The Role of Telehealth in Pacific Island Human Resource for Health (HRH) Development:

An Environmental Scan of Past Experiences and Potential Developments

Rieko Hayakawa, Christina Higa, Cathy Wasem

The 21st Pacific Congress OkinawaAsia Pacific Telecommunity Telemedicine Initiative

15-16 June 2007, Okinawa, Japan

I. IntroductionI. Introduction

22 island economies22 island economies >25,000 islands >25,000 islands 8.6 million people8.6 million people Populations from several thousand to over Populations from several thousand to over

6 million6 million Geologically diverse – from coral atolls to Geologically diverse – from coral atolls to

volcanic high islandsvolcanic high islands

1. Map of Pacific with flag of US, France, British, NZ, Au.

Political Affiliation Pacific Island Economy

Independent Countries: Papua New Guinea, Fiji, Vanuatu, Solomon Islands, Samoa, Tonga, Tuvalu, Nauru, Kiribati

US free association: Republic of the Marshall Islands, Federated States of Micronesia, Republic of Palau

NZ free association: Cook Islands, Niue, Tokelau

US territory: Commonwealth of the Northern Mariana Islands (CNMI), Guam, American Samoa

French Territory: French Polynesia, New Caledonia, Wallis & Futuna

British Territory: Pitcairn Island

Hideaki Satoh

Hideaki Satoh

Beliefs: Traditional & Western

Geography: small atolls and volcanic islands

Hideaki Satoh

Technologies: Traditional & Modern

II. HEALTH, HUMAN RESOURCE II. HEALTH, HUMAN RESOURCE FOR HEALTH (HRH) FOR HEALTH (HRH)

DEVELOPMENT IN THE PACIFIC DEVELOPMENT IN THE PACIFIC ISLANDS AND TELEHEALTHISLANDS AND TELEHEALTH

There is a global shortage of health workers estimated at more than 4 million doctors, nurses, midwives and others.

•This takes its greatest toll on the poorest and most vulnerable populations.

•unprecedented strain on health-care systems :-traditional diseases - malaria and tuberculosis-modern lifestyle-related diseases – diabetes & heart disease

•Add to this the newly emerging threats such as avian influenza

•The quality health care may soon be jeopardized in many countries.

Dr. Shigeru Omi In Preface to the Regional Strategy on Human Resources for Health 2006-2015 and in an article for World Health Day 2006

Pacific islands situation:

Double burden of disease - tuberculosis, Hansen's disease, high infant mortality - diabetes, cardiovascular disease, cancer - rise in communicable disease

- increasing alcohol and drug use

Lack of Human Resource - 80-90 % of health workers are expatriates in the Marshall Islands

Lack of training opportunities - quality education - funding - Small numbers of students

Telehealth

Use of ICT to support long distance clinical health care, health workers and patient health related

education, public health, and health administration

III. PACIFIC ISLANDS III. PACIFIC ISLANDS TELECOMMUNICATION – TELECOMMUNICATION –

MONOPOLIES, ICT POLICY REFORM, MONOPOLIES, ICT POLICY REFORM, TELECOMMUNICATION NETWORKS, TELECOMMUNICATION NETWORKS,

AND UNIVERSAL SERVICEAND UNIVERSAL SERVICE

Telecommunication CostsTelecommunication Costs

Long Distance Telephone RatesLong Distance Telephone Rates $.05 - $3.00 Minute$.05 - $3.00 Minute

T-1 RatesT-1 Rates

Guam – Hawaii, CNMI-HawaiiGuam – Hawaii, CNMI-Hawaii $200,000 Year$200,000 Year

American Samoa - HawaiiAmerican Samoa - Hawaii $300,000 Year$300,000 Year

Intrastate HawaiiIntrastate Hawaii $12,000-$24,000 Year$12,000-$24,000 Year

InternetInternet

Republic of the Marshall IslandsRepublic of the Marshall Islands $10 Registration, 0-free $10 Registration, 0-free hours, $3.50/hourhours, $3.50/hour

Federated States of MicronesiaFederated States of Micronesia $19.95 Monthly, 10-free $19.95 Monthly, 10-free hours, $1.95/hourhours, $1.95/hour

Republic of PalauRepublic of Palau $15.00 Monthly, 4-free hours, $15.00 Monthly, 4-free hours, $2.50/hour$2.50/hour

Regional commitment ICT policyRegional commitment ICT policy

2005 Pacific Islands Forum2005 Pacific Islands Forum ““Digital Strategy” in the “Pacific Plan”Digital Strategy” in the “Pacific Plan”

2004 UNDP funded by Japan2004 UNDP funded by Japan

““ePasifika”ePasifika”

2001 Pacific Islands Forum2001 Pacific Islands Forum ““Regional ICT Policy and Strategic Plan”Regional ICT Policy and Strategic Plan”

7. network chart of USPNet

http://www.usp.ac.fj/index.php?id=uspnet0

E-Rate NetworksE-Rate Networks

American Samoa E-Rate NetworkAmerican Samoa E-Rate Network

~$ 24+ Million in 7-Years~$ 24+ Million in 7-Years All Public and Private All Public and Private

Schools ConnectedSchools Connected Fiber Optics (4-strands)Fiber Optics (4-strands) Video TeleconferencingVideo Teleconferencing High Speed Internet High Speed Internet

