Day Two Afternoon: Tuesday, 23 March 2004

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Plenary Session: Problems in Least Developed Countries

In all too many LDCs, resources are spent to purchase weapons while, at the same time, national leaders claim that there is no money for medicines that prevent malaria or the transmission of the HIV virus from mother to child.

When this malfeasance is combined with other endemic parasitic diseases and unclean water, the result is a healthcare catastrophe. If this were not enough, these societies face the problem of not only having to educate their citizens in the most fundamental aspects of hygiene, but also the far more difficult task of modifying long-standing behavior patterns.

Most of these countries have often only recently emerged from colonial domination and it is troubling to realize that it has been responsibly estimated that the foreign bank deposits of the leaders of African nations since independence exceed the external debt of those countries. These countries are now poorer than they were in 1965. Surely, they have not been helped by commodity price manipulation in the West. It is equally painful to watch the people of a country like Zimbabwe, blessed with abundant agriculture, face famine and starvation because of corrupt political leadership, while neighboring leaders stand by mute.

Time was not available at GMF III to allow for a detailed enumeration and evaluation of the plethora of diverse afflictions from which the citizens of the countries suffer and die. These countries will always be in trouble unless they themselves in cooperation with the developed world make a joint commitment to honestly confront the reasons for their sorrow. The overview tone of this session will point a way towards this joint action.

Round Table 1: How can NGOs leverage multinational companies to improve outcomes in LDCs?

Traditionally, many NGOs have regarded any organization that needed to make a profit as an anathema to the interests of the poor. It is now however clear that one of the best routes forward for the improvement of healthcare in LDCs is public-private partnership directed against specific disease entities. NGOs now recognize their dependence on these partnerships for the near and long terms.

What are some examples of successes in this regard by NGOs? How did these successes come about and what are their remaining obstacles for future success?

Round Table 2: War & Medicine – Whose Responsibility?

How does one build a sustainable healthcare system in a war-ravaged society and whose responsibility is it to do so? The question is generic, but this round table focuses on the programs for healthcare development in Iraq. What is the role of the occupying power? How are the participants selected? How are priorities established? Is there room for NGOs?

While the current and most pressing concern is Iraq, the lessons learned there are applicable to Kosovo, Liberia, the Congo, and unfortunately in the wars to come.

Round Table 3: Improving patient care and safety through Electronic Medical Records

As advances in science and technology are opening new opportunities and, to some extent, making traditional methods of managing information obsolete, the healthcare community has begun to seek alternative tools and approaches to make information accessible to all participants. One way to accomplish this is by developing clinical information systems that electronically capture a patient’s medical interactions from birth throughout their lifecycle. This leads to an electronic medical record (eMR) for each patient – that is, a secure, lifetime record of his or her health history and care that would be available electronically to authorized healthcare providers and the individual anywhere, anytime. Electronic medical record initiatives have been undertaken by public health systems in the U.K., Australia, France and Spain, as well as many other parts of the world.

Electronic medical records are part of broader clinical information systems that incorporate:

• Information and history sharing between health professional enabling better informed diagnosis, drug-drug interaction early detection and faster access to radio or lab results
• Assessment, referral and patient management tools that direct and monitor the flow of patients across providers; order management and care planning tools
• Expert systems supporting physicians in their diagnosis
• Sophisticated data mining tools to research referral and utilization patters, clinical effectiveness and patient safety and adverse events

This Round Table provided a view into several countries’ approaches and experiences in instituting public and private electronic medical records. What constitutes an eMR? Will it be centric to the patient or the physician; national or regional? What are the objectives of deploying an eMR? What are the business cases and models for eMR? What services and processes can complement the eMR? What issues arise around confidentiality, data ownership and legal frameworks? What are success factors for deployment? Will multi-country eMR initiatives emerge?