Access to Opioids in Palliative Care in Low-and
Middle-Income Countries: The Case of Burkina-Faso
How
Can Blockchain and Internet of Things Assist?
Type of article: Editorial
Thierry Edoh1,
Martin Lankoande2
1 Department of Pharmacy,
University of Bonn, Germany
2 Teaching Hospital Yalgado
Ouédroago, in Burkina Faso.
Abstract
Background: People requesting palliative care or
suffering from pain are subjected to adhere to opioid-based treatment in order
to alleviate their pain. Commonly, access to opioids is strictly controlled.
Access to Healthcare delivery services remains challenging in Low-and
Middle-Income Countries (LMIC). In Burkina-Faso (BF), a Sub-Saharan African
(SSA) country, patients requiring palliative care (PC) are especially facing poor
access to pain drugs such as morphine. Facing poor access to pain-alleviating
medicine can severely impact the daily quality of life (QoL). On one hand,
patients are experiencing poor opioids access. On another hand opioids abuse,
leading to drug addiction is noticed. The question arising here is how can they
face poor access and at the same time abuse the given drug? One plausible
answer is the counterfeit chain, which provides illegal drugs. Beyond the
counterfeit issues faced, the public health care system is also facing, amongst
others, prescription falsification, fraud in the distribution, and stock
shortage.
Objectives: The main objectives are to fight against
opioid addiction, counterfeits, a stock shortage, and prevent related health
safety issues. The main aim is to enable the traceability of any opioids
prescription, secure the supply and distribution, and thus early detect any
fraud in the system.
This editorial paper would, therefore, focus
on investigating the reasons underlying the poor access to opioids in
palliative care in BF and make suggestions for improvement. A blockchain (BC)
and the Internet of Things (IoT) based system to secure and improve opioids
supply, distribution, and prescription will be proposed.
Method & Design: Mixed-Method-Design was
applied to this study. National stipulations, regulations, and the
state-of-the-art in the field of palliative care in BF were investigated and
analyzed. Based on the investigation‘s outcomes and following the paradigm of
design science research, and information system based improvement solution is
proposed to tackle the poor access to opioids, improve the supply and
distribution chain as well as to efficiently monitor the consumption of opioids
in BF, and prevent patients from any health issues, drug addiction, and death.
Results: The contribution analysis reveals the
potential of the proposed model to assist in many ways to improve access to
opioids and to secure this access. The model could contribute to preventing
drug abuse, overprescription, supporting off-label-use of opioids and thus
providing a knowledge database for off-label use of opioids. This model shows
promise to deliver accurate data and information about the exact opioid’s needs
and consumption atlas. This will assist to better distribute the product in the
entire country.
A proof-of-concept of the proposed model is
required. This is ongoing and will be presented in a forthcoming paper.
Conclusion: This editorial paper investigates access to
opioids in Burkina Faso. It pointed out by analyzing out the computer science
perspectives the different causes of the crisis. A contextualized model is
provided. A test in situ needs to be performed.
Keywords: Poor Access to Healthcare, Drug Supply
Chain, Drug Distribution, Palliative Care, Internet of Things for Healthcare,
Blockchain for Healthcare, Quality of Life, Morphine Provision.
|
Corresponding author: Thierry Edoh RFW-Universität Bonn, Bonn
Germany email: oscar.edoh@gmail.com Screened
by iThenticate..©2017-2019 KNOWLEDGE KINGDOM PUBLISHING. |
1.
Introduction
Morphine is one of the widespread pain-drug
after Tramadol that patients requiring palliative and/or pain care get
prescribed by their medical doctors. Frequently in-taking and misusing opioid
analgesic substances present a severe risk of addiction and can lead to death.
Precisely for these reasons, prescribing this class of drug is challenging for
medical doctors (MD), especially for those who are not trained for palliative
and pain care like anesthesiologists. Though, the global health care system is
facing the illegal drug market with all related issues. Catherine Monfajon, a
French journalist, has investigated the misuse of tramadol
(opioid) in Africa. She reports the outcomes of her investigations ARTE, a
European TV channel. The report is available at
https://www.arte.tv/en/videos/088982-000-A/togo-s-tramadol-problem/ (Available
from 30/09/2019 to 27/08/2022). The results of this work reveal to what extent
tramadol, a painkiller, is misused and becomes in entire Africa a major public
health care problem. Burkina Faso (BF) is also facing this scourge. Painkillers
are easily accessible at the “black market” and people prefer purchasing them
there for simple reasons like (i) high price of the drug at the legal pharmacy
and (ii) lack statutory health insurance [1]. Beyond issues related to
counterfeits of opioids, available at black markets, many public health care
systems worldwide also face overprescribing of opioids [2- 4], prescription
forgery. African countries, especially, face additionally stock-shortage
issues. Disciplinary actions are taken against physicians who overprescribe
opioids [5]. Healthcare authorities, worldwide, therefore, strictly control and
monitor the supply and distribution of opioids. The intention of the healthcare
authorities is to prevent any health safety issues that patients can face by
abusively using opioid analgesic substances. As a consequence, access to
opioids is restrictive. However, the restrictive access to opioid analgesics
like morphine leads or can drive to poor access to palliative and pain care,
especially in Low- and Middle-Income Countries (LMIC).
