Information in the field: eHealth innovations to further support healthcare in developing countries

According to Uduak Thomas’s article ‘Mobile technology is changing healthcare in developing nations’, which was re-posted in the Berkeley Science Review in December last year, the World Health Organisation (WHO) defines ‘mHealth’ or ‘mobile health as ‘…a subset of ‘electronic health’ that is concerned with the use of mobile and wireless technologies to support the achievement of health objectives…’. Looking at the many other articles concerned with mHealth projects that have emerged since, there appears to be little doubt that mobile and digital technology has indeed been used to do just that: to support the achievement of health objectives and thereby make a real difference in the provision of healthcare in the developing world.

The majority of the projects these articles cover seem to focus on improving the provision and distribution of vital healthcare information to remote, rural communities via SMS on mobile networks, where innovators have sensibly exploited the massive proliferation of mobile phone use in the communities concerned, particularly in Africa.

There is a question to be asked though, as to whether mHealth solutions such as these – which deserve huge merit in the achievements they have delivered – are to be the pinnacle of what can be accomplished in this field, as principally ‘data gathering and information distribution’ initiatives, or is it possible to extend the concepts of mHealth and eHealth to provide healthcare practitioners with more dynamic and interconnected tools, that do more than just deliver health advice messages and gather statistics. Is current technology being utilised to its full potential to provide more complex services to doctors and health practitioners in the field, such as access to complete health records and dynamic community health data whilst working at a remote rural location, in spite of the challenges presented by a lack of reliable internet connectivity or intermittent power supplies in many of the communities concerned?

The answer is arguably ‘yes’ with the three cases highlighted here, which all go some way towards demonstrating how technology can go a stage further by bringing additional complex functionality, the like of which was previously only available in larger hospitals and health centres, to healthcare workers ‘in the field’, thereby assisting to an even greater degree in their efforts to help people and their communities in the more remote and disparate communities in which they work.

Carego International: Utilizing open-source and the cloud to provide a practical solution

The Yahoo Finance website seemed an unlikely source for a story on a relatively new solution to provide access to health records in remote locations, but that is where I read about Carego International, and how their new product utilises developments in digital storage and open-source technology to provide a real solution to support the provision of remote healthcare.

According to the article, last month Carego International announced the launch of a new software application, built on Progress Pacific’s cloud-based, open-source platform, to ‘…help remote health clinics improve quality of care in developing regions around the world…’

Referring to the findings of Carego’s CEO Steve Landman, much of the existing medical software he had found in health institutions in developing countries  ‘…wasn’t compatible with local needs, largely due to complexity and an inability to tolerate frequent Internet service outages common in developing regions…’
Building on their previous experience in developing applications for the health sector, Carego decided to develop their latest product using the Progress Pacific development environment, with which they were able to deliver a cloud-based health records solution, which is inexpensive to deploy, easy to manage, and can be rolled out and accessed over nearly any device, be it fixed or mobile. These features make the product ideal for medical organisations in the developing world, which often have limited resources for expensive back-end support systems or mass data storage, and whose staff work in remote rural locations.

Kujua – Medic Mobile’s new communications hub for healthcare providers

In June of this year, following successful roll-out in various locations in Africa, Asia and Latin America, Medic Mobile announced the global launch of Kujua, their open-source information and communications hub for clinics in the developing world.  As described in the announcement made on their website: ‘…Kujua, which means “to know” in Swahili, is a web-based application for sending and receiving regular messages and forms, and also for scheduling time-targeted confirmation messages. Right now KujuaLite is optimized for three priority use cases — disease surveillance, stock monitoring, and service monitoring — but can be utilized for a wide range of communication and data collection activities…’ The article goes on to provide a link to a demo of the product, which can be found here: http://medicmobile.org/tools/kujua-lite/

Coupled with Medic Mobile’s existing programmes of distributing basic feature mobile phones to medical practitioners in the field, the company can now provide an end-to-end solution, connecting community members with health volunteers, doctors and the Kujua system as a back-end hub for collaboration and storage of information, to assist with monitoring emerging disease concerns and logging and maintaining communication between all those involved.

