ESSENTIAL HEALTH TECHNOLOGIES
Item
- Title
- ESSENTIAL HEALTH TECHNOLOGIES
- extracted text
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RF_DIS_30_SUDHA
Arab republic of Egypt
Ministry of Health and Population
Nasser Institute for Research
and Treatment
Nasser Institute for Research
and Treatment
• A unique medical institution with an
exquisite group of physicians and medical
experts.
• A highly-skilled nursing team with the
highest level of training and experience.
• Providing quality controlled healthcare
through a system of policies and
procedures developed with partnered
American and European centers.
co
Spine Surgery Unit
Cardiothoracic Surgery Unit
An advanced center with high survival rates
by international standards, collaborating and
exchanging expertise with major cardiothoracic
centers all over the world.
The average of major cardiac operations (CABGs,
Valve Replacements, Congenital anomalies) done in
the unit per year is around 2000 cases / year with
a survival rate of 97%.
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A specialized unit in correcting
malformations of the spine, vertebral
fractures and tumors with high success
rates.
The unit has exchange programs with
several spine surgery centers in Europe
and the United States.
The work team in the unit has done an
average of 1100 major spine surgery / year.
about 130 of them are scoliosis and their
success rates exceeded 95%.
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• Regular visits by eminent universal figures
in different medical subspecialties
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o Radiology department equipped with MRI,
CT scanner. Gamma Camera for nuclear
studies in addition to traditional options
as Ultrasound. Doppler and
x- rays.
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o Advanced critical care unit equipped to
monitor postoperative cardiothoracic.
spine and advanced brain surgery cases.
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Bone Marrow Transplantation
and Hematology Unit
Established in 1997, has 20 rooms equipped with
laminar flow technique for bone marrow
transplantation patients.
Maxillofacial Surgery Unit
The unit has achieved high results in the
treatment of cases of facial and
mandibluar fractures and tumors.
The unit witnesses an average of around 120 BMT
cases / year with a survival rate of 90% for
autologous BMT and 65%for donor BMT.
Interventional Catheter Unit
The unit serves to:
• Diagnose and treat arterial malformations in the
brain, face and limbs.
• Inject chemotherapy locally.
• Dilate and install stents for renal artery, carotid
artery and limb arteries stenosis.
. Inject osteoporotic vertebrae with bone cement.
The unit serves to diagnose and treat
cases of cardiac arrhythmias and also to
install cardiac pacemakers.
O
Cancer Treatment Unit
Accommodation Services
It serves both diagnostic and treatment
purposes for all cancer cases through
chemotherapy, surgery and radiotherapy
(through the linear accelerator).
MRI, CT, Nuclear Imaging are also available
in the unit.
Provided in suites and both single and double
rooms overlooking Cairo Nile by expert team
supervised by specialized dietitians.
Gamma Knife Unit
A specialized unit to treat inoperable and
inapproachable brain tumors, supervised
by a Swedish expert in this medical
specialty.
Welcomes patients from all over the world since
the moment they arrive to Egypt and provides all
the facilities through its patient reception office in
Cairo airport.
Provides arrangements for ambulance,
accommodation of relatives, reservation and
confirmation of air tickets.
Hand and Upper Arm
Microscopic Surgery Unit
Free medical consultations and inquiries
are available through fax, email or Nasser
institute website
This unit is specialized in microscopic
surgery as artery grafts, nerve grafts, hand
and finger re-implanting and also, upper
arm and shoulder trauma
Kidney Transplant and
Dialysis Unit
The unit is specialized in the diagnosis
and treatment of renal diseases with an
accessory renal dialysis unit and renal
transplant unit as well.
Nasser Institute for
Research and Treatment
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For further information
Nasser institute for research and
treatment
1351 Kornish El Nil Agha Khan
Shubra, Cairo, Egypt
Phone: 202 4324913 - 202 2017300
Fax: 202 2039236
Website: www.nasserinstitute.com
Email.- info@nasserinstitute.com
O World Health Organization
ESSENTIAL
TECHNOLOGIES
HEALTH
Avenue Appia 20, CH-1211 Geneva 27, Switzerland, Tel: (41) 22 791-4385; Fax: (41) 22 791 4836; e-mail: eht@who.int
Contacts in the
V
Department of Essential Health Technologies
E
Essential Health Technologies (EHT)
Dr Steffen Groth
Director
Office M032
Tel: (41 22) 791-4387
e-mail: groths@ who.int
Blood Transfusion Safety (BTS)
Dr Neelam Dhingra
Acting Coordinator
Office M024
Tel: (41 22) 791-4660
e-mail: dhmgran© who.int
Devices and Clinical Technology (DCT)
Dr Yvan Hutin
Acting Coordinator, DCT and Project Leader, Injection Safety
Office M022
Tel: (41 22) 791-3431
e-mail: hutiny@who.int
Ms Kay Bond
Technical Officer
Essential Medical Devices
Office M020
Tel: (41 22) 791-2262
e-mail: bondk@ who.int
Diagnostic Imaging and Laboratory Technology (DIL)
Dr Harald Ostensen
Coordinator
Office M029
Tel: (41 22) 791-3649
e-mail: ostensenh© who.int
Dr Gaby Vercauteren
Scientist, Laboratory and Diagnostic Services
Office M036
Tel: (41 22) 791-4728
e-mail: vercautereng© who
Quality and Safety of Plasma Derivatives and
related substances (QSD)
Dr David Wood
Acting Coordinator
Office M024
Tel: (41 22) 791-4050
e-mail: woodd@ who.int
Dr Ana Padilla
Scientist
Office M028
Tel: (41 22) 791-3892
e-mail: p a d ilia a @ who.int
Surgery and Transplantation (SAT)
Dr Luc Noel
Project Leader, Organ and Tissue Transplantation
Office M309
Tel: (41 22) 791-3681
e-mail: noell@ who.int
Dr Meena Cherian
Medical Officer, Surgery and Clinical Procedures
Office M021
Tel: (41 22) 791-4011
e-mail: cherianm© who.int
Information and Communication Technology (ICT)
Ms Irma Velazquez
IT Officer
Office M023
Tel; (41 22) 791-4687
e-mail: velazquezi©who.int
External Relations and Resource Mobilization (ER/RMB)
Ms Karen Reid
External Relations and Resource Mobilization Officer
Office M033
Tel: (41 22) 791-3821
e-mail: reidk@who.int
World Health Organization
HEALTH TECHNOLOGIES
-
THE BACKBONE OF HEALTH SERVICES
Health technologies range from the tongue depressor to magnetic resonance
imaging equipment, from blood transfusion to emergency surgical procedures.
n the simplest of health care systems to the most advanced.
ich and poor countries alike, they form the backbone of health
Yet access to health technologies is at the same time one of the most dis
tinct differences between rich and poor countries - far more so than access
to technologies associated with basic medical education. Young medical doc
tors educated in Bangladesh may have been taught by the same or virtually
the same textbooks as their colleagues educated in Great Britain. After their
graduation, thanks to internet access, they probably read the same medical
journals and continue to read the same kind of medical literature. And the
most important factor for this is access to health technologies. But the pre
ventive measures, diagnostic procedures and therapeutic interventions they
are able to offer their patients are a long way from being of the same mag
nitude and variety.
Strong health systems invariably rely heavily on access to and use of health
technologies. Together, they form a dense mesh throughout the health serv
ices into which they are interwoven. A strong mesh of health technologies
is one of the most fundamental prerequisites for the sustainability and selfreliance of health systems.
Essential health
ologies actively
pported by EHT
Blood transfusion safety
Blood products and related biologicals
Diagnostic imaging
District hospital surgery
Laboratory services
Medical devices and equipment
Tt ausplantation services
Page 1
Department of Essential Health Technologies
World Health Organization
Health teC ■
" Meet basic needs for health services
• Have been proven to be cost-efficient
3
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M Are evidence-based
iealth technologies are evidence-based when they meet well lefined specifications and have been validated through controlled
•;>!'.-;?cal studies or rest on a widely accepted consensus by experts
Health technologies are not developed as an end in themselves and should
never be promoted as such. They evolve or are invented as solutions to per
ceived health problems and are initially evaluated and applied for that
purpose.
As experience in their use accumulates, health technologies may come to
be used, either directly or after slight modifications, to address many other
problems than those for which they were initially developed. The strategic
use of technologies with multiple applications has become one of the most
cost-efficient tools in the creation of strong health systems.
The use of each technology calls for carefully evaluated procedures and
the availability of well-trained personnel. Some technologies are inher
ently safe, but the vast majority are not and require systematically
established quality assurance and quality control measures if undesired
effects are to be avoided in their application.
Indeed, for many technologies, it is desirable to ensure that any adaptation
coordinate under national legislation and their application under supervision
by regulatory authorities.
The mesh of technologies that countries in transition can afford obviously
cannot be as dense as that of a developed country. But if the elements that
make up the mesh are carefully chosen, a country may still be able to offer
its citizens a safe and reliable health service to its citizens, even where
resources are limited. The basic operational frameworks that EHT has estab
lished define such a level for the above aspects of access, use, safety and
policy. This is the level of health service WHO recommends its Member States
to reach as an important milestone on
their road towards development.
Department of Essential
Health Technologies
World Health Organization
Geneva 27, Switzerland
Fax:+4122 791 4836
www.who.int/eht
E-mail: eht@who.int
Page 2
Over the last four years, perhaps the
greatest achievement of EHT has been to
provide norms, standards, guidelines and
training material that match a substan
tial number of the elements that are now
included in the Basic Operational Frame
works. These products form the basis for
inputs to capacity building projects that
WHO can offer in response to requests
by countries for help in meeting the
requirements defined by the Frame
works.
Department of Essential Health Technologies
3^ / s
World Health Organization
COUNTRY
FOCUS
The most prominent strategic change in the programme of the WHO Depart
ment of Essential Health Technologies (EHT) for 2004-2007 is the shift to a
dedicated country focus.
All technical cooperation activities of the programme will eventually be
needs-driven in that an increasing proportion of resources will be allocated
to the implementation of country-prepared project proposals that aim to
take countries to a safe and reliable level of health services in relation to
the health technologies that are actively supported by the programme.
To achieve this, EHT is introducing the following mechanism.
EHT is developing lists of basic requirements (basic operational frame
works) for each technology, covering policy, quality and safety, access and
use. These frameworks, if implemented comprehensively within a coun
try, will result in a safe and reliable level of service for the technology.
EHT will review the lists with Member States to identify any gaps in
their services.
Member States will be invited to submit project proposals to EHT,
requesting assistance in closing the gaps.
Subject to the availability of resources, EHT will give priority to proj
ects that are supported by the infrastructure of the country, have direct
end-user benefit and have government commitment and support.
EHT will continue to develop norms, standards, guidelines, training
material and other tools to support its capacity building efforts to meet
the requests in the country-prepared proposals.
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Department of Essential Health Technologies
World Health Organization
, Jy
•- !•' 11
A Member State (or institutions in Member States) wishing to sub
mit a project proposal should do so in collaboration with and
through its Ministry of Health.
A standard applications form is available on the EHT homepage at
www.who.int/eht.
The Ministry of Health should indicate on the form how the proposal
will address identified gaps in the basic operational framework and
specify the government's commitment.
Applications should be forwarded, through the WHO Country Office
(or national liaison officer), to the WHO Regional Office for appraisal.
Currently, EHT is devoting more than 70 % of its extrabudgetary resources
to Headquarters-based activities. Over the next four years, EHT will gradu
ally reallocate at least 40% of its extrabudgetary funding to countries and
regions so that, by 2007, at least 70% of all extrabudgetary funding will be
spent at regional and country level to finance projects proposed by Mem
ber States. Any extrabudgetary funding increase during this period will be
used 100% for this purpose.
Objective
for 2004
To start implementing country focused activities for selected
countries (1-3 countries in each WHO region) for the following
technologies:
□ Blood transfusion safety
ffl Blood products and related biologicals
■ Laboratory services
■ Diagnostic imaging
■ Medical devices and equipment
District hospital surgery
The Department of Essential
Health Technologies (EHT)
has arisen out of what was
formerly the Department
of Blood Safety and Clinical
Technology (BCT).
Page 2
Department of Essential Health Technologies
World Health Organization
BASIC OPERATIONAL FRAMEWORK
THE CENTRAL TOOL IN
EHT’S COUNTRY
WHO DEPARTMENT OF ESSENTIAL HEALTH TECHNOLOGIES
FOCUS
BASIC OPERATIONAL FRAMEWORK
COUNTRY REVIEW
BLOOD TRANSFUSION SAFETY
1 POLICY
1.1
u
National coordination of blood transfusion services
1.1.1
National blood policy and plan
Aide-Memoire' Blood Safety
1.12
Legislation/regulation
Recommendations. Establishing a Nationally Coordinated BTS
1.1.3
National blood commission (or equivalent)
Examples of legislation
1.1.4
Specific organization responsible for blood transfusion services
Technical cooperation in establishing nationally coordinated BTSs
1.1.5
Standards for blood transfusion services
Guidelines: Minimum Requirements for BTSs
1.1.6
Assessment of blood requirements
Needs assessment model
1.1.7
Blood stock management system
Strengthening of collaborations and partnerships
Adequate resources
12.1
1.2.1a
u
1.4
I
Financial
Manual/software Costing Blood Transfusion Services
Fiscal allocation
1.2.1b
Cost recovery
122
Technical resources
1 2.2a
Adequate functioning equipment
Manual Guide to Procurement of Blood Cold Chain Equipment
1 2.2b
Reliable supply of test kits and reagents
HIV, HBV and HCV test kit bulk procurement scheme
1.2.2c
Stock control system
12.3
Adequate number of trained staff
_________
L
___
National data collection system
1.3.1
Capacity for computerization of BTS
1.32
Tools for assessment of blood safety situation
Global Database on Blood Safety
Data tor national decision-making for policy formulation
1.3.3
Information technology for blood transfusion services
Blood safety assessment tool
Studies on cost-effectiveness and burden of disease
I
1.4.1
Computerization of blood transfusion services
Guidelines. Computerization of the BTS
1.42
E-leaming programmes
Technical cooperation and infrastructure support
I = Completed by BCT
Q = Completed at country' level
Comments
Page 1
Department of Essential Health Technologies
World Health Organization
of the frameworks, EHT has therefore made available a series of products
(including norms, standards, guidelines, training material and technical coop
eration) that can be requested by Member Sates for capacity building in
the areas that are addressed by the frameworks.
Thus, in addition to defining a desirable level of health service in relation
to each technology, the basic operational frameworks provide guidance to
countries on how to achieve this level.
[ ,
L
merit that is shared by the basic operational frameworks is
„ commendation that countries should develop their own lists
of essential equipment.
essential equipment have very direct practical applications.
;: can be used as guidance for countries that are in the early
.
of use of a particular health technology or by countries that
< c o take a technology from national to provincial or district level.
cy are indispensable for countries needing to rebuild programmes
after an emergency that has damaged or destroyed the existing
infrastructure.
:: order to assist Member States in establishing lists of essential
equipment, EHT has initiated a project to create and maintain
lists for all the technologies that are actively supported under its
programme.
HOW THE BASIC OPERATIONAL FRAMEWORKS WORK
The table on the left shows a concrete example of what a basic operational
frameworks looks like in practice. It is an extract from the quality and safety
part of the basic operational framework for Blood Transfusion Safety. Other
parts of that framework (not shown below) include policy, use and access.
The full frameworks for all health technologies supported by EHT are avail
able on the EHT homepage at www.who.int/eht/.
Extract from a Basic Operational
Framework - the central tool in
The left column is the core part of the framework. It consists of the basic list
of requirements for quality and safety in relation to blood transfusion that
WHO recommends that Member States should meet.
EHT's country focus
The three narrow columns in the centre have been provided for countries
to use when reviewing the list to identify elements that are already in place,
not yet in place or partly in place.
www. who. int/eht/bof
Department of Essential
Health Technologies
The column to the right provides a list of WHO products and services that
are immediately available to support countries in meeting the basic require
ments in the left column. The products also form the basis for inputs to
capacity building projects that WHO can offer in response to requests from
Member States to establish the elements contained in the left column.
World Health Organization
Geneva 27, Switzerland
Fax: r47 22 791 4836
www.who.int/eht
E-mail: eht@who.int
Page 4
Department of Essential Health Technologies
'pr <5'2- ?-•
November 2003 Draft for comments by Member States
essential health technologies
STRATEGY 2004-2007
BLOOD TRANSFUSION SAFETY
BLOOD PRODUCTS AND RELATED BIOLOGICALS
■
LABORATORY SERVICES
ffl
DIAGNOSTIC IMAGING
■
MEDICAL DEVICES AND EQUIPMENT ■
DISTRICT HOSPITAL SURGERY
TRANSPLANTATION
MODEL LIST OF ESSENTIAL MEDICAL DEVICES
PREVENTION OF HEALTH CARE ASSOCIATED HIV INFECTIONS
INFORMATION TECHNOLOGY IN HEALTH CARE
World Health Organization
November 2003. Draft for comments by Member States
ESSENTIAL HEALTH TECHNOLOGIES
- Taking basic health solutions to countries
STRATEGY 2004-2007
A needs-driven programme increasingly
based on country-prepared proposals
World Health Organization
World Health Organization
EXECUTIVE
SUMMARY
Essential health technologies are evidence-based technologies that
provide cost-effective solutions to health problems.
Health technologies are used at every level of the health care system.
From the simplest to the most advanced, they form the backbone of
the services medicine can offer in the prevention, diagnosis and
treatment of illness and disease.
The Department of Essential Health Technologies (EHT) has arisen out
of what was formerly the Department of Blood Safety and Clinical
Technology (BCT). The renaming of the department does not mean that
WHO will give less priority to blood safety activities than in the previous
four years Bather, it reflects the recognition that many other health
technologies play equally important roles as blood transfusion in
prevention and health care and so also deserve to be given priority.
Consequently, the strategy proposed by EHT for 2004-2007 will build on
BCT's 2002-2003 strategy while at the same time reflecting more clearly
the department's role as WHO's programme on health technologies.
EHT will strengthen its emphasis on blood transfusion and biological
products of human origin, diagnostic imaging, laboratory services,
medical devices and surgical and anaesthetic procedures at the district
hospital.
EHT will also launch new key initiatives, including the establishment of
a WHO model list of essential medical devices, the prevention of health
care-associated HIV infection and e-health.
Page 2
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
The most profound differences, however, will be two major operational
changes that will take EHT effectively towards a strongly dedicated
country focus.
The first is the creation of sets of basic operational frameworks defining
achievable requirements for safe and reliable health services at country
level.
The second will be a progressive reallocation of resources in support of
country-prepared proposals for projects that aim to meet these
requirements in their health services.
As a result, EHT will evolve to become a needs-driven, project-based
unit in the sense that most of its activities will develop out of proposals
generated by Member States rather than by WHO staff members.
/Is WHO's health technology programme, EHT will continue to provide
authoritative advice on norms, standards and guidelines for the use of
essential health technologies and to work in close collaboration with its
partners
BLOOD TRANSFUSION SAFETY
BLOOD PRODUCTS AND RELATED BIOLOGICALS
■
LABORATORY SERVICES
■
DIAGNOSTIC
IMAGING
■
MEDICAL DEVICES AND EQUIPMENT
DISTRICT HOSPITAL SURGERY
iiS
TRANSPLANTATION
MODEL LIST OF ESSENTIAL MEDICAL DEVICES
PREVENTION OF HEALTH CARE ASSOCIATED HIV
INFORMATION TECHNOLOGY
Page 3
Department of Essential Health Technologies
INFECTIONS
IN HEALTH CARE
1
World Health Organization
BACKGROUND
I
Healtt
Health technologies are the backbone of all health systems. They are
essential tools in solving health problems. Even the most simple health
system cannot function without at least some of them.
Heaith technologies
are essential
when they:
■ Meet basic needs for health services
■ Have been proven to be cost-efficient
■ Are evidence-based.
Health technologies are evidence-based when they meet well-defined
specifications and have been validated through controlled clinical
studies or rest on a widely accepted consensus by experts
The WHO Commission on Macroeconomics and Health has documented
how heavy investment in building basic health systems in developing
countries will result in huge returns.
Today, the majority of the world's population is suffering from poverty
and is denied adequate, safe and reliable access to the solutions that
health technologies can offer.
There is a vast shortage of diagnostic radiology and laboratory services
in developing Member States while, at the same time, about half of
the available equipment does not function. About 6 million of some
80 million units of blood donated annually are not tested in accordance
with WHO recommendations on screening for infectious pathogens
and 22 million cases of hepatitis B, 2 million cases of hepatitis C and
260 000 cases of HIV/AIDS are caused by unsafe injections.
Clearly, health technologies should not be promoted as an end in
themselves. They should only be chosen when they meet an evident
need and are cost-effective.
Page 4
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
Some technologies address only one health problem, whereas others are
uniquely designed to address many problems simultaneously. Effective
health sector systems calling for optimal resource allocation
consistently rely on strong elements of cross-cutting technologies with
multiple applications.
Which essential
health technologies
are supported
hnok
supporter;
he chear
Diagnostic radiology services, clinical laboratory services and surgical
services are examples of health care services that typically make use of
technologies that have multiple applications. A vast number of health
problems can be dealt with where there is access to an X-ray machine,
a laboratory, a blood bank and a simple surgical operating room.
Focusing
sidelines
Page 5
Department of Essential Health Technologies
World Health Organization
HOW
DOES
EHT ACHIEVE
OBJECTIVES?
ITS
Targeting technologies that have multiple
applications at a realistic level
CHOICE OF TECHNOLOGIES AND INITIATIVES
The main thrust of EHT's activities will be to assist Member States in
establishing and optimizing the use of medical technologies with
multiple applications for health services in the fields of:
■ Blood transfusion safety
■
Blood products and related biologicals
■
Laboratory services
■
Diagnostic imaging
■ Medical devices and equipment
■
District hospital surgery
Transplantation.
The establishment of each of these technologies poses separate
challenges to which EHT is offering its distinctive solutions (see
Challenges and Solutions on pages 12-17).
In addition, EHT is giving priority to three key initiatives that cut across
these technologies:
■ Development of a list of essential medical devices
■ Prevention of health care-associated HIV infections
■ Use of information technology in preventive and curative health care.
TOWARDS AN ACHIEVABLE LEVEL OF SELF-RELIANCE
EHT is committed to helping countries to attain a safe and reliable level
of health service that is realistically achievable, even in economies that
are developing or in transition. To this end, EHT has created the concept
of hr.r.ic
.
which define the key requirements
for achieving this level of service.
Page 6
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
Fundamentally, basic operational frameworks are sets of elements that,
if implemented collectively, will confer a safe and reliable level for
health
,
and
,
and
of the technology
or service that is covered by the relevant framework.
What are
basic operational
frameworks?
Basic operational frameworks are lists of operational
elements that collectively define the requirements for a basic
level of health service, thus proposing to each Member State:
■ A milestone to be reached
■ Guidance on how to reach the defined level
■ A framework for EHT to fill out with products and services
that form the basis of technical cooperation in response
to requests for assistance.
Clearly, the requirements for the establishment of a technology differ
between technologies and, accordingly, there is a certain distinctive
variation between the EHT frameworks for each technology. But they all
share fundamental qualities in requirements such as efficacy, efficiency
and timeliness.
The full EHT basic operational frameworks are available on the EHT
homepage at www.who.int/eht.
EHT, WHO'S AUTHORITATIVE ARM FOR HEALTH TECHNOLOGIES
The support provided by EHT relates directly to the normative work of
setting standards, and providing guidelines, training material and other
products that EHT is expected to undertake under the WHO Constitution.
This statutory work will progressively be refocused to ensure that EHT
products and services provide more tailored support to countries aspiring
to establish the level of health service that is defined by each of the
basic operational frameworks.
Page 7
Department of Essential Health Technologies
World Health Organization
THE
COUNTRY
FOCUS OF
EHT
Reallocating resources to support
country-prepared proposals
The country focus of EHT will progressively form an increasing and
integral part of its programme, from the development stage through to
delivery and implementation. It will consist of four main elements:
Identification of gaps in services in Member States
Call for project proposals from Member States
Selection of proposals to be included in EHT's programme
Implementation of the selected projects.
EHT PROGRAMME DEVELOPMENT
During the 2002-2003 biennium, EHT devoted 30% of its extrabudgetary
resources to activities at regional and country levels. In 2004-2007, there
will be a progressive shift to regional offices and country offices in
decision-making on the allocation of these resources. The target for
2007 is that 70% of extrabudgetary resources will be spent at country
level in funding the implementation of country-prepared project
proposals.
Progressively, a system will be established to initiate programme
development at country level, starting with selected pilot countries in
the different regions.
First, Member States, together with WHO Representatives and
representatives from the regional offices, will be invited to use the basic
operational frameworks to identify gaps in their health services and to
write a short summary of their observations.
Next, Member States (Ministries of Health, in collaboration with
relevant national authorities and professionals) will prepare project
proposals requesting WHO for help to close identified gaps in the
frameworks and send the proposals, through the WHO country offices,
to their regional office. A template for project proposals can be
downloaded from the EHT homepage. In preparing their proposals,
Page 8
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
countries will set priorities regarding the identified gaps they wish to
close first and focus their proposals on those needs
Regional offices and headquarters will jointly appraise received
proposals and select the projects that can be financed from WHO
resources. Priority will be given to project proposals that demonstrate
high levels of government commitment and direct end-user benefit.
Funding for high quality project proposals that WHO is not in a position
to finance will be sought through dedicated applications to external
donors and partners.
REFOCUSING THE WORK OF EHT IN RESPONSE
TO COUNTRY NEEDS
As countries increasingly benefit from WHO assistance in bridging
gaps in the basic operational frameworks, WHO headquarters, in
collaboration with regional and country offices, will identify gaps in
the EHT portfolio of products that must similarly be filled to provide
effective support for each element of the frameworks, these include
norms, standards, guidelines, procedures and training materials The
identified gaps will form the central criteria for the selection of support
products and services to be developed by EHT in 2004-2007.
Guided by the frameworks, EHT will also refocus its network and
database activities as well as its agreements with collaborating centres
and collaboration with other partners.
EHT'S PROGRAMME
As the number of country-prepared project proposals gradually grows,
EHT's programme will increasingly focus on those project proposals that
can be supported.
Page 9
Department of Essential Health Technologies
World Health Organization
Regional offices, in collaboration with headquarters and country offices,
will coordinate the implementation of the projects that are included in
the programme. Delivery mechanisms include training courses and
workshops, expert missions, fellowships and the provision of equipment.
Headquarters, in collaboration with regional offices, will as in previous
years continue to develop and update the norms, standards, guidelines
and training material that have been selected for inclusion in the
programme.
