Health Information Forum

Working together to improve access to reliable information for healthcare workers in developing and transitional countries

‘Leapfrog technologies’: Hand-held computers and mobile phones. Can they meet the information needs of healthcare providers in developing countries?

Venue:British Medical Association, BMA House, London, UK

Date:   Tuesday 27 April 2004           

Chair:  Harry McConnell, Interactive Health Network

Leapfrog technologies ‘leap’ over legacy systems which hold back developing countries. Wireless, satellite and hand-held systems have the potential to help information technology into the next age.

Mobile phones and medical television in developing countries

Faina Linkov, Supercourse, University of Pittsburgh, USA  (tele-presentation). Further info: <http://www.pitt.edu/~super1/>  or email < > 

Powerpoint presentation (1.2Mb)

The University of Pittsburgh’s Supercourse is currently available as Microsoft PowerPoint (PPT) files, downloadable from 42 locally mirrored servers on the Internet and on CD-ROM (10,000 copies have been distributed so far). The Supercourse has 32,000 participants in 151 countries with 1700 lectures. 40% of participants are from developing countries.

It is now developing a new model for easier information transfer. From internet to cellular phone to school TV. PPTs are compressed in size (~200Kb) then downloaded onto cell phones which can be plugged into TVs to show PPT. Cell phones have a 2Mb capacity. PDAs have a 16Mb capacity. 50% of dev country schools have TV and 10% have computer. There is a big and expanding market for cell phones (eg there are 28 million cell phones already in Africa).

Discussion

Q1. Is there an index of the Supercourse PPTs?

Yes, access the main web site to find all the lectures there: http://www.pitt.edu/~super1/ 

Q2. Have any costings been done on downloading PPTs to cell phones in Africa?

Not yet. It’s more expensive to download in Africa than in developed countries but the 200Kb format of the PPTs is much smaller than traditional PPTs which can sometimes be as much as 10Mb.

Q3. There’s a lack of cell phone coverage in Africa. What is the ratio of satellite to cell phone coverage?

I don’t know but experts at Supercourse have said that cell phone is the way to go.

Q4. Which cell phones can connect to the TV?

Only more advanced models.

Q5. What stage is the project at? Have you begun testing yet?

No, it’s still at the development stage and requires funding.

Q6. Do the PPTs have audio?

No, because of size constraints.

Q7 Isn’t it easier to just give schools a computer?

Well that is one model but this way is simpler.

ICTs for health information in rural Latin America

Carolyn Stephens, London School of Hygiene and Tropical Medicine, UK; EnlaceHispano-Americano de Salud (EHAS): Colombia, Peru, Cuba. Further info: http://www.ehas.org/portal or email < > 

(Powerpoint presentation will be available here shortly.)

The EHAS team brings together South American universities/health networks and Spanish telecom engineers.

Problems in rural Latin America include: Limited telecommunications structure, high volume of health information on paper, frequent need for staff to make journeys by foot or boat, high cost of postal system ('snail mail'), mistakes in data re-entry, slow delivery of drug supplies.

Health posts in rural areas have no roads - some are 15 days to nearest health centre, no radio, no electricity – consequently health workers there are isolated, demotivated and high turnover.

The aim of EHAS is to contribute to improving system of  public health care by improving working conditions, capacity and infrastructure using appropriate and locally/nationally available services. It uses radio communication for email between and among health posts – Health centre – capital city. The system can be used for information on courses, advice on specific clinical problems, access to information, eg PubMed, and a shared message board.

There are three types of technical systems:

1. VHF – 60km @ 17 kbps. This is the most common type.

2. HF – longer distance but slower connection. Good for mountainous regions.

3. WiFi - <20km @ higher bandwidth. Might allow videoconferencing. Expensive. Only Colombia implementing.

Health Post Equipment: Old computer with Linux and Netscape, radio, modem, monitor. Electricity is generated by solar power.

Discussion

Q1. Health worker motivation is a problem in East Africa as well. Has this new system helped?

In an evaluation of health worker reaction, 100% were happy to have the new communication and 75% felt less isolated. They have also started to communicate horizontally with one another.

Q2. Can you tell us the timescale for rolling this out?

The project is funded by the European Commission for the next 3 years. Colleagues in Nicaragua and Venezuala are interested. It’s possible to give radio connection and then add on email functionality later.

Q3. How much does it cost to train the Health Workers?

Putting in the infrastructure for the project pays for itself in 3 years. The main savings are in terms of not having to pay for gasoline for riverboats.

Leapfrog technologies: a revolution in continuing medical education? 

