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SUMMARY OF EMAIL DISCUSSION ON HIF-NET@WHO:  ‘Role of CD-ROMs’

See also Health Information Forum: Role of CD-ROMs 
CD-ROM Exhibition

4 November 2002 – 4 February 2004

These notes summarize the HIF-net discussion surrounding the use of CD-ROMs and other media by health professionals in resource-poor settings. It began with questions posed by the moderator about the role of CDs in advance of the face-to-face Health Information Forum meeting on 25 November 2003 in London. Additions made since 28 November 2003 are in italics.

FRAMING THE DISCUSSION

This thread includes debate on the pros and cons of various media and discussions on the availability of health resources on CD, knowledge of that availability, and uses of CDs and other electronic media for health. The three overarching themes to date are:

• Most contributors say they or those they work with favour CDs over online access to resources because internet connections are absent, too slow and/or too expensive.

• Many wish for a catalogue of available health CDs

• Core uses of CDs are learning and teaching, research and resource access (e.g., journals) and medical data storage and retrieval (including images).

One key question is yet mainly unanswered: "Which CD-ROMs do you find most useful, and why?"

CONTENTS:

BUILDING A CD CATALOGUE
WHICH MEDIA AND WHY?
EXPERIENCES FROM MEDIA PROVIDERS
USABILITY AND RELEVANCE
SUGGESTIONS
USES OF CDs
RESOURCES/ORGANIZATIONS
DEFINITIONS
CONTRIBUTORS

BUILDING A CD CATALOGUE

• Producers could provide core information to be listed in a catalogue, including: intended audience, purpose, subject (using indexed keywords), style of content, accuracy, currency of material, update schedule, technical requirements, pricing, publisher and any associated support available.

• Reviewers would be needed to provide additional content including rating on ease of use, accessibility, functionality, display options, and an overall quality.

• Feedback from users could help feed into the reviews.

• Standardised evaluation criteria might help producers conform to common standards.

• The catalogue itself would need to be online an on CD.

• Several members noted how helpful even the limited catalogue produced by the HIF meeting is (see RESOURCES section below).

• Several members volunteered to help with this endeavour.

WHICH MEDIA AND WHY?

• Alternatives to CDs include DVDs, VCDs, email, online, VHS video and print. Below is a rough summary of views on the pluses and minuses of each (better to worse from left to right):

• Both CD and DVD data storage capacity are expanding with new technologies.

• Lack of an accepted format standard inhibits adoption of DVDs.

• VHS video may soon be obsolete with VCDs and DVD taking over.

• Postage is a main production cost for CDs. For example, half the costs of providing the Malaria Online CD are postage. [Abbott Diagnostics, the project sponsor, estimates that producing, packaging and posting 1000 CDs costs about 9,600 UK pounds.]

• CDs allow for indexing while email does not.

EXPERIENCES FROM MEDIA PROVIDERS

• High demand for CD versions over online versions of resources, even sometimes in richer countries.

• Permission for unlimited copying of health resource media enhances dissemination.

• User training is required not just for using the resources directly, but for cataloguing them and integrating them into their daily health work.

• Providers should write up and share their experiences, though this can fall by the wayside in the face of more immediate pressing matters.

• Materials produced, edited and/or adapted in the context in which they will be used tend to be more relevant and accepted than 'international' ones.

• Making videos locally has become easier and less expensive. In one project, successful video editing training took 5 days.

• Both a health video and health CD project found these resources to be effective according to knowledge and practice measures before and after usage.

• An AIDS resource centre in Papua New Guinea has found 30-40 reproductive health CDs to add to their library of video and print materials. They plan to distribute the CD collection to regional staff and provide training via travelling staff from central office, and to create a local CD.

• Like other resources, CDs need to be organized and labelled appropriately to be useful as part of a resource library.

• List members who produce media not only used this forum to share experience but, in at least one case, to build links to further CD dissemination (between e-TALC and Gadjah Mada University, Indonesia).

USABILITY AND RELEVANCE

• A key question on this topic went mainly unanswered: "Which CD-ROMs do you find most useful, and why?"

• Having knowledge of what is available seemed to be the main barrier to usage.

• Several people mentioned that locally relevant content and language are desirable, and are achievable through local production or adaptation.

• A member suggested providing materials in both English and the local language can help develop English skills as a side benefit.

SUGGESTIONS

• Many people desire a catalogue of health CD-ROMs available in a variety of media, including the following information: summary of content and purpose, target audience (including literacy or technical knowledge required), review of effectiveness, category (e.g., learning, statistics database, journal abstracts), costs and ordering details. [See last bullet in the Resources section.]

• One participant suggested investment in low-bandwidth connection and DVD-enabled computers is the way forward for e-learning. DVD would be used to disseminate the bulk of the content and then email and live chat among learners and instructors would support it.