Likewise, headquarters and regional offices will continue to coordinate
the networks and agreements with collaborating centres and the
development and maintenance of databases and other information
material.
mine on health technologies, EHT
intains basic operational frameworks for
health services and technologies
States in filling out the basic operational
jgh country-prepared project proposals
standards, guidelines, training materials,
ais and estimation of the burden of disease
■ Has a particular foe
Page 10
e diseases of poverty.
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
IMPLEMENTATION OF THE COUNTRY FOCUS
EHT aims:
By early 2004, to have started reviewing its work with Member
States to identify gaps in their health services that can be filled
through dedicated projects in pilot countries.
By mid-2004, to have received at least 10 project proposals from
Member States so that project implementation can start in early
2005 in selected countries and by mid-2005 on a broader base in a
larger number of countries.
Annually through 2005-2007, to implement an increasing number
of projects proposed by Member States, targeting at least 30 per
year by the end of 2007.
By the end of each year, to have produced a solid number of norms,
standards, guidelines and training material in support of the basic
operational frameworks.
By 2007, through annual review of the basic operational frameworks
with Member States, to be able to demonstrate that expected
outcomes have been achieved
Page 11
Department of Essential Health Technologies
World Health Organization
CHALLENGES
AND
SOLUTIONS
The Department of Essential Health Technologies offers specific
solutions to various challenges and concrete inputs when responding to
project proposals developed by Member States. In spite of the diversity
of the technical disciplines, each area of work is structured through its
basic operational framework and has the same four main strategic
objectives for the level of health service:
Policy
Quality and safety
Access
Use
As part of its
objective, EHT assists countries to benchmark,
assess, plan, implement and evaluate national policies and plans for the
area of work. As part of its
objective, EHT
contributes to the establishment of comprehensive systems to ensure
the quality and safety of products and services. As part of the
objective, EHT develops mechanisms to promote universal and equitable
access to health technologies Finally, as part of the
objective,
EHT formulates guidance on the rational, appropriate and cost-effective
use of health technologies
■ BLOOD transfusion safety
While blood transfusion is an essential and life-saving support within
the health care system, the safety of transfusion is not assured globally,
particularly in those countries without developed health care systems
where around 80% of the world's population lives. Threats include lack
of access to blood and blood products; the risk of transmission of
m ections such as Hiy an(j vira| hepatitis through unsafe transfusion;
technical and clerical o
. .■
errors in the processing and testing of blood,
inappropriate use of blona j
. • • ,
,
,
IQ°a and errors in the administration of blood
and blood components which m
may result in severe or fatal reactions.
Page 12
Department of Essential
Essential Health Technologies Strategy 2004-2007
Solutions
EHT supports the establishment of well-organized, nationally coordinated
blood programmes with quality systems including the development of a
national blood policy and plan, legislation and regulation and the
establishment of a national blood commission.
EHT assures the availability of national or international standards needed
for the development of a quality system and an effective and accurate
documentation system to ensure the traceability of all blood transfusion
safety activities.
EHT supports countries in establishing a well-organized blood supply
structure and a programme for the recruitment and retention of voluntary
non-remunerated blood donors. EHT supports the provision and correct use
of appropriate equipment and a reliable and adequate supply of blood
bags, reagents, test kits and other materials.
EHT promotes strategies to ensure the appropriate prescribing and safe
administration of blood and blood products to minimize unnecessary and
unsafe transfusions. EHT maintains a database on the situation of blood
transfusion services in Member States, maintains collaborative
partnerships in global blood safety and serves as the secretariat for the
Global Collaboration for Blood Safety (GCBS).
■ BLOOD PRODUCTS AND RELATED BIOLOGICAL PRODUCTS
Challenges
Page 13
"Biological products”, which include "biological medicines" such as vaccines,
animal sera, haematological products (blood, blood products and related
substances), cell regulators, somatic cells and tissues, as well as “biological
based in vitro diagnostic medical devices" are essential to the achievement
of the WHO mission. Yet many countries lack an appropriate regulatory
framework to assure the quality and safety of these biopharmaceutical
products. Because of the special quality and safety issues associated with
blood products and related biological products. Medicines Regulatory
Authorities and Control Laboratories in developing countries need to acquire
technical expertise to assure the compliance of these products with national
and international regulations on quality and safety.
Department of Essential Health Technologies
World Health Organization
Solutions
EHT is committed to strengthening the technical capacity of regulatory
authorities for medical devices, assisting national authorities to identify
gaps, set priorities, plan and implement activities to ensure the quality
and safety of the blood products and related biologicals used in human
medicine.
EHT supports the establishment of regional networks of National
Regulatory Authorities to develop their technical capacity and expertise
in the evaluation and control of blood products and related biological
products and in vitro medical devices.
EHT coordinates the development and establishment of biological
reference materials of application in this field.
At country level, EHT promotes the appropriate use of International
Biological Reference Preparations through training and technical support
carried out with international collaboration.
■ DIAGNOSTIC IMAGING
Challenges
Diagnostic radiology, ultrasound, magnetic resonance and nuclear
medicine are some of the most powerful medical technologies available
to address clinical problems. Yet, globally, diagnostic imaging services
are still insufficiently available. There is a depressing lack of equipment,
inadequate types of equipment, non-functioning equipment and incorrect
handling of equipment. It is estimated that some three-quarters of the
world's population have no access to such services.
Solutions
EHT helps countries to establish national policies and programmes for
diagnostic imaging services as an integral part of all health care and
strictly adapted to local needs and levels of care.
EHT focuses especially on the need to improve the skills and knowledge
of end-users at first referral (district hospital) level through the
development and implementation of training programmes and
educational material.
EHT develops norms and standards for diagnostic imaging services in
collaboration with the Global Steering Group for Education and Training
in Diagnostic Imaging, relevant nongovernmental organizations, WHO
collaborating centres and UN organizations, such as the International
Atomic Energy Authority.
EHT collaborates with manufacturers of imaging equipment to seek
solutions to the need for efficient and modern imaging equipment at
affordable prices. EHT is committed to supporting possible digital
solutions that are affordable and suitable for facilities in remote
locations with a poorly developed infrastructure.
Page 14
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
■ DIAGNOSTIC SUPPORT AND LABORATORY SERVICES
Challenges
Diagnostics and laboratory technologies in haematology, microbiology
(including parasitology) and pathology (histology and cytology) play a
critical role in surveillance, prevention efforts and the diagnosis and
monitoring of treatment of major diseases including HIV/AIDS,
tuberculosis and malaria. However, many countries have weak national
systems, suffer from rudimentary procurement and supplies systems,
present inequities between urban and rural areas and lack a suitable
infrastructure and human resources. As a result, the quality of laboratory
performance is variable and equipment is often either inappropriate or
not maintained.
Insufficient numbers and a high turnover of skilled staff are a reality in
many countries. Hence, there is a continuous need for training.
Solutions
EHT develops tools for benchmarking laboratory and diagnostic services
to assist in the development of national policies and guidelines on
laboratory and diagnostic services and in planning, implementation and
evaluation.
EHT assists in the strengthening of the National Regulatory Authorities
and National Reference Laboratories. EHT supports the establishment
of mechanisms to monitor the quality of performance of laboratory and
diagnostic services, including external quality assessment schemes,
audits and accreditation.
Information and guidelines on the selection of high quality diagnostics
and laboratory equipment are made available to countries. The WHO
bulk procurement scheme is facilitating wider access to these products
through lower prices.
■ MEDICAL DEVICES AND EQUIPMENT
Challenges
Despite the billions of dollars spent each year on an ever-increasing
array of medical devices and equipment, the majority of countries still
do not recognize the management of devices as an integral part of public
health policy. Around 95% of medical technology in developing countries
is imported, much of which does not meet the needs of national health
care systems. Over 50% of equipment is not being used, either because
of a lack of maintenance or spare parts, because it is too sophisticated
or in disrepair, or simply because the health personnel do not know how
to use it. This has far-reaching implications for the prevention of disease
and disability and invariably leads to a deplorable waste of scarce
resources.
Solutions
EHT offers assistance in the establishment of national systems for the
selection, procurement, use and disposal of medical devices that meet
Page 15
Department of Essential Health Technologies
World Health Organization
international quality and safety standards. Such systems must be based
upon needs assessment. In particular, the National Regulatory Authority
must be effective, with legislation and policies to cover each stage in
the life span of a medical device. This includes, as a priority, both the
development of a database of authorized products and suppliers and a
requirement that all medical devices meet international standards.
EHT encourages the establishment of national management of medical
devices programmes to ensure that trained personnel, facilities and
standard operating procedures are in place, with systems for preventive
maintenance and repair of equipment. EHT products include policy and
procurement guidelines, rapid assessment tools and training
programmes for different types of health professional. Among medical
devices, injections have been the focus of special attention because of
the burden of disease associated with the unsafe use of syringes and
needles.
■ DISTRICT HOSPITAL SURGERY
Challenges
Essential surgical care at the first referral level of health facility is a
major priority. Injuries and pregnancy-related complications are the two
leading causes of death, accounting for 12% and 18% of the global
burden of disease, respectively. Worldwide, 60% of pregnant women
and about 43% of children under 5 years of age are anaemic, with the
highest estimated prevalence in Africa and Asia, resulting in serious
consequences for surgical and anaesthetic care. The majority of the
world's poor live in rural areas. Death and disability due to injuries and
pregnancy-related complications often result from a lack of facilities and
trained human resources to give prompt appropriate care in rural health
facilities.
Solutions
EHT assists countries to develop national policies and plans for
basic requirements to be in place for essential emergency surgical
services and with health education and training for doctors, nurses
and paramedical staff on best practices and effective methods of
intervention in the management of trauma, pregnancy-related
complications and anaesthesia.
EHT develops best practice guidelines, protocols and e-learning tools to
monitor and evaluate the appropriate use of essential emergency
procedures and equipment for patient safety. EHT has already issued
guidance on the procurement and maintenance of essential emergency
equipment for procedures at the first referral level of health facility.
Page 16
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
■ TRANSPLANTATION
Challenges
Cell, tissue and organ transplantation have the capacity to save lives
and restore essential functions in circumstances when no medical
alternative of comparable effectiveness exists. The procurement of
human material for transplantation raises ethical concerns such as the
risk of commodification of the human body. Access to basic
transplantation, such as cornea or kidney, needs to be developed in
many countries. Given the potential risk of transmission of animal
pathogens, the promises of xenotransplantation need to be confirmed
through carefully monitored trials involving international cooperation
Solutions
EHT helps countries in implementing care using transplantation adapted
to their needs following internationally recognized principles on ethics,
safety and efficacy.
EHT assists Member States to develop evidence-based national policies
on cell, tissue and organ transplantation.
EHT provides standards and principles of good practices and quality
management systems to ensure the safety and quality of human material
for transplantation.
EHT helps countries to develop surveillance mechanisms for the safety
of the living donor and the success of transplantation in the long term
for the recipient.
EHT supports vigilance mechanisms to ensure that, in particular,
xenotransplantation trials are carried out under the oversight of health
authorities.
Page 17
Department of Essential Health Technologies
World Health Organization
KEY
INITIATIVES
FOR ESSENTIAL
HEALTH TECHNOLOGIES
Cutting across technologies
At one extreme, technologies can be chosen to address one specific
cluster of health problems (such as conditions associated with infectious
diseases) while, at the other extreme, a technology can serve as a tool
to address virtually all problems (e.g. information technology).
Regardless of the problem or the technology, when a country wishes to
engage in the use of a technology, it faces the challenge of how to get
started.
For 2004-2007, EHT has chosen three examples of how technologies may
span public health issues as key initiatives for its advocacy work and the
development of support products.
■ LISTS OF ESSENTIAL MEDICAL DEVICES
Medical equipment represents a significant proportion of national health
care expenditure However, many facilities, such as district hospitals,
continue to lack the basic technologies they need to provide quality care
to their patients, invariably because equipment is unavailable,
inoperative, misused or simply inappropriate. Appropriate procurement
policies and practices are fundamental to ensuring access to medical
devices and to guide their rational use. In the same way that the WHO
model list of essential medicines has been the keystone of the
development of national medicine policies, EHT will develop a model list
of essential medical devices.
Activities
Page 18
Model lists of essential equipment will be developed to address various
country needs, including the level of health care (from primary care to
referral hospital) and the discipline (e.g. surgery, blood transfusion).
Guidance will be offered to assist countries in establishing their own
national lists of medical devices to support appropriate use.
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
■ PREVENTION OF HEALTH CARE-ASSOCIATED HIV
INFECTIONS AND OTHER NOSOCOMIAL INFECTIONS
Background
Approximately 10% of all new HIV infections may be caused by the
transfusion of infected blood, unsafe injections or other unsafe skin
piercing procedures. These infections are preventable with simple,
effective interventions.
Activities
In 2004-2007, EHT will offer countries a toolbox of materials and technical
support to strengthen their capacity to prevent the transmission of HIV
and other nosocomial infections in health services. Key interventions
address the establishment of nationally coordinated blood transfusion
services that can provide safe and adequate supplies of blood, the safe
and appropriate use of injections and universal/standard precautions.
Essential procedures for these interventions also form part of the
Essential Health Technologies information package. In addition, EHT
serves as the secretariat for the Safe Injections Global Network (SIGN).
■ INFORMATION TECHNOLOGY FOR HEALTH CARE
Background
The need to develop and organize new ways of providing more efficient
health care services and major advancements in information and
communications technology have resulted in the increased use of e-health
applications over the past decade. The availability of e-health technology
to facilitate medical care, irrespective of distance and the availability of
medical specialists on site, makes it attractive to the health care sector.
Activities
EHT's information communication technology activities are managed
under its information technology resource centre (ITRC) with the purpose
of strengthening access to health information management through
improved information systems. It maintains the EHT website which
provides comprehensive access to EHT products and activities, including
EHT's packages of standards, guidelines and training materials. Much
of this material is supported by a wide variety of multimedia products.
EHT is specifically dedicated to meeting Member States' requests for
e-learning tools.
Page 19
Department of Essential Health Technologies
World Health Organization
RESOURCES
AND THREATS
EHT is staffed by highly motivated individuals. However, for several of
its core activities, it is, unfortunately, thinly staffed. This, together with
rather weak extrabudgetary funding for the department up to 2003, sets
a clear limit to the number of country-prepared proposals that can be
funded and supported under the programme if the resources available
are unchanged during the implementation of the 2004-2007 strategy.
Successful resource mobilization is a prerequisite, as well as an overriding
challenge, for the programme to achieve its planned outcomes.
EHT's anticipated budget and resources for 2004-2007 are shown below,
based on a projection of current allocations and donations (Figure 1).
Figures 2 and 3 show how the current budget is spent. Figure 4 shows
the expected effect of an annual 10% reallocation (40% over four years)
of extrabudgetary resources towards the regions and Member States as
a result of the new country focus of the EHT strategy.
Figure 1
EHT Resources 2004-2007
Percentage and USS thousand
21000 Other sources
42%
Page 20
5go^
Department of Essential Health Technologies
29524 Regular budget
Essential Health Technologies Strategy 2004-2007
EHT Resources 2004-2005: Regular Budget
Level at which estimated percentage spent
36%
34%
Country
Regional
Global
30%
EHT Resources 2003 - Other Sources
Level at which estimated percentage spent
20%
10%
70%
Country
Regional
Global
EHT Resources 2007
Level at which estimated percentage to be spent
30%
40%
Regional
30%
Page 21
Country
Department of Essential Health Technologies
Global
World Health Organization
WHAT WILL
EHT
HAVE ACHIEVED
BY
2007?
The EHT vision
Today there is a fairly low and unarticulated perception in many Member
States of the role that health technologies can play in prevention, health
care and the establishment of cost-effective health systems.
By 2007, EHT expects to have assisted Member States to reach or partly
reach a safe and reliable level of health service, as defined in the EHT
basic operational frameworks, and to set and achieve clear, concrete
goals and milestones for their health services that fall under EHT's
programme.
Important outcomes of EHT activities will be that countries will have
closed a substantial number of gaps in their health care services. Key
indicators of these outcomes include the following.
■ At least six additional countries will have established nationally
coordinated blood transfusion services with quality systems in all
areas.
■ At least two regional networks will have been established to
strengthen the technical capacity of National Regulatory Authorities
to assure the quality and safety of blood products and related in
vitro diagnostic procedures
At least 10% of the countries in each WHO Region will have
strengthened their technical capacity and improved the quality and
safety of, and access to, appropriate diagnostic support and
laboratory services.
At least one training centre for improving diagnostic imaging
services will be operational in each WHO Region.
At least one country in each WHO Region will have completed an
assessment of the National Regulatory Authority in the area of
medical devices and developed a follow-up strengthening plan.
At least two countries in each WHO Region will be using EHT
training materials and tools to improve the technical skills of health
personnel in the safe use of essential emergency procedures and
equipment at first referral level.
Page 22
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
hbm
10% of countries in each WHO Region will have implemented a
national policy and developed legislation to assure the ethics, safety
and quality of cell tissue and organ transplantation practices.
At least one country in each WHO Region will have piloted the WHO
model list of essential medical devices.
At least one country in each WHO Region will be implementing a
national plan for the prevention of health care-associated HIV
infection.
At least 10 countries will have established appropriate e-health
components in their health care systems.
As a result of the changes of the way in which EHT will be operating:
■ There will be a progressive reallocation of resources in
support of country-prepared project proposals, aiming at
achieving this level
■ EHT will evolve as a needs-driven project-based unit in the
sense that most of its activities will come out of proposals
generated in Member States and not by WHO staff members.
EHT will be one coherent programme across all levels in WHO and will
have achieved improved efficacy through harmonized, transparent and
streamlined procedures, focusing particularly on direct end-user
benefits
TOWARDS THE 2007 VISION: YEAR-BY-YEAR EHT MILESTONES AND
INDICATORS
Pending the concrete submission of project proposals by Member States
and projected activities for the development of support products,
specific annual EHT milestones (targeted outputs) and indicators of the
adoption of these outputs by Member States (indicators of outcomes)
are shown on pages 24-31.
Page 23
Department of Essential Health Technologies
World Health Organization
2004
BLOOD TRANSFUSION
SAFETY
BLOOD PRODUCTS
AND RELATED
BIOLOGICALS
Page 24
Milestones
Implementation of the Quality
Management Programme in at
least six additional countries
Indicators
Number of countries meeting
defined criteria for basic quality
systems
Milestones
Initiation of at least one Regional
Network project to provide
technical assistance to National
Regulatory Authorities (NRAs) for
control of blood products and
related biologicals
Indicators
Number of National Regulatory
Authorities involved in Regional
Network activities
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
2005
2006
2007
Training programmes in all WHO
Regions on establishing blood
donor programmes based on
voluntary non-remunerated
donation
Training strategies and materials
on testing for transfusiontransmissible infections introduced
in 24 additional countries
Introduction of guidelines and
tools to support the national
coordination of blood transfusion
services in at least six additional
countries
INumber of countries with 50%
^voluntary non-remunerated blood
odonation
Number of countries with 100%
testing for HIV and HBV and 50%
testing for HCV
Number of countries meeting
defined criteria for national
coordination of blood transfusion
services
WHO requirements for the
collection, processing and quality
ccontrol of blood, blood products
aand plasma derivatives updated
Second Regional Network of NRAs
for control of blood products
established
At least one WHO International
Biological Reference Material
established for blood safety and
related in vitro diagnostic clinical
technology or blood products and
related substances used in the
therapeutic field
Niumber of countries adopting the
WHO Requirements
Number of NRAs for blood
products involved in Regional
Network activities
Number of countries involved in
WHO collaborative studies and
using WHO International Biological
Reference Materials
Page 25
Department of Essential Health Technologies
World Health Organization
2004
LABORATORIES
DIAGNOSTIC
IMAGING
Milestones
Development of training materials
and provision of training therapy in
all regions on CD4 technologies for
monitoring HIV/AIDS ARV
Indicators
Number of countries implementing
CD4 technologies for monitoring
HIV/AIDS ARV
Milestones
Initiation of research and
development project with industry
on digital World Health Imaging
System for Radiology (WHIS-RAD)
Indicators
MEDICAL DEVICES
AND EQUIPMENT
Milestones
Assessment of at least one
National Regulatory Authority in
the area of medical devices
Indicators
Number of countries with
completed assessments and
follow-up plans
Page 26
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
2005
2006
Technical information and
guidelines on selection and
procurement of diagnostics and
equipment disseminated in all
WHO Regions
Updated agreement for bulk
procurement of HIV/AIOS and
other diagnostic technologies at
affordable prices
Expansion of external quality
assessment schemes (EGAS) to an
additional 30% of countries
Number of countries using the
information and guidelines
Percentage savings made in USS
as compared to general market
prices
Percentage of laboratories with
improved performances in EQAS
and other assessment tools
Designation and support
of at least three training centres
for diagnostic imaging
Feasibility study on teleradiology
systems undertaken in WPRO and
AFRO
Introduction of training manuals in
all WHO Regions
Number of countries meeting
defined criteria for diagnostic
imaging services
Recommendations on use of
teleradiology
Number of countries using the
manuals in training programmes
Piloting of Essential Healthcare
Technology Package (EHTP) in
selected countries in each WHO
Region to match evidence-based
interventions with equipment
needs
Piloting of Essential Healthcare
Technology Package (EHTP) in one
additional country in each WHO
Completion of an assessment of
the National Regulatory Authority
in the area of medical devices and
a follow-up strengthening plan
Number of countries using the
EHTP
Number of countries using the
Page 27
Region
EHTP
Number of countries with
completed assessments and
follow-up plans
Department of Essential Health Technologies
World Health Organization
2004
DISTRICT
HOSPITAL SURGERY
TRANSPLANTATION
LISTS OF ESSENTIAL
MEDICAL DEVICES
Page 28
Milestones
Introduction of training tools,
including list of basic essential
emergency equipment, in at least
three countries
Indicators
Number of countries using training
tools
Milestones
Essential tools for a global
network for surveillance of
xenotransplantation in place
Indicators
Number of countries involved
Milestones
Completion of systematic review
of existing lists of medical devices
Indicators
Evaluation report on existing lists
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
2005
2006
2007
Introduction of training materials
for emergency care (including
oxygen) at first referral level of
care in at least three additional
countries
Introduction of emergency care
training materials in at least three
additional countries
Introduction of revised manual on
surgery and anaesthesia in district
hospitals in at least six countries
Number of countries using training
materials
Number of countries using training
materials
Number of countries using revised
manual on surgery and
anaesthesia in district hospitals
Development of guidance material
for legal framework, policy making,
regulatory oversight and technical
aspects of basic transplantation
activities in low-income countries
Development of guiding principles
for ethics, safety and quality in
transplantation and core standards
for cell tissue and perfusable
organ transplantation
Significantly increased number of
countries with access to basic
transplantation
Number of countries using
guidance material
Number of countries using core
standards as a basis for national
standards
Number of countries with access
to basic transplantation
Availability of the draft WHO
model list of essential medical
devices
Availability of final WHO model
list of essential medical devices
Piloting of WHO model list of
essential medical devices in at
least one country in each WHO
Region
Review of draft model list by a
WHO model list of essential
medical devices adopted by
interested parties
Number of countries piloting the
WHO model list of essential
medical devices
meeting of experts
Page 29
Department of Essential Health Technologies
World Health Organization
2004
.
CARE-ASSOCIATED HIV
INFECTION
INFORMATION
TECHNOLOGY
FOR HEALTH CARE
Page 30
Milestones
Development of WHO model policy
for the prevention of health care
associated HIV infection
Indicators
WHO model policy approved by all
regions
Milestones
Availability of toolkit of EHT
materials in CD-ROM format in all
WHO Regions
Indicators
Number of countries using EHT
Toolkit
Department of Essential Health Technologies
Essential Health Technologies Strategy 2004-2007
2005
2006
2007
Availability of a WHO infection
control manual
Availability of WHO model list of
essential infection control
equipment and supplies
Technical support in the
implementation of a national plan
for the prevention of health careassociated HIV infection in at least
one country in each WHO Region
Number of countries using the
WHO infection control manual
Number of countries using WHO
model list of essential infection
control equipment and supplies
Number of countries implementing
a national plan for the prevention
of health care-associated HIV
infection
Availability of EHT e-health
package in all WHO Regions
Availability of technical
information and guidelines on
establishing e-health in all WHO
Regions
Availability of technical
information and guidelines on
selection and use of information
technologies to improve health
care in all WHO Regions
Number of countries using EHT
e-health package
Number of countries adopting
e-health
Number of countries using
guidelines
Page 31
Department of Essential Health Technologies
World Health Organization
DISTRICT
HOSPITAL SURGERY
BLOOD PRODUCTS
AND EQUIPMENT
TRANSPLANTATION
MODEL LIST OF ESSENTIAL MEDICAL DEVICES
PREVENTION OF HEALTH CARE ASSOCIATED HIV
INFECTIONS
INFORMATION TECHNOLOGY IN HEALTH CARE
I
Page 32
Department of Essential Health Technologies
■
World Health Organization
Essential Health Technologies
E-mail: eht@who.int
Fax: +41 22 791 48 36
www.who.int/eht
World Health Organization
TOWARDS A WHO MODEL LIST OF ESSENTIAL
MEDICAL DEVICES
THE NEED FOR A POLICY
Medical devices cover a wide range of consumables and equipment, from
simple tongue depressors to complex haemodialysis machines, although they
exclude infrastructure, such as buildings or power supplies. They are used
at all levels of health services and often require substantial capital
investment. The right choice of medical devices is crucial to health services
and has implications in terms of patient care and in the prevention of
disease, disability and death. Yet the management of medical devices is
too often relegated to a procurement issue rather than a public health policy
requirement
THE EFFECTS OF INAPPROPRIATE MANAGEMENT
The absence of policy and mismanagement of medical devices can result
in infection, injury or death to the patient - or the user - of medical devices.
The importance of ensuring patient safety was the focus of World Health
Assembly resolution WHA 55.18. Safety of services is an integral part of the
quality management of health systems. Safety is also needed for health
products, namely medicines, vaccines, blood and medical devices.
Page 1
Department of Essential Health Technologies
World Health Organization
A WASTE OF PRECIOUS HEALTH CARE RESOURCES
’ The global market
for medical devices is estimated
to reach US $260 billion by 2006
(WHO internal document.
1998 estimation)
To fight major diseases of poverty, ministries of health are faced with the
challenge of scaling up close-to-client services to deliver essential health
procedures. The gap between the rich and the poor is also a gap within
many developing countries. Medical devices represent a high proportion of
health care expenditure' and are frequently too expensive for the poor.
Despite this investment, information may be unavailable regarding their use
and their maintenance and ministries of health often lack a standardized
development plan or even an awareness of the medical devices available
in the country.
WHAT IS AW ESSENTIAL MEDICAL DEVICE?