When analyzing the proliferation of opioids at
the African black market, it is worth noticing that only the politic can
sustainably stem this scourge. The main question arising is to know where these
products come from.
Unlike purchasing fake or counterfeit drugs at
the black market in developing countries, the developed countries face the
import of counterfeits through the Internet. In this case, technology can help
to trace any drug purchase on the Internet.
High-Income Countries (HIC) dispose of
excellent pharmaceutical supply chain and distribution channels (like high
modern pharmacies and modern drug transport logistics). There also exist legal
and regulatory stipulations governing the distribution or sale of medicine,
especially opioid analgesic substances. In Germany, for example, only a few MD
can prescribe opioid analgesic substances since they are classified as a
narcotic drug. The prescribing of these substances is restrictive and strictly
regulated. For traceability and health safety purposes, MDs are under the duty
to use a special prescription form (Gelber Arztrezept, eng. yellow prescription
form) to prescribe such drugs. Each form is registered with the health
authorities, has a serial number, and is a bundle of three strains. The MD, who
has prescribed the substance, keeps a strain the pharmacist also keeps one
strain. The last strain is sent to the healthcare authorities. Each
prescription must be reported to the health authorities. All these legal
dispositions demonstrate how dangerous the said substances could be. The main
objectives that healthcare authorities are pursuing in this case (Germany) are
to prevent narcotic drugs addicted to forge prescription or misuse and, thus,
prevent them from health safety issues.
While high-income countries (HIC) have put
effort to prevent any misuse of opioid analgesic substances as well as trace
the provenance of opioid analgesic prescription and thus, ensure access to
palliative and/or pain care (P&PC), LMIC are facing various challenges
issues regarding the opioid analgesic accessibility. Purchasing pharmaceutical
products in LMIC is commonly challenging since most pharmacies are facing
stock-shortages for multiple reasons Stock shortage, price of the medicine,
cheap counterfeits available at the black market, and lack of health insurance
to cover health-related costs are the leading causes of poor access to pharmaceutical
care in LMIC. Beyond these causes, poor supply chain and distribution systems,
as well as lack of possibility to trace the prescription
provenance, are additional causes of poor access to opioid analgesic substances
such as morphine in LMIC. Therefore, the first research question is What are the leading causes of morphine stock shortage in BF? In BF, the
pharmacies are provided with opioids by the government. No pharmacy can, at its
own, order abroad opioids. Though, this aims to investigate Why the government is supplying a low stock of morphine?
Nowadays, modern technologies are used to
improve health and pharmaceutical care accessibility in HIC as well in LMIC
[1], [6]– [8]. and to collect data [9]. Since modern technology has shown
promise to assist to overcome challenges and issues in certain fields of
healthcare, it, therefore, judicious to develop an information system model
using modern information and communication technology (ICT) for improving the
opioid supply and distribution chains with the main objective to prevent any
drug abuse as well as prevent the population against health safety issues. This
model should include the traceability of prescriptions from their genesis to
medicine purchasing. The research question arising here is Can modern information and communication technology
assist in solving the morphine accessibility issues and challenges faced?
What are these challenges and issues? Furthermore, this study foresees to
investigate how to use the technology to prevent health care professionals
including pharmacists against legal liability. Though, the study's relevant
question is How to secure the morphine
prescription and trace the provenance in order to prevent healthcare
professionals such as pharmacists and medical doctors to face any legal
complaint? The objective of the
case study on morphine accessibility challenges and issues in BF, which is
reported in this paper is to provide a better understanding of the issues
causing the poor morphine accessibility in Burkina-Faso (BF) and to propose
innovation solution approaches using modern information technology. The main
focus of this study is on design, implementing, and deploying an information
technology-enabled poor access solution rather than palliative and pain care
delivery and why medical doctors decline to prescribe opioid analgesic
substances. This study just focuses on ensuring prescription provenance.
