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  • Point of View

    Connected Health: Transforming Healthcare in Emerging Markets

    Author Peter Drury

    Editor Eileen L. Lavergne

    Cisco Internet Business Solutions Group (IBSG)

    Cisco IBSG Copyright © 2007 Cisco Systems, Inc. All rights reserved.

    October 2007

  • 1Cisco IBSG Copyright © 2007 Cisco Systems, Inc. All rights reserved. 1

    Point of View

    In Emerging Markets, Cisco IBSG works with leaders of key national and regional government agencies, businesses, communities, multilateral institutions, and NGOs to turn their technology investments into strategic national assets. Serving as trusted advisers in varied assignments spanning broadband connectivity, digital inclusion, smart communities, and business productivity, IBSG aligns ICT to support socioeconomic development in these countries. Connected Health is IBSG’s approach to harnessing the power of ICT to serve the country’s national healthcare and transformation agenda.

    Executive Summary In every country, health is a major concern for government, citizens, businesses, and providers of information and communications tech- nology (ICT) services. Each country faces key healthcare issues, with developing countries carrying the greatest burden of disease and the fewest resources to deal with the problem. Despite the temptation to develop acute care at the expense of the primary care sector, there now is a growing realization that this approach is flawed and a more holistic solution is needed. Cisco’s fundamental proposition is that patients, clinicians, managers, or providers of services need to be part of a connected health community in order to make better decisions that transform healthcare.

    The Cisco® Connected Health program embodies a framework and methodology for the application of advanced healthcare info-structures1 that adapt closely to specific challenges and priorities in each country, while drawing on proven technologies and vast experience of applica- tions worldwide. Connected Health allows greater collaboration among professionals, faster delivery of patient care, easier and less demand- ing administration, and development of patient-centric healthcare services that enrich the quality of life and economic strength of the nation it serves.

    This paper develops the Connected Health model so that it can be applied in developing countries that can afford only a simple infrastruc- ture. It argues that when health is regarded as part of a holistic program of development, the aggregation of demand will make the connectivity needed to transform health (and other services) more affordable.

    Point of View: Connected Health

    The case for better healthcare may seem to be self-evident. Yet, however desirable universal access to excellent healthcare may be, the realities of budget and logistics present challenges as populations grow, chronic diseases escalate, and lifestyle realities take their toll.

    The Cisco concept of Connected Health delivers a framework for government and healthcare providers, and enables citizens to be more informed about their own health through the development of advanced ICT infrastructures that support next- generation healthcare provision.

    In the developing world, Cisco Connected Health provides the opportunity to accelerate the effective provision of healthcare even to remote areas. Improved collaboration among health workers, greater facility for self-treatment, and patient involvement in primary care all serve to optimize performance of the healthcare service as a whole. A healthier nation is an economically stronger nation.

    1. An info-structure is an integrated network of systems and information and communications technology that allows citizens, government, and businesses to connect on a common platform. In healthcare, such an info-structure allows citizens and people throughout the healthcare system to communicate with each other to make informed decisions regarding their own health, the health of others, and the healthcare system.

  • Cisco IBSG Copyright © 2007 Cisco Systems, Inc. All rights reserved.2

    Introduction For any government, ensuring all citizens have access to healthcare is a fundamental responsibility. It is an essential economic function; a healthy nation is a productive and competitive one. Healthcare must be accessible, affordable, and responsive, both to the specific, constantly changing medical and clinical needs of patients, and to the broader demographic, social, and cultural shifts that typify the modern world. The Millennium Development Goals2 for reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria, and other diseases are proving difficult to meet. They rely on progress elsewhere, not least in global partnerships for development, such as making available new technologies like ICT.

    Health is a fundamental right for all citizens. Article 25 of the Universal Declaration of Human Rights states that “…everyone has the right to a standard of living adequate for the health and well-being of himself and of his family.” Translating this right into knowledge of how best to maintain good health and manage ill health, however, remains a major challenge, as does enabling access to appropriate and affordable healthcare.

    From the perspective of businesses, whether a large multinational or a single-person start-up, ill health is a major threat to productivity and income generation. Conversely, a healthy workforce contributes significantly to providing resources that enable standards of living that support good health. In many countries, health services are the largest employer and a business that can consume up to 10 percent or more of gross domestic product (GDP). Investment in an ICT infrastructure enables health services to deliver better value for the money.

    For specialist providers of ICT services, significant challenges and opportunities exist. New technology is crucial to successful delivery of modern healthcare services. ICT has proven a major influence on growth, efficiency, and innovation worldwide. ICT integration, in which once disparate areas of infrastructure are unified and consolidated, is a critical concern, particularly in the distributed environment that typifies a healthcare infrastructure. It is now possible to deliver connectivity within and between health facilities, as well as to mobile health workers (and citizens) to enable fast, secure access to relevant and current knowledge.

    2. The Millennium Development Goals are eight aggressive goals that make up the Millennium Declaration that was signed at the 2000 UN Millennium Summit to end global extreme poverty by the year 2015. The eight goals are: 1: End Hunger and Extreme Poverty, 2: Achieve Universal Primary Education, 3: Promote Gender Equality and Empower Women, 4: Reduce Child Mortality, 5: Improve Maternal Health, 6: Combat HIV/AIDS, Malaria, and Other Disease, 7: Ensure Environmental Sustainability, 8: Develop a Global Partnership for Development.

  • Cisco IBSG Copyright © 2007 Cisco Systems, Inc. All rights reserved. 3

    Point of View

    For many developing countries, however, the costs of connectivity are prohibitively high and need to be reduced if health and economic development are to be improved.

    Cisco believes that the delivery of an ICT infrastructure to support Connected Health offers developing countries the opportunity to provide advanced healthcare services where they can be afforded, while at the same time offering coverage and knowledge access to all citizens and health workers. A range of issues and challenges to overcome can be presented in a general framework, but still need to be addressed in the specific context of each country.

    Issues and Challenges Health services worldwide are facing new and evolving challenges. The population of many countries, particularly in Africa and Asia, will increase greatly in the coming decades. In contrast, owing to below-replacement fertility levels, some developed countries are expected to experience a significant population decline. Developing countries account for 80 percent of the global population and 90 percent of the global disease burden, but only 12 percent of global health spending.

    Chronic diseases, such as heart disease, stroke, cancer, chronic respi- ratory diseases, and diabetes, are by far the leading cause of mortality in the world, representing 60 percent of all deaths. Eighty percent of chronic disease deaths occur in low- and middle-income countries. Chronic disease risks become widespread much earlier in a country’s economic development than usually is realized. For example, levels of body mass and total cholesterol increase rapidly as poor countries become richer and national income rises. For the poor, however, any form of ill health, such as poor nutrition, prevents them from working. They cannot earn the money needed to provide for themselves or others, so, although high mortality is the most significant population concern for developing countries, disability needs to be considered as well. The World Health Organization’s (WHO) work on the Global Burden of Disease3 shows that in low-income countries, the three leading causes of disability-adjusted life years lost to ill health are HIV/AIDS, perinatal conditions, and unipolar depressive disorders.

    3. A WHO response to the need for comprehensive, consistent, and comparable information on diseases and injuries at global, regional, and national levels.

  • Safety and quality of care are high priorities, especially with rising deman