Executive Summary

During Q3 2017, a 20% decrease was experienced in teleconsultations whereas a 36% increase was seen in eLearning participants trained.

In Q3 2017, 1668 teleconsultations were conducted across all sites in South-Central Asia as compared to 2104 teleconsultations in Q3 2016. In Afghanistan, there was a considerable increase in the uptake of teleconsultation services, however, it was offset by a 67% decrease in the store-and-forward consultations since the French Medical Institute for Children is availing services from an in-house radiologist as opposed to sending cases for second opinions to the Aga Khan University Hospital, Karachi.

The number of eLearning participants increased by 36% from 561 in Q3 2016 to 764 in Q3 2017. The notable increase was mainly due to various marketing and monitoring activities conducted in Pakistan which led to improved attendance in sessions

Additionally, during Q3 2017, a capacity building workshop was conducted by AKDN eHRC on eHealth innovations for health care professionals and programme managers. Thirty participants from various AKDN and non-AKDN agencies in Afghanistan, Kyrgyz Republic, Pakistan and Tajikistan attended the workshop in Istanbul, Turkey.

Afghanistan

922

Live
Teleconsultations

336

Store-and-Forward
Teleconsultations

26

eLearning
Sessions


 
293

eLearning
Participants

Teleconsultations


Live Teleconsultations

In Q3 2017, 922 live teleconsultations were conducted across all eHealth sites in Afghanistan compared to 568 teleconsultations in Q3 2016.

The French Medical Institute for Children (FMIC) conducts live teleconsultations with Bamyan Provincial Hospital (BPH) and Faizabad Provincial Hospital (FPH). Bashore, Ishkashim and Nusai Comprehensive Health Centres (CHCs) avail live teleconsultation services from FPH and Khorog Oblast General Hospital (KOGH) in Tajikistan. Baharak and Kesham district hospitals are connected with FPH for live teleconsultations while FMIC is connected to the Aga Khan University Hospital, Karachi (AKUH, K) in Pakistan and La Chaîne de l'Espoir in France for live teleconsultations.

FMIC conducted 374 teleconsultations with BPH and 309 teleconsultations with FPH. Bashore, Ishkashim and Nusai CHCs conducted 61 live teleconsultations with FPH, while Ishkashim and Nusai CHCs conducted seven teleconsultations with KOGH. No teleconsultations were conducted between Bashore CHC and KOGH.

FPH conducted 62 and 28 teleconsultations with BDH and KDH, respectively. FMIC conducted 33 live teleconsultations with Aga Khan University Hospital, Karachi (AKUH, K) and 48 live teleconsultations with La Chaîne de l'Espoir in France.
 

Store-and-Forward Teleconsultations

Store-and-forward teleconsultations are offered in pathology, radiology and ophthalmology. FMIC avails teleradiology services from AKUH, K in Pakistan and offers teleradiology and telepathology services to BPH and FPH. Similarly, FPH offers teleradiology services to the CHCs at Bashore, Ishkashim and Nusai and telepathology services to BDH and KDH. Teleopthalmology services connect FMIC to AKUH, K for diagnosis and second opinion.

In Q3 2017, 336 store-and-forward cases were referred across all sites in Afghanistan compared to 1032 cases in Q3 2016. Three-hundred and twenty-one teleradiology cases were resolved in Q3 2017 as compared with 1006 cases in Q3 2016 while 14 telepathology cases were referred as compared with 18 cases in Q3 2016. All telepathology cases were resolved by FMIC. One teleopthalmology case was referred from FMIC to AKUH, K during the quarter. A dramatic decrease in store-and-forward teleconsultations was seen in Q3 2017 since Q2 2017 as FMIC hired a radiologist.

Dr Esmatullah Hamid, Neurologist, FMIC, conducts a live teleconsultation with the Aga Khan University Hospital, Karachi.

Live Teleconsultations

Store-and-Forward Teleconsultations

*Note: Radiology cases were not referred to the consultant radiologist, since FMIC hired a radiologist in Q2 2017

eLEARNING


FMIC provides eLearning sessions to BPH, FPH, Mirwais Regional Hospital (MRH) in Afghanistan and to KOGH in Tajikistan. Similarly, FPH also provides eLearning sessions to CHCS in Bashore, Ishkashim, Nusai and district hospitals in Baharak and Kesham.
In Q3 2017, 293 participants were trained through 26 eLearning sessions delivered by FMIC and FPH in Afghanistan, as compared to 344 participants in Q3 2016.

FMIC trained a total number of 205 health care professionals at BPH and FPH. Likewise, FPH trained 88 medical and nursing staff at BDH, KDH and Bashore, Ishkashim and Nusai CHCs. No eLearning sessions conducted by AKU during Q3 2017.
An increased number of courses that were offered in Q3 2016 when AKU delivered eLearning courses to BPH, FPH and MRH for the

eLearning research study conducted under Central Asia Health Systems Strengthening Project. As a result, the number of eLearning participants from Q3 2016 to Q3 2017 has reduced.

eLearning Participants

*Note: Planned eLearning courses were offered for the Learning research project implemented through the CAHSS Project.

