Tiempo en ciclos Base
3.2.5 Multiprocesadores simétricos (SMP)
on what treatments should be provided and whether patients need to travel to specialist care in the
capital or not.
Project Description
One of the main problems of the Mali healthcare system is that almost all radiologists in Mali are located in the capital of Bamako. This means that all expert diagnosis of x-Rays have to take place in the capital, sometimes up to 1,000km away from the regional hospital where the first analysis is made.
In 2005, a group of doctors, with support from the International Institute for Communication and Development, established the Mali IKON project to link eleven trained radiologists with rural hospitals in order to transmit radiological images to experts for consultation. IKON initially equipped and set up Internet connections between a hospital in capital Bamako and three hospitals in Tombouctou, Sikasso and Mopti. In 2008, the project expanded to a total of six hospitals, all in rural areas that are difficult to access by road. The project leadership wants to expand the project in coming years to further -- even more remote -- locations beyond the reach of the current ground communications network by utilising satellite technologies. The project allows generalist doctors in more remote locations to send or receive x-ray scans and diagnosis, allowing them to get specialist advice on radiology outputs from trained radiologists which they can then use to provide better diagnosis and treatment for their patients.
From the outset, the Mali IKON project has been grounded in the realities that a telemedicine project can only be successful if the technology used is appropriate and there is a willingness on the part of health professionals to engage in the programme. For these reasons, organised awareness seminars were held at hospitals where interested people could sign up for telemedicine training. The telemedicine project thus only dealt with motivated people who decided themselves to use teleradiology. In addition, the project worked with elementary telemedicine equipment which was easier to maintain and understand than more sophisticated technology.
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Country Background
Mali is a physically large country in West Africa with a sparse population in the extensive rural areas (Table 11). It faces many of the same development and disease issues as the rest of sub-Saharan Africa faced with remoteness, low population density, limited resources and growing desertification which impacts on the rural areas ability to provide a livelihood for the population. In addition, transport costs in Mali are very high due to the low population densities in much of the country with only 21% of communities being within 5km of daily transport. This is a particular problem for emergency access to health services with 37% of communities being further than 15km away from the nearest health clinic.51These geographic realities strengthen the case for increased investment in telemedicine and eHealth services in Mali. Given that 80% of the population are outside the mobile phone network, a satellite based telemedicine and eHealth programme could provide significant health benefits to rural populations.
In Mali, using ICT in health is high on the agenda. Over the last six years, the government of Mali has started to use ICT as a development tool in a number of government projects, including computerisation of the entire health department, the governmental Intranet, the annual E-Festival and the creation of a government agency dedicated to ICT (AGETIC). At sub-regional level, Mali is even a founding member of the Francophone African Network for Telemedicine (RAFT) which is discussed later in this section.
Table 11: Socio-Economic Data for Mali Mali Population:13,918,000
Indicator Indicator
Gross National Income per capita (2007)
$ 500 % Population living in a rural
area (2006)
69%
Life Expectancy at birth (2006) 46 years Under-five mortality rate (per 1,000 live births) (2006)
217
Health Life Expectancy (2003) 38 years Rural under-five mortality rate
(per 1,000 live births) (2001) 253 Nurses and midwives per 10,000
population (2004)
6 Physicians per 10,000
population (2004)
<1
Total health expenditure as share of GDP (2006)
5.8% Govt expenditure on health as
share of GDP (2006)
2.9%
Population outside mobile
phone network (2007) 80%
Internet users per 10,000
inhabitants (2007) 81
51
World Bank (2001)The provision of conventional rural transport services case study: rural transport services in Mali
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Mali Population:13,918,000
Disease Burden (death rates per 100,000 inhabitants) (2002) HIV/AIDS – 97.3 Malaria – 179.9 Tuberculosis – 76.7 Maternal deaths – 54.3 Perinatal deaths – 144.5
Diarrhoeal and childhood-cluster diseases52- 360.4
Sources: International Telecommunications Union 2008 African Telecommunication/ICT Indicators 2008, World Bank World Development Indicators (accessed 10 November 2008), World Health Organisation WHOSIS (accessed 29 October 2008), World Health Organisation (2004) Age-standardized death rates per 100,000 by cause, and Member State, 2002
Issues Addressed by the Mali IKON Project
The objective of the Mali IKON Project is to address three key issues:
Poor penetration of health services in rural zones and poor communication channels
69% of the population lives in rural areas, and the distant regions of the North represent more than 60% of the national territory. These zones are very difficult to access from the capital and other population centres and have few clinics offering health services to local populations. The travel costs for patients to be treated by a doctor in the capital are very high, as are the risks to a sick patient. Many are unable to make the journey due to costs.