Prize winning idea provides practical solution to streamline information management in rural healthcare

Maintaining accurate health records in some sub-Saharan hospitals where paper-based systems still exist, whilst storing them securely and yet still having the means to safely transfer them if a patient moves; – these concerns are challenging enough, without the added difficulties that are sometimes encountered in identifying patients, matching them to their medical records and then needing to share that information as required between healthcare agencies, centres and hospitals. This is the impression one gets when reading an article in the Engineering for Change website (www.engineeringforchange.org), celebrating the winners of the recent ‘IEEE Global Humanitarian Conference’s Young Professionals Project Contest’, who have come up with an ingenious response to these challenges, with the application of an affordable, practical solution utilising RFID (radio frequency identification) cards. In basic terms, Radio-frequency identification (RFID) technology utilises radio-frequency electromagnetic fields to transfer data, for the purposes of identifying and tracking ‘tags’ containing electronically stored information that are attached to objects, such as the cards suggested in this solution.

The Engineering for Change article explains how, in the example of tracking and dealing with a disease outbreak in a rural community, the RFID solution could help:

‘…When polio or cholera or any disease breaks out in a community the local clinic will be the first to notice the uptick in cases. If clinics can share their records with central hospitals, then a local tragedy in one community becomes data points on a nationwide map. Then medical authorities can respond, and other communities can prepare and try to prevent new outbreaks…. Those two problems – sharing information between medical centres and identifying patients and their medical records – may have a solution. An entirely electronic health data system plus radio frequency identification chips implanted into ID cards for every patient might be a low-cost and simple way to address both issues…’

As the article continues to explain, RFID technology was chosen as it is a relatively low-cost approach and doesn’t depend on complex networks for communication. The winning team’s chosen system uses standard network protocols and can run on existing or inexpensively sourced hardware.

Accepting that there has been some opposition to using ID cards for similar purposes in the past – understandable, in the context of some of the locations and environments in which the communities concerned live – the project team acknowledged that some work needed to be done towards  local community ‘outreach’, before pilot schemes could be undertaken, but they remain positive on the long-term benefits the solution could provide.

With reference to a proposed pilot in the Kerala region of India, Hassaan Idrees and John Avrett , both involved in the project, added:

“…We would like to give a physical shape to our project by working with federally-endorsed government and non-government organizations. There still are a few grey areas: increased consumer-directed care, new methods of organizing care delivery, and new approaches to financing, but we hope to resolve these with the help of the appropriate stakeholders.”

Computer training on four wheels: Different approaches to ‘driving’ ICT education to where it’s needed

This week I’ve taken the blog down a mobile route, but not in the usual sense when it comes to ICT4D: It’s all about the different ways in which vehicles have been utilised to bring ICT training to those who might need it, in hard-to-reach, rural communities, where education in computing and the resources required are not normally readily available.

Many of the more remote communities in developing countries lack even the most basic in ICT infrastructure, let alone dedicated provision for ICT/computer skills training and internet access, and yet without some form of education in ICT, those communities and in particular their younger generation have restricted opportunities in terms of employment beyond their immediate environment, or access to further and higher education, because of their lack in ICT skills and training. In addition, the communities as a whole are less able to benefit from ICT-based innovations in health provision and agriculture, without access to the necessary training in order to utilise the developments available to them.

Mobile computer ‘labs’ and training facilities have existed in various locations in the developing world for some years now, through a local determination to overcome the lack of ICT provision that still persists in many communities, or a lack of any convenient location to provide lessons in ICT-related skills.

The vehicles used in the projects this post focuses on may vary, from converted four-wheel drive SUVs to full size buses, but the intentions are the same – to bring ICT training to those who may need it most, in the more remote and disconnected locations, and in environments where new skills and a greater understanding of modern technology could lead to greater opportunities for employment, and greater prosperity for the communities involved. Here I’ve looked at four of these stories, to give an overview of the different approaches adopted to provide mobile ICT education.

