1. APPLICATION OF TECHNOLOGY IN HEALTHCARE
A MODEL FOR RESPONSE TO HEALTH CRISIS IN DEVELOPING
COUNTRIES
Ernest C. Madu, MD, FACC, FRCP (Edin)
Professor of Cardiovascular Medicine and Imaging Technology
University of Technology, Kingston, Jamaica
Chairman and CEO, Heart Institute of the Caribbean, Kingston, Jamaica
Washington DC, USA, April 2012

2. 
Noncommunicable diseases in developing countries are a
major public health and socio-economic problem
The major challenge to development in
the 21st century
Source: WHO

3. Total deaths around the world:
58 million
Deaths from noncommunicable
diseases around the world:
35 million
Deaths from noncommunicable
diseases in developing
countries:
28 million
Deaths from noncommunicable
diseases in developing
countries which could have
been prevented: an estimated
14 million
Source: WHO

4. Noncommunicable Diseases
Projected Deaths in 2015 and 2030
30
Intentional injuries
Other unintentional
25
Road traffic accidents
Deaths (millions)
Other NCD
20
Cancers
15
10 CVD
Mat//peri/nutritional
5
Other infectious
HIV, TB, malaria
0
2004 2015 2030 2004 2015 2030 2004 2015 2030
High income Middle income Low income
Source: WHO

5. Noncommunicable Diseases
Death trends (2006-2015)
2005 2006-2015 (cumulative)
Geographical Total NCD NCD Trend: Death
Trend: Death
regions (WHO deaths deaths deaths from infectious
(WHO Chronic Disease Report, 2005)
from NCD
classification) (millions) (millions) (millions) disease
Africa 10.8 2.5 28 +6% +27%
Americas 6.2 4.8 53 -8% +17%
Eastern
4.3 2.2 25 -10% +25%
Mediterranean
Europe 9.8 8.5 88 +7% +4%
South-East Asia 14.7 8.0 89 -16% +21%
Western Pacific 12.4 9.7 105 +1 +20%
Total 58.2 35.7 388 -3% +17%
WHO projects that over the next 10 years, the largest increase in deaths
from cardiovascular disease, cancer, respiratory disease and diabetes will
occur in developing countries.
Source: WHO

6. Noncommunicable Diseases
Macro-economic Impact: Lost National Income
Lost national income from
premature deaths due to heart 2005 2006-2015 (cumulative)
(WHO Chronic Disease Report, 2005)
disease, stroke and diabetes
Lost national income Lost national income
Countries
((billions ((billions
Brazil 3 49
China 18 558
India 9 237
Nigeria 0.4 8
Pakistan 1 31
Russian Federation 11 303
Tanzania 0.1 3
WHO: "Heart disease, stroke and diabetes alone are estimated to reduce
GDP between 1 to 5% per year in developing countries experiencing rapid
economic growth"
Source: WHO

7. Progress Is Not Uniform
• Gaps in health between the rich and poor are as wide as
they were half a century ago and are becoming wider still
• Between 1975 and 1995, 16 countries with a combined
population of 300 million experienced a decline in life
expectancy
• By the year 2025, while life expectancy at birth in 26
countries will be above 80 years, in many low resource
countries it will be less than 55 years
• Even more experienced a decline in DALE

9. A New Approach Needed
• the worsening indices of health status in
developing countries demand a fresh look
at the way health systems are organized

10. Donors are not responding to requests for
technical assistance
* ODA = Official Development Assistance provided by 24 OECD/DAC donor countries, as well as the EC
Official Development Assistance for Health
(2006, in US$ Billions, total is US$21 billion)
STD & HIV/AIDS Control $4.75
Infectious Disease Control $2.10
Health Policy/Management $1.93
Basic Health Care $1.80
Reproductive Health Care $1.30
Basic Health Infrastructure $0.70
Medical Research $0.60
Medical Services $0.20
Family Planning $0.20
Basic Nutrition $0.10
Health Training $0.08
Health Education $0.00
Water supply/sanitation-large systems $2.70
Water Policy/Management $2.00
Basic drinking water supply & sanitation $1.00
River development $0.30
Waste management/disposal $0.20
Water resources protection $0.10
Water Education/Training $0.00