Essential medical devices are those that meet the priority health care
needs of the population. They are selected with respect to their public
health relevance based on their efficacy, safety and cost-effectiveness.
A static list of medical devices is neither feasible nor useful. Nonetheless,
evidence shows that a template list of essential medical devices can
assist countries to plan and manage their needs for health care delivery.
The relevance and public health benefit of this approach has been
documented through 25 years of implementation of the WHO model list of
Essential Medicines.
AN EVIDENCE-BASED PUBLIC HEALTH CONCEPT
The framework to define a model list of essential medical devices is to
1)
start from major diseases of poverty;
2)
define appropriate health interventions; and
3)
list the essential medical devices that will be required for these
interventions.
In summary, this is an evidence-based, public health concept where health
conditions define which devices are needed, rather than a marketing
approach where the availability of new devices justifies new markets.
Selection criteria
The following criteria will guide the development of an evidence-based list
of essential medical devices.
Devices should be necessary to the implementation of a cost-effective
health intervention
■ Devices should be effective
■ Devices should be safe
Levels of health care
and specific
health programmes
Page 2
The WHO model list of essential medical devices will take into account
both the level of health care service delivery (e.g., primary care, district
hospital and referral centres); and specific public health programmes
and initiatives (e.g., safe motherhood, district surgery, immunization, blood
transfusion services). These will be addressed in various subgroups of
the master list.
Department of Essential Health Technologies
World Health Organization
List of essential medical devices
as an integral element
in the national strategy for medical
technology
A list of essential devices
at the heart of a national
policy on medical devices
A national strategy for medical devices should be based on a strong policy,
within an adapted regulatory framework. Once consensus has been reached
over what set of medical devices is essential, assistance can be focused to:
'I) Ensure the quality and safety of the devices through norms and standards
enforced through national regulations and global vigilance systems;
2) Increase access through tools that facilitate procurement and supply
management;
3) Improve safe, cost-effective and rational use through technical guidance
and training.
Process to formulate
a WHO model list
of essential medical
devices
Page 3
The process used to formulate the list will be explicit, transparent and
consultative through an engagement of key partners (e.g., UNICEF, World
Bank and non-governmental organizations). This list will be based on
evidence, linked to health outcomes, operational at different levels of health
care, include complementary sections (e.g., infection control package) and
be adaptable to the morbidity profile of each country.
Key steps include:
1.
Formulation and review of existing lists
Lists that exist in WHO (e.g., WHO emergency health kit, medical
devices for surgical procedures at first referral level of health care
facility) or with selected partners (e.g., WHO/UNDP Compendium of
Basic Specifications for Emergency Relief Items, UNICEF Supply
Catalogue 2003) will be reviewed for audience, content and the
process used to develop them. First, the Department of Essential Health
Technologies will create a repository of all these lists. Second,
mechanisms to update them will be explored.
2.
Development and discussion of a blueprint of essential lists
A blueprint will be prepared of medical devices required at various levels
and categories of health care provision and circulated for peer review.
The result will be a draft list of essential medical devices that includes
interventions of special public health importance.
3.
Monitoring and evaluation
WHO will organize annual meetings of experts to review the lists for
comments and suggestions before their official clearance and publication.
Department of Essential Health Technologies
World Health Organization
THE WHO BASIC OPERATIONAL FRAMEWORK
The WHO Department of Essential Health Technologies assists countries
to achieve a safe and reliable level of health services in a variety of health
technologies through its Basic Operational Frameworks. Below is a summary
of the requirements for countries to attain this level of health service for
Medical Devices and Equipment, and the products and services that WHO
can make available to support this goal.2
It is easy to overlook how medical devices accompany us daily throughout
our lives. Whether to monitor the development of an unborn child, protect
an infant from measles, diagnose and treat today's killer diseases or to
perform keyhole surgery, virtually no health intervention can take place
without recourse to a medical device.
Despite huge investment, the majority of developing countries do not
recognize the management of medical devices as a public health priority.
This often means that products are unwittingly produced and procured that
do not meet international standards of efficacy, quality and safety. It is also
why over 50% of the medical equipment in developing countries is not
functioning, not used correctly or not maintained. Some equipment is even
unnecessary or inappropriate to fulfil its intended purpose. The misuse of
medical devices is another major concern. Each year, for example, unsafe
injection practices cause an estimated 260,000 new - and avoidable - HIV
infections.
EHT will focus on strengthening national capacity to regulate medical
devices so that they meet high quality and safety standards and are used
appropriately. Efforts will also concentrate on making appropriate devices
and equipment more available and affordable.
Policy
TO BE ]N PLACE IN COUNTRIES
Medical devices and equipment are often seen as a mere procurement issue,
while they are at the core of public health interventions for the prevention
of death or disability or for managing the diseases of poverty. To broaden
this vision, a clear policy on medical devices and equipment is required.
Key elements include:
□ National policy and plan for medical devices
□ National policy for the safe and appropriate use of injections
□ National Regulatory Authority functional in medical devices, empowered
with legislation
□ National coalition for injection safety and infection control
-- -■ National budget for devices and injection safety, using costing,
budgeting and financing
9 Assessment of needs
□ Inventory of suppliers and medical devices in use
■ The Basic Operational Framework
for Medical Devices and Equipment
can be found on the Internet at
www.who.int/eht
Page 4
Department of Essential Health Technologies
World Health Organization
WHO PRODUCTS AND SERVICES TO SUPPORT POLICY
REQUIREMENTS
■ Aide-Mdmoires on Medical Devices
□ Medical Device Regulations: Global Overview and Guiding Principles
El Managing an Injection Safety Policy document
□ Rapid Assessment Tools and Global Databases
□ National Regulatory Authority Assessment and Strengthening Tools
□ Secretariat of Safe Injection Global Network (SIGN) Alliance
□ Documentation on global burden of disease and cost-effectiveness
studies
□ Costing tools, including maintenance, spare parts, accessories and
replacement
TO BE IN PLACE IN COUNTRIES
Medical devices and equipment need to be of adequate quality and safety
to bring public health benefits without harming patients, health care
workers or the community. Thus, regulations should mandate that all devices
and equipment, whether imported or locally produced, meet international
norms and standards (or WHO specifications in the absence of standards).
In addition, the coordination of global and local vigilance networks ensure
the management of adverse events. Key elements include:
■ Good Manufacturing Practices and quality control for local production
of devices
□ National procedure for licensing/market clearance
□ Pre-qualification of suppliers
□ National regulations based on ISO standards or WHO specifications
■ Post-market surveillance/vigilance system for alerts, notifications and
recalls
□ National technology assessment centre
□ Introduction of syringes with reuse prevention feature
WHO PRODUCTS AND SERVICES TO SUPPORT QUALITY
AND SAFETY REQUIREMENTS
□ WHO pre-qualification procedures for medical devices
■ ISO standards and WHO performance specifications
El Standardized procedures for alerts, notification and recalls
■ Participation in the work of the Global Harmonization Task Force
□ Standardized assessment protocols for new medical devices
Department of Essential Health Technologies
World Health Organization
Access
TO BE IN PLACE IN COUNTRIES
Access to medical devices is not only about adequate resources. It is about
managing the supply chain from procurement to local distribution. A list of
essential equipment and devices is the keystone of a national system that
can ensure appropriate access. Key elements include:
■ National list of essential medical devices and equipment
□ National procurement procedures
□ Joint procurement of injectable substances and injection devices
□ National policy for acceptance of donations
□ Negotiated pricing
O In country production of essential technologies
WHO PRODUCTS AND SERVICES TO SUPPORT
ACCESS REQUIREMENTS
■ WHO Essential Healthcare Technology package
■ WHO model list of essential medical devices and equipment
□ Procurement guidelines
□ Guidelines on good donation practices
■ Collaboration with industry on fair pricing, R&D and technology transfer
Use
TO BE IN PLACE IN COUNTRIES
Health technologies are only effective if they are used in a safe, appropriate
and cost-effective manner. Key elements include:
■ National guide for management and use of medical devices
□ Standard operating procedures and best practices that cover every stage
in the life span of a medical device
■ Regular training in the management, use and maintenance of medical
devices
□ National recommendations for injection safety and infection control
□ Communication strategy for safe and appropriate use
□ Behaviour change for injection safety and infection control
WHO PRODUCTS AND SERVICES IN SUPPORT
OF USE REQUIREMENTS
H Assistance and tools on the management and rational use of devices
and equipment
■ IEC materials and resource toolboxes
■ Best practices standards
Page 6
Department of Essential Health Technologies
World Health Organization
BLOOD COLD CHAIN
Blood transfusion is an essential therapeutic intervention. We all may
need blood in an emergency, and some of us need regular transfusions.
Safe blood, used correctly, saves lives.
Survey on the status of
Rational blood cold chains
shows poor information
and resources as major
constraints
The blood cold chain is a series of interconnected activities involving
equipment, personnel and processes that are critical for the safe storage and
transportation of blood from collection to transfusion. Like any process, the
chain is only as strong as its weakest link, and a failure of a link will result
in the collapse of the chain. This has potentially fatal consequences for the
recipient of the blood, and is why each link must be carefully maintained.
Blood is collected at body temperature, i.e. 37°C. But in order to maintain its
vital properties, it must be cooled to below 10°C to be transported, and
stored at refrigeration temperatures of around 4°C until use. Hence the term,
blood cold chain. If blood is stored or transported outside of these
temperatures for long, it loses its ability to transport oxygen or carbon
dioxide to and from tissues respectively upon transfusion. Other factors of
serious concern are the risk of bacterial contamination if blood is exposed
to warm temperatures. Conversely, blood exposed to temperatures below
freezing may be damaged, and the transfusion of such blood can be fatal.
not coordinated
50%
Domestic equipment
in use
60%
No preventive
maintenance
in place
Picnic cooler boxes
in use
Scarce information
on BCC
65%
80%
70%
There are many health workers involved in the establishment and
maintenance of the blood cold chain, each playing a vital role to protect
the safety of the blood. They include the managers responsible for procuring
the equipment, implementing quality control systems and the training of all
staff. They also include the many users of the blood cold chain. Among these
are blood donor collection staff, clerks packing the blood bags, drivers
transporting the batches, laboratory technical staff assuring quality control
of the product, engineers and technicians maintaining the equipment, staff
trainers, and hospital clinic staff operating blood warmers and ensuring safe
blood transfusion to the patient.
The major items of blood cold chain equipment for whole blood are
refrigerators and transport boxes. Freezers are also essential for transfusion
centres that store plasma. Other vital devices and accessories include
standby generators and temperature monitors that can be fitted in
refrigerators to warn health personnel as soon as the blood stock approaches
unacceptable temperatures.
Breaks in the cold chain happen for many reasons. Far too often, the
equipment does not meet standards of quality and safety, is unsuitable for
blood storage - common examples are domestic refrigerators and picnic
Page 7
Department of Essential Health Technologies
World Health Organization
boxes, both in wide use in developing countries - or is not properly
maintained or repaired. Preventive maintenance prolongs the life of the
equipment and significantly decreases safety risks, yet many countries still
do not have a cost-effective equipment maintenance programme.
It is estimated that 2% of donated blood is discarded because of a poor blood
cold chain. If a unit of safe blood costs US$40, this means a waste of US$80
for every 100 blood bags donated. Preventive maintenance and more
appropriate use of the equipment will reduce replacement costs by 50%.
Blood donor
03)
Refrigerator
Patient
Domestic refrigerators and picnic boxes - unsuitable for storing blood are still in common use in developing countries
An effective blood cold chain makes blood safer for patients, and reduces
the unnecessary waste of donated blood and scarce financial resources.
Bridging
the Gap:
EHT TOOLKIT
A selection of tools developed by the WHO Department of Essential
Technologies to address country needs for a safe blood cold chain include:
LI Guidelines on management and maintenance systems for cost-effective
blood cold chain programmes
■ International quality standards for all essential equipment in different
environmental settings through collaboration with global organizations
and industry
□ Selection and procurement guidelines on blood cold chain equipment
and accessories, including WHO performance specifications
:..j
Department of Essential
Health Technologies
World Health Organization
Geneva 27. Switzerland
Fax:+4122 791 4836
www.who.int/eht
E-mail: eht@who.int
Page 8
Development of new technologies, such as a carrier especially designed
to transport blood
□ Toolkit for preventive maintenance and care of blood cold chain
equipment
—: Training materials for the appropriate use and preventive maintenance
of equipment
Technology transfer where feasible to improve access to essential
equipment and spare parts
Department of Essential Health Technologies
World Health Organization
WHY
SHOULD WHO BE
INVOLVED
IN TRANSPLANTATION?
Transplantation is a sophisticated and expensive form of treatment requiring
multidisciplinary collaborative work of experts and long-term follow-up.
Transplantation would be seen as the least of WHO priorities had it not an
unrivalled therapeutic effectiveness and had it not given rise to serious
concerns regarding ethics, safety and access at global level.
TRANSPLANTATION, A UNIQUE THERAPEUTIC RESOURCE
Transplantation of human organs, tissue or cells saves many lives and
restores essential functions in circumstances where no medical alternative
of comparable effectiveness exists.
With progress in immunosuppression over the last 15 years, transplantation
has become established as a standard therapy. The shortage of human
material for transplantation, however, is a major and growing limiting
factor. Today, approximately 70 000 solid organs are transplanted annually,
50 000 of these are kidney replacements and more than a third of these occur
in low- or medium-income countries.
Comeal transplantation
Likewise, human tissue transplantation is increasing in both developed
and developing countries. In Europe, hundreds of thousands of tissue
transplants are performed each year and in 1999 an estimated 750 000
United States citizens received human tissue, twice as many as in 1990.
Globally, it is estimated that 120 000 corneal transplantations and 18 000
allogeneic haematopoietic progenitor cell transplantations took place in
the year 2000.
CHALLENGES IN TRANSPLANTATION
Patients' needs for transplantation are far from being met in almost all
countries and all settings. A very important reason for this is an insufficient
supply of human donor material. Procurement practices from deceased
donors have failed to achieve widespread acceptance due to limitations
caused by cultural and religious beliefs, but also by a lack of public infor
mation and education As a consequence there is a trend to rely increasingly
on living donors and an extensive international circulation of tissue for
transplantation has emerged.
jng pc
Page 1
Department of Essential Health Technologies
World Health Organization
■'i’s possibility of using ceils, tissue and organs of animal origin
is explored as a way of overcoming the shortage of human organs/
tissue for transplantation. Clinical trials of xenotransplantation are
currently taking place in several countries. This raises public health
concerns, for example the risk of transmission of known - or
s yet unidentified - animal infections to the public (potentially
worldwide). Recommendations from WHO/OECD consultations in
2301? need to be pursued. For example, there is an urgent need for
regulatory oversight of xenotransplantation trials at the national
revel and tor international cooperation in xenotransplantation
surveillance.
Improvements in immunosuppression have reduced the need for living
donors to be genetically related to the recipient resulting in an increased
reliance on unrelated living donors. This calls for greater attention to
informed and voluntary consent. Remuneration for material of human
origin for transplantation and traffic concerning exploitation of the human
being is growing worldwide. Paying for human organs and tissues leads to
commodification of the human body and entails misuse. Safeguards need to
be established and maintained to ensure that transplantation does not
involve commercialization or exploitation.
Transplantation carries many risks of transmission of pathogens and
diseases. During the last decade several reports have demonstrated
transmission of pathogens previously not identified in the context of
transplantation, including parasites, bacteria, viruses and prions. Safety
measures need to be redefined. Internationally-agreed standards, good
practices and quality management systems are essential to maximize not
only the safety of the recipient but also of the living donor.
The immediate cost and complexity of transplantation have often hindered
its development in countries with limited resources but, in the absence
of transplantation, patients with problems that can be addressed with no
other available technologies are left unattended. Basic transplantation,
such as cornea or kidney transplantation, can be successfully carried out
by countries with limited resources at the national or provincial levels
in reference teaching hospitals.
THE CASE OF KIDNEY TRANSPLANTATION
Department of Essential
Health Technologies
World Health Organization
Geneva 27, Switzerland
Fax: +4122 7914836
www.who.int/eht
E-mail: eht@who.int
Page 2
The estimated global incidence of end-stage renal disease is 1.8 million
persons/year. The ability to correctly identify these patients is rapidly improv
ing in many countries. Kidney transplantation may make sense in countries
with limited health resources for several reasons: epidemiological (younger
patients), technical (simplest organ transplantation procedure, fosters
tertiary health care improvement and collaborative networks in care)
and economic. Indeed kidney transplantation not only yields survival rates
and a quality of life far superior to other treatments for end-stage renal
disease, such as haemodialysis, but is also less costly in the long run. There
is clearly room for progress and better use of health resources.
Department of Essential Health Technologies
World Health Organization
PREVENTION OF
HEALTH CARE-ASSOCIATED HIV
INFECTION
Medical treatment is intended to save life and improve health. For many
patients throughout the world, however, the treatments that are prescribed
to benefit them actually cause them direct harm and may even result in their
deaths.
UNAIDS estimates that, worldwide, there will be 45 million new HIV
infections by 2010 if efforts to fight the pandemic are not stepped up.
Without efforts to scale up the prevention of health care-associated HIV
transmission, up to 4 million of these infections will result from unsafe blood
transfusions, unsafe medical injections and other procedures performed in
the absence of universal precautions.
Further, basic universal precautions are required to protect both patients and
health workers because, as the SARS outbreak demonstrated, health care
facilities become disease amplifiers in the absence of effective infection
control measures. Every new infection will, in turn, contribute to a widening
pool of infection in the general population.
Each health care-associated infection is preventable - and therefore
unacceptable.
[Phoiocfedit] Lysiane Maurice
WHO has launched the 3 by 5 initiative to provide antiretroviral treatment
for three million people living with HIV/AIDS by 2005. The effectiveness of
this strategy will be directly undermined without interventions of proven
effectiveness to prevent the health care-associated transmission of HIV.
Protecting the vulnerable from HIV infection
Page 1
Department of Essential Health Technologies
World Health Organization
PREVENTING HIV TRANSMISSION
DUE TO UNSAFE BLOOD TRANSFUSION
In the absence of any blood safety interventions, up to 300 000 HIV infections
could be transmitted annually through unsafe transfusions in the 34 countries
with the highest burden of HIV/AIDS, given the prevalence of HIV in the
general population (data extrapolated from the WHO Global Database on
Blood Safety, 2000-2001).
The majority of these 34 countries require continuing support to meet
achievable targets for blood safety. Only 8 have blood programmes based
entirely on voluntary non-remunerated blood donation, only 9 achieve 100%
screening of donated blood for HIV and, in the remaining 25 countries, the
regularity and quality of testing is not assured. Many others require similar
support to develop safe blood programmes.
Countries that have implemented well-defined strategies for blood safety
have shown how it is possible to prevent the transmission of infection
through transfusion, including countries with a high seroprevalence of
infection.
Zimbabwe, where 33.4% of the adult population are HIV positive,
faces major challenges in ensuring a safe blood supply. Despite extreme constraints,
the national blood transfusion service's policy to recruit only blood donors
who are at low risk for HIV transmission, coupled with stringent donor selection
procedures, results in only 0.25% of units of blood testing positive for HIV
among regular donors and 0.89% among new donors. These units are discarded
and the donors are excluded from further donation.
The risk of HIV transmission through blood is therefore minimal in Zimbabwe.
The strategies used to ensure blood safety in Zimbabwe could be applied
in every country if sufficient resources were available to ensure that blood
is collected only from donors who are at low risk transmitting HIV, every unit
of donated blood is correctly tested for HIV and blood and blood products are
given safely and only when no alternatives are available.
PREVENTING HIV TRANSMISSION
DUE TO UNSAFE INJECTIONS
In developing and transitional countries, 16 billion health care injections are
administered each year - an average of 3.4 injections per person, per year.
This high figure, along with evaluation reports indicating the inappropriate
use of injections, suggests excessive use of injections to administer
medications. Injections are not only overused, but also unsafe because of
shortages of single use injection equipment. As a result the reuse of
injection devices accounts for about 260 000 new HIV infections in
developing and transitional countries each year (5% of the total).
HIV infections associated with unsafe injections could be prevented if all
injectable substances were supplied with matching quantities of single
use injection equipment.
Page 2
Department of Essential Health Technologies
World Health Organization
in tiie early 1990s, world headlines told of Romanian orphans dying ol AIDS
due to unsafe injection practices. The resulting outcry, both nationally
and internationally, created a high level of awareness about the need for injection
safety. By 1998, 98% of the population were knowledgeable about the risks
of HiV transmission through unsafe injections and the reuse of dirty injection
equipment was eliminated. Injection-associated HIV infection is no longer
reported from Romania.
Simply increasing the availability of safe injection equipment can stimulate
demand and improve practice. Because the cost of safe disposable syringes is low
(less than 5 US cents per unit) when compared to the fee paid for receiving an
injection (50 US cents, on average), patients are usually willing to pay a little extra
for safety once they personalize the risks. In Burkina Faso, a revised supply policy
that increased the availability of disposable injection equipment through
community pharmacies contributed to a 92% decrease in the reuse of non-sterile
equipment without major side-effects in terms of waste management
or injection overuse.
PREVENTING HIV TRANSMISSION
DUE TO UNSAFE HEALTH CARE PROCEDURES
Worldwide, health workers receive an estimated 170 000 exposures to HIV
infection through needlestick injuries each year. These injuries may result in
up to 500 HIV infections, mostly in developing countries. Cleaners, waste
collectors and others involved in handling blood-contaminated items are also
at risk.
Universal precautions are a simple set of effective practices designed to
protect health workers and patients from infection with a range of
pathogens, including bloodborne viruses. They should be followed in the care
of every patient, regardless of their diagnosis and should be applied
universally.
Page 3
Department of Essential Health Technologies
World Health Organization
COST-EFFECTIVE INTERVENTIONS
The prevention of the transmission of HIV infection in health care settings
can be accomplished with only a modest shift in the allocation of resources
because blood safety, injection safety and universal precautions are highly
cost-effective interventions. Some of the poorest countries in the world have
made substantial progress through implementing safe blood strategies,
ensuring that all injectable medications are made available with sufficient
quantities of single-use syringes and needles and training all staff in
universal precautions. A spin-off benefit is that patients are also protected
from infection with other bloodborne pathogens, including hepatitis B virus
and hepatitis C virus.
A failure to prevent health care-associated HIV transmission not only causes
human suffering, but directly increases the number of patients requiring
expensive antiretroviral treatment.
EHT'S RESPONSE
EHT has identified the prevention of health-care associated HIV as a key
initiative that cuts across the work of the department and supports the work
of other WHO departments and agencies such as UNAIDS. In addition to
strengthening its existing activities in blood safety and injection safety, it
will support Member States in developing and implementing comprehensive
national plans for the prevention of health care-associated HIV infection.
Department of Essential
Health Technologies
World Health Organization
Geneva 27, Switzerland
Fax: +4122 7914836
www.who int/eht
E-mail, eht@who.int
Page 4
Department of Essential Health Technologies
ESSENTIAL DIAGNOSTIC
IMAGING
THE DIAGNOSTIC WORK-UP
A systematic and organized approach to a patient leading to a conclusion is
what in medical terms is called a diagnostic work-up. and is a prerequisite
before any medical treatment or intervention can be prescribed.
An incorrect diagnosis, or treatment in the absence of any diagnosis,
can have serious, even fatal consequences for the patient. It is therefore in
the interests of the patient, the medical profession and the general public
that diagnostic conclusions are as correct as possible and that the final
diagnosis is based on adequate and reliable medical and scientific procedures.
In the majority of cases, a diagnosis is based on a combination of "patient
history" and a medical examination without the need for additional
diagnostic procedures. The accuracy of this diagnosis, however, depends on
the knowledge, skills and experience of the person making the judgement,
i.e. the health staff establishing the diagnosis.
CAUSES OF INADEQUATE DIAGNOSIS
Although no reliable documentation exists, it is generally assumed that in some
20%-30% of cases worldwide, clinical considerations alone are not sufficient
to make a correct diagnosis. A child with severe cough and fever, for exam
ple, is often diagnosed to have pneumonia, although an X-ray examination may
uncover information to indicate a different condition and avoid the expensive
and potentially dangerous antibiotics that would otherwise be prescribed
Similarly, sometimes a correct diagnosis is insufficient to prescribe appro
priate treatment. For example, it is normally easy to diagnose a limb fracture
when combining patient history and clinical signs, but it may be difficult to
give proper treatment without an X-ray examination revealing anatomical
details such as the position of fragments, distortion etc.
Why is
a medical diagnosis
necessary?
Medical treatment - and global disease surveillance - depends on
a correct diagnosis. This is nothing more than a summary of the
patient's complaint, objective clinical signs such as fever or pallor,
and physical, social or environmental conditions which may have
an influence on the patient's condition.
WHAT IS DIAGNOSTIC IMAGING?
Diagnostic imaging is a means to take pictures of the structure and
processes in the body and make them visible or "accessible" to the human eye.
Page 1
Department of Essential Health Technologies
World Health Organization
It encompasses the use of so-called ionizing radiation (i.e. X-ray based
examinations including CAT scan (computed tomography), or nuclear medicine
procedures or "scintigraphy"), ultra-sound, magnetic resonance and a few
other highly sophisticated procedures. Practically, however, some 80%-90%
of diagnostic problems can easily be solved using "basic X-ray examinations
and/or ultrasound examinations, regardless of the type of hospital or medical
setting.
Unfortunately, two-thirds of the world's population has no access to this type
of service. When it is available, both the quality and safety of the procedures
may be questionable or even dangerous, both to the patient, the health care
worker and the public.
In general, such conditions are most prominent in low-income countries
with insufficient infrastructure, an unstable political environment and a
considerable burden of disease. This is compounded by the need of these
countries to allocate scarce resources to basic life-saving issues such as the
supply of safe, clean water and nutrition.
Appropriate policies for diagnostic imaging services are therefore rarely seen
as a global health priority, or integrated into the national health plan. National
health authorities are often simply unaware of the problem. On the other hand,
basic diagnostic imaging services are invariably taken for granted in the
modern world, leading to insufficient aid and support being channelled to
diagnostic capacity in the developing world.
WHO'S IMMEDIATE RESPONSE
Increased political and financial awareness from all sides will have a
tremendous impact on the health of all, particularly those in greatest need.
Much could be achieved rapidly and effectively by working with countries to
improve the skills and capacities of those working in difficult conditions, often
using inadequate, old and unreliable equipment in a questionable way. The key
to success is education adapted to local needs.
