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Home    Projects

EMPHIS - Euro-Mediterranean Public Health Information System - 105

Eumedis Project number: 105

EC Project code: 105

Contract "signature" date: 2002-08-02

Planned start date: 2002-09-01

Planned duration: 42 months

Planned end date: 2006-02-28

Actual start date: 2002-09-01

Total Budget: 3.349.292,00 ?

EC Contribution: 

2.679.343,00 �

Sector: Healthcare networks


In the context of the epidemiological transition taking place in the Mediterranean region, a better prevention of infectious diseases still remains a major concern. This issue has been emphasised these last years during several important health meetings held by the European Union. The Barcelona conference (1995), and The Hague (1997) and Montpellier (1999) meetings recommended that prevention of infectious diseases should aim to a more cost efficient strategy and to a more global partnership among health actors around the Mediterranean. In addition, the final declaration of the Montpellier meeting of health ministers of European and Southern Mediterranean countries recognised the importance of developing regional collaboration for the prevention of infectious diseases, based on the use of new technologies facilitating communication and training. Accordingly, the EMPHIS project identifies three categories of critical infectious diseases that would benefit from ICT, namely leishmaniasis (ZCL), tuberculosis (TB) and nosocomial infections (NI). These are three different epidemiological models which involve complementary types of communication.
� ZCL is a vector borne disease highly conditioned by environmental factors. Cyclic emergence of epidemics in the semi-arid belt extending from Morocco to Afghanistan is determined by the density of susceptible human hosts and by the ecological factors favouring the rapid multiplication of the rodent reservoirs harbouring the parasite pool. ZCL is presently one of the most prevalent parasitic diseases in the Southern Mediterranean countries and is expanding to previously safe areas
� TB remains a major public health threat in the Mediterranean region. For the last ten years, due to internal urban migration and to the expansion of the national health care capacities in each country, the total absolute number of TB cases for the three countries has continuously increased from 41.319 in 1990, to 46.622 in 1998. It is expected that this increase will continue in 2001.
� NI are the most prevalent adverse events resulting from health care. It is a world-wide health problem mainly associated with the growing number of elderly and/or immuno-compromised patients, the increased use of invasive procedures and the inappropriate use of antibiotics, either for treatment or prophylactics.
The Mediterranean countries have structured rather efficient health systems and have established surveillance and reporting of infectious diseases as recommended by WHO. However, data collection and communication are too often based on traditional methods (paper based) suffering from slow circulation, unidirectional and poorly interactive diffusion.
Organised electronic communication within and between the different levels and sectors of the national health systems would improve data transmission and the decision process. In particular, the control of the three selected diseases suffer from similar communication drawbacks and will largely benefit from the use of ICTs improving the information flow between care providers, field practitioners, experts, programme managers, decision makers and other stakeholders.


Overall Objectives
* Better monitoring of preventable diseases by enhancing the exchange and dissemination of relevant data and experiences at regional level through the use of ICT to improve communication and networking

Specific Objectives
* To Implement a multi-sectorial (medical, environmental, agricultural and socio economic) integrated GIS in 2 pilot countries.
* To connect Health professionals acting at the peripheral level and national control programs, within the same network at the national level.
* To interconnect TB national program managers at Euro-Mediterranean level through Networking of professionals in health care organisations.
* To organise the access to existing relevant databases, documentation and expert advice.
* To exchange the epidemiological indicators.
* Set up a pre and post doctoral contextual and problem based dynamic training. TB, ZCL and NI sub-projects provide the content models and take advantage of the new pedagogical methods adapted to distant learning meeting the needs of field professionals and other potential end users.
* To disseminate the outcomes among people and institutions having personal and/or professional interests in the issues dealt with by the project.