South Africa – ‘The Big Green eMachine’

One of original (if not the very first) attempts to deliver ICT education in a mobile format was the ‘Big Green eMachine’ on South Africa’s ‘Wild Coast’; a specially converted 4×4 truck that was set up as a joint venture between local NGO Friends of Chintsa, Volunteer Africa 32 Degrees and African Heartland Journeys, with additional financial assistance from other charities. The project has been running since 2010 and provides a mobile lab complete with server, laptops and all the necessary kit to provide ICT training, in as close to a ‘classroom’ environment as can be achieved on four wheels. As explained in a short piece from the E-learning Africa website, the initiative’s aims are all about bringing ICT to those who would otherwise have little access to it in their community environment:

‘…This directly addresses the lack of technology in the extreme rural areas by visiting schools and bringing computer based learning to children in these areas! Furthermore, the mobile lab has proved to be the solution to the lack of space, security risks to assets and the unreliable or non-existent electricity supply. It’s a fantastic project and the students absolutely love it!…’

Sri Lanka – Esoft’s mobile computer bus

Initially put together in 2011, this project provided by local ICT education provider ESoft, aimed to bring basic ICT knowledge and understanding to students and children in disadvantaged areas, where ICT resources and training were scarce or non-existent. At the centre of the project was ESoft’s ‘mobile computer bus’, fully equipped with all the necessary IT equipment required to provide a mobile classroom that is, as described in an article in Sri Lanka’s Sunday Times, ‘…on a par with any modern IT laboratory of an ICT training institute…’

As the CEO of a technology education company, you would expect Dr. Dayan Rajapaksa, ESoft’s Managing Director, to be vocal on the importance of providing ICT education to a mass audience. Yet what he’s quoted as suggesting in the Sunday Times article rings true and reads as a very concise recognition of the need to address the ‘digital divide’, between those with and those without access to ICT resources, education and understanding:

“…In the future world, nobody will be able to successfully steer his/her personal or professional life without depending on ICT. It is such a critically important component. Therefore, it is a national duty to impart knowledge and training on ICT to the younger generation who will take over as the country’s future leaders… It is bad enough that these students have no access to ICT due to a dearth of facilities, but it is still worse that they have no proper understanding of how important it is to be computer literate for their future prospects and wellbeing. There must be students among them who have the aptitude for ICT excellence. The objective of the ESOFT CSR project is to impart basic ICT knowledge and training and make these students understand the importance of academically arming themselves to excel in this important sphere. This will also open the door to better career prospects in a diverse field…”

St Lucia –  ICT for schools in the back of a mini-bus

A recent development on the Caribbean island of St Lucia has brought ICT to local schools, ‘centres for boys’ and correctional facilities, using a converted mini-bus packed with ICT resources and learning aids. When the bus pays weekly visits to two local schools, pupils are given the opportunity to use various ICT learning devices to help with their mathematics and language skills. Through an EU-funded programme (the EEICTP or Education Enhancement through Information Communication Technology Programme), the project is supporting the existing curriculum by providing the children with invaluable additional experience that would not normally be available to them, using digital devices and computers alongside their usual classroom teaching.

An article on the EEICTP St Lucia website explains the ethos behind the mobile facility, again recognising the need to address issues surrounding the division between those who do and those who don’t have ready access to ICT training and resources:

‘…The pioneering mobile ICT bus is equipped with Wi-Fi and electronic gadgets and visits the Boguis Primary School in Babonneau and the Les Etangs Primary School in Soufriere once a week…The initiative is part of the EEICTP’s outreach which has ushered in a new era of digital inclusiveness, bridging the gap between access to technology among students of urban and rural schools.…’

The Principal of one of the schools, Murina Julian of Boguis Primary, elaborates further on the importance of ICT education for her pupils:

“…In this technological world, our students need access to computers and since we are a rural school, we still have some students who are deprived of this access. You find as a result the students look forward to the visit of the Mobile ICT bus and are enthusiastic about learning…”

Uganda – One women’s mission to bring ICT to rural communities

The last focus of this post is perhaps the most appropriate to round off with, demonstrating as it does how one person’s drive and enthusiasm, with a little help from technology and a local NGO, can provide the solution to a communities lack of ICT knowledge, awareness or opportunity.

Ina Fried’s informative article from October 2012 in the All Things D website tells the story of Asia Kumukana. Asia was educated in Uganda and attended university there,  yet didn’t use a computer until she was 22, due to a dearth of resources or access to ICT at any stage of her education. Once hooked on technology, she decided she wanted to address the problem, particularly for those in rural areas:

‘…From the moment she got her first taste of computing, Uganda’s Asia Kamukama knew that she wanted more of her people to get their hands on this…Fast-forward a few years, and she helps run Maendeleo Foundation (see below), an organization that does just that — bringing a solar-powered mobile computing lab to rural villages. The effort brings together about 15 Intel Classmate PCs, along with the solar panels needed to power the machines…’

The article goes on to explain how Asia’s project planned to leave some of the computers and equipment behind at the schools and libraries that the mobile lab visited, hopefully providing a more permanent resource for those in the remote locations which up until then had not had access to them; – an additional benefit that this clever mobile solution was able to impart to those it has helped.