Estimated needs
for diagnostic imaging
The WHO Team of Diagnostic Imaging, in collaboration with the Global
Steering Group for Education and Training in Diagnostic Imaging, is responding
to immediate needs for improving quality, safety, quantity and equity of
diagnostic imaging services for small and mid-size hospitals in remote areas by:
■ assessing short- and long-term needs
Chest problems
40%
Musculoskelatal
problems
10%
.1 supporting local and regional experts to develop and implement train
■ Accidents
and injuries
j improving medical and technical capacity through centres of excellence
to train trainers according to local needs
trainers programmes adapted to local needs.
20%
S supporting research into the availability of modern technology for
resource-poor settings, such as digital imaging facilities
10%
THE WHO BASIC OPERATIONAL FRAMEWORK
15%
The WHO Department of Essential Health Technologies assists countries
to achieve a safe and reliable level of health services in a variety of health
technologies through its Basic Operational Frameworks.’
■ Abdominal
problems
:■ Pregnency-related
■
problems
Other
5%
Page 2
Department of Essential Health Technologies
World Health Organization
Below is a summary of the requirements for countries to attain this level
of health service for Essential Diagnostic Imaging, and the products and
services that WHO can make available to support this goal.
Diagnostic imaging - the most common and most needed procedures
of which are X-ray and ultrasound examinations - plays a critical role in
surveillance, prevention and diagnosis of disease as well as in monitoring
treatment.
Scaling-up health services in a country implies that essential diagnostic
imaging services are available nationwide. However, countries face major
challenges in achieving this goal. These include weak national systems,
rudimentary procurement and supplies procedures, great disparity between
urban and rural areas, a lack of infrastructure and human resources,
variable quality of laboratory performance and equipment that is either
inappropriate or ill-maintained.
Policy
TO BE IN PLACE IN COUNTRIES
National policies and guidelines related to diagnostics services need to be
based on an assessment of the current situation. Such assessments, or
benchmarking, are largely missing in developing countries. Road maps
for planning, implementation and evaluation of national systems also need
to be developed. Key elements include:
133 Formalization of government commitment to diagnostic imaging services.
□ Development of a national plan to include and implement accreditation.
□ National regulations on radiation protection
■ National staff training programme
■ Commitment of capital and resources to set up, maintain and further
develop nationwide diagnostic imaging services according to local needs.
WHO PRODUCTS AND SERVICES TO SUPPORT POLICY
REQUIREMENTS
M Aide Memoire on Diagnostic Imaging
□ Essential requirements for imaging technology
■ Policy guidelines for diagnostic support for surveillance and treatment
M Tools for assessing diagnostic imaging services
Quality
and safety
TO BE IN PLACE IN COUNTRIES
National systems need to monitor the quality, safety and performance of
diagnostic imaging technologies appropriate for their country.
Key elements include:
H National regulatory authority on radiation protection.
1 The Basic Operational Framework
for Essential Diagnostic Imaging
can be found on the Internet at
n Curricula for radiologists and radiological technologists
■ Harmonized procurement of equipment and consumables, such as films
and chemicals.
wwwwho.int/eht
Page 3
Department of Essential Health Technologies
World Health Organization
■ Regular measurement of laboratory performance against international
standards
■ Establishment, implementation and monitoring of quality control
programmes adapted to local needs and conditions
WHO PRODUCTS AND SERVICES
TO SUPPORT QUALITY AND SAFETY REQUIREMENTS
□ Assessment of the quality of diagnostic technologies
□ Guidelines on establishing a national quality system
□ Training of health care staff in quality and safety standards
Access
TO BE IN PLACE IN COUNTRIES
Access to high quality diagnostic imaging products should be based on an
essential list of services and equipment. Key elements include:
H National policy including support to the management of injuries and
disease according to needs and medical capacity.
□ Nationally negotiated prices through WHO and partner institutions
□ Reliable and timely distribution of equipment and consumables
□ Lightened tax levies on imports of equipment
WHO PRODUCTS AND SERVICES TO SUPPORT
ACCESS REQUIREMENTS
B Guidelines for procurement and supply management systems for
equipment and supplies
□ Essential equipment list for hospitals at various levels
□ Training in equipment maintenance and basic repair
■ Negotiations with industry and guidelines on donations
■ Facilitated technology transfer
■ Training of medical and technical staff according to national guidelines
□ Training in handling equipment safely and appropriately
□ Upgrading medical and diagnostic knowledge of users
Use
Department of Essential
Health Technologies
World Health Organization
Geneva 27. Switzerland
Fax: +4122 7914836
www.who.int/eht
E-mail: eht@who.int
Page 4
TO BE IN PLACE IN COUNTRIES
Insufficient and high turnover of skilled staff is a reality in many countries.
In addition, national curricula for a degree related to diagnostic imaging
services may not be up to date with the rapidly evolving diagnostic
technologies. Continuous training is therefore essential, especially for those
actually carrying out diagnostic imaging activities. Key elements include:
□ National and regional Centres of Excellence for Education and Training
in Diagnostic Imaging
□ Train-the-Trainers programmes adapted to national and local needs
■ Train the users of the equipment and services to increase their medical
and technical knowledge
Department of Essential Health Technologies
EMERGENCY AND SURGICAL PROCEDURES
AT THE
FIRST
REFERRAL
HEALTH
FACILITY
Each year one million people are losing their lives because of road traffic
accidents and more than half a million women are dying from pregnancyrelated complications. In these situations and in many others the ability to
apply the correct emergency clinical procedures at the first referral hospi
tal is vital. Young people between the ages of 15 and 44 years account for
almost 50% of world's injury-related mortality.
Road traffic injuries in men aged 15-44 years constitute the second highest cause
of ill health and premature death worldwide, second only to HIV/AIDS.
For women in low- and middle-income countries, the leading causes of death
are haemorrhage, hypertension, sepsis, abortion and obstructed labour.
Worldwide, 60% of pregnant women and about 43% of children under
5 years of age are anaemic, with the highest estimated prevalence in Africa
and Asia
Estimated needs
for emergency clinical
procedures
Interpersonal
violence
10%
War
6%
■ Other
□ Road traffic injury
Often, these conditions
require life-saving, basic
surgical and anaesthetic
care that cannot be
safely postponed until
the patient can be trans
ferred to a distant level
of health facility.
17%
25%
6%
A LACK OF TRAINED STAFF AND EQUIPMENT
■ Falls
■ Fires
6%
E3 Drowning
E Self-inflicted
violence
9%
Many first referral level (district or rural) health facilities in developing
countries have no specialist surgical teams. The few medical, nursing
and paramedical staff available have to perform a wide range of
clinical procedures, often with inadequate training. Moreover, essential
surgical procedures, such as those to treat fractures, caesarean section,
appendectomy, abdominal and genital trauma, require anaesthesia services.
Poisoning
5%
16%
Page 1
Department of Essential Health Technologies
World Health Organization
Estimated needs
for emergency clinical
procedures: causes of
maternal death worldwide
The quality of essential surgical care is frequently constrained by
inadequate basic equipment to perform simple but vital interventions
such as resuscitation, the provision of oxygen, assessment of anaemia,
suctions, chest drains, airway support, etc. Anaemia is highly prevalent in
developing countries and must be appropriately assessed, as anaemia
lowers a patient's resistance to infection and presents a serious risk during
an operation. Facilities, as well as basic supplies (e.g. gloves, soap, water)
and intravenous fluids are also too frequently lacking.
The fact that the majority of the world's poor live in rural areas with
limited access to these facilities, is a serious challenge to public health.
For example, a recent survey in a developing country found that 75% of
hospitals had an oxygen supply for less than three months of the year.
B Severe bleeding
24%
Infection
15%
□ Unsafe abortion
■ Eclampsia
13%
12%
Obstructed labour
■ Other direct causes
8%
8%
■ Indirect causes
20%
COST EFFECTIVENESS OF ESSENTIAL SURGICAL PROCEDURES
The economic costs and consequences of traffic injuries are enormous. Some
50% of road traffic fatalities worldwide involve the most economically
productive segment of the population, namely young adults. Road casualties
threaten to take up about 25% of hospital beds in developing countries.
Surgical
Care
at the
District
Hospital
Two simple and cost-effective measures can drastically reduce the incidence
of death and disability due to injuries from road traffic accidents, violence,
and complications due to pregnancy. The first measure is to increase the
availability of trained human resources. The training of existing rural
health facility personnel to perform relatively straightforward, life-saving
procedures promptly, safely and appropriately is a crucial element The
second is to ensure that certain inexpensive yet essential equipment is
available at the first referral care facility.
BASIC OPERATIONAL FRAMEWORK
". Indispensable manual
for outlying health centres.'
- Internationa! Federation
of Surgical Colleges
Electronic format: The file is available
at: http://whalibcloc.who.int/
publications/2003/9241 545755 pdf
Page 2
The WHO Department of Essential Health Technologies assists countries
to achieve a safe and reliable level of health services in a variety of health
technologies through its Basic Operational Frameworks. Below is a summary
of the requirements for countries to attain this level of health service for
Surgical Services at the First Referral Level, and the products and services
that WHO can make available to support this goal1
Department of Essential Health Technologies
World Health Organization
The Basic Operational Framework
for Surgical Services at the First
Referral Level can be found on the
Internet at www.who.int/eht
Health personnel at the district or rural health centre are often unable to
carry out essential surgical procedures or emergency care, either because of
untrained staff, or due to inadequate facilities, equipment and supplies or a combination of both. Essential equipment is invariably missing, too
sophisticated for local needs or not functioning due to disrepair or lack of
spare parts
EHT is focusing on two activities that will have a sustainable impact
on the safety and quality of surgical services at the first referral level
Firstly, training to deal safely and promptly with emergency surgical
and anaesthesia care; and secondly a model list of essential emergency
equipment and supplies to enable countries to channel their resources where
they are needed most.
Policy
NEEDED TO BE IN PLACE IN COUNTRIES
A national policy and plan needs to include emergency surgical services
to be carried out at the first level of health care for the population.
Key elements include:
■ National policy and plan for basic requirements for emergency surgical
services.
□ Commitment to education and training of health care providers in
essential procedures for surgery, obstetrics and anaesthesia.
WHO PRODUCTS AND SERVICES
H Aide-Memoire on Essential Surgical Care
□ Needs assessment tools on procedures and equipment safety
Quality
and safety
NEEDED TO BE IN PLACE IN COUNTRIES
To ensure patient safety at all levels, health systems need appropriate
infrastructure, training of health personnel and best practice guidelines
and protocols to monitor and evaluate services and equipment.
Key elements include:
□ Assessment of safety of emergency equipment
□ Assessment of intervention of emergency procedures
□ Standard operating procedures and records
El Monitoring and evaluation of the quality of procedures and equipment
WHO PRODUCTS AND SERVICES
□ Technical cooperation and guidelines for quality systems
□ Tools to monitor and evaluate quality and safety of procedures and
equipment
Page 3
Department of Essential Health Technologies
World Health Organization
Access
NEEDED TO BE IN PLACE IN COUNTRIES
Access to recommendations on basic requirements for essential surgical
services need to be available, as well as guidance on the procurement and
maintenance of essential emergency equipment. Key elements include:
□ Generic list of essential emergency equipment
□ Adequate functioning equipment and trained staff at first referral health
facility
□ Disaster plan for trauma care
WHO PRODUCTS AND SERVICES
□ Generic list of essential equipment for resuscitation, acute care and
emergency anaesthesia at various levels of health facility
□ Guide to procurement and maintenance of equipment
□ Best practice protocols on essential emergency clinical procedures,
oxygen therapy, anaemia, infections, waste disposal
Use
NEEDED TO BE IN PLACE IN COUNTRIES
Continuous education and training on best practices is central to a well
functioning health facility. Effective interventions in the management of
trauma, pregnancy-related complications and anaesthesia will significantly
reduce mortality and morbidity in the rural areas of developing countries.
Key elements include:
□ Training, education and e-learning tools on best practice protocols on
emergency procedures
■ Preventive maintenance of essential equipment
□ Assessmentof impact of training
Surgery at the
District Hospital
WHO PRODUCTS AND SERVICES
□ Comprehensive training manual on Surgical Care at the District Hospital
□ Guidelines on Clinical Use of Oxygen and Essential Trauma Care
■ Tool to detect anaemia in resource-poor settings
□ E-learning tool on best practices and effective interventions for
essential procedures
Publications
■ Training videos on clinical procedures: wound and injuries management,
fractures in adults and children
Department of Essential
Health Technologies
World Health Organization
Geneva 27, Switzerland
Fax:+4122 791 4836
www.who.int/eht
E-mail: eht@who.int
Page 4
Department of Essential Health Technologies
p/3 - 2-'r. /;
- : ini
SK
LABORATORY SERVICES
AT THE DISTRICT
LEVEL
Laboratory services are essential to health care delivery. They address both
preventive and curative activities, i.e. patient diagnosis, and the selection of
drugs for treatment. They are also an indispensable tool in the surveillance
and control of diseases, since improved disease recognition will improve the
accuracy of statistical reporting, and thus effective national health planning.
In countries with limited resources, even rural health facilities can manage
the most common diseases and those with outbreak potential by carrying
out simple laboratory tests.
Regrettably, a lack of adequate diagnostic laboratory services leads to
unnecessary, inappropriate or wrong treatment. This results in longer
hospitalization and/or recovery time. The monetary repercussions of this are
wide ranging, both from the national and the personal perspective.
The underlying causes of a faulty diagnosis are many. One reason is
a general shortage of skilled staff. Other reasons include substandard
infrastructure and facilities, and obsolete laboratory procedures due to lack
of awareness of current advances.
Similarly, modern equipment is ineffective unless staff are trained to use
it, the reagents are affordable and it is properly maintained.
QUALITY MANAGEMENT
Without a quality management programme, the likelihood of a faulty
laboratory result - due to a clerical or technical error - is much greater. In
addition, poor biosafety procedures may cause hazards to both laboratory
staff and the community at large.
Another serious impediment to effective laboratory services is the lack of
sustained financing. Annual government funding is often insufficient to meet
all running costs. Although user fees have been introduced for clinical and
laboratory services at some levels of health care, uncertainties over levels
of funding prevent proper planning. Conversely, opportunities for more
cost-effective running of laboratory services may not be fully investigated.
AN EAST AFRICAN INITIATIVE
One project which is aiming to overcome these problems involves three
countries in East Africa, namely Kenya, Uganda and United Republic of
Tanzania.
Page 1
Department of Essential Health Technologies
World Health Organization
Based on a review of their laboratory services at district level, they drew
up comprehensive National Laboratory Policy Guidelines that address the
administrative structure, essential tests, techniques, equipment, facilities,
staffing, supply systems and training needs.
In each country, a national quality assurance advisory body has been
established, as well as a legal framework to regulate both laboratory
premises and laboratory staff. A standard list of essential laboratory
procedures is supported by generic standard operating procedures for use
in district health services in all four countries.
Key to effective laboratory services are qualified staff. Training on new
laboratory tests and updating skills, including record keeping, good labo
ratory practice, maintenance of equipment and biosafety are envisaged.
Monitoring laboratory performance is another important component,
which includes the training of laboratory inspectors and external quality
assessment of the essential laboratory tests.
The harmonized approach taken by these countries will facilitate the
collection of meaningful data that can be used to monitor the burden
of diseases in the region.
The project has already had a great impact on the quality of laboratory
services and has allowed the countries to achieve goals that would have
been difficult to achieve individually.
Strengthening of laboratory services merits support as it ensures safe and
adequate patient care worldwide.
BASIC OPERATIONAL FRAMEWORK
The WHO Department of Essential Health Technologies assists countries
to achieve a safe and reliable level of health services in a variety of health
technologies through its Basic Operational Frameworks. Below is a summary
of the requirements for countries to attain this level of health service for
laboratory services at the district level, and the products and services that
WHO can make available to support this goal1.
With the scaling up of interventions against the major diseases of poverty
- HIV/AIDS, TB and malaria - the need for diagnostic and laboratory
services has never been greater. These technologies play a critical role in
surveillance, prevention efforts, diagnoses and the monitoring of treatment.
Scaling-up implies that health services are able to deliver essential labo
ratory and diagnostic support nationwide. However, major challenges need
to be faced at country level, including weak national systems, rudimentary
procurement and supply systems, disparity between urban and rural areas,
lack of infrastructure and human resources, the variable quality of laboratory
performance, and equipment that is either inappropriate or ill-maintained.
' The Basic Operational Framework
for Laboratory Services at the
District Level can be found on the
In addition, scarce resources are often used to buy "high-tech” laboratory
equipment that is never used, either because staff are unable to operate it,
or due o lack of affordable reagents or spare parts. Conversely, obsolete and
less rehabie techniques can still be seen, resulting in substandard patient
Internet at www.who.int/eht
Page 2
Department of Essential Health Technologies
World Health Organization
Policy
TO BE IN PLACE IN COUNTRIES
Tools for benchmarking laboratory and diagnostic services will have to
be developed. National policies and guidelines related to laboratory and
diagnostics services may have to be reviewed in light of these tools. Road
maps for planning, implementation and evaluation of national systems will
be developed. Important activities include:
■ Government commitment to laboratory and diagnostic support services.
□ Development of a national plan
■ Registration, regulation /accreditation of laboratory services and staff
■ Capital and resources for a national reference laboratory
■ Establish laboratory networks for monitoring major diseases
□ Professional associations
■ Ensure minimum laboratory infrastructure at national and district level
(at least one central laboratory).
WHO PRODUCTS AND SERVICES TO SUPPORT POLICY
REQUIREMENTS
□ Essential requirements for laboratory technology
■ Policy guidelines for diagnostic support for monitoring HIV/AIDS ARV
therapy
□ National diagnostic testing guidelines
Quality
and safety
TO BE IN PLACE IN COUNTRIES
National systems need to identify the diagnostic reagents, technologies
and equipment that are appropriate for their country. Basic laboratory
procedures and testing strategies for specific markers need to be validated
and standardized at national level. Quality systems are vital at each level
of laboratory services, including mechanisms to monitor the performance
of laboratory and diagnostic services. Key elements are:
□ Mechanisms to assess and validate diagnostic reagents and procedures
□ National Regulatory Authority
□ National Reference Laboratories
■ National guidelines on basic laboratory procedures and testing strategies
■ Quality systems, including standard operating procedures
□ Regular measurement of laboratory performance against international
standards
WHO PRODUCTS AND SERVICES TO SUPPORT QUALITY
AND SAFETY REQUIREMENTS
0 Assessing the quality of diagnostic technologies and laboratory procedures
□ Standard procedures for laboratories
□ Quality management guidelines
H Support to external quality assessment schemes for different laboratory
disciplines
Page 3
Department of Essential Health Technologies
World Health Organization
Access
TO BE IN PLACE IN COUNTRIES
Access to high quality diagnostic and laboratory procedures and equipment
is increased through bulk procurement. Technology transfer and use of local
products should be encouraged. Key elements are:
■ National selection and validation procedures for diagnostics and
equipment
□ Standardized national procurement mechanism
□ Streamlined procurement and distribution channels
■ Negotiated prices through WHO and partner institutions
□ Procurement Committee including all key players
□ Reduced tax levies on imports of diagnostic reagents and equipment
WHO PRODUCTS AND SERVICES TO SUPPORT ACCESS
REQUIREMENTS
■ Guidelines for procurement and supply management systems for
commodities, including donations and technology transfer
□ Essential equipment list for laboratories and diagnostic support
□ Bulk procurement at reduced costs
Use
TO BE IN PLACE IN COUNTRIES
Insufficient and high turnover of skilled staff is a reality in many countries.
Also national curricula for educational degrees related to laboratory
and health care services may not be adapted to the rapid evolution in
diagnostic technologies. Hence there is a continuous need for additional
training. Key elements are:
■ Training of medical and technical staff, including biosafety procedures
□ Clinical use of essential laboratory tests
□ Appropriate use of laboratory technologies and equipment, including
maintenace and quality assurance
WHO PRODUCTS AND SERVICES IN SUPPORT OF USE
REQUIREMENTS
□ Training of medical and technical laboratory staff in basic procedures
□ Training in good laboratory practice and biosafety
Department of Essential
Health Technologies
World Health Organization
Geneva 27, Switzerland
Fax:+41227914836
www.who.int/eht
E-mail: eht@who.int
Page 4
Department of Essential Health Technologies
I",
AND RELATED BIOLOGICALS
Since the middle of the 20'" century, medical science has found ways to
prepare therapeutic products derived from human blood and plasma for the
treatment of many life threatening diseases, as well as for complex surgical
procedures. Blood consists of cells and fluid, or plasma. Plasma contains a
variety of proteins, including albumin, immunoglobulins, clotting factors and
protein inhibitors, which have a wide range of important therapeutic
functions. Processing blood into various types of medicines - or products is a highly complex process because unlike conventional pharmaceutical
products (which are produced and controlled using highly reproducible
physicochemical techniques), blood products and other biologicals are
inherently variable due to the nature of the source materials and the methods
to test them.
An example of a blood product with essential therapeutic characteristics is
anti-haemophilic factor, which is present in large quantities during the
freezing and thawing of plasma, and without which people with haemophilia
would not survive.
VALIDATED QUALITY ASSURANCE SYSTEMS
Blood and plasma screening, along with viral inactivation procedures during
manufacture and strict adherence to Good Manufacturing Practices, are
essential to control the viral safety of blood-derived medical products. With
regard to quality assurance systems, difficulties in comparing biological
activity at the global level require the use of International Biological
Reference Preparations (IBRPs) as essential tools in the validation and
assessment of medical products and in vitro diagnostic tests.
IBRPs serve throughout the world as a source of defined biological
potency expressed in an internationally agreed unit. They are intended
to assist regulatory authorities (national control laboratory authority or
reference laboratories) and manufacturers in the quality control of specific
biological activities and in ensuring the consistency of the production
processes.
More generally, they allow a uniform reporting system, helping physicians
and scientists involved in patient care, regulatory authorities and
manufacturing settings to communicate in a common language.
Page 1
Department of Essential Health Technologies
World Health Organization
A single contaminated
blood donation can spread
infections (HIV, Hepatitis)
throughout the world
Assured quality
Risk
NATIONAL REGULATORY AUTHORITY
Only blood products and related biologicals of demonstrated quality, safety
and efficacy should be used, which is the overall goal of the National
Regulatory Authority (NRA). Yet experience gained from regulatory systems
worldwide indicates that many countries have significant difficulties in
fulfilling their tasks in this field.
NRAs need to be independent with strong political backing and have clear
authority to develop and enforce appropriate regulations. They also need
to interact closely with medical and scientific institutions and civil society
organizations representing health care users and professionals in the
countries.
Unfortunately, National Regulatory Authorities in developing countries often
do not have access to this type of professional structure. When the structure
is available, the technical capacity and expertise may be questionable, or
completely absent.
77 million donations
■ Stringent safety
regulations
61%
i Deficient
regulatory system
34%
B Not tested
5%
WHO activities
(SEE BASIC OPERATIONAL
FRAMEWORK OPPOSITE)
Such conditions are most prominent in unstable political conditions and
where there is a considerable burden of disease. National health authorities
are often unaware of the problem. On the other hand, the lack of development
of appropriate infrastructure is invariably taken for granted in the modern
world, leading to insufficient aid and support being channelled to regulatory
capacity in the developing world. Yet biological products do not respect
national borders.
WHO is responding to immediate needs to improve the quality and
safety of blood products and related biologicals by:
□ assessing short- and long-term needs
□ improving technical capacity of National Regulatory Authorities
□ promoting the development of regional networks of regulatory
authorities, and supporting local and regional experts to
implement Train-the-Trainers programmes
□ providing specific information and International Reference
Materials to assure the compliance of manufacturers to quality
and safety measures.
THE WHO BASIC OPERATIONAL FRAMEWORK
The WHO Department of Essential Health Technologies assists countries
to achieve a safe and reliable level of health services in a variety of health
technologies through its Basic Operational Frameworks. Below is a summary
of the requirements for countries to attain this level of health service for
Blood Products and Related Biologicals, and the tools and standards that
WHO can make available to support this goal'
1 The Basic Operational Framework
for Blood Products and Related
Biologicals can be found on the
Internet at www.who.mt/eht
Page 2
Blood products and related biologicals used as medicines and in vitro
diagnostics in human medicine play a major role in improving and sustaining
health These products require specialized expertise of the National
Regulatory Authority and coordination across national boundaries.
Department of Essential Health Technologies
World Health Organization
The importance of an appropriate regulatory framework to assure the quality
and safety of blood products and related in vitro biological diagnostic
procedures is unanimously recognized. The control of the quality, safety
and consistency of production of these products involves the evaluation of
starting materials, production processes and test methods to characterize
batches of the product.
Policy
TO BE IN PLACE IN COUNTRIES
A regulatory system supported by adequate legislation and independent from
manufacturers is required to ensure that only blood products and related
biologicals of proven quality, safety and efficacy are available in the country,
whether imported or manufactured locally. Key elements include:
■ National Regulatory Authority with a statutory mandate
■ Standard setting and controls
■ Access to independent laboratory facilities
■ Recourse to relevant scientific and medical expertise
■ Adequate human and financial resources
■ Adoption of internationally recognized recommendations and
guidelines
WHO PRODUCTS AND SERVICES TO SUPPORT
POLICY REQUIREMENTS
□ Aide-Mdmoire on National Regulatory Authorities
□ WHO Guidelines on Regulation and Licensing of biological products
■ International Conference of Drug Regulatory Authorities
□ Assessment of regulatory and technical capacity of National Regulatory
Authorities
Quality
and safety
TO BE IN PLACE IN COUNTRIES
The transmission of blood-borne pathogens such as hepatitis and HIV is of
particular concern in the manufacture of human blood plasma products.
Safety of these products depends on validated quality assurance systems.
The growing exchange of products between countries and continents requires
that internationally agreed standards are available. Key elements include:
■ Licensing of products, manufacturers and distributors
■ Adherence to Good Manufacturing Practices from collection of starting
materials to manufacture of final product
■ Regular inspection of production and distribution sites
■ Laboratory testing and/or lot release
■ Assessment of relevant technologies and methods for production and
control
■ Regional/national biological reference materials for standardization of
biological measurements
■ Control of clinical trials
■ Post-marketing safety monitoring
Page 3
Department of Essential Health Technologies
World Health Organization
WHO PRODUCTS AND SERVICES TO SUPPORT
QUALITY AND SAFETY REQUIREMENTS
■ Aide-Mdmoire on Blood Products and related Biologicals
■ WHO Requirements, Guidelines and Recommendations to assess quality
and safety of blood products and in vitro related diagnostic medical
devices
■ Guidelines on Good Manufacturing Practices
■ WHO International Biological Reference Materials (IBRMs) and Reference
Panels for the standardization and quality control
■ WHO Guidelines for safety monitoring of medicinal products
Access
TO BE IN PLACE IN COUNTRIES
The provision of safe and relevant blood products and related biologicals
to meet the needs of populations requires well-designed technical and
economical support. A careful assessment of the clinical needs and a clear
definition of the type of products required for the appropriate diagnosis
and treatment of patients is essential. Key elements include:
■ Consensus guidelines, using evidence-based principles, on product
needs
■ National policy that addresses the clinical needs of the health care
system
■ National policy on donations
■ Oversight through a national authority involving all stakeholders
WHO PRODUCTS AND SERVICES TO SUPPORT
ACCESS REQUIREMENTS
■ Lists of essential medicines and in vitro diagnostic medical devices
■ Fact Sheets on Plasma Contract Fractionation programmes and
regulatory requirements
■ Advice on national strategies for the provision of medicinal products
derived from human blood and plasma
Use
TO BE IN PLACE IN COUNTRIES
Regional and international collaboration of regulatory authorities to protect
consumers from unsafe and ineffective products and biologicals is a priority.
