The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia

Background: Eighty-five per cent of the Ethiopian population lives in remote areas, without access to modern health services. The limited health care budget, chronic shortage of health care workers and lack of incentives to retain those in remote areas further jeopardize the national health care delivery system. Recently, the application of information communication technology (ICT) to health care delivery and the use of telemedicine have raised hopes.Objective: This paper analyzes the challenges, failures and successes encountered in setting-up and implementing a telemedicine program in Ethiopia and provides possible recommendations for developing telemedicine strategies in countries with limited resources.Design: Ten sites in Ethiopia were selected to participate in this pilot between 2004 and 2006 and twenty physicians, two per site, were trained in the use of a store and forward telemedicine system, using a dial-up internet connection. Teledermatology, teleradiology and telepathology were the chosen disciplines for the electronic referrals, across the selected ten sites.Results: Telemedicine implementation does not depend only on technological factors, rather on e-government readiness, enabling policies, multisectoral involvement and capacity building processes. There is no perfect ‘one size fits all’ technology and the use of combined interoperable applications, according to the local context, is highly recommended.Conclusions: Telemedicine is still in a premature phase of development in Ethiopia and other sub-Saharan African countries, and it remains difficult to talk objectively about measurable impact of its use, even though it has demonstrated practical applicability beyond reasonable doubts

Global health in transition: The coming of neoliberalism

Global health as a transnational, intergovernmental, value-based initiative led by the World Health Organization (WHO), working toward improving health and achieving equity in health for all people worldwide, has for years yielded to a growing reliance on corporate-led solutions. Private organizations, non-governmental organizations (NGO), religious and other philanthropic and charitable organizations, increasingly serve a dominant role in setting the global health agenda. Short-term success in combating epidemics and in the provision of funding for project-based initiatives appeals to supporters of marketization of health services. For 30 years, a neoliberal paradigm has dominated the international political economy and hence the governance of global health. A utilitarian logic or the ethics of consequentialism have attained prominence under such banners as effective altruism or venture philanthropy.  This contrasts with the merits and relevance of deontological ethics in which rules and moral duty are central. This paper seeks to explain how neo-liberalism became a governing precept and paradigm for global health governance. A priority is to unmask terms and precepts serving as ethos or moral character for corporate actions that benefit vested stakeholders.   &nbsp

Spectrum of cardiovascular disorders in a national referral centre, Ghana

Objective: To determine the pattern of cardiovascular disorders in Ghana.Design: A four-year prospective study.Setting: National Cardiothoracic Centre (NCTC), Korle-Bu Teaching Hospital, Accra, Ghana.Subjects: Seven hundred and eight subjects with cardiovascular disorders referred to the NCTC, Accra, were evaluated clinically and with ancillary laboratory tests, chest x-ray, and electrocardiography. Subjects were also assessed with the aid of two-dimensionalechocardiography with doppler and colour flow mapping.Results: Hypertensive heart disease(n=133), rheumatic heart disease(n=123), idiopathic cardiomyopathy(n=103), congenital heart disease(n=90) and coronary artery disease(n=80) were the major causes of cardiovascular morbidity. The mean age of the subjects was 41.6 ± 0.8 years. The male to female ratio was 1.3:1.0. The peak incidence of cardiovascular disease occurred in the fifth decade. Subjects with coronary artery disease were relatively older and had the highest incidence of hypertension(66.3%), diabetes(22.5%),smokers(11.8%), hyperlipidaemia(8.8%) and regular alcohol use(12.5%). The commonest rheumatic valvular lesion was mitral regurgitation. Dilated cardiomyopathy was the commonest form of cardiomyopathy(n=56). Hypertrophic cardiomyopathy andendomyocardial fibrosis were seen in 25 and 22 subjects respectively. Ventricular septal defect, atrial septal defect, tetralogy of Fallot and patent ductus arteriosus were the commonest congenital lesions. The major cardiovascular disorders in children were congenital(n=27) and rheumatic heart(n=11). Idiopathic cardiomyopathy(n=1) was rare in children.Conclusion: Major causes of cardiovascular morbidity in Ghanaians were hypertension, rheumatic heart disease and cardiomyopathy. Congenital and rheumatic heart diseases were the commonest cardiovascular disorders in Ghanaian children. Idiopathic cardiomyopathy was rare in children

A qualitative evaluation of an operational research course for acute care trainees in Kigali, Rwanda

Introduction: the blended SORT-IT model uses a combination of online modules and teleconferences with local and international mentors to teach operational research. We modified SORT-IT to create the Acute Care Operational Research (ACOR) course directed to anesthesiology residents in Kigali, Rwanda. This course takes students from an initial research idea through submitting a paper for publication. Our viewpoint on entering this study was that ACOR participants would have adequate resources to complete the course, but be hampered by cultural unfamiliarity with the blended teaching approach. Methods: we conducted a qualitative analysis of the experiences of all those who participated in the ACOR course to understand obstacles and improve future course iterations. Six anesthesiology residents participated in the first iteration of the course, with 4 local mentors and 2 secondary mentors, one of whom was based at the University of Virginia, with a total of 12 participants. Semi-structured interviews were conducted with all participants and mentors, which were independently coded for topics by two reviewers. Results: there was a 50% publication rate for those enrolled in the course and an expected 100% acceptance rate for those who completed the course. Some reported benefits to the course included improved research knowledge, societal improvements, and knowledge exchange. Some reported obstacles to successful course completion included time limitations, background knowledge, and communication. Of note, only 4 out of 12 participants recognized cultural barriers. Conclusion: although successful in the sense that all participants completed their research project, ACOR did not fully solve the main issues hindering research training. Our results show that research training in low-resource settings needs a continuing and formal focus on the factors that hinder participants´ success: mentorship and time