• National postage services could be lobbied for reduced rates for health education material.

• Redistribute resource CDs such as older Cochrane library disks.

• The WHO Blue Trunk Library (a collection of over 100 books on medicine and public health plus with three medical journals subscriptions packaged in a blue metal trunk) could be put on CD.

• As e-media increasingly dominates, we must ensure print is still available to those without access to these technologies.

• HealthNet reports that users prefer text to be given in a contextual framework. This is hard to provide in any depth with frequent publications but a CD twice annually would create an opportunity to assess what to include and provide commentary and context. 

• A template for applying for funding from donors to develop CDs and other IT-related projects might help increase application success.

• Regional hubs should be used to aid communication between producers and consumers and  help distribution of CDs.

• Capacity building projects should put their training materials onto CD for ease of further dissemination and reuse.

USES OF CDs (and other e-media)

• Training and education was the most mentioned usage, including CME and patient education.

• Research, resource and publication access (e.g., journals, newsletters, abstracts, databases)

• Copying, recording and storing medical data (including images).
  

RESOURCES/ORGANIZATIONS (Links checked and okay on 4 Feb 2004 unless noted)

• Malaria On-Line Project. Provides information and training about preventing, identifying and treating malaria for medical workers. Available on CD and online at no cost in Spanish, French and English. www.rph.wa.gov.au/labs/haem/malaria/index.html 

• WHO Reproductive Health Library (RHL). Provides evidence for reproductive health care, including editorials, beneficial and harmful practices, systematic reviews and expert commentaries, implementation aids, articles on research synthesis methodology, and Internet links. Available on CD in English and Spanish, free for developing countries. www.who.int/reproductive-health/rhl/dissemination.html 

• The Health Systems Trust in South Africa publishes the South African Health Review (which is an annual publication on an overview of healthcare provision progress in South Africa) online (at no cost) and in print and on CD for a small fee. www.hst.org.za 

• Instituto Peruano de Paternidad Responsible (INNPPARES) has produced an HIV/AIDS education CD, in Spanish, for teenagers. www.innppares.org.pe  (not working on 4 Feb 04)

• ExtraMED, an electronic collection of over 300 biomedical journals from the developing world, will soon be free on BioMed Central, though is no longer being produced on CD. www.biomedcentral.com 

• Adroit Insights, a health communication firm, creates health media resources for doctors and patients. www.adroitinsights.com 

• Gamos has created DVD, CD and video media based on content from the 'Facts of Life' health promotion series. www.gamos.org 

• CABI Publishing is cataloguing health CDs as part of their Global Health bibliographic database, available online and via CD subscriptions (www.cabi-publishing.org). The CD directory may become part of a catalogue that Source wishes to develop (www.asksource.info) 

• e-TALC, which collates contributed health, educational and training materials onto searchable CDs, has sent out 30,000 CDs since June 2002. Free to developing countries. www.e-talc.org

• The list of CDs exhibited at the Health Information Forum 'International Health CD-ROM Exhibition' at the Wellcome Trust, London, 25 November 2003 is online at www.inasp.info/health/workshop32/cdroms.html

DEFINITIONS [Adapted from www.computeruser.com/resources/dictionary] : CD-ROM = Compact Disc Read-Only Memory. Physically the same as an audio CD, but contains computer data. Storage capacity is about 680 megabytes. VCD = Video Compact Disc. A CD that can display full motion video and sound. Using 650/700MB CDs, can hold up to 74/80 minutes respectively. Quality is similar to VHS based tapes. DVD = Digital Versatile Disc or Digital Video Disc. Has about 7 times the capacity of a CD. Can be used for multimedia and data storage. Can store a full-length film with up to 133 minutes of high-quality video and audio.

CONTRIBUTORS

ANUPAM AGGARWAL is a public health physician and medical publisher, based in Mumbai, India. He is Director of Rural Health Communications Pvt Ltd. He is particularly interested in the provision of information for health care providers in rural India.

SIMON BATCHELOR works with Gamos, UK. Having started his career in the eighties with appropriate technology (water and agriculture), Simon worked throughout the nineties on social empowerment using innovative creative thinking techniques to help communities problem solve. Over the last five years he has become increasingly interested in the potential benefits of the new technologies for poverty reduction, and consults on Information and Communication for Development.

IBRAHIMA BOB works at Africa Consultants International, Senegal. He is also president of AHILA, the Association for Health Information and Libraries in Africa. He is the coordinator of the Open Knowledge Network, Francophone West Africa. His professional interests include improving access to information in developing countries, Internet training, and information resources for developing countries.

