Welcome to Room 1!

While telehealth services have been rolled out in many low- and middle-income countries, public and private health providers are facing challenges to implement and scale up these services cost-effectively and systematically. The rapidly evolving technology space and the overwhelming diversity of available tools have made it difficult for actors in health systems to identify, adapt or develop solutions that are appropriate to their specific context and needs.

This room aims to facilitate the sharing of country experiences, lessons learned and good practices in implementing telehealth services. The discussions will also hope to identify national priorities, key challenges and technical support needs in the development, roll-out and utilization of innovative digital health solutions.

Please respond to one or more of the following questions, and indicate which question you are responding to in your post, don't forget to press "Comment":
  1. Describe the telehealth solutions that have been introduced in your country/region. If available, please share a link to relevant literature.
  2. What health system challenges/priorities do these telehealth services aim to address? What health outcomes have been achieved?
  3. Describe the technical support that was needed for expanding the coverage and quality of telehealth services.
  4. What were the biggest wins and the biggest challenges in implementing the telehealth solution?
  5. How has UNDP supported the introduction and scale up of telehealth services?
  6. Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized?

 

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ūüí° Return to the¬†main group page for background information or go directly in Room 2: Key principles, policies and strategies in promoting telehealth.

Comments (94)

Nithima Ducrocq Moderator

Week 3: Discussion Summary (6th - 10th September) :

Dear all,

Sharing here a brief summary and some reflection from last week. Thanks to everyone.

  • Thank you [~89902]¬† for sharing experience from Somalia and [~117720]¬† n for sharing the experience of UNDP Vietnam

  • We heard from [~117843]¬† about PockerPatientMD platform an electronic medical record platform for providers (doctors, hospitals, clinics, Ministries of Health), with other features to connect the entire healthcare ecosystem. Mark highlighted how interoperability and lack of secure patient management system leads to significant waste, increased cost and decreased quality of care, and often worse compliance and how health system could be more resilient if we could ensure that patients records and telemedical visits transfer over to in-person points of care.

  • [~117820]¬†shared the experience of telerehabilitation project in India and how optimizes the timing, intensity and duration of therapy that is often not possible within the constraints of face-to-face treatment protocols in current health systems.

  • We discuss sustainability model, funding and financing. thank you [~93308]¬† for sharing the business model of Tele-ICU. Interesting questions were raised by [~117791]¬† about how can startups and individual organization scale-up their solution and ensure their sustainability?

I think the following questions are interesting to explore: 

  • For successful projects that were implemented, what were the enablers and barriers of your projects?
  • Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized?

Thank you all for sharing your experience and your learnings, and looking forward for this last week of discussion,

Nithima

Evelyn Acquah

Telehealth for improved access, coverage and availability of quality service 

Patients in remote areas of Ghana face geographical barriers to health services. These barriers include poor transport networks, limited access to healthcare providers, and inadequately resourced health facilities resulting in high mortality and morbidity rates for diseases that may be easily treated.

Prior to the COVID-19 pandemic, the Ghana Ministry of Health, the Ghana Health Service, the National Health Insurance Authority, the Ambulance Services of Ghana, Millennium Promise partnered with the Novartis Foundation to roll out a telehealth model after a successful pilot in the Ashanti region.  The telehealth model is developed around the frontline health worker, with digital technology allowing for the centralization of healthcare expertise. The doctors, experienced nurses and midwives, who are staffing the teleconsultation centre at the referral hospital 24/7, are coaching and guiding less-skilled community health workers in their patient care.   The objective is to expand access to quality care for populations in remote rural areas, reducing transport times and costs for patients and avoiding unnecessary referrals. 

This is an efficacious intervention for addressing the unavailability, unaffordability or inaccessibility of healthcare services amidst the pandemic for many people in Ghana and beyond. In 2016, more than half of all teleconsultations could be resolved directly by phone, including 31% that avoided referrals. This reduces the burden on referral facilities helping to address the patient to bed ratio challenges in these facilities. It also strengthens the health system by empowering community health workers and improving the quality of care with a direct impact on patient health outcomes.

Considering the contextual complexities of our communities and the health system, how do we ensure that this efficacious intervention becomes effective with no remote area left behind.

https://www.novartisfoundation.org/past-programs/digital-health/ghana-t…

Addressing questions 1 and 2

Leslie Ong Moderator

Dear Evelyn, thanks so much for sharing such an amazing example of an impactful telehealth service in Ghana. I'm really glad you spoke about the empowerment of community health workers through the introduction of a digital technology. Sure, there is currently a lot of attention given to (and investment in) the development and adoption of innovative technologies, but ultimately it is the human factor that determines the effectiveness and outcome of a health intervention, with the digital solution being a tool that supplements (rather than subsumes) the role played by the health worker. I think this is an important point that we, whether as policymakers, programme managers or service providers, should remember when introducing digital health solutions, and ensure that capacity building of the health workforce is part and parcel of any digital health programme.

Claudia Olmedo Moderator

Hello Evelyn, many thanks for sharing this inspiring project. I find two very relevant aspects of this experience that can be defined as essential for the success of telehealth services delivery: 1) A diverse and articulated group of strategic partners, which is crucial to the design and implementation of such initiatives since it enables the alignment of expectations and efforts, thus reducing duplicity and ensuring an effective use of available resources and 2), The user centered approach that empowers the front-line worker with skills and tools as the most important link between the patient and the remote health provider.

Reflecting on your post, I can think of a question to follow up this discussion

  • What aspects should be considered in telehealth programs for training and supporting frontline health workers so they can¬† safely and effectively carry out their responsibilities?

Thank you for your participation!

Belynda Amankwa Moderator

Hello Everyone,

My name is Belynda, and I am very happy to be your moderator for this 1st week of this e-consultation. ¬†Telehealth is gaining increasing relevance especially during this COVID-19 pandemic and has the potential to enhance the efficient and effective delivery of essential health services and health system resilience in low- and middle-income countries. The pandemic has also further heightened the critical role innovative digital solutions play in the provision of essential health services. This discussion room provides a space for discussants to share experiences of their own and reflect on the challenges and lessons learned in the implementation of telehealth. It will be refreshing to hear your thoughts and insights on how we could use¬†telehealth to promote access to essential health services and products. Your thoughts/insights can be shared in English, but the platform can also translate the text of pages into over 100 languages (use the ‚ÄúSelect your Language‚ÄĚ option at the top right of SparkBlue). Kindly use this function to translate comments in other languages, and feel free to post in the language you feel most comfortable with.

At the end of each of the 4 weeks of this consultation we will pin a summary to the top of the page. Kindly spare some time to contribute your thoughts and experience! And do reach out if you have issues posting,

We look forward to interacting with you!

 

 

Maryam Inam

Posting on behalf of UNDP Pakistan

1. UNDP Pakistan supported the Federal Ministry of Health to introduce an innovative telehealth platform as part of the COVID response in 2020. While several private tele-medicine platforms were available in Pakistan at the time, there were limited in scope and outreach and UNDP felt there was more space to engage tele-medicine platforms to enhance the National COVID response. Following discussions with the Federal Ministry of Health, UNDP then engaged a partner to assist the design and roll-out of the Tele-ICU pilot in Pakistan and in parallel provided technical assistance to support the Ministry of Health to institutionalize tele-medicine through policy and legislative changes with support from the UNDP Office for Technology, Innovation and Sustainable Development as well as the Regional Office in Bangkok. 

https://www.pk.undp.org/content/pakistan/en/home/blog/2020/how-telemedicine-is-helping-in-the-fight-against-covid-19--and-w.html

Clara Aranda

Hi Maryam,

This is a really interesting example. I was wondering if you could share more about your experience working with the partner/platform developer and government while implementing and expanding the deployment of the tele-medicine platform. What do you think were the main reasons for success and, also, the main challenges in the process? Also, regarding the Tele-ICU pilot, what is the status of the project and do you think that post-COVID19 the adoption of telemedicine will continue in Pakistan? 

Thanks! Clara

Maryam Inam

Posting on behalf of UNDP Pakistan

2. With the total of 0.919% of GDP spent on public healthcare, there are currently less than 100 intensivists to meet the needs of Pakistan, requiring at least 500 more to face the pandemic. While these 70 critical care experts were available in the major cities of Pakistan, a large number of small intensive care/ High dependency units suffered due to lack of human resource. To tackle this challenge UNDP, in collaboration with the Government of Pakistan and Sehat Kahani initiated one-of its kind Tele-ICU Project last year with an aim to build capacity and assure access to critical health services safely through a virtual platform. 

 

While our partner Sehat Kahani already had a functioning and successful telemedicine platform with 27 e-clinics across the country, with UNDP support the platform was modified under the Tele-ICU project in order to meet the needs of both public and private hospitals and clinics as well as critical care experts who were the intended users of the modified platform.

Maryam Inam

Posting on behalf of UNDP Pakistan

4. Wins: The Telemedicine Platform has proved to be an asset in the screening, triaging, and referral of the COVID-19 cases identified all around the country. Through this model around 5,000 doctors and medical staff have been provided medical education and telehealth training while thousands of patients have now received virtual consultations. Additionally, 60 tele-ICUs were created across Pakistan under the UNDP supported project.

Major challenges for the implementation of this initiative include behavior change for health professionals, connectivity issues and sustainability for public hospitals although Sehat Kahani is planning a model whereby fees paid by Private Sector hospitals will help provide subsidies for public hospitals. On UNDP’s side, given we don’t have a large health portfolio, it has been complicated to provide detailed health related technical support, but we were able to leverage our digitalization and innovation teams in the CO to some extent for this work.  We have also been happy to receive guidance for BRH and Singapore UNDP teams on digital health and to share experiences with other countries in a similar situation.

Leslie Ong Moderator

The difficulty in changing the behaviour of health professionals, and their resistance to digital disruption, are probably very underrated as significant barriers to successful adoption of digital solutions. How did Sehat Kehani overcome this? I feel that there are important lessons we can learn from this experience in Pakistan, about how to ensure buy-in and acceptance of end-users and how to navigate the often rigid nature of the medical profession (my apologies to all the medical professionals in the room!)

Clara Aranda

Hi Maryam,

I just saw that your post was in different parts. I asked a question in the first post and I think you've addressed it here. I just wonder if you think that the changes seen in behaviour during this rapid implementation and expansion of Sehat Kahani's solution will continue. Now that health professionals have used the solution, do you think others will adopt it and perhaps expand the tele-medicine services to other specialist areas? Or do you think the challenges you saw at the beginning of the implementation will continue? Thanks!

Maryam Inam

Posting on behalf of UNDP Pakistan

5. UNDP continues to engage on the policy level with the Digital Health team in the Ministry of Health, the Ministry of IT and the National Database and Registration Authority (NADRA) to support further efforts to enhance policy-making around digital health and tele-health specifically via the Digital Health Strategy which is underway and was also supported by technical assistance for UNDP, although with a smaller footprint given our funding scenario for this line of work.

Leslie Ong Moderator

Hi [~89398]. Thanks so much for this excellent summary and congratulations on the excellent support UNDP Pakistan has been providing MOH and MOI on not only the roll out of Tele-ICU, but also on the broader digital transformation of the health system. We would love to hear more about the work you are undertaking on developing a national digital health strategy in Discussion Room 2. I've already made a post about this topic, so please feel free to respond to it.

Belynda Amankwa Moderator

Many thanks Evelyn for sharing this very useful insight which clearly demonstrates the utility of telehealth in low resource settings. I would also reiterate your  thoughts on ensuring that we support  these interventions  to make them sustainable and effective. This is because often times some of these interventions are project based, so how do we sustain the gains after the project is over, what kind of support will be needed to expand the coverage of these interventions

Evelyn Acquah

This is very true Belynda. The sustainability of interventions is mostly taken for granted. It becomes important when the intervention begins to face challenges in the real world when in fact it should have been the first point of consideration. I believe the discussions will help us to change the narrative.

Leslie Ong Moderator

Apart from the obvious need for continuous funding (which is possible to be self-sustaining if done right) I believe that how the digital intervention is designed (interoperable? appropriate?), used (inclusive of marginalized populations? adhere to human rights?) and rolled out (accepted by the end-users?) all significantly affect sustainability of the solution. How has the novartis telehealth solution been sustained following the end of the pilot? 

Clara Aranda

Hi Evelyn,

This is a really interesting example. You mentioned that it was a pilot project, has there been any follow ups? Les' message indicated some common challenging scaling up digital health solutions. Has this project been scaled up? Are there any lessons you could share? Thanks

Belynda Amankwa Moderator

 Many thanks Marya for kindly sharing your insights on UNDP's support. Particularly noteworthy is the provision of support to institutionalize telemedicine whilst also providing technical assistance for the roll out. This approach is really critical to guarantee sustainability of interventions

Leslie Ong Moderator

Hi [~8942] thanks for sharing the link to the oDoc platform. I'm wondering what role UNDP Sri Lanka played in the development / roll out of this platform? 

Leslie Ong Moderator

I would like to highlight an innovative, low-cost disease surveillance system from Kenya. This case example is illustrated in the background paper developed specifically for this e-discussion (please check out the paper!).

