Healers Abroad Americans Responding to the Human Resource Crisis in HIV/AIDS (2005) / Chapter Skim
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Appendix E E-Health and the HIV/AIDS Epidemic: Using Technology to Support U.S. Workforce Expansion and Local Capacity Building in PEPFAR Nations
Appendix E E-Health and the HIV/AIDS Epidemic: Using Technology to Support U.S. Workforce Expansion and Local Capacity Building in PEPFAR Nations
Pages 195-213
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As the World Health Organization (WHO) reported at a 2002 joint meeting with the World Bank in Addis Ababa: There is an emerging crisis of health manpower in Africa.
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The most cost-effective and successful interventions are likely to be those that creatively leverage existing infrastructure and skills, such as low bandwidth e-mail, or those that introduce new technologies that are relatively inexpensive and easily adoptable, such as handheld computers and cellular telephones. A variety of e-health projects that follow these guidelines are already in existence and should be evaluated and considered as possible resource partners for a United States volunteer program before new projects are initiated.
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These approaches are compatible with the PEPFAR's strategy for "rapidly training and mobilizing health care personnel to provide treatment services."4 To facilitate this effort, the PEPFAR explicitly states that "telemedicine and distance education can be used to build the skills of health professionals in the focus countries and strengthen local, national, and international connections among medical institutions."5 WHAT IS E-HEALTH? A variety of technologies -- and terms to describe their use -- have been developed to facilitate the delivery of health care over long distances 4PEPFAR, pp.
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for health" can overlap with both of these concepts, but is also used to describe the use of technology to realize time and cost efficiencies and quality improvement in day-to-day practice, such as the use of handheld computers for routine data collection. The World Health Organization has adopted the use of the term "ehealth" to encompass the whole range of technologies and applications that have variously been identified as telemedicine, telehealth, and ICT for health, and advocates their use to improve health care delivery in a variety of circumstances.6 Throughout this paper, the term "e-health" will refer broadly to the exchange of actionable information over distance to facilitate both health service delivery and capacity building within the health sector.
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What e-Health can offer, Bulletin of the World Health Organization.82(10)
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200 HEALERS ABROAD projects and contains useful references about a wide range of related issues.12 THE TECHNOLOGY BEHIND E-HEALTH Pipeline Technologies An assessment of the potential to utilize e-health in any environment must first take into consideration the "pipeline" technologies that might be used. These are the networking mechanisms that convey information and data from one point to another.
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As the conceptualization of e-health projects to support United States medical volunteers under PEPFAR evolves and the number of variables is reduced, the range of appropriate software will become increasingly evident.
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Lack of leadership or vision 4. Other political, systemic, or institutional barriers, such as staff resistance to technology Limitations of the Existing Workforce The use of e-health to extend the United States workforce presence will require the cooperation of and coordination with the existing local workforce, which, as has been discussed, is already overburdened by enormous
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, the local GSM cellular telephone network, and self-contained relay stations or "Jacks," to provide a two-way flow of data and information between health facilities in Mbale and Rakai Districts and the Ministry of Health in Kampala. Now moving into its second year of operation, UHIN is independently owned and man Focus on South Africa: Africa Centre for Health and Populations Studies An "HIV Confidant" carries confidential HIV test results to remote locations on handheld computers (PDAs)
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A costeffectiveness study has shown that UHIN results in a 25 percent cost savings in this routine data collection, a figure that the project partners expect to increase as additional data collection forms are converted to the PDA. The network has resulted in significant local capacity building, both at UCH, which has acquired the technical and administrative skills to manage the network, and at the networked facilities in Mbale and Rakai, which are not only improving their data collection capacity but also receiving valuable content through the network.13 E-HEALTH AND HIV/AIDS Understanding the Environment, Identifying Real Demands The design of e-health programs to expand the United States workforce and build local capacity in PEPFAR countries must complement the existing in-country networks of HIV/AIDS care providers.
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APPENDIX E 205 tries requires record keeping at both the patient and facility level, yet the practice and quality of record keeping varies widely between and within countries. Medical records are not standardized within or across PEPFAR countries.
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206 HEALERS ABROAD Focus on Rwanda: Central Hospital, Kigali- Institute of Tropical Medicine, Antwerp An on-site training course on the use of ARV is conducted at the Central Hospital by ITM staff, then followed up by remote e-mail support, continuing training, and access to a community of practice that reinforces the theoretical course. SOURCE: http://telemedicine.itg.be/telemedicine/site/Default.asp?
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For example, a community health volunteer can use a PDA to keep track of ARV regimens to support compliance during household visits.
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E-HEALTH, HIV/AIDS, AND VOLUNTEERS E-health can factor into the design of a program for United States medical volunteers working in or with PEPFAR countries in a variety of ways. The extent and nature of an e-health component in the volunteer program will depend on how the program itself is ultimately designed, but several models should be considered: 16Systematic review of cost effectiveness studies of telemedicine interventions.
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Roy Colven of the University of Washington, working in partnership with the MRC Telemedicine Research Council, has established a teledermatology project at the University of Cape Town in South Africa. The network will serve regions of southern Africa that have limited access to health care providers.
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This relationship can continue after the volunteer returns home through "e-twinning," the use of e-health tools to provide: · Sustained communication and consultations · Access to reference and resource materials not available in the PEPFAR country · Regular updates of relevant medical and clinical information · A peer network (e.g., e-mail discussion groups) that enables the volunteer and the PEPFAR country program to call upon the resources of a community of practice Building on Existing Programs As an e-health component of the United States volunteer program is developed, it will be important to assess and, where possible, leverage existing programs.
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SOURCE: http://www2.telemed.no/publikasjoner/nedlastbare/telecomm_dev_bureau%20.doc. develop a national telehealth strategy as a means of extending health services throughout the country.23 · In Tanzania, the Muhimbili University Health Exchange Forum has been established "to facilitate communication and the flow of health information between healthworkers in the districts and regions of Tanzania and health experts and postgraduate students of Muhimbili."24 · In Uganda, the Academic Alliance for AIDS Care and Prevention in Africa has identified telemedicine as one of the tools it will use to support the training efforts at the Infectious Disease Institute in Kampala.25 · South Africa has a national telehealth strategy that includes hospitals and universities, with the goal "to make telemedicine live up to its potential as a valuable tool to improve access to high quality and cost effective health care services in South Africa."26 Existing federally-funded programs such as the Global HIV/AIDS Program, Office for the Advancement of Telehealth, at the U.S.
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212 HEALERS ABROAD KEY CONSIDERATIONS Over the course of its 16 years in implementing e-health projects throughout Africa, Asia, and Latin America, SATELLIFE has learned that a variety of considerations beyond content and technology must factor into the design of a successful program. These lessons include the following.
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Within the context of a United States medical volunteer program, ehealth has the potential to provide support to volunteers, to extend the reach of volunteers into remote areas, and to serve as a conduit for capacity building and support between volunteers and local counterparts. Sufficient functional models exist to merit a more comprehensive inventory of ehealth activities in each PEPFAR country to determine whether the placement of volunteers may be able to leverage existing initiatives, although such a determination should be made within the perspective of other urgent critical needs.
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