Geneva, Switzerland, 26-27 April 2012

Barriers & opportunitiesto adoption:

perspectives from Bangladesh

Dr Sultan Shamiul Bashar,Medical Officer

Management Information SystemDGHS, MOHFW, Bangladesh

e-mail: dr.bashar@mis.dghs.gov.bd

Joint ITU-WHO Workshop on e-Health Standards and Interoperability

(Geneva, Switzerland, 26-27 April 2012)

Geneva, Switzerland, 26-27 April 2012 2

Introduction

In our view,

adoption of standards & interoperability framework in eHealth

needs consideration from 2 perspectives:

1.National

2.Global

Before explaining these perspectives,

please allow me to give a brief overview of:

health care infrastructures &

eHealth

in Bangladesh

Health Care Infrastructures

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Geographic unit

No.Average

PopulationHealth Facility

Bangladesh - 150 mill Super-sp. Hospitals

Division 7 23 millTertiary Hospital/

Medical College Hospital

District 64 2.5 millDistrict Hospital/ Medical

College Hospital

Sub-district 483 0.3 mill Sub-district hospital

Union 4,501 35,500 Union Health Center

Ward 13,503 12,000Community clinic – one

for 6,000 population

~600 hospitals~24,000 day-care

facilities~150,000 health

workforce

ehealth found phenomenal changein 3 years from 2009

Digital Bangladesh 2021

5-yr HPNSDP 2011-2016 with ambitious ehealth plan

National Health Policy 2011 with ehealth as a major component

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ehealth vision 2016

Internet ConnectivityCurrently 1,000 places, national to sub-districtTo scale to 20,000 places (USCs to CCs) by 2 yrs

DHIS v2.7Currently collecting data for >5,000 health facilities

(national to union level)To be scaled soon to >20,000 health facilities

Tele-medicine8 centers with quality videoWeb camera in all district

& sub-district hospitalsSoon to be scaled to CCs

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ehealth found phenomenal change…

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DatabasesHRM, PDS, Field Staff InfoSupply Chain ManagementHealth Facility DatabaseOthers

mhealthPregnancy care advice by

SMSComplaint-suggestion boxHealth Statistics Distribution

SystemBulk SMS for health staffs

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ehealth found phenomenal change…

Hospital automationwith OpenMRS1 yr3 hospitals (all

modules)All district & sub-

district hospitals (2 modules)5 yrsAll hospitals (all

modules)

Recognition

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United Nations Digital Health for Digital Development Award 2011

One of top 11 Global Innovations in 2011

The Manthan Award South Asia

National Digital Innovation Awards 2010 & 2011

Barriers & Opportunities:National Perspective

ProblemDatabases flourishing

both within & outside health sectorThey lack uniform

coding system for locations, common fields & optionsOpportunity of

interoperability is being missedHardware & network

choice also often lack standardization

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BarriersLack of knowledge among

database developers about standardization &interoperability

Lack of knowledgeable & skill staffs in public sectorPolicy makers want quick

solutionsInadequate communications

& TAs from DPsInadequacy of freely

available standards

ehealth in preliminary stages - Still have timeThe Highest level Policy Support – Digital Bangladesh 2021The country started initiative to develop Common National Coding System & Standards

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Barriers & Opportunities:National Perspective

MoH initiative to form multi-sectoral & GO-NGO-DP National HIS Steering Committee for interoperability & standardization issue

A HL7 committee exists

We prefer OpenSource SW (compatible with IMR, SDMX-HD, ICD-10, HL7 (e.g., DHIS, OpenMRS)

Hardware choice follows ministry-wide approach

Opportunities

Conclusions & Recommendations

1. Improve availability knowledge & practice of ehealth standards & inter-operability in developing countries

2. Ensure free & easy accessibility of ehealth standards

3. Improve DP coordination for ehealth

4. Increase ehealth TA for developing countries

4. Increase TA to developing countries with advancing situation of ehealth for generating global ehealth knowledge for replication

5. Consider geo-locations & common demographics to include for standards development

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Thank you!

Woman receiving prescription from from Union Information & Service Center given by doctor at our office