11. Health and Foreign Policy
Source: http://www.economist.com/printerfriendly.cfm?story_ID=693193

12. Shift from Foreign Aid to Sustainable
Development
Source: http://www.economist.com/printerfriendly.cfm?story_ID=693193

13. The Technological Lag
Advances in technology not applied to healthcare delivery in low
resource nations
– Low public awareness of appropriate technology options (demand drives
supply)
– absence of appropriate technology transfer and access to technological
advances
– Lack of infrastructure and expertise in new technological advances
– Deficit in capacity building
– High cost of capital and limited organized private sector involvement in
healthcare service
– Absence of favorable policies to support and attract investment in
healthcare and mitigate against the risk

14. Misconceptions about Technology in
Healthcare
Myth Reality
– Increase healthcare cost – Technology improves healthcare
– Cost-effective/improves access
– Widens inequalities
– Improves workflow efficiency
– Reduces access – Improves patient information
management
– Does not improve quality of
care – Improves reliability and patient
safety
– Unaffordable – Opportunity to extend quality care
to rural settings
– Only fit for the western world
– Expand the reach of limited
expertise
– TOO GOOD FOR THE DEVELOPING
WORLD – Saves lives……..improves
QOL….makes life better

15. Intervention Through Appropriate Technology Transfer
adapted from Chris Madu et. al
Factors
Determined
by the Country
Aquisition Factors
Identif y & Implement
Appropriate Technology
Stable
Capabilities Gov ernment &
Political Sy stem
Ef f ectiv e
Needs & Objectiv es Success of Technology Transf ers
Management
Structural Factors Educate & Train
(Culture Value
Sy stem)
R&D
Inf rastructure Resources
Figure 1. Critical Factors for Successful Technology Transfer
Madu CN: Long Range Planning, Vol 22(4), 115-24, 1989

16. Case Studies
• HIC
• DOCS
• EMS

17. OUR MODEL
HEART INSTITUTE OF THE CARIBBEAN

18. Our Model
• Smart, efficient and cost effective use of
appropriate technology anchored on
knowledge and expertise.
• Leveraging advances in technology to improve
access, quality and affordability
• Focus on training, research, development and
innovation

19. Our Model: Niche Focus and Delivery
• Organization and Strong Management Team
• Capital Formation and Access
• Shift from Aid to Sustainable Development
• Specialization and Economies of Scale
• Innovative Use of Technology
• Strategic Partnerships
• Internal Capacity Development
• Evolving Vision and Direction

20. Jamaica 2005
• Population; 3 million
• #1 Cause of Death and Disability: CVD
• Access to CVD Care limited
– No Cardiac Center of Excellence
– Few Cardiologists with limited availability
– Waiting time for Stress Test 3-6 months
– Waiting Time for Echocardiograms 3-6 months

21. • The HIC Solution

22. Our Model: Making Technology
Work
• Technology applications relevant to low resource
economies
• Sustainable international partnerships rather than the
current “dumping ground” approach
• Global Telemedical services to expand access to health
care.
• Cost effective and clever use of health care resources
• Specialization and “niche” positioning for more efficient
service delivery
• Creating value at competitive price
• Private-Public Sector Partnerships

23. Improving Healthcare
through Telemedicine
• Implementation of web based image management portal
and electronic medical reporting
• Training of CV Techs for diagnostic studies
• Engagement of Telecardiologists in different countries
• Web based interpretation of cardiovascular diagnostic
studies to improve access and outcomes
• Rapid turn around time with improvement in healthcare
• Cost-effective
• Opportunity to extend quality care to rural settings
• Expand the reach of limited expertise