In 2019, the Kenyan mobile network operator Safaricom, partnered with the Ministry of Health and Korea Telecom (KT) to launch ‚ÄėSafiri Smart‚Äô. The platform was originally developed by KT as part of their Global Epidemic Prevention Project. Safiri Smart offers a free low-tech solution that uses short code or USSD to alert subscribers about disease outbreaks and epidemics. Subscribers need to opt-in to the services, and they can receive information about the disease, such as symptoms signs to observe, and preventative measures. The technology also allows people to report their symptoms, allowing health officials to monitor potential focal points of disease outbreak. This system was introduced in Kenya prior to the COVID-19 outbreak to help the surveillance of disease spread of diseases such as yellow fever, cholera, Ebola. However, Safiri Smart provided an important tool for disease surveillance in Kenya during the COVID-19 pandemic.

Are there similar experiences in other countries, where they have implemented a low-cost and highly adaptable disease surveillance system? Or have repurposed the use of an existing digital solution for the COVID-19 response - what were your challenges and lessons learned in this process?

Amitrajit Saha

Dear all. Amitrajit Saha, UNDP Team Leader HHD for Africa here. In responding to Q1., let me share Bhutan’s digital tracking system for COVID vaccination (https://www.bt.undp.org/content/bhutan/en/home/presscenter/pressrelease…). In addition, it was wonderful to learn from Bhutan govt. representative today on how they successfully rolled a remarkable COVID vaccination program in the country. He also raised the question of a hiccup they had: elder/more senior community health workers found it tougher to adapt digital and mobile tools. Which brings me to some issues I want to raise

1. How do we quickly sensitize/capacity build primary/grassroots healthcare workers and/or volunteers on digital tools to enable swiftly moving from paper-based to digital M&E and reporting tools? Some examples of successful, evaluated training of HCP to use digital reporting systems would be helpful.

2. What procurement and budgeting provisions do we need to make, to quickly transform a paper-based LMIS to a digital one? Cash amount/proportion of budgets from anyone who’s had this experience?

3. What support we may need to provide national governments to transform, with corporate partners, the primary digital infrastructure and/reach of internet/mobile and broadband data at affordable prices? Any lessons? There exists big Urban/Rural divide in access to the Internet is a big reality in Sub Saharan Africa? Any examples of support to strengthen internet coverage from countries will be helpful for us in Africa.

4. Finally, together with your examples, am looking for examples of strong frameworks that ensure patient confidentiality, and strengthen data security for government, CSOs and the individual client?

 Thanks. 

Belynda Amankwa Moderator

 Many thanks Amitrajit for sharing this.

Indeed a paper published in  2019

(https://www.researchgate.net/publication/332098410_On_Telemedicine_Implementations_in_Ghana ),to highlight key  telemedicine applications and implementations in Ghana also noted low investment in fast internet and data transmission infrastructure  as key challenges and further identified the need to do more research on data transmission to enhance quality of  VoIP and video calls in the presence of low-speed internet connection especially in the rural areas.

It also noted that due to the requirement for high bandwidth internet connection and the costs involved most of the telehealth interventions   used simple messaging applications on PCs and cell phones to transmit the information. Emphasizing the need to contextualize the telehealth interventions based on prevailing circumstances

Kenechukwu Esom

[~88695] the point you make about challenges of uptake for some populations is a real one. Elderly persons, people with disabilities, people who cannot read and write [even if fluent in app languages], rural populations are all groups that must be taken into consideration while rolling out telehealth services, otherwise there is a real risk of lack of acceptance/uptake.

Room 2 of this e-discussion asks the important question - What are the key approaches in improving acceptance, broad uptake/usage and sustainability of telehealth services? How can service providers effectively build awareness and use of telehealth services among community members and health professionals, and promote their retention on these platforms? it touches on some of the questions you asked. I wonder what your thoughts on these are? [~89398] it looks like there is much to be learned from the Pakistan example. Please feel free to share your thoughts and continue this conversation in Room 2.

Thanks

 

Nora Nindi Arista

Dear all, my name is Nora Nindi Arista, Project Manager for STRATEGIC project in UNDP Indonesia. I would like to share telehealth in Indonesia and our support in the development of telehealth services in Indonesia.

1. Telehealth in Indonesia

The development of telehealth in Indonesia has been done since 2012. The Ministry of Health launched an internet-based telemedicine pilot project with tele-radiology and tele-electrocardiography (tele-EKG) services in 2012. Apart from tele-radiology and tele-EKG, Indonesia also uses video conferencing (VICON) based telemedicine (teleconference) in July 2013. Seeing the expanding potential of telemedicine, the Indonesian government proposes the implementation of a national scale telemedicine as the indicators for the Strategic Plan and National Medium Term Development Plan 2015-2019.

In 2016, telemedicine services were initially run with 3 main aspects which were tele-radiology, tele-EKG, and tele-USG. assigned to use this service, which is also combined with tele-consulting. in 2017 all services were executed using a single application established by the Ministry of Health. This service application uses a web-browser platform and can be accessed in all regions of Indonesia by opening www.temenin.kemkes.go.id . To ensure the spread of telemedicine implementation, the Ministry of Health is also responsible for conducting several consecutive trainings between doctors and health service provider operators. The implementation of this Temenin program is stated in detail in a ministerial decree number HK.01.07 / Menkes / 650/2017 for the Telemedicine Service Hospital and the Telemedicine Trial Program. In 2020, there are 56 facilitating hospitals and 151 managed hospitals / Puskesmas registered with Temenin, with general practitioners being the most registered doctors.

page12image9441760

Figure 2. History of Telemedicine program by Ministry of Health Indonesia (MoH, 2017)

Telemedicine Services between Doctors and Patients

  1. Telemedicine services at SehatPedia by the Ministry of Health

Sehatpedia is an e-health application developed by the Directorate General of Public Health Services at the Ministry of Health in February 2018. Sehatpedia was developed to answer three health challenges that exist in Indonesia today, namely making health services accessible to all Indonesians, increasing health awareness for the community to maintain health, and providing reliable health information to the public. Sehatpedia is an open and free online health information application that can be accessed by all Indonesians wherever they live. This allows all citizens to have equal access to health information and access.

  1. Telemedicine Services for Doctors to Patients conducted by Hospitals

There are telemedicine services provided by hospitals to support their existing patients (customers) through the system that is connected to the Hospital Information Systems (HIS). Patients can be served via communication systems such as web chat, WhatsApp, phone-call and many other technologies.

Telemedicine during COVID-19 Pandemic

Since Indonesia President, Joko Widodo has officially declared COVID-19 a national disaster, telemedicine has been one of the tele-health services to reduce in person contact between doctor and patient and reach out the self-isolation COVID-19 patients. In July 2021, Ministry of Health announce that they are collaborating with 11 telemedicine platforms to provide doctor consultation services and also free medication delivery services for self-isolation patient. The telemedicine provider was:

  1. Alodokter
  2. GetWell
  3. Good Doctor
  4. Halodoc
  5. KlikDokter
  6. KlinikGo
  7. Link Sehat
  8. Milvik Dokter
  9. ProSehat
  10. SehatQ
  11. YesDok

Besides that, Ministry of Health also developing their telemedicine website which are www.isoman.kemkes.go.id . this website also providing free doctor consultation and medication for COVID-19 patients who were self-isolating. The Ministry of Health has expanded consultation services and free medicine delivery through telemedicine services for self-isolated COVID-19 patients to 4 regions, namely Bogor, Depok, Tangerang and Bekasi (Bodetabek).

Nora Nindi Arista

2. What health system challenges/priorities do these telehealth services aim to address? What health outcomes have been achieved?

The digital health service ecosystem in Indonesia has become a necessity, especially during the COVID-19 pandemic. Telemedicine does not only provide teleconsultation, tele-prescribing, and telenursing via chats or video call, but also collaborates with digital transportation application companies such as Gojek and Grab providing delivery of medicines to patients at home. These services can help the government identify suspected cases that should be prioritized for testing and hospitalization/quarantine in a dedicated isolation facility, and improve access to essential health services for women, children, vulnerable and poor people. With the second wave of COVID-19 in Indonesia where the new cases daily reach up to more than 50.000 new cases, the telemedicine services have supported the government to monitor and support the patient who are self-isolating to consult with the doctor and provide medication to them for free.

Nithima Ducrocq Moderator

Hi [~117654] ,

Thank you for your answer. I know that e-prescription was a barrier to telehealth in Thailand because government policy doesn't allow for it. Do you know since when online prescription has been authorized in Indonesia? What pushed the government to change the legislation on this?

Thank you very much,

Nora Nindi Arista

3. Describe the technical support that was needed for expanding the coverage and quality of telehealth services.

Based on our assessment, several challenges remain for telemedicine services in Indonesia and these are our recommendations on how to expand the coverage and quality of telehealth services especially during the outbreak:

  1. The integration of telemedicine into international and national guidelines for public health preparedness (in keeping with International Health Regulations, 2005) and response.
  2. The definition of national regulations and funding frameworks for telemedicine in the context of public health emergencies.
  3. A strategy to quickly define telemedicine frameworks; use case scenarios; develop clinical guidelines; and standardize triage auto questionnaire and remote patient-monitoring algorithms for any outbreaks at local, national, or global scales,
  4. A strategy and operational plan guiding health care providers to switch to outpatient teleconsultation and increase tele-expertise and remote patient monitoring.
  5. A communication toolkit to inform and educate the population on the recommended use of telemedicine.
  6. A data-sharing mechanism to integrate telemedicine providers’ data with epidemiological surveillance.
  7. A scientific evaluation framework and dedicated research funds to describe and assess the impact of telemedicine during outbreaks.
Leslie Ong Moderator

Hi [~117654] thanks very much for sharing this very comprehensive assessment. How has the Ministry of Health decided to take the recommendations forward? Rec #2 on funding frameworks - does the report specify what this framework would look like? This relates to an earlier point made by [~98869] about the sustainability of telehealth services will largely depend on their inclusion in the national health insurance benefits basket. Is it covered in Indonesia? Does the assessment provide any evidence (Eg. affordability / OOP payments) to suggest that this is warranted? 

Nora Nindi Arista

[~85614] 

Hi Les, thank you for your comment. Currently, we have not yet shared this assessment with the Ministry of Health and we just present this assessment to ATENSI colleagues. However, we are planning to do the dissemination within the next month and hopefully, this recommendation would lead to an initiation to improvement based on the recommendation with the UNDP assistance and/or MoH budget.

For Rec #2, We currently studying a funding framework that would be suitable for the Indonesian context. In Indonesia, we have national insurance called BPJS which is not yet working with any of the current telemedicine providers, and some of the telemedicine providers are covered by several private insurances whereas the majority still pay out of pocket. As I mention below, one of the issues of telehealth in Indonesia is the amount of out pocket that patient needs to pay with lack of insurance support which could cause the vulnerable population will left behind. I am looking forward for other country experience on what kind of funding scheme they use in the utilization of telehealth in their country.

Nora Nindi Arista

4. What were the biggest wins and the biggest challenges in implementing the telehealth solution?

WINS: With the existence of Telemedicine services that have been carried out in Indonesia, both from the government and the private sector, it gives hope that these services will develop further, where this is supported by various conditions such as developments in information technology including increasingly even network infrastructure, population demographics dominated by productive age and understanding Digital-based health services, challenging geographical conditions, and increasingly conducive legal regulations and following the development of digital services.

 

Challenges: Some of the challenges in the implementation of Telemedicine services in Indonesia were immature organization and lack of financial support where most of the payment method is out-of-pocket. The payment model used is fee for service, and only a small proportion of them collaborate with insurance partners.

The majority of telemedicine operators in Indonesia consider their current human resources to be insufficient. This shows that telemedicine administering organizations are on average still in their early stages and moving towards maturity. There is lack of training for doctors to improve their skills in providing telemedicine services which for some doctors is a new form of service to patients.

In general, some Indonesians can enjoy telemedicine services, although they are still limited in big cities where internet access is easier to obtain. It could cause inequality and people who were in poor situation with little to no access to internet cannot utilize this services. further efforts are still needed to equalize access from low-income and disadvantaged education groups.

Belynda Amankwa Moderator

Dear Nora Nindi Arista,

Many thanks for sharing this very insightful experience from Indonesia.

Noteworthy is the fact that only a small proportion of telemedicine implementers collaborate with insurance partners.

I was wondering  whether telehealth services are included in the national health insurance package  as this could ultimately improve coverage and also strengthen sustainability of these telemedicine interventions

Nora Nindi Arista

[~98869] Dear Belinda, unfortunately, the national health insurance is not yet cover the telehealth services by private telemedicine providers. this is one of our goals to provide recommendation on funding scheme to accomodate the national health insurance into the telehealth services in Indonesia.

Nora Nindi Arista

5. How has UNDP supported the introduction and scale-up of telehealth services?

During the COVID-19 pandemic, the use of telehealth has increased and supported to improve patient health outcomes. Many professional medical societies endorse telehealth services and guide medical practice in this evolving landscape not only for COVID-19 services but also for other diseases such as AIDS, tuberculosis, diabetes, etc.

