This morning I attended the Next Steps in Health Information Systems Applications panel.

The speakers:

• Johan Saebo, Health Metrics Network, Norway: A Global Analysis of Health Information System Assessments
• Gashaw Shiferaw, Supply Chain Management System (SCMS), Ethiopia: Ethiopia’s Innovative Approach for Bigger, Better, Faster Logistics Decisions
• Anwer Aqil, John Snow, Inc., United States: Strengthening Routine Health Information System (RHIS) for Better Health Systems Outputs
• Theo Lippeveld, John Snow, Inc., United States: Case Studies Illustrating Contributions of Health Information Systems
• Moderator: Dykki Settle, IntraHealth International, United States

Two aspects of the panel deserving special attention:

ARV supply chain management in Ethiopia: Gashaw Shiferaw presented a system developed by Ethiopia for tracking ARV supplies. The system is called HCTS, or Health Commodity Tracking System. It was motivated by Ethiopia’s extremely ambitious scale up/universal coverage program. For example, Ethiopia is aiming to scale up from 220,000 patients on ART to just under 2.4 million by the end of 2010. The technical system makes use of PDAs and offline desktop applications for data entry, and a centralized web service that aggregates data, performs analysis, and produces reports. And all this of course influences the behavior of the supply chain. It’s interesting to hear about a present-day PDA example, a seemingly successful one no less. In the past 1-2 years it seems PDAs have become passe in our mHealth community – it’s all about mobile phones these days. The system has been used by the Clinton Health Access Initiative (CHAI) and FMOH medical stores for five decision cycles. Results include the following: reporting turnarounds have been reduced from 1-2 months to 3-5 days; reporting is up to 99+%, well above the 80% target, from 70%; and emergency orders due to stock outs have been reduced to 0. It is now being implemented nationwide. More information is available from the HCTS website.

Quasi-experimental RHIS studies: In 2009, HMN contracted JSI to conduct case studies in four countries examining the impact of improving HMIS on health services: Ethiopia, Haiti, Cote d’Ivoire, and Pakistan. In Cote d’Ivoire, where the focus was on HIV/AIDS prevention, they observed dramatic increases in VCT rates between 2005 and 2008. During this period there had been significant RHIS efforts that could have led to this increase. Despite results such as these (Lippeveld also presented DHIS improvements from Pakistan), there is no clear causal link between RHIS efforts and system outcomes. Lippeveld conceded that there needs to be a stronger, “more structured, more scientific” link between RHIS performance and health system performance. The MEASURE evaluation team is now developing a “linking tool” and everal quasi-experimental studies are in the works, with results expected in three years.

This is a report from the Global Health Council’s annual conference in Washington, DC. This year’s conference, Dateline 2010: Global Health Goals & Metrics, was held June 14-18, 2010. GHC37 is a reference to the Twitter hashtag used for the meeting. Make sure to check out the Council’s own conference blog coverage for more depth. This is our third year covering the meeting (2008 posts, 2009 posts).

This is the first of two posts I’ll be writing based on today. The other one probably won’t be ready until tomorrow. This one is from my attendance at an afternoon panel focused on nutrition: Nutritional Supplements and Complementary Feeding Practices.

Unfortunately, Zhang was unable to attend, so Labbok read her abstract and presented some of her own thoughts+experience on complementary feeding practices.

The session was organized around three evaluations of nutrition interventions: 1) an education and iron folate supplement program in northern Bangladesh, 2) Ultra Rice in Andhra Pradesh (India), and 3) a education program using health workers in northwest China. Ultra Rice was the primary reason I came to this session. If you don’t know, Ultra Rice is a micronutrient supplement that takes the size, shape, and other characteristics of rice. It is mixed in with regular rice at a ratio of roughly 1:100. More from PATH.

The overarching theme that I pulled from the session – as one of the few nutrition outsiders in the room – was an emphasis on what the field of nutrition needs,  in terms of interventions, research, and resources. Here’s the detailed view:

Continuum of interventions: Labbook did an excellent job of moderating, providing a global view of the presentations – including Zhang’s – throughout. She spoke of a “continuum of interventions”, which she presented in two different ways. First, in terms of target age: infants (Zhang), adolescents (Talukder), and women/children (Galloway). Second, in terms of approach: clinical – delayed cord clamping to increase the flow of nutrients to infants at birth; behavioral – via various education programs; and systemic – food-based solutions such as Ultra Rice.

