The MIDJAN Group

telemedicine in developing countries

(Version française, cliquer ici)

Contact : Guy Rossignol - dhsi@sante.worldnet.fr

An European collaboration group was created in March 1996 for the promotion of telemedicine in developing countries. Presently, the group involves twenty telecommunication and medical informatics suppliers, telecommunication operators, universities, hospitals and assistance organisations, administrations and international governmental organisations.

In May 1996, members of the group organised telemedicine sessions involving physicians of the developing countries and European hospitals. All live sessions demonstrated successfully the technical feasibility of telemedicine to delegations of countries invited in two major international conferences : Abidjan (Ivory Coast) conference on telecommunication in Africa and G-7 conference on the Global Information Society held at Midrand (South Africa). Tele-consultation and distant learning sessions were held on actual medical cases : dermatology, tuberculosis, neurology and traumatology emergencies. Taking the floor during various conferences, some members of the group promoted the idea of launching practical telemedicine projects in the developing world, in partnership with health centres, industry and governments from these countries.

Going further than a plain exhibition, the group was giving a shape to the "share vision of the information society" mentioned by many speakers during the Midrand conference, in particular the vice-president of the United States of America.

The message was well received. In Abidjan, a formal Resolution from the International Telecommunication Union was adopted for the launching of telemedicine trial in Africa. In Midrand, the Chairs conclusions have invited the governments to act as catalysts for launching projects in the areas of education and health, and prepare the migration of the services to the market.

Considering the success of all initiatives and demonstrations held in Abidjan and Midrand, the group adopted the name "Midjan" and is now entering a new phase for the promotion of telemedicine in developing countries.

Which telemedicine ?

The International Telecommunication Union (ITU) and the World Health Organisation (WHO) have signed an agreement in 1995 for the "introduction of communication and informatics technology facilitating the provision of medical and healthcare services". In the context of the developing world, telemedicine addresses mainly remote consultation and therapeutic assistance, between hospitals, health centres in rural areas and travelling physicians. But it should also comprise education and technology transfer actions between developed countries and the developing world, in order to help users to take over the IT systems and avoid dependence from western competence centres.

This is the environment where the Midjan Group wants to work, but with a major priority given to public health. "Public" telemedicine has to be distinguished from a "commercial" view of telemedicine, i.e. distant consultations offered by private companies within insurance contracts or subscriptions. The "public health" orientation, which is close to the "health for all" WHO programme, implies telemedicine services to be integrated into the social and welfare policy of the country, but do not prevent private companies to build and operate them.

Benefits to developing world brought by telemedicine

The current situation may be summarised with this phrase : "solutions are in the North, needs are in the South".

Developed countries have set-up telemedicine systems since the 60's, with a huge progress in the 90's, mainly to support medical competencies in rural and isolated areas. Telemedicine systems developed in the Northern countries were and still are largely subsided by governments, very often for the purpose of technology innovation. To date, a number of excellence centres in the developed countries are successfully operating local telemedicine networks. They more and more collaborate, in particular in the framework of the G-7, to ensure a regional and global inter-operability between them.

On the other hand, developing countries have tremendous needs for healthcare, but distribution costs are increased by the lack of basic infrastructures, equipment, human resources and training. In those countries, telemedicine could be very cost-efficient, as shown by the following examples :

Difficulties in implementing telemedicine yet explain the small number of existing developments :- some countries still have basic needs ( supply of medicine, pandemics, regional conflicts) and use of information technology can hardly be envisaged at short term,

Therefore, in the intermediary developed countries, telemedicine can be useful pending that expenses for preliminary studies, awareness and adaptation of existing solutions are covered by public funding within an international approach for large scale trials. Under this condition, a favourable background for private investment in sustainable services can be elaborated.

Added-value from a collaboration group.

Current bilateral co-operation lead to a small number of telemedicine projects in the developing world, with the financial assistance of one or more international organisation.

Looking for a multi-lateral approach leading to large scale trials, the Midjan Group wishes to (i) raise the high quality of all proposals (ii) assist to consortia when they negotiate with users and funding organisations, (iii) initiate new proposals from needs expressed by developing countries. In this last case, the group would take over preliminary studies, leading to a new proposal.

Therefore, the group supports proposals managed by consortia of industry and users.

In this process, the following advantages need to be considered :

To summarise, an European collaboration group could stimulate the dialogue between developed and developing countries, increase the number of telemedicine systems, identify appropriate technology and software and build on European telemedicine expertise which could also be appropriate for developing countries.

Composition of the group

The Midjan Group is a non-profit initiative. Membership is open, pending existing members approve new candidates.

Participation may bring various kinds of benefits, according to the origin :

The Midjan Group will work in the context of the development bureau of the ITU, question 6/2 "impact of telecommunication on healthcare systems and other social services" ; within this specific question of the ITU-BDT, delegates contribute to the elaboration of a report on telemedicine in the world. ITU-BDT is member of the Midjan Group, as well as Inmarsat, co-ordinator of the ITU report and study on implementation of telemedicine in developing countries.

The Midjan Group will work in close relationship with the G-7 healthcare application programme, in particular sub-project 4 aiming at the setting-up of a world-wide, multilingual, 24 hours and multi-disciplinary emergency telemedicine service. The French Ministry of Health, direction des hôpitaux, co-ordinator of sub-project 4, and the European Institute of Telemedicine, project leader, are member of the group.

The Midjan Group will work in liaison with the European Commission, Health Telematics specific programme of the fourth R&D framework programme. It contributes to the re-enforcement of the scientific and technological background of the Community, and the international competitiveness. (Treaty of the European Union - article 130F ).

Other members are currently :