Further Information: The Maendeleo Foundation

The Maendeleo Foundation, a United States registered NGO, was set up with the aim of promoting the development of a productive computer services industry in East Africa, in part by helping local communities to have greater access to ICT through the use and promotion of solar energy sources at a local level. This is particularly relevant in Uganda, where some sources suggest that less than 10% of the rural community has access to a continuous electricity supply.

Their mission statement available from their website explains the organisations’ aims: ‘…Maendeleo Foundation’s mission is to complement the existing education system by making computers available to people of all ages, providing customized training, and encouraging and supporting the formation of Information Communication Technology businesses. We operate innovative training programs in a network of primary schools, and cooperate with organizations of similar interests that share our commitment to the promotion of technology for development…’

Mobile technologies supporting vital information services to farmers in Africa: Some ICT4 Agriculture success stories

With the ICT4Ag conference well underway in Kigali, it seemed a timely opportunity to highlight some of the ICT4Ag initiatives that have been put into action across Africa, with a focus on the power of mobile devices to bring real benefits to rural farmers and significantly improve their lives and those of the communities in which they live. I’ve tried to bring together three different initiatives in different African states, to give an overview of how this technology can be put to such effective use in meeting the challenges that farmers are facing, and to present them in a way that can inform the uninitiated as much as those with a keen interest in ICT4D.

Ghana: SMS assists local farmers to improve the results of their efforts in rice farming

Non-governmental organisations and G8 member states have made Ghana one of their top priorities in terms of providing financial support and advice to improve farming methods and to help farmers harness the new technologies that can assist them in getting the most from the resources they have available. Under the G8 banner, the New Alliance of Food Security and Nutrition was launched in 2012 with commitments from African leaders, private sector partners and G8 members to make substantial investments towards improving food security, agricultural practices and nutrition levels for 50 million people by 2022. The ‘Feed the Future’ project is their main US initiative for input and involvement in the New Alliance, which includes a significant level of focus on Ghana.

At a far more local level, an article and accompanying video by reporter Nan Boakye-Yiadom for Ghanaian website and radio station Citifm Online was a fascinating source of information on mobile tech helping farmers in the field, as it gave such an interesting and and accessible account of the focus of the article – rural farmer Abdul Rahman Takoro and his family – and the difficulties and challenges they face with subsistence rice farming, and trying to make it an affordable and even profitable venture.

The article explains how only three years ago, Abdul could not afford to send all his eight children to school, unable to earn a living to provide for his family through rice farming as he lacked both the resources and agricultural education to be able to make the farm a success.  Thanks to the involvement of Esoko, a private communication company in Ghana, Abdul was able to benefit from an SMS message system to gain information on weather changes, improved farming methods and market prices. The article explains the difficulties that farmers face in getting the information and the help they need through traditional means:

‘…Currently the only way most farmers get such information is through extension officers. The government employees meet with farmers to provide information, but they barely reach a quarter of the total number of farmers in Ghana. As well, according to information from Ghana’s Finance Ministry, about 70 per cent of extension officers will retire from active service in the next three years…’

The article goes on the explain how the Esoko initiative works, and reinforces the idea that private companies and contractors have a huge part to play in assisting with these projects – which in the end can help to improve the economy in the company in which they operate, by increasing the contribution that farming can make to the nation’s GDP:

‘…Esoko has representatives who visit about 50 different markets in the various regions each day and compile the going price of foods. They relay that information to the Esoko headquarters, where it is packaged into simple and comprehensive SMS and distributed to the farmers and traders who are also subscribed on the platform. Farmers also receive information on weather patterns, when to plough their land, when to sow, apply fertilizer, check weeds and harvest…Takoro is one of about 120,000 farmers in the Northern Region making use of the information from Esoko. He’s been receiving the SMS messages for two years. “What we gain from Esoko is immeasurable,” he said. “They alert us with prices in markets nationwide, tell me whatever I produce I can send it there to sell and get interest. They also help us with weather forecasts too…” …Takoro says with the information he can now decide whether to send his produce to the market for sale or sell it to middle men and women, considering which of the options will make him get more money…’

Soil testing results by SMS: Crop Nutrition providing innovative service to Kenyan farmers

Crop Nutrition, and agribusiness company, have set up an innovative service to speed up the process of soil testing and analysis for farmers in Kenya.

