vol46.1 LR.pdf - International Hospital Federation

Opinion matters
Low-tech, low-cost prostheses enable amputees to return to work
and support their families. Minimally invasive surgery techniques
simplify procedures and reduce the need for in-patient care and all
that is associated with this. As a result, costs fall.
Information and communications technology increase contact
between healthworker and patient and among healthworkers.
Mobile phones, for example, enable health workers to follow up
with patients and ensure that treatments are being adhered to – an
important issue when dealing with chronic diseases, for example.
Phones and email enable specialists in urban settings to provide
real-time technical support to colleagues working hundreds of
kilometres away in remote, rural areas. Electronic patient records
ensure that accurate records are kept, greatly facilitating lifecourse
approaches to patient management.
But more needs to be done to make the most of such
technologies. To have real impact on health outcomes,
technologies must be available, accessible, affordable, safe,
effective and appropriate for the setting in which they will be used.
Twenty-first century technology is itself one means to increase
access and availability of services. For example, solar energy
powers laboratories and keeps medicines cool in places where
there is no power grid. Portable ultrasound permits diagnostic
imaging in remote areas.
But technology is not enough on its own. Technology is only as
effective as the wider health system of which it is part.
For a health system to make the most of modern technology,
there must be strong leadership on health at national and district
level, with a commitment to moving towards universal coverage of
patient-centred care. This, in turn, requires a parallel commitment
and capacity to establish a robust and well-trained health
workforce; strong and equitable financing; well-governed and
efficient delivery mechanisms; and reliable information systems –
nationwide.
To optimize use and maximize the impact of technologies, good
management is essential. This includes the establishment of
checks and balances to ensure that they are appropriate to the
settings in which they will be used. A machine which requires
electricity is of limited use if the energy supply is unreliable.
Complex equipment loses its value if staff have not been trained to
operate it, or if replacement parts are hard to get hold of.
Greater collaboration between clinical and biomedical engineers,
clinicians, managers, and users can greatly improve management
of health technology.
In 2010, more than 40 countries enter a new phase in their
national health planning cycles. It will be vital that those involved in
the planning process fully address health technology needs, and
allocate resources for the use, maintenance, and surveillance of
technologies.
To conclude, the relationship between technologies and health
systems and services is mutually reinforcing. Technologies have
the potential to greatly strengthen systems and improve services
and outcomes so they meet contemporary health needs. But in
turn, health systems are vital to obtaining maximum benefit from
technologies.
That is why WHO’s medicines and technologies work is
embedded with its efforts to strengthen health workforce and
service delivery, and to improve financing and information
mechanisms. Our goal is to strengthen health systems and create
a robust foundation for maximizing health outcomes in this fastchanging
world. ❏
References
1.
Everybody’s Business - Strengthening Health Systems to Improve Health Outcomes, WHO,
2007
2.
Osler, W, Aequanimitas, Philadelphia PA, Blakiston, 1904
Technologies must also be affordable, providing optimal
value for money
They must be safe and they must be effective. This requires a
good evaluation of the context in which they are to be used, and
research into how they have performed in similar contexts
elsewhere – something that can itself be greatly facilitated by
electronic dissemination of research. That said, there is a need
both for more research, greater use of impartial studies, and less
reliance on information provided by suppliers.
All this means making difficult choices – for example between
investing in new state-of-the art equipment for a hospital in the
centre of a town and in strengthening blood safety facilities in a
health facility out in the suburbs. And it means having proper
regulatory systems, procurement procedures and financing
mechanisms that are sustainable, inclusive and fair. This may
require introducing new regulations, changing the way
procurement decisions are made, and adjusting financing
mechanisms. It is particularly important to improve coordination.
World Hospitals and Health Services Vol. 46 No. 1 05