CNMI Partners in Distance Learning CNMI Partners in Distance Learning NetworkNetwork

~$12+ Million in 4-Years~$12+ Million in 4-Years 20 VTC Sites20 VTC Sites

Public School SystemsPublic School Systems Office of the GovernorOffice of the Governor Electronic Data Processing Electronic Data Processing Commonwealth Health Commonwealth Health

CenterCenter 1Gpbs between schools1Gpbs between schools

Guam Education NetworkGuam Education Network

~$12+ Million in 4.5-~$12+ Million in 4.5-YearsYears

30+ VTC Sites30+ VTC Sites* Public Schools* Public Schools

* University of Guam* University of Guam

High Speed InternetHigh Speed Internet On-island Fiber On-island Fiber

Gigabit Fiber Gigabit Fiber ConnectivityConnectivity

IV. EXPERIENCES AND IV. EXPERIENCES AND ISSUES IN HRH ISSUES IN HRH

DEVELOPMENT USING DEVELOPMENT USING TELEHEALTHTELEHEALTH

1. network maintenance and operations 2. telecommunication cost3. collaboration within and among the POLHN sites4. POLHN resources could be further maximized by working with other governments, health care providers and educational institutions5. mechanisms for articulating higher education coursework and certifying continuing education

State of HawaiiState of Hawaii Telehealth Access Network Telehealth Access Network

A different telehealth network model is that of the Hawaii State Telehealth Access

Network (STAN). This network, of nearly forty health care facilities throughout

Hawaii, is used to deliver continuing medical education and for telehealth

consultations.

Direct Network ConnectionsDirect Network ConnectionsOahuOahuHHSC Corporate OfficesHHSC Corporate OfficesNorth Hawaii Community HospitalNorth Hawaii Community HospitalLeahi HospitalLeahi HospitalMaluhiaMaluhiaShriners Hospital for ChildrenShriners Hospital for ChildrenSt. Francis Health Care SystemSt. Francis Health Care SystemVeterans Administration (and Network)Veterans Administration (and Network)UH College of Tropical AgricultureUH College of Tropical AgricultureJABSOM Telemedicine Network (and JABSOM Telemedicine Network (and Clinics)Clinics)UH Affiliated ProgramsUH Affiliated Programs

KauaiKauaiKauai Veterans Memorial HospitalKauai Veterans Memorial HospitalSamuel Mahelona Memorial HospitalSamuel Mahelona Memorial Hospital

MauiMauiMaui Memorial Medical CenterMaui Memorial Medical CenterKula HospitalKula HospitalMaui Community CollegeMaui Community CollegeLanai Community HospitalLanai Community Hospital

East HawaiiEast HawaiiHilo Medical CenterHilo Medical CenterKau HospitalKau HospitalHale Ho`ola Hamakua HospitalHale Ho`ola Hamakua Hospital

West HawaiiWest HawaiiKona Community HospitalKona Community HospitalKohala HospitalKohala Hospital

Others Connections…Others Connections…Chubu Hospital, OkinawaChubu Hospital, OkinawaEtc.Etc.

•Tripler Army Medical Center’s (TAMC)

•Pacific Rim Regional Telerehabilitation Program

•The Pacific Area Health Education Centre(AHEC)

•Pacific Association for Clinical Training(PACT)

The University of Guam has established 30 telecentres in the remote islands of the Micronesian region HF radio email system

V. EXPERIENCES AND ISSUES IN ICT HUMAN RESOURCE DEVELOPMENT

Tokai University Medical School

Leading telehealth in Japan and Asia Pacific

2006 – 2008 ICT training in Japan (3 month)Special designed for Pacific Islands Health workers

Pacific ICT AcademyPacific ICT Academy

Partners: ASG, ASCC, Partners: ASG, ASCC, DOI, eCDC, DELTA, DOI, eCDC, DELTA, TIPGTIPG

Accredited, Professional Accredited, Professional Certificates CISCO, Certificates CISCO, Microsoft, OracleMicrosoft, Oracle

Modality: VTC/ Local Modality: VTC/ Local FacilitatorsFacilitators

1-Year Program 1-Year Program Agreements with Agreements with

EmployersEmployers

1. Problem in the access and cost of telecommunication services: need to increase access and lower costs by

i. universal service mechanismsii. accelerate development of ICT strategiesiii. support networks eg. PEACESAT & USPNet

2. Problem – a lack of a regional coordinating body (or bodies) in this arena: improve the linkages between the health, education, and ICT sectors, and the local, regional, and international funding agencies

3. Problem – there is a small number of ICT technical personnel: need to enhance local higher education institutions to provide training

4. Problem – a lack of policies that support the articulation of coursework and the certification of continuing education : need to develop mechanisms for sharing HRH programs among higher education institutions.

Conclusions

Collaboration between Okinawa and Pacific

E-Health for Okinawa (Chubu Hospital)

For 50 remote islands*2 Hospitals: Miyako Island and Yaeyama Islands*19 Clinics

Needs:

To help doctors and nurses who work in remote Is.

Mahalo, Arigatou, ViNaka, Mifaiyu, health professionals and administrators who contributed valuable information and insights regarding HRH development and ICT in the Pacific for this paper

(ed.) Sumiko Ogawa (2000)「 Public Health Nursein Okinawa」 .Educational video. JICA