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

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