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.”

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.

Central Asia and the success of ICT4D initiatives: continued support as vital as initial investment

Whilst looking at ‘ICT4D’ projects in the former Soviet republics of Central Asia, two major themes seem to come to the fore, time and time again. These were the marked disparity between the levels of ICT investment and internet connectivity between the various neighbouring countries in the region, and how the success of the projects and initiatives that had been undertaken seemed to be determined not so much by the level of initial investment, but by the amount of continued, on-going support that was provided, post ‘launch’.

A fairly obvious link between levels of economic and industrial prosperity and levels of access to ICT and the internet can be drawn from most of the information that is available about Central Asia. The region as a whole has much more restricted levels of internet access, both in practical and censorship terms, than is typically enjoyed in Eastern Europe and elsewhere in the West, whilst ICT education is generally limited if not completely unavailable, and there is a lack of freely available information on what is actually provided in this area for people and their communities. Added to this, with several of the countries that occupy the region maintaining severe restrictions on what can viewed online, it is understandable that any drive to substantially increase access to ICT is seen as an up-hill struggle by those with more than a passing interest in the subject. It is also not simply a case that the wealthier and more economically advanced a country is, the greater the access to the internet, both in terms of number of users and the content that is available to them. It seems the situation is more complex, with certain comparatively wealthy nations in the region only allowing highly-restricted web access that is severely censored.

In an article from April this year in the Eurasian.org website, and with reference to the latest Global Information Technology Report, David Trilling casts his eye over the stark contrast in ICT fortunes between Kazakhstan and Kyrgyzstan, two former-Soviet states at the heart of Central Asia, but who’s levels of ‘relative’ prosperity – and adoption and deployment of ICT resources – are very different:

‘…They might be neighbors on the map, but Kazakhstan and Kyrgyzstan couldn’t be further apart in how they utilize information and communications technology (ICT). A model for the former Soviet Union, Kazakhstan is charging ahead, according to a new report measuring how ICT affects competitiveness, leaving much-poorer Kyrgyzstan in its digital dust…’

The article goes on to explain the basis of its findings (the report itself), which uses various indicators as a means of measuring the effectiveness of ICT provision in the region in relation to social development:

‘…In its 12th year, the Global Information Technology Report uses the Networked Readiness Index – computed with 54 indicators – to compare how 144 economies “leverage ICT for growth and well-being.”
This year Kyrgyzstan ranked last among former-Soviet states, at 118, between Suriname and Bolivia. Kazakhstan on the other hand, at 43, beat out all post-Soviet countries, save for the advanced Baltic states…’

The article adds further clarity to these statistics, elaborating on how they are calculated based on various scores, such as ‘strong government vision’ , continued development in ICT infrastructure, and a support for ‘…stronger ICT uptake – as evidenced by the number of Internet users…along with households with a personal computer…and those with Internet access…’

As suggested with greater detail in the article, by contrast Kyrgyzstan struggles in pretty much every criterion. A simplistic view is that this is purely down to being a poorer, less-developed state, which despite having great potential mineral wealth has not been able to harness it to the extent that the oil reserves have provided for Kazakhstan. But there also appears to be a problem of sustainability, which may be down in part to a lack of education and understanding of how to make ICT work, long-term, to the benefit of the nation’s communities.

In a report published by the Asian Development Bank last year, entitled ‘ICT in Education in Central and West Asia’, the key theme that keeps appearing is how those nations under the spot light have far greater success with their community-based, educational ICT initiatives when a sustainable approach is used, prioritising (beyond initial investments) the additional on-going support and maintenance of  IT hardware, adequate ICT training to teachers and practitioners, and maintaining investment to ensure ‘kit’ is kept up-to-date with software updates and an adequate antivirus solution.

