Telemedicine in Maldives
Regional Consultation on Telemedicine: Sharing Experience and a way forward
by: Dr. Mohamed Ali
Dr. Nusaiba Farouk Hassan
OverviewDemographyEvolution of E-Health and TelemedicineCurrent Scenario
Strategic DirectionInnovations and applications of eHealth and
telemedicineStrengthWeaknessOpportunityThreatsThe way forward
DemographyAn archipelago: 1192 IslandsInhabited: 200 islandsPopulation: 360,000 Distribution:
Largest: Over 100,000 in Male’ CityArea: 90,000 sq km ( sea)Ethinicity - Asian
Background In constitution: The right of every citizen to
access good quality health services is protected.
The Government: Constitutionally mandated to realize this right for all.Guiding Principles;
Recognizing Health as a human right and its universality
Ensuring equitable access to affordable, quality health services based on primary health care approach
Harnessing solidarity for health in all national policies
Ensuring policy development based on facts and scientific evidence
Vision for Health: Improving the quality and affordability of
health care with a focus on access for all. Goal for E- Health:
Providing standardized high quality medical services, by using interoperable, compatible, reliable, and scalable E-Health solutions such as telemedicine, HIMS, whereby all residents of Maldives have equal access medical expertise available in the Maldives as well as internal medical care institutes.
Strengths:ICT is one of the fastest growing areas in
HealthExisting institution based programmes /
databases National ID Nos are being entered to
independent systems, which can be used as a unique patient identifier
Large potential for M-Health; extensive use of mobile phones and related devices
Major Healthcare initiatives in place:
Online Nutrition and Child Health Surveillance System (ONCHSS)
SEARO Integrated Data Analysis System (SIDAS)
Hospital Information System (HIS)E-Government Portal for online birth and
death registrationNeonatal/Perinatal Database
E – Health ObjectivesEstablish an integrated health information
SystemImprove access and quality of health care
given to general public using E-HealthStrengthen the capacity to monitor health
indicators and conduct system reviews in a timely manner
Facilitate efficient emergency or disaster management and timely decision making in health emergency situations
Specific Strategies Establishment of a governance structure to deliver the E-
Health StrategyUnique citizen identifiers for a common health services and
health insurance Implementing TelemedicineAvailability of needed health information at a national level in a
timely manner Implement consumables management information systemBegin introduction of more clinical information systems and
EPRsExpand use of M-Health Invest in computing infrastructureAccess to broad-band servicesAdequate communication of E-Health strategies
Current Investments, goals and plans:
Patient centered information systemsElectronic Health Record SystemsTelemedicineInformation DatabasesPreventive Health Services using Mobiles
Telemedicine in MaldivesVision: Provide a telemedicine solution to
Maldives which is compatible, scalable, reliable and inter-operable. The objective is to upgrade the quality of health care and minimize the cost of medical care through effective acquisition of relevant clinical information at remote sites. And also to ensure that all residents of Maldives have equal access to high quality health services regardless of their location.
Telemedicine in Maldives• Objective: • Enable people in islands to use tele-consultation and
avoid travel and support continuing medical education:
• Implemented in II Phases
• Aiding agencies• Integrated Human Development Project; World Bank• Khalifa Bin Al Nahyan Foundation; Abu Dhabi
Implementation:• Phase I: Integrated Human Development Project;
World Bank Telemedicine: 4 Main hubs connected on 5th May
2010 Indhira Gandhi Memorial Hospital – Central Kulhudhufushi Regional Hospital - North Thinadhoo Regional Hospital – South B. Eydhafushi Hospital
Phase II34 New Centres joined Telemedicine Network
under Khalifa Bin Zayed Al Nahyan Foundation; Abu Dhabi: 20th November 2011
Two componentsTelemedicine Kiosk and EquipmentTraining Component
70 Nurses 10 Specialists; Biomedical Engineers, Obstetrician
Gynaecologists, Paediatricians, Surgeon and Physicians
4 Referral Hospital and 34 Remote pointsHdh. Kulhudhufushi Regional HospitalIndira GandI Memorail HospitalGdh. Thinadhoo Regional Hospital S. Hithadhoo Regional Hospital
Current SituationSporadic CasesNo designated personnel Trained staff unavailable to provide serviceInsufficient attention to Telemedicine due to
inadequate number of Clinicians at referral centersExpensive equipment under lock and KeyNo existing referral systemUse of M-Health; applications like what’s ap for
case discussion by Clinicians
AIM: Strengthening of existing services
Map I
Innovations and Applications of E- Health / Telemedicine
Tele-Education Department of Child Health, IGMH and AIIMS, New Delhi Dengue Season 2011; CMEs in all 4 Centres Staff at Thinadhoo Regional Hospital had participated in
the Workshop on Management of Dengue Cases conducted in association with WHO and QSNICH via tele-education 2011
Telemedicine Potentional for development
Dermatology Pathology Radiology Orthopaedics General Medicine /Paediatrics
StrengthsHigh Priority Project for Ministry of Health
and FamilyHealth workers at remote points are
motivated to learn and maximize use of Telemedicine
Clinicians at the Referral Centers are committed to attend to cases
Human Resource Development
Weaknesses Central
Lack of an Alert System Unaware of the enhanced equipment availability Remote points Inadequate number of Clinician to attend to inpatient and outpatient facilities, hence
telemedicine is not made a priority No designated personnel / infrastructure 1:38 Ratio of telemedicine carts; central: peripheries
Peripheral High turn over of trained staff Nurses trained under Telemedicine project refuse to go back to the island Inadequate infrastructure and power supply at HC to support equipment Unavailability of Medications and Basic investigations
Common Telemedicine Network has not been integrated with the Hospital Networks No networking between focal points Lack of awareness among doctors about Telemedicine License for teleconferencing has to be purchased; hindrance for tele-education Lack of awareness among clinical staff and management at the hospitals Lack of telemedicine trained specialists Referral centers do not have telemedicine links with Regional Centres abroad
OpportunitySAARC Telemedicine ProjectCollarboration with Regional Centres;
AIIMSReduce expenditure on Health insurance
referrals to male’ and abroad.Gain the confidence of the public in the
health sector
ThreatsRemote island losing hope due to failure to
attend to cases promptlyLack of maintenance of equipment may lead
to loss of equipment performanceReferral centres do no have the necessary
consultants
Way Forward Encourage doctors to utilize telemedicine To integrate M-health in to the telemedicine system officially To train the personnel responsible for the telemedicine and assign roles To assign personnel to manage the telemedicine equipments and to give
responsibility of maintaining them To assign login responsibilities to the individual doctors, rather than the institute To include teleconsultation in the duty roster To assign CME points in return to the tele-consultation hours spent To give bonus salary for the cases spent on tele-consultation To give preference to tele-radiology To provide basic equipments to the remote kiosks, like USG machines, ECG
machines and X-ray machines and maintain the supply to the basic laboratory investigations
Assign budget for telemedicine WHO and other NGO’s support to implement these services and to train personnel In assigning the login responsibilities, the MOH should assign license to tele-
medicine Include tele-consultation in National Insurances’ (ASANDA) patient evacuation
system, to minimize the cost of improper referral and improper referral diagnosis thus reducing cost of referral system.
ConclusionTelemedicine is a great promise to Maldivians
to achieve better healthcare without having to travel by highs seas to the nearest referral centre, and then inevitably to the capital.
Telemedicine is the alternative route to achieving the best possible treatment rather than referring abroad for issues which can be resolved within the country, hence better utilization of resources.
Thank You!