Country Programme on e-Health and m-Health

Introduction

Information, communication and technology (ICT) infrastructure is the backbone of any functioning Universal Health Coverage (UHC) monitoring system. Use of e-Health and m-Health plays important role in achieving UHC.

With vast land area, Mongolia faces challenges in delivering health services to its citizens especially those living in rural areas. In response, the government of Mongolia started to implement the E-Mongolia Programme to provide population with access to internet and other information technology by reducing price of computers and internet connection fees and expanding access to fibre optic internet connectivity in countryside. The Programme aims to use ICT and develop it in health sector as a patient-centered service regardless of time or location. As a result, almost all sub-province or soum centres have been connected with fibre optics. The Government has planned to establish an “integrated electronic database system of medical records” through implementation of the World Bank and the Chinese Government-supported projects. The Asian Development Bank, Governments of Luxembourg, Switzerland and WHO have provided financial and technical support to the Government of Mongolia for implementing the National e-Health Strategy and establishment of telemedicine between Ulaanbaatar city tertiary hospitals and provinces’ (aimag’s) health departments and hospitals.

However, e-health investments have been fragmented, thus preventing from achieving a full potential in improving efficiency and quality of service delivery. Information systems in Mongolia have no integrated platform or standards and use different programmes such as H-info, Monthly Reporting System, TUBIS, Flunet, Medsoft, E-hospital, EPI programme and STI system. Moreover, the human resources capacity for coordinating different projects and soft-wares and efficiently using telemedicine and data analysis is limited. Health sector lacks a robust Enterprise Architecture (EA).

Major activities since 2013

Technical and financial assistance on developing the next generation of the National e-health Strategy and Health Enterprise Architecture

A rapid assessment of the National e-Health Strategy indicators was done with support of a WHO consultant. The assessment is used as a basis for the next strategy draft. The WHO-ITU National e-Health Strategy Toolkit was used as a framework for the overall structure of the document developed by the Ministry of Health and Sports.

Since the National Information Technology Council chose TOGAF EA framework for the National enterprise architecture activity, the TOGAF was reviewed by the WHO consultant in collaboration with stakeholders. TOGAF was considered the best fit for Mongolia. Thus a TOGAF workshop and certification training was conducted in 2013 and the “Archimate”, an enterprise architecture modelling language workshop and certification training was conducted in 2014. Participants from the Ministry of Health, the Information, Technology, Post and Telecommunications Agency and other stakeholders attended the trainings. The participants collaborated on drafting a roadmap of activities to bring the EA efforts of the Ministry to the next level. Representatives from the Ministry of Health and Sports, Ulaanbaatar City Health Department and other stakeholders have attended Asia e-Health Information Network meetings in 2013, 2014 and 2015 and learned from experiences in other countries. In addition, an executive seminar for decision makers on e-health EA was organized.

Introduction of District Health Information System 2 (DHIS 2) at selected subnational health system strengthening sites (Umnugobi aimag and Songinokhaikhan district)

MOHS and WHO Country Office take lead in strengthening the health systems in Songinokhairkhan (SKH) district and in Umnugobi (UG) aimag. One of the priority areas of the medium-term strategic plan for health system strengthening in UG province and SKH district is to strengthen health information systems. In order to support this objective, DHIS 2 is being introduced to these selected sites. The DHIS 2 is a web-based health information systems platform, designed to serve as a district-based country data warehouse to address both local and national needs. It supports use of information in decision-making at all levels of health care.

In May 2015, a team of WHO consultants including regional office team leader conducted a joint mission to look into UG aimag and SKH district feasibility and readiness for setting up the DHIS-2 as the web-based reporting tool for creating dashboards for policy and decision makers and other users. The team conducted a workshop at national and local levels with practical sessions. In order to start the DHIS-2 piloting in SKH district and UG aimag, a national team consisting of the MOHS, National Centre for Health Development, SKH district and UG aimag and the National Centre for Communicable Diseases staff were trained in Health Information Systems Program (HISP) at the DHIS academy in Vietnam. After this training, a technical support was provided to UG aimag and SKH district to strengthen capacity of users and operators of the DHIS-2. Various technical meetings were conducted to discuss how to start piloting in UG and SKH and what is the role of stakeholders at national level including the MOHS, the Centre for Health Development and the National Centre for Communicable Diseases. A roadmap is being developed.

Establishment of the E-Learning Centre, development of interactive training materials and use of telemedicine centers for distance learning

WHO supported establishment of an up-to-date E-Learning Centre at the Mongolian National University of Medical Sciences (MNUMS) with high-tech connection to three regional branches of the MNUMS in Darkhan-Uul, Dornogobi and Gobi-Altai aimags. The Centre was launched on 1 December 2015. At the same time, using excellent fibre optic connectivity in Mongolia WHO has supported production of interactive and distance and self-learning video training programmes for health care staff and health promotion materials for general public. The E-Learning Centre will also be used for vocational trainings of doctors, nurses and health professionals from aimags and soums. The university will offer pre-graduation and post-graduation trainings and practical classes via the E-Learning Centre using its high-tech facilities with excellent image and sound features.

Telemedicine centre at the Centre for Health Development (CHD) is used for distance learning trainings and conducting tele-conferences. Most recently, tele-trainings on antimicrobial resistance were organized for the aimag health professionals in November 2015 using telemedicine facility at the CHD. All together 290 professionals from 15 aimags such as members of drug treatment committees, laboratory doctors and hospital pharmacists attended.

Introducing m-health technology at the primary health care and community level

Mobile health is defined as a medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants and other wireless equipment. In the global and local market, health-care and technology companies are introducing sophisticated mobile health applications and a range of products such as monitoring devices and wearable sensors. The well-developed fibre optic connections in Mongolia create good opportunities for the health sector to use m-health technologies to reach remote populations and improve access to primary health care. Therefore, WHO is supporting the government of Mongolia to introduce m-health at the primary health care and community levels. In 2016 WHO is planning to pilot a Wi-Fi ready portable technology such as android blood pressure monitoring, portable electrocardiography (ECG) and ultrasound equipment along with ICT functionalities, data storage, retrieval and utilization for screening, diagnosis and management of chronic non-communicable diseases as well as antenatal care at the selected soum and family health centres including baghs (sub-soums) in selected aimags and remote districts of Ulaanbaatar city.

Way forward: expansion in 2016 and beyond

To ensure the sustainability of WHO support in strengthening e-health and m-health towards UHC, WHO will:

• mobilize more resources to support m-health to reach remote populations and improve screening and preventive services;
• pilot DHIS 2 in UG aimag and SKH district. Expand and roll-out DHIS 2 implementation to other aimags and leverage onto the national level based on results of pilot projects;
• continue technical support in building and strengthening capacity at national and subnational level;
• continue building up on present partnerships and engaging stakeholders into coordination of various initiatives.