|
|
|
Health
Information Forum: Working together to improve access to reliable information for healthcare
workers in developing and transitional countries
STRENGTHENING LOCAL CAPACITIES TO CREATE AND ADAPT HEALTH INFORMATION
REPORT OF A MEETING at the British Medical Association, London, 22 January 2002
HIF BUSINESS: Neil Pakenham-Walsh announced that INASP-Health had been allocated a grant from the British Medical Journal to run HIF meetings during 2002. Further to a request for volunteers on 'HIF-net at WHO' the HIF organizing group now has five new volunteers, making a total of 11.
http://www.inasp.info/health/forum.html
STRENGTHENING LOCAL CAPACITIES TO CREATE AND ADAPT HEALTH INFORMATION
Richard Horton (Editor, The Lancet) introduced the meeting, emphasizing a focus on the community and primary care level.
Two e-mail contributions had been received, one from Paget Stanfield (Independent, UK) and one from Joseph Ana (Nigerian Medical Forum, UK). Both highlighted the problem of insufficient funding for creating and adapting health information at local level. 'How can we persuade donors to fund local capacity building?'
Presentation 1: COMMUNICATING THROUGH PARTNERSHIP: A Good Idea but does it work in practice? (Roger Drew, Director, Healthlink Worldwide
[email protected] )
Background to AHRTAG/Healthlink Worldwide
- Formed in 1977
- Recognised for newsletters
- Practical, accurate and relevant
- Excellent distribution
- Sophisticated feedback mechanisms
But….
- Is Western 'expertise' relevant?
- Are 'messages' always appropriate/needed?
- Are newsletters the best way of communicating?
- Is information the main constraint to improved practice?
- Are resource centres accessible to health workers?
- Is health worker performance the main determinant of community health?
Learning from Experience (1)
- Evaluations of Child Health Dialogue, Health Action, AIDS Action 1998
- Evaluation of resource centre project with KANCO 1997
- Evaluation of Middle East Programme 1996
Learning from Experience (2)
- Importance of network of international contacts and feedback from various levels
- Value of newsletters as resource for training
- Strong call for more locally-tailored content and decentralised production
- Continued need for print media
- Role for partners beyond translation only
- Northern informational input may undermine Southern capacity development
- Healthlink's role to be support and capacity building
Positive Examples
- Middle East Programme - no international newsletter. Focus on training of resource centre staff, university course in primary health care and in-country production of materials and health information systems
- A Brazilian partner (ABIA) working on HIV/AIDS produced a lot of their own materials including photographs, descriptions of local experiences and lists of local support services
Is this all spin?
- Changing funding environment
- Lower priority given to print media
- Difficult to get funding for newsletters
- Is this because of greater emphasis on electronic media?
- Difficulties of demonstrating impact?
- Failure to link print to other programmes, e.g. training?
All change...
- Major restructure in April 2000
- Cessation of international newsletters
- Merger of London resource centre with Centre for International Child Health to form 'Source'
- Abolition of thematic, vertical programmes
- Formation of regionalised partner support team
- Greater emphasis on electronic media
- Shift from 'message delivery' to 'giving voice'
Focus on...
- 'Source' material - Reuters-like approach
- Signposting
- Reversed coffee filter
Experience to date (1)
- Allowed difficult questions to be asked
- Required key symbols of the organisation to be questioned, e.g newsletters
- Established ways of working within Healthlink and partners
- Need to build understanding and confidence of staff members
Experience to date (2)
- 'Locked into' funding agreements
- Lack of unrestricted funding, e.g. for partner to participate in this meeting
- Pressure from funders for short-term 'products'
- UK costs of capacity building perceived 'expensive'
Experience to date (3)
- Identified other sources for support for staff development, e.g. Investors in People
- Doesn't suit all partners - consider starting capacity
- Attracted other new partners, e.g. SAfAIDS
Experience to date (4)
- Affects selection of new partners
- Some partners have found it harder than expected
- Greater need for skills sharing
- Tensions involved with partners driving project design more
- Allows more scope for interaction with international agencies, e.g. WHO Department of Health Information and Management Dissemination
Experience to date (5)
- Many partners have responded positively, e.g. KANCO seeking to recruit new staff
- Key difficulty - moving beyond description to analysis and principle identification
- Importance of linking information materials with other activities, e.g. training
- Importance of learning and reflection, monitoring and evaluation, feedback mechanisms
New funded projects
- Strengthening HIV/AIDS care initiatives in Latin America and the Caribbean (2001)
- Strengthening civil society in Palestine (2001)
- Information for mental health: Influencing policy and practice (Palestine) (2001)
- Strengthening voice of vulnerable groups in India (2002)
Conclusion:
It is a good idea
It does work
BUT
It's hard work and quite a struggle.
