Article

Can ICTs Contribute to the Efficiency and Provide Equitable Access to the System in Sub-Saharan Africa? The Experience

BAGAYOKO, Cheikh-Oumar, et al.

Abstract

The aim of this study is to demonstrate from actual projects that ICT can contribute to the balance of health systems in developing countries and to equitable access to human resources and quality health care service. Our study is focused on two essential elements which are: i) Capacity building and support of health professionals, especially those in isolated areas using telemedicine tools; ii) Strengthening of hospital information systems by taking advantage of full potential offered by open-source software.

Reference

BAGAYOKO, Cheikh-Oumar, et al. Can ICTs Contribute to the Efficiency and Provide Equitable Access to the Health Care System in Sub-Saharan Africa? The Mali Experience. Yearbook of Medical Informatics, 2011, vol. 6, no. 1, p. 33-38

PMID : 21938322

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Can ICTs Contribute to the Efficiency and Provide Equitable Access to the Health Care System in Sub-Saharan Africa? The Mali Experience

C. O. Bagayokoa,b,c, A. Anne b,c, M.Fieschid, A. Geissbuhlera a Department Radiology and Medical Informatics, University Hospitals of Geneva, Switzerland b Department of Public Health and Specialties, Medical School, University of , Mali c Centre d’Expertise et de Recherche en Télémédecine et E-santé, Hôpital Mère Enfant, Bamako, Mali d Laboratoire d’Enseignement et de Recherche sur le Traitement de l’Information Médicale, University of Marseille, France

Summary think that the use of ICT can be a pow- Introduction erful of balance in health sys- Objective: The aim of this study is to demonstrate from actual tems but also a way to promote equal projects that ICT can contribute to the balance of health systems in The healthcare system in sub-Saha- access to care in Sub-Saharan African developing countries and to equitable access to human resources ran Africa is characterized mainly by countries. and quality health care service. Our study is focused on two essential three major problems: a) a severe elements which are: i) Capacity building and support of health pro- shortage of health care professionals, fessionals, especially those in isolated areas using telemedicine especially in rural areas within coun- tools; ii) Strengthening of hospital information systems by taking tries, source of medical deserts, par- advantage of full potential offered by open-source software. ticularly in the very large countries; Methodology b) a severe imbalance in terms of Methods: Our research was performed on the activities carried out in Our study is based on a series of cases Mali and in part through the RAFT (Réseau en Afrique Francophone healthcare services offered and profes- sionals leading to a sharp inequality in from the experience of ICT application pour la Télémédecine) Network. We focused mainly on the activities in the field of health. We will focus of e-learning, telemedicine, and hospital information systems. These access to care, and c) the absence of healthcare information systems, espe- mainly on three areas: activities of include the use of platforms that work with low Internet connection telemedicine, hospital information sys- bandwidth. With regard to information systems, our strategy is cially within care facilities. Given all these problems it is ex- tems and capacity building in e-health mainly focused on the improvement and implementation of open- and medical informatics. In all three source tools. pected that the use of information and communication technologies (ICT) will cases we will be focusing on projects Results: Several telemedicine application projects were reviewed in- that have been already completed or are cluding continuing online medical education and the support of provide immediate and significant so- lutions to the healthcare system. This underway in Mali and replicated or can isolated health professionals through the usage of innovative tools. be reproduced in other Sub-Saharan This review covers the RAFT project for continuing medical education potential has been evoked in 2005 by the World Health Organization in its African countries. in French-speaking Africa, the tele-radiology project in Mali, the The specific methods and tools to “EQUI-ResHuS” project for equal access to health over ICT in Mali, resolution WHA58.28 on e-health [1]. Its regional committee for Africa has each project will be describe in their The “Pact-e.Santé” project for community health workers in Mali.We review. also detailed a large-scale experience of an open-source hospital reinforced this position in August 2010 information system implemented in Mali: “Cinz@n”. by adopting a resolution in Malabo on Conclusion: We report on successful experiences in the field of “solutions for e-health in the African telemedicine and on the evaluation by the end-users of the Cinz@n region: current state and perspective.” This resolution is intended primarily to project, a pilot hospital information system in Mali. These reflect the Projects Review potential of healthcare-ICT for Sub-Saharan African countries. encourage African states to recognize the role of ICT in enabling the strength- eHealth and Telemedicine Activities ening of health systems in order to ac- Keywords Role of ICT in Continuing Medical Education Telemedicine, tele-expertise, teleradiology, ultrasonography, Africa celerate the achievement of the Millen- nium Development Goals (MDGs). in Developing Countries Yearb Med Inform 2011:33-8 The aim of our study is to demon- Although its influence on medical prac- strate through tangible realizations that tice can be discussed in certain domains it is neither unrealistic nor utopian to [2], continuing medical education is

