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India - Pan-African e-network for medical services and human resources

Organization(s):

1. Nodal Ministry for Implementation - Ministry of External Affairs (MEA)

2. Implementing Agency - Tele-Communications Consultants India Limited (TCIL)

3. Several Universities and Super Specialty Hospitals in India

Country (ies):

Donor – Government of India (GOI) Recipient – African Union (A.U.) Member States (53 countries in total).

Overview:

Recognizing that Africa-India cooperation can go a long way in the globalizing world for mutual advantage , inspired by a boost in expertise in it's IT and medical sciences sector, and in an effort to contribute to the Millennium Development Goal of increasing education levels across the developing world, the Government of India proposed the Pan African e-network Project that allows India and African countries to be linked to one another through a satellite run network, that will further enable the transfer of other facilities such as tele-conferencing between heads of states, tele-medicinal consultations etc.

Background:

In 2004, at the inaugural session of the Pan- African Parliament held in Johannesburg, the then Pr. of India, A. P. J. Kalaam offered the idea of connecting India and nations of the African Union (A.U.) through an e-network (a fibre optic cable and satellite that would allow the setting up of tele-education, tele-medicine, videoconferencing, and VIP communication services) - consequently supporting the emerging field of e-governance, e-commerce etc.

Basic Objective – help build capacity on three levels

• Technology Transfer – software and hardware. During the implementation of the project, TCIL will organize training programs at each country centre to familiarize the local staff in operating and running the equipment and network on their own.

• By way of giving access to education for African students from selected Indian universities and educational institutions.

• By way of tele-medicine services for consultation with experts in super specialty hospitals in India.

• Also, the project will cover Continuing Medial Education (CME) for practicing doctors and nursing staff to update their knowledge and skills from medical specialists and educationalists in India.

• VVIP connectivity – set up in offices of state heads for video conferencing and VoIP services between African countries and (either internally or with) India.

Challenges

The project itself was not based around over coming any specific goal based challenge. In stead it targets perennial issues in Africa's development (the field visit in Tanzania, for example, revealed more fully the lack of medical expertise in some African countries).The project aims to enhance services and consequently build capacity in three sectors – ITC, Education and Medicine.

Expectations

• Once the technology and skills have been shared and transferred (after the initial five year period), local engineers continue this network for internal purposes (connecting African countries with one another), or expand it to other countries, or in rural areas.

• Make education affordable for students in Africa to learn from Universities in India on an interest and need based program in the comfort of their own zones No limitation on the number that can avail this.

• To use the latest technology and expertise available for the gain of patients and doctors in Africa.

Previous cooperation and political context

India has had a long standing relationship with Africa – it shares a common colonial past, the experience of mass forced migration (that have added to a huge Indian population amongst the locals), partnerships from the time of the Non Aligned Movement, other bilateral treaties etc. Further, the GOI has already been engaging in several capacity building projects (apart from commercial ventures) in Africa.

As an effort to continue this relationship, promote SSC and play its role as an emerging donor, the Pan African e-network project was devised and proposed. The project however, is for a period of 5 years. After which, if internal capacity has not been built to a sufficient level, the services of TCIL can be commercially hired (showing the investment perspective of Indian authorities endogenous in the project).

Implementation:

1. To begin with, an 'umbrella' MoU was signed between the MEA, TCIL and the A.U. Commission in 2005 declaring the interests of all parties to come on board with the proposed project. TCIL was designated the implementation agency. However, the signing of an MoU with TCIL to actually begin the project remains at the independent discretion of each country. The current status is at 47 out of 53 countries that have signed the MoU with TCIL. 2 are in the pipe-line. And in over 20 out of these 47, tele-education and tele-medicinal activities have already begun.

2. Regular delegations visit different centers in various countries – both from the A.U. and India (MEA/TCIL) to keep themselves updated on the status of the project.

3. Annual meetings between all stakeholders, workshops to share the details process of the project, and an attempt to coordinate tele-education as per the demand in each country is an on-going, regular process as part of the project.

4. A Data Centre in New Delhi and a Satellite Hub Station in Senegal have been connected through a submarine cable in order to connect the Indian and African partners.

5. These centers will connect, at the end of the project – 7 Universities and 12 Super Specialty Hospitals in India with 53 Learning centers, 53 medical centers, 53 VVIP nodes in each African country. Further it will also connect 5 African University Centers and 5 Super specialty hospitals for internal communication and participation.

6. The proposal provides for imparting education to over 10, 000 students, 500 practicing doctors, 1000 practicing nurses, and one hour of live tele-consultations per day per country (with a provision of 5 offline consultations per day as well).

7. The countries in which education and medical centers are already running, a team from TCIL is present to monitor the process on the recipient end. Alongside, they are working with local staff to transfer the knowledge to run this technology. A pilot that has been carried out in Ethiopia for MBA students experienced a high success rate, with a graduating batch of 34 students from an Indian University. At this stage, the demand for more courses and the attendance of students in each class is increasing.

8. With tele-medicine, the CMEs are running on their schedule (at least where they have begun). However, with patient consultation there has been hesitation on part of the African doctors to share confidential information with others. To overcome this, the data storage facility for patient records has been set up only at the African medical centre with no facility for any computer in India to store confidential information of patients.

9. Roles and Responsibilities of the stakeholders

• MEA – Over seeing body. Keeps a tab of TCIL's implementation of the project and provides funds.
• TCIL - Implementing Agency.
• Turn Key Solution Provider
• Planning
• Procurement of hardware and software
• Preparation of site and team
• Implementation of activities in learning and medical centers.
• Running and Monitoring for the designated 5 year period.
• African countries – The recipient country is expected to provide TCIL with basic infrastructural facilities. From the field visit, and in conversations with staff at TCIL, it is clear that this step itself has proved to be a deterrent in the progress of the project in certain places. In Tanzania, for example, at the CME centre, there are two chairs available in the entire room (that is originally supposed to be a conference room for medical professionals). However, it is important to keep in mind that this project is still in its initial stages, and has immense potential, despite the lag in schedule. For example, the CME facility in Ethiopia (the first country to begin the project) is functioning at a very popular rate.

