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HEALTH INFORMATION FORUM: Working together to improve access to reliable information for healthcare workers in developing and transitional countries
REPORT: Improving access to information for nurses and midwives in developing countries
Royal College of Nursing, London, Tuesday 23 September 2003
Chair: Sylvia Denton, President, Royal College of Nursing
PRESENTATION 1: Nester Moyo, Midwifery Trainer, Zimbabwe; Programme Manager, International Confederation of Midwives: 'Access to information for nurses and midwives in developing countries -the current situation'
Why are we all worrying about increasing access to information to nurses and midwives in developing countries? What is the value of information? While I was wondering about that a friend sent me e-mail on something very different. At the bottom of the e-mail was a sentence: "Information produces interest, interests leads to inspiration/motivation, inspiration may lead to involvement, involvement leads to investment!" So I felt well my question has been answered. I thought about myself while I was working way out in the isolated areas of Zimbabwe. Yes indeed each time I received information from the district hospital I wished I had more. I wished I could learn more and wondered if I could access more. I felt inspired and motivated. Once the motivation was there my morale improved. I used whatever information I had received. This improved the quality of what I was doing, and of course once I saw the pleasure in the patients' faces, I wanted to do more.
This took me to the next step. While working with the information, issues would arise where I needed either more information or answers to questions. So I felt, "I can be part of those people who are producing the information". I wanted to take part in the material production and even to send some over to colleagues ten or so km away. But I knew this was going to take time and effort and energy. But I was prepared, because to me, it was a worthwhile cause.
This life experience shows that while we consider the issue of increasing access to information to nurses and midwives in developing countries, we need to work out a few things. Where is the information coming from? Who decides what information needs to be sent out or what needs to be researched? Whoever we decide it should be, we should remember to consider: Who prepares it and how?
Going back to my story, in my excitement about the need to be involved and all, I would meet colleagues and share the idea with them. The responses were varied. Some joined in. Others wondered whether I was not already overworked enough! Yet others would ask what the benefits would be!
This leads us to the next set of issues to look at:
- Do midwives themselves see the need for information? If they do then we have no problem. But if they don't...
- How do we create the need?
- How do we generate the desire to do well and raise morale in countries where the morale is already low from an intricate mix of events and situations - social, political cultural and economic?
- How do we create an environment conducive to introspection, circumspection and retrospection so that the care provider realises the difference that easy access to information produces. If there is no critical evaluation of the situation a lot may go on that the health care provider never gets to realise it. In our desperate desire and enthusiasm to improve the situation, there are some traps to watch out for...
- Solving the wrong problems
- Assuming midwives are not informed because they have no access to information. Lets look beyond that.
- Are there midwives out there? If they are not there where have they gone to and why?
- If they are there, is there adequate infrastructure to support the informed health care worker?
- What is the state of the environment in which we are expecting the care providers to access information easily? Is the environment enabling to the one informed?
Otherwise we will send information find there is no-one to use it. Or someone is there but is not interested. Or the person is interested but there are no support. Or yet another case scenario the people are there, they are interested, the environment is not bad but the information is not usable in this situation.
And there are further issues:
- How important is an enabling environment?
- What are the training needs of health care workers in isolated areas?
- What is the best direction of flow of information? Bottom up or top to bottom? Or what?
- How best can we use existing structures - not only health structures any structures other e.g.
- What is the reward for keeping up to date besides the improvement of patient care? - Attend courses (will they stay? It appears the more informed people get the further away from the patient they go!)
- Are there nurses and midwives with special needs because they are in special circumstances (conflict, political unrest, economic unrest). The nurses and midwives in these countries still have to think globally and act locally. Is there need to tailor make the information disseminated to them. How can we facilitate interactions with them on a global scale and facilitate country level sharing of experiences and lessons learnt
- Who else is there? It is important to encourage health care workers to know how to handle isolation. They should find out who else is there - nurse midwife, tradition health care provider, herbalist, police man business man, school teacher, councillors business people etc so that they together can form a network which can strategise on how best they can remain in the loop.
- What approaches in information, knowledge, and training have been found to WORK?
In short, the big questions are "How can we communicate for better health anywhere any time? How can we make other people aware of these
issues?"
PRESENTATION 2: Pat Hughes, International Council of Nurses, Geneva (on behalf of Naeema Al-Gasseer, WHO): 'Nursing and Midwifery Services: Strategic Directions 2002-2008'
The Fifty-fourth World Health Assembly in 2001 acknowledged that nurses and midwives play a crucial and cost effective role in reducing excess mortality, morbidity and disability and in promoting healthy life styles and that recognised the importance of nurses and midwives being at the core of any health system. They expressed concern about the global shortages of nurses and midwives. They passsed a resolution, WHA 54.12, which called upon Member States to:
- involve nurses and midwives in the framing, planning and implementation of health policy.
- review and develop models of education, legislation, regulation and practice.
- develop human resource plans that support training, recruitment and retention.
- ensure healthy workplaces.
- continuously assess nursing and midwifery plans.
- enhance the development of nursing and midwifery services based on evidence.
As part of their response the WHO secretariat in Geneva produced "Strategic Directions for Strengthening Nursing and Midwifery Services 2002-2008" which was endorsed by nine international organisations including the International Council of Nurses and the International Confederation of Midwives. Five key result areas have been identified as being crucial to the process of strengthening nursing and midwifery services:
- Health planning , advocacy and political commitment.
