Aga Khan Development Network
eHealth Programme


AKDN eHRC and the Aga Khan Foundation, Kyrgyz Republic present the AKDN eHealth Programme at the ITU Regional Development Forum for Commonwealth Independent States (CIS) and Georgia. The presentation focused on eHealth initiatives specifically in Kyrgyz Republic and Tajikistan. The theme of the forum was ‘ICT for Sustainable Development.’

Executive Summary


As the AKDN eHealth Programme continues to expand with new sites, services and connections, an increase in the uptake of services has been observed. However, in some countries, reduced activity was experienced in Q4 2016 as compared to Q4 2015 due to various reasons, which led to a moderate increase in overall numbers.

In Q4 2016, 1998 teleconsultations were conducted across all countries in South and Central Asia, as compared to 1778 teleconsultations in Q4 2015. The increase is due to two reasons. From Q4 2015, services were expanded to two existing and one new site in Pakistan while three additional specialities were added. Furthermore, there was a heightened uptake of teleradiology services in Afghanistan due to additional cases being sent to a consultant for referrals. Store-and-forward cases referred in Tajikistan declined due to a technical issue, but this was compensated for through increased live teleconsultation numbers.

The number of eLearning participants increased from 399 in Q4 2015 to 421 in Q4 2016. The number of participants attending eLearning sessions increased considerably in Kyrgyz Republic, but decreased substantially in Tajikistan because most of the eHealth staff and trainers were on leave in Q4 2016. This shows a greater need in the better planning and utilisation of human resources. The number of eLearning participants continues to remain low in Pakistan due to the lack of motivation among health care providers to attend courses.

Q4 AT A GLANCE


AFGHANISTAN



TELECONSULTATIONS

Total Teleconsultations: 1552

Live Teleconsultations: 891

Store-and-Forward Teleconsultations: 661


Live Teleconsultations

In Q4 2016, 891 live teleconsultations were conducted across all sites in Afghanistan compared to 1038 teleconsultations in Q4 2015.

The French Medical Institute for Children (FMIC) conducted 288 teleconsultations with Bamyan Provincial Hospital (BPH) and 298 teleconsultations with Faizabad Provincial Hospital (FPH). FMIC also conducted 39 teleconsultations with the Aga Khan University Hospital, Karachi in Pakistan and 77 teleconsultations with La Chaîne de l'Espoir in France.

Bashore, Ishkashim and Nusai Comprehensive Health Centres (CHCs) conducted 84 teleconsultations with FPH and 20 teleconsultations with Khorog Oblast General Hospital in Tajikistan.

Forty-six teleconsultations were conducted between Bharak District Hospital (BDH) and FPH. Thirty-nine teleconsultations were conducted between Kisham District Hospital (KDH) and FPH.

In Q4 of 2016, monthly teleconsultation targets for teleconsultations conducted from FMIC to BPH and FPH were increased to the original targets after being reduced by 50% in the first three quarters of 2016 due to budgetary constraints.

The graph below exhibits the comparisons with Q4 2015:


Store-and-Forward Teleconsultations

In Q4 2016, 697 store-and-forward cases were referred across all sites in Afghanistan compared to 280 cases in Q4 2015.

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 Q4 2016, 661 teleradiology cases were resolved compared to 280 cases in Q4 2015.

Telepathology cases are referred from BPH and FPH to FMIC and from Bharak and Kisham District Hospitals to FPH. In Q4 2016, 12 telepathology cases were referred for second opinion. Eleven cases were resolved by FMIC while FPH resolved one case.

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

The graph below displays the comparison with Q4 2015.

*Note: eHealth services did not exist in Q4 2015.


eLEARNING

eLearning Sessions: 26

eLearning Participants: 246


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 Q4 2016, 246 participants were trained through eLearning sessions delivered by FMIC and FPH in Afghanistan and Aga Khan University in Pakistan compared to 201 participants in Q4 2015. Thirteen sessions were offered by FMIC to 164 medical and nursing staff at BPH, FPH and MRH. Furthermore, 13 sessions were delivered by FPH, benefitting 82 participants at the three CHCs, BDH and KDH.

In December, FMIC offered an online workshop on Radiation Protection which was attended by 20 participants from BPH.

The graph below displays the comparison with Q4 2015.

