Jhai & Telemedicine

I must say that hearing Lee Thorn talk about Jhai was very inspiring and exciting especially since rural telemedicine is something I'm quite interested in at the moment. Clearly Jhai, along with its telemedicine partner, Neurosynaptic, is positioned to lead the way in this field and it appears they have figured out how to do it sustainably (at least in terms of financing). That being said, I still struggle with so many of the questions I'm sure everyone is tired of hearing me ask but once again I have to harp on some key issues:

• How do we (and ultimately, should we) transition (both from a behavioral and cultural standpoint) beyond the provision of health care as a social service/public good and is this possible across different regions? Is there a willingness to pay for care in some places - and is this seen as acceptable - that will enable the development of market-based ICT solutions for health care? How do we control or balance the issue of health care as a "right" versus health care as a commodity that can be controlled by price?
  
• Most of the models for telemedicine that curently seem feasible are in Southeast Asia - how do we adapt and scale these models to other regions like sub-Saharan Africa?
• What is the role of the government and institutions like Ministries of Health in the creation and implementation and ongoing deployment of ICT-based health solutions? Is there a clear threshold below which the government should provide basic primary care and above which the market should be responsible for or better able to provide?
• How do we ensure quality and consistency of care with all of these models when we have now agreed upon standards and are still struggling with these issues in the developed world? Should the solutions and the regulations and standards all be developed in tandem? What will we do with all this data and who will own it?
• How do we rebuild broken or non-existent health systems that can use ICT solutions but that vary so substantially in terms of culture, tradition, politics, and economies?
  

Ok, enough with the questions for now. Off to investigate more thing health and technology related.

Thoughts on Neal Lesh's Presentation

I really enjoyed Neal's presentation and am looking forward to speaking with him in more depth when we meet tomorrow morning. He really is a trailblazer in the health ICT4D arena and hearing about his experiences in the field was both informative and inspiring.

Neal's presentation raised a number of questions in my mind - many that have been floating around in there for some time - and I have to admit that while I left the class excited I was also a bit frustrated. The same dilemmas regarding funding, sustainability and impact measurement seem to be incredibly evasive particularly for health-based ICT solutions and this is something I hope we can continue to discuss throughout the course. I continue to remain conflicted as to whether or not basic health care is a "right" to be provided as a social service by a government or public entity (and if so, at what level do we surpass basic care?) or whether the creation of a market opportunity and the subsequent delivery of quality, timely and appropriate care is the route to follow. In terms of technological solutions, the potential to provide scalable quality care seems evident yet the model with which to fund and sustain such technology does not appear to exist. In particular, in relation to Neal's work with EMRs (and based on my previous experience with EMR/EHR/PHR initiatives and development), I would state that the implementation of such technological solutions may be better positioned as a business opportunity in oder to improve the delivery of health and may not fall within the purview of "basic health provision." Therefore, would such solutions benefit from a market-based strategy?