Public eHealth in the Caribbean
Nancy Muturi
Kansas State University
Public eHealth Innovation and Equity in Latin America and the Caribbean
eSAC Caribbean Webinar Series
Public eHealth and Equity: Media Focused
Outline
Defining eHealth
 Concept of mHealth
 eHealth in the Caribbean
 Gender and health
 Gender and ICTs
 Considerations for women in eHealth
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eHealth Defined
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The combined utilization of Information
Communication Technologies (ICTs) and
networked data processing to transmit, store and
retrieve digital data for clinical, educational and
administrative purposes by the health sector
 (Rodriguez, 2003)
ICTs refers to:
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Innovations in microelectronics, computing (hardware and
software), telecommunications and opto-electronics—
micro-processors, semiconductors and fibre optics.
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In other words, innovations that are used to handle:
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(UNDP, 2001)
Telecommunications
Broadcast media
Information management systems
Audiovisual processing transmission systems
Network-based control and monitoring functions
Includes: Radio, Television, Internet, Telephones, Computers, Hand-held
computing and telecommunications devices etc.
Global Recognition of eHealth

Healthy people 2020 recognizes the role of
Information Technology (IT) to improve
population health outcomes and health care
quality, and to achieve health equity.

Millennium Development goals underscored the
benefits of ICTs in achieving gender equity and
equality
Health Information Technologies

Health Information Technologies (HITs) have
tremendous promise for delivery of health
care and health promotion esp. in less
developed nations
Use of HITs
 Cost effective and secure use of ICTs in
◦ Health-care services – diagnosis and treatment
◦ Health surveillance
◦ Healthcare policy and decision-making
◦ Health literature
◦ Healthcare marketing
◦ Health education, knowledge and research
◦ Health communication
HITs Usage in the Caribbean

Mainly used for:
◦ Surveillance
◦ Management information systems/ Patient information
systems
◦ Information dissemination
◦ Not much for communication and behavior change
◦ Limited interaction with the audience
◦ Limited audience participation
eHealth Applications
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Websites
 (e.g. Medline Plus, Healthfinder, and Web MD)
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E-mail, message boards, chat rooms, interactive
websites,Voice recognition, etc.)
Online social support networks and communities,
Interactive electronic health records
Health decision support systems
Tailored health education programs
Health care system web portals
Mobile health communication devices
Advanced telehealth applications
Online gaming for health promotion
If used correctly HITs can:

Increase patient and provider access to relevant
health information
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Enhance the quality of care
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Reduce health care errors
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Increase collaboration among providers

Enhance doctor/patient interactions
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Improve patients’ knowledge and confidence
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Empower patients in health decision-making
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Encourage the adoption of healthy behaviors
mHealth Defined

The mobile computing, medical sensor, and
communications technologies for health care.

Wireless connection of personal server to the
telemedical server
 Through personal computer, cell phone, other telecommunication
devices

This developments is driven by the evolving mass
markets for cell phones and portable computing
devices
mHealth in the Caribbean

Mobile technology expanding rapidly in the
Caribbean

Pervasive access to mobile telephony, with some
countries having over 100% penetration

By Dec. 2011, there are approximately 2,945, 395
cell phones in Jamaica
 Mobile penetration rates of 109%

Internet penetration
 118, 259 subscribers – 4%
 Internet Users – 1,581,000.
Other Examples
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Computer penetration
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◦ 68.9% in Barbados
Suriname -- 14%
Antigua and Barbuda -- 47%
Trinidad and Tobago – 25%
Barbados – 39.6%
◦ 59% in Antigua and Barbuda
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Internet access:
◦ 36% in Antigua and Barbuda
◦ 34% in Barbados
Access at home:
Mobile phones
 Barbados – 61.2%
 Belize – 50%
Source – Lawton, 2010
Technological Divide
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Based on:
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Age
Gender
Income
Disability access
Literacy/illiteracy levels
Computer/digital literacy
Geographical location
ICT Usage in the Caribbean

Infrastructure and access  mobile strong,
other areas some progress
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Education  some progress
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Public management  some progress
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Production sector  some progress
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Policy instruments and strategies  progress
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Health  limited progress
Challenges for eHealth

Cost Concerns
 For organizations to operate inexpensively
 Lack of adequate funding for healthcare
 For consumers/women to participate affordably
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Standardization
 To enable different systems to communicate
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Security and Privacy
 Data security and privacy of personal health data
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Quality of Publicly Available Information
 Timeliness, accuracy, depth, and diversity
eHealth Imperative

eHealth is imperative for Caribbean due to:
◦ Changing demographics – age and population structure
◦ Increase in digital natives (young adults who grew up in
the digital age)
◦ Lifestyles changes due to urbanization, immigration and
industrialization
◦ Global advancement in technological development
◦ Global advancement in medical fields
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A dynamic model of healthcare is required to match
these changes
Gender and Health