• Also, Customs relaxation, and VAT exemption for the equipment is required on part of the African governments (which has again been a reason for delay in delivery due to lack of coordination between the ministries in charge of the Pan African e-network at Africa's end and the Border control agencies)

Outcomes:

The project itself is fairly recent. Even though it was proposed in 2004, its funding came through only in 2007 after approval by the Union Cabinet in 2007. Each country has a different time line of implementation and outcome achievement according to when it comes on board.

Current status of what has already been achieved
• Tele-Education set up in 3 Indian Universities.
• Tele-Education set-up in 3 regional universities in Africa
• 24 learning centers in 24 African Countries.
• 22 Patient End Hospitals
• 22 VVIP Nodes (for video conferencing and Voice over IP among the Heads of States) in African countries.

Relationship between recipient and donor countries

India – Africa relations go back a long way, and are multi-dimensional. When African heads of states (and other officials), visit sites, and receive a positive feedback – the improvement in relations with India (political, commercial and as a donor-recipient automatically improve) deepen, and increase in scope for the future.

On Sustainability

The project was designed, keeping in mind the sustainable impact of providing educational facilities, and the transfer of technology and medicine.

With the infrastructure of satellites and fiber optic cables in place, African countries can use this nexus to develop their own e-networking agenda – Both internally (urban- rural) and externally (Inter-African).

On the point about replication – one aspect is that of taking tele-education and tele-medicine to rural areas, in order to really make these facilities mobile (there are intentions of doing so in the next phase. The next phase however, will no be funded by the GOI).

Further, TCIL and the GOI are already in the process of proposing similar projects of e-connectivity to other countries in South and South-East Asia.

However, since the project is funded by the GOI only for a term for 5 years, one can raise doubts about the sustainability of such huge investments. Even if internal capacity is built through training, if individual governments do not have the political will to continue funding this project, it will only have benefitted those who are part of it for this first phase.

Positive and Negative Impacts

While the term 'long term' is relative, the Pan African e-network project, as already mentioned operates on transferring skills to locals. This in turn, should create sustained capacity building at least in the arena of education and ITC.

On the downside, as already mentioned – with the future of funding and expansion of this potentially sustainable project undetermined, the impact of building capacity to take this project further is questionable.

Aid Effectiveness:

Admittedly, this project, as an example of SSC enabling better aid effectiveness due to over lapping contexts and common problems of a developing nation are not the cementing factors. However, it does base itself on emerging expertise from the donor country, to be shared and transferred to the recipient as an exercise in building capacity. India has a growing comparative advantage in the IT sector and is becoming amongst the top destinations for medical treatment. For example, Cancer research borne out of India has been highly regarded in the Medical world. In Tanzania, the tele-medicinal centre connects to Cancer specialists in India.

Secondly, the presence of TCIL in Africa for the last 40 years in other ventures helped aid the process of igniting local enthusiasm and trust, as they were participating with a name they were familiar with. Similar is the case for Indian Universities like IIT, Kanpur (India's leading IT School), University of Delhi etc. that have established reputations with the student body in Africa

SSC in facilitating the use of aid for a need based program has been given due diligence. The selection of courses offered, the attempt to have multi lingual classes (especially in French), and the time at which they are held (to overcome time difference between Africa- India), have all been decided after consultations from the coordinators at the A.U.

The program is also cost effective for the recipients as it is all offered to them in their local institutions.

The VVIP Nodes for enabling easy access between heads of states through video conferencing is an attempt to further promote South-South relations between governments.

National leadership and ownership

The project is fully funded by the Government of India and works in collaboration with each individual government in the A.U. based on their independent decision to come on board.

While the project is not aligned with urgent priorities (like tackling poverty, HIV/AIDS etc.), getting on board with the latest developments in ITC is fast becoming every country's agenda – as a way of moving forward and linking themselves to the rest of the world in the 21st century. The Pan African e-network is a big push forward in this direction.

It is important at this juncture however, to note that there has been no effort from the GOI to harmonize and coordinate with other programmes and development actors that may be involved in similar work, causing over-lapping development work.

On the point about monitoring – since TCIL is directly involved in the first five year period, there is an inherent monitoring process that is being undertaken of the local participation in the project. But no attempt to have a third party over view of accounting for the project, its impact and its sustainability has been made.

There is also no requirement of mutual accountability, which leaves TCIL itself unmonitored, in its process of implementation. So for example, when service delivery in certain countries is delayed from TCIL's side, it goes unnoticed.

Capacity Development:

While the project works at two levels, individual and organizational, it's difficult to assign a systemic function to it.

As a tele-education project, it gives access to individual students to gain from learning opportunities abroad. As a tele-medicine and CME service, it gives patients the chance to gain a second opinion from experts in India, and for doctors and nurses to engage with peers on the latest developments in medical science.

At an organizational level, it is allowing the transfer of technology, knowledge and skills to take ownership, operate and use the network provided as per requirement.

Improving overall environment

The popularity of this program can act as a pressure system on African governments to improve their own institutions of higher learning, invest in upcoming fields like e-governance, e-commerce etc.

At then end of 5 years, its success rate will also determine the extent to which it is expanded to other areas, including rural ones.

Duration:

On-going

Budget (Optional):

INR 5429 million – over $ 125 million

Name of Primary Contact Person:

Surabhi Tandon

Title of Primary Contact Person:

External Consultant, ICRIER

City:

New Delhi