large scale capacity development in ehealth - who, geneva, sept 2010

Large  Scale  Capacity  Development  in  eHealth    Addressing workforce development through global

partnerships  

Presentation at the High Level Working Session on the Development of economic Models and Metrics for

eHealth in Support of the Health-related Millennium Development Goals

Arletty Pinel, MD

Director, eHealth and Telemedicine - iCarnegie Geneva, 6 September 2010

apinel@icarnegie.com

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•  eHealth  for  Health  Sector  Strengthening  (HSS)  –   Educa?on  and  workforce  development  as  an  integral  part  

•  Leveraging  exper?se  Globally:  iCarnegie  •  Leveraging  exper?se  Globally:  Brazil  

2  

Agenda  

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ü eHealth  for  Health  Sector  Strengthening  (HSS)  – Educa?on  and  workforce  development  as  an  integral  part  

•  Leveraging  exper?se  Globally:  iCarnegie  •  Leveraging  exper?se  Globally:  Brazil  

3  

Agenda  

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•  eHealth  has  poten?al  for  HSS  but  qualified  workforce  poses  addi?onal  strain  to  system  

•  Challenges  will  increase  before  solu?ons  arise    •  Innova?on  for  large  scale  training  of  ICT  and  health  workforce  needed  for  cost-­‐effec?ve  eHealth  implementa?on  

•  HSS  for  equitable  health  delivery  and  South-­‐South  and  triangular  coopera?on  at  core  

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eHealth:  Key  issues  

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•  Shortage  of  skilled  workforce  •  Shortage  of  teachers  and/or  educa?onal  content  

•  Desire  by  governments  to  invest  in  workforce  development  

•  Realiza?on  that  this  can  only  be  met  through  educa?on  

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Common  Themes  

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What  is  needed?    

•  Public-­‐Social-­‐Private-­‐Partnerships  (PSPPs)  at  different  levels  (from  local  to  regional  to  global)    

•  Strategic  plan  constructed  in  a  par?cipatory  fashion  with  key  stakeholders  in  eHealth/ICTD  

•  Mul?professional  team  to  develop  content  and  design  appropriate  learning  plaVorm  

•  Exis?ng  ini?a?ves  from  which  to  build  •  Boldness  and  crea?vity  to  promote  a  paradigm  shiW  on  delivery  of  capacity  development    

•  Inspired  individuals  and  commiXed  ins?tu?ons    

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Global  South    

•  Start  locally  but  secure  globally:    – Value  developing  and  transi?onal  countries’    priori?es,  applied  knowledge  and  crea?ve  solu?ons  

– Match  with  specific  know-­‐how  to  create  high  quality  products  

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Team  and  pla<orm  

•  Credibility  of  the  ini?a?ve  requires  a  top-­‐class  mul?professional  and  mul?cultural  team  as  well  as  a  tailor-­‐made  learning  plaVorm    

•  Appropriateness  of  the  approach  needs  to  consider  disparate  educa?onal  levels,  learning  processes  and  styles  of  applying  knowledge  

•  Strength  of  the  product  is  key  to  overcome  skep?cs    

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•  eHealth  for  Health  Sector  Strengthening  (HSS)  –   Educa?on  and  workforce  development  as  an  integral  part  

ü Leveraging  exper?se  Globally:  iCarnegie  •  Leveraging  exper?se  Globally:  Brazil  

9  

Agenda  

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Mission  

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Approach  

FoundaAonal  Knowledge  

SoC  Skills    &  

CommunicaAons  

Experience  Accelerator    Projects  

Problem  Solving,  Learn  by  Doing,  Outcome  Based  and  Profession  Focused  

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How  Are  We  Different?  