Crop Nutrition provide special specimen bags to farmers through their network of field advisors, who train the farmers in the correct methods for collecting the samples, which are then delivered to Crop Nutrition’s laboratory via local agro dealers. Costs are kept low due to the high volumes involved and the level of sophistication of the company’s testing equipment, which also contributes to a much faster turnaround than other more traditional methods of soil testing. The results are then sent via SMS message directly to the farmer, again cutting down on the time it takes from initial sample collection to when the farmer is able to act on the results of their analysis.

USAID’s briefing paper explains how Crop Nutrition assume that local representatives will assist farmers with understanding the implications of the results, if needed, and the importance of soil testing in global farming:

‘…Crop Nutrition works on the expectation that if the results and recommendations are unclear to the farmers, they will be interpreted for the farmers by the agro dealer or field advisor. Soil testing is important for any farmer to know what minerals their soil is deficient in and what type of fertilizer or other inputs may be used to increase soil health and fertility, yields, and resistance to pests and disease…’

The paper can be viewed at via the e-agriculture.org website, (which also provides further information on this initiative), and provides further information on the users and business model of the project, the costs of which are provided entirely by Crop Nutrition, again a private company, as part of their operational expenses. One additional point from the paper is worth reposting here, and that is the anticipated impact of the initiative:

‘…Crop Nutrition lab reports include technical recommendations so that farmers apply the correct fertilizers, lime or other inputs to reduce production costs and improve yields. When correctly used by farmers, this information can contribute to larger crop yields. Agro dealers also receive a small commission for facilitating the service…’

Uganda: ‘Community Knowledge Workers’ provide farmers with invaluable information and market data in exchange for completing surveys

The Grameen Foundation was set up in 1997 to assist communities in developing countries to address their own challenges and reach their full potential, through the provision and application of the right tools and resources. Their website explains further the ethos behind the work they do in trying to help people in the world’s poorest countries:

‘…Our collaborative approach to poverty alleviation recognizes the multidimensional and complex nature of global poverty. We work with private sector companies, non-governmental organizations, government agencies and others to ensure we achieve lasting impact in the regions where we work.’

As explained in an article from the ICT in Agriculture website and as part of Grameen’s work developing new agricultural programmes in Uganda, the organisation has set up the Community Knowledge Worker (CKW) programme with financial support from the Bill and Melinda Gates Foundation. The program involved the training of over 800 village-level representatives (CKW’s) to provide agricultural ‘extension services’ to farmers in exchange for their participation in completing mobile device-based surveys. These extension services include the provision of advice in relation to agricultural methods, livestock, crop diseases, weather forecasts and other relevant information. In return, the information provided by the completed surveys helps Grameen and their partner organisations with their research to build up a clearer picture of the issues the farmers are facing – which in turn helps in providing the solutions and advice they are provided with.

This simple, cyclical process has helped local farming communities in Uganda by improving their agricultural yields, whilst the farmers involved have been able to achieve better prices through greater market knowledge of the products they produce. It has also created employment through the recruitment of CKW’s, who, as the article suggests, can further increase the benefits of this two-way cyclical approach, by providing solar-energy services whilst in the field alongside their survey data-collection activities, and thereby increase their earnings at the same time:

‘…CKWs are trained to 1) provide a link to agricultural research institutions and extension services and administer surveys, and 2) to set up off-grid electrical charging micro-enterprises using solar energy. These enterprises can earn CWKs as much as 40 USD/month, which doubles the 1.25 USD/day previously earned by 60% of CKWs.’

The article states that due to access to CKW’s, farmers in Eastern Uganda have seen a 17 percent increase in the prices they achieve for maize compared to those who do not have access to these resources, a clear indication that when applied simply and effectively, with a combination of technology and common-sense human input, these new innovations can be highly successful in improving people’s lives.