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

16

Live
Teleconsultations

5

eLearning
Sessions


 
52

eLearning
Participants

Teleconsultations


Live Teleconsultations

National Centre of Maternity and Childhood Care (NCMCC), Bishkek and National Surgery Centre (NSC), Bishkek provide live teleconsultation services to Naryn Oblast Merged Hospital (NOMH). Republican Centre for Infectious Diseases and Geneva University Hospitals (HUG), Switzerland also offers teleconsultation services to patients at NOMH. Teleconsultation services provided by HUG are supported by the Medical Education Reform Project.

Additionally, NCMCC provides live teleconsultation to the At-Bashy Territorial Hospital. During Q3 2017, NSC, Republican Clinical Infectious Disease Hospital and HUG also initiated live teleconsultation services for At-Bashy Territorial Hospital.

In Q3 2017, 16 teleconsultations were conducted as compared to 46 live teleconsultations in Q3 2016. Thirteen teleconsultations were offered to NOMH by NCMCC and three by Republican Centre of Infectious Diseases. HUG did not conduct any teleconsultations with NOMH.
No consultations were conducted for At-Bashy Territorial Hospital.

The graph given below displays the comparison of teleconsultations with Q3 2016.

Live Teleconsultations

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

A paediatric teleconsultation session being conducted between the Naryn Oblast Merged Hospital and National Centre for Maternity and Childhood Care, Bishkek.


eLEARNING


NCMCC, Kyrgyz State Medical Academy (KSMA), Kyrgyz State Medical Institute of Continuing Education (KSMIEC) and the National Hospital of the Ministry of Health (NHMH) provides eLearning sessions to health care professionals at the Naryn Oblast Family Medicine Centre, Naryn Oblast Merged Hospital and At-Bashy Territorial Hospital.

During Q3 2017, three eLearning sessions were delivered to 52 participants as compared to four eLearning sessions delivered to 40 participants in Q3 2016. KSMICE offered five eLearning sessions to 52 health care professionals, of which 33 were at Naryn Oblast Merged Hospital and 19 at At-Bashy Territorial Hospital. No eLearning sessions were conducted by NCMCC in Q3 2017.

The graph below displays the comparison with Q3 2016.

Monitoring and Implementation Activites


During August, the AKDN eHRC team visited Kyrgyz Republic to conduct monitoring and implementation activities in Bishkek and Naryn. Activities included installation of Wondershare Filmora software to be used by surgeons to record voice-overs for surgery recordings and training of health care professionals. Training was offered to health care professionals on the use of the software was conducted. During the visit, the team also encouraged the use of teleconsultations and the importance of regular voice recordings of telesurgery sessions to increase awareness among health care professionals.

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

149

Live
Teleconsultations

0

Store-and-Forward
Teleconsultations

17

eLearning
Sessions


 
156

eLearning
Participants

Teleconsultations


Live Teleconsultations

Aga Khan University Hospital, Karachi (AKUH, K) and the Aga Khan Medical Centre, Gilgit (AKMC, G) provide live teleconsultation services to various eHealth sites across Pakistan.

In Q3 2017, 149 live teleconsultation services were conducted across all sites in Pakistan compared to 105 teleconsultations in Q3 2017. AKUH, K conducted 60 live teleconsultations with Aga Khan Medical Centre, Booni (AKMC, B) and 43 live teleconsultations with AKMC, G.
AKMC, G conducted 46 live teleconsultations with various sites across Gilgit-Baltistan and Chitral, including 12 teleconsultations with Aga Khan Family Health Centre, Chatorkhand (AKFHC, C); 20 teleconsultations with Garam Chasma Tehsil Hospital (GCTH); and 14 teleconsultations with Aga Khan Family Health Centre, Soust (AKFHC, S). No teleconsultations were conducted with Comprehensive Health Centre, Aliabad (CHC, A) and Singal Medical Centre (SMC).

The graph below displays the comparison with Q3 2016.

Store-and-Forward Teleconsultations

In Q3 2017, no store-and-forward teleconsultations services were conducted in Gilgit-Baltistan and Chitral. Since live teleconsultation services initiated, majority of the patients avail these services over store-and-forward services.

The graph below displays the comparison with Q3 2016.

Live Teleconsultations

*Note: Live teleconsultation services did not exist between the sites in Q3 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


The Aga Khan University (AKU) provides eLearning and CME (Continuing Medical Education) sessions to physicians and nurses at AKMC, G; AKMC, B; CHC, A; and SMC. To further enhance educational and learning capabilities of nurses, AKMC, G also provides eLearning and CME sessions for nurses at AKMC, G; AKMC, B; AKFHC, S; AKFHC, C; CHC, A; and SMC.

