1. 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
1

2. Agenda
• 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
9-­‐novi-­‐11
2

3. Agenda
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
9-­‐novi-­‐11
3

4. eHealth:
Key
issues
• 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
9-­‐novi-­‐11
4

5. Common
Themes
• 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
9-­‐novi-­‐11
5

6. 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
9-­‐novi-­‐11

7. 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
9-­‐novi-­‐11

8. 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
9-­‐novi-­‐11

9. Agenda
• 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-­‐novi-­‐11
9

10. Mission
9-­‐novi-­‐11
10

11. Approach
FoundaAonal
SoC
Skills
Experience
Knowledge
&
Accelerator
CommunicaAons
Projects
Problem
Solving,
Learn
by
Doing,
Outcome
Based
and
Profession
Focused
9-­‐novi-­‐11
11

12. How
Are
We
Different?
EducaAonal
Content
/
InstrucAonal
Quality
Harvard
iCarnegie
MIT
Stanford
LEGO
Berkeley
Yahoo
Cisco
Entrepreneurial
RoseXa
Stone
Ins?tute
eCornell
Public
Universi?es
Learning
Tree
NGOs
Industry
Training
SENA
Trade
Schools
NIIT
Local
Community
Colleges
9-­‐novi-­‐11
Scale
12

13. Global
Partnerships
9-­‐novi-­‐11
13

14. Global
Presence
11/9/11
9-­‐novi-­‐11
©
iCarnegie
Inc
–
NOT
FOR
DISTRIBUTION
14

15. 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
9-­‐novi-­‐11

16. China
• 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
9-­‐novi-­‐11
16

17. Colombia
• 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
9-­‐novi-­‐11
17

18. 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
9-­‐novi-­‐11
18

19. Kazakhstan
• 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)
9-­‐novi-­‐11
19

20. Timeline
• Assessment
6
Months
• Vision
(where
we
• Instructor
Training
want
to
go)
• Program
• Course
delivery
• Gap
Analysis
development
• Course
Evalua?on
(where
we
are
• Industry
involvement
• Enhancements
and
currently)
• Integra?on
and
process
Customiza?on
improvement
3
Months
4
years
11/9/11
9-­‐novi-­‐11
©
iCarnegie
Inc
–
NOT
FOR
DISTRIBUTION
20

21. Agenda
• 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
9-­‐novi-­‐11
21

22. Brazil
Telehealth
Acknowledgement
Ana Estela Haddad (Ministry of Health) and Beatriz de Faria Leão
9-­‐novi-­‐11

23. 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
9-­‐novi-­‐11

24. 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
9-­‐novi-­‐11

25. 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
9-­‐novi-­‐11

26. Family
Health
Strategy
1998
5% coverage
FHT/Community Workers/Oral Health
FHT/Community Workers
Community Workers
Without any kind
9-­‐novi-­‐11

27. Family
Health
Strategy
2009
90% coverage
FHT/Community Workers/Oral Health
FHT/Community Workers
Community Workers
Without any kind
9-­‐novi-­‐11

28. 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
9-­‐novi-­‐11

29. Telehealth
Program
Coverage:
9 states centers
implementing telehealth
in 900 e-health points
supporting about 2,700
FHT, covering 11 M
inhabitants
9-­‐novi-­‐11

30. Telehealth
Program
Coverage:
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
9-­‐novi-­‐11

31. Telehealth
Program
9 Centers – June 2010
1.209 Points
890 Municipalities
5.900 Family Health Teams
17.786 Formative Second Opinion
14.302 Complementary Exams
9-­‐novi-­‐11

32. Telehealth
Program
A Telehealth point of care A Telehealth Center
R$ 2.800,00 (±US$1,400) R$ 200.000,00 ((±US$100,000)
9-­‐novi-­‐11

33. MoH
investments
1º
Phase
2007
–
2008
2º
Phase
2009
–
2010
R$
14.831.778,35
R$
21.830.720,00
US$
7
M
US$
11
M
Total:
R$
36.662.498,35
(±US$
18,400,000)
9-­‐novi-­‐11

34. Maintenance
costs
Maintenance
costs
of
Human
Resources
by
center/month
for
100
points
of
Telehealth
R$
29.560,00
(±US$15,000)
Maintenance
of
teleconsultants
of
a
center/month
for
100
points
of
Telehealth
R$
31.560,00
(±US$15,500)
9-­‐novi-­‐11

35. Savings
• 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
9-­‐novi-­‐11

36. Workforce
retenAon
Low importance
No important
2%
4%
Minas Gerais – Clinical
Hospital: survey with 105 Medium
professionals of PHT from 32 27% Important
municipalities: 67%
67% of the respondents felt that
access to training at the
workplace was a major factor in
to stay in their hometowns
9-­‐novi-­‐11

37. 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
9-­‐novi-­‐11

38. SIGA
Saúde
São Paulo is the
largest city in South
America, with 12M
inhabitants and
some 22M in the
Metropolitan Area.
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
SIGA Saúde is present in 100% (704) of
other
ci?es,
states
and
countries.
theSIGA
Saúde
has
bPaulo’spublic health care providers
city of São een
developed
using
free-­‐soWware
open-­‐code
concepts.
9-­‐novi-­‐11

39. SIGA
IT
model
Management
SMS-SP (Surveillance, Auditing
and Billing)
Dept of
Health
Internet Patient Flow
Organization & Mngmnt
(Specialties, Beds, Exams)
Electronic Health Record
Access Control
SP City
Datacenter
9-­‐novi-­‐11

40. Paulistana
Mother
• 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.
9-­‐novi-­‐11

41. We’re going to keep calling you until the
name of your baby is in our list…
9-­‐novi-­‐11
Source: Diario de São Paulo, July 25th Pg. 53

42. Paulistana
Mother
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
9-­‐novi-­‐11

43. Results
• 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
9-­‐novi-­‐11

44. EVOLUÇÃO DOS COEFICIENTES* DE MORTALIDADE INFANTIL NO MUNICÍPIO DE SÃO PAULO, 1980 A 2008.
ANO 1980 1990 2000 2002 2004 2006 2007 2008
COEFICIENTES
MORT. 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 239.262 196.985 207.462 185.417 183.883 173.901 171.602 173.799
FONTE: Fundação Sistema Estadual de Análise de Dados (SEADE).
* Coeficiente por 1.000 nascidos vivos (NV).
**Por mil habitantes
9-­‐novi-­‐11

45. SIGA’s
evaluaAon
9-­‐novi-­‐11
http://vitalwaveresearch.com/healthit/

46. SIGA evaluation
9-­‐novi-­‐11

47. 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
9-­‐novi-­‐11

48. 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
9-­‐novi-­‐11

49. Thank
you.
Ques?ons?
11/9/11
9-­‐novi-­‐11
49