IMIA Yearbook of Medical Informatics 2011 34 Bagayoko et al.

necessary to provide quality healthcare. work of Information and Communi- portant to note that 80% of these It also motivates the professional de- cation) and funded by the State of courses are now produced and webcast velopment of health care workers es- Geneva, Switzerland. This project from Africa by African experts. Even pecially in remote areas where there are brought convincing results in Mali [6, if a study by the RAFT network had fewer peer discussion and exchange 7] in a short period of time, and con- concluded that the key to the success opportunities. tributed to the development of a wider of such practice depends more on the It is an ancient practice that dates back network for continuing medical edu- organizational feature than the techno- to the city of Venice in 1300 where the cation [8] as part of the RAFT, the net- logical aspects [11], it is clear this specialist certification gave the initial work in French Speaking Africa for method of training through ICT would right to practice medicine. Introduced Telemedicine [9]. This network ini- be a failure without concrete adaption into Western medicine for a long time, tially covered French-speaking coun- of the necessary tools suitable to the it is required in the U.S. for nearly 40 tries and is now increasingly extend- African context. These include the dis- years [3] and in France only since 2002. ing to English speaking ones under the tance learning platform Dud@l which It is still optional in developing coun- auspices of WHO with currently 18 ac- allows distributing and receiving the tries like those in Sub-Saharan Africa tive countries in around the continent. online courses with very low Internet where health professionals are the ones It is also a WHO collaborating center speed using any computer. The overall who are demanding its application. for e-health and telemedicine [10]. environment is open-source and users The last twenty years have seen a surge In terms of results, courses of con- need no additional program installation of telemedicine platforms to support this tinuing medical education are offered except free Java software. All existing continuing medical education [4, 5]. by health professionals in Africa since courses are available to anyone. This What about the Sub-Saharan 2001, on a weekly basis. Primarily tar- system, based on a technological envi- countries? geting those working in isolated re- ronment adapted to the local infrastruc- According to the World Health Or- gions, they are broadcast every Thurs- ture, providing access to continuing ganization (WHO) most countries of day morning and accessible anywhere education to thousands of health pro-

Sub-Saharan Africa suffer from an acute with even a low speed (25 to 40kbits/s) fessionals, convincingly demonstrates crisis of qualified health professional. Internet connection. Nearly 1’500 hours the potential of ICT in medical educa- In light of that reality it is difficult of e-courses have been performed on tion in low-resource countries, in par- to think that they will have the neces- the network to date. All courses are fol- ticular with the development of South- sary financial and organizational re- lowed by discussions through an e-learn- South collaboration network, and sources to reverse this trend quickly. It ing platform (Dud@l) which connects long-term sustainability through insti- therefore becomes essential to explore the speaker and participants. It is im- tutional anchoring. the appropriateness of ICT for a wide and low-cost training. Convinced of not having access to continuing medical education when posted in rural areas after medical school and with the advent of the Internet in 1996 in Mali, some stu- dents asked a important question at the preparatory conference of the World Information Summit in Bamako in 2000. They framed the issue as follows “We will soon gradu- ate, we will be serving in remote ar- eas, how we will continue to improve our skills and learn about new medi- cal discoveries without any professional contact with our peers?” This sparked the use of ICT to support health profes- sionals within the country, thus, the birth of the first telemedicine pilot project in Mali, led by REIMICOM (Réseau Informatique Malien d’Information et de Communication, i.e. Malian Net- Fig. 1 The Dud@l listener’s interface for continuing medical education

IMIA Yearbook of Medical Informatics 2011 35 Can ICTs Contribute to the Efficiency and Provide Equal Access to the Health Care System in Sub-Saharan Africa? The Mali Experience