KYRGYZ REPUBLIC


TELECONSULTATIONS

Total Teleconsultations (Live): 28


Live Teleconsultations

The Republican Children’s Clinical Hospital in Bishkek provides live teleconsultations to the Naryn Oblast Hospital. With the support of the Medical Education Reforms Project, the Geneva University Hospitals, Switzerland, continues to offer teleconsultation services for patients at the Naryn Oblast Hospital.

In Q4 2016, 28 live teleconsultations were conducted compared to 39 teleconsultations in Q4 2015. Among these, 22 teleconsultations were conducted by the Republican Children’s Clinical Hospital and six were conducted by Geneva University Hospitals in adult cardiology and dermatology.

The graph below displays the comparison with Q4 2015.

*Note: Teleconsultation services were initiated in Q4 2015.


During Q4, two eHealth assistants at the Republican Children’s Clinical Hospital, Bishkek were replaced. The time it took in replacement led to a gap, which resulted in a significant decrease in the number of teleconsultations as compared to Q4 2015.

In addition to routine teleconsultation services, seven teleconferences were held, which connected the health authorities in Naryn with the Ministry of Health, Kyrgyz Republic. The eHealth connection was used to facilitate the process.

eLEARNING

eLearning Sessions: 10

eLearning Participants: 106


Ten eLearning sessions were conducted by the Kyrgyz State Medical Institute of Continuing Education (KSMICE) benefiting 106 health care professionals at the Naryn Oblast Family Medicine Centre as compared to 10 health care professionals trained in Q4 2015.

The graph below displays the comparison with Q4 2015.

*Note: eLearning services initiated November 2015, the second month of Q4 2015.


No eLearning sessions were conducted by the Republican Children’s Clinical Hospital or the Kyrgyz State Medical Academy due to the change in eHealth staff in Q4. New eLearning staff was hired which needed to be trained on delivering eLearning sessions. As a result, no sessions were offered in Q4.

OTHER eHEALTH ACTIVITIES

In October, AKDN eHRC visited Kyrgyz Republic to provide trainings and meet with officials to discuss progress, expansion and sustainability of eHealth activities in the country. A series of meetings were held with the Ministry of Health, Kyrgyz Republic (MoH, KR); leadership of hospitals in Naryn, Bishkek and At-Bashy; and the Swiss Medical Education Reforms Project team.

Furthermore, in November, AKDN eHRC and the Aga Khan Foundation, Kyrgyz Republic presented the AKDN eHealth Programme at the ITU Regional Development Forum Commonwealth Independent States (CIS) and Georgia. The presentation focused on eHealth initiatives specifically in Kyrgyz Republic and Tajikistan. The theme of the forum was ‘ICT for Sustainable Development.’ The Forum was held at the Kyrgyz State Technical University in Bishkek, Kyrgyz Republic.

In December, a Rapid eHealth Needs Assessment was conducted at the National Surgery Centre in Naryn for expansion of eHealth services to adult surgery services.

PAKISTAN


TELECONSULTATIONS

Total Teleconsultations: 161

Live Teleconsultations: 161

Store-and-Forward Teleconsultations: 0


Live Teleconsultations

During Q4 2016, 161 live teleconsultations were conducted in Pakistan compared to 65 teleconsultations in Q4 2015. Sixty-six teleconsultations were conducted between the Aga Khan Booni Medical Centre (AKBMC) and the Aga Khan University Hospital, Karachi (AKUH, K) and 50 teleconsultations were conducted between Aga Khan Medical Centre, Gilgit (AKMC, G) and AKUH, K. Twenty-seven teleconsultations were conducted between AKMC, G and Chatorkhand Health Centre while 17 teleconsultations were conducted between AKMC, G and Garam Chasma Tehsil Head Quarter (GCTH). Aliabad Extended Family Health Centre conducted one teleconsultation with AKMC, G.

The graph below depicts the comparison with Q4 2015.

*Note: : Live teleconsultation services did not exist between the sites in Q4 2015.


During Q4 2016, connectivity was upgraded from on-demand connectivity to 24-hour connectivity at Soust Health Centre, GCTH and AKBMC. A family medicine physician was hired as a focal person at AKMC, G to support teleconsultation services to spoke sites and an eHealth coordinator for Chitral was hired at AKBMC.