KURT BRAUCHLI works for the University of Basel, Switzerland, where he is developing the iPath telemed software. This forms the technical support for the West African Doctors Network. Kurt also helped to set up a histopathology lab and telepathology service in Honiara, Solomon Islands.

STEWART BRITTEN worked in Britain as a child psychiatrist, though also trained as an adult and child psychotherapist. His main interest is prevention of, and early intervention for, child mental health problems. He works with the British NGO HealthProm in Russia and Uzbekistan.

ANDY CRUMP is Information Designer with the UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR) <http://www.who.int/tdr>.  He is a multimedia information designer with interests and experience in research, technical, non-technical authoring, graphic design, visual literacy, cultural literacy, communication theory, training, and psychology/behaviour. He specializes in Environment and Development issues, photography, video/TV, CD/web and all forms of electronic publishing.

JOHN EVANS works as a short term adviser at the Papua New Guinea National HIV/AIDS Support Project. The project is aiming to place print and CDROM health collections at all hospitals, nurse training institutions, research institutions, universities, > relevant NGOs, teacher training and functioning public libraries as well as national and provincial AIDS offices in Papua New Guinea.

BILLY FUTTER is an Associate Professor in the Faculty of Pharmacy, Rhodes University, South Africa. In the context of this discussion thread, he is interested to make more effective use of e-learning opportunities to encourage ownership of learning by students and, more particularly, to inculcate a culture of life long learning.

ERNESTA GREENIDGE is the Head of the Medical Sciences Library, University of West Indies, Trinidad and Tobago.

METIN GULMEZOGLU works at the Department of Reproductive Health and Research at WHO headquarters in Geneva. <www.who.int/reproductive-health/rhl/index.html> 

MOHAMMAD NAGI HADI as Sudi works as a health communications specialist with the National Centre of Health Education and Information, Amran, Yemen.

MARK HEPWORTH is a lecturer in Infomation Science at Loughborough University, UK.  He teaches information retrieval and the development of user-centre information services.  His main area of research interest is understanding people's information and knowledge needs, how they interact with information and how information should be provided to enable access. Two recently funded studies concerned the information needs of informal carers and people with multiple sclerosis. These studies led to recommendations for and improved information provision to these communities. Other areas of research include: the impact of physical and psychological disabilities on access to and use of information; and information literacy and skills.

DICK HOOPER is a Peace Corps Medical Officer and Independent Health Consultant, English Speaking Medical Group of Rabat, Morocco.  He is working to develop primary care and family medicine in Morocco.

CORNELIUS HOPMANN is an Independent Consultant for eReadiness and Development in Nicaragua. He coordinates the Nicaraguan Country Gateway Project. His contribution was an extract from a message posted on the GKD-DOTCOM listserv (Digital Opportunity through Technology & Communication Partnerships) and forwarded to this list by the moderator.

GRAHAM ICKE is Principal Scientist of the Division of Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia. The Royal Perth Hospital Malaria Education Campaign aims to make malaria education freely available to all, either via the internet or for institutions without, or with only limited internet access, via free CD-Roms. The resource is available in English, French and Spanish.

PETRIDA IJUMBA is an editor with the HealthLink Programme, Health Systems Trust, South Africa. She is interested in HIV/AIDS and its impact on development, and health promotion.

ELIZABETH KAMAU is a PhD student and a lecturer in nutrition in the Department of Food, Nutrition & Dietetics at Egerton University, Kenya.

HOLLY LADD is the Executive Director of SatelLife (HealthNet). SatelLife is an international non-profit organization that fosters the global exchange of information among health professionals, focusing on the needs of the developing world. Its services include global discussion groups (eg AFRO-nets), GetWeb, and a range of email publications.

DAVID MORLEY is Professor Emeritus at the Institute of Child Health, Tropical Child Health Unit. He has been involved with Teaching Aids at Low Cost (TALC) and Child-to-Child for many years. His particular present concern is in creating a reading culture among health workers and assisting numeracy by involving family and community in measurement of their children.

AMUNGWA ATHANASIUS NCHE works as a principal senior nurse in Bamenda, Cameroon. He is also Chief of Bureau Research and Documentation.

WENDIE NORRIS works as content editor for human sciences at CAB International, UK. She has a background as a research scientist in developmental biology.

B OWOYELE works in the department of physiology and biochemistry at the University of Ilorin, Nigeria, as a lecturer of human physiology to medical and BSc. physiology students. Research interests include animal models of pain.

NEIL PAKENHAM-WALSH prompted and moderated this discussion. He has a background in medicine and medical publishing, including work with the World Health Organization, the journal Medicine Digest, and the CD-ROM series Topics in International Health (Wellcome Trust). He has worked as a medical officer in rural Ecuador and Peru. He currently runs the INASP-Health programme (International Network for the Availability of Scientific Publications), which aims to support cooperation, analysis, and advocacy among those working to improve access to reliable information for healthcare workers in developing and transitional countries.