Food-based solutions: In addition to Galloway (Ultra Rice), Talukder advocated for food-based solutions based on his study. Instead of iron folate tablets, he recommended food fortification, homestead food production, and dietary modifications. Talukder said, “We have to think about people and culture with interventions”, to which Galloway agreed, “We need more food-based solutions”.

Understanding behaviors (1): A Nepali in the audience asked a question about the impact of grinding Ultra Rice into rice flour (Ultra Rice Flour?) on micronutrient levels for the “end user”. This has not been studied, but it seems that it should be, particularly for areas that grind their own rice flour and use it significantly in cooking. I’m not a food expert, but I would guess that South Indian and Bengali cuisine qualify.

Understanding behaviors (2): In the Ultra Rice study, the “excess” method of boiling rice, where the extra water is poured off, resulted in levels of iron content more than 2x lower than the “absorption” method. Galloway, however, indicated that the excess method is preferred in many areas in India. The challenge becomes reconciling food culture with behavior change. (I wonder if the cookstove people and the nutrition people talk much.)

More studies: There were a variety of studies suggested by the panel and audience members that have not been conducted. Among these were rigorous, comparative studies of the various micronutrient innovations, such as Ultra Rice, Sprinkles, and Nutributter.

This is a report from the Global Health Council’s annual conference in Washington, DC. This year’s conference, Dateline 2010: Global Health Goals & Metrics, was held June 14-18, 2010. GHC37 is a reference to the Twitter hashtag used for the meeting. Make sure to check out the Council’s own conference blog coverage for more depth. This is our third year covering the meeting (2008 posts, 2009 posts).

This our first in a series of posts blogging from this year’s Global Health Council Conference in Washington, DC. This year the focus is on goals and metrics, which is of interest to us at Global Health Ideas because of the potential for technology and innovative services to improve measurement and outcomes.

Some of the more interesting themes that emerged:

The missing link is not analysis, but a need for better data collection: Rasmussen argued that we’re good at analysis, but – citing Jody Ranck – he said that data collection is abysmal. Too much of what is being done is removed from on-the-ground, day-to-day activities.  Carucci said that we “haven’t done a good enough job of collecting data in real-time” for decisions in real-time.

… but analysis can overcome some of this: While Rasmussen advocated for basic training on data collection, he also suggested that mathematical approaches can be used to successfully resolve inconsistencies/gaps/errors in data. He gave a laundry list of tools from the field of AI (artificial intelligence) that can be useful: Hidden Markov Models, BLAST (basic local alignment search tool) technology from DNA sequuencing, satisficing approaches from economics, and neo-Bayesian classifiers. For more see InSTEDD.

Systems integration is a key issue: This was brought up both by Carucci in context of mHealth and López in context of health information systems in Mexico: “The individual elements are relatively simple, one of the greatest challenges to face is the integration”. And: ”There are big mountains of data, big mountains of information”, but these are not integrated with doctors in the hospital.

Improved information can save money and improve outcomes: Stansfield presented the Belize case study, where a pharmaceutical information management system has reduced stock outs and successfully increased supply reliability. They estimate that they have saved US$500,000 (?) in a year – all this saving despite expanded procurement. With PillBox, a US HHS drug identification system designed as an alternative to traditional poison control hotlines, Hale discussed ROI (return on investment). The cost of a single call to a poison control hotline is estimated at US$50. There are more than a million of these every year. The costs of PillBox are those of running an open-access website. Both Stansfield and Carucci indicated, in response to a question from Hay, that it is less about convincing donors that better information systems are important – it’s more about convincing them that this is important relevant to other priorities. Lesson – for the time being, we should be looping cost into the discussion on outcomes.

We need to end the “command-and-control” model: From Carucci: “public health is no longer command-and-control”. By opening up the creation of data (Carucci) and the analysis of data (Hale) we can achieve much more innovation. Carucci: “Public, paticipatory, cocreation of data”. Hale: Engaging communities in open data initiatives can lead to a “virtuous cycle, where even competitors work together”. And check out this new “hacking” contest from the US government, cited by Hale.