UNDP Indonesia collaborating with Indonesian Telemedicine Alliance (ATENSI) to strengthen telemedicine services for Doctors to Patients conducted by Private Companies based on Smartphone applications and websites, organized by Alliance Telemedicine Indonesia (ATENSI). This cooperation agreed on several activities, such as:

  • Evidence-based practices through Assessment to analyze the telemedicine service in pandemic situations and university network development on telemedicine research to provide recommendations to government regarding working areas of telemedicine services to improve their services and as part of the public health service system;
  • Advocacy on development of national framework and governance on telemedicine; and
  • Support to promote South-South learning, exchange, and capacity building.

In addition, UNDP has the initiative to implement an assessment to measure the extent to which this telemedicine service can provide benefits to the people of Indonesia, what types of services are accessed by patients through this telemedicine service, the quality of health services, how much is the cost raised through this telemedicine service. UNDP Indonesia engaged with the Ministry of Health Republic Indonesia and ATENSI to conduct this assessment and aim the objective where the Government received a valuable recommendation and became evidence for policy improvement related to telemedicine services in Indonesia. The objectives of this assessment are:

  • The extent to which the telemedicine service can provide benefits to the people in Indonesia
  • Provides recommendations to the government regarding working areas of telemedicine services to improve services and as part of the public health service system in addition to hospital, clinic, and Puskesmas health services.

This assessment report has been presented to ATENSI members and we are planning to disseminate the assessment result to the Ministry of Health and provide recommendations on improving the telemedicine services and regulation.

source: www.atensi.or.id

Nora Nindi Arista

6. Besides that, Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized?

There are a lot of opportunities in expanding the use of telehealth in Indonesia. Through STRATEGIC project, UNDP Indonesia aimed to develop telemedicine platform scheme during pandemic and post-pandemic such as ethical standard, emergency decree, code of conduct (in practical do and don’t) material with MoH, ATENSI, and beneficiaries and establish a national multi-stakeholder platform to promote engagement, coordination and collaboration between government agencies, public and private health providers, telemedicine developers, and CSOs.

Besides telehealth, UNDP Indonesia will assist the Ministry of Health in developing the Digital Health Strategy. Ministry of Health through Data Information Centre and Digital Transformation Office has been developing health digitalization priority 2021-2024. Therefore, this digital health strategy will be supporting digital health transformation from the policy framework, institution strengthening in central and district level, human resource capacity, infrastructure readiness, and feasible and measurable implementation strategy.

Leslie Ong Moderator

It is great to see the leadership shown by MOH, ATENSI and UNDP in co-convening a multistakeholder platform for the promotion of telemedicine. May I ask what outcomes have been achieved so far (or what the intended outcomes are)? It'd be great to hear from other discussants of examples of similar national-level multistakeholder platforms on digital health that bring together developers, service providers and government? [~88695] this may be related to one of your questions about examples of efforts to promote public-private partnership.

Nora Nindi Arista

[~85614] So far, the telemedicine assessment is one of the outputs of this collaboration. This assessment has help us understand the telemedicine situation in Indonesia including the implementation and challenges. Since this is a new multistakeholder platform, we are planning to conduct series of meeting on developing ethical standard, emergency decree, code of conduct (in practical do and don’t) material with MoH, ATENSI, and beneficiaries. HIV would be one of the issues that we will piloting in this multistakeholder platform.

Leslie Ong Moderator

Here's an example of a digital psychosocial intervention from Ghana (illustrated in the background paper): 

MindIT, founded in 2017, provides free mental health services through mobile technology for people in Ghana where an estimated 650,000 people live with a severe mental health disorder and over two million live with moderate to mild mental health condition. There are less than 20 psychiatrists and around 1,000 registered mental health nurses in the country, and many people in Ghana are not aware of mental health conditions and do not know where to access affordable services.

MindIT uses a toll-free ‚Äúquick code‚ÄĚ (USSD, or unstructured supplementary service data) that enables screening for symptoms that are suggestive of mental health conditions. Responses are sent to a government-funded call centre where trained personnel analyse the data and refer people to the nearest community psychiatric unit, where patients can access either free or subsidised services from the National Health Insurance Scheme in Ghana. In 2021, the short code was incorporated into the Ghana Mental Health Services authority and is free of charge. In the last two years, more than 8,000 people have accessed the service and many of those received attention and treatment provided by clinical staff.

Dr. [~117635] do you have any reflections about the success of this intervention? What would need to happen to scale this service up in Ghana?

Belynda Amankwa Moderator

Week 1 Discussion Summary, 23 - 27 August 

Dear All,

Happy to kindly share a brief summary and some reflections from our discussions last week.

Many thanks!

  • Several countries have introduced different telehealth interventions in recent times to improve health outcomes.
  • In Ghana, a telehealth intervention aimed at strengthening the capacity of community health workers has empowered health care workers and improved¬†¬† access, efficiency, and quality of care. In Pakistan, a telemedicine platform has been used to train about 5,000 doctors and medical staff and provide virtual consultations for thousands of patients. In Indonesia, an e- health application and other channels such as web chat and WhatsApp are being utilized to support patients and provide health information. In Kenya, a free low-tech solution¬†that uses short code or USSD is being used to strengthen disease surveillance whilst in Bhutan a digital system has supported the country‚Äôs very successful COVID 19 vaccination efforts
  • Telehealth services have been beneficial in addressing human resource deficits in the health sector by strengthening capacity of health personnel and connecting health personnel with patients. During this pandemic, telemedicine interventions have also been used for surveillance, screening, monitoring of patients and the delivery of medicines.
  • Despite all these benefits, numerous challenges impede the expansion and quality of telehealth services. These include lack of financial support, uneven /unequal internet connectivity, inadequate human resource, and low uptake of telehealth interventions in certain populations. Promoting behavior change to encourage uptake and ensuring that telehealth interventions are context specific and sustainable, will be critical for the scale up of telehealth interventions
  • Collaborations and partnerships are proving to be critical ingredients for the initiation and scale up of telemedicine interventions as evidenced by partnerships between UNDP Indonesia and Indonesia telemedicine alliance (ATENSI) and collaborations with Safaricom, Kenyan Ministry of health and Korea telecom. Harnessing public private partnerships and developing broader multi stakeholder platforms for engagement, coordination etc. will also be instrumental in scaling up interventions
  • Providing technical support for the development of the telehealth infrastructure as well as supporting the institutionalization of the interventions through broader policy and legislative support could be a winning formula as highlighted by work done by¬† UNDP Indonesia and UNDP Pakistan
Leslie Ong Moderator

Hi everybody, WELCOME to week 2 of the e-discussion. Thanks very much [~98869] for your brilliant moderation last week and for getting Room 1 off to a cracking start! My name is Les Ong and I will be your moderator for Room 1 this coming week.

Thank you to those of you who kindly shared several examples of telehealth solutions across a broad range of health system functions. We heard about good practices, key challenges and lessons learned in introducing and scaling up these solutions, and the policy, regulatory and strategic framework that enable their sustainable use. Several UNDP colleagues also highlighted the support that they provided in helping to rollout telehealth solutions.

For Week 2, we would like to continue pretty much in the same vein as last week. We hope that you are able to build on the discussion that has already taken place. Please feel free to react/respond to the questions or points raised by other discussants, and tag relevant individuals (either those who are already part of the e-discussion or those yet to join) so that they are aware of your posts. Please also share any relevant literature / resources in your interventions (either as a hyperlink or as an attachment to your post).

Apart from the guiding questions listed in the introduction, please also consider addressing some of the questions that discussants raised last week:

  • How can we best change the behaviour of health professionals in adopting the use of telehealth?
  • Are there any examples where existing digital solutions have been repurposed ¬†for the COVID-19 response?
  • How can we quickly build the capacity of primary healthcare workers to enable the transition from paper-based to digital M&E and reporting? Some examples of successful, evaluated training of HCP to use digital reporting systems would be helpful.
  • What support is needed by national governments in upgrading their digital infrastructure to delivery broadband data at affordable prices? Any examples of support to strengthen internet coverage?
  • What examples do we have of strong frameworks that ensure patient confidentiality, and strengthen data security for government, CSOs and the individual client?

Looking forward to our discussion this week!

Jai Ganesh Udayasankaran

Telemedicine Practice Guidelines from Government of India

Until March 25, 2020, India did not have legislation or guidelines on the practice of telemedicine, through video, phone, Internet based platforms (web/chat/apps etc). The existing regulations that used to be applicable were those primarily governing the practice of medicine and information technology. Lack of clear guidelines resulted in ambiguity on the practice of telemedicine. Considering that gaps in legislation and the uncertainty of rules pose a risk for both the doctors and their patients as well as potential of tele-consultations in meeting the needs of citizens during the Covid pandemic the Government of India released telemedicine practice guidelines. Available online @ https://www.mohfw.gov.in/pdf/Telemedicine.pdf

Related references:

Frequently Asked Questions (FAQs) on Telemedicine Practice Guidelines 

Modification in Medicine List in Telemedicine Practice Guidelines 

Purpose:

The purpose of these guidelines is to give practical advice to doctors so that all services and models of care used by doctors and health workers are encouraged to consider the use of telemedicine as a part of normal practice. Also these guidelines were to be used in conjunction with the other national clinical standards, protocols, policies.

Catalytic effect of the guidelines on the virtual care ecosystem in the country:

The practice guidelines releases by the Government had a catalytic effect on the virtual care ecosystem in India. Here is an attempt to sum-up the key developments in a chronological fashion following their release. 

March 25, 2020:¬†Board of Governors in supersession of the Medical Council of India (MCI) released¬†‚ÄúTelemedicine Practice¬†Guidelines: Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine‚ÄĚ

April 7, 2020: Telemedicine Practice Guidelines for Ayurveda, Siddha & Unani practitioners

April 10, 2020: Telemedicine Practice Guidelines for Homeopathy practitioners

May 12, 2020:¬†Gov amends ‚ÄúIndian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002‚Ä̬†

‚ÄĘNew¬†regulation: ‚ÄúIndian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2020‚Ä̬†

May 14, 2020: Gov notified the regulation and published them in the Gazette of India (Deemed to have been effective from March 25, 2020)

June 11, 2020: Insurance Regulatory and Development Authority of India (IRDAI) issued directive

‚ÄĘTo allow claim settlement for telemedicine consultation wherever normal consultation with a medical practitioner is allowed in the terms and conditions of the policy contract.¬†

‚ÄĘTelemedicine offered shall¬†be in compliance with¬†the Telemedicine Practice Guidelines and amendments if any from time to time

October 1, 2020: Telemedicine consultations will be covered under health insurance policies 

‚ÄĘHealth policies covering consultations through physical visits will include consultations over telemedicine as well

October 15, 2020: The National Health Authority (NHA) issued invitation to conduct Proof of Concept¬†(PoC) for ‚ÄėTelemedicine Building Block‚Äô¬†under "National Digital Health Mission‚ÄĚ

Scope: 

‚ÄĘMeant for Registered Medical Practitioner (RMP) enrolled in the State Medical Register or the Indian Medical Register, RMP is a person enrolled and entitled to practice under the Indian Medical Council Act 1956.

‚ÄĘCovers norms and standards of the RMP to consult patients via telemedicine¬†

‚ÄĘIncludes all channels of communication with the patient that leverage IT platforms, including voice, audio, text & digital data exchange

Exclusions: 

‚ÄĘSpecifications for hardware or software, infrastructure building & maintenance

‚ÄĘData management systems involved; standards and interoperability¬†

‚ÄĘUse of digital technology to conduct surgical or invasive procedures remotely¬†

‚ÄĘResearch, evaluation and continuing education of health-care workers¬†

‚ÄĘDoes not provide for consultations outside the jurisdiction of India¬†

The seven elements 

1.Context: Is telemedicine appropriate and sufficient in the given situation?

2.Identification of Dr and Patient: Consultation should not be anonymous

3.Mode of Communication: Video, audio or text

4.Consent: Implied (when patient initiates) or explicit (when initiated by health worker, Dr or a caregiver)

5.Type of Consultation: First consult or the follow-up consult

6.Patient Evaluation: Professional discretion to gather the type and extent of patient information required to be able to exercise proper clinical judgement

7.Patient Management: Provide health education as appropriate in the case; and/or provide counselling related to specific clinical condition; and/or prescribe medicines (specific restrictions apply as per guidelines)

‚ÄėTrain to Practice Telemedicine‚Äô Certificate Course

‚ÄĘLaunched by Telemedicine Society of India on 4th¬†April 2020¬†(within 10 days of release of Telemedicine Practice Guidelines)

‚ÄĘTo¬†train doctors on the basics of telemedicine practice as per the notified practice guidelines

‚ÄĘEligibility: All doctors registered and practicing in India can to enrol for the online course

‚ÄĘFour modules of 20-30 minutes each, followed by Q & A.¬†

‚ÄĘConducted on weekends (Saturdays and Sundays)

‚ÄĘCovers introduction to telemedicine, tele-triage, legal aspects of practice guidelines and setting up telemedicine practice (a DIY approach)

The Course Flow

     1. Registration
2. Pre-course quiz
3. The course
      a. Introduction to Telemedicine
      b. Introduction to Tele-triage
      c. Legal aspects of the Telemedicine Practice Guidelines
      d. Setting up your telemedicine practice - A DIY approach
4. Question and Answer Session
5. Post-course quiz
6. Certificate of completion of course.