Support Health Professionals through ated in 2005: x-ray images performed qualified, motivated and well supported Innovative ICT by technicians are scanned and sent to human resources in health in French experts with information on clinical Speaking Africa) is to find out whether The management of medical person- indications via a server. Every day the ICT can contribute to an equitable dis- nel is problematic in every country of expert reviews all the cases and re- tribution of human resources and health the world, especially when it comes to sponds to requests from regional hos- care services in the countries of the services by specialists in remote areas. pitals. Urgent cases that cannot wait scope of the study. A recent law in France allowing the for the regular hours for processing are The project which started in Decem- practice of telemedicine for remote ex- communicated to the experts by ber 2009 for three years will allow to pertise illustrates this fact [12]. phone. From its inception in 2005 un- better understand and objectively This problem becomes more chal- til now the network links the Univer- measure the following research ques- lenging when focusing on the health sity Hospital of Point G in Mali which tions: a) assess the role of ICT in medi- care systems in developing countries is the focal point of expertise for re- cal education, motivation of health pro- especially those in Sub-Saharan Africa. gional public hospitals as well as for a fessionals in three pilot sites in Mali; Outside their capitals, these countries private clinic. The network currently b) experiment with the delegation of face severe shortages of health profes- extends to Gabon and will continue to tasks in the areas of medical imaging sionals of all categories (nurses, mid- grow within Mali and in other African (Obstetric ultrasound) and cardiology; wives, general practitioners and spe- countries. c) establish a knowledge evaluation cialists). Members of the last category To date, more than 2’500 cases have grid for implementing large-scale (i.e. specialists) are almost exclusively been processed, including 144 urgent telemedicine tools from the results of concentrated in the main cities at the cases and 103 cases for screening for the study on the pilot sites; d) test the expense of other regions of the coun- breast cancer. It is estimated that these role of a computer simulator in the tries. Without a miracle solution to activities have saved the population a clinical reasoning, medical decision train in mass these specialists and de- little more than 60 million CFA francs, making and teacher training in medi- ploy them in the places where there is or about 125,000 USD. This financial cine; e) the impact of medical tele- a great need, the only credible alterna- estimate does not include collateral ex- consulation in caring for patient in situ- tive to make their expertise available penses incurred by the patient when ation of isolation; f) stimulate and all over the country is to move the ex- travelling to the capital to get medical develop research capacity in the field pertise, rather than moving them or exams done. For example the loss of of e-health through medical gradua- their patients, through the use of ICT. earnings for a farmer forced to leave tion theses. To illustrate this, two projects from work in order to accompany his wife The main activity of this project is Mali are described here: one focusing to the capital during the raining sea- currently focused on the delegation of on imaging and the other offering a son can be hard to quantify. tasks in the field of medical imaging, service package to make the health care The evaluation conducted during the including ultrasound imaging and tele- accessible for all: five-year review of the project shows cardiology (electrocardiography).Other the overall satisfaction of patients in areas such as remote continuing medi- almost 98% of cases regarding the serv- cal education will be especially and The Project of Tele-radiology IKON in Mali ices offered. With regard to health pro- properly assessed continuously during Why implement a tele-imaging network fessionals they were satisfied in all the three years of the project. in Mali? With only a dozen radiolo- 100% of the cases. Methods for the delegation of tasks: gists providing service for 14 million It would be important to replicate four pilot district hospitals are equipped inhabitants and with all of them these positive results through in-depth with internet connection, portable ul- practicing in Bamako, the capital of evaluation of a return on investment trasound and electrocardiogram which Mali, the answer to such question is in tele- imaging to formulate great and operate via USB connection to laptops. clear and simple. Paradoxically, at irrefutable arguments in order to con- Two health professionals from the dis- least all regional hospitals in the coun- vince decision-makers. Such a study is trict hospital (general practitioner, mid- try are equipped with radiological units already planned by the Center for Ex- wife or nurse on duty) got previously with technicians capable of perform- pertise and Research in Telemedicine trained by specialists in cardiology and ing the examinations. To overcome this and E-health. imaging of the University Hospitals of problem it was necessary to imagine a Bamako for the manipulation and in- scenario of collaboration between re- The EQUI-ResHuS Project [13] terpretation of basic tests (ultrasound gional hospitals and experts concen- imaging for obstetrics and ECG for trated in the capital via the use of the The main purpose of the EQUI-ResHuS cardiac emergencies). The goal is to Internet. The IKON project was initi- project (ICT for equitable access to enable them to diagnose early an ab-

IMIA Yearbook of Medical Informatics 2011 36 Bagayoko et al.

