Providing Access to Health Care: In Gilgit-Baltistan, northern Pakistan, the AKDN eHealth Programme connects communities in Gulmit and Soust with specialists in Aliabad and Gilgit through teleconsultations. In the absence of the eHealth service, patients’ only option is to spend time and money and travel by boat for approximately 45 minutes across the Attabad lake (pictured) to reach the next level health facility.
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In Q1 of 2015, no live or store-and-forward teleconsultations took place between the Aga Khan Hospital, Dar es Salaam (AKH, Dar) and the Primary Medical Centres (PMCs) in Dodoma and Mwanza or the government facilities under the Joining Hands Initiative (JHI). No live and store-and-forward teleconsultations took place in Q4 2014 either.
Remuneration models for health care providers and uptake of eHealth technologies for teleconsultations remain the biggest challenges this quarter as well. As specialists at AKH, Dar work on a voluntary basis, their availability is often limited. In addition, as JHI approaches its concluding stages, the implementation of eHealth technologies has decreased significantly resulting in no teleconsultations being conducted this quarter.
Under the JHI project, teleconsultations services commenced in the Dodoma and Mwanza regions in May 2013. As of March 2015, a total of 134 teleconsultations have been conducted. Of these, 107 teleconsultations (49 live teleconsultations and 58 store-and-forward cases) have taken place between the PMCs in Dodoma and Mwanza and AKH, Dar. In addition, government facilities referred 27 cases to AKH, Dar using store-and-forward technology. Services have been provided in the areas of Family Medicine, Internal Medicine, Obstetrics and Gynecology and Pediatrics.
In Q1 2015, two eLearning sessions were conducted, benefitting 50 nurses and doctors. Both sessions were held in March, of which one was offered by AKH, Dar to PMC Dodoma and the other by PMC Mwanza to PMC Dodoma.
In Q4 2014, three eLearning courses were conducted benefitting 58 participants. Courses were offered from the PMC in Dodoma for AKH, Dar and PMC Dodoma; PMC Mwanza for AKH, Dar and PMC Dodoma; and by AKH, Dar for PMCs Dodoma and Mwanza.
Although eLearning services have been positively received by participants at AKH, Dar and the PMCs in Dodoma and Mwanza, these sessions have yet to be extended to health workers at government facilities. Distance and high speed internet connectivity pose as major challenges for health workers at district hospitals and health centres. It is hoped that the JHI team in collaboration with Aga Khan Health Service, Tanzania will put in place measures that can enable government health workers to participate in these sessions.
eLearning sessions were introduced through JHI in 2013. Since then, 10 eLearning training sessions have been conducted between AKH, Dar and the PMCs in Dodoma and Mwanza benefitting 200 health care providers.
The AKDN eHealth Strategy for East Africa 2015-2019 has been finalised and endored by stakeholders. Currently, funding is being sought and discussions with potential funding agencies are on-going, which will determine the initiation date of the plan.
The plan to expand eHealth activities in East Africa focuses on transforming health care delivery by implementing systems that will provide enhanced health care service availability and access as well as health education, knowledge and research to communities residing in remote areas in the region.
In Q1 2015, 608 live teleconsultations took place in Afghanistan. Bamyan Provincial Hospital (BPH) conducted 266 teleconsultations and Faizabad Provincial Hospital (FPH) conducted 288 teleconsultations with the French Medical Institute for Children (FMIC), respectively. Bashore, Ishkashim and Nusai Comprehensive Health Centres conducted 39 teleconsultations with FPH and 15 teleconsultations with Khorog Oblast General Hospital (KOGH) in Tajikistan. A breakdown of these teleconsultations is listed in the table below.
Teleconsultations between BPH and FMIC decreased from 297 in Q4 to 266 in Q1. Similarly, teleconsultation sessions between FPH and FMIC decreased from 318 in Q4 to 288 in Q1 of 2015. Teleconsultation sessions from 3 CHCs to FPH declined from 43 to 39 and from 3 CHCs to KOGH also declined from 43 to 15 between Q4 2014 to Q1 2015. Weather conditions contributed to the decline in the number of teleconsultations conducted. In the harsh days of winter, patients are unable to reach the hospitals. In February, all eHealth coordinators travelled to Karachi, Pakistan to attend a week-long workshop offered by AKDN eHRC. During this time, eHealth operations were temporarily halted, also contributing to the overall decline in numbers this quarter.
Teleradiology services connect BPH and FPH with FMIC and FMIC with the Aga Khan University Hospital, Karachi (AKUH, K) in Pakistan. In Q1 2015, 210 cases were reported and diagnosed.
The number of teleradiology cases has decreased as compared to Q4 2014. The decline in cases from FMIC to AKUH, K is due to reduced number of clinics from two to one per week (due to budgetary reasons) and the recruitment of a dedicated radiologist at FMIC. Now, FMIC does not refer as many cases to AKUH, K for second opinion.