This research seeks to answer the main research
questions and verify the hypotheses.
2.
Problem
Statement and Analysis
The analysis of the opioid supply and
distribution process (supply and distribution chains) at the legal “drug
market” in Burkina Faso, the prescription and the purchase at a pharmacy,
reveals that the government controls the provision of most products from abroad
and many different health bodies monitor the distribution and collect
information on the distribution and consumption of legal drugs. This procedure
is similar in all developing countries which lack pharmaceutical industries and
must purchase abroad. In Africa, especially in BF our study case, the ministry
of health (MoH) oversees coordinating, purchasing opioids abroad. Prior to the
order abroad, many structures of the MoH, like DGPML, select and determine the
number of opioids to be ordered. The structures of the MoH are also in charge
of supplying the purchased opioids to legal pharmacies in the entire country.
The opioid regulations and stipulations request
pharmacies to report the movement of the opioids as well as the consumption.
For these purposes, paper-based report forms have been prepared [10].
Paper-based reports are limited and can bear errors since the information
containing is transcribed by human beings. Furthermore, the stipulations
request the pharmacists to lock the product in available deposit boxes and,
thus, prevent any inappropriate access to the product.
The health care system further faces
prescription forgery problems. Many addicted people use that way to legally buy
opioids and misuse it. Medical doctors overprescribe these medicaments for two
reasons (i) they have no control over the patient records [Medical Record
issues], thus, they are not really aware of being overprescribing. (ii) Provide
a better quality of life to the patient in prescribing the product off the
label what results in overprescription and off-label-use of the given product.
With respect to above-discussed issues and
analyzing the whole out the perspective of computer science, a question is,
therefore, arises to what extent can the Information System assist to overcome
the given issues in order to:
1.Improve access to opioids?
2.Ensure health safety and prevent any opioid
abuse and addiction?
3.Secure the drug stock against frauds?
4.Assist medical doctors in prescribing and
thus avoid or prevent overprescription and off-label prescriptions?
5.Build a knowledge database for off-label use
of opioids?
6.Improve information collection on opioids
consumption and thus precisely determine the needs of opioids in the whole
country?
7.Assist the MoH and affiliated department to
gain accurate information?
3.
Blockchain
and Internet of Things IoT based Contextualized Model
The main issues, when the problem is analyzed
in the viewpoint of computer science, are on one hand the information gathering
methodology and the support used for this purpose. On the other hand, the BF
public health care system like most African care systems lacks electronic
medical records (EMR). The problem analysis points out the association between
the lacking EMR/EHR and overprescribing.
This section presents a contextualized model to
overcome the issues facing.
4.
Drug
Supply chain, Distribution and Consumption Report
BF MoH provides some directives [10], [11] on
how to monitor the distribution of opioids in the entire and how to determine
the number of opioids that the BF health care system needs. Purposely, the
different department of the MoH, hospitals, clinics, as well as the pharmacies,
are being provided with paper-based forms to report the consumption by
inpatients, opioids purchase at pharmacies, the quarterly countrywide
consumption report.
A Blockchain-enabled report form is proposed to
improve and ensure the different reports. Blockchain technology is combined
with the Internet of things (IoT) technology (Figure 1) for this purpose.
Blockchain (BL) can assist to secure the system entries (data and information)
so that no change can happen during the transfer from one station to the other
(e. g. from a pharmacy to local government service and vice versa). No one can
change any information without informing the other partners on the network.
Data consistency and integrity are though guaranteed. It will be easy to detect
fraud and who commit it (the essence of blockchain). Each actor on the
blockchain network owns a copy of each transaction (reports on opioids, etc.).
BL can, therefore, assume system robustness and prevent against cyberattacks,
assure data integrity [12]. Since Blockchain fundamentally opts for
transparency where transactions are cryptographically signed but unencrypted,
sensible medical data needs additional technology to encrypt the data so that only
authorized persons can access the information containing in the data.
Today, there exists various blockchain-enabled
health platform to better secure health generated data. In [13], the authors
present healthbank, a blockchain-based platform, for securing health data.