National authorities need to identify areas of weakness, define priorities,
and plan and implement corrective measures. Key elements include:
■ Needs oriented training based on sound technical advice
■ Appropriate dissemination of validated technologies and regulatory
decisions
■ Dissemination of information for access and appropriate use of IBRMs
or national biological reference materials
■ Regional collaboration and inter-country information exchange
Page 4
Department of Essential Health Technologies
World Health Organization
WHO PRODUCTS AND SERVICES TO SUPPORT
REQUIREMENTS FOR USE
■ Technical capacity building through education and training
■ Harmonized international standardization processes and use of validated
technologies
■ Advice on the preparation and calibration of reference materials used
by manufacturers and NRAs
■ Educational regional workshops
Blood Transfusion Safety
Department of Essential
Health Technologies
World Health Organization
Geneva 27, Switzerland
Fax:+41 22 791 4836
www.who.mt/eht
E-mail: bloodsafety@who.mt
Page 5
Department of Essential Health Technologies
Estimated use of red cell
transfusion in developed
countries
BLOOD SAVES LIVES
Every second, someone in the world needs blood. In every country, surgery,
trauma, severe anaemia and complications of pregnancy are among the
clinical conditions that demand blood transfusion.
In countries with advanced medical, diagnostic and laboratory services, a
large proportion of blood is used in sophisticated treatments requiring a high
level of transfusion support, including chemotherapy, open heart surgery,
organ transplantation and the management of haematological disorders such
as leukaemia, thalassaemia and haemophilia.
E Pregnancy-related
6%
Children
3%
Surgery
34%
■ Trauma
7%
Medical
35%
El Haematological
15%
The pattern of blood usage is very different in countries where diagnostic and
treatment options are more limited, with a much greater proportion of
transfusions being given to women with obstetric emergencies and children
suffering from severe anaemia, often resulting from malaria and malnutrition.
Whatever the degree of development of the health care system, transfusion
is the only option for survival for many patients.
Estimated use of red cell
transfusion in developing
countries
■ Pregnancy-related
Children
37%
14%
■ Surgery
12%
Trauma
18%
19%
Medical
A life saved by safe blood
Page 1
Department of Essential Health Technologies
World Health Organization
Blood transfusion is a unique technology in that its collection, processing
and use are scientifically based, but its availability depends on the
extraordinary generosity of people who donate it as the most precious of
gifts-the gift of life.
Therein lies the fundamental challenge: safe transfusion requires not only
the application of science and technology to blood processing and testing.
It also requires social mobilization to promote voluntary blood donation by
sufficient numbers of people who have no infectious diseases that can be
transmitted to the recipients of their blood.
THE PROBLEMS
Many patients do not have access to blood when they need it. Of the
estimated 80 million units of blood donated annually worldwide, only 38%
are collected in the developing world where 82% of the world's population
live. The shortfall has a particular impact on women with complications of
pregnancy, trauma victims and children with severe life-threatening
anaemia. Up to 150 000 pregnancy-related deaths could be avoided each
year through access to safe blood.
Even where sufficient blood is available, many people are exposed to
avoidable, life-threatening risks through the transfusion of unsafe blood.
The risk of acquiring HIV through the transfusion of infected blood is virtually
100%. Blood is also an effective means of transmitting hepatitis B,
hepatitis C, syphilis, malaria and Chagas disease. About 5% of HIV infections
are transmitted by unsafe transfusion as a result of the collection of blood
from unsafe donors, irregular or inadequate supplies of materials to test
blood for infections, poor laboratory testing procedures, inadequately trained
staff, absence of quality systems or unnecessary transfusions
While blood transfusion can be life-saving, many transfusions are given
unnecessarily when the availability and use of simpler, less expensive
treatments would provide equal or greater benefit. Not only does this expose
patients needlessly to the risk of potentially fatal transfusion reactions,
it also widens the gap between supply and demand and contributes
to shortages of blood and blood products for patients who really need
them.
THE COSTS OF UNSAFE BLOOD
Access to safe blood and blood products cannot be achieved without cost.
However, an unsafe or inadequate blood supply is even more costly - in both
human and economic terms.
Morbidity and mortality resulting from the non-availability of blood or the
transfusion of infected blood have a direct impact on individuals and their
families. The transfusion of infected blood also contributes to an ever
widening pool of infection in the general population with far-reaching
consequences for society as a whole. Increased requirements for medical
and social care, the loss of productive labour and higher levels of dependency
place heavy burdens on overstretched health and social services and on
national economies.
Page 2
Department of Essential Health Technologies
World Health Organization
BLOOD SAFETY - A COST-EFFECTIVE INTERVENTION
A unit of safe blood costs an estimated US$40 to produce, including the
recruitment of low-risk blood donors, testing, blood grouping, processing into
components and storage and transportation. Compare this with the cost of
even only one year's antiretroviral treatment for a patient infected with
HIV by transfusion.
An investment in a safe and adequate blood supply is therefore not only a
responsibility of governments, but also a cost-effective investment in the
health and economic wealth of every nation.
The incidence of transfusion-transmitted infection - and its associated costs
-will increase in countries that do not take stringent measures to ensure
blood safety. However, effective national blood transfusion services have
demonstrated how the implementation of the WHO strategy for blood safety
can prevent the transmission of infection and ensure access to safe blood
and blood products for all patients requiring transfusion.
WHO strategy
for blood safety
■ A well-organized, nationally-coordinated blood transfusion
service that can provide adequate and timely supplies of safe
blood for all patients in need
0 The collection of blood only from voluntary non-remunerated
blood donors from low-risk populations
□ Testing of all donated blood for transfusion-transmissible
infections, blood grouping and compatibility testing
□ The appropriate clinical use of blood, including the use of
alternatives to transfusion wherever possible, and the safe
administration of blood and blood products
□ Quality system covering all stages of the transfusion process.
THE BASIC OPERATIONAL FRAMEWORK FOR BLOOD
TRANSFUSION SAFETY
The WHO Department of Essential Health Technologies assists countries
to achieve a safe and reliable level of health services in a variety of health
technologies through its Basic Operational Frameworks. Below is a summary
of the basic requirements for blood transfusion safety and some of the
products and services available from WHO in support of this goal.1
An efficient national blood programme is an essential component of an
effective health system. The critical requirement is access to safe and
clinically effective blood and blood products for all patients requiring
transfusion and their safe and appropriate use.
' The full Basic Operational
Framework is accessible
on the internet at
www who.int/eht/
Page 3
Blood safety depends on the recruitment and retention of blood donors who
are at low risk of transmitting infection, safe blood collection procedures,
correct testing for transfusion-transmissible infections, blood grouping and
compatibility testing and the appropriate use and safe administration of
blood.
Department of Essential Health Technologies
World Health Organization
Policy
REQUIREMENTS
Consistent quality and safety in the provision, prescription and administration
of blood and blood products cannot be achieved where services are
fragmented and uncoordinated. National coordination of the blood
programme is required to ensure uniform standards at all levels and facilitate
economies of scale in testing and processing. Key elements include:
□ National blood policy and plan
□ Legislation and regulation
□ Well-structured blood transfusion service (BTS)
■ Specific budget allocation
□ Standards for blood transfusion services.
WHO PRODUCTS AND SERVICES
■ Strategy for blood transfusion safety
□ Guidelines and recommendations
□ Technical cooperation
□ Collaborations and partnerships in global blood safety
■ Guidelines and software on costing BTSs
□ Promotion of World Blood Donor Day
■ Global Database on Blood Safety
□ National needs assessment tool
□ Tools for evidence-based practice.
Quality
and safety
REQUIREMENTS
The quality and safety of blood provided for patients depends not only on a
national quality system for blood transfusion services, but quality in every
activity. An effective national quality system requires:
□ National quality policy and plan
■ Quality officers at national and local levels
□ Quality standards
□ Documentation system
□ Training of all staff
■ Assessment of the quality system.
Regular, voluntary non-remunerated blood donors from low-risk populations
are the foundation of a safe blood supply. Requirements include:
□ National blood donor programme
■ Identification of low-risk donor populations
■ National criteria for donor selection
□ Safe blood collection procedures
El Donor notification and referral for counselling
□ Donor records.
Page 4
Department of Essential Health Technologies
World Health Organization
All donated blood should be blood grouped and tested for transfusiontransmissible infections (TTI). This requires:
■ National strategy for TTI testing and blood grouping
□ Evaluation and reliable supply of test kits and reagents.
The preparation of high quality blood components requires:
B Sustainable programme that responds to clinical demands
□ Application of good manufacturing practice
All blood and blood products must be stored and transported correctly to
prevent bacterial contamination and maintain viability. This requires:
0 Specialized storage and transportation equipment
□ Regular monitoring and maintenance of equipment.
WHO PRODUCTS AND SERVICES
□ Advocacy documents, recommendations and learning materials
□ Training courses
S Regional quality networks
□ External Quality Assessment Schemes
S Guidelines, screening strategies, selection criteria and evaluation of test
kits
Access
The provision of safe blood and blood products requires an appropriate
infrastructure and an adequate and reliable supply of reagents and test kits.
Trained staff and continuing professional development are a prerequisite.
Provision should be made for a rapid response to emerging infections,
emergency situations and post-disaster reconstruction.
WHO PRODUCTS AND SERVICES
El Advocacy documents, recommendations and learning materials
□ Test kit bulk procurement schemes
Use
Blood and blood products should be prescribed only to treat serious or life
threatening conditions that cannot be prevented or managed effectively by
other means. The appropriate clinical use of blood requires:
3 National policy and guidelines on transfusion
□ Training of all staff involved in transfusion
□ Availability of alternatives to transfusion
□ Hospital transfusion committees
□ Blood request form
E3 Blood ordering schedule
□ System for monitoring transfusion practice.
Page 5
Department of Essential Health Technologies
World Health Organization
The safe administration of blood and blood products prevents avoidable
transfusion reactions. This requires:
■ Standard operating procedures for bedside transfusion
■ Training in bedside transfusion
□ Haemovigilance system for monitoring, reporting and investigating
adverse events associated with transfusion.
WHO PRODUCTS AND SERVICES
□ Advocacy documents, recommendations and learning materials
□ Training courses.
Blood Transfusion Safety
Department of Essential
Health Technologies
World Health Organization
Geneva 27. Switzerland
Fax: +4122 731 4836
www.who.int/eht
E-mail: bloodsafety@who.int
Page 6
Department of Essential Health Technologies
World Health Organization
s.
INFORMATION TECHNOLOGY
IN SUPPORT OF HEALTH CARE
The need for new ways to providing more efficient health care services,
coupled with major advancements in information and communications
technology have resulted in the increased use of the Information and
Communications Technology (ICT) applications over the past decade.
ICT in general, and the Internet in particular, can help generate the
human capital needed by the health systems. ICT has the potential to
revolutionize the way medicine is learned by students and healthcare
professionals
Its role is one of providing support to the human resources generation
function by facilitating initial training and continuing education processes
in some form -improving access, increasing effectiveness, lowering costs,
etc. A study of health telematics projects in fifteen European countries,
undertaken by the European Health Telematics Observatory (EHTO) shows
that training had a 6% share of all health telematics uses.
WHAT iS HEALTH TELEMATICS?
Health Telematics is a composite term for health-related activities, services
and systems, carried out over a distance by means of information and
communications technologies, for the purposes of global health promotion,
disease control, and health care, as well as education, management, and
research for health
WHAT IS E-HEALTH?
E-health is the combined use in the health sector of electronic communi
cation and information technology (digital data transmitted, stored and
retrieved electronically) for clinical, education and administrative purposes,
both at the local site and at a distance.
WHAT IS TELEMEDICINE?
The delivery of health care services, where distance is a critical factor,
by health care professionals using information and communications
technologies for the exchange of valid information for diagnosis, treatment
and prevention of disease and injuries, research and evaluation, and for
the continuing education of health care providers, all in the interest of
advancing the health of individuals and their communities.
Page 1
Department of Essential Health Technologies
World Health Organization
Key Actors in Health
Telematics in Europe
Source: The European Health
Telematics Observatory, IEHTO)
ICT activities in the area of telemedicine will be carried out in close
collaboration with the Evidence for Information and Policy Cluster.
E-Health/Telemedicine should be directed by health needs and not driven by
technology. This would be the case for EHT since it would be concentrated
to support countries request E-Health/Telemedicine has to be supported
by various categories of stakeholders from the health sector as well as
from industry. The situation in Europe is illustrative. There, health telematics
activities are driven by a broad spectrum of individual and institutional actors
- hospitals (34%), telephone utilities (14%), academic institutions (12%),
clinicians (12%), governments (7%) and social services (4%).
In spite of the potential that E-Health/Telemedicine has given the world to
improve the quality of health care, a number of barriers, at various levels,
would need to be overcome for health systems to take full advantage
of these opportunities. These barriers are not uni-dimensional, focusing on
technical knowledge as previously thought, but rather a multi-dimensional
construct, encompassing technical knowledge, economic viability, organi
zational support and behaviour modification.
EHT/IT translates material practices, guidelines, protocols and E-learning
tools, for health promotion and disease prevention, in areas such as,
Diagnostic Imaging, Laboratory disciplines, Medical Devices and equipment,
District Surgery, Blood Transfusion Safety, HIV/AIDS Diagnosis, and Trans
plantation Services.
An important role for WHO/EHT is to continuously monitor developments
in relevant fields and countries' readiness for Telehealth, and advise
Member States as to when it is most opportune to introduce such services.
EDUCATION AND TRAINING
EHT/IT aims to assist countries by providing evidence-based policy guidance
on human resources development with particular focus on increasing global
migration of health professionals
EHT/IT plans and manages the delivery of information technology and
telecommunications services, to support the basic operational frameworks.1
ITC/EHT TOOLS:
Internet development:
EHT Website, rich ICT tool that enhances access to EHT products and
activities.
Multimedia Development:
ICT management for the development of the appropriate package format of
the standards, guidelines and training materials.
E-health/Telemedicine
Development:
The availability of e-health to facilitate medical care, irrespective of
distance and availability of medical specialists in site make it attractive
to the health care sector.
1 Department Essential
Health Technologies,
http://www. who. int/eht
contact us: eht@who.int,
Fax.+ 4122 7914836
Page 2
Monitoring developments will also enable the Organization to address
changes in health care delivery systems in the future, which will be brought
about by developments in information and communication technologies,
especially in support to developing countries and countries in transition,
for which these developments will represent disruptive changes
Department of Essential Health Technologies
BASIC OPERATIONAL FRAMEWORK
WHO DEPARTMENT OF ESSENTIAL HEALTH TECHNOLOGIES
E-HEALTH FOR HEALTH CARE DELIVERY
COUNTRY REVIEW
REQUIREMENTS
THEME
HBV I Yes I
1
IN PLACE
No | In, progress | HUHMI
WHO PRODUCTS AND SERVICES
|
Requested
POLICY
1.1
National coordination of e-health services
1.1.2
National policy
National e-health plan
1.1.3
Legal framework for protection and transfer of patient data
1.1.4
National E-health committee
1.1.5
Education Programmes
Inventory of applications
1.1.1
Aide-Memoire for e-health for healt-care delivery.
Guidelines: Minimum requirements for e-health services
Legal Issues
1.1.6
1.2
E-health for emergencies
1.2.1 I Emergency respondness proper plan
[Guidelines: Minimum requirenebts for an emergency responsiveness plan.
J
1.3 Adequate resources
1.3.1 Financial
1.3.1a Fiscal allocation
1.3.1b Cost recovery
1.3.2
1.3.2a
1.3.3
Technical resources
Adequate functioning equipment
Adequate number of trained staff
Date: 2004-05-17
Completed by:
1
BASIC OPERATIONAL FRAMEWORK
WHO DEPARTMENT OF ESSENTIAL HEALTH TECHNOLOGIES
E-HEALTH FOR HEALTH CARE DELIVERY
COUNTRY REVIEW
THEME
COUNTRY LEVEL
2
WHO PRODUCTS AND SERVICES
IN PLACE
REQUIREMENTS
1 Yes 1
No
|
.
1
progress
|
■
In
QUALITY AND SAFETY
2.1
Standards for Patient Care Information Systems’ (PCIS)
2.1.1
Hospital Information Systems (HIS)
Report on Review of existing standarisation efforts in EU/World, for HIS.
2.1.2
Electronic Patient Record (EPR)
Open Source Reference; Implementation plus tooling of an electronic health
record (EHR), based on International Open Standards
Smart Cards. Guidelines on developing and implementing a smart cards
system
Patient Information Systems (PIS)
Physician Order Entry (POE)
2.1.5 Decision-Support Technique (DST)
2.1.6 Medication System
2.1.7 General Practitioner Information Systems (GPIS)
2.1.8 Data Warehouse
2.1.9 Training of all staff
2.1.10 Quality assessment system
Documentation system for all processes
2.1.11 Security
2.1.3
2.1.4
2.2
Quality aspects of e-health (Patient safety and Information security)
Standards for Telematics services
2.2.1
2.2.2
2.2.3
2.2.4
2.2.5
2.2.6
2.2.7
2.2.8
2.2.9
National strategy for Telematics services
A country feasibility study on telemedicine
Telemedicine, tele-education, telematics for health research and
telematics for health services management
Working description of the techniques
Organizational and human capacities
Technical Issues
Health technology assesment
Testing of all donated blood units
Good Telemedicine practice
Guidelines: Basic steps in Telemedicine
A country feasibility study on e-Health
Study Report
Decision trees for patient self-management of Chronic diseases
Guidelines in e-referral
Guidelines in training material on problem-solving
2
BASIC OPERATIONAL FRAMEWORK
WHO DEPARTMENT OF ESSENTIAL HEALTH TECHNOLOGIES
E-HEALTH FOR HEALTH CARE DELIVERY
COUNTRY REVIEW
IN PLACE
No | In progress |
REQUIREMENTS
THEME
COUNTRY LEVEL
3
WHO PRODUCTS AND SERVICES
IRequested
ACCESS
Connectivity
3.1
3.1.1
_______ I
E-mail
3.1.2
Internet
3.1.3
3.1.4
Connnections
3.1.6
Video Equipment
Computers
Smart cards
3.1.7
3.1.8
Specific hardware for PCIS
Distance learning for trained professional and health workers
3.1.5
Sotfware and Hardware Standards
3.2
3.2.1
3.2.2
E-readiness
Basic standards for technology readiness
3.2.3
3.2.4
Guidelines on adherence to technology standards
Protocols for hardware
3.2.5
3.2.6
3.2.7
Protocols for software
Standards and guidelines of open sources software
Benchmarking and comparative studies
3.2.8
3.2.9
Technology transfer and investment protocols
Computing manufacturing
3.2.10
Development and production of component chips
3.2.11
3.2.12
Encryption
Public software style standards
3.2.13
Guidelines on policies for licensing and reimbursement
___ I
3
BASIC OPERATIONAL FRAMEWORK
WHO DEPARTMENT OF ESSENTIAL HEALTH TECHNOLOGIES
E-HEALTH FOR HEALTH CARE DELIVERY
COUNTRY REVIEW
REQUIREMENTS
THEME
COUNTRY LEVEL
4
| Yes I
IN PLACE
No | In progress |
WHO PRODUCTS AND SERVICES
Requested
|
USE
4.1. Appropriate Technical Use of e-health services
4.1.1
National policy and guidelines on e-health
4.1.2
Training of health care workers involved in e-health
4.1.3
E-based patient tracking and recording
4.1.4
Patient demographics
4.1.5
4.1.7
ADT events
Diagnosis
Radiological images and Laboratory results
4.1.8
e-referral
4.1.6
*2 Store and forward image exchange
4.2.1
Tele radiology
4.2.2
Tele ultrasound
4.2.3
Tele clinical physiology
4.2.4
Tele pathology
Tele laboratories
4.2.5
I 43 Title Tele consultation
4.3.1
Dermatology
4.3.2
Pediatrics
4.3.3
Densitometry
Psychiatry
Surgery including laparoscopy
4.3.4
4.3.5
4.3.6
4.3.7
4.3.8
4.3.9
Cardiology
Psychiatry
Decision trees for patient self management of chronic diseases
Tele conferencing
4.3.10 Distance learning
4.4 Title
e-learning
4.4.1
Laboratory
4.4.2
Diagnostic Imaging
4.4.3
Blood Safety and Clinical Technology
Injection Safety
4.4.4
4.4.5
4.4.6
http://www.who.int/eht/Resource_Centre.htm
Surgical Care and Transplantation
Medical devices
4
-seventh World Health Assembly
Technical Briefing on...
e-Health
e-Health for Health-care Delivery and Education
Friday, 21 May 2004 at 13:00 hrs
Room XII Palais des Nations Unies
Geneva, Switzerland
IH £
e-Health
e-Health is the use, in the health sector, of digital data that is transmitted,
stored and retrieved electronically in support of health care, both at the local site
and at a distance. It encompasses three main areas:
B Information for health promotion and awareness, medical education, health
and biomedical research, evidence-based medicine and e-learning
n Information for health information systems, monitoring and evaluation, including,
disease surveillance, health statistics, and management information systems
■ Information for health-care delivery and electronic patients' records, including,
diagnosis, treatment, consultation and telemedicine applications
II
e-Health for care delivery and education
Over the last decade, the need to develop and organize new ways of providing
efficient health-care services has been accompanied by major advancements
in information and communications technology (ICT). This has resulted in a dramatic
increase in the use of ICT applications in health care, collectively known as e-Health.
Today the integration of e-Health into the everyday life of health-care workers is
becoming a reality in developing as well as developed countries.
e-Health has a tremendous potential of strengthening primary health care by taking
medical services to rural and isolated areas where access to trained medical human
resources including medical specialists may be extremely limited. When adequately
used, applications like telemedicine and electronic patient records are highly
cost-effective. They can render travels unnecessary and may effectively break
professional isolation.
1113
Effective education including public information on important health issues is another
application where e-Health can drastically increase outreach. The Health Academy
recently launched by WHO, is a virtual school of public health which harnesses
technology, health information, and education for the good of human development.
Its aim is to reach people all over the world and give them the knowledge and knowhow they need to protect and improve their health and environment.
Directed at the entire community, the Health Academy illustrates essential
public health functions in a language people can easily understand. It creates public
awareness of how individuals, families, and communities can benefit from progress
in medicine, public health, environmental health, sanitation, and management.
The purpose of the proposed technical briefing is to present current WHO initiatives
in e-Health for health-care delivery and education.
For more
information
Irma Velazquez
Direct Tel: +41 S3 731 46 87
Information Technology Officer
Operator: +41 22 791 21 11
Department of Essential Health Technologies
World Health Organization
BQ. avenue Appia
CH -1311 Geneva 27 Switzerland
Fsx;
+41 22 731 46 36
E-mail:
velazquezi®who.int
http://www.who.int/eht
CHOosinq Interventions that are Cost Effective
WHO-CHOICE
www.who.int/evidence/cea
Health interventions (completed analyses)
Background information
Population-level analysis in 14 epidemiological
sub-regions of intervention costs (measured in
international dollars), effects (measured in
DALYs averted) and cost-effectiveness (cost
per DALY averted) for the following risk
factors/diseases have been completed:
•
General description of WHO-CHOICE
•
Background papers and published
guidelines/journal articles detailing WHOCHOICE methodologies & results
•
demography: population size, mortality and
birth rates by region
•
Unit costs for inpatient, outpatient and
health centre care (by region)
•
Prices of traded and non-traded goods (by
region) for estimating programme and
patient costs
•
•
•
•
•
•
•
•
•
•
Costlt: An adapted package designed to
record and analyse intervention costs
PopMod: A software tool used for
evaluating population-level effectiveness
of interventions
MCLeague: A software program that
estimates uncertainty around costs and
effects
Contextualizotion tool: A software
program for use by country analysts to
convert regional results to country level
estimates. (Available soon)
Unsafe water, sanitation and hygiene,
indoor air pollution
Childhood undernutrition
Iron deficiency
Cardiovascular disease risk factors
Addictions: Heavy alcohol use; Tobacco
Unsafe sex
Unsafe use of injections in health care
biseases (data available soon)
Estimated resource requirements for
programmeand patient costs
Analytical tools
•
•
Health state valuations (between 0-1,
where 1 is healthy) for time spent in
different states of health or disease
•
Risk factor-s
»
•
•
•
•
•
•
•
•
HIV
Tuberculosis
Malaria
Vaccine preventable diseases in childhood
Maternal health (e.g. safe delivery)
Mental health (schizophrenia; depression)
Blindness
Diabetes and cardiovascular disease
treatments
•
Cancers
Diseases (planned)
•
•
•
•
Chronic lung disease
Road traffic accidents
Newborn diseases
Sensory disorders
•
And more....
WHO-CHOICE e-mail address:
'
whochoice@who.int
________
pneumonia and diarrhoea. Maternal and newborn disor
WHO-CHOICE approach’. Uniquely, this met^l
ders, malaria, tuberculosis, vaccine preventable diseases
are soon to be added, and work is ongoing in other areas
including cancers, cardiovascular diseases, injuries, and
allows existing and new interventions to be analysed at the
same time. Previous cost-effectiveness analyses have been
restricted to assessing the efficiency of adding a single new
intervention to the existing set, or replacing one existing
intervention with an alternative. Using WHO-CHOICE, the
analyst is no longer constrained by what is already being
done, and policymakers can revisit and revise past choices
if necessary and feasible. They will have a rational basis for
deciding to reallocate resources between interventions to
achieve social objectives.
diabetes.
Can analysts adapt the estimates to their own
SETTINGS?
Regional databases represent a compromise between a
single global database, that is not applicable locally, and
the ideal of a separate database for each country, which is
not feasible in the short run. However, WHO-CHOICE will
provide information allowing analysts to modify the results
of the regional databases to their country.
WHO-CHOICE allows comparison of current interventions
together with interventions being contemplated for imple
mentation. It takes into account, from the health system's
perspective, synergies between interventions on costs and
effectiveness.
