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USING NEW

TECHNOLOGIES TO
SUPPORT HEALTH
SECURITY
Henning Nassler
Senior Health Systems Specialist

Disclaimer: The views expressed in this paper/presentation are the views of the author
and do no necessarily reflect the views or policies of the Asian Development Bank
(ADB), or its Board of Governors, or the governments they represent. ADB does not
guarantee the accuracy of the data included in this paper/presentation and accepts no
responsibility for any consequence of their use. Terminology used may not necessarily
be consistent with ADB official terms.
HEALTH SECURITY – BIG WORDS,
BIGGER SCOPE
• (Global/Public/Human)“Health Security”: even
key organisations like the UN and WHO cannot
agree on a terminology, much less on a scope.
• A basic consensus is that health security is the
combination of policies, strategies, agendas,
and governance which minimize the
susceptibility of public health to threats”
• Pandemics and emerging infectious diseases
• Bioterrorism
• Malnutrition/Poverty
• But should also include(for example):
• Climate Change and environmental factors
• Commercialisation of health care

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PRIORITY HEALTH SECURITY RISK:
COMMUNICABLE DISEASES - NEW
PROPAGATION TRENDS AND FACTORS (1)
• Increase in urban – rural commuting
• Statistics suggest that between 20 and 30% of rural households in
developing countries in Asia have an “urban commuter”, an income
provider who travels frequently between a rural family home and an
urban workplace.
• As a result, high population areas are more and faster vulnerable to
communicable diseases from remote areas as infectious diseases bypass
traditional hamlet > village > town > city migration paths.

• Affordability and liberation of travel


• Reduction of cost and restrictions from personal travel increase mobility.
Movement in and out of communicable disease “hotspots” (i.e. religious
festivals, sporting events) has increased.

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COMMUNICABLE DISEASE: NEW
PROPAGATION TRENDS AND FACTORS (2)

• The biggest impact on


communicable disease patterns in
developing country is economic
cross border traffic
• For example, in Vietnam an
estimated 100.000 people regularly
cross the Vietnamese – Chinese
Border and another 20.000 to 25.000
Vietnamese are (illegally) employed
in Chinese Enterprises along the
1.400km stretch of the border.

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GAPS IN “TRADITIONAL” COMMUNICABLE
DISEASE MONITORING
Existing communicable disease monitoring systems in developing
countries are either:

A. Selective, monitor/document a very small and specific


subset of diseases (event driven implementation)

B. Part of a larger set of routine healthcare data monitoring,


unresponsive and with a very large delay between incident
occurrence and incident notification

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“NEW” TECHNOLOGY IMPACT IN DMC
• Single most relevant
technological enabler in DMCs
is the expansion of the mobile
network infrastructure
• Mobile network operators have
a financial incentive to make
mobile technology available
even in poor and
disadvantaged areas
• Coverage now between 60% to
99% in all DMCs

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UTILIZING NEW TECHNOLOGIES
• Due to extensive mobile network coverage in even rural,
remote and underdeveloped regions: low-bandwidth internet
tools finally feasible
• If certain ground rules are observed it is now possible to implement web-
based data collection points at any permanent population area

• Mobile networks “built-in” data transmission via SMS (Short


Messaging System) an often overlooked healthcare monitoring
enabler
• “mHealth” (using mobile technology in the healthcare sector)
is gaining increased traction both in healthcare organisations
and the private sector

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CASE REVIEW: VAHIP VIETNAM
Avian and Human Influenza Control
and Preparedness Project (VAHIP)

2009 - ongoing

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AVIAN AND HUMAN INFLUENZA CONTROL
AND PREPAREDNESS PROJECT (VAHIP)
• In 2003, H5N1 (Avian Influenza) spread to 57 of Vietnam’s
Provinces, resulting in the ultimate loss of about 20% of the
country’s poultry production in that year. The economic toll is
estimated to have been 0.5% of the national GDP ($250
Million)
• The highly pathogenic nature of H5N1 and the rapid
occurrence at least 15 confirmed human deaths from the virus
in 2003/2004 in Vietnam prompted a number of
communicable disease management initiatives.
• VAHIP was established by in cooperation with the Ministry of
Agriculture and the Ministry of Health and co-financed by
World Bank, ADB and other donor/health organisations.