Beyond the security and privacy aspect, Blockchain technology, a distributed
ledger technology (DLT), relies on secured distributed database technology,
which history is traceable [14]. BL can be used for an efficient supply chain
process. It assists to reduce transaction costs and time. It improves
visibility across the supply chain and thus offers increased transparency since
the entries (ledgers) are open for any trading partner [15]. The government and
the pharmacies are trading partners, where the government is the supplier in
this context. BL Technology would, therefore, provide more transparency,
connect government institutions to the pharmacies for better control and
monitoring of opioid consumption, prevent fraud, and would provide accurate
information on the real opioid needs or demand.
IoT technology has the potential to judiciously
autonomously and automatically collect data dependently on the system settings.
IoT is using for many health applications such as patient remote monitoring
[16]. Originally, IoT uses RFID (Radio Frequency Identification) technology to
identify any movement an object is making [17]. Today, many perception units
like sensors are used to catch data that are transmitted over the IoT platform
to a remote server (e. g. often in the cloud). Using this technology to monitor
will assist to seamlessly collect accurate data on opioid consumption,
distribution in the entire country. The collected data will assist the
government to accurately to determine the opioid’s demand and needs countrywide
and, thus, it could order the required number of opioids. Ordering the exact
required number of opioids will partially resolve the opioid shortage since the
new cases could be predicted by the system. Based on this, a prediction system
is needed on top so that the government can forecast supplement orders of
opioids to face new palliative cases and related opioid demand.
As a Study assumption
Combining both BL and IoT could assist, on one side to
accurately collect information from pharmacies, hospitals, and clinics. On the
other side, this will resolve the opioid shortage (H1).
Figure 1 shows the architecture of a blockchain
for the internet of things. Collected data are automatically stored in the
distributed database underlying the blockchain part of the system. The
traditional data ingestion layer of an IoT architecture is though replaced with
the data ingestion layer of the blockchain. The docked blockchain architecture
includes two technologies to assure data interoperability by data exchanges
within the blockchain network. Both technologies are (i) HL7 assist to format
medical data and (ii) FHIR assure secure and interoperable data exchanges. A
smart contract processor assists in computing smart contracts between the
different nodes on the network.
3.2.
Combating Drug Abuse and Counterfeits
Overprescription of legal opioids, unaware
off-label use of opioids, sale of counterfeits available at the black market
are direct causes of opioid abuse that can lead to health safety issues as well
as death.
Despite numerous efforts that the government is
putting together to stem the counterfeit scourge in the entire country, many
addicted purchase opioids at the black markets, even palliative patients also
purchase opioids at the black market for diverse reasons such as high prices at
the legal pharmacies, a stock shortage, addiction, intensive pain, etc.
The proposed model foresees a social media-like
platform for monitoring and collecting data about drug abuse. Parents,
relatives, or friends can anonymously report cases of drug abuse. Any addicted
can report on himself and ask for help. Beyond the monitoring platform,
video-based visual monitoring systems must be used at places like schools,
universities, and other public places. This video-based monitoring should work
like the system proposed in [18] to monitor flooding events. Using video
sensing presents many advantages amongst others, the dissuasive effect of the presence
of the video. Combining both video sense, included in the IoT system, and the
social platform will assist to reduce the extent of illegal intake of and deal
with opioids at any public place. Though, counseling works need to be done with
young addicted people to show them the negative impact of illegally intaking
opioids.
Combating counterfeits using information
systems in the context of Africa, and particularly in BF would not work because
consumers (patients and addicted, health bodies and others) are aware that the
products sold at the market are counterfeits, though they purchase them due to
the high prices practiced at the legal pharmacies. A prominent approach here
will be to launch health insurance that will cover medical expenses.
Unlike counterfeits available at the market,
commonly and wrongly called “Generic drug”, some counterfeit drugs are being
sold in pharmacies. Though, since 2015 a verification system called MPedigree
is used to fight against counterfeits drugs in Africa. However, MPedigree
presents some limitations since only the drug’s containers or packages are
labeled. One can replace the package’s contents with counterfeits and retail
the legal drugs in detail since selling detail is often practiced in Africa.
The drug’s packages need to be sealed and can only be open with a unique key
that can only be tried once.
Blockchain technology can also be applied to
secure drugs against fraud. This topic will be discussed and a model will be
presented in the forthcoming paper.
3.3. Improve Off-Label Prescribing and Use of
Opioids
Off-label prescribing and use is a worldwide
phenomenon. Many countries own stipulations and regulations regarding
prescribing and using a medicine off label. In Germany, off-label is legally
allowed but strict regulated, while this is strictly forbidden in the USA.