The databases include the raw cost and effectiveness data,
as well as the method and calculations that were used to
obtain the summary cost-effectiveness ratios. The costing
template accompanying all interventions uses an ingredi
ents approach ■ quantities of resources used and prices are
recorded separately. Effectiveness data is presented in a
similarly transparent format. Analysts from different coun
tries will be able to modify any of the base assumptions to
make them consistent With their own settings.
How WILL THE RESULTS HELP POLICY-MAKERS?
The WHO-CHOICE databases should not be used in a for
mulaic way. They will reveal a menu of interventions that
are cost-effective in each region, a menu of interventions
that are not cost-effective, and another menu of interven
tions in between. Policy-makers would then assess the
appropriate mix for their settings, taking into account other
goals of the health system as well as the improvement of
population health. WHO will work closely with policy-mak
ers on ways of using the evidence WHO-CHOICE produces
to achieve social goals.
WHO-CHOICE initiative has developed computer-based
tools that are available for use by analysts.
✓ PopMod, is a population model used for measuring
intervention effectiveness in terms of comparable
units across different types of interventions and dis
eases.
✓ The MCLeague, program presents the cost-effective
The databases on the cost-effectiveness ratios, together
with the methodology, software programs and raw data
sets will be made available on the Internet. The databases
are also expected to guide recommendations coming from
within WHO and will be offered as a resource to policy
makers who request technical assistance in these areas.
ness results in a stochastic league table, i.e. explicitly
taking into account uncertainty surrounding cost and
effectiveness estimates of many interventions at the
same time.
✓ Cost-lt, is used to analyse and report cost data.
1
For further details visit: http://www.who.int/evidence/cea
or contact: whochoice@who.int
What other benefits does WHO-CHOICE offer?
Generalized cost-effectiveness analysis forms the basis of
World Health Organization
‘ Murray C|L et al. (2000) Development of WHO Guidelines on Generalized Cost-
Effectiveness Analysis. Health Economics 9(3): 235-51.
Improving Health System Performance
WHO-CHOICE
CHOosing Interventions that are Cost-Effective
I
i
Evidence and Information for Policy
Global Programme on Evidence for Health Policy
Choosing Interventions:
Effectiveness, Quality, Costs, Gender and Ethics (EQC)
Why is cost-effectiveness analysis important?
Health systems have multiple goals, but the fundamental
reason they exist is to improve health. Yet health systems
with very similar levels of health expenditure per capita
show wide variations in population health outcomes. Part
of these differences can be explained by variation in non
health system factors, such as the level of education of the
population. But part can also be explained by the fact that
some systems devote resources to expensive interventions
with small effects on population health, while, at the same
time low cost interventions with potentially greater benefits
are not fully implemented.
Cost-effectiveness analysis (CEA) is one tool decision-mak
ers can use to assess and potentially improve the perform
ance of their health systems. It indicates which interven
tions provide the highest "value for money" and helps pol
icy-makers choose the interventions and programmes
which maximize health for the available resources.
CEA requires information on:
costs, impact on population health and cost-effec^^
ness of key health interventions. This work known as
WHO-CHOICE started in 1998 with the development of
standard tools and methods' and is now in the phase of
collecting and analysing the necessary data on costs and
outcomes.
The objectives ofWHO-CHOICE are to:
✓ develop a standardized method for cost-effectiveness
analysis that can be applied to all interventions in dif
ferent settings;
✓ develop and disseminate tools required to assess
intervention costs and impacts at the population level;
✓ determine the costs and effectiveness of a wide range
of health interventions, presented with probabilistic
uncertainty analysis;
✓ summarize the results in regional databases that will
be available on the Internet;
✓ assist policy-makers and other stakeholders to inter
pret and use the evidence.
✓ the extent to which current and potential interventions
Why is it necessary to compare a wide variety of
improve population health, i.e. effectiveness '
✓ the resources required to implement the interven
health interventions?
tions, i.e. costs.
The impact of interventions on population health is vital.
But it is also important to determine the role of different
interventions in contributing to other socially desirable
goals, such as reducing health inequalities, and being
responsive to the legitimate expectations of the popula
tion.
Policy-makers are concerned with two questions requiring
evidence on costs and effects:
“Do the resources currently devoted to health achieve as
much as they could?"
To answer this question, the costs and effects of all inter
ventions currently employed must be compared with the
costs and effects of alternatives. Reallocating resources
from inefficient to efficient interventions can increase
population health with no change in costs.
What is WHO doing?
WHO seeks to provide the evidence decision-makers need
to set priorities and improve the performance of their
health systems. The Global Programme on Evidence for
Health Policy (GPE) is assembling regional databases on
1 An intervention is defined as any action whose primary intent is to improve health.
This definition incorporates disease specific actions and integrated care. It covers
prevention and health promotion as well as curative care. It incorporates some inter
sectoral actions such as the provision of seat belts in cars - the primary purpose of
which is to maintain health.
"How best to use additional resources if they become avail
able?"
This type of analysis is critical for ensuring that as soci
eties become wealthier, additional resources are well
used. But it is pointless asking this type of question if
the current mix of interventions is inefficient - both ques
tions need to be asked together.
2 Documentation available in: Making Choices in Health: WHO Guide to Cost-
Effectiveness Analysis published by WHO in 2003.
WHO-CHOICE permits both questions to be asked and
both types of analyses to be undertaken simultaneously.
Why do we need regional databases on interVENTION COST-EFFECTIVENESS?
The pioneering effort of the World Bank's Health Sector
Priorities Review (HSPR) encouraged policy-makers to
incorporate evidence on the costs and effects of interven
tions into their decision-making. The HSPR focused on a
limited number of interventions, the individual studies
used different methodologies, and estimates of cost-effec
tiveness were produced only on a global basis. This made
it difficult for country policy-makers to decide if the results
across interventions were comparable, and if they were rel
evant to their settings.
Epidemiology, baseline levels of infrastructure, the history
of disease control and health promotion, and cost struc
tures vary across countries. So the costs and effectiveness
of any health intervention will vary from one setting to the
next. Consequently, a single "global average" estimate for
an intervention's cost-effectiveness is not of great value to
decision-makers. However, the ideal of specific estimates
for each intervention in every setting is not achievable in
the short run. As a compromise, WHO-CHOICE is pro
ducing databases reporting the costs and effectiveness of
interventions for 14 subregions that have been grouped
together on the basis of epidemiology, infrastructure and
economic situation.
WHO-CHOICE has assembled regional databases on costs
and population effectiveness of approximately 250+ health
interventions using a standardized methodology. The inter
ventions range from preventive to rehabilitative, from indi
vidual to packaged, from those addressing infectious to
non-communicable diseases, including risk factors.
Currently, the regional databases provide information on
the cost-effectiveness of interventions targeting tobacco
and heavy alcohol use, unsafe sex, lack of safe water and
proper hygiene, indoor air pollution, hypertension, obesity,
high cholesterol, physical inactivity, unsafe health care
practices, mental disorders, childhood undernutrition,
Let's Change the World Together - Invest in eLearning
THE HEALTH
ACADEMY
eAcademy for Knowledge. Know-how and Technology
World Health Organization
© World Health Organization 2004
All rights reserved.
The designations employed and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps rep
resent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or rec
ommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors
and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
The World Health Organization does not warrant that the information contained in this publication is complete and cor
rect and shall not be liable for any damages incurred as a result of its use.
For more information contact:
Dr Marc Karam
Director Office of the Assistant Director-General
External Relations and Governing Bodies
World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland
Facsimile: +4122 791 47 06
Emaihkaramm^ who.int
Concept and Design
Prepress and Printing
Design Frame Egypt
Raidy Printing Press
THE PRINCIPLES OF THE HEALTH ACADEMY
• The Health Academy is in keeping with the concept of eHealth as the backbone for the re-engineering of
health systems, with citizens at the centre
• It will not duplicate the effective efforts of others in health education. It offers a new approach to learning,
which will complement other ongoing actions
• It will bring information, technology, education and health together, in the form of eLearning, to create
awareness and convey pertinent basic health knowledge in a language that everyone can understand
• It addresses the problem of the knowledge divide, provides solutions, and takes effective action to bring
health and technology to those most in need
• It promotes equality, whether based on gender, nationality, culture, or education
• It operates on the principle that people can improve their lives when provided with the necessary skills,
knowledge, and access to health information
• The Health Academy embodies that the privileged few have a responsibility to assist the less privileged
£
THE MISSION
The Health Academy is about investing in people. It has a
commitment to provide information on health to all, in order to
prevent ill health and to alleviate suffering. It is a vision of how to
harness technology, health information, and education for the
good of human development
Its aim is to reach people in all walks of life, especially those
living in remote areas, and give them the knowledge they need to
protect and improve their health and environment. It is directed at
the entire community, the young and the old, the strong and the.
weak. It illustrates essential public health functions in the language
of the people.
It creates public awareness of how individuals, families, and
communities can benefit from progress in medicine, public health,
environmental health, sanitation, and management. It will share
knowledge so that individuals and communities may become
more self-reliant in tackling their health problems in their own
context.
This will bring untold benefits to the population as information
II'
“The Health Academy provides unprecedented opportunities for effective
health promotion through people-centred partnerships. It is more than just
education; it is a means to influence attitudes and behaviour towards
a healthier Ijfestyle, which in turn may help reduce gaps between prosperity
and poverty and health and sickness.
• Director-General, World Health Organization
OUR HEALTH
eHEALTH FOR ALL
Access to informatioi
is a universal value that transcends culture and class
that has taken on nev
be
the Internet as a basic tool for learning.
,at
at the heart of human development. In an age where
... ...___ ..... L... .. ..______________
gender, income or age.
ims of i
and d
The Health Academy promote
.
countries to existing and futureafiI
has been enormous pr
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Information and Communication Teel
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THE MISSION
The Health Academy is about investing in people. It has a
commitment to provide information on health to all, in order to
prevent ill health and to alleviate suffering. It is a vision of how to
harness technology, health information, and education for the
good of human development.
Its aim is to reach people in all walks of life, especially those
living in remote areas, and give them the knowledge they needjtpi
protect and improve their health and environmi
lirected at
the entire community, the young and the old,
weak. It illustrates essential public health functions in tl
iaSe
of the people.
It creates public awareness of how individuals, fa
communities can benefit from progress in medicine, pi
environmental health, sanitation, and management I
dll share
knowledge so that individuals and communities m
become
more self-reliant in tackling their health problems in
leir own
context.
This will bring untold benefits to the population as information
technology is a major educational and economic engine.
Productivity will increase as a result of less school days and works
days lost due to ill health, and the standard of living, which is
directly correlated, will increase.
‘‘The Health Academy provides unprecedented opportunities for effective
health promotion through people-centred partnerships. It is more than just
educatipn; it is a means to influence attitudes and behaviour towards
a healthier lifestyle, which in turn may help reduce gaps between prosperity
and poverty an
ealth and sickness.'
ector-General, World Health Organization
OUR HEALTH
eHEALTH FOR ALL
Access to information has been a deep-seated problem
Health is a universal value that transcends culture and class,
that has taken on new importance with the emergence of
and is considered by the World Health Organization to be
the Internet as a basic tool for learning. It is crucial that
at the heart of human development. In an age where
technology is available to everyone, regardless of race,
gender, income or age.
information travels at its fastest ever, but where many
remain victims of ill-health and disease, spreading awareness
The Health Academy promotes sustainable access by all
countries to existing and future health technologies. There
has been enormous progress and success during the past
and
educating
communities
and
individuals
on
life
sustaining approaches to health is of the utmost priority.
20 years in the field of Information and Communication
The opportunity to enjoy the highest attainable standard of
Technologies with unexpected opportunities for private
health has been enshrined in the World Health Organization's
and public collaboration, including in the health domain.
Constitution for more than half a century. Yet today, an
The integration of these technologies into the daily life
intolerable burden of illness still afflicts a large part of the
of citizens depends on many factors. However, this is
world's population. For millions of people around the world,
already occurring in many regions of the world.
particularly in the poorest segments of society, the reality is
In less
developed countries, completely new eHealth solutions,
based on satellite, on mobile means of communication,
one of rampant disease, aggravated by poverty and lack
of health knowledge. On the other hand, it is quite obvious
and other developing technologies, offer new opportuni
ties for public health and health care delivery.
Information and Communication Technologies will induce
fundamental changes in all the facets of health and will induce
a more citizen-centred, personalised health delivery system.
that development,
economic growth,
stability,
human
dignity, and the fulfilment of human rights will only be
achieved when people are given the opportunity to live
healthy lives.
“All development starts with human development”
Abdellatif Youssef AL-HAMAD,
Director-General and Chairman of the Board,
The Arab Fund for Economic and Social Development
GLOBALIZATION
PARTNERS
Globalization has shrunk the world, but not completely, and
The Health Academy has a worldwide vision and is a model
not evenly. There are still many parts of the world that are
of a new method of working in the Information Society
difficult to access at any time and many more areas during
with a strong commitment from national authorities. It coF
the rainy season or wintertime. In addition, many rural
laborates with other organizations, public and private, to
populations do not have the same services and facilities as
fulfil its mission.
urban dwellers.
Thus, there is still much to be done to
connect populations.
WHO has initiated the pilot phase of the Health Academy
with Cisco Systems, Inc, a specialist technology company.
Building upon what has already been put in place, and
especially in network infrastructure and provision of images
what is planned to be done, the Health Academy will reach
and products, as its main technology partner. Other part
out to communities to bring the knowledge and know how
ners include the International Telecommunication Union
needed for them to be able to lead a more healthy and
and The Geneva Foundation for Diseases of the Tropics.
productive life.
Although this will take time to become
diffused over the existing networks, it will expand as the
technology reaches more people, and will promote the
extension of Information and Communication Technologies
to the remotest corners of the earth.
“The information was short and brief but it got to the point
and the main idea was right there in front of you. You learn
from your own mistakes and you learn at your own pace,
I did not have to wait for any body else to catch up.”
Ali
A 14-year old school boy from Kuwait
A VISION IN LINE WITH THE MILLENNIUM
A NEW APPROACH TO LEARNING
DEVELOPMENT GOALS
The Health Academy strengthens both education and
In September 2000, the United Nation's General
health. In keeping with the efforts to provide universal pri
Assembly adopted the Millennium Development Goals, a
mary education for all, it will transform the role of teachers
set of time-bound and measurable targets for combating
into that of mentors, and guide users through their educa
the most pressing perils of our time.
tional experiences rather than directing their learning.
The Millennium Development Goals enjoin countries
It transforms learners from passive recipients of informa
to unite to combat poverty, illiteracy, hunger, lack of
tion to active participants in knowledge acquisition. Using
education, gender discrimination, child and maternal
eLearning technology it reduces the time it takes learners to
mortality, disease and environmental degradation. They
understand and grasp contents, through a multimedia pres
are a challenge to the world community to hasten the
entation of information. Thus, much more subject matter
pace of development.
The World Health Organization has risen to the
can be presented to a user in the same amount of time
challenge in many aspects of its work. One of these, the
ceed at their own pace, without sacrificing the amount of
Health
material covered. Equal educational opportunities for all, at
Academy,
targets
all
sectors
of
society,
particularly the underprivileged, especially in remote
allotted to classroom learning. In addition, users can pro
the individual’s own tempo.
areas. It makes available information on health to all, in
By following these eLearning courses, it is expected that
a language and in a manner that is easily grasped in a
people will have quickly acquired sufficient health informa
short space of time and which is straightforward to
tion to enable them to adopt a healthier life-style and the
implement.
younger generation, to develop attitudes conducive to
health promotion. It is anticipated that the digital divide will
have been bridged with respect to health and that individ
ual families and the whole community will have benefited
“Technology has the power to change the lives of people in
poorer parts of the world, giving access to education, health
and commerce, and transforming living standards and the
economic prosperity of developing nations.”
John CHAMBERS
CEO. Cisco Systems, Inc.
12
eLEARNING
CONNECTING CULTURES
The eLearning technology used by the Health Academy is
By making health information accessible, people will have
not simply distance learning. Its essential feature is rela
the opportunity to attain a safe, healthy, and productive
tional learning, that is, it allows the learner to construct by
lifestyle. It should also stimulate a dialogue between the
oneself, from first principles, the very essence of what is
public, medical professionals and policy makers. The Health
being taught and to consolidate vital relationships between
Academy especially takes into consideration individual cul
each building block. This approach helps to develop critical
tural sensitivities. With its globally spread educational net
thinking and enhances concentration capacities. Recall of
works, it will connect people from different nationalities
material is facilitated by the reinforcement of the written
and cultures. Such enhanced global interaction will lead to
word with active listening. The content of the courses is
an exchange of knowledge and cultural customs that can
exciting to both educators and users, as it is a truly inter
engender a global society that is rich in its diversity and
active mix of different media technologies.
united in its humanity.
A VIRTUAL SCHOOL OF PUBLIC HEALTH
WHO's information resources and expertise in
health issues, as well as its worldwide access to
health information in all countries, is the main
source of validated health content for the Health
Academy. The combined focus of everyone
involved, equals a library of knowledge and
decades of experience.
A web-based health reference system is key to achieve our
strategy
Web-based health reference system
13
“We need to renew the fundamental commitment to equity
expressed by “Health for All”: the Health Academy will con
tribute by empowering people to become more healthy and
more active participants of the global society we live
in today.”
Dr Hussein A. GEZAIRY,
Regional Director for the Eastern Mediterranean
World Health Organization
REDUCING GLOBAL HEALTH INEQUITIES
COURSE DEVELOPMENT
Health is determined more by educating people to make
The
informed decisions about their lives. The Health Academy
eLearning courses for the Health Academy has been care
strives to reduce global health inequities by accelerating
fully formulated and tested. Courses are developed to
complete
process
for designing
and
the development, deployment and sustainability of health
meet the needs of countries and clusters of countries
information interventions that will save lives and signifi
according to their health problems. The World Health
cantly diminish the disease burden in developing coun
Organization consults the World's specialists in the various
tries. It will enhance the visibility of valuable public health
subjects and, together with its own specialists, develops
approaches and promote public health leadership.
the course content based on the most currently available
THE PILOT PROJECT
Academy processes the content in a form suitable for
The Health Academy is being piloted in schools in the Arab
eLearning and translates it into the six official languages.
information, evidence and best practices
The Health
Republic of Egypt and in the Hashemite Kingdom of Jordan.
It is then adapted, where necessary, to be acceptable in
All types of schools in the countries, and both genders in the
local cultures. This is validated by the World Health
age range 12 to 18 years, are included.
Organization's education and community health special
This is providing a very valuable practical experience in
testing the materials and the processes of the Health
Academy. The eLearning courses have been developed in
both English and Arabic. The outcome from this pilot
study will be used to guide the extension of the Health
Academy both in the country and beyond, to other parts
of the world.
14
producing
ists prior to being developed into eLearning courses that
can be accessed through the Internet.
ENDLESS POSSIBILITIES
Wherever there is a need for transfer of knowledge
and know-how and to change attitudes and behaviour
given the resources, the Health Academy could be the
vehicle to accomplish this in the fields of health,
human development, environmental sustainability and
management.
As
new
knowledge
and
evidence
emerge, it is in the enviable position that it can rapid
ly disseminate this new information widely to the peo
ple. Its potential is limitless.
"The Health Academy has been created to bring
information technology and health together as a
viable strategy to enhance the well being of individu
als in all societies across the globe. It will provide free
dom of thought, freedom of expression and empower
the people to take charge of their own health. We
have a responsibility to see this technology in the pub
lic domain. By providing sufficient information of the
right type and quality in the right way to help people
lead a more healthy and creative life will make the
world a better place to live in for our children and our
children's children." Dr Kazem Behbehani, Assistant
Director-General, World Health Organization.
-L
. ;s
been completed <md are be.ng used in t iglish
Ail the Way to the Blood Bank
.'i:.1 AiD.s <s shatienng young peoples opportunities 01 nea.tny adult tees and tn<: r*(xj:iC'
AiOliu..
X .!•,•<. ted to i t;' young people who offer the greatest hope for changing the course of the epidemic.
donuti.ip
-
d
bes the vark
compoi
'
■
■'
■
rtance o
id. lists the most common diseases that can be transmitted by blood, in particular HIV.
and explains wno is suitable to donate blood.
b_e_ informedL_
'iht cteath rates on the reads a-e high and are growing daily. This course enipo-.'
)ote safe behaviour on the roads for a*’ users, driveis as v#?i: as {Ledest:i?ns in this
behaviour or whole communities will ue changed The learners may tlian advocate
environments where road traffic ci
World Health Organization
5.Central Bureau of Health Intelligence System
(CBHI)__________________________________________
Information Systems for E-Health
Developed by the
5^/ Regional Office for South-East Asia
Objectives
Provide ready information on various health indicators for India,
which are of great significance to planners, policy-makers, health
administrators and research workers.
Target Users
CBHI, Ministry of Health and Family Welfare, Government of India.
Information Systems for E-Health
Salient Features
•
Online data collection from different sources at different
administrative levels.
Health statistical data available from 1991 to 1999 from the
publication "Health Information of India" organized into various
sections such as Population Statistics, Vital Statistics, Socio
Economic Indicators, Pattern of Investment and Expenditure on
Health etc.
1.
SEARO Integrated Data Analysis System
(SIDAS)
3.
Tuberculosis Programme Information
System (TPIS)
4.
Surveillance Project Management
System (SPMS)
Analytical and graphic presentation and dissemination of
information through reports available over web.
•
Electronic archival and retrieval of documents including
scanning and indexing.
Health Telematics System (HTS)
2.
Area of Work
Evidence for Health Policy
5. Centra! Bureau of Health Intelligence
System (CBHI)
Business Owner
CBHI, Ministry of Health and Family Welfare,
Government of India
6. National Institute of Communicable
Diseases (NICD)
Architecture
Web based n-tier application
Technology Platform
6.National Institute of Communicable Diseases
(NICD)__________________________________________
Web based applications
Development Environment
ASP 2.0 / 3.0, VB script and Javascript
Objectives
Promote and facilitate exchange and dissemination of
on communicable diseases surveillance in India.
Application Server
information
Target Users
NICD, Ministry of Health and Family Welfare, Government of India.
Salient Features
•
Online (Web-based user interface) and offline (MS-WORD
d templates) modes to collect the data relating to
municable diseases surveillance from field officers.
Analytical and graphic presentation and dissemination of
information.
Electronic archival and retrieval of documents including
scanning and indexing .
•
Electronic community building using discussion forum.
Area of Work
Communicable Diseases Surveillance
Business Owner
NICD, Ministry of Health and Family Welfare, Government of India
Architecture
Web based n-tier application
IIS 4.0/5.0 ,COM Components, Crystal Report 8.0, SMTP
Services, MS Office 97/2000, ASPMAP 2.0
Database Server
MS SQL Server 7.0
Client-Server applications
Development Environment
Power Builder 6.5/ Visual Basic 6.0, VBA, COM
Components, Crystal Report 8.0, MS Outlook 2000/XP,
MS Word 97/2000/XP
Database Server
MS SQL Server 7.0
Contact
Ms.Jyotsna Chikersal
Head, Information & Communication Technology
Informatics Systems Management Unit
Email: ChikersalJ@whosea.org
World Health Organization
Regional Office for South-East Asia
New Delhi, India
Telephone : 91-11-23370804
Fax : 91-11-23370197,9395
___________ Website : www.whosea.org______
3.Tuberculosis Programme Information System
(TPIS)
1. Health Telematics System (HTS)
Objectives
Facilitate the delivery of health care services by health care
professionals using Information and Communications Technology
(ICT) for the exchange of information for diagnosis, treatment and
prevention of disease.
Target Users
Medical practitioners and health professional in Member States of
WHO's South-East Asia Region.
Salient Features
•
Objectives
Promote and facilitate the exchange and dissemination of
information on Tuberculosis Programme In India.
Target Users
Revised National Tuberculosis Control Programme (RNTCP),
Ministry of Health and Family Welfare, Government of India.
Salient Features
• Online (Web-based GUI) and offline (MS-WORD-based
templates) modes to collect data from field officers.
Enables secure exchange of information and suggestions on
patients and on diagnosis between medical practitioners and
health professionals using MS-Outlook e-mail client.
•
Analytical and graphic presentation and dissemination of
information.
•
Allows medical practitioners to consult other health
professionals regarding history, provisional diagnosis, clinical
information and laboratory test results of patient.
Tracking transfer of TB patients from one treatment unit to
another In accordance with the guidelines for DOTS
implementation programme in India.
•
Facilitates sending documents and reports such as X-ray and
ultrasound reports.
Centralized drug inventory maintenance using on-line drugs
requisition and approval by Central TB Division (CTD) in the
Ministry of Health.
•
Enables recipient to respond to queries.
•
Enables archival of relevant information in the database for future
reference.
•
Enables full text
Online submission of budget by State TB Officers (STO)/
District TB Officers (DTO) and allocation of finance by CTD.
Automatic feedback on technical reports submitted online by
STO and DTO In India.
& criteria-based search of archived information.
Area of Work
&
Organization of Health Services
Business Owner
[»
L 1
Electronic archival and retrieval of documents including
scanning and Indexing.
Electronic community building using discussion forum, bulletin
board and web-based e-mall services.
Health Systems
Architecture
Client Server 2-tier application
• Back-office application for system administration.
Area of Work
Tuberculosis
2.SEARO Integrated Data Analysis System (SIDAS)
Business Owner
Central TB Division (CTD), Ministry of Health and Family Welfare,
Government of India
Objectives
Architecture :Web based n-tier application
A single integrated tool for surveillance, collection, analysis and
dissemination of data using indicators and to take advantages of
synergies between programmes, avoiding duplication of work.
Target Users
All Technical Programmes in the Regional Office for South-East
Asia and WHO country offices.
Salient Features
• Data collection using online (Web-based GUI) and offline
(MS-WORD-based templates) modes.
Data input for any available administrative levels for desired
periodicities.
4.Surveillance Project Management System (SPMS)
bin
... .................................................................. ■
,■ r.r............... .....
1 Objectives
j Enhance transparency and access to accounting data of Polio
Project and improved management reporting.
Target Users
National Polio Surveillance Project (NPSP), India, Regional
Coordinators (RC)s and Surveillance Medical Officers (SMOsl^P
Salient Features
•
Online data collection such as monthly cash books, Online
accumulation and validation of data entered by Surveillance
Medical Officers (SMOs) as per business rules defined in the
system.
•
Analytical presentation of data.
•
Electronic archival and retrieval of documents Including scanning
and Indexing.
Maintaining hierarchy of indicators organized into groups and
sub-groups up to any level.
Further segregation of Indicators based on categories .
Analysis of data on the basis of infrastructural sources.
•
Presentation of data through analytical reports, charts & maps.