A key question which lingered for us and I’m sure for others in the audience: What is it that connects these various efforts* beyond a superficial level? It’s essential that we find such clarity, particularly for those who don’t work in the space of health information systems.

*mHealth,  biosurveillance using noisy data, HMIS country guidelines, government open data initiatives, rural telemedicine

This is a report from the Global Health Council’s annual conference in Washington, DC. This year’s conference, Dateline 2010: Global Health Goals & Metrics, was held June 14-18, 2010. GHC37 is a reference to the Twitter hashtag used for the meeting. Make sure to check out the Council’s own conference blog coverage for more depth. This is our third year covering the meeting (2008 posts, 2009 posts).

I just heard about a cool new project that is launching this week – WWARN: the Worldwide Antimalarial Resistance Network. The about us section is really bad, so don’t bother going there (WWARN please please re-write this section). Here is what you need to know – this is a Gates funded effort to crowd source information and data from the ground up about various metrics that might provide more rapid (“real time”) signals of drug resistance to anti-malarial drugs, basically “tracking the emergence of malarial drug resistance”. What could have previously taken years (waiting for publications as proof) will hopefully now be speeded up. Browse through the website, their tool should be going live this week:

“The WWARN Explorer collates and analyzes data examining complementary aspects of antimalarial drug resistance: treatment outcomes and measures from clinical trials of drug efficacy; pharmacological profiles of antimalarial drugs across key target populations; in vitro assessment of drug susceptibility of parasite isolates; and molecular markers of parasite resistance. The preview version of WWARN Explorer links a repository of standardised data to our interactive tool, which allows users to perform custom queries of more than a hundred studies and display the results using dynamic interactive maps.”

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E-health

A large part of the conference focused on e-health implementation which could help to improve care and care management, empower patients themselves, and reduce costs. According to one of the speakers during the first e-health session, redundant procedures currently account for 1.5 BN Euros annually, and 128,000 hospitalizations occur due to preventable drug interactions. With electronic medical records much of these costs could be avoided.

One example demonstrated at the conference was the Danish national health portal. As is the case in many industries, the Scandinavians manage to do everything well. The Danish portal sundhed.dk is designed to provide decision support, information, and a communications medium for patients and health professionals. It consists of three rooms, an open room which all patients and professionals can access, a closed room for each professional, and a closed room for each patient’s interactions and information. The portal structure is simple and accessible, and usage in Denmark is high with penetration of electronic medical records at over 90%. Other countries have instituted similar portals but with less success. So the most important question is why are they so successful? The French have thrown buckets of money into trying to implement electronic medical records while making only very limited headway. The conference definitely threw out some great ideas but implementing them in other places is easier said than done.

Chronic disease management

Chronic diseases currently account for almost 40% of the burden of disease. With that kind of statistic, chronic disease management was a major focal point at the conference. Different countries have identified the need for improving access to bikes, and putting showers in offices. Prevention programs at schools and a variety of nutrition focused initiatives have also come into play.

An interesting concept brought out by Alliance Boots, a community pharmacy in the UK, is combining condition management with the local pharmacy. Their pharmacies have begun to offer vaccinations, weight management programs, smoking cessation programs, among others, all administered by specially trained personnel. In addition, the company has initiated a Web MD platform to provide better information to patients, along with a health assessment portal with an online personal health record. Many stores have also joined with general practitioner offices to increase the convenience for people – a doctor’s appointment at the same time as you pick up some new shampoo. By increasing the convenience of these care offerings, people are more likely to take advantage of them. Particularly in the case of weight management and smoking cessation, convenience is a major factor in success, even if people are required to pay their pharmacist for it. The real question though is how many people are willing to pay for such services? Is it only the richest segment of society? Or can we somehow make such facilities available to the less socio-economically privileged?