Poor communication channels
Lack of road infrastructure and telephone lines are important obstacles for health practitioners. In 2008, for example, a meningitis epidemic was reported in five distant zones, close to the Burkinabe border. It took six days after the first outbreak for the report to reach a clinic where health practitioners were able to respond to the epidemic. This is an example of the type of situation in which satellite-based communications could play a key role in managing the situation.
Lack of trained radiologists
There is a real dearth of health practitioners in Mali. The only radiologists are based in the capital, which can be up to 1000 km from a regional hospital. More than 73% of people live in zones where there are no trained radiologists to confirm a doctor’s diagnosis. As such, many diseases go undiagnosed or are discovered too late to save the patient.
Satellite Use
The Mali IKON project is planning to use satellite communications technology to transmit diagnostic images and information from the rural clinics to specialists in the capital where land-based and radio-based communications are not available. Mali has very poor ICT penetration. Even in the capital zone of Bamako, spanning 800 km, there are very poor internet and landline telephone services. Currently, the project is facing many obstacles due to the very poor internet connections in rural areas.
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A pilot project is planned for 2009 to link the IKON project to satellite communications. IKON’s project leadership considers satellite links are the only practical way to ensure good quality communications connections between the current six sites, central clinic and potential new centres once the satellite connection is operational.
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Impact Pathway: Mali IKON Objectives
To tackle health access inequalities in Mali through addressing:
Poor penetration of health services in rural zones and poor communication channels
Poor communication channels
Lack of trained radiologists
Inputs
Six local clinics, with trained radiologists based in the national centre.
Scanners and scanning software
Internet connection
Training for hospital staff on how to use a scanner and software.
Activities
The IKON project currently operates out of six clinics which are connected using internet to a national centre.
Outputs
Diagnoses from trained radiologists based in a central hospital, who provide results within 24 hours for normal cases and within two to three hours for urgent cases.
Patients in rural zones are able to have an x-ray taken in one of the six local clinics and to receive a diagnosis, often for cancerous tumours, without having to travel to the capital and waiting up to two months for an appointment.
Initial Outcomes
Patients who receive a diagnosis in time are able to be treated and to undergo needed treatment. Significant reductions of costs for both hospitals and patients were expected on travel costs for patients, and improved use of local hospital facilities (less pressure on -more expensive - hospital facilities in the capital).
Hospital staff develop general ICT skills
Longer term Outcomes
Increased health and longevity as the health system reach extends across the country and greater interaction with specialists is achieved
Wider Outcomes
Improved telecommunications linkages across the country will increase the capacity for communications in a range of areas beyond health such as business and public services
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Benefits
The main direct benefits from the IKON project are faster and better diagnoses of health problems for patients. This should lead to more timely and appropriate care reducing the severity of illness and the mortality rate. The IKON project is not expected to have a significant impact on morbidity as it only applies to people who are already ill.
To ensure sustainability of the programme, patients are charged for the service. Initial evaluations of the programme showed that the existence of the clinics resulted in significant reductions in travel costs for patients as well as improved use of local hospital facilities which reduced pressure on more expensive hospital facilities in the capital.
Costs
The initial costs for the IKON system are the telecommunications equipment required to access the network and complementary technology in computers and diagnostic equipment. The on-going costs are staff costs, the running and maintenance costs of the equipment and the time and costs required for patients to get to the nearest centre connected to the project.
The Mali IKON project had an overall budget in the first year of $160,796 to equip, train and establish the first three clinics which is an average of only $53,598 per clinic. The majority of the budget was spent on equipment and training and is exclusive of the costs of the underlying ICT infrastructure investment.
Reported Impact
In 2005, the three rural hospitals involved in the Mali IKON programme treated 135 cases and 203 in 2006. Up to October 2008, a total of 967 people have been treated through the IKON project. Based on conversations with the IKON project team, we have estimated that current capacity of the IKON project is about approximately equal to this number of people as the annual rate.
Of these cases seen, 94% were judged normal, and 6% were urgent. 92% of the images sent from the remote clinics were successfully transmitted and led to credible diagnoses from the radiologists in the central hospital. According to the IKON evaluation, the feedback received from radiologists led to a change in treatment for the patient in 45% of cases.
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4.3.2 eCare in the Village: Uganda Health Information Network