Off-label prescription and use mostly rely on
long-term experiences of medical doctors. Therefore, the proposed model
features large and decentral/distributed knowledge database using the
blockchain technology to secure the entries again falsification but keep a high
level of transparency so that any health care professionals can benefit from
experiences of others (experiences exchanges with same requirements as data
exchanges).
Figure 1: Architecture
Palliative Care related data and documents exchange system architecture (using
Blockchain for the Internet of Things)
3.4. Overprescribing
The further problem the BF public health care,
as all other public health care systems, opioid abuses. Patients or people can
access certain opioids like tramadol at the black market. Unlike tramadol,
morphine is difficult to be purchased at the black market. In order to control
the morphine intake, the MoH released several directives like monitor exactly
who dispenses the products, who consumes it. These details have to be provided
to the government. Though, many people forge prescriptions and can thus
“legally” and easily purchase the product at a pharmacy. This model has
answered the question of how technology can assist here to prevent prescription
forgery, overprescribing, and opioid abuse.
To avoid overprescribing, medical doctors (MD)
need more information on patient medication. However, such information is often
recorded in a booklet kept by the patient at home. Such booklets are lost and
the containing too [19]. Depth analysis of the overprescribing issues reveals
that the lack of medical and health data following by off-label use of the
products is the leading cause of overprescribing. Regarding the leading causes,
a disturbed and ubiquitous electronic health / medical records (EMR/HER) system
is needed to centralize the patient-data. These data would be accessible
anywhere and anytime so that the patient can visit any MD they want.
EMR systems as required here should be robust
against any cyberattack in order to prevent any data integrity issue. Combining
blockchain technology with HL7/FHIR (Health Level 7/ Fast Healthcare
Interoperability Resources) presents two advantages
(i) data integrity [20]and (ii) interoperable
data exchange supported by HL7/FHIR standards. FHIR uses external cryptography
to enable data privacy and integrity. The model foresees to uses the FHIR,
standards to enable data interoperability, on the blockchain technology to
distribute and secure the data. In [21], the authors implemented a
blockchain-supported EMR that enable the data interoperability and secure the
data. However, their proposed solution does not use the FHIR standard. HL7 and
FHIR are the widely used standard in the medical field to feature data
interoperability. EMR carries important data that can impact patient health
outcomes [22].
Additionally, to Blockchain technology, the IoT
can also contribute to collect key data that could be integrated into EMR.
The second assumption is that
EMR can contribute to
reducing overprescribing and stemming prescription forgery.
(H2)
However, the model is limited to fight drug
abuse supported by black-market opioids. Figure 2 presents at a glance the
architectural view of a prescription supporting system. The medical doctor is
connected to the patient medical records, lying in the central database. The
data exchange between the medical doctor and the medical records system is
supported by the blockchain technology in order to assure data integrity during
the transaction. Any prescription is forwarded to the blockchain network
comprising the MoH, health bodies, patients, pharmacies, and any relevant
actor. The system automatically provides the patient with a copy of the
prescription that he will use to purchase the given drug.
Figure 2: Prescription Process
(Preventing any overprescription)
4. Contribution Analysis
This section analyzes the contribution of this
editorial study to the literature as well as to the improvement of palliative
care in BF. Two assumptions (H0 & H1) were made and need to be verified.
4.1. Research Questions
The main research question is substantially to
investigate the causes of the poor access to palliative care regarding the
availability of opioids. Based on the findings of the investigation, a novel
model should be built to tackle the causes.
This section aims to figure out the novelty of
the proposed model in the context of palliative care in Burkina Faso (BF) and
the contribution to the literature.
Four research questions are presented in the
introduction. Mainly, this editorial paper aims to investigate to what extent
ICT can assist to improve the palliative care in BF, whereby
to secure prescription against any forgery in order to prevent health safety
issues. A further question is how ICT can underly the reporting process.
Most questions are already answered in the
literature. Though, the answers need to be adapted to the context. Therefore,
the context related questions are still open and are judicious to be posed.
4.2. Theory of Changes and related Risks
Two major assumptions were made regarding the
improvement objectives. The health informatics literature widely presents cases
of IT solutions that assist to improve care delivery and processes. Though, regarding
the context (BF a financial and technological resource-poor country), the H1
can become challenging. Therefore, in situ-tests need to figure out.
H2 assumes that EMR can contribute to reducing
overprescription. Theoretically, when the MD is aware of the medication history
of a patient, he can adjust his prescription. Though an in-situ test is needed
here too.