Scale  

EducaAonal  Content  /  InstrucAonal  Quality  

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MIT  Berkeley   Stanford  Harvard  

NIIT  

SENA  

Learning  Tree  

RoseXa  Stone  

iCarnegie  

Cisco  Entrepreneurial  Ins?tute  

LEGO  

Trade  Schools  

Local  Community  Colleges  

Public  Universi?es  

eCornell  

NGOs  Industry  Training  

Yahoo  

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Global  Partnerships  

13  13  

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Global  Presence    

©  iCarnegie  Inc  –  NOT  FOR  DISTRIBUTION  

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Skills  Transfer  

•  Learning  needs  context  •  eLearning  is  a  complement;  nothing  subs?tutes  face-­‐to-­‐face  interac?on  

•  Teaching  can  be  relevant  without  sacrificing  quality  

•  Access  relies  on  local  delivery,  local  languages  and  local  costs  

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China  

16  16  

•  China,  City  government  of  Wuxi  –  iCarnegie  Center  for  IT  professionals,  Wuxi  China  

–  Training  center  for  5000  students  in  SoWware  and  web  development  

–  Focused  on  academic  and  professional  educa?on  for  the  Chinese  Outsourcing  industry  

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Colombia  

17  17  

•  SENA  –  Training  40,000  people  yearly  in  ICT  (but  not  geing  hired)  

–  Large  scale  2500  hrs  programs  in  soWware  development,  soWware  engineering,  game  development  and  informa?on  systems  

•  Min  of  EducaAon  –  Middle-­‐school/High-­‐school  STEM  using  Robo?cs  

•  Min  of  Commerce  –  Human  Capital  Development  Programs  and  Industrial  ‘Competency’  commiXees  

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India  

•  B-­‐Tech/M-­‐Tech  aren’t  producing  needed  talent  

•  Industry  creates  ‘bridge  courses’,  ‘finishing  schools’  and  expensive  campuses  to  train  new-­‐hires  

•  iCarnegie  looking  at  increasing  quality  of  formal  training    

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Kazakhstan  

19  19  

•  Government  of  Kazakhstan  –  Large  investments  in  overseas  educa?on  

•  Crea?ng  a  world  class  mul?versity  in  Astana  to  develop  the  research  and  management  talent  for  the  country  

•  iCarnegie  developing  academic  and  professional  based  cer?ficate    programs  (e.g.,  soWware  engineering,  IT  management)  

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Timeline  

• Assessment  • Vision  (where  we  want  to  go)  

• Gap  Analysis  (where  we  are  currently)  

3  Months  

6  Months  

4  years  

•  Program  development  

•  Industry  involvement  •  Integra?on  and  Customiza?on  

•  Instructor  Training  •  Course  delivery    •  Course  Evalua?on  •  Enhancements  and  process  improvement  

©  iCarnegie  Inc  –  NOT  FOR  DISTRIBUTION  

9-­‐novi-­‐11  

•  eHealth  for  Health  Sector  Strengthening  (HSS)  –   Educa?on  and  workforce  development  as  an  integral  part  

•  Leveraging  exper?se  Globally:  iCarnegie  ü Leveraging  exper?se  Globally:  Brazil  

21  

Agenda  

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Brazil  Telehealth  

Acknowledgement Ana Estela Haddad (Ministry of Health) and Beatriz de Faria Leão

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Brazil  

• Population: 190,000,000 • States:26 + 1 Federal District • Municipalities: 5,563 (40% in metropolitan areas)

• 220 native ethnicities (0,2% of the population) • 185 languages

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Unified  Health  System  

•  The  Unified  Health  System  (Sistema  Único  em  Saúde  –  SUS)  has  the  following  principles:  

 –   Universal  Care  –   Equitable  Care  –   Comprehensive  Care  

–   Unified  Care  –   Regionalized  Services  Network  –   Social  Par?cipa?on  

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• 

Primary  Health  Care  

•  Family  Health  Strategy  – started  in  1994  – Family  health  team  (FHT):    1  Medical  Doctor  (MD),  1  Registered  Nurse  (RN),  1  Den?st  

