system to support easy access from areas with poor communication linkages.
Description and Background
The RAFT project brings together continuing medical education (eLearning) and tele-consultation (eCare) over the Internet in French speaking Africa. It involves fifteen French speaking countries in Africa and was piloted in Mali in 2001. The project does not solely rely on eLearning and eCare between Europe and Africa but is also encouraging intra-African collaboration.
The project is sponsored by the State Government of Geneva and by private foundations. It is reliant on a web of networks between medical and technical coordinators active in each country, and partnerships with the Université Numérique Francophone Mondiale (UNFM), le Digital Solidarity Fund (DSF) and the World Health Organization (WHO). The core activity of the RAFT is the webcasting of interactive courses, putting emphasis on knowledge sharing across care professionals, usually in the form of presentations and dialogues. Other activities include videoconferences, teleconsultations, collaborative knowledge bases development, support for medical laboratories quality control and the evaluation of the use of telemedicine and eHealth in rural areas.
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The RAFT programme initially focussed on a telemedicine and eHealth application based on a north-south relationship. Early evaluations of the RAFT programme highlighted that local teaching (south-south) is often more effective than north- south networks. Current plans are focus on increasing the African content in the programme which was already about 70%.
RAFT is built around two main components:
iPath is a secure teleconsultation environment, which enables «virtual communities»of experts to collaborate remotely in order to solve patient specific problems: diagnostic support, second medical opinion, help with evaluating, deciding and planning the medical evacuation of a patient. Application domains include radiology, dermatology, surgical follow up, infectious disease, etc. Access to this tool is limited to users and experts identified by the RAFT coordinators.
Dudal software is the distance education environment developed for the RAFT project, specifically tuned in order to function over low bandwidth connections (25kilobits/seconde), thus enabling remote users to participate, even from a cyber café in a small town. Open to anyone, freely, these weekly courses, 70% of which are produced in Africa, are frequently followed by hundred of care professionals.
The project has focused on low-bandwidth technologies, in order to reach as far as possible using existing communication infrastructure.
The project identified a number of problem areas they wanted to address such the critical shortage of care professionals in Africa, particularly in remote areas. Outside the main urban centres, care professionals do not have access to continuing education or help of specialists and it is often expensive and sometimes dangerous to transport a patient who could have been managed locally. Hence, the project objectives are to:
Provide individual in rural/isolated areas access to healthcare services.
To develop a South-South network for distance continuing medical education and teleconsultations ensuring that there is a capacity for high quality, local, medical online content.
Ensure the remote support of care professionals, helping local doctors to make better diagnostic and therapeutic decisions, while also ensuring that doctors have access to medical education without having to leave their work place.
Issues Addresse
The key issues addressed are the transmission of knowledge and experience to the African medical community and developing a network in which the African and other medical practitioners can exchange information and ideas.
Satellite Use
The development of the network depends on the improvement of the internet connections bandwidth and the geographical deployment of internet access. The RAFT programme provides topical and interactive learning opportunities for these health professionals to maintain and increase their professional skills.
Rural areas have the most to gain from the use of telemedicine and eHealth for the development of health systems which would make health professionals less isolated and also support the transfer of information from the capital to the
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periphery and vice versa. Satellites offer the only reasonable means to bridge the communications gap for these locations.
Impact Pathway: RAFT Objectives
Increase the knowledge exchange between medical professionals in Africa with each other and with experts in Europe
Provide individual in rural/isolated areas access to healthcare services
To develop a South-South network for distance continuing medical education and teleconsultations ensuring that there is a capacity for high quality, local, medical online content.
The project aims to ensure the remote support of care professionals, helping local doctors to make better diagnostic and
therapeutic decisions, while also ensuring that doctors have access to medical education without having to leave their work place.
Inputs
Computers
Content
Activities
Secure teleconsultation environment which enables «virtual communities»of experts to collaborate remotely in order to solve patient specific problems: diagnostic support, second medical opinion, help with evaluating, deciding and planning the medical evacuation of a patient.
Distance education environment which provide free weekly courses on health issues
Outputs
Increased knowledge among medical professionals in Africa
Deepened and widened professional medical networks both within Africa and between Africa and Europe
Initial Outcomes
Better treatment outcome for patients through more appropriate care
Longer term Outcomes
Lower rates of disease and mortality through prevention and better focussed treatment
Wider Outcomes
Raised skill levels – including technology -- in the community which will have wider economic benefits
Increased and deepened integration into the international medical community
Benefits
The main benefits are the deepening of professional knowledge and networks which will improve the productivity and effectiveness of health professionals in treating their patients.
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Costs
The project requires communications equipment to broadcast the conferences and make the discussions possible. There are on-going costs for content development and provision of instructors. The participants bear costs with regard to their time and the connection costs to the network.
The cost of the RAFT programme varies annually but averages $205,000 per annum for running costs. The cost of the terminals and satellite access point is approximately $949,410 with a monthly cost of about $450 for connection.
Reported Impact
Several hundred care professionals connect each Thursday for the two-hour courses (up to 1000+ in 42 sites in 12 countries). These numbers have been increasing over the last 8 years. In parallel, several hundred teleconsultation requests (second medical opinion requests) have been brokered through ipath (the teleconsultation platform) and contributing to practical answers to deal with difficult cases throughout Africa. Some of the remotely supported physicians have successfully completed degrees in distant universities, and others are starting to use new (cheap) diagnostic techniques that were until now restricted to main hospitals. Initially, RAFT targeted mostly physicians, but has now expanded to work with nurses, pharmacists, lab technicians, public health agents, and, more recently, hospital administrators. The expansion to help support the initial training of healthcare professionals is also being considered.
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