‚ÄĘCourse completion certificate: Provided for those who pass online assessment with a score of 80% or above

Alliance for Telemedicine Registry and Evaluation

‚ÄĘLead by Digital Health India Association with partners - Consortium of Accredited Healthcare¬†Organisations,¬†College of Healthcare Information Management Executives (India), Healthcare Information and Management Systems Society and supported by National Resource Centre for EHR Standards.

‚ÄĘSurvey targets four broad categories of telemedicine solutions

‚ÄĘPrimary survey: Output is the registry of telemedicine solution providers¬†

‚ÄĘEvaluation: By panel of experts from participating associations and preparation of a curated list of providers meeting the requirements of healthcare providers and conformance with telemedicine practice guidelines

While there are lot more developments that have happened/happening in India on virtual care front this post is to highlight the relevance of regulations and their impact in the overall ecosystem that evolves over time. 
 

 

 

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Leslie Ong Moderator

Hello [~117780] thanks so very much for sharing all this great information! There's a lot to digest here, so I'll try to address some of the key points your brought up one-by-one. 

The "Telemedicine Practice Guidelines" is clearly an excellent tool for helping practitioners mainstream the use of telemedicine into clinical practice. One catalytic effect of this guideline that you highlighted was that "health [insurance] policies covering consultations through physical visits will include consultations over telemedicine as well" - can you please clarify this point? Is this provision enforced through a specific policy/legislation? or is this merely part of the guideline? [~98869] and [~117647] may be interested to find out also.

In a similar vein, the certificate course and evaluation by the telemedicine industry group - are these  mandatory for health professionals to undertake so that they are licensed to practice 'telemedicine'?

It'll also be good to hear your reflections about how well you think the implementation of the practice guidelines have gone. What have the challenges been? Of particular interest is the partnership between peak public bodies (Medical Council of India, National Health Authority) and industry groups (Telemedicine Society, Digital Health India Association) in improving the telemedicine space through this guideline (and the subsequent handbook, training course and evaluation). UNDP in Indonesia is currently working with the Ministry of Health to establish a similar coordination platform [~117654] 

 

Nora Nindi Arista

Hi [~117780] Thank you for sharing this very important experience from India in developing telemedicine practice guidelines. As mention by Les, UNDP Indonesia planned to support the government of Indonesia in developing the ethical standards, emergency decrees, and code of conduct (in practical do and don’t) of telemedicine services. We are planning to conduct the first workshop to initiate this development and maybe people from UNDP India or the ministry of health in India could share their experience, the challenges, and lesson learned during the guideline development. During the guideline development, can you share the challenges and how you overcome the issues? it would be very valuable for us to learn from you and colleagues from India. Do you mind sharing your email with me? so we can contact you for further discussion.

Jai Ganesh Udayasankaran

[~85614] here are my replies to your questions.

Insurance coverage for telemedicine 

The Insurance Regulatory and Development Authority of India (IRDAI), the apex body that regulates insurance in India asked insurers to allow claim settlement for telemedicine consultation wherever normal consultation with a medical practitioner is allowed in the terms and conditions of the insurance policy contract and telemedicine services offered shall be in compliance with the Telemedicine Practice Guidelines dated 25th of March 2020 and as amended from time to time. IRDAI's advisory also said that the provision of allowing telemedicine shall be part of claim settlement of policy of the insurers and need not be filed separately with the Authority for any modification. 

Certificate course on telemedicine for health professionals 

Any registered medical practitioner in India can provide the service in line with the practice guidelines. The participation in the online course from the Telemedicine Society of India I had mentioned is voluntary and the objective of this course was to explain the expectations in the practice guidelines (especially the do's and don'ts) to  medical practitioners and get them to practice telemedicine in way that is safe for the patient as well as the practitioner. The national medical commission is in process of developing an online telemedicine course for ensuring uniformity. Once the course is developed, it will be mandatory for all the registered medical practitioners in India to undertake the course within three years of its
notification. So at present training and certification is not mandatory to practice but once the course from the national medical commission is developed, notified it will become a must compulsory for all RMPs who wish to teleconsult to have undergone such a course within three years of the notification of the course. 

Evaluation of the telemedicine solutions by the industry consortium and formation of the registry

Again the process of enrolling their telemedicine solution and subjecting it to be evaluated is voluntary for the solution providers/vendors. Since a whole lot of solutions were being made available and individual practitioners as well as hospitals were finding it challenging to evaluate prior to procurement among very many choices this consortium consisting of industry, professional societies and supported in the evaluation by the National Resource Center on Electronic Health Record Standards (NRCeS) which was established by the Ministry of Health was to categorize the solutions available, set evaluation parameters and ensure the evaluation process is transparent and objective. The experts involved in the evaluation exercise were in fact volunteers nominated by the consortium partners and it was a strenuous effort. This also cannot be a one-time effort but needs to be undertaken periodically when more solutions are introduced in the market and also existing solutions undergo updates to to the features. There was consensus among the consortium partners that they will not only evaluate the solutions for compliance with standards and other criteria they had agreed upon but also to help smaller players like startups may not have resources unlike the established vendors with guidance and inputs that will help them to improve their solutions. 

UNDP Indonesia

Glad to know about the efforts from UNDP in Indonesia Will respond to the comment from Nora Nindi Arista next. Would be glad to share any insights from my work and experience. 

Jai Ganesh Udayasankaran

[~117654] have sent you my email. Look forward to know more about the workshop being planned by UNDP Indonesia. Will do my best to participate in the workshop virtually and also help with resource persons required if any to share experiences from India at this workshop.  

Laura Sheridan

Hi again, just responding somewhat late to Les's point on behaviour change of doctors towards using telehealth solutions. After consultation with our telemedicine partner Sehat Kahani, we can share the following challenges they faced during the implementation of the UNDP funded telehealth initiative in Pakistan and how Sehat Kahani has tried to respond to these challenges: 

  • The mode of health care delivery has always been physical hence the first barrier was to convince the doctor that virtual consultation can be as effective for the patient as a physical consultation. The doctors often have issues navigating technology, become conscious¬†of their appearance¬†and are resistant to do detailed conversation to the patient¬†as they are very used to skimming patients quickly as it is in physicals hospitals due long waiting lines.
    • How we mitigate this is by doing training with doctors on usage of the telemedicine platform, communication and soft skills, taking a detailed history¬†and exercising increased empathy towards the patient. These are four training sessions done within a month of recruitment and are mandatory for all doctors to attend.¬†
  • The doctors somehow fear that they would earn less in a telemedicine consultation than in a physical consultation or will not get as many patients coming to them as there in a physical consultation.¬†
    • How we mitigate this is creating a business model that gives them a 70% to 80% cut of the revenue earned from the consultation. We also make them understand that they are saving travel and time cost that they would in physical consultation. We also help them market themselves through digital marketing campaigns to increase patient flow.¬†
  • Sometimes doctors consciously¬†or unconsciously behave or address the patient casually on a telemedicine platform. This reflects in their clothing or place of consultation or noise management in the room they are practicing in.¬†
    • We have created a SOP for client management for the doctors that helps them communicate/display themselves in a professional manner for clothing to room setup to solitude within the room they are practicing¬†in with no distractions.¬†
  • Doctors often face internet disruptions as they may be based in diverse settings as they work from home rather than one physical setup.¬†
    • We provide internet connectivity packages to doctors along with random speed tests to make sure their internet coverage is smooth.
Leslie Ong Moderator

Your successes in Pakistan is very impressive, [~93308] ! A sustainable business model is absolutely critical in this regard and the incentive scheme you've implemented is clearly working. I'm wondering how you arrived at the "70-80%" revenue-sharing split? For instance, is that what was calculated to be the minimum incentive for the health professional to provide their service? or perhaps this is what's left over after covering all other operational costs? or perhaps some other calculation. I guess there would also be questions around OOP/affordability and the implications on the demand side. 

Do other discussants have any examples of a sustainable service model (for telemedicine or other telehealth services)?

Finally, on the SOP for client management - I don't suppose this has been incorporated into a national training guide as is the case in India? (see post above by [~117780] )

 

Claudia Olmedo Moderator

Hi Laura, thank you for sharing these challenges faced in the implementation of telehealth solutions in Pakistan. Behavioral changes are very important in adoption of digital solutions and in many settings, specially those involving vulnerable communities, may take many efforts for then in sinking in due to diverse factors (such as trust, connectivity issues, access to devices, among others) and be sustained over time. In that sense, could you comment on what challenges were faced regarding patients and what strategies were used to overcome them?

Jenniffer Taveras

Greetings from Dominican Republic! 

Telemedicine for remote areas in the Dominican Republic

In the Dominican Republic, we are accelerating and pivoting a teleconsultation system with the Private Sector Unit and the Accelerator Lab.  In Previous years, some specialized centers consulted online., however, after the COVID 19 pandemic and the drastic physical distance measures, the eHealth has become most needed. Some doctors avoid getting infected by doing their own online consultations without having an official platform, system medical policy, and the security of the data shared by patients.

As a result of all the above, a team of innovators in conjunction with one of the most recognized universities in the country began to iterate and test an online hospital platform, where you could not only consult with a specialist to treat covid symptoms but to treat the psychological sequelae that the confinement was leaving in the people, this platform called eHospital has been scaling and implemented to rural environments, where people of limited resources, facing different geographical barriers can save costs and time and have quality health through monitoring and prevention of their comorbidities.

Also, at the country level, some digital gaps could be understood as one of the biggest barriers or detractors to be able to realize the efforts related to telemedicine. We are aware of the impossibilities for everyone to access existing platforms and understand them, both as a medical body and as patients. However, the UNDP in the Dominican Republic through the Digital X initiative has been selected to accompany and accelerate this telemedicine project called eHospital, this platform seeks to reduce the gaps and barriers that the population in rural areas faces, bringing medical specialists closer to patients.

The main feature of the platform it doesn’t enhance the digital gap for the users and the medical staffs by being installed in rural clinics, which are first-level care centers where patients from remote areas usually generate confidence with the central doctor, however, patients visit the center only to treat emergencies and seek medication, without being able to make use of it for it was conceived, monitoring and prevention of serious consequences to already known diseases; this is why the UNDP Dominican Republic seeks to pilot with this platform that can ensure health and prevention in remote areas saving costs and time to patients while reducing the digital divide.

Also, the platform will support the creation of a unique medical record of beneficiaries that is necessary at the country level, it will also allow us to have inputs and data to build public policies that support telemedicine, to know how the systems work in vulnerable areas.

You can read more about the launch here.

Clara Aranda

Hi [~107353], thanks for sharing this example from the Dominican Republic. I have a couple of questions, hope it is ok to ask. Do you know how the eHospital platform is currently being funded (the facility-based version)? And, also, what will be done to ensure that the unique medical record for beneficiaries (digital) and the current records (analogue, I assume) are harmonised? Finally, what is financing and operations plan if the pilot is successful--is this going to be owned by the government/organisation?

Wisdom Atiwoto

Ghana's digital health space is a very busy space right now with many entities aggressively implementing one digital health solution or the other. Telehealth with all it's potential, appears on surface, to be just one of the many digital health interventions, just like the others and as result faces many sustainability risks and even decline in uptake, as demonstrated by the existing implementations.

 

The Ghana Telemedicine Project funded by the Novartis foundation was scaled up with the establishment of teleconsultation centers (TCC) in six (6) regions in Ghana; and it clearly demonstrated, through an evaluation, the many benefits that are worthy scale up.

 

Years down the line, the story is evolving. Currently only the implementation in the national capital have seen substantial numbers in service uptake due to reconfiguration of the teleconsultation center to serve COVID-19 patients . All the other regions have decline in uptake; and even two of the regions have stopped operating their teleconsultation. Nevertheless because the current COVID-19 pandemic, a review of the model of telemedicine is being undertaken by the Ghana Health Service.

 

To curtail the challenges above, a different approach in concept design, borne out of the challenges experienced and lessons learnt from the six region scale up, have been adopted to refine the model of telemedicine to be implemented in the review and scale up of the Ghana Telemedicine project. The approaches include:

 

  1. Integration at both the service level and the the technology level. Telehealth is not being redesigned as a standalone innovation, but rather a comprehensive technology platform that is focused to serve as the backbone for service delivery. This is informing our approach to the conceptualisation, design and branding.   Creating a home for telehealth in one of the key service delivery efforts, we believe, will enhance its sustainability rather when it run as a standalone. We want to see telehealth as a service delivery solution rather a technology solution.

