Name/Title of initiative: *

Name of institution/organization that executes the initiative: *

Type of institution/organization:

International  Governmental  Civil Society or Non-Governmental 
Academic  Public-Private Partnership  Private Sector

Other participating institutions/organizations:

(Separate names with a comma if more than one)

Category:

Infraestructure  Health Information Systems  mHealth
Telehealth or Telemedicine  Access to Information  Public Policy
eLearning or ICT training  Risk Management & Patient Safety
Patient Identification & Electronic Health Records
Standards & Interoperability  Legal issues  eGovernment
Other  

What health topic(s) does it address?
(comma-separated if more than one)

Where is the initiative being implemented?

Country or countries: *

Locality or localities:

Is there a target group or beneficiary population? Yes  No

If the answer above is yes, please specify:

When did the initiative begin? (mm-yyyy):

Is it still active? Yes  No

If not active, end date?

Description: * Provide an overview of the initiative that includes: a description of the problem being addressed, the main objectives of the initiative and a description of the implementation process, as well as an overview of the results or impact that demonstrate the effect that was had on the initial problem.

Other information could include: Main partners involved and ways in which they contributed; Any obstacles encountered that affected the results and measures taken to overcome them; Budget and resource; Technologies Applied; if there any plan to extend or expand the project in the future; if there any experiences that could be replicated in other areas or contexts ; What could have been done differently and/or better.

Additional Resources:

Optionally, you can include below a number of resources to help better understand and visualize this experience. You can include two links to informative documents (e.g., a brochure, a presentation) and links to a photo gallery, a video, and the project homepage.

Link to Document #1:
Document Title:

Link to Document #2:
Document Title:

Link(s) to video(s): (on YouTube, Vimeo or similar sites)

Link(s) to photo album(s): (on Picasa, Flickr or similar sites)

Initiative website:

Main Contact:

Name and Title of Main Contact Person: *

Institution/Organization: *

Email: *

Name and Title:

Name and Title:

Name and Title:

Name and Title:

If you still need to include contact information for additional key participants, please use the box below.

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