Conclusion

The different platforms and tools demonstrated at the conference certainly show promise in chronic disease management, reducing costs, and improving care quality. At the level that is visible from a presentation of course, it is difficult to translate such new learning into practice in a different location. The World Health Care Congress does of course offer networking opportunities which can perhaps be leveraged into practical implementation. The most important lesson I will take from it is a reminder of the similarities in the problems that health systems face across Europe and the world. In spite of this, local differences make it difficult to apply foreign solutions, although knowledge of external best practices may help to generate new ideas that are more customized to particular environments and societies.

A couple of weeks ago I attended the World Health Care Congress Europe event in Brussels. The event was organized as a forum for networking and discussion of the different issues and solutions being implemented around the world in the health care arena. With speakers and attendees from around Europe and the world, the presentations were generally engaging, although certain sessions were a bit jam-packed.

According to a speaker from the OECD, European health care spending is expected to double by 2050. This massive increase is attributed to ageing, the rising cost of technology, values which place a greater emphasis on health, and public health enemies such as increasing obesity. Obesity already accounts for 8-15% of the burden of disease, while high cholesterol accounts for another 5-12%. In this growing cost atmosphere, a major policy dilemma arises. How do we control health expenditures in both the short and long term, while ensuring sustainable care? The financial crisis has brought this question to the front line even more so than before. Although the conference centered on several themes such as e-health and chronic disease management, the underlying theme was how to continue to increase the quality of care while controlling costs.

Academic health science centers

One of the most interesting presentations focused on the role of academic health science centers in improving care. I’ve heard reference to a common phrase – the “valley of death” between academic research and clinical application. We’ve mapped the genome but how useful has that been in patient care? We are able to identify patients with a substantially higher risk of breast cancer, but what can they really do about it? When I asked them how to combat this valley of death, each of the panelists stressed the need to change the state of mind of scientists to be more application focused. Professor Wong from the National University of Singapore demonstrated how his team has been able to isolate a particular gene which determines whether a patient should receive chemotherapy or an alternative therapy in the case of some cancers. In the presence of this gene, the alternative therapy is effective, but without it, chemotherapy is the more effective treatment. Applications such as this are the reason that academic health science centers receive so much funding and attention; however, ensuring that such applications can occur is the tough point. Still it’s promising to note that research teams which are driven towards a specific application can sometimes have success.

The 6th Annual World Health Care Congress – Europe is taking place 19-20 May, 2010 in Brussels, Belgium. This annual event is the only major international forum that convenes over 400 leaders from all sectors of health care to share the best practices and successful initiatives for improved delivery and outcomes in Europe. The 2010 Congress will feature the top industry influencers including health ministers, leading government officials, hospital directors, IT innovators, and decision makers from public and private insurance funds, pharmaceutical and medical device companies, and heath care industry suppliers.

**Save $400 when you register by Friday, May 7, 2010. To qualify, contact World Congress at 800-767-9499 with code YTK462, not applicable to government registration.**
For more information, visit: www.worldcongress.com/europe.

Global Health Watch 3
Examining the World’s Health from an Alternative Perspective
Call for Case Studies and Testimonies
Contribute to the Alternative World Health Report

The Global Health Watch provides a platform for activists  to share experiences and inform each other with practical examples and theoretical analyses  to strengthen local, national, regional and global campaigns towards  Health for All!

How you can voice your views:

The Global Health Watch is putting out a call for the submission of country or region specific case studies and testimonies. These case studies and testimonies will form part of the electronic platform of the alternative world health and selected case studies shall also be incorporated into the final document of Global Health Watch 3 – scheduled for publication in 2011.

Some suggestions:

•       Positive and negative examples of policies and actions to secure improved and equitable access to health care.

•       Examples of interventions to address public sector corruption and inefficiency.

•       Examples of effective, efficient and inclusive public health care systems.

•       Evidence showing the negative effects of commercialised health care on professional ethics.

•       Case studies on what is driving good and bad processes of decentralisation, with some analysis illustrative case studies of where deconcentration, devolution and delegation have worked, where it hasn’t worked and why.

•       The good and bad practices bilateral and multi-lateral donors on public health stewardship and on the performance of health care systems.

•       Examples of civil society resistance to the effect of privatised public water and electricity utilities on equitable and fair access.

•       Case studies of the positive and negative impact of multi-national corporations on health policy.