–   2  technical-­‐degree  nurses  and  4  to  6  Community  Health  Workers  

–   30.000  FHT  covering  90  million  people  in  60%  of  the  Brazilian  municipali?es  

–   major  impact    in  the  reduc?on  of  children  mortality  in  the  last  decade  

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Family  Health  Strategy  

1998 5% coverage

FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind

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Family  Health  Strategy  

FHT/Community Workers/Oral Health FHT/Community Workers Community Workers Without any kind

2009 90% coverage

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Brazilian  Telehealth  

Brazil Telehealth Program - remote assistance and continuing education Pilot Project: 9 states and 900 points www.telessaudebrasil.org.br

Open University of Unified Health System - provides in-service training for thousands of health care providers www.universidadeabertadosus.org.br

Telemedicine University Network - RUTE, initially about 80 University Hospitals in collaborative research and education across all federal states – http://rute.rnp.br

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Telehealth  Program  Coverage:

9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants

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9 states centers implementing telehealth in 900 e-health points supporting about 2,700 FHT, covering 11 M inhabitants

Expansion states (3 + Federal District) Priority: Northeast region and Brazilian Amazon

Coverage:

Telehealth  Program  

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9 Centers – June 2010

1.209 Points

890 Municipalities

5.900 Family Health Teams

17.786 Formative Second Opinion

14.302 Complementary Exams

Telehealth  Program  

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A Telehealth Center R$ 200.000,00 ((±US$100,000)

A Telehealth point of care R$ 2.800,00 (±US$1,400)

Telehealth  Program  

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1º  Phase  2007  –  2008     2º  Phase  2009  –  2010    

R$  14.831.778,35  US$  7  M  

R$  21.830.720,00  US$  11  M  

Total:  R$  36.662.498,35  (±US$  18,400,000)  

MoH  investments  

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Maintenance  of  teleconsultants  of  a  center/month  for  100  points  of  Telehealth  

R$  31.560,00  (±US$15,500)  

Maintenance  costs  of  Human  Resources  by    center/month  for  100  points  of  Telehealth  

R$  29.560,00  (±US$15,000)  

Maintenance  costs  

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•  Evalua?on  of  33  pilot  municipali?es  at  North  and  Northeast  of  Minas  Gerais:  

–  Referral  costs  in    Primary  Health  Care  were    8x  more  expensive  than  Second  Opinion  offered  by  TeleHealth.  

–  Savings  was  about  5  referrals/municipali?es/month;  avoiding  1.5%  of  referrals  is  enough  to  cover  telehealth  costs  

Savings  

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Minas Gerais – Clinical Hospital: survey with 105 professionals of PHT from 32 municipalities: 67% of the respondents felt that access to training at the workplace was a major factor in to stay in their hometowns

Important 67%

Medium 27%

Low importance 2% No important

4%

Workforce  retenAon  

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SIGA  Saúde  

City  of  São  Paulo’s  Health  

InformaAon  System  

 Acknowledgement

Heloisa Helena Andreetta Corral, Maria Aparecida Orsini (Director Paulistana Mother Program) and Beatriz de Faria Leão

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SIGA  Saúde  

SIGA  Saúde  is  the  city  of  São  Paulo’s  Integrated  and  Distributed  System  for  Managing  the  Public  Healthcare  System.  The  system  belongs  to  the  city  of  São  Paulo,  which  is  willing  to  share  it  with  other  ci?es,  states  and  countries.    

SIGA  Saúde  has  been  developed  using  

free-­‐soWware  open-­‐code  concepts.  

São Paulo is the largest city in South America, with 12M inhabitants and some 22M in the Metropolitan Area.

SIGA Saúde is present in 100% (704) of the city of São Paulo’spublic health care providers

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Electronic Health Record

Patient Flow Organization & Mngmnt (Specialties, Beds, Exams)

Management (Surveillance, Auditing

and Billing)

Internet

SP City Datacenter

SMS-SP

Dept of Health

Access Control

SIGA  IT  model  

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•  Program    created  by  the  city  of  São  Paulo’s  Health  authority  in  2006,  that  extended  the  SUS  Maternal  Health  Program.  