Under the heading ‘Budget and Financing’ and with particular reference to issues with on-going support, the report first looks at Kyrgyzstan:

‘…Among its recommendations, the study notes the urgent need for governments to adequately fund school ICT operational costs and avoid under-use, misuse, or even non-use of the hardware provided and the widespread waste of scarce investment resources.
In the Kyrgyz Republic, for example, 25%–30% of computers supplied to schools were non-operational when surveyed in 2008. Participating countries reported high levels of non-operational hardware, also a common finding in developing countries outside the region; in some cases, more than 50% of computers in surveyed schools were reported to be non-operational. This is usually caused by difficulties in affording, or even accessing, reliable maintenance services. Difficulties in accessing maintenance services tend to be greater in rural and remote areas and this also widens the domestic digital divide…’

Elsewhere, the report echoes the findings illustrated in the Eurasian.org article, particularly in relation to ICT education, both in terms of student assessment and of the education of teachers themselves to be better equipped to teach via ICT resources:

‘…Kazakhstan has a significant training requirement because of the high level of subject-based activity in e-course materials development and the sophisticated hardware profiles of some schools specified by the Ministry of Education. Kazakhstan recognizes that its advanced ICT activity means that its training requirements are more complex and need to be upgraded, intensified, and widened as rapidly as possible.
This means that teachers need to be trained in ICT use on a subject basis using basic teaching and learning methodologies…’

In contrast, with reference to student assessments:

‘…Neither the Kyrgyz Republic nor Tajikistan has yet developed an approach to the assessment of ICT on student performance across subjects and has no effective monitoring of ICT use in schools.
Kazakhstan is confident of the beneficial impact of ICT, both in informatics and across curriculum subjects, and has produced case studies of innovative approaches after intensive research into ICT use and impact in the classroom…’

The report goes on to mention a fundamental factor that seems to appear throughout the region, particularly in more rural areas, and that is the lack of a reliable power supply, especially in school environments. A town or community may be hooked up to the national power grid, but this doesn’t guarantee that the schools there have continuous power available to them, uninterrupted, throughout the school day and beyond, which presents serious challenges when trying to maintain ICT infrastructure at a local level. In what little research material there is available, the power issue keeps coming up and is clearly a major hurdle to sustainable improvement and development of ICT in these areas.  

Another factor that appears to be resonating throughout the region and in particular with the least developed states is the dependence on NGO investment, rather than local government or commercial, in maintaining any real longevity for ICT community projects. This appears to be even more of an issue when extra staffing is required to fulfil ICT training and education requirements, which may not have been allowed for when planning the budgets at educational establishments in the region. It is fair to say that dependence on NGO’s for financial assistance is inevitable in developing nations throughout the world and particularly when maintaining ICT projects and initiatives, which may not be initially prioritised at a local level. But when those states are not as open to international assistance and support as other parts of the developing world, as appears to be the case in some of the more complex environments in Central Asia, NGO assistance may not be as abundant or as easy to access than with the more public and well-documented initiatives in many African and Latin American countries.

What is clear is that whilst the initial ideas and enthusiasm to provide communities with ICT training, education and the required resources is admirable and has been taken up with great zeal in many developing countries, if it isn’t backed up with the necessary on-going support, continued training and essential maintenance, the dream of closing the ‘digital divide’ soon fades. The net result is not only a low uptake in digital connectivity for the communities involved, but a huge waste of resources when the original investment in hardware and training comes to nothing. If the real goals and aims are to improve people’s lives and opportunities through embracing the digital age, then the support has to be there from day one and to stick around until it’s no longer needed.

Further Information on Source Material

EurasiaNet.org

EurasiaNet.org is a New York based website, providing information and analysis about political, economic, environmental and social developments in the countries of Central Asia and the Caucasus, as well as in Russia, Turkey, and Southwest Asia.
For more information, visit http://www.eurasianet.org/

Asian Development Bank
Some background information (from their website – www.adb.org)

‘Since its founding in 1966, ADB has been driven by an inspiration and dedication to improving people’s lives in Asia and the Pacific. By targeting our investments wisely, in partnership with our developing member countries and other stakeholders, we can alleviate poverty and help create a world in which everyone can share in the benefits of sustained and inclusive growth.’
For further information, visit: http://www.adb.org/