QUESTIONS
1. How do you get information to the rural areas?
A: We have found that post, even if slow, does get to people in rural areas. Information can also be passed on at health team meetings.
2. In the past, the impression was that Healthlink was concentrating on the needs of health care providers. Has that changed?
A: Yes, there has been a shift from health care providers to a wider developmental focus and giving people a voice. With communication through partnership, we have more of a human rights/advocacy role. Our disability and HIV/AIDS experience has moved us to include human rights and social issues as well. We focus on reaching health, development and community workers through our partners.
3. How does Healthlink choose its partners?
A: Healthlink Worldwide chooses partners who have the starting capacity to bring about developmental change.
Presentation 2: HEALTH INFORMATION IN RURAL KENYA (Chris Wood and Caroline Nyamai, AfriAfya: African Network for Health Information and Communication
[email protected])
Health Information
- Abundance in some settings
- Scarcity - especially in rural settings
- Information - needed, desired, useful
- Example from Uganda - Acacia story
- Information transfer - getting to the end user
- Role of ICTs
- Role of adapting information
Why AfriAfya?
- ICTs useful in institutions
- But ICT is failing to impact on community health
- Health could be improved if relevant information was made available
- Could we find out information required and develop a system to provide it?
- Thinking together - Mombasa Workshop
Harnessing ICTs for Community Health - workshop discussion
- Increase the availability of up-to-date relevant information
- Improve communication methods
- Increase the skills required to receive and transmit information
- Change the climate for continuing education
- Increase public demand for better health care
- Develop the necessary software for improved communication
AfriAfya - Concept to Reality
- Establishing a consortium
- Steering committee
- Grant proposal
- Funding
- 18 month exploratory phase
AfriAfya - Specific Objectives
- Explore and develop mechanisms for harnessing community knowledge and experience
- Explore innovative models and technologies for information management and communication at community level
- Develop training modules for health knowledge management and communication
- Document and share experiences
Setting Up - A Coordinating Hub
- Small - two staff
- Not a Headquarters
- Coordinating role
- Hosted by AMREF (African Medical and Research Foundation, Nairobi)
Field Centres [1]
- One for each Partner Agency
- Diversity
- Geographic distribution
- Types of facilities
- Already functional facilities
- Incorporating use of ICTs
Field Centres [2] A wide range of health facilities
- An isolated rural dispensary with no electricity or telephone
- A health center in an urban slum
- A district medical office
- A mission hospital
- A community development training center
- An established IMCH programme
- A primary school health committee
Setting up Activities
- Security issues - Doors, windows etc
- Electricity - Solar panel
- Staff Changes - Retraining
Information Collected
- Baseline survey
- Communication methods in use at FCs
- HIV/AIDS information being communicated
- Desired HIV/AIDS information
- HIV/AIDS Information
- From the National AIDS Control Council
- From Partner Agencies
- From the Internet
Repackaging Information
- Collating information from the various sources
- One page summaries on desired topics
- Responding to information queries
- Eg use of video shows for health information communication
- Developing a website
We need a knowledge management system
Dissemination of Information
- AfriAfya Website - Content
- FC information
- Partner Agency information
- Health information
- Resources
- Loaded on FC machines or on CD ROMs
- Cooperation with WorldSpace
Conclusion
- ICTs can help in information dissemination even in rural settings in Kenya
- Equipment and setting up are a significant cost
- 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
What help we need
- Database to act as an information resource
- People we can share ideas with
- Funds
- Checking validity of information we are sending out
- Disseminating mechanisms
ICTs can help in information dissemination even in rural settings in Kenya, but
traditional communication methods remain important in taking information beyond the computer.
