|
|
|
Strengthening Local capacities to Create and Adapt Health Information
AfriAfya: Health Information and Health Education in Rural Kenya
A presentation for the Health Information Forum
22nd January 2002
Chris Wood & Caroline Nyamai
Background to AfriAfya
AfriAfya is an African Network for Health Knowledge Management and Communication, an initiative established by Kenya-based health development agencies to explore new opportunities for harnessing communication and information technology for community health.
In this presentation we would like to describe some of the ideas, challenges, very early results and problems that our new organization AfriAfya has encountered.
Why did we start a new organization?
Among the thoughts that had been circulating were:
a) ICT was expanding and proving useful to many organizations such as hospitals, Ministries, research institutes but the results were not reaching communities
b) Could ICT be used to develop a system whereby relevant health information could be passed to those who need it?
c) How could those who we think 'need information' let us know what information they need?
Discussion led to a workshop to explore 'harnessing ICT for community health'. The topics discussed at the workshop included how to:
a) Increase the availability of up-to-date relevant information
b) Improve methods of communication
c) Increase the skills required to receive and transmit information
d) Change the climate for continuing education
e) Increase public demand for better health care
f) Develop the necessary software for improved communication.
The workshop recognized that all the partner agencies had a problem in this area, and that none of them had adequate solutions. It was therefore proposed to establish a consortium - later called AfriAfya - to explore health knowledge management and communication. A steering Committee was established, a grant proposal developed and submitted to the Rockefeller Foundation, who have funded the current 18 month 'exploratory phase' of our activities.
AfriAfya's Goals and Objectives
Goal
The goal of AfriAfya is to contribute to health and social development in Africa through health knowledge management and communication.
Purpose
The purpose is to establish mechanisms for generating, managing and sharing health knowledge at community level through active institutional networking.
Specific Objectives
The specific objectives of the project are to:
1. Explore and develop mechanisms for harnessing community knowledge and experience.
2. Explore innovative models and technologies for information management and communication at community level
3. Enhance the capacity of members of the network in health leadership, knowledge management and communication
4. Develop training modules for health knowledge management and communication
5. Document and share experiences with others
For AfriAfya it is important that this is not a top-down system that dumps information on communities. AfriAfya's communication network is designed to be a 2-way communication. AfriAfya wants to find out what communities already know, how they communicate, and what more information they want. There is an example from Uganda where a system of communication was set up, which was initially a success, then interest waned down as the information communicated was not what they wanted. AfriAfya wants right from the beginning to ensure it is a 2-way communication.
AfriAfya has set up a hub and identified FCs that will then be set up to explore the use of ICT in these two-way communications. AfriAfya will work through the FCs and help them do their own jobs better by providing them with the necessary information. It will generate knowledge and share it with the FCs, Partner Agencies and outside world.
AfriAfya will aim at sharing of successes and failures - the later helping to avoid wastage of resources repeating the same failures. We will aim at involving communities we are working with in their own decision-making. AfriAfya partner Agencies recognize that we are not competing but are there to serve the community.
Information is a rare kind of commodity, rare in that the more you give away the richer you become.
What we have achieved so far
Process - How we are doing it
- 18-month pilot phase - now 9 months into the project after a full year of planning and sourcing for financial support.
- Setting up office and related logistical issues. MOUs with Partner Agencies.
- Identifying and equipping the 7 different tyepes of FC's. Equipment - a computer and its operating software, printer, WorldSpace receiver and the WorldSpace PC Adaptor - for each FCs. A solar panel for one of the FCs without electricity was installed. Security issues - having to put bars on windows and doors.
- Training FC staff in basic IT skills - basic computer literacy, wordprocessing, and the key skills of the use of email messaging tools and web surfing skills. Demonstration of the WorldSpace receivers and data downloads using these was also done. Staff changes - requiring retraining of lower level cadre of staff..
- Establishing an information network
- Locally among the FC's and the Kenyan health NGO's. AfriAfya Partner Agencies have a lot of varying experience in the community health field that could be shared among the organizations and this was to be encouraged.
