however, has been resolved and starting in November, AKUH, K will begin giving credit hours for participant attendance. Hence, a rise in attendance is anticipated in Q4.
In Q3 2015, 105 teleconsultations took place across all eHealth sites in Tajikistan.
Seventy nine teleconsultations took place between KOGH and the three district hospitals, with 22 cases in Darwaz, 25 cases in Ishkashim and 32 cases in Roshan District Hospital. Teleconsultations between KOGH and the district hospitals decreased from 86 in Q2 2015 to 79 in Q3 2015.
Twenty-six teleconsultations took place between KOGH and NMC, a decrease from 32 in Q2 2015. No teleconsultations were conducted between KOGH and FMIC in Q3. Comparatively, only one teleconsultation took place between the two sites in Q2.
Teleconsultations conducted at all sites in Tajikistan decreased from Q2 to Q3. This was due to the absence of a focal eHealth coordinator at the three district hospitals. Most of the physicians were also away on vacation in Q3, resulting in a decline in teleconsultations conducted.
In Q3, 187 store-and-forward teleconsultations took place as opposed to 217 consultations in Q2 2015. KOGH referred 167 cases to NMC and 20 cases to the Aga Khan Health Board, USA (AKHB, USA).
In Q3, 11 eLearning courses were attended by 144 participants. Five eLearning courses were offered from FMIC to KOGH benefitting 79 nurses. KOGH offered five courses to RDH, benefitting 54 nurses. KOGH offered one course to DDH, benefiting 11 nurses. In Q2, 2015, 10 courses were offered, benefitting 148 participants.
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.
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