Store-and-Forward Teleconsultations

In Q4 2016, no store-and-forward teleconsultations were conducted in Gilgit-Baltistan. In Q4 2015, 57 store-and-forward teleconsultations were conducted. Due to live teleconsultation services now being offered at various sites in Gilgit-Baltistan, store-and-forward teleconsultation services are not being availed by patients.


eLEARNING

eLearning Sessions: 10

eLearning Participants: 4


In Q4 2016, the Aga Khan University (AKU) delivered 10 eLearning sessions, benefitting four health care professionals at AKMC, G. In Q4 2015, nine eLearning sessions were attended by 44 health care professionals. Reasons for low attendance include occasional connectivity problems at the spoke sites and unavailability of health care providers to attend courses at spoke sites.

The graph below depicts the comparison with Q4 2015.

TAJIKISTAN


TELECONSULTATIONS

Total Teleconsultations: 257

Live Teleconsultations: 171

Store-and-Forward Teleconsultations: 86


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 Post-Graduate Medical Institute in Dushanbe (PGMI), to which it was connected with in Q1 2016.

In Q4 2016, 171 live teleconsultations took place across all eHealth sites in Tajikistan as compared to 109 teleconsultations in Q4 2015. 139 teleconsultations took place between KOGH and the three district hospitals, with RDH referring 50 cases, DDH referring 44 cases and IDH referring 45 cases, respectively.

Thirty-two teleconsultations took place between NMC and KOGH. No teleconsultations were conducted between PGMI and KOGH and between the FMIC in Afghanistan and KOGH.

The graph below depicts the comparison with Q4 2015.

*Note: The KOGH-PGMI connection did not exist in Q4 2015.


Store-and-Forward Teleconsultations

KOGH is connected to NMC and the Aga Khan Health Board, USA for teleradiology services. Through this service, KOGH shares CT scans and mammography images with NMC and AKHB, USA for second opinion and diagnosis.

In Q4 2016, KOGH referred 86 teleradiology cases for second opinion as compared to 190 cases in Q4 2015. Forty-one cases were referred to NMC and 45 cases were referred to the AKHB, USA. The number of store-and-forward teleconsultations decreased considerably as compared to Q4 2015 because the CT scan machine was out of order for two months.

The graph below depicts the comparison with Q4 2015.

eLEARNING

eLearning Sessions: 7

eLearning Participants: 63


KOGH offers eLearning sessions to DDH, IDH and RDH and receives eLearning courses from PGMI. In Q4 2016, seven eLearning courses were offered, benefitting 63 physicians and nurses. Of these, one eLearning session was offered from PGMI to KOGH, benefitting eight physicians. Furthermore, KOGH offered two courses to 19 participants at DDH; two courses to 20 nurses and physicians at RDH; and two courses to 16 participants at IDH.

In Q4 2015, 144 health care professionals benefitted from 11 eLearning sessions. Because most of the trainers and eHealth staff were on annual leave in Q4 2016, there was a decrease in eLearning participants and sessions as compared to Q4 2015.

The graph below depicts the comparison with Q4 2015.

*Note: eLearning services did not exist between the sites in Q4 2015.

PLANS AHEAD


AFGHANISTAN


  • Equip the cardiology and dental clinics at French Medical Institute for Children with eHealth modalities.
  • Equip cardiology and dental clinic at French Medical Institute for Children with eHealth modalities.
  • Train eHealth coordinators on telemedicine and mHealth innovations.
  • Increase eLearning sessions from Faizabad Provincial Hospital to Kisham and Bharak District Hospitals and Bashore, Ishkashim and Nusai CHCs.

KYRGYZ REPUBLIC


  • Train eHealth coordinators on telemedicine and mHealth innovations.
  • Tender and procure eHealth equipment for the expansion of eHealth services.
  • Under the Central Asia Health Systems Strengthening project, Aga Khan Foundation, Kyrgyz Republic to initiate support of teleconsultation services at At-Bashy Territorial Hospital starting Q1 2017.
  • AKDN eHRC team to install new eHealth equipment at the National Surgery Centre, Naryn Oblast Merged Hospital and At-Bashy Territorial Hospital for the expansion of services.

PAKISTAN


  • Increase specialities focusing on non-communicable diseases (NCDs) in Gilgit-Baltistan.
  • Implement multipurpose scope at various sites for screening and diagnosis for NCD clinics.
  • Conduct training for eHealth coordinators on telemedicine and mHealth innovations.
  • Train Master Trainer in Chitral and Gilgit Baltistan on teleconsultation process.

TAJIKISTAN


  • Train eHealth coordinators on telemedicine and mHealth innovations.

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 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.

Stadium Road
P.O.Box 3500
Karachi, Pakistan

ehrc@akdn.org

(+92 21) 9924-4230