Area of Work
Communicable Diseases Surveillance
Business Owner
Director, Communicable Diseases (CDS)
Architecture
Web based 3-tier application
Electronic community building using discussion forum, bulletin
board and web-based e-mail services.
Area of Work
Immunization and Vaccine Development
Business Owner
NPSP, India
Architecture: Web based n-tier application
I
A tiny heart is not beating the way
it should be. Worry, waiting and
the child and the family.
With the
telemedicine
service for trans
mission of heart
sounds, we can
help to provide
easier access
to the health
service, better
conditions for
the patient
and family,
shorter waiting
time and less
travelling.
Excellent Health Services Available to AIT
<u
E
cu
Norwegian Centre for Telemedicine
University Hospital of North Norway
Norwegian Centre
for Telemedicine
Norwegian Centre for Telemedicine
(Nasjonalt senter for telemedisin, NST)
aims to provide research, development
and consulting in telemedicine, and to
promote the introduction of telemedicine
services in practice.
The target groups are decision-makers,
groups of patients, health practitioners
and industry. Our primary task is to
serve the public Norwegian health
service, but we also aim to serve
public- and private-sector organizations in
Norway and abroad.
As a non-commercial part of Norway’s
health sector, our task is to focus
on democratic values such as equality,
participation and quality of care.
Research
The Norwegian Centre for Telemedicine at the
University Hospital of North Norway conducts inter
disciplinary research in all aspects of telemedicine, since
the different aspects of telemedicine are so closely inter
linked. Research takes place both in the form of projects
commissioned by authorities and on our own initiative.
Several professors and PhD students in discplines
including medicine, educational science and informatics are
associated with rhe centre.
Research topics include:
o Factors that encourage and that hamper the use of
telemedicine
o The clinical quality of telemedicine services
o The need for telemedicine
|
o Using the Internet to promote health
o Telemedicine in the home
o Organizational changes resulting from telemedicine
Issues in health economics associated with
telemedicine
o Evaluation and documentation of the use of
telemedicine
o New technologies
o Legal issues
Telemedicine Services
Telemedicine services can contribute to:
° Making specialist services available locally, and improving their efficiency
o Making health services available directly from the patient s home
° Providing faster treatment for patients
Information on all medical conditions that can
be documented using sound or images can be
transmitted via PCs in a network or via video
conferencing. The Northern Norwegian Health
Network (Nordnorsk helsenett) has developed a
closed and secure network for the distribution
of telemedicine sendees in the health sector. The
NST has developed several of the services that are
available in this network.
The primary care doctor or nurse can send
questions by e-mail to a specialist. Files with sound,
images or video can be transmitted as attach
ments. Specialists can use the information to make a
diagnosis, assess the need for closer examination
by' a specialist, or follow up patients with known
diagnoses. The primary care doctor or nurse
receives an answer to the enquiry via e-mail. Tele
medicine is also useful for doctors who want to con
sult colleagues in cases where there is uncertainty
about rhe diagnosis or treatment.
Sounds of the heart
A digital stethoscope is used to record the sound
of the patient’s heart. The primary' care doctor
sends the recording via e-mail to a cardiologist. The
specialist can analyse the sound and assess whether
the patient should be admitted to hospital for further
investigation.
Telemedicine:
“Telemedicine is the investigation, monitoring and
management of patients and the education of
patients and staff using systems which allow ready
access to expert advice and patient information no
matter where the patient or relevant information is
located."
(Advanced Informatics in Medicine 1991)
Examination of the optic fundus
Diabetes can cause blindness. For most patients,
their sight can be saved if laser treatment is
undertaken at an early stage. Patients are offered
examinations of the fundus every' year to check the
retina for changes. Specially trained nurses take
images of the eye, which they' send via e-mail to a
specialist at the hospital.
Ear, nose and throat conditions
Primary’ care doctors who have patients with
ear, nose or throat conditions can use special
equipment at their offices to take images of the area
affected by' the condition. The images are sent to an
otorhinolaryngologist for evaluation. Images can
also be transmitted viaa videoconferencing link. The
primary care doctor, the patient and the specialist are
present at the same time, and can communicate
directly with each other.
Dermatological conditions
Images of dermatological conditions and lesions
are transmitted via videoconferencing or e-mail for
specialist assessment. With the use ofe-mail, it is not
necessary for the patient, the primary' care doctor
and specialist to be present at the same time.
Teaching and continuing
professional education
The NST has organized distance education using
videoconferencing since 1994, and has considerable
experience in this form of teaching. The centre is
currently developing Web-based distance education
services. We offer expertise in:
■ Using the technology to optimize learning
• Setting up studios
• Selection of technical equipment
• Training in the use of videoconferencing
equipment
Telepathology
A pathologist examines and diagnoses a tissue
sample under a microscope while the patient is
under anaesthesia. The operation is concluded
on the basis of the pathologist’s diagnosis. Tele
pathology makes it possible to transmit live images
of tissue specimens using videoconferencing and
a remote-controlled microscope. In this way, a
hospital without its own pathologist obtains
immediate access to a frozen section service, and
the health staff can receive professional support.
The concept was developed and established in
North Norway more than 10 years ago, as the first
service of its type in the world. At present, 10
hospitals in Norway have access to this online
service, and 22 hospitals have installed advanced
workstations for telepathology.
Teleradiology
Teieradiology is the electronic production, storage
and transmission of X-ray images. The Radiology
Department at the University Hospital of North
Norway is a pioneer in the development of digital
radiology services, and now uses only digital images
in assessment and diagnosis.
All doctors’ offices and hospitals linked to the
Northern Norwegian Health Network have access
to radiology services from the university hospital.
Helse 0st, the Eastern Norway Regional Health
Authority, has also developed effective teleradiological services.
Professional network
Together with partners from commerce and
industry, the NST has developed professional
networks for various medical professions.
Examples include a network for pathology and the
Eyenet (0yenett), a collaborative application for
ophthalmologists. This Web-based solution includes
a case archive as well as functions to allow
consultations among colleagues, discussion and
Web conferences. The purpose of the professional
network is to improve and ensure the quality of
health services by enabling closer professional links
between specialists.
Teledialysis
Teledialysis provides dialysis patients in remote
locations in Finnmark county with the same
possibilities for treatment as patients in the
Tromso region. Via videoconferencing, patients
and nurses at the dialysis stations in Finnmark can
communicate directly with specialists and nurses
in Tromso. All data from the dialysis is transmitted
electronically to the University Hospital of North
Norway. Improved follow-up and monitoring helps
to reduce rhe risk of complications and hospital
admissions, and to integrate dialysis nurses in rural
areas into the broader professional environment.
Collaboration
Consulting Services
The NST exists for the Norwegian State health service,
and collaborates mainly with partners from this sector.
However, we also work together with other public- and
private-sector institutions in Norway and abroad, and
contribute to business development and product
development in telemedicine. The NST has been
designated World Health Organization Collaborating
Centre for Telemedicine.
The NST has long experience in telemedicine, and we arc
happy to provide consulting services in connection with
the development, implementation and quality assurance of
telemedicine services.
The NST’s partners
and sources of funding:
° Norwegian government agencies
o Health organizations and institutions in the five
Norwegian health regions
A Patients and other users of telemedicine.
o Doctors, nurses and social care workers in the primary
health care sector
o Universities and colleges
o The Research Council of Norway
o The Norwegian Industrial and Regional Development
Fund (SND)
o The Programme for Innovation and Technology in
Northern Norway
o The Executive Committee for Northern Norway
(Landsdelsutvalget)
o The National Centre for Emergency Communication
in Health (KoKom) and the Norwegian Centre for
Medical Informatics (KITH)
o Other institutions in research and development,
commerce and industry
The NST receives funding from the public sector to
l^vide consulting services to Government departments
and authorities. The centre also seeks funding for various
collaborative projects from Norwegian and international
organizations.
In cooperation with the NST, industrial partners can:
o contribute to total solutions for remote diagnosis
and treatment, for example, mobile units, portable
telemedicine kits, services in electronic health
networks, applications for use at home, and
applications for the Norwegian Armed Forces and
the maritime sector.
c carry out development, testing and quality assurance
of their own solutions in cooperation with the NST
o transform ideas and solutions developed by or in
cooperation with the NST into commercial products
The NST provides a meeting place for service providers,
users product developers and suppliers to share their
experience, develop new ideas and build networks.
The NST provides advice about all aspects of tele
medicine, and has developed information packages about
the individual services developed at the centre. We also
have our own staffwho can assist with implementation and
training.
The NST’s expertise
o
o
o
o
o
o
o
o
Needs analysis
Specification of requirements and design
Choice of technical solutions
Development, testing and maintenance
Legal, medical and financial assessments
Studies of patient and user satisfaction
Implementing telemedicine
Security
The NST’s expertise is in international demand. For
several years we have undertaken consulting outside
Norway. The centre has conducted pilot studies in
countries such as Botswana, Greenland, Sri Lanka, Kyrgyz
Republic and Nepal, and has collaborated in the
development of services, research and teaching in north
west Russia for almost 10 years.
In cooperation with the Norwegian Armed Forces, the
NST will contribute to a health intranet, mobile units
and satellite-based telemedicine. The NST will also under
take a survey of requirements, cost-benefit analyses and
telemedicine applications for training and information
activities for the Armed Forces.
ian Centre for Telemedicine
Through telemedicine, the NST aims to contribute to excellent and effective
health services that are equally accessible to everyone who needs them.
Development The NST will develop telemedicine services that can be applied in practice.
Research
The NST will obtain knowledge about telemedicine that can be applied in practice.
Distribution
The NST will contribute to wide-scale adoption of telemedicine services by the
Norwegian health service.
Consulting
The NST is a resource centre for everyone who seeks cooperation, knowledge and
support in telemedicine in Norway and abroad.
The NST’s expertise is available without charge to the public Norwegian health sector
The NST’s expertise can be shared with non-profit organizations
The NST’s expertise can be exported to a global market
The NST organizes courses and conferences in telemedicine.
Visit our Web site www.telcmed.no for updated information.
Norwegian Centre for Telemedicine
University Hospital of North Norway
P.O. Box 35
9038 Tromso
NORWAY
Telephone: +47 77 75 40 00
Fax: +47 77 75 40 98
post@telemed.no
www.telemed.no
A tiny heart is not beating the way
it should be. Worry, waiting and
ital visits lie in store for both
the child and the family
■
With the
telemedicine
service for trans
mission of heart
sounds, we can
help to provide
easier access
to the health
service, better
conditions for
VI
the patient
and family,
shorter waiting
time and less
travelling.
Excellent Health Services Available to All
. orwegian Cenire for Telemedicine
University Hospital of North Norway
Norwegian Centre
for Telemedicine
Norwegian Centre for Telemedicine
(Nasjonalt senter for telemedisin, NST)
aims to provide research, development
and consulting in telemedicine, and to
Research
The Norwegian Centre for Telemedicine at the
University Hospital of North Norway conducts inter
disciplinary research in all aspects of telemedicine, since
the different aspects of telemedicine are so closely inter
linked. Research takes place both in the form of projects
commissioned by authorities and on our own initiative.
Several professors and PhD students in discplines
including medicine, educational science and informatics arc
associated with the centre.
promote the introduction of telemedicine
services in practice.
The target groups are decision-makers,
groups of patients, health practitioners
and industry. Our primary task is to
serve the public Norwegian health
service, but we also aim to serve
public- and private-sector organizations in
Norway and abroad.
As a non-commercial part of Norway’s
health sector, our task is to focus
on democratic values such as equality,
participation and quality of care.
Research topics include:
o Factors that encourage and that hamper the use of
telemedicine
o The clinical quality of telemedicine services
o The need for telemedicine
(
o Using the 1 nternet to promote health
o Telemedicine in the home
o Organizational changes resulting from telemedicine
Issues in health economics associated with
telemedicine
o Evaluation and documentation of the use of
telemedicine
o New technologies
o Legal issues
Telemedicine Services
Telemedicine services can contribute to:
• Making specialist services available locally, and improving their efficiency
• Making health services available directly from the patient’s home
° Providing faster treatment for patients
Information on all medical conditions that can
be documented using sound or images can be
transmitted via PCs in a network or via video
conferencing. The Northern Norwegian Health
Network (Nordnorsk helsenett) has developed a
closed and secure network for the distribution
of telemedicine services in the health sector. The
NST has developed several of the services that are
available in this network.
The primary care doctor or nurse can send
questions by e-mail to a specialist. Files with sound,
images or video can be transmitted as attach
ments. Specialists can use the information to make a
diagnosis, assess the need for closer examination
by a specialist, or follow up patients with known
diagnoses. The primary care doctor or nurse
receives an answer to the enquiry via e-mail. Tele
medicine is also useful for doctors who want to con
sult colleagues in cases where there is uncertainty
about the diagnosis or treatment.
Sounds of the heart
A digital stethoscope is used to record the sound
of the patient’s heart. The primary care doctor
sends the recording via e-mail to a cardiologist. The
specialist can analyse the sound and assess whether
the patient should be admitted to hospital for further
investigation.
Examination of the optic fundus
Diabetes can cause blindness. For most patients,
their sight can be saved if laser treatment is
undertaken at an early stage. Patients are offered
examinations of the fundus every year to check the
retina for changes. Specially trained nurses take
images of the eye, which they send via e-mail to a
specialist at the hospital.
Ear, nose and throat conditions
Primary care doctors who have patients with
ear, nose or throat conditions can use special
equipment at their offices to take images of the area
affected by the condition. The images are sent to an
otorhinolaryngologist for evaluation. Images can
also be transmitted via a videoconferencing link.The
primary care doctor, thepatientand the specialistare
present at the same time, and can communicate
directly with each other.
Dermatological conditions
Images of dermatological conditions and lesions
are transmitted via videoconferencing or e-mail for
specialist assessment. With the use of e-mail, it is not
necessary for the patient, the primary care doctor
and specialist to be present at the same time.
Ear examination
Telemedicine:
"Telemedicine is the investigation, monitoring and
management of patients and the education of
patients and staff using systems which allow ready
access to expert advice and patient information no
matter where the patient or relevant information is
located."
(Advanced Informatics in Medicine 1991)
Teaching and continuing
professional education
The NST has organized distance education using
videoconferencing since 1994, and has considerable
experience in this form of teaching. The centre is
currently developing Web-based distance education
services. We offer expertise in:
■ Using the technology to optimize learning
• Setting up studios
• Selection of technical equipment
• Training in the use of videoconferencing
equipment
Telepathology
A pathologist examines and diagnoses a tissue
sample under a microscope while the patient is
under anaesthesia. The operation is concluded
on the basis of the pathologist’s diagnosis. Tele
pathology makes it possible to transmit live images
of tissue specimens using videoconferencing and
a remote-controlled microscope. In this way, a
hospital without its own pathologist obtains
immediate access to a frozen section service, and
the health staff can receive professional support.
The concept was developed and established in
North Norway more than 10 years ago, as the first
service of its type in the world. At present, 10
hospitals in Norway have access to this online
service, and 22 hospitals have installed advanced
workstations for telepathology.
Teleradiology
Teleradiologj- is the electronic production, storage
and transmission of X-ray images. The Radiology
Department at the University Hospital of North
Norway is a pioneer in the development of digital
radiology services, and now uses only digital images
in assessment and diagnosis.
All doctors’ offices and hospitals linked to the
Northern Norwegian Health Network have access
to radiology services from the university hospital.
Helse Ost, the Eastern Norway Regional Health
Authority, has also developed effective teleradiological services.
Professional network
Together with partners from commerce and
industry, the NST has developed professional
networks for various medical professions.
Examples include a network for pathology and the
Eyenet (Oyenett), a collaborative application for
ophthalmologists. This Web-based solution includes
a case archive as well as functions to allow
consultations among colleagues, discussion and
Web conferences. The purpose of the professional
network is to improve and ensure the quality of
health services by enabling closer professional links
between specialists.
Teledialysis
Teledialysis provides dialysis patients in remote
locations in Finnmark county with the same
possibilities for treatment as patients in the
Tromso region. Via videoconferencing, patients
and nurses at the dialysis stations in Finnmark can
communicate directly with specialists and nurses
in Tromso. All data from the dialysis is transmitted
electronically to the University Hospital of North
Norway. Improved follow-up and monitoring helps
to reduce the risk of complications and hospital
admissions, and to integrate dialysis nurses in rural
areas into the broader professional environment.
Examples of Current Activities
www.helseutdanning.no
The NSTis working together with business and industry to develop the Web sitewww.helscutdanning.no.
1 he project is supported by the Norwegian Industrial and Regional Development Fund and the
Ministry of Health. The multimedia Web site gathers information and presents details of the health
education programmes available in Norway. It is also intended for patients and their families as well
as people with a general interest in health.
Maritime Telemedicine
The NST is assessing the requirements for maritime telemedicine in cooperation with several relevant
organizations in shipping and emergency communication services. The objective is to develop health
services for sailors and others at sea, which can make their workday safer. The practical benefits, user
satisfaction and economic implications associated with maritime telemedicine are to be evaluated, and
the conclusions will provide guidelines for further work with the services.
www.hels6-vett.no
The Internet offers a number of possibilities, but for those interested in health services there are also
many pitfalls. There is no reason for not using the Internet for health purposes. However, it may be
sensible to be critical of health services offered on the Web. The NST has established the Web site
www.helse-vett.no which offers suggestions and tips that maybe useful when analysing online health
information and health services.
PatientLink
Annual surveys conducted by the NST have shown that an increasing number of people request e-mail
communication with their family doctor. Thus far, security issues have prevented this from becominga
reality. The NST is currently developing a prototype for Internet communication between patients and
their GP in compliance with data protection regulations. Duringa trial period, medical, organizational,
security and socio-economic implications will be studied.
Broadband Born
The ‘Broadband Born’ project uses broadband technology to transmit cardiotocography (CTG)
recordings and ultrasound foetal images from the delivery room in Lofoten to the Nordland
Central Hospital (Nordland Sentralsykehus). This makes obstetric services available to women
in Lofoten without the need for them to travel to the central hospital. The recordings can also
be transmitted electronically to other hospitals if necessary for consultation with colleagues.
The service creates opportunities for shared teaching and for staff at hospitals in the rural areas
to keep in touch with the latest developments in their professions.
Scenarios
The NST develops scenarios to communicate visions and ideas about solutions for health
issues in the future. The decisions taken today affect the future of the health service.
Important methods used in the development of scenarios include contextual analysis and
design, visual communication and the development of prototypes. The scenarios must
communicate knowledge about relevant trends and developments 3-10 years into the future.
CyberNINA is a visualization of health work and the use of mobile applications in the future:
‘Nina, the cardiologist, rushes along the corridor. In her car, a ringing tone sounds. A voice
alerts her that the municipal doctors wants to ask her advice about a patient. Nina retrieves
the patient’s electrocardiogram on the display, and recommends immediate admission. At
the same time, she displays treatment protocols and alerts all the staff who need to be ready.
She can coordinate all the telephone services, retrieval of information from the network, com
munication via e-mail or videoconferencing and other tools for teamwork with colleagues via
equipment integrated into her white coat. She can retrieve wireless data from stethoscopes,
electrocardiographs and other technical medical equipment.’
www.telemed.no
w.
Collaboration
Consulting Services
The NS1 exists for the Norwegian State health service,
and collaborates mainly with partners from this sector.
However, we also work together with other public- and
prix arc-sector institutions in Norway and abroad, and
contribute to business development and product
development in telemedicine. The NST has been
designated World Health Organization Collaborating
Centre for Telemedicine.
The NST has long experience in telemedicine, and we arc
happy to provide consulting services in connection with
the development, implementation and quality assurance of
telemedicine services.
The NST’s partners
and sources of funding:
0 Norwegian government agencies
o Health organizations and institutions in the five
Norwegian health regions
flk Patients and other users of telemedicine.
o Doctors, nurses and social care workers in the primary
health care sector
o Universities and colleges
o The Research Council of Norway
o The Norwegian Industrial and Regional Development
Fund (SND)
o The Programme for Innovation and Technologj’ in
Northern Norway
o The Executive Committee for Northern Norway
(Landsdelsutvalget)
o The National Centre for Emergency Communication
in Health (KoKom) and the Norwegian Centre for
Medical Informatics (KITH)
o Other institutions in research and development,
commerce and industry
The NST receives funding from the public sector to
■.divide consulting services to Government departments
and authorities. The centre also seeks funding for various
collaborative projects from Norwegian and international
organizations.
In cooperation with the NST, industrial partners can:
o contribute to total solutions for remote diagnosis
and treatment, for example, mobile units, portable
telemedicine kits, services in electronic health
networks, applications for use at home, and
applications for the Norwegian Armed Forces and
the maritime sector.
o carry out development, testing and quality assurance
of their own solutions in cooperation with the NST
. transform ideas and solutions developed by or in
cooperation with the NST into commercial products
The NST provides a meeting place for service providers,
nsers product developers and suppliers to share their
experience, develop new ideas and build networks.
The NST provides advice about all aspects of tele
medicine, and has developed information packages about
the individual services developed at the centre. We also
have our own staff who can assist with implementation and
training.
The NST’s expertise
o
o
o
o
o
o
o
o
Needs analysis
Specification of requirements and design
Choice of technical solutions
Development, testing and maintenance
Legal, medical and financial assessments
Studies of patient and user satisfaction
Implementing telemedicine
Security
The NST’s expertise is in international demand. For
several years we have undertaken consulting outside
Norway. The centre has conducted pilot studies in
countries such as Botswana, Greenland, Sri Lanka, Kyrgyz
Republic and Nepal, and has collaborated in the
development of services, research and teaching in north
west Russia for almost 10 years.
In cooperation with the Norwegian Armed Forces, the
NSO will contribute to a health intranet, mobile units
and satellite-based telemedicine. The NST will also under
take a survey of requirements, cost-benefit analyses and
telemedicine applications for training and information
activities for the Armed Forces.
Norwegian Centre for Telemedicine
University Hospital of North Norway
Through telemedicine, the NST aims to contribute to excellent and effective
health services that are equally accessible to everyone who needs them.
Development The NST will develop telemedicine services that can be applied in practice.
Research
The NST will obtain knowledge about telemedicine that can be applied in practice.
Distribution
The NST will contribute to wide-scale adoption of telemedicine services by the
Norwegian health service.
Consulting
The NST is a resource centre for everyone who seeks cooperation, knowledge and
support in telemedicine in Norway and abroad.
The NST’s expertise is available without charge to the public Norwegian health sector
The NST’s expertise can be shared with non-profit organizations
The NST’s expertise can be exported to a global market
The NST organizes courses and conferences in telemedicine.
Visit our Web site www.telemed.no for updated information.
Norwegian Centre for Telemedicine
University Hospital of North Norway
RO. Box 35
9038 Tromso
NORWAY
Telephone: +47 77 75 40 00
Fax: +47 77 75 40 98
post@telemed.no
www.telemed.no
Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research
wm/yemisphenprg
co-fundedby the European Union.
EUMEDIS B7-4100/2002/2165-083 P110
r/’-■
EVMU - The EMXSH®
Virtual
University
In this second Newsletter we report on the
EMISPHER Virtual Medical University (EVMU)
for e-learning (teleteaching).
SEPELM
IN7E8 4WJEUES
ASSISTANCE
t
L
The main medical partners involved in the
EVMU are:
• CICE - Centre International de Chirurgie
Endoscopique, Clermont-Ferrand, France (Co
Leader);
• ASU - Ain Shams University, Cairo, Egypt (Co
Leader);
■ ANDS - Agence National de Documentation de la
Sante (Ministere de la Sante), Algiers, Algeria;
• NIFRT - Nasser Institute for Research and
Treatment (Ministry of Health and Population,
MOHP), Cairo, Egypt;
• FMPC - Faculty of Medicine and Pharmacy of
Casablanca, Morocco;
■ Tunis - Faculty of Medicine of Tunis, Tunisia;
• ISTEM - Continuing Medical Education and
Research Centre, University of Istanbul,
Turkey;
• SEPELM - Societe Europeenne pour I’ELearning Medical, in combination with UMVF
- Universite Medicale Virtuelle Francophone,
Paris, France;
• IsMeTT - Istituto Mediterraneo per i
Trapianti
e
Terapie
ad
Alta
Specializzazione, Palermo, Italy;
■ Charite Hospital, Berlin, Germany.
'
—
“
Newsletter December 2003
• endoscopic surgery (CICE, ISTEM, FMPC)
• gynaecology-obstetrics (ASU, CICE, ISTEM)
■ reproductive medicine (FMPC, CICE)
• infections diseases (CICE, ANDS, FMPC)
• interventional radiology (FMPC, CICE, Tunis,
ASU, ISTEM)
■ liver transplantation (NIFRT/MOHP, IsMeTT)
■ tumour diagnosis and therapy (Charite, ISTEM,
ASU)
The Universite Medicate Virtuelle Francophone
(UMVF), involved through project partner
SEPELM, already has a certain experience in
tele-teaching and e-learning. In particular, the
UMVF has created digital campuses proposing
pedagogical contents validated at national level
and accessible via Internet (www.umvf.org,
ecole de e-learning).
EMVU has started work after two exploratory
workshops (Clermont-Ferrand, CICE in January
2003, and Casablanca, Faculty of Medicine and
Pharmacy in June 2003).
Some of the pedagogical contents are presented
on www.emispher.org and on various CD-ROMs.
Through recorded videos and live video
transmissions over the satellite-based network
of surgical operations, EVMU hopes to enhance
the effectiveness of the medical education in
this region.
In the EVMU it is planned to use real
time broadcast of lectures, surgical
operations, pre-recorded video
sequences etc., as well as web-based
e-learning applications.
The target population of the EVMU is
comprised of medical students (both
undergraduate and postgraduate),
university hospital staffs, general
practitioners and specialists,
health officers, and citizens.
Seven medical specialities have
been selected for the educational
programme of EVMU:
EMISPHER Consortium meeting in Casablanca
(9-12 October 2003)
This publication has been produced with the assistance of the European Union. The contents of this publication is the sole responsibility
of the persons /organisations indicated in the colophon/imprint and can in no way be taken to reflect the views of the European Union.
The priorities for selecting the pedagogical
programme are based on the following criteria:
For each topic, the gateway will propose title, expert
author, location, date, and keywords.
■ needs expressed by the recipient countries;
The satellite network as a tool for teleteaching
■ contents validated by experts;
■ the proposed contents on the platform (selection,
translations, digitalization, re-writing, page layout,
preparation of multimedia contents, availability
experts and teams) have been defined.
Live surgical operations from operating theatres, live
lectures, etc. to one or several sites simultaneously
(point-to-point or multipoint) will soon be reality, when
the network between the 10 partners will be
operational by the end of April 2004.
