Panelists

• Moderator: Dr. Kgosi Letlape, President of the South African Medical Association
• Mr. Bill Souders, Cisco Systems, Program Director, NEPAD e-Schools Initiative
• Dr. Pamela Johnson, Co-Founder and Executive VP, Voxiva
• Mr. Peter Mehlape, General Manager, BD Southern Africa
• Dr. Donald DeKorte, Director of HIV/AIDS Access Program, MSD

Summary

Mr. Souders: Mr. Souders gave a brief overview of NEPAD’s E-learning program and described the initiative’s focus on developing appropriate solutions to address healthcare needs using information and communications technology. He also emphasized the importance of addressing healthcare needs in the context of other country issues such as poverty. The NEPAD initiative has three areas of focus:
1. Localizing health knowledge through the use of online access, hand held devices and cell phones.
2. Enable the delivery of health information
3. Extend access to telemedicine

Ms. Johnson: Ms. Johnson reminded the audience that Africa has the fastest growing telecommunications network in the world: the market grows by one million new cell phones per day. She emphasized that development partners should leverage the massive investments that have already been made in IT infrastructure to address health concerns on the continent in a sustainable fashion. Voxiva started its work by using cell phones to capture disease surveillance information in Peru. Recently, Voxiva began working in Rwanda with the National AIDS Commission to strengthen disease surveillance efforts in order to increase the number of people on treatment. A partnership was soon developed, Phones for Health, that brought together Voxiva, CDC, a local cell phone company (MTN), Motorola, the Accenture Development Partnership, PEPFAR and GSMN to leverage existing infrastructure to address healthcare needs in Rwanda. The partners plan to expand the initiative to ten countries over the next ten years.

Mr. Mehlape: Mr. Mehlape described BD’s involvement in the following four programs:
1) A partnership with PEPFAR in 10 African countries over five years to improve hospital laboratories
2) A Foundation for New and Innovative Programs, which includes a program for TB liquid culture diagnosis and treatment accessibility
3) A volunteer program that uses the expertise of company employees to address the healthcare needs of the countries in which BD works
4) A partnership with International Counsel of Nurses to develop a wellness center in Swaziland, a bottom-up project based on real needs and real goals

Dr. DeKorte: MSD feels they cannot supply medical products without addressing the health demands in Africa that necessitate those products. The company looks at HIV/AIDS but also cervical cancer and other diseases. MSD is focused on HIV/AIDS workplace policies because less than 3% of firms in Africa have such plans in place. MSD was attracted to the idea of a simple toolkit for implementing workplace health policies and felt such a blueprint could go a long way. The tool they came up with was created by a group of experts in Africa and generates a presentation of a cost benefit analysis showing the financial implications of initiating an HIV/AIDS policy that can be communicated to management.

Dr. Letlape: How do these private sector initiatives lead to sustainable results and fit into the national picture?

Mr. Souders: Governments are not the most dependable source of propagating health sector technologies into communities; the private sector is able to fill this gap at an affordable price.

Ms. Johnson: The key is real-time monitoring: identifying resource shortages and surpluses and redistributing accordingly. In terms of sustainability, having an national information technology-driven health system in place provides a critical foundation. In Rwanda’s case, the system that has been established is the official governmental system that is used throughout the country.

Question from Dr. Letlape: How do we deal with the fact that HIV/AIDS treatments are cutting-edge and well-funded while treatments for others diseases are outdated and often suffer from lack of funding?

Mr. Mehlape: Health sector instruments and services are becoming a museum. Mr. Mehlape characterized the health sector as a group of ATM machines that must be serviced and refilled constantly.

A discussion ensued during which participants debated the need for governments to lead the way in pushing for updated health guidelines vs. the private sector taking responsibility for making sure that health guidelines are kept current.

Dr. DeKorte: Dr. DeKorte refers to a piece in The Journal on Foreign Affairs, Do No Harm, which argues that vertical systems for HIV/AIDS actually work to the detriment of the health system because innovation in other areas is stifled.

Ms. Johnson: You can’t build an effective health system by only addressing HIV/AIDS

Comment from a Representative from Motorola/SA: There are other new communication technologies outside of cell phones that need attention. The Limpopo Hospital uses a video-conferencing technology where a doctor in the city can “guide” a nurse as she works with a patient at a rural clinic. A microphone and a small camera allows the doctor to see and hear what is happening and instruct accordingly. Motorola is also looking at a remote “whiteboard” technology for virtual education including medical education.

Comments from Dr. Letlape: HIV/AIDS guidelines must be a societal endeavor. HIV/AIDS money needs to be used for building the system.

It is important to understand the limitations of virtual medical communications. Reminders to take medication are appropriate whereas medical counseling may not be. Technology should not be viewed as an alternative healthcare system that can replace the need to build the human capacity of healthcare workers, but instead as a supplement to assist the healthcare workers in the field. So that brings up the question: how can we increase the capacity of healthcare workers?

The ensuing discussion from the audience covered the following issues:
· Technology is essential to fill the gap of a fractured health care system to ensure a reasonable standard of health care is delivered.
· While capacity building for healthcare workers in the developing world needs to be discussed, hopefully the entry point to solve this important issues is a long overdue high level discussion with the developed country governments who attract skilled health workers to come to service their respective communities . Perhaps a compensation model needs to be developed and implemented for the ongoing ' brain drain' crisis.