QUESTIONS
1. Could you tell us more about how you found out what information people want?
A: Several baseline HIV/AIDS surveys at local level to find out about local knowledge and experience. In some areas, focus groups were used.
2. Are the people at the 8 field centres paid?
A: No, they are not paid extra for this work. They have been given free ICT training and the incentive that participation in the project will make their work easier.
3. You mention that you need a knowledge management system, but it seems you need a knowledge management and communication system. A knowledge management system to deal with the filtering, sorting, signposting and content of information and a communication system to deal with communication flows and social/cultural obstacles (e.g. gatekeepers for information, cultural/social variations, etc).
A: Yes, a two-way communication system is essential and we will closely monitor that.
GENERAL DISCUSSION
The discussion moved around four areas (well beyond the scope of the meeting!):
1. General issues
2. Local capacities
3. Information flow
4. Information and change
GENERAL ISSUES
Who decides on what information should be communicated. Who filters the information? Who signposts it and determines if it is appropriate for various audiences?
Should international development organizations be using a culture-based or evidence-based approach? The example of breastfeeding was cited, where a culture-based approach may be more suitable.
'If you use a top down approach, advocacy for local partners is the key. If you use a bottom up approach, scaling up is the key.'
LOCAL CAPACITIES
The emphasis of development assistance on 'projects' rather than institutional capacity building leads to a lack of resources for building local communication and information capacity and a lack of an integrated government policy across sectors.
Is 'sustainability' possible for projects to strengthen local capacities to create and adapt health information? What do we mean exactly by 'sustainability'? Is it realistic or necessary to have cost recovery? Are concepts of sustainability too 'donor-driven'? 'On a global basis, local capacity building is sustainable.'
Capacity building projects are a global public good versus economically sustainable projects which sell services.
One participant cited experience in Iran where primary health care was achieved successfully without computers. The important elements there were regular dialogue and supervision and good transportation for health workers.
'ICT, information gateways, portals, etc. have added new levels of complexity to communication. We were better at information coordination a century ago. There was a library in every primary and secondary school and links with town libraries, info centres, health centres, churches, etc.'
INFORMATION FLOW
What will be the impact of the BMJ and WHO initiative (HINARI) to make electronic 'Northern' journals free to low-income countries? Would healthcare workers in low-income countries find such publications relevant to their daily work?
'Is information from the North drowning out the voices from the South?'
'The key is to help local professionals write articles for journals. This documents local experience, is a source of pride for the authors and helps with their distance education.'
INFORMATION AND CHANGE
'Motivation is vital.' AfriAfya is achieving motivation by showing field centre staff how the ICTs can make their job easier, can give them more prestige and can make work more fun (edutainment). Financial incentives are not 'the answer'.
'Getting information out to people is not enough. The important thing is to look at what blocks people from taking action after they receive information. After receiving information, the logic to action phase is where things break down. People tend to do things the way they have always done it. We need to look at established routines and barriers to change.'
'I am glad to hear the emphasis on giving people a voice, on listening to a mix of voices and on two-way communication and feedback.'
Acknowledgement: Thanks to Indira Benbow (Simplexity, UK) for recording the proceedings of this meeting.
The Health Information Forum is run as an activity of
INASP-Health, a cooperative network for organizations and
individuals working timprove access treliable information
for healthcare workers in developing and transitional
countries. Participation is free of charge and without
obligation. INASP-Health is supported by the BMA, Danida,
ICSU-Press, and WHO. INASP is a programme of the
International Council for Science (ICSU).
|