The e-learning programme has been accepted at the
end of May 2003 as multimedia data base for the
following topics:
For these transmissions a video programme is prepared
that will be communicated on the various web sites
listed in the EMISPHER portal. The programme will list:
Gynaecology-Obstetrics
• Live broadcasting schedule, according to the yearly
teaching programmes of the various partners
institutions
A national French course of gynaecology-obstetrics is
already on line, with free access to all.
• Monthly video programme
For undergraduate students:
http://www.uvp5.univ-paris5.fr/campus-gynecoobst/cycle2/default.asp?frame=sommaire
For postgraduate students:
http://www.uvp5.univ-paris5.fr/campus-gynecoobst/cycle3/sommaire.asp
Surgery and Endoscopic Surgery
CICE pedagogical web site: http://www.endosurg.org
contains a database of up-to-date surgical techniques
and offers a forum allowing on-line chatting with
experts and surgeons.
Turkish Association for Trauma & Emergency:
http://www.travma.org
Turkish Association for Endoscopic-Laparoscopic
Surgery: http://www.elcd.org includes information
on endoscopic-laparoscopic and minimal invasive
surgery:
Reproductive Medicine
In Cooperation with Professor Jean-Luc Pouly of the
Department of Gynaecology from Clermont-Ferrand
http://perso.wanadoo.fr/fivnat.fr
a web site about reproductive medicine that contains
educational and epidemiological data.
The EMISPHER partners have defined certain policies
for the development of pedagogical contents for the
project:
■ Respect the charter of the Health On the Net (h®<)
http://www.hon.ch/HONcode/Conduct.html, a code of
conduct for medical and health web sites.
• Each pedagogical topic will contain title, author, date
of release, date of up-date, keywords and if possible, a
short summary.
• Quality of the contents: contents are to be validated
by the workgroups, working towards diploma-earning.
Further Actions
The partners have also discussed some further actions to
be envisaged beyond the content building:
• To propose a first video broadcasting programme based
on the schedule of equipment installation at the various
partners’ sites and the needs expressed by those
partners already equipped;
• Advertise on the various relevant web sites, tabSxJs,
medical magazines, etc. as soon as the satellite dishes
and telemedicine workstations are installed;
• To evaluate the EMISPHER internet-satellite platform
as pedagogical tool (questionnaire, evaluation, final
validation of the e-learning / tele-teaching activities.
The EVMU Gateway
As central gateway to the contents of the EVMU, a
dedicated section of the EMISPHER website has been
created: http://info.emispher.org/virtual.htm
Each partner will present their own contents as well
on their own website. Every page will be reachable
from the EVMU gateway.
This method allows liberty and independence
between the partners, allowing each of them to
work at their own pace, based on their own design
and contents, choosing their level of interactivity
and access.
q ,
Conference in Casablanca
(9-12 October ?onri
elENProigct: MEDASHIP
MEDASHIP: Medical Assistance for Ships
Duration: 4/2002-12/2003
Participants: D'Appolonia S.p.A. (IT); Centre for Law
Ethics and Risk in Telemedicine, Avienda (UK);
Eutelsat (FR), National Centre for Scientific
Research, NCSR Demokritos (GR); SRU OP 2000,
Charite, Berlin, (DE); co-funded by the EC under the
eTen Programme, Contract No. C27271
Pi oject Coordinator: F.Bagnoli (D'Appolonia)
http: //www.medaship.com
An integrated solution for health services on board
ships is not readily available in Europe or
elsewherein the world at the present time. Such
technologies also have a vital role to play in
providing medical care to passengers and crews on
board ships and can dramatically improve the quality
of medical care on board suitably equipped ships.
These considerations led D'Appolonia in Genua, an
Italian Engineering Company, which started few
ye^ agos some experimental activities in this
domain, to form a group including a telemedicine
tools developer and satellite carrier for the final
assessment and running of the service, aiming at
validating it in the day-by-day clinical practice.
The technical services offered to the shipowners include
the onboard installation and integration of the
MEDASHIP service, the updating and retrofitting of
structures already available on board and the design and
development of medical facilities during the
construction phase of the ship. The principal aim is to
provide existing vessels and new builds with a turnkey
platform and infrastructures for all medical services to
be used on board. Other telecommunication services
can also be integrated into the MEDASHIP service so that
all services can be provided on a single platform. The
telemedicine service will offer the shipowner the
opportunity to install a satellite communication system
on board.
This could be also used profitably for different other
applications including videoconference, television
channels, GSM and wireless telephony via satellite,
remote banking services, fast internet and fleet
management.
During the validation phase the service has been
tested on board of three ships (European Stars of
Festival Cruises, Olympia Explorer of Royal Olympia
Explorer) and in the ferry boat sector (Superfast XII
of Superfast Ferries)) having the possibility to
connect to three land medical centers, participating
in the project:
• Charite Hospital, Berlin;
■ Sotiria Hospital, Athens;
■ Evangelico Hospital, Genoa.
During the project, which represents a further step
towards the commercialization of the telemedicine
service, technical issues have been finalized and
other aspects (like medico-legal and business
aspects) have been dealt with.
The services offered by MEDASHIP fall into two
distinct categories: medical services, and technical
The medical services that are provided
include telecardiology, ultrasound examinations and
videoconferencing using the WoTeSa/WmVicos
system.(This is the same system as wi I be used for
the real-time telemedicine applications in
EMISPHER.)
In the market validation phase the MEDASHIP consortium
has investigated and developed two business models on
the commercial delivery of the MEDASHIP service to its
potential customers. The models are the "ticket price"
and the "additional insurance” model. In the first of
these models telemedicine services are paid through a
slight increase in ticket price charged to cruise or ferry
passengers. In the second model passengers will be
offered the opportunity to buy an additional insurance
for telemedicine services. These models have been
developed after extensive discussions with the
interested parties, including shipowners and travel
insurers.
Preliminary results indicate that the MEDASHIP service is
sustainable on a commercial basis.
f' 7 ~
~
-
.........
.
.
.
-
COLOPHON / IMPRINT
♦
Content of Leading Article on EVMU by CICE, ClermontFerrand
*
Editors of the EMISPHER Newsletter:
. H. Kessis,ANDS
. C.vanDoosselaere, EHTEL
. T.A. Roelofs, Charitd
EUMEDIS Project: EMPHIS
EMPHIS (Euro-Mediterranean Public Health
Information System), 09/2002-08/2005, EMPHIS
Consortium of 19 international partners, under the
leadership of Fondation Merieux
Project Coordinator H.Deboi FONDATION MERIEUX
http://www.emphis.org
Distance Learning at the service of Public Health
EMPHIS is one of the 5 projects in the Healthcare
sector currently co-funded under the EUMEDIS
programme.
The EMPHIS project intends to develop information
systems within public health practice, care and
education in the Mediterranean region, using as pilot
projects
■ the strengthening of disease surveillance in
tuberculosis (TB);
• the development of a decision support tool in the
control of zoonotic cutaneous leishmaniasis (ZCL)
based on a geographic information system (GIS);
• the active exchange of data and counseling in
nosocomial infections (Nl).
Modern information and communication technology
(ICT) tools will also be used to develop distance
learning modules in public health and to disseminate
information among end-users. The challenge of the
distance learning component of EMPHIS project is to
produce educational supports that can exploit the
flexibility offered by the new technologies, in order
to overcome possible geographical, material and
human limitations to the use of EMPHIS products.
Needs analysis and innovative technologies are the
strengths of the project. Through needs analysis, two
types of targets have been identified:
• institutional, useful for carrying out national
programs and projects; and
• academic, necessary for access to basic and
continuous education.
Three obstacles remain, however, before the
accomplishment of these objectives: economic,
organisational and pedagogical
The main economic obstacle is the very high cost of
pedagogical resources, both initial and maintenance
costs. This limits the access to distance learning to
only those countries or organisations with sufficient
availability of money.
The EMPHIS project overcomes these problems by
using XML (Extensible Markup Language), in
association with a specific method for producing
pedagogical supports. This lowers the price 5 to 10
times.
The organisational obstacle consists in questioning
traditional professional practices and the organisational
culture surrounding these practices. In order for the
new tools to be effective, the actors must own them.
The EMPHIS project aims to overcome this issue by
promoting incremental changes, thereby allowing
organisations and professionals to change their
instruments and methodologies at their own pace, from
a light change to, over time, a complete one.
Technological solutions make these many changes over
time almost free of charge.
The main pedagogical obstacle is that of pedagogical
innovation. Professionals have their own methodology
and it can be difficult and even unjust to ask them to
abandon it. The EMPHIS project therefore proposes
different pedagogical models, covering a great variety
of methodologies, and offers tools through which it is
possible to adapt each model to the clients’ needs. It is
also envisaged to create different kinds of material
supports.
The final network proposed by the EMPHIS project is
composed of three main areas, covering the entire ttpMediterranean region: area North (France, Universiade
Technologie de Compiegne), area South (Tunisia,
Universite du Centre), area East (Lebanon, Universite
Saint Joseph). They accompany the end users in their
adaptation to distance learning technologies at the level
of pedagogical engineering and use of technical tools.
The end goal of the three geographical areas will be to
transfer their competencies as much as possible to the
end users, in order to continue the process that EMPHIS
has begun and further the dissemination of distance
learning tools even beyond the life of the project.
Emphis Dissemination Office, Departement of Public Health,
Turin, University via santena 5 bis, 1-10126 Torino, Italy, tel
0039 01 1 6706593, Fax 0039 01 1 6706551,
e-mail silvia.rovere@unito.it
EMISPHER International
Conferences
Dissemination
- Casablanca (Morocco): "Medical E-Learning”, 9-12
October 2003 Host: Faculty of Medicine and
Pharmacy Casablanca, FMPC, (Prof. Mohamed
Kebbou)
- Cairo (Egypt): "Public Health in the Euro
Mediterranean Region", 19-22 February 2004
Host: AYn Shams University (Prof. Gamal Wafa)
- Nicosia (Cyprus): "Continuity of Care", 24-27 June
2004 Host: University of Cyprus (Prof. Marios
Dikaiakos)
- Istanbul (Turkey): "Telemedicine: Best Practices",
16-19 September 2004 Host: ISTEM, Istanbul
University (Prof. Cavit Avci)
• • ® • • NST | Norwegian Centre for Telemedicine
UNIVERSITY HOSPITAL OF NORTH NORWAY
WHO Collaborating Centre for Telemedicine
Global Telemedicine Partnership
The Norwegian Centre for Telemedicine was designated as the first World Health Organization
Collaborating Centre for Telemedicine in July 2002. The activities of the centre cover the major aspects
of telemedicine. The collaboration is based on the Terms of Reference which cover country work,
research and dissemination, distance learning, advisory services and resource mobilization.
A global telemedicine fund-raising programme, the Global Telemedicine Partnership, will be launched
in 2004.
Scope and objectives
The Global Telemedicine Partnership aims to reduce the digital divide between the haves and have-nots
within and between nations. The aim is to encourage telemedicine projects and services in developing
countries and under-served regions. The programme will support studies, projects and activities. The
ambition is to allocate 5-10 million euros every year.
The fund's values and work methods will reflect openness, equality and fairness.
Target group
The partnership is targeting:
• People who would not otherwise have access to health services
• Health workers in developing countries and other economically weak areas
• Public- and private-sector organizations with good ideas which need funding to develop
telemedical services
Contributors
Private-sector players will be invited to contribute to the fund according to WHO guidelines for working '
with the private sector. The European Space Agency (ESA) has agreed to contribute satellite capacity for
the partnership. The Norwegian Ministry of Health and the Directorate for Health and Social Affairs are
supporting the initiative.
Organization
The fund will be managed by the WHO Collaborating Centre for Telemedicine through Norut MH, a
company which organizes research for the University of Tromso and the University Hospital of North
Norway, and works with the commercialization of research results. A maximum of 15% of the income will
be used for administration.
A board for the fund will be established, with up to 10 members. The board will ensure effective
communication with contributors, the fund's administration, fund manager and other stakeholders.
The board will decide the criteria for support. Applications will be evaluated by the board twice a year.
Applicants will be expected to fund at least 20% themselves.
°S” I ®
www.telemed.no
Would you like to be kept informed about the progress of the
Global Telemedicine Partnership?
Application forms and other material will be available soon. In the meantime, you are very welcome to
indicate your interest by submitting the form below.
I would like to contribute to the partnership
I would like to submit an idea for funding
I would like to receive the Global Telemedicine Partnership Newsletter
Other contribution (ideas and comments)
Name (person / institution):
e-mail address:
Comments & suggestions:
Contact:
Tove Sorensen, Head, WHO Collaborating Centre for Telemedicine
tove.sorensen@telemed.no
Tel. +47 911 956 96 / + 47 77 75 40 00
www.telemed.no/who
r
r
r
r
Norwegian Centre for Telemedicine
E
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WHO Collaborating Centre for Telemedicine
r t a 1/ r c
j IAKtJ
University Hospital of North Norway
Citizen participation in eHealth:
Challenges for research, technologies and
health care organisations
Welcome to TTeC 2004
.
, nonnio HQinn eHealth for their own health purposes, and the
The TTeC 2 004 conference is abo
t people us_ing ettea
organisations.
ensuing challenges for research, technology ana neaiin
s
, .•
. innothor with nolicv makers and experts from the field of health
sociaJscfences'and'tVJnJ.g,,. are in’lled lo «Janje’knowledge and debase atrategles In eHealth/
We hope this event will strengthen efforts to pb“’'d.tn®rek,® am%%fsn°W1 ed9e
potentials, and limit the pitfalls, inherent in eHealth developments.
facilitate the
On behalf of the conferance co-orga n ise rs ■ tha N°^.e9fianwCee|fJrree aVd TH ia R V ’C ’ °6
NST), the National Research and D eve 1 o pm en t Cent re for We I fa re a nd M e a I tn
Finland! the Norweoian Federation of Organisations or uisauieu reupie
FFO) the Norwegian Cancer Society (DNK) and the Finnish Centre for Health
’romo’tion (FCHP)9 I extend a warm welcome to all those interested in contributing
to, and learning more about, this exciting field
Deede Gammon
Conference chair
Head of eHealth consumer programme, NST
About the conference
The conference will provide a meeting place for
exchanging knowledge and debating strategies
between the key players in eHealth.
We invite citizen and patient representatives
together with policy makers and experts from the
field of health, social sciences and technology.
Keynote speakers
Angela Coulter Ph.D. is chief executive of Picker Institute Europe. She is visiting professor
in health services research at the University of Oxford, visiting fellow at Nuffield College,
Oxford, a governor of Oxford Brookes University, and an honorary fellow of the faculty of
public health medicine.
Angelica Frithiof is a consultant in medical staff/patient communication based on principle®
of Narrative Therapy at AF Patientkommunikation. Present elected positions are chairperson
of the VIS (Health consumers in Sweden), member of the education committee of the Swedish
Rheumatism Association and board member of EHTEL.
David Gustafson is a professor of Industrial Engineering and Director of the University's
Center of Excellence in Cancer Communication Research (funded by NCI) and Director of the
National Program Office for the National Improvement Network for Addiction Treatment and
the founding Director of the Center for Health Systems Research and Analysis.
Hiroshi Ishii is a tenured Associate Professor of Media Arts and Sciences, at the MIT Media
ntLMi^iunn »t anT'ibleD.^e(!,i?l.GrouP t0 pursue a new vision of Human Computer
”??nnih □, i rH-C I Tan3'‘)l,e Bits. His team seeks to change the "painted bits" of GUIs to
tangible bits by giving physical form to digital information and computation.
a'tornei! an,d English barrister until medical retirement in 1 9 97.
He has been living with HIV since about 1 982 He has served as Viep-Chair of the UK
Pof 14°"p°eo le°P;e»dLis,i»L’hi!h, »W!S' cxo-?hair 01 lhs B"a” of the E^opeen Network ot
Positive People, and a member of the board of the Global Network of Positive People.
hVhKar«?a bPPnWHvinnCwliithOIHniV
(NICE^ 'aViVitTna nou>SfessoV
V rR8lD a- the Natl0nal Institute of Clinical Excellence
University of Amstefdam and
"fVT1a‘1 c5 at the Academic Medical Centre,
,
at Centreyfor Evidence Based Medicinei in OxVo'^ ** NHS Nat'°nal Knowledge SerV1Ce'
The name of a speaker from the EC eHealth Unit will also be announced
Preliminary Programme TTeC 2 004
'
Monday 21 June
07.30-09.00
09.00- 1 0.1 5
10.15-11.00
11.00-11.15
11.15-11.45
Registration
Opening session by co-organizers and WHO representative
ngelica t-rithiof, consumer and patient representative, will speak about patient empowerment:
- definitions, Jutu£e_Perspectives, strategies and the potential role of ICT
Questions, comments and discussion
Coffee break in exhibition area
_________
Preliminary tracks'
11.45-13.00
Patient empowerment
13.00-14.00
14.00-14.45
14.45-15.00
15.00-15.30
-
Driving forces and barriers for
Patients' access to electronic
eHealth
records
Lunch/registration in exhibition area. Posterjiresentations
Professor Ishii Hiroshi, MIT Media Lab, will speak about his research on Tangible Bits and the
relevance of Human Computer Interaction research for eHealth developments
Questions, comments and discussion
Coffee break in exhibition area
Preliminary tracks
^30-18.00
Future technologies and
perspectives
Patient education
Confidentiality and privacy
Tuesday 22 June
09.0 0- 1 0.00
10.00-10.15
10.15-10.45
10.45-11.30
11.30-11.45
Professor David Gustafson, Centre for Health Systems Research and Analysis, will speak about
the guiding perspectives in the CHESS research community and the role this type of research may
have in eHealth developments
Questions, comments and discussion
Coffee break in exhibition area
Professor Jeremy Wyatt, Academic Medical Centre in Amsterdam, will speak about the relationship
between evaluation and the adoption of new eHealth technologies and services
Questions, comments and discussion
Preliminary tracks
15 .30-16.00
Researching virtual
eHealth in prevention and
Debate session on evaluation
communities
health promotion
of eHealth applications
Lunch/reqistration in exhibition area
Ian Kramer, Vice-Chair of the UK Coalition of People Living with HIV/AIDS, will discuss patients
as experts and outline strategies for enhancing equality in relationships with care providers
Questions, comments and discussion
Coffee break in exhibition area_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
16.00-17.00
eTreatment and eTherapy
11.45-13.15
1^15-14.30
W30-15.15
15.15-15.30
Preliminary tracks_ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Wednesday 23 June
Digital divide and equity of
access
Organisational issues
____________________________________________________________
09.00-09.45
Angela Coulter, Chief executive of Picker Institute Europe, will address the issue of user
invoivement in 'health care and health policy_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
09.45-1 0.00
Questions, comments aim
--------------- -------- __ ---------------------------------------------------------^TTiTT^iHhTTFeHea 11 h Unit (name to be confirmed)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
10.00-10.30
10.30-11.00
1 1.00- 1 1.30^
TT30-13.00
13.30-14.00
' 14.^0-15.00
Coffee break in exhibition area----- ------------------- _----------------------------------------------------------------Ipipnary session: Unique cnaiienges mi icacmii m new
------------------------------------------Preliminary tracks
_ _ _ _ _ _-------- ---------------------------- - --------------------------------------------^^-^y^j^TtrnnTTesearch | Quality assurance of health sites | eHealth in home care_ _ _ _ _ _ _ _
Closing plenary sej^jon------- - ---------- - -------------------------------------------------------------------------------
Lunch_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Practical details
The TTeC 2004 conference has applied for both Norwegian and international accreditation.
Please visit the conference website at www.telemed.no/ttec2004 for further details.
Conference venue and accommodation
The conference will be held at Tromso Performing Art Center in the centre of the city.
The conference hotels are Radisson SAS Hotel, Hotel Amalie and Saga Comfort Hotel. The
rates are the same regardless of which hotel you are staying at:
single room NOK 1 0 95 per night,
double room NOK 1295 per night.
Prices include breakfast. Please register at www.telemed.no/ttec2 0 04
Travel
Note that there might be discounts on air fares if your stay in Tromso includes the night
between Saturday and Sunday. Why not grasp this opportunity to enjoy the weekend in the
town described as the Paris of the North?
Registration and payment
Register for TTeC 2004 at the conference website: www.telemed.no/ttec2 0 04. The regular
registration fee is NOK 380 0 for full conference participation. For discount rates, please
read more at the website. Payment can be made through VISA or MasterCard or by invoice.
Trade exhibition
A number of interesting exhibitors will be present at the conference. Exhibitions are open
during the whole conference. Please check the conference website for available and further
information.
Members of the Scientific Committee
Affiliation
Name
Chair: Professor Per Hjortdahl
University of Oslo, Norway
Deede Gammon, Programme Manager
Norwegian Centre for Telemedicine, Norway
Dr. Finn Skarderud
Regional Centre for Child and Adolescent Psychiatry, Oslo, Norway
Ass. Prof. Katelyn McKenna
Assistant Research Professor, New York University, USA
Prof. Pekka Ruotsalainen
Head of OSKE/STAKES, Finland
Risto P. Roine, Chief Physician
Helsinki 8 Uusimaa Hospital Group, Finland
Sameline Grimsgaard, research fellow
NAFKAM, University of Tromso, Norway
Practical details/registration
Torill Berg
Phone + 47 99 27 56 77
Fax: + 47 77 75 40 98
e-mail: torill.berg@telemed.no
Programme details
Ellen Kari Christiansen
Phone + 47 41 68 47 05
e-mail: eilen.christiansen@telemed.no
Sponsorship/trade exhibition
Turid Kirkhaug
Phone +47 95 74 85 75
Fax +47 77 75 40 9 8
e-mail: turid.kirkhaug@telemed.no
Address
Norwegian Centre for Telemedicine
University Hospital of North Norway
P.O. Box 35, N-9038 Tromso, Norway
WMO's health Telematics Programme
m South-East Asia Region
Goals
To improve health services delivery in particular and health system performance
in general through the use of ICT in member states.
Objectives
•
•
•
•
Raising awareness of Health Telematics benefits and applications.
Establish pilot projects aiming towards development of strategic direction.
Contribute towards Improvement of health care services.
Evaluation of cost and benefits of Health Telematics Projects.
*
Intended Impact
•
•
•
•
Improve Access to Health care delivery.
Improve Public health services.
Improve Quality of Health.
Improve Cost savings for Health Care.
Implementation Framework
Major Constraints
•
Delay in receiving response from
consulting sites.
•
Comfort of medical Doctors with
the use of ICTTechnology.
• High cost and non availability of
funding.
Identify healthcare needs.
Design system to meet those needs. • Lack of basic health infrastructure
at the requesting sites.
Identify the equipment, services and
ICT requirements.
Assess expected costs and potential benefit and what each of the
partners contribute.
• Preliminary Studies
♦
♦
♦
♦
• Pilot Projects
To address issues of organization, acceptability and interoperability.
Help raise the awareness of governments and health care professionals.
Demonstrate potential advantages and ingredients to build national
strategies.
♦
*
♦
• Evaluation of initial experience.
• Operational Implementation.
Three Step implementation approach for pilot projects
r-^
Step 1: Improve access to Information (Tele-Education)
Internet connectivity.
Access to journals.
Step 2: Improve access to Advice (Tele-Consultation)
♦ Through Email and multimedia attachment.
♦ Patient History, Pictures, Digital ECG ,Digital Stethoscope waves etc.
Step 3: Improve access to diagnosis & patient management.
♦ Tele-radiology , Tele-pathology and/or Tele-ultrasound.
♦ Integration with Health Management Information Systems.
♦
♦
Regional Situation for Pilot Project
Bhutan
Sri Lanka
Maldives
Myanmar
Nepal
-Completed
-Launched
-In Progress
-To be Planned
-To be Planned
Details Overleaf...
Implementation Sites
By the end of 2000, a Pilot project Including all three steps was established
between National Hospital at Thimphu (NH) and Regional Referring Hospital at
Monger (MRRH). Later the facilities were extended to four more sites
(Gelephu, Riserboo, T/Yangtse, Lhuentse).
Current Status
All the three steps have been establised at Thimphu and Mongar. For other four
step 1 & 2 have been established.
ie f
Type of Consultations
Number of Consultations
Dermatology
ENT
Gynecology
Medical
Oral Surgery
Orthopedics
Pathology
Pediatric
Psychiatric
Radiology
Surgical
TB
Others
43
03
08
68
02
22
04
11
06
114
07
01
01
Total Number of Consultations
290
Sri Lanka: Launched
implementation Sites
In 2002, based on the lesson learnt from Bhutan, a Pilot project hac
initiated at eight sites in Sri Lanka
project has been
Current Status
Step 1 and 2 have been establised., except at one Hospital (Amnara
Hospital), where Step 3 has been implemented. A Pilot project ™as be™
launched at eight sites in December 2003.
Deen
/Anuradhapura
District
lAnuradhapura General
CAmpara
District
^Dehlattakandiya Base Hospital
Zkandy District
Ampara District
ra General Hospital
I Kandy General Hospital
Badulla District
Badulla General Hospital
Badulla District
Banderwela District Hospital
\
J
J
J
Hambantota District
Hambantota Base Hospital
/fiambantota District
]
(Tissamaharama District Hospitalj
Step
Improve access to Information- all eight sites
•
Internet and Email over Dial up or Lease Line
Step 2: Improve access to Advice (Tele-Consultation)-
•
•
•
•
all eight sites
Web Camera
Digital Camera
Document Scanner
Voice Over IP (VOIP)
Step 3: Improve access to Diagnosis and Patient Management - one site (Ampara)
•
•
Tele-radiology
Tele-pathology
1
Maldives: In Progress
Implementation Sites
A plan for implementing Pilot
Health Telematics project has
been finalized for four Regional
Hospitals located in the extreme
North and South of Maldives
Island
Current Status
The scope limits to step 1 and 2,
except at one Hospital, where
step 3 will also be implemented
Myanmar and Nepal
To be Planned
A project plan will be developed
by year 2005 for establishing f Gaafu Dhaal
pilot projects.
Conclusion
The question is not "if" the Health Telematics services should be
adopted by countries, but it is "when" to do so
Role of WHO
•
•
•
•
Continuously monitor developments in relevant fields and country
readiness for health telematics.
Advise member states as to when it is most opportune to introduce such
services.
Strong assessments of Health Telematics trials to measure evidence of
the technology's impact on health system goals.
Encourage the Health community, to develop innovative approaches for
sustainable application of Health Telematics.
Contact
Ms. Jyotsna Chikersal
Head, Information & Communication
Technology
Informatics Systems Management Unit
[Email: chikersalJ@whosea.org
World Health Organization
Regional Office for South-East Asia
New Delhi, India
Telephone : 91-11-23370804
Fax : 91-11-23370197,9395
Website : www.whosea.org
- Media
RF_DIS_30_SUDHA.pdf
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