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e-Health in Latin America and the Caribbean: progress and challenges e-HEALTH IN LATIN AMERICA AND THE CARIBBEAN: Progress and challenges Andrés Fernández and Enrique Oviedo (editors) This document was prepared by Andrés Fernández and Enrique Oviedo of the Economic Commission for Latin America and the Caribbean (ECLAC), in the framework of the programme Alliance for the Information Society, phase 2 (@LIS2), – Inclusive political dialogue and exchange of experiences, carried out jointly by ECLAC and the European Union. The editors are grateful to Daniela Huneeus and Ignacio Carrasco, ECLAC consultants, for their assistance in the preparation of this document. The opinions expressed in this document, which has not undergone formal editing, are the sole responsibility of the authors and do not necessarily reflect the views of the Organization. United Nations publication LC/L.3252 Copyright © United Nations, July 2011. All rights reserved Printed in United Nations, Santiago, Chile Applications for the rights to reproduce all or part of this work are welcomed and should be sent to the Secretary of the Publications Board, United Nations Headquarters, New York, N.Y. 10017, United States of America. Member States and their governmental institutions may reproduce this work without prior authorization, but are requested to mention the source and inform the United Nations of such reproduction. e-Health in Latin America and the Caribbean: progress and challenges Contents Introduction . .7 I . Potentials of e-Health in the social and epidemiological context of Latin America and the Caribbean . 11 II . Background information and e-Health applications in Argentina . 25 III . Telehealth initiatives in Brazil . 37 IV . Information and communication technologies in health care: enabling projects and applications in Chile . 45 V . e-Health in Colombia: regulations, applications and challenges . 53 VI . Costa Rica’s Telesalud programme: experiences and challenges . .61 VII . e-Health development potentialities in Ecuador . 71 VIII . e-Health policies, programmes and projects in Mexico . 79 IX . The National Telemedicine and Telehealth Programme in Panama . 101 X . e-Health in Peru: an emerging issue . .107 XI . e-Health in Uruguay: development and challenges . 115 XII . Technological projects for e-Health in the Bolivarian Republic of Venezuela . .131 5 Index XIII . Public health information systems in the Caribbean . .139 XIV . The e-Health experience in Spain: lessons for Latin America and the Caribbean . .157 XV . Discussion and proposals . 167 Bibliography . 173 6 e-Health in Latin America and the Caribbean: progress and challenges Introduction This publication, “e-Health in Latin America and the Caribbean: progress and challenges” was prepared in the framework of the programme “@LIS2 –Alliance for the Information Society 2– Inclusive political dialogue and exchange of experiences”. The purpose of @LIS2 is to encourage political and regulatory dialogue between Latin America and Europe in order to facilitate the formulation of regional, subregional and national strategies aimed at the development of the information society in Latin America, drawing inspiration from the eEurope experience. One of its specific objectives is to contribute to the formulation, implementation and monitoring of the Regional Action Plan for the Information Society in Latin America and the Caribbean (eLAC), by engaging different sectors in a regional cooperation framework. Following the first and second phases of the World Summit on the Information Society (Geneva, 2003 and Tunis, 2005), the countries established a political consensus and a common strategic vision at the Rio de Janeiro Regional Conference (2005), redefining the goals of the Global Plan agreed to in Tunis to reflect the specific needs of the region. This gave rise to the first Regional Action Plan for the Information Society in Latin America and the Caribbean (eLAC 2007), which was signed by 33 countries. The eLAC 2010 Regional Action Plan was signed at the Second Ministerial Conference on the Information Society, held in San Salvador in 2008, as the second step in the eLAC process leading up to 2015. This renewed plan reflects an important change of direction, moving away from corporate-centred ICTs towards integrated human and social development: development that uses ICTs to promote growth with equity. 7 Introduction Indeed, it is essential to consider the potential contribution of ICTs to social and economic development, knowledge generation and integration among countries. ICTs can help to reduce inequality and overcome poverty, as well as to guarantee economic, social and cultural rights (ESCRs). They are tools that can be used to bridge gaps and provide citizens with opportunities, such as broader access to quality health care. Although there has been a boom in public and private initiatives in the region over the past decade, most have been small-scale projects that were not incorporated into national public health and ICT strategies. However, some progress has been made and is taking shape in the form of national or subnational plans that typically focus on modernizing management of health-care services and procedures, providing distance learning to enhance the skills of health-care teams, and expanding the use of telemedicine. The Latin American and Caribbean region now faces the challenge of incorporating ICTs to maximize their potential for enhancing the quality of health care for their populations. This requires State leadership and commitment, particularly at the sectoral level, as well as public-private collaboration that brings together specialized professional teams to integrate medical, public-health and ICT knowledge. Also needed in this process is citizen engagement and participation in health-care issues. Frequent use of ICTs for health-care applications entails new forms of organization, learning and information, as well as new social relationships, with improved health serving as a stepping stone for strengthening democracy and social oversight in the region. Moreover, ICTs have a positive contribution to make to the health-care economy (ECLAC, 2010a). For example, as the demographic make-up of Latin America and the Caribbean shifts towards a larger elderly population, the ability of ICTs to provide more effective treatment and increased well-being for the chronically ill and their families takes on increased importance. The use of ICTs in health care is part of a cultural evolution occurring in the region. These technologies transform people’s spatial and temporal reference points (ECLAC, 2010a) and reduce physical and cultural distances, while bridging the most extreme gaps in health-care vulnerability —among rural and indigenous populations and in isolated areas with limited access to goods and services. To address the health-care challenges faced by the region, including that of incorporating the use of ICTs, the eLAC 2010 plan provided for the creation of a Health-care Working Group (HWG), coordinated by Nancy Gertrudis (Mexico) and charged with encouraging the implementation of national strategies, taking advantage of lessons learned from experiences to date. 8 e-Health in Latin America and the Caribbean: progress and challenges This book is an outgrowth of the workshop “Regional e-Health and Telemedicine Goals and Policy Follow-up”, hosted in part by ECLAC1 and held in Santiago, Chile on 30 November and 1 December 2009. The workshop served as the first meeting of this multi-stakeholder group, which included specialists from Argentina, the Bolivarian Republic of Venezuela, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru and Uruguay. Participants discussed progress and challenges relating to the development of e-Health and telemedicine in their countries. There was also discussion of the current situations in some Caribbean countries —Trinidad and Tobago, the Dominican Republic, Grenada, Belize, the British Virgin Islands, Saint Lucia, Jamaica and the Cayman Islands. In keeping with the aim of @LIS2 to promote dialogue between Europe and Latin America, a description of progress in Spain is also included. The book is divided into 15 chapters. The first chapter, “Potentials of e-Health in the social and epidemiological context of Latin America and the Caribbean”, describes population trends that underscore the need to incorporate ICTs more decisively into health care in the region. This chapter describes, from a development perspective, the promise that e-Health holds for meeting health-care challenges through expanding access to quality health care. The impending challenges for the public policies on ICTs in health care stem from major inequalities which create access barriers to timely and quality health care for much of the population in Latin America and the Caribbean. These barriers are related to both the characteristics of the health system in each country and factors specific to patients and their families. The chapter discusses inequalities through the lens of health-care indicators relating both to individuals and families and to characteristics of the different health-care systems. The second to thirteenth chapters examine the progress and challenges in the area of e-Health and telemedicine in 12 Latin American countries and 8 countries from the Caribbean subregion. These countries have a wide range of projects, either completed or in progress, relating to the promotion of health care for remote areas, the connection of primary health centres
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