The EMPHIS project is built as a matrix crossing three transversal activities (which are dynamic portal, dissemination and distant training) with three health demonstrators. These activities are integrated in a common co-ordination and evaluation scheme. The demonstrators have been chosen to cover a representative range of epidemic and communication processes.
EMPHIS intends to develop Information systems within public health practice, care and education in the Mediterranean region, using as pilot projects:
- the strengthening of disease surveillance in Tuberculosis (TB);
- the development of a decision support tool in the control of Zoonotic Cutaneous Leishmaniasis (ZCL) based on a Geographic Information System (GIS);
- the active exchange of data and counselling in nosocomial infections (NI).
Modern Information and communication (ICT) tools will also be used to develop distant learning modules in public health and to disseminate information among end-users. EMPHIS gathers major actors and institutions of public health in 6 countries of the Southern Mediterranean region and 4 countries in the Northern part.

Outcomes for potential exploitation
(i) An extensive use of ICT tools for:
� Development of specific databases and decision support systems (ZCL, TB, NI)
� Access to distant expertise for a better risk management of infectious diseases,
� Access to international databases
� Continuous education and self-administered training,
� Dissemination of epidemiological information and public health `good` practices in the Euro-Mediterranean region.
(ii) A larger number of better trained health professionals at peripheral and intermediate level, actually using distant training on a regular basis.
(iii) A significant increase in the exchange of experience across health disciplines and socio-economical sectors through a common Internet portal that puts into communication at least:
� 20 contents providers,
� 40 institutional end-users,
� in 10 countries, including six Southern Mediterranean countries.
(iv) The coverage of the communication needs of a variety of professional groups: managers at national or regional level, medical doctors, nurses, public health workers. For example, for ZCL in the pilot zone in Tunisia, the number of health professionals who will be reached will be about 100 by the end of the project, with a potential extension up to 2000 at the national level. For TB in the Maghreb region, these figures are estimated to over 400 and 5000 respectively. For NI, ten large hospitals and 80 trainees will use the system during the development phase. At a later stage about 500 hospitals and primary health care organisations could join the network.
(v) Dissemination of information (statistical data, protocols, guidelines for good practice, etc.) inside and outside the health sector.
(vi) Contribution to the harmonisation of public health policies and practices over the Euro-Mediterranean region.
The above results do prepare the ground for the future implementation of a Mediterranean-wide epidemiological alert system for epidemic threats, as recommended by the Montpellier Conference.

Tangible results:
Each of the following tangible results will deserve a special attention with regard to exploitation and continuation of the project in business perspective.
ZCL: A GIS tool for decision support, targeted to the health and socio-economic sectors; the demonstration of the usefulness of such a tool for other health problems at the local, national and regional level.
TB: Establishment of an appropriate surveillance system and communication network allowing for a more tight and rigorous follow-up of ongoing TB patients, in order to reduce the risk of MDR-TB emergence in the Med region. Introduction, through distant learning methods, of the evolving concepts and approaches of TB control in the curricula of medical and non-medical faculties in Med countries and implementation of a continuous training programme for health professionals. Creation and sustained dissemination of an electronic newsletter for Epidemiology and Control Initiative in the region.
NI: A communication tool linking infection control centres and professionals for exchange of surveillance data, technical expertise and counselling. Promotion of good practices and standardisation of preventive measures against NI through a distant training programme.

Estimated impact on target group
The exploitation will benefit from the foreseen impact EMPHIS will have :
� On the population:
Improved medical practice leads to alleviating the burden of infectious diseases. For example, a better management of TB patients decreases the risk of multi-resistant tuberculosis, thanks to a generalized compliance to treatment. For ZCL, identification of high-risk areas will allow appropriate interventions to protect population from outbreaks. For NI, the increased awareness will result in a reduction of morbidity.
� On the health professionals:
Improved computer literacy, easy access to relevant information and life long education through ICT tools will improve the medical practice and the quality of care. Interactivity will also increase field practitioners� motivation and the global understanding of epidemiological issues.
� On the Public Health system:
Filling the gap in the existing communication channels, starting from the most peripheral levels up to the central one, and networking all actors, in particular data providers, will considerably improve the responsiveness and efficiency of the whole system.
The demonstration of the interest of ICT tools for the management of the selected health issues could lead to a generalisation of their use for the prevention of other infectious diseases.
� On other non-health sectors:
Land use: the results of the activity will allow for health risks to be taken into account when planning development projects in tourism, agriculture, town planning�
Education: introduction of distant learning in medical education could foster its use in other disciplines.
� At the Euro Mediterranean level:
A better integration of health policies, allowing reduction of the health risks, will facilitate the circulation of goods and people. EMPHIS will contribute to increase the transparency in the sharing of epidemiological information among the Med countries, in the larger context of the objectives set forward by the 'Information Society'.
Finally, it will facilitate the emergence of co-operative research projects taking advantage both of the data and of the partnerships generated by EMPHIS.