4.3. Evidence Gathering
At this stage of the study, the long-term and
longitudinal test is in preparation to be conducted in the entire country to
collect an important amount of data for evidence. The literature review and
studies conducted prior have shown the potential of information systems to
improve the health care delivery process and health outcomes.
4.4. Contribution Assessment
IoT is facing huge roadblocks such as
automation, interoperability, and security issues such as data privacy. Using
blockchain for IoT could solve some of these issues. However, Blockchain in its
fundamental transparent. The novelty of this work is to combine FHIR and
blockchain for IoT. FHIR on the blockchain will assume the data
interoperability among the system and the IoT part will assist to autonomously
and automatically collect data and secure them. In [23], a concept called
FHIRChain is design and implemented. The evidence of the FHIRChain architecture
has shown promise to fulfill the requirement of the Office of the National
Coordinator for Health Information Technology (ONC). ONC requires all hospitals
and clinics based in the USA to adhere to a secure and scalable data sharing to
enable collaborative decision making. The objective of this requirement is to
support interoperable medical data sharing. Based on the test conducted in the
study reported in [23], and a prior study conducted on IoT in medical
Emergency, the proposed model has the potential to produce accurate data, which
can secure the opioid distribution, improve access to opioids in the entire
country since the opioid order and supply chain will rely on accurate data on
the real needs of the population. Paper-based reports would be replaced by
digital report form, which gets automatically filled using the IoT technology
without any manual implication.
4.5. Additional Evidence
This paper presents a Blockchain combined with
FHIR on IoT Technology to improve access to opioids in Burkina Faso. Improving
access to opioids implies to improve the supply and distribution chains,
prevent opioid abuse and addiction by monitoring the prescription
in order to prevent overprescription, hinder prescription fraud. It is also
important to monitor and enact off-label prescription and use regulation.
Though the design and implementation and
although, that blockchain on FHIR has shown in the USA, additional evidence on
the blockchain on IoT technology using FHIR for data interoperability is needed
to be collected in the context of palliative care in BF in order to show the
potential and feasibility of such a technological and financial resource-poor
health care system. The additional evidence collection is pursuing the
objective to conduct an action study and thus adjust the designed model till to
find out the suitable model parameters.
4.6. Revision of the Contribution
The revision of the contribution will be
performed afterward the evidence gathering in the scope of an action study.
5. Conclusion
This study presents the opioids crisis and
abuse. It focuses on Burkina Faso and analyzes the different factors
contributing to the opioid shortage, challenges, and issues to adequately
monitoring the opioid consumption, the supply chain, as well as the order
aboard. Depth analysis of the directives released by MoH has revealed the
limitation of these directives. A contextualized model proposed has the
potential to overcome the different issues, though it is limited to stem the
illegal distribution channel, which is the black market.
6. Future Work
The
implemented and test of the proposed model will be reported in the future
paper.
7. Conflict of Interest Statement
We certify that there is no conflict of interest
with any financial organization in the subject matter or materials discussed in
this manuscript.
8. Authors’ Biography
Dr. Thierry Oscar Edoh is an
associate and affiliated researcher at the University of Bonn (Germany)/
Department of Pharmacy, visiting associate lecturer at the Institute of
Mathematics and Physics (IMSP)/University Abomey-Calavi, (Benin-Africa),
visiting lecturer at IUT Lokossa (Benin-Africa), and an affiliated researcher
at the Technical University of Munich/department of Applied Software
Engineering (Germany). He is a guest lecturer at many African, Asian, and East
European Universities. He received his Diploma in computer sciences from the
Technical University of Munich in Germany and held a Ph.D. at the German
Federal Army University, where he worked for several years on the improvement of
rural health care provision and access to healthcare in developing countries
using ITC systems.
He performed postdoctoral research at the
University of Bonn (Germany)/department of pharmacy. He worked on Drug
Regulatory Affairs with a focus on Knowledge discovery and Drug marketing
authorization. He is a member of IEEE.
Dr. Martin Lankoandé is
anesthesia and Intensive Care physician, at the teaching Hospital Yalgado
Ouédroago, in Burkina Faso. He received a Diploma in medicine from the
University of Ouagadougou in Burkina Faso and holds a master's in
anesthesiology from the Catholic University of Louvain in Belgium. He was
award-winner of the first prize for excellence at the Burkina Faso National
Secondary Education Olympiad Competition in 2004, the best prize of palliative
care diffusion at the French-speaking international palliative care federations
in Paris in June 2019. His research interests are anesthesia, intensive care,
pain and palliative care, health informatics. He has authored about 30 original
papers.
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