Building Capacity for Health Workers in Developing Countries: M-Libraries concept/proposal Adesina Iluyemi firstname.lastname@example.org
Mobile ICT in Africa Up to 300 million GSM mobile users in Africa Similar figures in India, China and South America Mobile ICT impact and growth in Africa –Increased GDP –Individual and personal empowerment –Business process transformation (m-commerce)
Health Workers in Africa Delivers essential primary care services Agents of Change and health promoters Brain drain Community/facility based care (HIV/AIDS, TB, Malaria etc) Information, communication & logistic needs Work as individuals & in teams But issues of organisational and end-users context need to be considered
Different users’ Context CBHWs –Remote, Local & Fixed mobility Clinicians, Managers, Administrators, Technicians –Local & Fixed mobility (Remote?) Context modulates devices and connectivity access
mHealth-Libraries Process Process Collection Transmission Presentation Geography: Rural or Urban Facility: Community vs. Hospital/Clinics Users: –Community Based Health Workers (CBHWs)- Volunteers, salaried, Mid wives. (Community Level) –Doctors, Nurses (Hospital/Clinic) –Managers/Administrators
M-Libraries: A rethink Libraries means database or repositories (Traditional or Electronic) Re-conceptualizing M-Libraries in developing countries within the wider eHealth paradigm To improve adoption and diffusion For mainstreaming and sustainability What is eHealth?
eHealth as a developmental tool eHealth is the use of information (data) and communication technologies for health processes (Health System) either locally and at a distance (WHO 2005). Also health workers and health system capacity For improving patients’ outcomes eHealth involves health management information systems, (EHR, DSS etc) health knowledge systems (Libraries). The combination of mobile/wireless technologies with eHealth is known as mHealth Instead of M-Libraries should be “mHealth Libraries”
Rationale: Rethinking M-Libraries Mobile/Wireless ICTs provide the most appropriate and Low-cost for bridging digital divide in developing countries (Africa) (ITU 2007). Future mobile ICTs trend demonstrate cheaper, increased capacity and availability Why?
Rethinking M-Libraries : Wireless/Mobile tools Wireless technologies use: GSM/GPRS/3G, WiFi, WiMAX, WLL (Fixed or Mobile CDMA), Broadband wireless, Satellite, VSAT (Mobility vs Universal Access) Mobile devices: PDAs, Smartphone, Cellular phones, Tablet PCs, Laptops, smart cards, memory sticks, USB keys, sensors.
Rethinking M-Libraries : Applications Electronic Health Records Health data collection Health Management Information System, Continuing medical education (CME)/e- Learning Laboratory Information System Drug management system Telemedicine
Proposed Model: Context and Technology mHealth-Libraries Technology HEALTH WORKER Human & Organisational issues mHealth-Libraries Integration Interoperability Connectivity Access Mobility EHR Facility & Community Levels CMEHMISDDS Mobile Devices mHealth-Libraries Technology Mobile Devices EHR CME HEALTH WORKER HMISDDS
mHealth Libraries: Different faces mHealth Libraries in developing countries have different presentation Depending on the mHealth technology available Cases to illustrate below the applications
mHealth-Libraries: Case Study 1 UHIN (Uganda) – Started in 2003 and has continued to expand within & beyond the Country (Mozambique). – Uses existing GSM/GPRS/ WiFi links with PDAs to support (community) health workers (HWs) creating a regional eHealth network – Uses solar panels for power – For Primary Health Care service provision – Provides learning materials, health information and e-mail (upcoming) to HWs BACK
mHealth-Libraries: Case Study 2 Cell-Life (South Africa) –Started in 2003 by 2 universities in SA –EHR for the therapeutic and logistic management of HIV/AIDS population –Mobile devices (Cellphones & PDAs) with 3G/GPRS/SMS networks –Enable community health volunteers to assist their fellows HIV + management.