1. A sustainable and smooth running GIS tool for ZCL monitoring and control (WP2).

2. A better communication between the different levels of the health sector allowing an updated monitoring of ZCL and a better risk assessment (WP 2).

3. Appreciated electronic surveillance system on TB in the Maghrebean region (national and peripheral level) and a smooth running electronic communication network (WP 3).

4. Successful introduction through distance learning methods (case studies) of the evolving concepts and approaches of TB control to a large number of health professionals in the Maghrebean region (WP 3).

5. TB control strategies and results are taken into consideration for decision making at national and Maghreb level (WP 3).

6. A smooth running electronic communication tool linking infection control centres and professionals for exchange of surveillance data, technical expertise and counselling (WP 4).

7. A distance learning programme (case studies) on the promotion of good practices and standardization of preventive measures against NI to improve the number of trained health professionals (WP 4).

8. Increase communication and transfer of training information in the field of public health among the EMPHIS network (WP 5).

9. Adaptation of the training programme to the users� needs and their specific constraints (WP 5).

10. Set-up of the Dynamic Communication Support (EMPHIS Internet Portal) (WP 6).

11. The portal gives easy and controlled access to the internal and external resources and applications created and/or validated by the EMPHIS initiatives (WP 6).

12. The Portal is entirely manageable in French and English (WP 6).

13. The Portal only requires a conventional web browser on the end user side (WP 6).

14. Web site known and used by the population, the health professionals and the decision makers in the involved countries (WP 7).

15. A great deal of information material made available (WP 7).

16. Creation and sustained dissemination of an electronic newsletter (WP 7).

17. Creation of Internet points to improve access to the EMPHIS portal services (WP 7).

Project Management: 

The coordinator is in charge of the technical and strategic project coordination and the management of the financial and administrative matters, the production of a quality plan and the follow up of its application.
The work will comprise the organisation and steering of project meetings, project internal reviews, and management of project deviations and follow-up of achievements.
The day to day management will make use of Project NetBoard to keep track of participants� activities (individual monthly time sheets), periodic reporting, follow up of tasks and deliverables in close connection to parallel control of costs commitment and cost claims. Implementation monitoring and project fine tuning report will be the tools for Project Risk Management and reporting significant events that could impact project results.
A "project web site" will be created using the Home NetBoard dynamic groupware platform to exchange documents in any format.

Web site:

Project Coordinator: Henri, DEBOIS (more details ...)

Project Manager: Martina, GLIBER (more details ...)

Leading partner


Fondation Mérieux []

Participating Partners


Agence Nationale de Documentation de la Santé []
Institut National de Santé Publique
Institut Pasteur Alger
Ministère de la Santé - Algeria []
Ministère de la Santé, de la Population et de la Réforme Hospitalière


General Organisation of Hygiene Training in Hospitals and Institutes


Université Claude Bernard Lyon 1 []
Universit� de Technologie de Compi�gne []
Vitamib Sarl []


Foundation for Research and Technology Hellas []


Università Degli Studi Di Torino []


Ministry of Health, Director General of Primary Health Care []


Université Saint Joseph, Faculté de Médicine []


Ministère de la Santé - Marocco []


Institut Pasteur Tunis
Ministère de la Santé DSSB - Tunis
Service Hygiène Hospitalière - CHU Sahloul
Université du Centre, Faculté de Médicine

United Kingdom

London School of Hygiene and Tropical Medicine []