normal pregnancy and decide a fast facilities. They become more comfort- more equitable access to care in de- support treatment by using the ultra- able with on-site diagnostic tools and veloping countries. Further evaluation sound images. It is the same scenario appreciative of the opportunities to have is obviously needed, and should be as with a congenital heart electrocar- remotely the advice of experts, whom aimed at providing better understand- diogram (Figure 1). For complicated they are not sure to meet easily even ing of the returns on investments, and difficult cases to interpret, the im- by bearing the cost of a trip to the capi- changes in healthcare outcomes, as ages are sent instantly to the Center of tal. However, evaluations will continue well as socio-anthropologic aspects Expertise and Research in Telemedi- throughout the project in order to get related to the perception of patients and cine and E-health, which, thanks to its objective results on the role of these health professionals. staff of medical doctors, will assign tools in the equity in access to health, them to the available appropriate spe- their net impact on motivation and re- cialists, who will read them and re- tention of health professionals in re- turn results to the applicants. For this mote areas and finally the economic Healthcare Information Systems purpose, 24 hours/7 services is provided benefits and improved services. The implementation of computerized at the Center of Expertise and Research healthcare information systems is a ne- in telemedicine. The training lasts 42 cessity to be able to cope with the in- hours of classes and laboratory time Telemedicine in the Peripheral Structures creasing complexity of care processes. for two weeks for the subject of ultra- Closest to the People: the Case of PACT- In the clinical setting of US hospitals, sound and 24 hours for a week for e.Santé Project it has been demonstrated that the usage electrocardiography. The PACT-e.Santé project “Programme of clinical information systems can lead After training, all cases examined d’Accès Communautaire à la Télé- to reductions of in-hospital mortality, in remote hospitals are sent to experts medecine et E-santé” aims to bring to morbidity and costs [15]. The success- via the Internet connection for at the healthcare frontline the potential ful implementation of such systems least three months, in order to verify benefits of ICT and innovative tools. depends on many conditions, includ- the diagnostic ability of the trained In addition to continuing medical edu- ing technological, but mostly organi- professionals. This is done using a cation and tele-consultation, we have zational dimensions. Given the differ- specifically designed platform to developed tele-cytology activities us- ences in financial, technological and transmit images on low-bandwidth ing cheaper innovative tools such as a human context, should the countries in connections. The assessment takes into cheap, portable digital microscope. the South embrace different strategies account the socio-anthropological as- To date 26 community health to successfully deploy and sustain such pects of ICT. centers benefit from this project which information systems? Results for the delegation of tasks for was initiated in 2009. The goal is to ECG and ultrasound imaging: in the demonstrate improvements in the qual- Cinz@n in Mali: an Free and Open Source 10-month period deployment for the ity of patient care services in the first- first two district hospitals and two line of healthcare. Ultimately, this Hospital Information System months for the last two, respectively should lead to a reduction of the cur- Our model called Cinz@n and imple- 453 and 73 cases of ultrasound imaging rent bottleneck at the few major hos- mented at the hospital Mere Enfant and ECG were treated by experts re- pitals which are often overwhelmed “Luxembourg” in Mali, is based on the motely. The cases relate mostly to preg- with cases that could be taken care of adaptation of the free and open-source nant women and children with congeni- at the primary and secondary levels, software MediBoard [16]. Cinz@n [17] tal heart diseases. Diagnoses made by while the centers closest to the means, in vernacular Bambara lan- local care professionals were confirmed populations remain underutilized due guage, the fence around the house which in 99% of cases by the experts. to lack of patient confidence. always leaves an opening through which Two anecdotes illustrate the impact neighbors can come and go as they of these tools on the satisfaction of both please. But it also means responsibility patients and care professionals: a pa- Conclusion and control since it defines the bounda- tient said: “the mere fact of asking me After ten years of practice of eHealth ries of a property. to go to Bamako, Mali’s capital for fur- and telemedicine activities in French Technically MediBoard is an appli- ther examination is greatly exacerbated Speaking Africa, mainly continuing cation based on web technologies. The my illness. This project is a miracle for medical education, tele-consultation advantages of this technology are ob- me.”; a doctor said: “I refused a more and recently the deployment tools for vious: ease of deployment, scaling and interesting job because of this project.” decision support [14], elements of evi- use, and maturity of the features used. Additionally, this project has changed dence are being gathered to demon- In terms of functionality it is a com- the patients’ perception about the health strated how these tools can foster a plete hospital information system.