mHealth-Libraries: Case Study 3 MindSet Health (South Africa) – Started about 2002 – Uses DVB wireless satellite technology to provide – Health education (eLearning) to rural health workers in clinics and hospital (datacasting) through PCs/Laptops – Health promotion to patients and citizens through large screens and TVs (broadcasting) in clinics and community settings in form of documentaries, drama etc. – Delivers health information all aspects of health (TB, HIV, Malaria etc). – Improves health workers’ capacity and empowers citizens’ to keep healthy
mHealth-Libraries: Case Study 4 EHAS (Peru) –Started in Peru is early 2000 with joint collaboration between a Spanish and two Peruvian universities & MoH and an international NGO –Initially with HF/VHF but now with long distance WiFi wireless links connected with Laptops creating a regional eHealth network – Uses solar panels for power – For Primary Health Care service provision – Provides learning materials, e-mail and voice communication and teleconsultation to HWs, organisational health information & data exchange
Issues & Barriers Understanding context for sustainable mHealth-Libraries in developing countries End-users Technological Organisational
Success & Failure from Developing countries 2 cases will be employed for illustration Could provide “bottom-up” experience to mHealth Libraries implementation India Uganda
IHC-Case India: The India Health Care (IHC) project Started in 1994 (Apple Newton) 2001 new PDAs (Compaq Ipaq, Simputer) Closed in 2003 CBHWs, mostly women Primary Health Care Standalone 200 PDAs deployed
India: IHC case Purposes –Digital data collection –Improved and timely data collection process –Decision support system for immunization management –CBHWs’ workflow process planning and coordination Outcome: Failure! Why?
Technological Technical –Insufficient memory (I6MB?) (technical) –Low Battery life –Low processing speed –Poor software design (These accounted mostly for the failure rate)
Organisational Process –High health needs and demand –Poor HIS & database design –Perceived high cost of the PDAs –Lack of ownership due to fear of financial responsibility –Lack of piloting or modular approach –Lack of technical support and poor maintenance process
Users’ impact & Outcome (Negative) Users’ impact –Low users’ adoption due to duplication of efforts –Poor Human Computer Interface (HCI) design –Eye sight and visibility issues (Black and white screen & Sunlight) –Lack of adequate training provided The failure of this programme is due to improper recognition, analysis and management of human and organization issues (BEANISH 2006).
Uganda UHIN: A contrast Organisational behaviour –Improved organisational efficiency –Modular and iterative approach –Local ownership (UCH, a research of the university) –Multiple applications –Choice of PDAS? (Palm vs. Pocket PC) (Linux?) –Networked devices (GSM, GPRS, WiFi?) –Solar panels ($30) Local production –Local contents development –Open source software End users’ behaviour –Health workers’ integration –Health workers’ ownership –Health workers’ usage and adoption
Human Issues: Technical HCI –Screen size and design (Adaptive) –Power- Solar? (Global Green Movement) –Memory (Stable and Labile) –Security –Structure- (Ruggedized) –Connectivity –Network Configuration- Thin & Thick clients, remote & located synchronisation
Low-cost devices One Child Per Laptop, Simputer, Intel Classmate RM Asus MiniBook - Linux Open Source? Interface Open Source Multi-wireless connectivity
Human Factors: Social Issues Doctors in South Africa (Banderker et al 2005) –Job relevance –Usefulness –Perceived User resources –Device Characteristics –Supports from Public National government & hospital administrators –Patient influence –Legal issues (Decision Support Systems, Drug directories)
Organisational Issues Technology Technology is not enough! Positive economic benefits Users led and focus Social and ethical issues Health workers’ responsibility Device and applications development and regulation. (HealthService 24- 2006) Environment Health Policies, regulation, structure and financing Evaluation in real-life contexts Multiple actors and structures Health IT infrastructure (organisation). Users’ Trust Users’ led model (MOSAIC -2005)
Organisational issues Adequate mobile ICT access and equity procedure is necessary Facility based technical support important Re-engineering of organisational & work process required for mHealth-Libraries Standards for data sharing & communication important for success- Different databases Appropriate mobile devices for tasks i.e voice vs. data –Podcasting- Medical lectures –RSS feeds
Organisational issues Policies Telecommunication Health System reform Low-cost devices ( Digital World) HWs’ primary tasks should be protected from interferences HWs’ views and empowerment is very important Content development and adaptation very important (HIFA 2015 project).
Conclusion mHealth-Libraries have is applicable for health development in developing countries Barriers should be evaluated, understood and tackled
Thank you Open University! Adesina Iluyemi CHMI, UK email@example.com@port.ac.uk Policy implications and Change Management in the implementation & use of mobile/wireless eHealth in Africa’s Health Systems