Women are more likely to suffer from lifestyle-related
illnesses
 e.g. diabetes, cardiovascular disease, HIV/AIDS and other sexual and
reproductive health infections

Caribbean women between the ages of 24-44 years old are
more likely to get be infected by HIV than men
 Due to gender inequity and inequality

Women are less likely to have access to preventive
healthcare
 Lack of adequate health insurance/coverage
 Low or no income
 Stigma and Discrimination
Gender and ICT

ICTs are not gender neutral
 Access and use of ICTs differ by gender
 Digital divide based on gender

Previous Studies show that:
 Women are more likely to search for health information
online
 Women are more likely to use ICTs for social networking
 Women living in developing countries are 21% less likely to
own a cell phone than men
 Women are more likely to feel connected and empowered to
connect with the healthcare professionals if they own a cell
phone
Women’s Access to ICTs

More likely to have access to internet at work
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More women with low-paying jobs – limited access
 More women working at call centers
 Mostly using computers for word processing, typists,
data entry clerks
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Women have limited IT training
 Limited understanding of ICTs and HIT applications
 Low computer literacy
 Men have more skilled IT-related jobs
Gender Considerations
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Gender component in the IT policy
Ownership – hardware/software
Training and capacity building
Access points – public/private
Cost and capability
Literacy/computer skills/technophobia
Participation
Confidentiality/privacy issues especially in dealing
with stigmatized diseases
Ethical issues in health care
Security issues in regard to ICT access and use
Effective eHealth among women
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Key questions to ask :
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How easy are ICTs for women to understand and use?
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How comfortably do ICTs fit within the policies, practices, and
technical infrastructure that are built into existing health and social
systems?
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How affordable are they for the women and other intended
audience?
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Are the messages delivered on eHealth programs easy enough for
women to understand and apply the health information provided?
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Are the information systems adaptive, interactive, and selfcorrecting?
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Do ICTs provide interesting, relevant, and engaging information for
the women?
References

Blaya, J. A., Fraser, H. S., & Holt, B. (2010). E-health technologies show promise in developing countries. Health Affairs (Project
Hope), 29(2), 244-251. doi:10.1377/hlthaff.2009.0894; 10.1377/hlthaff.2009.0894
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Dunton GF, Robertson TP. A tailored Internet-plus-email intervention for increasing physical activity among ethnically-diverse
women. Prevent Med 2008;47:605–11.
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Healthy People 2020. Health Communication and Health Information Technology. Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18

ICA World Factbook
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Jansen C. (nd). Information, Communication Technologies (ICTs). Technopedia. Accessed from
http://www.techopedia.com/definition/24152/information-and-communications-technology-ict
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Kreps G. L., & Neuhauser L. (2010). New directions in eHealth communication: Opportunities and challenges. Patient Education
and Counseling 78: 329–336
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Lawton, O. (2010). Monitoring Caribbean Information Societies. IDRC, Canada, Project Document. Retrieved from
http://www.cepal.org/publicaciones/xml/9/38899/W315.pdf
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Lindsay S, Smith S, Bellaby P, Baker R. The health impact of an online heart disease support group: a comparison of moderated
versus unmoderated support. Health Educ Res 2009;24:646–54.
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Marsh, W. (2012). Why are businesses ignoring the mobile opportunity? Jamaican Observer, July 15. Retrieved from
http://m.jamaicaobserver.com/mobile/business/Why-are-businesses-ignoring-the-mobile-opportunity-_11949851
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Muturi, Nancy (2005). Gender, ICTs and Health in the Caribbean. In Cummings, Sarah, Henk van Dam, and Minke Valk, (Eds.)
Gender and ICTs in Rural Development. A Global Source Book, Gender, Society & Development series, no. 8. (pp.61-74), Oxfam, UK.
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Muturi, Nancy (2006). Access and Use of ICTs among Women in Jamaica. In Tauth Eileen M. (Ed). Encyclopedia of Gender and
Information Technology. (pp.1-6), Hershey, Idea Group Inc. (Peer reviewed)
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Rodrigues, R. J., & Risk, A. (2003). eHealth in Latin America and the Caribbean: Development and policy issues. Journal of Medical
Internet Research, 5(1), e4. doi:10.2196/jmir.5.1.e4