•       Case studies of the difficulty that country governments have in responding to the needs and demands of multiple international agencies (creditors such as the World Bank, traditional bilateral donors, relatively new institutions such as GAVI and the Global Fund).

All case studies, pictures and videos will be published on the website of PHM Global with pictures

Guidelines

We are looking for short and concise submissions of 1000 -2000 words with pictures
Please indicate:
•       your organisation
•       your locality/country/region
•       whether you want your submission to be anonymous and why
•       Ensure a clear link of your case study with one of the subjects covered by the course or issue mentioned above.
•       Pictures or videos

Looking forward reading your stories, experiences, analysis and observations!!

We should receive the first draft by 30th August, 2010.

Please write back to asengupta@phmovement.org

Why should you get involved

The Global Health Watch is a non-government initiative aimed at supporting civil society to more effectively campaign and lobby for ‘health for all’ and equitable access to health care. This is not a matter of finding a technical or economic prescription, but is one that requires political mobilisation to shift resources and attention towards the needs of the poor, and to reform the very political and social institutions that have generated the state of ill health today.

Promote the accountability of governments and global institutions that affect health (such as the World Health Organisation, UNICEF and the World Bank)

Identify policies and practices at the global and national levels that are unfair, unjust and bad for health

Highlight the needs of the poor and reinvigorate the principle of ‘health for all’

Shift the health policy agenda to recognize the political, social and economic barriers to better health and to advocate alternatives to market-driven approaches to health and health care

You can get more information about the Global Health watch at: http://www.ghwatch.org/

The answer is yes if you ask Carina Lupica.

Carina is Executive Director of Fundación Observatorio de la Maternidad (OM), an entrant in this year’s Healthy Mothers, Strong World competition. The competition, jointly sponsored by Ashoka and the Maternal Health Task Force, seeks to identify maternal health innovations from around the world. OM is a globally unique organization that is dedicated to using data as a policy advocacy tool for maternal health in Argentina.

Argentina’s maternal mortality ratio (MMR) – 44 deaths per 100,000 live births in 2007 – is much lower than high maternal mortality countries, but it is high when compared to other national indicators (Ramos et al., WHO Bulletin, 2007). In 2007, OM identified a lack of quality data focused on maternal health issues as a key gap in Argentina. OM has responded to this gap by aggregating data from various sources to develop a comprehensive understanding of the maternal health landscape in Argentina. OM maintains a holistic view of maternal health, including environmental factors and social issues, such as access to clean drinking water and the increasing frequency of single mothers.

As Carina writes by email, “This is brand new information that contributes to a complete diagnosis of the state of motherhood, which constitutes the necessary grounds for any public policy proposal.”

The organization’s focus on policymakers is having a real and significant impact. In 2009, OM research helped to pass national law 1914-D-2009: Universal Payments to Children and Adolescents (link in Spanish), a conditional cash transfer program that aims to reduce poverty and improve family health. This program was based on OM research showing that poorer mothers are more likely to contribute a higher share of household income, 72.5% in the lowest income group.

Just this month the Lancet published a study that estimated that there were 343,000 maternal deaths in 2008. Included in this study were detailed estimates for individual countries, including success stories such as China, Egypt, and Bolivia. Study lead Christopher Murray remarks, ”Finding out why a country such as Egypt has had such enormous success in driving down the number of women dying from pregnancy-related causes could enable us to export that success to countries that have been lagging behind.” As with OM, this comment suggests that better data can result in better maternal and child health.

Can better data save the lives of mothers? Absolutely.

The important question now is this: Can the OM model be replicated globally?

The mission statement from Medicall’s site (chem’em out here):

Proveer atención médica de acceso inmediato, presencial y a distancia, a través de un sistema de membresías y una red de proveedores médicos, con calidad y descuentos garantizados, e incorporando conocimientos y tecnologías vanguardistas.

Translation (forgive my Spanish translation…it’s been a while): To provide immediate and live medical attention at a distance through a membership system and a network of medical providers with quality and guaranteed discounts and incorporating knowledge and advanced technologies.

The skinny:

- 1 million households subsribe

- 90,000 calls per month

- 62% of calls are resolved over the phone

- $5/month/household

Thanks Ashsish for passing along the info.