- Management of Health personnel for nursing and midwifery services
- Practice and health system improvement
- Education of health personnel for nursing and midewifery services
- Stewardship and governnance
Fundamental to delivery in each of these result areas is the requirement that nurses and midwives in every region of the world to have access to appropriate relevant and up to date information.
PRESENTATION 3: Pat Hughes, International Council of Nurses, Geneva: 'The ICN Mobile Library for Nurses':
Powerpoint presentation
PRESENTATION 4: Jennifer De Pasquale, Dreyfus Health Foundation, New York, USA: Communications for Better Health and Problem Solving for Better Nursing
Powerpoint presentation
PRESENTATION 5: Mariama Sumani, Chief Nursing Officer, Ghana Health Service: 'Addressing the information needs of nurses in Ghana'
Powerpoint presentation
PRESENTATION 6: Richard Koman, AnywhereBooks, San Francisco, USA: 'The digital bookmobile for health information, anywhere, anytime'
Proposal for a definitive online archive of free multi-lingual health literature
A collaboration between health and linguistics professionals, the Internet Archive, and Internet
Bookmobile/Anywhere Books
BASIC PROPOSAL
- Internet Archive starts a 'catalog' to hold highly rated public domain health literature
- Network of international health experts provide upload what they think is important
- Rating system prioritizes material
- Network of linguistics professionals distribute translation and localization efforts
- Each contributor has friendly interface for adding material
- Small oversight and organizational effort to make materials 'book-ready'
- Internet Bookmobile provides one way of bringing the results to those who need them
VALUE PROPOSITION
- Much literature is already out there
- Difficult to find and know what's best
- Collective effort greatly increases accessibility and reduces redundancy
- Efficient access motivates translation and localization
- Distributed contribution keeps it up-to-date and efficient
- Perfect application for the Internet Bookmobile
ECONOMICS
- Small effort to organize a catalog
- User Interface for submission of new material
- Groupware for facilitating collaboration among the health and linguistics communities
- Probably need to fund some translation to not be dependent on free efforts
PARTNERS
- Internet Archive provides hosting and catalog interface
- Internet Bookmobile/Anywhere Books works on proliferating book-making capability and distribution
Linguistics dept. at Berkeley interested in supporting translation efforts
- UNESCO interested in helping make it happen
- Existing networks of health orgs
- Other? World Health Organization?
PRESENTATION 7: Claire Constable, Royal College of Nurses, London: 'NMAP: the internet gateway for nurses, midwives and allied professionals'
Powerpoint presentation
PLENARY DISCUSSION Lively debate was generated around themes raised in the presentations.
1. INFORMATION FOR NURSE PRESCRIBING In developing countries nurses' often carry out prescribing which is not acknowledged. There is tacit acceptance of this but no formal recognition, education or training. What can be done?
- This is fundamental to the position of nurses. What nurses do is not formally acknowledged.
- It would be useful for nurses and midwives to compile information about what they prescribe. Give this to the policy makers to encourage them to acknowledge nurses' role in prescribing and the need for training.
- In Ghana the nurses' role in prescribing is acknowledged. There are guidelines and protocols.
- Nurses often work as a 'one man station'.
- In order to prescribe correctly, the isolated nurse must first make the correct diagnosis, which requires skills in diagnosis, history-taking and examination.
2. APPROPRIATE INFORMATION PROVISION
- Information sent out to local areas should be appropriate.
- It is possible to over-provide information - for example, many international organizations send unsolicited information, which is often not relevant to local needs and is often duplicative or contradictory.
- Information could be distributed to coincide with seasonal diseases.
- The digital bookmobile offers flexibility. You can mix and match content so people can choose what they need and build up a local library of information.
- There is something to be said for creating books, which will last rather than handouts.
- Local translation is an important issue.
3. DIALOGUE AND COLLABORATION
- All information has to be a dialogue between the user and provider.
- In Uganda there is an outreach program to tell health professionals what is available to them through the medical library, and that they can access this service through the Internet or letter.
- When making requests to the library, users need skills to be able to articulate their needs to librarians so that the latter fully understand their requirements.
- Searchers need knowledge of the users' working environment.
- The Dreyfus project provides a model for collaboration. Programmes differ in different areas. The outside partners can't tell people what information they need.
- ICN works through its international network of nursing associations, and is aware of their resources and priorities.
4. CAPTURING LOCAL KNOWLEDGE Have there been any projects trying to capture local knowledge in the local language?
- That is the vision with the digital bookmobile. It can scan materials and upload them.
- The HINARI service (Health Internetwork Access to Research Inititiative) provides developing countries access to 2,200 medical journals free or at low cost. There are many paradoxes including the fact that locally published journals can't afford to join the programme.
- Dreyfus attempts to capture local knowledge in the local language through its partnership working.
5. INTRODUCING NEW IDEAS AND RESEARCH BASED PRACTICE
- There can be difficulty introducing new ideas/research based practice, and convincing people of change.
- A digital camera can be used to capture images of local events/practices. They can be shown to demonstrate effectiveness.
- If practices originating in the community are captured they can be tested scientifically to see if they would work elsewhere. This also means that the work nurses and midwives are doing anyway starts to become valued.
6. LOCAL NETWORKING
- A major barrier to local networking is professional territorialism.
- The bookmobile can help with local networking.
- Convention and professional titles can intimidate the initiative/local workers e.g. birth attendants
- In Ghana there has been a successful project to put health workers in the community to work with local healers, including encouragement for local healers to make referrals to them when necessary.
Acknowledgement: Thanks to Caroline Lynch, Libraries for Nursing, UK, who prepared notes on the plenary discussion.
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