  2. Establishing key linkages with service delivery innovation and Primary Health Care initiatives that are aimed at addressing the many challenges that confront the Ghana Health Service. In this regard telehealth concept redesign and implementation planning is focusing at using telehealth as the technology backbone to support the implementation of the new Network of Practice initiative defined in Ghana's roadmap to Universal Health Coverage.  The Networks of Practice is an initiative to reorganise Primary Health Care service delivery around what is described as Model Health Centers to ensure there is the provision of quality to 24- hour clinical services at the sub-district (rural areas). The new telehealth implementation s includes 4 key components

    1. Provider to Provider Telehealth

    2. Provider to Client Telehealth

    3. Health System Strengthening  such referral management, coaching, supportive supervision, service reorganisation. etc etc

    4. eLearning and capacity building

Nithima Ducrocq Moderator

Hi [~117635] ,

Thank you for sharing your experience from Ghana. I particularly agree with your first point, telehealth platform as standalone tend to not be engaging enough for the user (they might not know about it, or try it once but the retention is quite low after). I was curious to see how you embedded the telehealth platform into a service delivery platform. Could you expand a little bit?

Thank you very much,

Clara Aranda

Hi Wisdom,

 

Thanks for sharing this project in Ghana. You mentioned that only the implementation in the capital had substantial uptake. Could you share more about the reasons why you think the uptake in other regions wasn't as successful? In the design approaches described, it seems like there were some challenges with the integration of the solution into the service provision. Was there any push back from service providers adopting the telehealth system? Or are there any barriers from the patient/user side?

Wisdom Atiwoto

[~117791]  A quick and  dirty initial assessment was done ahead of detailed evaluation of the Telemedicine implementation in Ghana which is being planned, and I must say the reasons for the dwindling uptake are many, but key among them is the issue of Telemedicine service design and the inability for the Teleconsultation centers (TCC) to introduce new services over time.

The Ghana Telemedicine Project was largely a Provider-to-Provider Telemedicine model that started with a very limited set of clinical conditions that community health nurses could called for support on. The protocols for structured step by step guidelines were developed on  only these small number of patient conditions so once community health nurses had called a number of times, their own capacity is developed as a result there is no need to call again for support. What should have happened was for new services to be introduced to continue to attract community health workers to make the calls. New users could have also been targetted to take the services that were still available at TCC.

New services also had to be developed using services design and service science approaches that focuses on the continued delivery of value to patrons. The TCC were rigid and with the pandemic, none of them, apart from the TCC in the national capital, was able to reorganise to provide services to meet the needs of the COVID-19 pandemic. 

The new Ghana Telehealth Program is making service design and services introduction one of the four main pillars for the success  of the implementation. These pillars are 

1. Project Management 

2. Service Design 

3.Technology Design

4. Informatics and M&E

With a robust service design principles and a the plan to gradually expand the range of services offered via Telehealth, services will be designed for continued delivery of value. 

Greater Accra Telehealth program saw a large uptake because they expanded their services and went into the provision of provider-to-client telehealth services and become the main contact center for COVID-19 support to the people of Accra, which remain the epicenter for COVID-19 in Ghana for a long time. They have also started the introduction of Hypertension and diabetes services that a small number of citizens have started taking up.

 

Wisdom Atiwoto

[~117328] Integration and comprehensiveness are key success factors for any health service intervention in Ghana currently and telehealth is no exception. We are looking at telemedicine integration from atleast two perspective service integration and technology integration. 

You specific question bothers on technology integration. We have only currently designing an HIE to be implemented. Due to the plurality of our approach, we are adopting HIE with a service bus to provide shared services such clinical decision support to be consumed by different players. We do not think embeding telemedicine solutions into other patient care solutions is profitable. We find that quite restrictive. 

Nithima Ducrocq Moderator

[~117635] thanks a lot for your answer. I agree we tend to restrict ourselves when it comes to integration. I think the right integration (i mean service integration) needs to be tailored to the user's needs -  I usually see telehealth company focusing on very specific needs with highly motivated users (like chronic disease management ex. having a telehealth platform integrated in an app specialized for diabetes patients). Or on the other hand, integrating with much broader services so the user's has more incentives to use the services.

I am curious abou the different reason you it is not profitable to embed telehealth in other patient's services in particular. I think this can be good learnings for other players developing telehealth plaftorms.

Thank you very much

Wisdom Atiwoto

[~117328] Some services are critical for successful rollout of telehealth. Some of these will be clinical decision support, prescription service, infobuttons, analytics and other context sensitive areas such quality assessment and improvement.  Though building these services require a lot of work, it is better if the government health authorities lead these and set them up as shared services while maintaining same as a single source of truth. For instance adding national treatment guidelines for obstetric care into a telehealth decision support system may require that these guidelines are maintained and updated by the national authorities who are mandated to operationalize  such guidelnes.

Multiple players usually benefit from these shared services so with a single source truth, duplication of work effort will be minimised even as the opportunities to have all players use such resource becomes a reality.  Making these shared services available to all players will ensure consistency of use and lead to consistency in outcome. These present opportunities that these offer for care quality improvement and also for opportunities for reimbursment.  

Making individual vendors implement or maintain these shared services will unnecessarily increase their overhead costs and in the process reduce profitability. Such arrangements will also rob the health systems of the benefits of using the huge data assets on an adhoc basis.

Ranjeet

Since 2018, Jan Vikas Samiti (JVS), Varanasi (India) is implementing Telerehabilitation project in the North India in collaboration with 19 partner organisations. Our focus area is physical rehabilitation and school readiness. Through this project, rehabilitation of children with disabilities managed by experts from remote location and CBR facilitators through technology for door-step delivery of services.

Using technology and digital penetration even in resource-poor settings, an integral platform of telerehabilitation is built using Mobile phone and Web portal. CBR facilitators are guided to conduct physical assessment and prepare a rehabilitation plan by qualified team operating from remote location. CBR facilitators even with basic knowledge can drive entire process using this platform. Direct transfer to pictures, videos, checklists and standardized tests conducted through application   helps developing a robust rehabilitation plan immediately.

Rehabilitation cost reduced by 50%; no wage loss and transportation cost for parents as no travel required; immediate services for children and on-job training  for CBR facilitators-entire process is optimised  for delivering efficient, cost-effective and quality services. At present 703 children with disabilities (mainly children with Cerebral Palsy) are getting benefits of the programme. Even during COVID crisis, parents and children were in direct contact with us.

Clara Aranda

Hi [~117820], Thanks for your sharing this project. I was wondering if you expand a little bit more on the role that the 19 organisations and JVS play in the rollout of this project. Are there any plans to expand to other regions in India and what do you think would be the main challenges of doing so?

Ranjeet

[~117791]¬†This innovative initiative is easy to access and quite practical to service users.¬† There is a huge scope for replication in the country. Here it is important to mention that the JVS telerehabilitation project ‚ÄúSambhav‚ÄĚ has won the best rural health initiative award and is shortlisted for Zero Project Award 21-22. Moreover, this project is selected for Zero Project Impact Transfer Program as the most impactful and replicable initiative. Of course, the COVID -19 pandemic situations put telehealth in the frontline service delivery system. It is high time to prioritize the telehealth solution to every health care delivery system from top to bottom whenever and wherever possible.

Gertjan van Stam

There are many cases of telehealth projects. Possibly, not too many emerged from African grassroots and have been considered by Ministries of Health for national implementation. Here in Zimbabwe, triggered by the demand for access to health care during the COVID-19 pandemic, in the outlying province of Masvingo, the community built together with the Ministry of Health a telehealth solution: the Digital Information and Consultation Platform for COVID-19 information. Attached, a report describing the context, content and observations for your perusal. 

Nithima Ducrocq Moderator

Hi [~99893],

Thank you for sharing the detailed report. Feel free to share what you personally consider the biggest learning in the chat as well.

Best,

Joaquin Blaya

Hi all,

This is a great discussion. We have been working with VillageReach in creating a toolkit for governments and service providers to create national-scale telemedicine and health hotline systems. VillageReach has experience in several countries implementing these systems. We are finishing these two reports and hope to have them available in the next 2-3 months. If anyone is interested in receiving one, they can email me at jblaya@worldbank.org.

Leslie Ong Moderator

SUMMARY OF WEEK 2

Thank you to all your insightful discussion last week! We heard about the interesting and innovative work that is going on in the Dominican Republic, Ghana, India, Indonesia, Pakistan and Zimbabwe. Here are some highlights for me:

Introducing policies, regulations and processes

Several countries are in the process of developing or implementing national guidelines, policies and regulations to create an enabling framework for effective and sustainable telehealth sector. India recently launched its ‚ÄúTelemedicine Practice¬†Guidelines‚ÄĚ to help facilitate the mainstreaming of telemedicine into national clinical standards and protocols, and to provide the framework for quality and ethical telemedicine practice. This has led to the introduction of a raft of new regulations, policies and processes that aim to improve ethical and professional conduct, clinical practice and standardization of the telehealth sector.

Indonesia is also currently in the process of developing ethical standards, emergency decrees, and code of conduct for telemedicine services. While Ghana is re-conceptualizing its overall approach to telehealth - they realise that an effective, sustainable telehealth service needs to be fully integrated into the entire system for health service delivery.

It would be important to understand the successes (and failures) when formalizing and enforcing these policies, regulations and processes, particularly in a sector (health) that is already heavily regulated, and the need for buy-in from professional bodies and patient/consumer groups. [~117827] [~117635] [~107353] [~93308] [~117780] [~117654]  what are your reflections on the development and implementation of these guidelines / policies / strategies? A toolkit created by the World Bank and VillageReach provides governments and service providers with guidance on establishing national-scale telemedicine and health hotline systems, may also be a useful resource to help navigate this process.

Importance of fostering partnerships

It is evident that public-private partnerships are critical in facilitating the introduction and scale up of telehealth services. In India and Indonesia, peak public bodies are working closely with industry groups on creating the policy, regulatory and capacity strengthening frameworks; while in the Dominica Republic, UNDP is facilitating the collaboration between technology innovators and academia to develop and scale an online hospital platform. We need to learn more about how these partnerships can be fostered, and what role should development partners, such as UNDP, be playing.

Promoting sustainability

In many of our countries, the telehealth landscape is typically crowded and fragmented, and pose a significant challenge to quality and sustainability for many of these solutions. Some lessons learned in overcoming these challenges include:

  • improving the broad acceptance among health professionals by providing guidance on how to engage with patients virtually and building their capacity in using the technology;
  • introduce regulations that ensure adequate health insurance coverage of telehealth services and minimization of out-of-pocket payments for patients;
  • Implement a business model that can sustainably incentivize health professionals - through revenue-sharing arrangements, making it easier to engage with patients and expanding service reach, or other approaches. We need to learn from successful telehealth models that are financially self-sustaining, that can ensure retention and motivation of health providers, and which also take into consideration issues of affordability and satisfaction of clients and patients. [~117820] [~107353]¬†[~117827] do you have any lessons to share?

Finally, with a multitude of telehealth services springing up during COVID-19, an interesting question that was raised by [~117791]¬†is the sustainability of these services ‚Äėpost-pandemic‚Äô (if that time ever arrives!). Will the momentum of rapid telehealth adoption continue post-pandemic? Is the proven value-proposition of telehealth enough to continue its expansion among a broader group of health professionals / clients, but also across other areas of the health system?

Thanking you all for making this discussion a pleasure to moderate! Please feel free to offer your own summary of the discussion so far. I Iook forward to another week of conversation. Over to you, [~117328] 

Mark Wien

Hi,

We are a digital health and electronic medical platform that is currently most active across Africa and Asia. We have had quite a few experiences trying to integrate and work with telehealth. One of the big problems we have encountered is lack of interoperability, and lack of secure patient management systems that can be accessible for more stakeholders. Most of the work is on paper, patients don't have their medical history or doctors aren't able to pass on pertinent information to other health practitioners as patients move through the health systems. The lack of information and follow-up leads to significant waste, increased cost and decreased quality of care, and often worse compliance. Being able to ensure that patients records and telemedical visits transfer over to in-person points of care is extremely important and also improves resiliency of health systems.

This is a problem we are actively overcoming with our platform.

 

Best,

Mark

Nithima Ducrocq Moderator

Hi Mark,

Thank you for your comment. I strongly agree with the interoperability barrier and I would be curious to understand how does your platform overcome the problem. Could you describe in more details what is your platform doing and how it is working?

Thank you,

Nithima

Mark Wien

[~117328] Nithima - our platform (PocketPatientMD) is an electronic medical record platform for providers (doctors, hospitals, clinics, Ministries of Health), with other features to connect the entire healthcare ecosystem. It is designed in a manner to be able to link with any system, with the flexibility to be customized and adapted as new healthcare challenges emerge. We have had success getting doctors to utilize our platform which is the first step in digitization, but a key challenge with interoperability is when a company or organization is against it or does not want to link with other systems. So there must be some cooperation or collaboration. As an example, Epic was in a lawsuit regarding interoperability rules and regulations in the US. I hope this answers your question.

