This a brief presentation about the starting proposal for my PhD thesis. The presentation was given at IPID Conference 2011 in Lugano and discussed with the audience.

1. Improving sustainability
of primary e-healthcare
projects in rural areas of
developing countries
Inés Bebea González
ines.bebea@ehas.org
Project Manager at Fundación EHAS
PHD Student at Universidad Rey Juan Carlos

2. Motivation
• Fundación Enlace Hispano Americano de Salud
– International NGO promoting an appropriate use of ICTs to improve healthcare
processes in rural areas of developing countries.

3. Motivation
• Fundación Enlace Hispano Americano de Salud
– International NGO promoting an appropriate use of ICTs to improve
healthcare processes in rural areas of developing countries.
• Work areas
– R & D in ICT technologies and telemedicine services
• Long distance voice and data connectivity
• Telemedicine
– Advice and evaluation of primary healthcare processes using ICT
– Education and knowledge transfer on ICT solutions
• Capacity building
• Technology transfer
• High-level education (Engineering, Msc, PhD)

4. Motivation
• Fundación Enlace Hispano Americano de Salud
– International NGO promoting an appropriate use of ICT to improve
healthcare processes in rural areas of developing countries.
• Work areas
– R & D in ICT technologies and telemedicine services
• Long distance voice and data connectivity
• Telemedicine
– Advice and evaluation of primary healthcare processes using ICT
– Education and knowledge transfer on ICT solutions
• Capacity building
• Technology transfer
• High-level education (Engineering, Msc, PhD)
• Traditionally in Latin America: Peru,
Bolivia, Ecuador, Colombia and Cuba

5. Motivation: Improve public Healthcare to the rural
Source: Worldmapper.org (retrieved March 2011)
3 billion people live in rural areas of developing countries

6. Motivation: Apply e-Healthcare in rural areas
Rural regions characterised by isolation and unavailability of resources
Operation and maintenance of ICTs is hard
Few ICT initiatives in developing countries are sustainable

7. Motivation: Apply e-Healthcare in rural areas
Rural regions characterised by isolation and unavailability of resources
Operation and maintenance of ICTs is hard
Few ICT initiatives in developing countries are sustainable
But, hey, sustainability is complex!
Technology Public Institutions
Road Infrastructure User Acceptance Cost
Maintenance & Logistics Operational Capacity
Patient Acknowledge Health Policy
Telecom Regulations etc.

8. Motivation: Apply e-Healthcare in rural areas
Rural regions characterised by isolation and unavailability of resources
Operation and maintenance of ICTs is hard
Few ICT initiatives in developing countries are sustainable
But, hey, sustainability is complex!
Technology Public Institutions
Road Infrastructure User Acceptance Cost
Maintenance & Logistics Operational Capacity
Patient Acknowledge Health Policy
Telecom Regulations etc.
What if we could measure & fit sustainability of ongoing ICT initiatives?

9. Context: EHAS-Napo case study

10. Context: EHAS-Napo case study
• Rural Health Network
– Reference Hospital
– 3 Health-care Centers
– 12 Health Posts
• Distances are 30-50 km
(over 500 km end-to-
end)
• Infrastructure:
– River transport
– Unstable power supply
– VHF/HF radios if any
– 90% out of cellular
coverage
• Scarce cualified health
& ICT staff

11. Context: EHAS-Napo case study
• Rural Health Network
– Reference Hospital
– 3 Health-care Centers
– 12 Health Posts
• Distances are 30-50 km
(over 500 km end-to-
end)
• Infrastructure:
– River transport
– Unstable power supply
– VHF/HF radios if any
– 90% out of cellular
coverage
• Scarce cualified health
& ICT staff

12. Context: EHAS-Napo case study
• Rural Health Network
– Reference Hospital
– 3 Health-care Centers
– 12 Health Posts
• Distances are 30-50 km
(over 500 km end-to-
end)
• Infrastructure:
– River transport
– Unstable power supply
– VHF/HF radios if any
– 90% out of cellular
coverage
• Scarce cualified health
& ICT staff

13. Context: EHAS-Napo case study
• Rural Health Network
– Reference Hospital
– 3 Health-care Centers
– 12 Health Posts
• Distances are 30-50 km
(over 500 km end-to-
end)
• Infrastructure:
– River transport
– Unstable power supply
– VHF/HF radios if any
– 90% out of cellular
coverage
• Scarce cualified health
& ICT staff

14. Context: EHAS-Napo case study
Napo telemedicine network provides
– Broadband wireless connectivity using WiLD Technology (WiFi
modified for long distances)
– Voice services based on IP telephony and videoconference,
– Data applications with Internet access, mailing and messaging, e-
learning, support for telediagnosis, teleconsultation and telepresence.
– Systems autonomy via solar power.

15. Context: EHAS-Napo case study
• Network topology • Transportation Times

16. Context: EHAS-Napo case study
• Problems encountered:
– Low availability of e-
Healthcare services
• High time to recover from
failures
• Main failures:
– Lightening damage to
equipment
– Inaddecuate battery usage
– IP telephony degradation due
to PBX version conflicts

17. Research methodology
• Qual & Quant research review
• Problem analysis through Logical Framework Approach (LFA)
• Sustainable ICT Framework Analysis (Sunden, 2006)
• Action Research

18. Research methodology
• Qual & Quant research review
• Problem analysis through Logical Framework Approach (LFA)
• Sustainable ICT Framework Analysis (Sunden, 2006)
• Action Research
• Factor-based Approach

19. Research methodology
• Qual & Quant research review
• Problem analysis through Logical Framework Approach (LFA)
• Sustainable ICT Framework Analysis (Sunden, 2006)
• Action Research
• Factor-based Approach
Management
Framework for
Sustainable rural e-
healthcare provision
(Bebea, 2011)

20. Next steps...
I. Explore additional concepts to help analysis: Capability
Framework (Grunfeld, 2007), Communication Framework
(Barroso, 2007), Risk Theory, Institutional Theory, Actor
Network Theory.
II. Design action frameworks for technical – institutional –
financial factors
III.Consider a 2nd case study based on rural e-health
IV.Analyse sustainability assessment through “risk
measurement”

21. Improving sustainability of
primary e-healthcare projects in Inés Bebea González
rural areas of developing ines.bebea@ehas.org
countries
Thank you for your attention!
Questions?