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VAHIP’S CHARACTERISTICS AND
APPROACH TO COMMUNICABLE DISEASE
MANAGEMENT
• Highly de-centralised approach and community-centred
initiatives
• Dubbed as a “One Health approach”, VAHIP’s initial agenda
was to primarily monitor and prevent further H5N1 outbreaks in
poultry livestock which subsequently expanded into health
sector measures, addressing a wider field of communicable
disease management issues
• Medical, Laboratory and Vehicle Equipment for CD management
• Equipment, Policies and Training for Outbreak Management
• Capacity Building and Competency Building Measures
• Vaccines
• Improved communicable disease reporting and monitoring procedures

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COMMUNICABLE DISEASE MONITORING &
SURVEILLANCE PLATFORM (VIETNAM)
• Financed by ADB as part of the initiative to expand VAHIPs
agenda and infrastructure into general communicable
disease management.
• Developed and implemented in 2010-2011
• Mission: Develop and implement a web-based communicable
disease monitoring system to be implemented and used in
community health centres.
• Implemented and training provided in approx. 100 community
clinics in Thai Binh Province (est. 230.000 pop) before handing
over to PEA

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VAHIP WEB-BASED MONITORING TOOL

• Table-based entry,
non-personalised
• Highly customizable
reporting
• Exporting to
DOC/PDF/XML
• ICD-10 based disease
selection

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VAHIP WEB-BASED MONITORING TOOL

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VAHIP WEB-BASED MONITORING TOOL

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VAHIP WEB-BASED MONITORING TOOL

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VAHIP WEB-BASED MONITORING TOOL
– GEO MONITORING

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VAHIP’S SUCCESS – AND ITS DEFICITS
• The VAHIP initiative can be considered a success, at least in
terms of H5N1 containment and management. However,
some factors need to be taken into consideration:
• In the agricultural area, the implementation through the local
counterparts was very much motivated by a strong economic incentive.
• The success of containing H5N1 outbreaks in Vietnam is largely based on
the implementation and strict adherence to vaccination policies, less on
the success of monitoring and reporting measures.
• The decentralized approach worked well in the self-contained and self-
managed agricultural communities (from a poultry perspective) but
makes an effective approach to human communicable disease
management difficult.

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LESSONS LEARNED (1)
• Communicable disease management measures are often
implemented in their immediate impact sphere but the
dissemination of data through the health sector network is
often unclear and the utilization of data neglected:
• Devaluation of data collected
• Loss of “sense of purpose”

• With focus on the immediate impact sphere there is also a risk


that the central health sector bodies are not sufficiently
committed to include communicable disease management
into a national agenda:
• Lack of sustainability measures and improvement actions

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LESSONS LEARNED (2)
• Communicable disease monitoring and reporting often adds
additional workload to already overworked and undertrained
staff:
• Risk of multi-reporting and overlapping initiatives
• Lack of feedback from central authorities (see before) demotivates

• Communicable disease monitoring and reporting measures


are sometimes implemented without insuring that resources
and capacities to actually identify a communicable disease
are in place:
• Over/Under and miss-reporting of communicable diseases

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ALTERNATIVE MONITORING CONCEPTS
• Crowdsourcing:
• Social Media can in theory be utilized to monitor and analyse potential
health security threats
• Search query based anaysis can (again: theoretically) identify
communicable disease outbreaks

• Due to advances in computational technology and medical


sciences, Infectious Diseases Modeling is becoming more
accurate
• metapopulation models
• Agent-based modelling

• Problem: Not DMC friendly

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FROM SELECTIVE TO UNIVERSAL DATA
MANAGEMENT: DHIS2 ET AL
• Platforms like DHIS2 can target selected healthcare areas but
also provide tools to comprehensively collect, visualize and
analyze the entirety of healthcare data
• Initially an aggregation tool, now starting to move from
combined data to transactional data (case-based and
potentially personalized)
• Focus on mobile and agile data entry tools
• Free (!) - but use this argument carefully

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PROBLEM AREA: DATA MAINTENANCE
AND ANALYSIS
• Data collection initiatives are implemented without
appropriate capacity building at the back end
• Financial benefit of healthcare data management difficult to
outline or demonstrate.
• Data maintenance (=sustainability) becomes neglected once
the implementation drivers leave
• Cost sometimes underestimated

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"TAKE AWAY" - CONCLUSION:
healthcare data collection and Capacity
Building
reporting requires a strong
anchorage in the health sector
framework and substantial Commitment
commitment from policy makers and and Ownership

healthcare governing bodies.

Selective and isolated healthcare


reporting will lead to unrecoverable
Clear Policies
gaps between risk manifestation, risk
identification and risk mitigation

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QUESTIONS TO ASK:
• How to incentivize DMCs to adopt a comprehensive
healthcare data management?
• How to show the long term financial benefits?
• How to build the capacities not only to manage the data
collection but also the data analysis?

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