Nithima Ducrocq Moderator

[~117844] thanks a lot for your answer

Laura Sheridan

@LesOng - re the sustainability model, Sehat Kahani is currently managing the business model of the Tele- ICU model in private hospitals is based on annual subscription or retainer by the hospital. This retainer will cover management cost, tech cost, support cost and doctors cost based on an assumption as to how many consultations will be done per month per ICU. These assumptions are build on market research and existing patient flow in the ICU. The doctors providing services via the teleICU platform are paid on a revenue share basis of total consultations that they have done on a monthly basis. The net profit margin is 30 % which is invested further in business expansion and cross subsidising services in low income hospitals. As for government hospitals, Sehat Kahani is currently applying to government procurement tenders that can help provide services in public (and under-resourced private) teleICUs.  

 

Hira Nand

At present, JVS Telerehabilitation  " Sambhav" is providing guidance for the physical rehabilitation service to selected 19 Partner Organisations (POs) in Uttar Pradesh, Bihar, Uttarakhand, Jharkhand, Madhya Pradesh, Odisha, Chhattisgarh, Rajasthan, Manipur and Meghalaya under this project.

Ha Nguyen Thanh

Hello everyone, I'm Dr. Nguyen Thanh Ha from UNDP Viet Nam. On behalf of the team, I would like to share experience and post the responses for question 1, 4 and 5 as below:

1. Describe the telehealth solutions that have been introduced in your country/region. If available, please share a link to relevant literature.

In the context of the COVID-19 pandemic and the Industrial Revolution 4.0, UNDP Viet Nam CO places strong importance on supporting ‚Äôs national digital transformation roadmap to 2025 and vision to 2030, including digital transformation of health. Also, in many areas of Viet Nam, people have been facing geographical, physical, cultural, and climate change related barriers (droughts, floods, storms, landslides, etc.). It is even more severe in the context of social distancing and/or lock down due to COVID-19 pandemic. Given that situation, UNDP is closely cooperating with the Electronic Health Administration/ Ministry of Health (EHA/MoH) to develop the B√°c Sń© X√£ (‚ÄúCommune Doctor‚ÄĚ) ‚Äď a web-based digital platform and smartphone application for connecting health staff at commune health stations with local people to provide health information and remote consultation services in mountainous and remote areas, including ethnic minorities and people with disabilities, with a focus on leaving no-one behind. This digital solution includes a secure video conferencing platform enabling commune health staff to seek consultation from medical staff at district hospitals/health centres and higher levels of the healthcare system.

The technology platform

The grassroots digital health platform utilizes a fully open-source software stack with underlying technologies such as the Database Management System (PostgreSQL), Server Operating System (Linux CentOS) and programming language of web application as recommended by the Ministry of Information and Communications (MIC) for purchase and use by government authorities according to Circular No. 20/2014/TT-BTTTT dated December 5, 2014. This helps to optimize long-term investment and operating costs (without additional costs for platform software licenses). The video conference uses the open-source Jitsi Meet platform which is also recommended by MIC for wide application as an alternative to online platforms like Zoom due to its commitment to security and information safety. This platform has also been used by MIC for online video conferencing during the COVID-19 pandemic.

4. What were the biggest wins and the biggest challenges in implementing the telehealth solution?

The biggest wins in implementing the telehealth solution:

UNDP and EHA/MoH supported Provincial Departments of Health Services in Ha Giang, Bac Kan and Lang Son provinces from December 2020 to March 2021 to pilot the grassroots digital solution (Commune Doctor) including installation, training of district and commune personnel and field testing of the system in three remote and mountainous districts. Training was provided for IT staff of the Provincial Departments of Health and district hospitals and health centers to support and operate the system. A total of 153 health workers including 38 from district health facilities, 105 from commune health stations and 10 village health workers from three provinces were trained on using the web-based software and the smart phone application. Training materials and user manuals were compiled and provided to each training participant. The working team also directly went to commune health stations to guide the installation, check the connection and set up a direct call to the higher-level hospital/health centers in three communes (one per pilot district).

The results of this initial pilot show that the system has very good potential for contributing to the national programme for digital transformation of health in the context of the COVID-19 pandemic and the Industrial Revolution 4.0 by improving people‚Äôs access to high quality health information, diagnosis and treatment in remote areas while saving time and costs for travel, supporting social distancing during the COVID-19 pandemic, and reducing overcrowding of higher-level facilities. This could be an additional option for the commune health station to rapidly expanding scope of the Tele-health project hosted by Ministry of Health (the Telehealth ‚Äď 1,000-point connection), as Viet Nam has more than 11,000 commune health stations and very few of them have been equipped with this telehealth set.

The biggest challenges in implementing the telehealth solution:

Given the information technology (IT) infrastructure including both IT devices and internet signal is quite poor in the remote and mountainous provinces, more investment to set up the grassroots telehealth functioning rooms at commune health stations to make the program be implemented.

The IT capacities of health staff at the grassroots health facilities are also low. Training and continuous technical assistance need to be provided.

5. How has UNDP supported the introduction and scale up of telehealth services?

UNDP and EHA/MoH supported Provincial Departments of Health Services in Ha Giang, Bac Kan and Lang Son provinces from December 2020 to March 2021 to pilot the grassroots digital solution (Commune Doctor) including installation, training of district and commune personnel and field testing of the system in three remote and mountainous districts including Hoang Su Phi district of Ha Giang, Ba Be district of Bac Kan and Cao Loc district of Lang Son.

Building on the initial success of the pilot period, UNDP continues cooperating with EHA/MoH to implement the scaling-up phase from April 2021 to June 2022. The grassroots telehealth software will be upgraded to meet the requirement of program expansion to full three provinces (Ha Giang, Bac Kan and Lang Son). The launching conference and Training of Trainers (ToT) for health representatives of all 63 provinces will be organized by UNDP and EHA/MoH as a preparation step for nationwide expansion.

Nithima Ducrocq Moderator

Hi [~117720] ,

Thank you very much for sharing your experience, the pilot is impressive and a lot was done. I see that one barrier that you faced is digital capacity. I would be curious to know how was the services received by both the health staff and the community? Were there a lot of engagement during the pilot after the trainings was provided? What would be your advises if someone was to implement a similar project?

Thank you,

Nithima Ducrocq Moderator

Hi everyone,

My name is Nithima and I'll be your moderator for this week. I've been following the discussion in both rooms, and I'm excited to keep hearing more about your experiences and engagement with such an important topic.

I'm currently working with the Chief Digital Office at UNDP, focusing on the CDO Country offices support . Prior to joining UNDP, I've worked as an innovation and digital consultant IOM and WFP, working on various project from nutrition educational app in schools to using AI for disaster response.

I was also the founder of a mobile health company for Thai women focusing on sexual and reproductive health. I've been passionate about e-health and its potential to provide healthcare and information directly to the patient. The topic became even more relevant since the start of the pandemic.

As a reminder, here are the questions that we are trying to address in this room:

  1. Describe the telehealth solutions that have been introduced in your country/region. If available, please share a link to relevant literature.

  2. What health system challenges/priorities do these telehealth services aim to address? What health outcomes have been achieved?

  3. Describe the technical support that was needed for expanding the coverage and quality of telehealth services.

  4. What were the biggest wins and the biggest challenges in implementing the telehealth solution?

  5. How has UNDP supported the introduction and scale up of telehealth services?

  6. Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized?

I'm looking forward to hearing (and learning!) from your experiences. Feel free to message me on here if you have any questions about the consultation.

Roxani Roushas

On behalf of UNDP Somalia:

As part of a joint program on youth led by UNFPA, five youth centres will be established across Somalia with a view to expanding access to decent jobs, supporting youth civic and political engagement and the YPS agenda, as well as increasing use of youth-friendly health services. In partnership with a local telehealth startup, Ogow Health, UNDP Somalia will be unrolling a telemedicine pilot across the youth centres, focused on sexual and reproductive health services. Clinics within the youth centres, serviced by nurses, will be connected through telemedicine equipment to volunteer medical students and doctors in the diaspora, with the aim of enhancing the clinics’ diagnostic capacities. Nurses will be trained to refer suitable cases for telemedicine consultations. The model is informed by work previously conducted by UNDP Egypt. To the extent possible, design thinking and behavioural science principles are being drawn on to anticipate possible behavioural barriers to the solution's adoption.

Nithima Ducrocq Moderator

Hi [~89902],

Thank you very much for sharing your experience. I would be curious to understand more on the following point:

1. I love that this pilot was informed by an other country office's experience. What were the learning you got from UNDP Egypt? Did they implement a similar project?

2. What are the main current barriers to your users to receive sexual and reproductive health information and how do you think the tele-health platform will help overcome these barriers?

3. I think the choice of partnering with a private sector very appealing. I often think that UNDP is not necessarily the best equipped to developed its own technology solutions. What made you choose Ogow Health as a partners? What pros and cons do you see with setting a partnership with a private start-ups?

4. How many users are you targeting with the pilot? What are the metrics you are looking at to evaluate if the pilot is a success?

Thanks again,

Nithima

 

Ranjeet

With the rapid evolution of digital technology seen as an opportunity to improve rehabilitation services in remote parts of the country, Jan Vikas Samiti has introduced the telerehabilitation project ‚ÄúSambhav‚ÄĚ with a motto reaching the unreached using the web portal and the mobile app for a better individual rehabilitation plan and service delivery. The project ‚ÄúSambhav‚ÄĚ aims to capacitate CBR facilitators on rehabilitation diagnosis, making custom made treatment/rehabilitation plans and providing appropriate therapies to the children and youth with disabilities who are most in need in the rural parts of India using recent technology. The main purpose and focus of the project Sambhav is the application of the web portal and mobile app for purpose of assessment and rehabilitation plan, progress and outcomes.¬† Currently JVS Telerehabilitation unit is providing guidance for the physical rehabilitation service to selected 19 Partner Organisations (POs) in Uttar Pradesh, Bihar, Uttarakhand, Jharkhand, Madhya Pradesh, Odisha, Chhattisgarh, Rajasthan, Manipur and Meghalaya under this project.

https://janvikassamiti.org/tele-rehabilitation-2/#1627462648229-e71defc7-1ac2

What health system challenges/priorities do these telehealth services aim to address? What health outcomes have been achieved?

Our Priorities:

On the role of telemedicine in health care service delivery, a patient survey predicts that 75% of all patients expect to use digital services in future. 75% of the country’s healthcare infrastructure is concentrated in urban areas while more than 75% of the population lives in rural areas. The majority (69%) of persons with disabilities reside in rural areas. 71 % of children with disabilities live in rural India and facing a range of barriers. E- Rehabilitation technology will thus provide an opportunity to serve the poorer and marginalized sections of the community.

Outcomes:

  • Reached to 714‚Äď Children with Disabilities
  • For physical rehabilitation services 75% - Parent Satisfaction Rate Parents reported a high level of satisfaction with the telerehabilitation service due to saving time and money.
  • 46% Children achieved mobility Progress reports shows at nearly half the children with disabilities achieved mobility.
  • 30 Staff Trained Staff trained and gained confidence to able to render quality services in the community

Describe the technical support that was needed for expanding the coverage and quality of telehealth services.

A protocol for the physical rehabilitation diagnosis/planning of children with developmental disabilities is made at JVS to help the selected partner organizations to develop their capacities in terms of providing quality physical rehabilitation service.

To provide better Telerehabilitation service delivery, regular training programs are conducted for selected CBR workers from the Partner Organisations (POs) on video filming and the use of rehabilitation protocol. Web portal and Mobile app on Telerehabilitation is developed by JVS and the same is shared with the selected CBR workers. Store and Forward (in which after video shooting, it can be stored and at the time of need can be forwarded to the JVS headquarter for intervention planning) method of technology which is quite practical and suites well to the concept of telerehabilitation and as per need real-time interaction and guidance have been provided to the parents/caregivers and field staffs as well. Rehabilitation professional/expert at JVS Telerehabilitation unit regularly receives videos of children with disabilities and assesses the case and provides treatment protocol/rehabilitation plan to the POs and periodically monitors the progress of cases.

 

What were the biggest wins and the biggest challenges in implementing the telehealth solution?

Wins:

Telerehabilitation service delivery will give the best benefit to the end-user (i.e., an individual with a disability) within their environment. It optimizes the timing, intensity and duration of therapy that is often not possible within the constraints of face-to-face treatment protocols in current health systems. From the inception of the program in mid-2018 to till date more than 700 children with disabilities are assessed and their rehabilitation plan has been made in the pilot phase. Partner Organisations heads and field staff have shared that they are now able to provide quality intervention in remote areas as per the physical rehabilitation protocol through tele-rehabilitation.

Challenges:

The challenges in this project are very minimal but some risk factors are observed during the project implementation as mentioned below-

  • Retention and attrition of the CBR staff.
  • Poor technological skills among CBR staff.
  • The vast project area is covered by less human resources in the field.
  • CBR staff are engaged in almost every activity of the organisations.
  • Poor understanding and lack of interest in the project at the higher level of some organisations.
Nithima Ducrocq Moderator

Hi [~117820],

Thank you for sharing your experience, your project is very inspiring. I was wondering if you had any advises for anybody designing a similar project. Have you identified any particular enabler or barrier along the way (from conception to implementation)?