Suzanne Stensaas, Slice of Life, Utah, USA. Further information from <http://medlib.med.utah.edu/sol/>  or email < >

Powerpoint presentation (1.8Mb) 

Prefer to call CME ‘Life Long learning’ as it’s about changing people’s attitudes

Who are the people we’re trying to target? And what do they want?

• Students – IT literate
• House Staff – IT literate but no time
• Academic Clinicians – Want research
• MD in Urban Clinics – Too much paperwork
• MD in Rural Hospitals – Poor funding
• Health workers in Rural Clinics – No access, no training, no support

Do they want to use Leapfrog technologies? What are the issues?

• Who are these Leapfrog technologies for?
• Who will pay and maintain them?
• Who will standardise software and platforms?
• Technology is not enough on it’s own – need teachers and language translations
• Need open access resources – available to repurpose locally in any language

Some recommended websites:

• The HEAL web site of free resources: mission is to provide free digital materials of the highest quality that meet the needs of today's health sciences educators.
  http://www.healcentral.org 
• BRISTOL BIOMED image archive web site
• Slice of Life annual conferences & web site
• Biomedcentral.com
• Public Library of Science www.plos.org
• Sparc- www.arl.org/sparc/

Leapfrog technologies: lessons learned and future prospects

Sandra Jordan, Global Health Bureau, USAID, USA. For further details:  <www.usaid.gov/our_work/global_health/>  

Full text of presentation

USAID primarily provides technical support for NGOs and aid agencies in developing world, eg Save the Children, and Satellife.

Leapfrog technologies can help provide info and service provision, e.g. computer assisted interviews, suitability of weather for timing deliverables, getting help dealing with outbreaks to the right place, getting info to policymakers quickly.

Points to consider include rechargeable batteries (not unit), backup cards to protect against loss of data, freeware software, need for training (couple of days). The weather can affect communications: no WiFi in rainy season. Increased rate of data from PDAs (handheld computers) may cause bottlenecks further up the system.

Discussion

Q1. You mentioned a project in Zimbabwe, where women were trained to use PDAs to administer questionnaires. Had they used computers before?

No. There was a big range in the age and education of the women involved but they all liked it. Medical students in Kenya loved PDAs once they could personalise the use of them and use popular programs.

Q2. The last presentation was on a very different model from the 2nd presentation. Can you comment?

I see places we could mesh. We have similar problems with mountainous areas. You have to go into communities and see what’s possible, e.g. providing bicycles to transport condoms.

Q3. Do you foresee problems with ongoing technical support? When the PDAs break what will happen?

It’s not all success stories. The projects started in 2002 so we need to wait 4 more years to see how it goes. We try to keep the set-up basic so there won’t be much equipment failure.

Comment from participant: Leapfrog technologies allow empowerment of rural people, e.g. training farmers in Word and Excel to create their own proposals and budgets against globalising companies.

Q4. African Internet Coverage?

Good enough so far but need to wait on research.

Q5. Initial use of PDAs has been gathering information to support projects or future plans. Not leaving PDAs in community to allow information to travel the other way. Are you looking at this?

Probably not right now. PDAs do get to community centre clinics and health workers. Information is used to affect policy within country (e.g. at health minister level).

Comment from participant: Satellife are using PDAs to deliver health information with HealthNet which delivers abstracts of articles from the world's leading journals.

Q6. Will moving to open access have negative effects? For example, most open access articles are electronic only and so difficult for people in developing countries to access. Also, the move to the 'author pays' model may affect future levels of R&D.

Most developing countries can’t afford the subscriptions in the first place, mail gets stolen, it’s too expensive – so electronic form only doesn’t hurt. Electronic content can be cut and pasted as needed, articles can be downloaded one by one.

Comment from participant: I don’t know any big African Libraries that have decent paper journal collections.

Conclusion

The chair invited speakers to name their top technologies and issues, for the next 2 years and in the longer term.

Carolyn Stevens: Biggest issue is that people need access to technology to escape trap of globalisation. We should be careful not to see technology as only going from North to South. That’s colonialisation.

Suzanne Stensaas: Mobility issue and standardisation. Issue is not technology but organisational. What are people’s needs? E.g. bike battery rechargers.

Sandra Jordan: Technology can be a crutch. Need innovative ways of using info. Need South to North flow as well. There won’t be any standardisation any time soon.

Acknowledgement: The Health Information Forum thanks Sally Parsley (London School of Hygiene and Tropical Medicine) and Maurice Long (BMJ Group) for taking the notes for this meeting.

Contact: Neil Pakenham-Walsh:    Web: http://www.inasp.info/health