Talepathology cases are referred from BPH and FPH to FMIC. 22 cases were referred to FMIC for consultation.
eLearning sessions are received by BPH and FPH and Mirwais Regional Hospital (MRH), a government-owned hospital from FMIC on various topics including medical, allied health and nursing. In Q1 of 2015, FMIC offered 16 sessions to 236 medical, allied health and nursing staff at BPH, FPH and MRH.
Fluctuation in sessions delivered and participants per session often depends on necessity and needs of health care providers and nature of course delivered. While FMIC organises certain courses per month, receiving hospitals can accept or reject courses as per their staff need. Number of participants also depends on nature of the course delivered.
In March 2015, officials from the Aga Khan Development Network eHealth Resource Centre (AKDN eHRC) and Aga Khan Foundation (AKF) visited Bishkek and Naryn to discuss plans to establish an eHealth link between government facilities in the two cities. Ministry of Health authorities in Bishkek and Naryn have signaled their strong support for establishing eHealth connectivity between the Republican Children’s Clinical Hospital in Bishkek and the Naryn Oblast Hospital and the Naryn Oblast Family Medicine Centre in Naryn. The new connection will focus on teleconsultations in Paediatrics and eLearning in Family Medicine.
The Central Asia Health Systems Strengthening project focuses on strengthening the performance of health facilities, especially government facilities, and improving the accessibility and quality of maternal, neonatal and child health services. The AKDN team visited Dr. Kamchybek Uzakbaev, Chief of the Maternal, Newborn and Child Health Centre in Bishkek and the Chief Paediatrician in the country to discuss the establishment of the eHealth link between his facility and the two facilities in Naryn. The eHealth link would enable the Bishkeke-based centre to provide second opinions on cases, i.e., teleconsultations, referred by clinicians in Naryn and to broadcast from Bishkek short courses and seminars on child health topics to residents and clinicians based at the two facilities in Naryn.
AKDN eHRC and AKF officials then traveled to Naryn to meet with Dr. Anara Berdikojoeva, the Head of the Naryn Oblast Family Medicine Centre and Dr. Anara Kalmanbetova, Deputy Director of the Naryn Oblast Hospital to discuss their willingness to participate in the proposed eHealth programme. A meeting also took place with Mr. Karybek Tolgoev, Director General of Naryn Oblast Branch Office of JSC Kyrgyztelecom to assess the willingness of the telecom company to connect the two facilities in Naryn.
Given the oral agreement now in place between the government facilities in Bishkek and Naryn and the AKDN representatives, certain measures will be taken to launch and operate the eHealth link. Starting from the second quarter of 2015, these measures include formalising agreement with the government, assessing sites in Bishkek and Naryn, procuring and installing eHealth equipment, recruiting and training eHealth coordinators, and implementing eHealth operations.
Live teleconsultations in Psychiatry take place between Aga Khan Booni Medical Centre (AKBMC) and the Aga Khan University Hospital, Karachi (AKUH, K) and between Gilgit Medical Centre (GMC) and AKUH, K.
In Q1, 64 teleconsultations took place in Psychiatry out of which 46 teleconsultations were conducted between GMC and AKUH, K and 18 teleconsultations were conducted between AKBMC and AKUH, K.
Telepsychiatry services were initiated in Gilgit-Baltistan in 2014 given the lack of availability of quality services in Psychiatry in the area. Later that year, services were expanded to AKBMC as well.
No store-and-forward teleconsultations took place in Q1 2015 or Q4 2014. GMC is working on a physician remuneration plan to encourage physicians to carry out eHealth services and increase the uptake of teleconsultations.
A meeting between Aga Khan Development Network eHealth Resource Centre (AKDN eHRC) and Aga Khan Health Service, Pakistan (AKHS, P) in March focused on strengthening teleconsultation services from Aliabad to Soust and to Gulmit and on initiating teleconsultation services between Gupis and Yasin and between Singal and Chatorkhand. Connectivity has continued to pose a challenge at Immit and Thoi. Therefore, it was decided that services will be shifted from these two sites and moved to Yasin and Chatorkhand where there is a need for eHealth services and specialists. These two sites are in close proximity to Immit and Thoi.
In February, the AKDN eHRC conducted a week-long workshop in Karachi, Pakistan for eHealth coordinators from Afghanistan, Pakistan and Tajikistan. The workshop focused on three main areas: effective communications; Cisco® IT Essentials training; and monitoring and evaluation of eHealth activities. Coordinators participated in presentation sessions and hands-on activities that were designed to enable them to effectively implement eHealth activities in the region.
AKDN eHRC is committed to building the capacity of health care professionals in eHealth. This workshop was a follow-up to a similar workshop that the Centre offered in 2014.