•  The  Paulistana  Mother  is  an  integrated  program    to  assist  and  monitor  ALL  pregnant  women  of  the  city  of  São  Paulo.    

Paulistana  Mother  

9-­‐novi-­‐11   Source: Diario de São Paulo, July 25th Pg. 53

We’re going to keep calling you until the name of your baby is in our list…

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The  program:  •   Monitors  all  pregnancies  within  the  public  system,  •   Establishes  the  referrals  to  hospitals  and  emergencies,    

–  High  risk  pregnancies  ate  treated  separately  by  special  alerts  in  the  system  

•  Guarantees  bed  alloca?on  for  deliveries  •  Follows  up  mother  and  child  un?l  the  baby  is  one  year  old  •  Recharge  of  the  transport  card  at  each  prenatal  visit  •  Provides  counseling  on  breast  feeding  and  baby  care  •  Mother  receives  a  full  bag  with  products  for  the  baby  at  delivery  

Paulistana  Mother  

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•  Free  access  to  all  pregnant  women  •  Registra?on  done  in  any  of  the  409  primary  care  units  

•  36  hospitals    •  25  specialized  outpa?ents  clinics  •  80,000  pa?ents  in  program  •  10,000  deliveries  /  month  •  74%  of  paAentes  with  7  or  more  prenatal  consultaAons  

Results  

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ANO 1980 1990 2000 2002 2004 2006 2007 2008COEFICIENTESMORT. INFANTIL GERAL 50,62 30,90 15,80 15,10 13,96 12,86 12,54 11,99

MORT. INF. POS-NEONATAL 25,31 11,87 5,49 4,97 4,73 4,59 4,36 4,00

MORT. NEONATAL TOTAL 25,31 19,03 10,30 10,13 9,23 8,27 8,18 7,98

MORT. NEONATAL PRECOCE 18,29 15,36 7,70 7,27 6,31 5,74 5,46 5,60

MORT. NEONATAL TARDIA 7,03 3,67 2,60 2,86 2,91 2,53 2,72 2,38

MORT. PERINATAL 30,46 23,80 17,41 16,51 14,00 12,60 11,67 12,72

NATIMORTALIDADE 12,40 8,57 9,78 9,31 7,73 6,90 6,24 7,16

TAXA DE NATALIDADE** 28,23 20,71 19,90 17,56 17,19 16,07 15,77 15,89

NASCIDOS VIVOS 239.262 196.985 207.462 185.417 183.883 173.901 171.602 173.799FONTE: Fundação Sistema Estadual de Análise de Dados (SEADE).* Coeficiente por 1.000 nascidos vivos (NV).**Por mil habitantes

EVOLUÇÃO DOS COEFICIENTES* DE MORTALIDADE INFANTIL NO MUNICÍPIO DE SÃO PAULO, 1980 A 2008.

9-­‐novi-­‐11   http://vitalwaveresearch.com/healthit/

SIGA’s  evaluaAon  

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SIGA evaluation

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Ana Estela Haddad aehaddad@gmail.com Heloisa Helena Andreetta Corral hcorral@PREFEITURA.SP.GOV.BR Maria Aparecida Orsini Maria.aparecida@uol.com.br Beatriz de Faria Leão bfleao@gmail.com

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Paradigm  shiC  

•  Boldness  and  innova?on  (technological,  human,  social)  at  core  of  the  ini?a?ve:  it’s  a  transforma?onal  process      

•  Poten?al  goes  beyond  developing  a  product  to  work  towards  a  paradigm  shiW  in  capacity  development  using  eHealth  and  ICTD  as  an  entry  point    

•  No  quick  fixes:  investment  in  educa?on  takes  ?me  

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Thank  you.  Ques?ons?  

11/9/11   49