IMIA Yearbook of Medical Informatics 2011 37 Can ICTs Contribute to the Efficiency and Provide Equal Access to the Health Care System in Sub-Saharan Africa? The Mali Experience

However, the main elements for the The fear often mentioned about the care facilities in Mali. Several requests decision to use this solutions were the inconveniences that could arise from are already underway by other Afri- fact that it was free, and was available the use of free and open-source tools can countries such as Burkina Faso, in French. is not an argument nowadays since they Niger and Cameroon. Key steps of the projects were: the provide similar functionalities and the After evaluating our model, we establishment of a steering committee same level of security risks as com- can conclude that users generally headed by the director of the hospital, mercial products. It is reassuring to see seem to identify issues related to the setting up hardware and operation infra- that some are being used in healthcare implementation of a hospital infor- structure (servers, wiring), training of the institutions of affluent countries. mation system. As a result, users are team conducting the project and users Also, the price of paper produced ahead of the directors of hospitals and the implementation phase. This im- each day for medical records and the who are still waiting to identify most plementation was done in a modular way cost of losing information related to of these issues. We demonstrated that based on priorities of the hospital: the the risks of paper records are more ex- Cinz@n can be deployed in the real computerization of the administrative pensive to the hospital and patients context of a 100-bed hospital in record of the patient with a scheduling than the cost of investing in the devel- Mali, for an investment cost of about management option of appointments and opment of an adapted computerized ten thousand euros. the computerization of medical consul- hospital information system. For ex- tation file. The deployment of additional ample, the average annual cost for the modules such as management of the op- purchase of paper at the Hospital “Mere erating rooms are underway. Enfant” is significantly greater than Capacity Building of Human The evaluation has focused on ba- the sum of the cost of adapting Resources in e-Health and Medical sic knowledge in computer informa- MediBoard to its needs and the cost of tion systems, ergonomics of Cinz@n basic infrastructure (server, intranet). Informatics and the users’ perception of the appli- The economic and material aspects To implement and monitor these ac- cation. All users considered that the should not be the cause to lose sight of tivities whether related to tele-medi- system increases significantly data re- the cultural and organizational ones. cine or hospital information systems, liability. One user considered that the The latter could be a true hindrance to development of local skills is an abso- system had no impact on improving the the deployment of the system in some lute necessity to ensure the mainte- quality of his work, but 84% agreed cases, should we fail to pay attention nance and sustainability. In the case of that the computer system has improved to them. Mali, considerable effort over several the quality of their work. Two-thirds Indeed, when it comes to starting years has led to the establishment of of users considered that the system a new task or implementing new in- the Center for Expertise and Research workload is compatible with their du- frastructure, it is very common to be in Telemedicine and E-health in ties. All users are willing to continue confronted with problems of ego Bamako, Mali. The center’s role is to the experience with the deployment of strongly linked to culture. For ex- develop research and training in the new features. They also recommend that ample, we tend to believe that any field of e-health in Africa, especially the system must be extended to all the investment must be introduced by the in French- speaking regions. This departments of the hospital. head of department or an elder; and center has now acquired a certain ex- this is seen as a great sign of respect pertise and the ability to raise com- regardless of the field. The concept petitive research funds, as illustrated Lessons Learned of “Elder” becomes important in Af- by the EQUI-ResHuS project. The first lesson learned is that it is nei- rica. They must always be the first to To date the center has trained sev- ther utopian nor unrealistic to imple- be served as there is saying “first- eral thousand health professionals in ment a computerized hospital informa- served are best served.” This passage all categories to use basic computer tion system in a developing country, is taken very seriously in general in tools, telemedicine tools (remote medi- despite the lack of material and opera- the African society but particularly cal education, tele-consultation). tion infrastructure. The economic ar- in Mali. Therefore, it is so easy for a More than ten students who have gument no longer holds when there are project of this type to fail without completed certificate courses by e- freely available open-source tools any obvious reason because people, learning in the field of medical adaptable at negligible cost by local paradoxically, do not openly express informatics have been trained by the teams prepared and competent with a such deep feelings. center. This is indeed the only struc- dual benefit: the development of local Another sign of success is that the ture of its kind in Mali and in the expertise and economic potentials for Ministry of Health of Mali has decided region. small local businesses. to scale the Cinz@n HIS to all health-

IMIA Yearbook of Medical Informatics 2011 38 Bagayoko et al.