In an effort to enable health care providers to carry out eHealth services effectively, the Aga Khan University provided training to physicians from GMC and AKBMC. The training equipped them with the medical knowledge required to conduct teledermatology services with patients at GMC and AKBMC in Gilgit-Baltistan. The training commenced in March and lasted for six weeks.
Under the on-going Central Asia Health Systems Strengthening (CAHSS) Project, AKHS, P has identified health care facilities where eHealth assessments need to be conducted to assess the viability of initiating eHealth services. One such site is the Garam Chashma Tehsil Hospital in Chitral. The hospital is owned by the Khyber Pakhtunkhwa government and managed by AKHS, P. In January 2015, AKDN eHRC and AKHS, P members conducted an assessment at the hospital and determined the need to establish and initiate eHealth services.
The assessment resulted in the following health care specialities being identified as eHealth priorities: Obs/Gyn; Pediatrics; Surgery; Dermatology; Urology; Gastroenterology. After the assessment, specialised eHealth equipment for GMC and basic eHealth equipment for Aliabad, Chatorkhand, Garam Chashma, Gulmit, Singal, Soust and Yasin was purchased.
Moving forward, there are plans to procure eHealth equipment and connect Garam Chashma Tehsil Hospital to AKBMC within Chitral.
Staff members from AKDN eHRC visited GMC and Aliabad Extended Family Health Centre in Gilgit-Baltistan in March to discuss Year 3 planning (2015-2016) for all eHealth sites in Gilgit-Baltistan under the CAHSS Project. Discussions with AKHS, P focused on initiating teleconsultation services between Civil Hospital, Gupis and GMC.
During the visit, Periodic Preventive Maintenance manuals and instruments (to detect problems), were provided to the eHealth coordinator at GMC to help better maintain eHealth equipment.
In Q1 2015, 67 live teleconsultations took place across the eHealth sites. Forty five teleconsultations took place between the three district hospitals – Darwaz, Ishkashim and Roshan – and Khorog Oblast General Hospital (KOGH), 12 at Darwaz, 15 teleconsultations at Ishkashim and 18 teleconsultations at Roshan.
Teleconsultations from the three district hospitals to KOGH decreased from 56 in Q4 2014 to 45 in Q1 2015. In February, all eHealth coordinators were out of the country attending the week-long eHealth workshop offered by AKDN eHRC in Pakistan. eHealth activities were not being carried out as usual during this time. In March, there was an extended public holiday resulting in a decline in eHealth activities.
Nineteen teleconsultations took place between KOGH and National Medical Centre (NMC) and three teleconsultations took place between KOGH and the French Medical Institute for Children (FMIC) in Afghanistan. Live teleconsultations in Dermatology and Neurology were initiated between KOGH and FMIC in March 2015.
Teleradiology services are offered in KOGH with consultations being taken from NMC and the Aga Khan Health Board, USA (AKHB, USA). In Q1, 138 store-and-forward teleconsultations took place as opposed to 131 consultations in Q4 2014.
In Q4 2014, the radiologist at NMC was away on a two-month training in Moscow. Store-and-forward cases were therefore being sent to AKHB, USA for second opinion and diagnosis. As the radiologist at NMC returned from the training in January 2015, KOGH started sharing cases with NMC, resulting in the increase from 36 to 125 cases between the two quarters. This, therefore, resulted in the decline in cases from 95 to 13 that were sent to AKHB, USA between Q4 and Q1. Store-and-forward teleconsultations are still on-going with AKHB, USA with complicated cases shared with them for second opinion.
eLearning sessions are received by KOGH from FMIC and by Darwaz District Hospital (DDH), Ishkashim District Hospital (IDH) and Roshan District Hospital (RDH) from KOGH on various topics including medical, allied health and nursing. In Q1, six eLearning courses were delivered benefitting 82 nurses. Four eLearning courses were offered at KOGH from FMIC benefitting 54 nurses. RDH received 2 courses from KOGH, which were attended by 28 nurses.
No sessions were offered at DDH or IDH from KOGH. At DDH, there is no eHealth coordinator to assist with the activity and at IDH, internet connection is too poor to support eLearning sessions.
The Aga Khan Development Network eHealth Resource Centre (AKDN eHRC) was established in 2011 to provide strategic eHealth support to the AKDN health agencies and their partner health institutions that are managing eHealth operations. AKDN eHRC, employs information and communication technologies (ICT) to support the assessment, development and implementation of eHealth initiatives and activities of its clients in Asia and Africa.
The mission of AKDN eHRC is to make health care accessible to communities with reduced access, increase the quality of health care provision, build the capacities of health care professionals and ultimately strengthen health systems.
G-3a, Block 17,
(+92 21) 9924-4230
AKDN eHealth Resource Centre