Thank you very much,

 

Clara Aranda

Hi everyone! My name is Clara Aranda and I only joined the discussions late last week, but I have read some contributions to the conversations and they have been so interesting and insightful. I was wondering if someone has experience with (successful) funding and financing mechanisms for telehealth. There are two areas that I think might be interesting to discuss (but please, do share other thoughts).

  • Startups or individual organisations are developing many telehealth solutions, and these are then piloted in one or several healthcare facilities. In these cases, it seems like there is often an external organisation (international aid/development organisation or private sector) supporting the initial pilot and development of the solution. It seems that after this stage, there are many challenges experienced scaling up and ensuring the sustainability of the solution. Could someone share your experiences on this?
  • Secondly, a smaller number of solutions have been government-funded. Some of these are part of research institutions or funding provided to research-level solutions to evaluate a solution or prove a concept. In these cases, if the government adopts the solution, the institutionalisation of the solution seems to provide a mechanism for long-term funding. In HICs, an example of this would be the NHS apps. Does anyone have experiences to share around government-led/funded telehealth solutions in LMICs?
Nithima Ducrocq Moderator

Hi Clara,

During my experience founding a mobile health company, we explored couple of business model (on top of fundraising from VCs) for monetization of the app: there is B2C model that can be put in place where patient would pay for premium content and/or consultation with doctors. On the B2B model, we had interest from insurance company and healthcare provider to whitelabel the app.

One thing to note is that when we talked to other actors in the space they often said that telehealth alone was not enough to retain user (which is needed to have a sustainable solution). The e-health service needs to find a strong pain point for user to come back on the app (in our case, it was focus on sexual and reproductive health).

Best,

Oscar RDZ

Dear Clara;

I am Oscar Rodriguez (Mexican), clinical engineer and fortunately with international experience all over the world with different organizations. Nowadays, I am collaborating with UNOPS for e-health projects in Central America as Project Coordinator.

Regarding to your first point, here are a couple of steps we are doing in our e-health projects that have helped us to have a good project management and ensuring the quality of the service:

1) Assessment of medical need in collaboration with MoH.

2) Nationwide case study for service implementation (locations and medical specialties).

3) Cost estimation of the project through a consultant.

4) Project profile.

5) Elaboration of technical specifications.

6) Search for companies with expertise in the field.

7) Open invitation to participate in the bidding process.

8) Selection of the supplier that will provide services.

9) Implementation of the project.

10) Training.

11) Communication campaign (users - patients).

12) Accompaniment for 2 years, strengthening, monitoring, evaluation and delivery of the project.

 

For your 2nd request:

A program called the Technological Modernization Project was designed with different phases to help the institute change and improve its health services technologies.

Leslie Ong Moderator

There‚Äôs been strong interest in the issue of sustainability and financing, and we‚Äôve had a number of examples of telehealth solutions that have been piloted and scaled up, including the Ghana Telemedicine Programme (Evelyn Acquah),¬†Sehat Kehani (Laura Sheridan)¬†and B√°c Sń© X√£¬†(Ha Nguyen Thanh)¬†‚Äď perhaps these colleagues may have more to say about sustainable business / financing models.

For me, your question [~117791] alludes more to broader funding mechanisms that can sustain the telehealth sector / approach as a whole, which I think is as critical as a sustainable business model for a specific solution.

These broader mechanisms can of course be shaped by the lived experiences of individual start-ups like the one [~117328] led, but there are also lessons that can be learned from how countries implement their approach to telehealth. From our discussion, there are already several lessons highlighted:

  • The national digital health strategy not only commits domestic resources to investing in digital innovation, infrastructure and transformation, but also provides the necessary coherent policy and operational framework that promotes interoperability and mainstreaming (ie. broad acceptance) of telehealth in routine clinical practice, which leads to sustainable financing. [~117635]¬†highlighted Ghana‚Äôs innovative approach to ‚Äėre-conceptualising‚Äô telehealth to ensure Integration at both the service level and the technology level, with the view to serve as the backbone for health service delivery. As [~117843]¬†also highlighted, improving interoperability will also make it easier for seamless linkages across the continuum of care, and hence adaptability and usability of the system (which warrants continuous funding)
  • There was also an example shared by [~117780]¬†on the inclusion of telehealth in health insurance package of services in India, a provision mandated by the peak regulatory body, which presumably provides a steady revenue stream for the service provider (while improving affordability for the client). It would be interesting to see if there is a correlation between coverage by health insurers (public and private) and the financial sustainability of telehealth.
  • One thing we need to hear more about is the importance of public-private partnerships in accelerating scale up of impactful solutions and promoting sustainability. The ‚ÄėGhana Telemedicine Programme‚Äô shared by Evelyn Acquah is a joint initiative between Ghana Health Service and the Novartis Foundation. It would be interesting to learn more about this partnership (and others) and how this approach can be replicated.
  • Another factor contributing to the sustainability of digital solutions is the use of ‚Äėopen-source‚Äô applications, which allows for flexibility and adaptability, without licensing restrictions or recurring fees. I‚Äôd like to hear from [~91917]¬†about the efforts of the UNDP Global Centre on Technology and Innovation in promoting the creation and use of ‚Äėdigital global goods‚Äô to strengthen digital ecosystems in low- and middle-income countries.
Claudia Olmedo Moderator

Good morning, afternoon or evening everyone,

My name is Claudia, and I am honored to act as your moderator for this 4th and last week of the e-consultation Scaling Up Telehealth to Promote Equitable Access to Essential Health Services. In Room 1, we¬īve been learning about country experiences in implementing telehealth services, in an effort to understand its benefits in expanding health access but also its particular challenges regarding financing, articulation, quality, connectivity and uptake.¬†

As COVID-19 spread, telehealth relevance surged as a solution to protect both patients and staff. Virtual healthcare did not only made possible remote COVID-19 screening and monitoring, but also, it has facilitated access to other medical services in contexts that are deemed too risky for patients with pre-existing conditions, or complicated due to lockdowns or limited transportation. Telehealth holds the potential to forever change how health practitioners work, many of whom are now using digital tools to work remotely, but also to increase health access to vulnerable communities such as senior citizens and those living with disabilities; telehealth can also help institutions manage resources and space more efficiently by keeping low-risk patients at home, preventing medical systems saturation and an overwhelmed staff. Still, discussing and evaluating its potential limitations due to regulatory issues, cultural barriers and access to technological devices, to name a few, its essential to harness its true telehealth true potential.

This discussion room constitutes a space to share experiences and reflect on past learnings in the implementation of telehealth solutions. It will be inspiring to read your ideas and insights¬† during this wrap-up week. You can share your thoughts in English, however, the platform can translate the text on pages into over 100 languages (use the ‚ÄúSelect your Language‚ÄĚ option at the top right of SparkBlue). Use this feature to translate comments into your preferred language, as well as to translate the comments of others. Also, feel free to comment in the language you¬īre most comfortable with.

A kind reminder to answer one or more of the following questions, and indicate which question you are responding to in your post:

  1. Describe the telehealth solutions that have been introduced in your country/region. If available, please share a link to relevant literature.

  2. What health system challenges/priorities do these telehealth services aim to address? What health outcomes have been achieved?

  3. Describe the technical support that was needed for expanding the coverage and quality of telehealth services.

  4. What were the biggest wins and the biggest challenges in implementing the telehealth solution?

  5. How has UNDP supported the introduction and scale up of telehealth services?

  6. Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized?

At the end of this week¬īs consultation we will pin a summary to the top of the page. Take some time to read and contribute with your insights, ideas and learnings, engage with other commenters and do reach out if you encounter any issues posting. Looking forward to share this space with you!

Hira Nand

Hello everyone, I am Hira Nand from India working as a project officer for the telerehabilitation project Sambhav (possible). The project is being implemented in the 10 states in India by the 19 collaborating organisations. ¬†The project Sambhav with its motto ‚Äėthe reaching the unreached' has been started in 2018. From its inception, more than 700 children with disabilities are getting benefits of physical rehabilitation in their environment.

Please find the our response on above questions-

  1. Describe the telehealth solutions that have been introduced in your country/region. If available, please share a link to relevant literature.

With the rapid evolution of digital technology seen as an opportunity to improve rehabilitation services in remote parts of the country, Jan Vikas Samiti has introduced the telerehabilitation project ‚ÄúSambhav‚ÄĚ with a motto reaching the unreached using the web portal and the mobile app for a better individual rehabilitation plan and service delivery. The project ‚ÄúSambhav‚ÄĚ aims to capacitate CBR facilitators on rehabilitation diagnosis, making custom made treatment/rehabilitation plans and providing appropriate therapies to the children and youth with disabilities who are most in need in the rural parts of India using recent technology. The main purpose and focus of the project Sambhav is the application of the web portal and mobile app for purpose of assessment and rehabilitation plan, progress and outcomes.¬† Currently JVS Telerehabilitation unit is providing guidance for the physical rehabilitation service to selected 19 Partner Organisations (POs) in Uttar Pradesh, Bihar, Uttarakhand, Jharkhand, Madhya Pradesh, Odisha, Chhattisgarh, Rajasthan, Manipur and Meghalaya under this project.

https://janvikassamiti.org/tele-rehabilitation-2/#1627462648229-e71defc7-1ac2

  1. What health system challenges/priorities do these telehealth services aim to address? What health outcomes have been achieved?

Priorities:

On the role of telemedicine in health care service delivery, a patient survey predicts that 75% of all patients expect to use digital services in future. 75% of the country’s healthcare infrastructure is concentrated in urban areas while more than 75% of the population lives in rural areas. The majority (69%) of persons with disabilities reside in rural areas. 71 % of children with disabilities live in rural India and facing a range of barriers. E- Rehabilitation technology will thus provide an opportunity to serve the poorer and marginalized sections of the community.

Outcomes:

  • Reached to 714‚Äď Children with Disabilities
  • For physical rehabilitation services, 75% - Parent Satisfaction Rate Parents reported a high level of satisfaction with the telerehabilitation service due to saving time and money.
  • 46% of Children achieved mobility Progress reports shows at nearly half the children with disabilities achieved mobility.
  • 30 Staff Trained and gained the confidence to able to render quality services in the community
  1. Describe the technical support that was needed for expanding the coverage and quality of telehealth services.

A protocol for the physical rehabilitation diagnosis/planning of children with developmental disabilities is made at JVS to help the selected partner organizations to develop their capacities in terms of providing quality physical rehabilitation service.

To provide better Telerehabilitation service delivery, regular training programs are conducted for selected CBR workers from the Partner Organisations (POs) on video filming and the use of rehabilitation protocol. Web portal and Mobile app on Telerehabilitation is developed by JVS and the same is shared with the selected CBR workers. Store and Forward (in which after video shooting, it can be stored and at the time of need can be forwarded to the JVS headquarter for intervention planning) method of technology which is quite practical and suites well to the concept of telerehabilitation and as per need real-time interaction and guidance have been provided to the parents/caregivers and field staffs as well. Rehabilitation professional/expert at JVS Telerehabilitation unit regularly receives videos of children with disabilities and assesses the case and provides treatment protocol/rehabilitation plan to the POs and periodically monitors the progress of cases.

  1. What were the biggest wins and the biggest challenges in implementing the telehealth solution?

Wins:

Telerehabilitation service delivery will give the best benefit to the end-user (i.e., an individual with a disability) within their environment. It optimizes the timing, intensity and duration of therapy that is often not possible within the constraints of face-to-face treatment protocols in current health systems. From the inception of the program in mid-2018 to till now more than 700 children with disabilities are assessed and their rehabilitation plan has been made in the pilot phase. Partner Organisations heads and field staff have shared that they are now able to provide quality intervention in remote areas as per the physical rehabilitation protocol through tele-rehabilitation.

Challenges:

The challenges in this project are very minimal but some risk factors are observed during the project implementation as mentioned below-

  • Retention and attrition of the CBR staff.
  • Poor technological skills among CBR staff.
  • The vast project area is covered by less human resources in the field.
  • CBR staff are engaged in almost every activity of the organisations.
  • Poor understanding and lack of interest in the project at the higher level of some organisations.
  1. How has UNDP supported the introduction and scale-up of telehealth services?

                       There is no support for this project from UNDP

 

  1. Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized?

This innovative initiative is easy to access and quite practical to service users.¬† There is a huge scope for replication in the country. Here it is important to mention that the JVS telerehabilitation project ‚ÄúSambhav‚ÄĚ has won the best rural health initiative award and is shortlisted for Zero Project Award 21-22. Moreover, this project is selected for Zero Project Impact Transfer Program as the most impactful and replicable initiative. Of course, the COVID -19 pandemic situations put telehealth in the frontline service delivery system. It is high time to prioritize the telehealth solution to every health care delivery system from top to bottom whenever and wherever possible.