- Externally - electronically with Internet resources, mailing lists, INASP and others
- Have started gathering information
- From communities through the FC's - a baseline survey was done at the FCs to establish communication mechanisms and HIV/AIDS information currently being communication and desired
- From the Partner Agency NGO's
- From National sources including the MOH, National AIDS and STIs Control Council (NASCOP)
- From external sources including the Internet
- Modifying the information, making it locally relevant, repackaging and disseminating it back to the FCs who in turn pass it on to their change agents - CHWs, youth groups etc.
- An emphasis on a two-way communication and not a top-down information damping. It was important for the hub to get feedback from the FCs.
- Responding to FCs requests for information
- Sharing of information between FCs - FCs have started sharing information.
- Networking and sharing experiences with others - we have been keen to share our experiences and learn from others in this. We were therefore happy to participate in the videoconference on universal access to health information jointly organized by The Exchange Programme, INASP-Health and the Interactive Health Network. AfriAfya was additionally fortunate to have been participated in the Global Citizen's Congress in December 2001 where a paper was read on our behalf thanks to support from Exchange. Additionally, consultations have been held with UNESCO who have a programme 'Towards a Communication and Information Society for ALL' that seeks to use Community Multimedia Centers (CMCs) to bring together community radio and multipurpose community telecenters to increase access to information, knowledge and communication for community development. Through the Aga Khan Health Services Kenya, collaboration has been invited in this area. UNESCO are currently doing an evaluation of the AfriAfya project in Mtaa Dispensary, and the feasibility of the establishment of CMCs in rural Kenya will be done as a start at this one site with potential for expansion into the other sites.
- Knowledge management software development - a commercial firm has been contracted to develop this and our website for us. Once developed this software will greatly increase the ease with which the information gathered is managed and will form the platform from which the AfriAfya project will be able to share this information with others.
Lessons learnt
- It is possible to set up functional networks between health NGOs, but this does take quite a bit of commitment and time to build up the necessary trust.
- Equipment is not available in the vast majority of community health settings and setting up does remain a major expense - equipment, Internet access etc.
- It is fairly easy to impart the necessary IT skills to community health workers, and with the necessary enabling environment they can be able to themselves collect, compute, utilise and communicate information gathered from their respective communities with other CHW's.
- Two-way communication is essential if the information being provided is to remain relevant to the people on the ground. Keeping the 'right' information flowing - from the users' point of view - does remain a real challenge.
- IT can make it a lot easier to access relevant information at the time and place it is required. There is a lot of information available on all sorts of different health issues and the possibility of information overload is a reality.
- To make this information useful it is, however, necessary to have a process where the information is collated, modified and adapted to the practical realities on the ground. For example, feedback from the FCs where selected web content is being downloaded directly through WorldSpace was that the information is too complex for some FCs and suggested that hub should get together easy comprehensible information that can be given to WorldSpace to uplink.
- We at AfriAfya see ourselves as a Staging Post accessing and receiving information from other levels above us eg INASP, WHO websites, etc, and modifying that information, adapting it and ensuring it is relevant to practical issues in our setting, and then disseminating it to the community-based health intervention sites that we are working with. The quality of information available to us is therefore an important input into this whole process.
- Web resources can help improve the quality of content and presentation for local production. Sites that can summarise reliable accurate information become of particular interest - searching the vast www on bad slow connections can be an absolute nightmare.
- We are currently at an experimental stage with web resources and are open to learn from others who are more versed with this.
Key Challenges
- How to stimulate (and maintain) peoples' interest in acquiring information - steering committee members and the mentoring programme. Relevance, providing information that people do want are important, but what more can be done in this area?
- Getting the information to those who need it. AfriAfya is developing a system of getting information from and to designated change agents. If our system works it will have to be expanded possibly with more computers or possibly with WorldSpace receivers. BUT the real challenge is "beyond the computer". Here we are back to old-fashioned health education. It looks as if we can get relevant information nearer the people who need it but can we get it all the way?
Conclusion
- We are right at the beginning.
- ICTs can help in information dissemination even in rural settings in Kenya.
- Skills transfer to local CHWs is possible
- Access to reliable information sources is necessary
- Traditional communication methods remain important in taking information beyond the computer
- The help that we need to strengthen our local capacity to create and adapt health information can be summarized as
- Access to databases that can act as reliable information resources to us
- People that we can share ideas with
- Funds to keep the initiative going
- Checking validity of information we are sending out
- Dissemination mechanisms to take this information beyond the computer.
|