Acknowledgments 2007;76:351-6. Discussion and Conclusions This work was supported by the Uni- 9. RAFT website, http://raft.hcuge.ch, last visit, 20 February 2011. Evidence is mounting to demonstrate versity Hospitals of Geneva, Switzer- 10. http://www.who.int/collaboratingcentres/en/ how ICT can contribute to the effi- land, the International Institute of De- 11. Bagayoko CO. Réseau de Télé-enseignement ciency of the health system in devel- velopment and Communication, the Médical: Identification des Barrières oping countries. It is obvious that a Canadian International Development Technologiques, Organisationnelles et Humaines. [Medical e-learning network: identification of lot still needs to be done in terms of Research Centre, and the Foundation for technological, organizational and human barriers.] technological infrastructure, but these Children of Mali through the Children Master d’Informatique Bio-Médicale 2005-2006, shortcomings are not insurmountable. Mother Hospital “Luxembourg.” Université de Paris 5. This is why we must continue to de- 12. Décret n°2010-1229 du 19 octobre 2010 relatif à la télémédecine [2010 Decree from the French velop applications adapted to the tech- government on Telemedicine], http://www. nological and socio-economic contexts References legifrance.gouv.fr/ of developing countries. The develop- 13. EQUI-ResHuS website, www.certesmali.org/ 1. www.who.int/healthacademy/news/ equireshus ment of qualified human resources in eHealth_EB_Res-fr.pdf. 14. Bagayoko CO, Niang M, Traoré ST, Bediang G, ICT and health shall be promoted as a 2. Thurin JM. La formation médicale continue a-t- Naef JM, Geissbuhler A. Deploying Portable priority. elle une influence sur la pratique médicale? [Does Ultrasonography with Remote Assistance for In the studies we have not discussed continuing medical education have an influence Isolated Physicians in Africa: Lessons from a Pilot on medical practice?] Psychiatrie Française Study in Mali. Stud Health Technol Inform mobile-telephony based applications. 2000;1:117-32. 2010;160 (Pt 1):554-8. Experiments are underway throughout 3. Carriere M F, Harvey D. Etat de la formation médicale 15. Amarasingham R, Plantinga L, Diener-West M, Africa: these are promising and have continue à distance en Amérique du nord. [Status of Gaskin DJ, Powe NR. Clinical information yet to be evaluated. distance continuing medical education in North- technologies and inpatient outcomes. A multiple America.] Revue du conseil Québécois de la forma- hospital study. Arch Int Med 2009;169(2):108-14. A special attention should be paid to tion à distance 2003;:51-72. 16. Website Mediboard, www.mediboard.org the qualification of eHealth and medi- 4. Kemp LJ. Learning about Teamwork in an online 17. Bagayoko CO, Dufour JC, Chaacho S, Bouhhadou cal informatics professionals in Africa. study environment. MERLOT, Journal of Online O, Fieschi M. Open Source Challenges for Hospital

Indeed, it is not uncommon to see un- Learning and Teaching 2006;2(1):30-41. Information System (HIS) in developing countries: a pilot project in Mali. BMC Med Inform Decis trained individuals declaring them- 5. Brauchli K, O’Mahony D, Banach L, Oberhozer M. iPath – a Telemedicine Platform to Support Health Mak 2010 Apr 16;10:22. Available from: http:// selves specialists with empty statements Providers in Low resource Settings. The journal www.biomedcentral.com/1472-6947/10/22 18. Bagayoko CO, Traore AK. Analyse du contexte des and ambitions often lacking any meth- of information Technology in Healthcare 2005;3(4): Technologies de l’Information et de la odology and realism in ICT and health. 227-35. Communication dans le développement des This kind of behavior may jeopardize 6. Geissbuhler A, Ly O, Lovis C, L’Haire JF. Ressources Humaines en santé au Mali. [Context the long term future of this area. Edu- Telemedicine in Western Africa: lessons learned from analysis of ICT for the development of human cation in this field must be structured, a pilot project in Mali, perspectives and recommen- resources for .] Etude de synthèse, dations. AMIA Annu Symp Proc 2003:249-53. décembre 2010. regulated, and provided by Universities. 7. Bagayoko CO, Mueller H, Geissbuhler A. Assess- As demonstrated by a study paper ment of Internet-based Telemedicine in Africa (the on the role of ICT in human resource RAFT Project ). Comput Med Imaging Graph 2006; Correspondence to: development [18], health professionals 30(6-7):407-16. Dr. Cheick Oumar Bagayoko 8. Geissbuhler A, Bagayoko CO, Ly O. The RAFT Centre d’Expertise et de Recherche agree about the potentials of ICT in network: 5 years of distance continuing medical En Télémedecine et E-santé, CERTES improving their work and their own education and tele-consultations over the Internet Bamako, Mali development. in French-speaking Africa. Int J Med Inform E-mail: [email protected]

IMIA Yearbook of Medical Informatics 2011