Cecil Behino

UNDP Philippines - Tele-psychotherapy

Hi everyone! My name is Cecil Behino from UNDP Philippines and we would like to share with you our free tele-psychotherapy project in 2020 aimed to support the psychosocial needs of PLHIV and Key Populations during the lockdown periods due to the pandemic. 

1. Describe the telehealth solutions that have been introduced in your country/region. If available, please share a link to relevant literature. 

UNDP Philippines provided free online psychosocial support services to people living with HIV (PLHIV) and key populations (KP) in 2020 during the height of lockdowns in the Philippines due to the COVID-19 pandemic.  

2. What health system challenges/priorities do these telehealth services aim to address? What health outcomes have been achieved? 

In 2020, UNDP Philippines and UNAIDS conducted a survey on the treatment and care concerns of PLHIV, and the result showed that 20% of the participants said that they need psychosocial support as some of them experienced anxiety and depression (UNDP, 2020). A total of sixty (60) clients were catered from May-December 2020. 68% or 41 clients are still active or are continuing their free telepsychotherapy sessions with their assigned psychosocial support specialist (PSS), two have been discharged, while 17 have terminated their sessions to discontinue receiving the offered services. 

3. Describe the technical support that was needed for expanding the coverage and quality of telehealth services. 

Technical expertise in clinical psychology and support from the local government units, academic institutions, and community-based organizations were needed to implement this program. The collaboration and close working relationship among these organizations contributed to the success of the program.  

4. What were the biggest wins and the biggest challenges in implementing the telehealth solution? 

Biggest wins: The psychosocial needs of some of the PLHIV and KP were addressed, and this raised awareness of the need for psychosocial support, especially during lockdowns and uncertainties 

Biggest challenges: Few people signed up for the first few months of running the project, even with the help of the referral system. In addition, there were instances of no-shows or no-response from the clients. Lastly, some clients expressed the need to back out of the telepsychotherapy programs for reasons related to changes in their schedule with work or school as they adapted to a new normal and offices started opening.  

5. How has UNDP supported the introduction and scale-up of telehealth services? 

Under the UBRAF project, UNDP and local government units and academic institutions initiated the project and contracted the technical expert on Clinical Psychology. 

6. Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized? 

Yes. However, funding is needed to contract clinical psychotherapists and a good telemarketing solution to spread the news of free telepsychotherapy, especially those in rural areas.  

 

Cecil Behino

tagging my colleagues in UNDP Philippines Ms [~57328] and [~89898] 

Claudia Olmedo Moderator

Hello [~113716], and thank you for sharing UNDP Philippines experience on tele-psychotherapy, an important and growing branch of telemedicine that has gained momentum due to the COVID-19 pandemic due to its practicality, which enables timely and consistent support of patients, family members, and health service providers. The intervention seems successful as 68% of patients are still active with ongoing tele-psychotherapy. Given these results, have you identified funding sources for scaling the project? I was thinking that UNDP Chief Digital Office's Digital X program could be interesting for you to explore if there's interest both at UNDP, government and partners.

Clara Aranda

Hi Cecil, this is an interesting intervention, in a clinical area where affordable and accessible services are much-needed and telehealth solutions can have great benefits. From the project description, this project is still a pilot, right? Do you have plans to scale up and increase the number of users? Are there any partners that have proven key for the success of this solution?

Nithima Ducrocq Moderator

Thank you [~113716]  for sharing the experience of Philippines CO.

It is not the first time that I see great project with little engagement. Coming from the private sector originaly, I noticed that in the private sector there is as much energy spend on the marketing strategy than the product/project (as they want to sell it). On the other hand in none-profit sector, the engagement strategy is often done fast or even forgotten even though the discoverability of a services is essential for it to succeed. I also see that engagement strategy is rarely digital while it can allow to reach to a broader population in less amount of time. I remember when I started working with IOM, my team used a lot of Facebook advertisement but I've rarely seen digital engagement being used in UN-led projects.

I am not sure what was the strategy for the psychotherapy services but i'd be curious to hear your thoughts on this.

Thank you very much,

 

Boyan Konstantinov

Greeting, everyone.

My first experience with telemedicine was in 2019 during the COVID-19 pandemic, when I was on a detail assignment in Kazakhstan. I developed an eye infection and could not visit an ophthalmologist due to the lockdown. My U.S. eye doctor examined me through Google meet and prescribed medicine that I was able to buy from a pharmacy. Ever since I have been following different projects related to telemedicine and would like to share some interesting recent innovations. My apologies if these come across as too technical, or focused on "gadgets" - but geographical distances, lack of equipment and emergency situations show how important these technical solutions can be.

https://echonous.com/en_us/  -   The first AI-assisted handheld ultrasound tool to increase diagnostic confidence at the bedside. A clinician can perform heart, lung and abdominal assessments in minutes.

https://www.patchai.io/ - A cognitive platform focusing on patient engagement. The platform is embedding an intelligent virtual assistant with conversational frameworks for patient engagement and real-time data collection. It bridges patients and doctors during clinical trials. Obviously, there are some privacy concerns and some ethical data use questions that have to be addressed.

https://www.smarttab.co/ - a personalized wireless medicines delivery platform comprised of an ingestible capsule with a microprocessor, proprietary smart polymer actuator, and active ingredients.

https://vocalishealth.com/ - using voice as a biomarker to check health status. Developed because of the COVID-19 pandemic and obviously associated with some concerns about privacy and accuracy. Technology is experimental and not yet approved for use.

 

 

 

 

Claudia Olmedo Moderator

Hi [~91596], personal experiences can definetely trigger interest in exploring digital solutions. Thank you for sharing these interesting solutions, have you found inspiration in these tools that could be translated to inclusive development projects?

Clara Aranda

Hi Boyan, Thanks for sharing these examples. Do you know if any of these solutions are/have been implemented in an LMIC? Typically, it is advocated to design solutions that are contextualised and conscientious of the local needs. I wonder what is the experience from telehealth solution developer/providers when scaling up and moving to other regions/countries. The examples you shared seem to be based in the US or/and Europe. It would be interesting to learn if these teams have any lessons to share about scaling up, expanding and contextualising solutions for other regions/countries.

Deena Patel

Dear colleagues,

Thank you for this thoughtful discussion on telehealth.

We are responding to Question 1) Describe the telehealth solutions that have been introduced in your country/region. If available, please share a link to relevant literature.

From the perspective of the HIV and Health Team at HQ, we wanted to share some country examples from the Japanese Supplementary Budget (JSB). In May 2020, the Japanese government announced its supplementary budget for COVID-19 emergency response and prevention, which includes $63,635,654 for 29 countries of priority for UNDP and Japan (Bangladesh, Bhutan, Burkina Faso, Egypt, Ethiopia, Fiji, India, Indonesia, Iran, Iraq, Kenya, Kyrgyzstan, Libya, Maldives, Mali, Mauritius, Mongolia, Myanmar, Nigeria, Palestine, Philippines, Rwanda, Somalia, South Africa, Sudan, Thailand, Turkey, Uzbekistan, Vietnam). Implementation of this programme started in June 2020 and will continue through December 2021. It highlights Japan‚Äôs interest to help realize human security and focuses on three areas:¬† 1) Health Systems Support; 2) Inclusive and Integrated Crisis Management and Response; and 3) Social and Economic Impact Needs Assessment and Response. Telehealth, or digital solutions that enhance or enable self-management of healthcare, facilitate remote support from healthcare providers, and support any components and activities in the health system in the provision of care ‚Äď are a crucial component of a digital approach. With funding from the JSB, countries are implementing digital approaches that enable health systems strengthening, disease monitoring, and preventive and diagnostic efforts.

This e-discussion has already highlighted select examples from JSB countries such as Bhutan, Indonesia, India and Vietnam. Other select examples are below.

In Mauritius, UNDP is digitizing the COVID-19 response. Similar to the cloud-based digital systems introduced in India (Electronic Vaccine Intelligence Network; eVIN) and Indonesia (Sistem Monitoring Imunisasi Dan Logistik Secara Elektronik; SMILE), UNDP Mauritius has partnered with the Central Health Laboratory to adopt an Electronic Laboratory Information Management System (OpenELIS Global). ‚ÄčFollowing a successful rollout, the government partnered with UNDP to further scale-up the system at the airport.

In Burkina Faso, digitalization has been instrumental in addressing the need for official/verified, reliable and accessible information. In partnership with the Ministry for the Digital Economy, the Ministry of Health and the Ministry of Science and Research, UNDP developed a unified COVID-19 web platform, which includes public health information, health records as well as a COVID-19 database.

http://surveillance-sante.bf/.

In Libya, UNDP, in partnership with the Ministry of Health, the Government of Japan and a private sector start-up company, Speetar, launched the country’s first telemedicine initiative. The app connects Libyans with physicians in diaspora communities who speak their language and understand the local context. It also reduces the burden of travel and mobility for people suffering from chronic diseases who require constant monitoring. This Telemedicine Initiative engages around 6,000 patients and 1,000 specialists and will process 10,000 virtual consultations and e-prescriptions. The Libyan National Centre for Diseases Control used the app to provide information and consultations during the COVID-19 pandemic.

In Vietnam, Rwanda and Kenya, UNDP has procured smart anti-epidemic robotic solutions to aid the health response and management of the COVID-19 pandemic. Compelling evidence has shown that the use of technology can accelerate the development of COVID-19 diagnostics, therapeutics and vaccines, including through the use of robots, which minimizes transmission of a highly infectious disease.

For more info:

Kenya: https://www.ke.undp.org/content/kenya/en/home/presscenter/pressreleases/2021/undp-in-collaboration-with-the-ministry-of-health-to-pilot-smart.html

Rwanda: https://www.rw.undp.org/content/rwanda/en/home/presscenter/articles/2021/News0/News.html  

Vietnam: https://www.vn.undp.org/content/vietnam/en/home/presscenter/pressreleases/15Robot.html

(More information can be provided by Doug Webb, Deena Patel, Simisosenkosi Mloyi)

 

Luca Bucken

Dear Colleagues, very delighted to come across this rich discussion (and sorry for being (very) late to the party). Thanks to Nithima Ducrocq, Les Ong, Belynda Amankwa for the incredibly helpful summaries!

I will briefly share our overall experience in Libya and then specifically focus on Nithima's question: Are there opportunities to expand the use of telehealth in your country? If so, which telehealth solutions and/or health challenges should be prioritized?

Our social enterprise, Speetar, has partnered closely with UNDP Libya (incl. UNDP Digital X and extending to stakeholder support with the MoH and wider comms support) to provide telehealth services in Libya and, through partnerships, in the wider MENA region. Speetar’s platform integrates a patient mobile app, doctor web-based app, and an on-ground patient site, offering a wide range of telehealth services and access to GPs/specialist doctors/psychosocial support to the organization’s constituents - none of which are otherwise accessible to them in Libya’s current healthcare crisis. Next to general health services, we partnered with UNDP, MoH, and CDC, to integrate a national COVID19 triage, testing, tracing (and are pursuing to launch a vaccination platform) (https://www.forbes.com/sites/andrewwight/2020/04/02/how-did-a-libyan-doctor-give-back-a-covid-19-fighting-app).

While the benefits of telemedicine in Libya are very straightforward (healthcare infrastructure was consistently and systemically targeted during the civil war, affordability and geographic distances/insecurity prevent equitable access), adoption of digital health solutions by care providers and receivers remains a key challenge. Speetar has made progress in this area through strategies, similar to those mentioned by [~104518]. Furthermore, we have identified a narrowed focus on particular patient populations (ie diabetic, elderly homes, mental health) and corresponding corporations with key stakeholders as a successful entry point. Despite the adoption challenges, one clear win has been the consistently enthusiastic feedback we receive from users. 

Next to this, our priority remains to reach remote, rural, and other ethnically marginalised populations in the south of Libya (key challenge: last-mile outreach; internet access; exploring to expand telehealth service points and partnerships with network companies) and to serve the many displaced communities in Libya. We work closely with local youth, women’s rights and migrant organizations to reach young women, IDPs/refugees/migrants and we are exploring how Speetar could also provide employment opportunities for health care providers from displaced communities. A key blocker for this remains the vetting of doctors' qualifications and associated liability issues (something that, in general, we now made progress through supporting the Libyan government in the adoption of medical liability insurance policy for telemedicine providers). Together with other UNDP country offices and the RSC, it would be interesting to explore how cross-border cooperation could provide better health support to mobile populations entering Libya from Sudan/Chad/Niger/Algeria, for whom we really see a unique benefit that telemedicine and central patient registries could provide.

Outside of Libya, we partnered with Egyptian company Smart Doc to launch ‚ÄúYashfi‚ÄĚ telehealth platform, which was recognized as one of the top 3 companies at the Egypt TechHack. Yashii is currently scaling to combat COVID in Egypt.¬†¬†In Syria, we initiated a COVID19 related project in partnership with the Syrian Expatriate Medical Association to create a basic tool designed to function in low-connectivity areas (offline-first capabilities allowing workers to screen their patients at the point of care, and securely share the data with organizers of the local response).