In Q3 2017, AKU and AKMC, G trained 156 health care professions and nurses through 17 eLearning sessions, including Grand Rounds and CME sessions, as compared with 9 participants trained through 10 eLearning sessions in Q3 2016.
The expansion of eLearning services to additional sites has increased the number of participants considerably as they benefit from professional development opportunities.

The graph below displays a comparison with Q3 2016.

eLearning Participants

Marketing, Monitoring, Evaluation and Training Activities


During Q3, the AKDN eHRC team visited Gilgit and Chitral to conduct marketing, monitoring and training activities.
In order to engage communities and raise awareness about the AKDN eHealth Programme in Pakistan, outreach activities were conducted, which include interviews of community members; site visits and obtaining feedback from health care providers working at the eHealth sites.

Furthermore, emphasis on conducting more CME and nursing eLearning sessions was made during the visit.
Another purpose of the visit was to provide training to the health care providers regarding the use of eHealth applications and to evaluate the impact of teleconsultation services in Aliabad, Booni, Chatorkhand, Gilgit and Soust. Refresher trainings were provided to eHealth coordinators at the Aga Khan Medical Centre, Gilgit (AKMC, G) on Periodic Preventive Maintenance (PPM) activities; the use of Virtual Doc software and the calibration of eHealth equipment. Seventeen volunteers were also selected for training to conduct the upcoming breast cancer screening camp.

An eHealth needs assessment survey was conducted at the Mastuj Health Centre to evaluate whether the eHealth services can be initiated at the centre.  


 

Tajikistan

137

Live
Teleconsultations

108

Store-and-Forward
Teleconsultations

23

eLearning
Sessions


 
263

eLearning
Participants

Teleconsultations


Live Teleconsultations

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

During Q3 2017, 137 live teleconsultations were conducted across all sites in Tajikistan compared to 163 teleconsultations in Q3 2016.

One-hundred and ten live teleconsultations were conducted between KOGH and the three district hospitals, with DDH referring 39 cases, IDH referring 35 cases and RDH referring 36 cases, respectively. NMC offered 23 live teleconsultations to KOGH whereas four teleconsultations were conducted between FMIC and KOGH. DMDC did not conduct any teleconsultations with KOGH in Q3 2017.

The reason for decline in teleconsultations is due to the district hospitals conducting fewer teleconsultations with KOGH.

The graph below depicts the comparison from Q3 2016.

Store-and-Forward Teleconsultations

KOGH offers teleradiology services to district hospitals in Darwaz, Ishkashim and Roshan. KOGH receives teleradiology services from NMC and the Aga Khan Health Board (AKHB), USA.

During Q3 2017, 108 store-and-forward cases were referred across all sites compared to 190 cases in Q3 2016. Twenty-eight cases were referred to KOGH for second opinion from the district hospitals, while KOGH referred 47 cases to NMC and 33 cases to AKHB, USA.  A radiologist was hired at KOGH for second opinions on complicated cases during Q3 2017. As a result, fewer cases are being referred to NMC.

Moreover, two telepathology cases were referred from KOGH to FMIC for second opinion, marking the initiation of telepathology services in Tajikistan. The graph below depicts the comparison with Q3 2016.

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

Live Teleconsultation

*Note: In Q3, 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 Q3 2016, hence a comparison is not available for the sites.

eLEARNING


Health care professionals at DDH, IDH and RDH receive eLearning services from KOGH, similarly KOGH receives eLearning services from Post Graduate Medical Institute (PGMI) and FMIC in Afghanistan. During Q3 2017, 23 eLearning courses were offered to 263 participants across various sites in Tajikistan, as compared to 203 participants trained through 22 eLearning courses in Q3 2016.

PGMI delivered twelve eLearning courses to KOGH, benefitting 128 participants. KOGH also offered 9 eLearning courses to 104 participants at RDH and 2 eLearning courses to 31 participants at IDH. No eLearning sessions were conducted between KOGH and DDH and between FMIC and KOGH.  No eLearning sessions were conducted between FMIC and KOGH.

There was an overall increase in eLearning participants due to an increase in the number of courses PGMI offered KOGH and expansion of eLearning services from PGMI to RDH. 

The graph below depicts the comparison from Q3 2016.

ENGLISH LANGUAGE tRAINING FOR HEALTH CARE PROFESSIONALS


In efforts to help build capacity of health care professionals, during August 2017, the AKDN eHRC team visited Tajikistan to conduct face-to-face English language classes. The classes were offered to enhance English communication skills of health care professionals, so they are better able to engage with patients and health care professionals. After the visit, these classes were converted into eLearning sessions and lasted through September 2017.

 

eLearning Participants

Note: *eLearning services did not exist between PGMI and RDH in Q3 2016, hence a comparison is not available.
** AKU offered eLearning courses to KOGH temporarily in Q3 2016 for the CAHSS eLearning project.

Post Graduate Medical Institute conducts an eLearning session for health care professionals at Khorog Oblast General Hospital.


 

Get in Touch

Aga Khan University Hospital,
Karachi, Pakistan

ehrc@akdn.org

(+92 21) 99244230