ASHUTOSH PRADHAN is a medical doctor, medical communicator and consulting homoeopath. He is one of the directors of Adroit Insights Lifesciences Pvt. Ltd., a healthcare/medical communication agency. He has several years of experience in developing short documentary films, videos, scientific material and interactive CD-ROMs for patient education and continuing medical education. His interests include world health, problems concerning the South East Asia region, and medical communication. <www.adroitinsights.com>  <www.drpradhan.com> 

C R REVANKAR is a public health physician in preventive and social medicine and a specialist in Leprosy Programme. Professional interests include leprosy and Tuberculosis/HIV/AIDS programme management.

UPIEK RIPTONIGRUM is working as a lecturer in the Graduate Program in Health Policy and Service Management, Faculty of Medicine, Gadjah Mada University, Indonesia. She manages projects of health education materials for health workers (collaboration among GMU, WHO, and MoH), and she is also interested in district health information system (in Indonesia, national level and district level), and is co-supervisor for some graduate students' theses. Her background is medical science (BSc, from Gadjah Mada University) and medical informatics (MSc, from Erasmus University Rotterdam, The Netherlands). Her current interest is community informatics focusing on health information, with an emphasis on women participation.

NICOLA RUCK is a health education and promotion specialist with extensive experience of training health personnel in management, human resource development, communication methods and training strategies. She has worked in health promotion in the British NHS, and in long term projects in India, Afghanistan, Egypt and South Africa. She taught international health care management and planning in the UK from 1987 to 2000 and now do consultancy work on training strategies, training needs assessment, training and motivation of health staff, health human resources development and the planning and management of health education and promotion programmes. She is particularly interested in training materials and measuring the effectiveness of training.

MIGUEL SANTILLANA is founder professor of the Cayetno Heredia University, and former Chairman of the Department. of Surgery at Cayetno Heredia School of Medicine, Lima, Peru. Currently, he is Director of the School of Nutrition and professor of surgery at the School of Medicine at the Universidad Cientifica del Sur, a recently created university in Lima. He has worked in General Surery at the Johns Hopkins Hospital, US, and as Governor of the American College of Surgeons and member of the Committee on Trauma.

JEAN SHAW is a retired medical school librarian from the University of Leicester, UK. She is the Research Officer for Partnerships in Health Information, which seeks to support and create active partnerships between UK health science library and information services and those in developing countries. Phi's objectives are to support information professionals in developing countries in this way so that they are involved in the development of better systems to make information accessible to health professionals.

PAGET STANFIELD is a retired paediatrician with a long experience in Africa, including work with the Makerere University, Uganda, and with AMREF. He has a longstanding interest in improving access to texts for medical and postgraduate medical students in very poor-resource situations, particularly in Maternal and Child Health. He is editor of the publication, Diseases of Children in the Tropics.

JAMES TUMWINE is the editor of African Health Sciences at Makerere Medical School, Uganda. He has a special interest in paediatrics, child health, publishing, and health and development issues.

ANIBAL VELASQUEZ is a medical doctor and Director of Planning and Evaluation at INPPARES, a family planning organization in Lima, Peru. <www.inppares.org.pe> 

CHRIS ZIELINSKI spent over 20 years as a publisher in WHO and FAO, working in Africa, Asia and Europe. Chris is Principal Consultant of Informania Ltd, the company he originally founded in 1992 to produce ExtraMED, a database which presents the full text and images of over 300 Third World biomedical journals on a monthly CD-ROM. He is currently Director of the Health Information for Development Project, the projected first phase of the Information Waystations and Staging Posts project, which seeks to build the technological capacity of some 1,000 health information resource centres and develop selected centres into large-scale producers of locally appropriate health information. Chris serves on the board of Healthlink Worldwide.

CHRISTINE PORTER provided this summary. She recently completed her MA dissertation, entitled 'Networking for Health-a r/evolution: Using new ICTs to support health professionals in developing countries'. She works as a consultant on using ICTs to support further education, health and development. Her core clients include Cornell University's eLearning subsidiary and an academic research funding and networking service. She is interested in how new ICTs are, can and should be used by and for development professionals in the field. <http://myprofile.cos.com/c_porter> 

[Note from moderator. Our thanks again to Christine for providing and maintaining this summary, and to all contributors. This summary is posted on the Web at www.inasp.info/health/hif-net.html.  A report of the HIF meeting on this subject (Wellcome Trust, London, 25 November 2003) is available online at www.inasp.info/health/workshop32.html.  How can we translate some of these ideas into practical action? Further contributions on this subject are welcome. Best wishes, Neil PW]

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