25. Universal Access to Medical Expertise

26. Universal Access
to Patient Information
and
Reporting
Just a click away

27. Impact of Technology in Healthcare
Jamaica 2005 Jamaica 2012
– Echo waiting time: 3-6 months – Echo waiting time; Same Day
– ETT waiting time: 3-6 months. – ETT waiting time: Same Day
– Cardiology Consultation: 2-3 – Cardiology Consultation: Same Day
months
– Reduced healthcare cost
– Increased healthcare cost
– Equality of care and expertise
– Wide inequality in care
– Open access to many
– Reduced access to many
– Opportunity to extend quality care
– Limited access to quality care widely and to rural settings
– Improved Quality of Life

28. NIGERIA 2012
PROBLEM SOLUTION
– Limited access to timely – Open access through 24
healthcare or reliable hour medical hotline
health information (DOCS)
– Limited access to – DOCS Telemedicine Clinics
Specialist Opinion
– Introduce EMS service run
– Absence of emergency by medical professionals
medical response
system

29. Looking to the Future
Electronic and Mobile Health
Platforms
Universal Access to Medical Advice
and Healthcare Information

30. Launching July 2012
• Access to Doctors 24/7 from anywhere
• Medical advice, drug information, clinic and
hospital information
• Internationally approved protocols
• Aimed at improving access and reducing cost of
accessing healthcare
– Physician and hospital visits
– Transportation costs and Forgone earnings
• Earlier intervention = better outcomes
• Invaluable “peace of mind” 24/7

31. DOCS Nigeria Medical Hotlines
• Innovative healthcare delivery model aimed at
improving access
– Will make widespread infrastructure accessible at low cost
– Leverage 60-90 million unique mobile phone accounts to disseminate
healthcare services
– Circumvents lacking infrastructure
– Improves quality of care and will yield better outcomes
– Will drastically reduce overall cost of healthcare by delivering accurate
information at the right time
– Reduction in healthcare spending and productivity loss

32. Real World Examples – Call Analysis
Telehealth Service Ontario, Canada
• Data collected demonstrates that 43% of healthcare inquires can
be resolved by self-administered care
• 35% resulted in the need for physician consultation
• An even smaller 16% resulted in the need for emergency care

33. DOCS TELEMEDICINE CLINICS
• Real Time Audiovisual
Telemedicine
• Direct connection to US
based Specialists
• Virtual diagnosis and
treatment
• VOIP based solution
• Flexible access from
smart phones, tablets
and laptops

34. • “an emergency medical service - contains 3 words
that are critical;
1. It must be available and accessible in emergencies.
2. It must be led by medical professionals.
3. It must be a service - integrated from the point of
patient collection, to the nearest hospital with all the
emergency care facilities i.e a fully functional surgical
theatre”
– Source; http://www.nigeriahealthwatch.com/
• March 13, 2012

35. • “So far in 2012, 52 years after independence there
is no functional "Emergency Medical Service" in
Nigeria. Terms like ‘The Golden Hour’ and the
‘Platinum Ten Minutes’ that define Emergency
Medical Services all over the world are practically
irrelevant in Nigeria. EMS is an essential part of
the overall healthcare system as it saves lives by
providing care immediately”.
– Source: http://www.nigeriahealthwatch.com/
• March 13, 2012

37. • Launching in Enugu, Nigeria, July 2012
• Will be readily and widely available and accessible at minimal
cost
• Led by experienced medical professionals with experience in
emergency medicine
• Fully equipped EMS vehicles and trained personnel to
respond to emergencies
• Will be integrated with key participating hospitals in Enugu
• Model will be replicated in other cities nationwide

38. DOCS EMS PHONES

39. SUSTAINABLE SOLUTIONS
• Anticipate, adapt and respond
• Develop cost effective multidimensional
technology transfer policy and action plan
• Build and maintain relevant infrastructure
• Build internal capacity
• Open up access to capital
• Bridge socio-economic inequalities
• Embrace new and emerging technology
solutions

40. Take Home
• Good healthcare is possible everywhere
• The Developing World can and should
leapfrog using advances in technology