Emerald Research Register: Literati Club Research Fund Awards 2003
Health Information Systems Programme in Andhra Pradesh, India:
Developing Computer Supported Training and Educational Material
Submitted by Professor. Sundeep Sahay, Department of Informatics,
University of Oslo.
February 25, 2003
(Total word count approximately 1600 words)
1. Specific goals, outcomes and benefits of the research
The proposed project entails the development and dissemination of computer based
training material to help strengthen information management practices of the Primary
Health Care (PHC) system in Andhra Pradesh (AP), India. This project is proposed by
Prof. Sundeep Sahay, Department of Informatics, University of Oslo, Norway, in
collaboration with the Health Information Systems Programme (HISP) currently underway
in India and the Department of Health, Government of AP.
This project is part of and will support a larger initiative called HISP (Health Information
Systems Project) that is currently being implemented by the University of Oslo (UIO) in
AP in collaboration with the Government of Andhra Pradesh (AP). HISP, in AP is part of a
larger global initiative of UIO that is currently being implemented in a number of
developing countries including South Africa, Mozambique, Cuba, Mongolia and Tanzania.
The HISP initiative in AP, India, started in Dec 2000, and after a successful pilot
experiment in 9 PHCs in the Kuppam electoral constituency within Chittoor district, the
government of AP has signed a MOU with Oslo to extend the project to computerize 46
PHCs, and then subsequently the complete district (86 PHCs). In January 2003, the
HISP implementation has also been started in another district called Guntur on the
initiative of the Joint Collector of the district. Also, in January, we have made a
presentation of the project to the Health Minister of the state, who has asked us to submit
a proposal to implement selected aspects of the project in the whole state (covering 1200
PHCs).
A major component of the project to date in AP has been the training effort directed
towards the health staff in the PHCs including field workers (called Multi Purpose Health
Assistants), health supervisors, pharmacists and medical officers. The training has
included three key components:
1. Basics of computer awareness: This includes basics of hardware, software,
networks, email, MS Office etc.
2. Basics of the HISP software: This includes the basics of the HISP software (which
is on MS Access), with special focus on the data entry and report generation
modules. In the 9 PHCs of the pilot site, the health workers are now using HISP
completely for all their information processing activities including data entry and
generation of all the routine reports which need to be sent to the district authorities.
3. Use of health information: The HISP philosophy is to encourage local use of
information so that the data being collected every month is not only used to satisfy
the needs of the bureaucracy, but to be also used actively by health staff to support
local action. For example, to use the analysis for calculating indicators (like
immunization coverage) and comparing those with targets. Such local analysis can
then become a basis, for example, to have more meaningful targets set for the health
staff.
However, as the project needs to be scaled up, from 9 PHCs to 42, and then to another
district and maybe the state, the demand for training gets exponentially multiplied. While
in the pilot phase, we were responsible to train about 60 staff, in the current expansion
stage we would be covering at least 200 staff. In the coming period, this demand could
be for about 1000 people. To deal with this issue of effectively scaling up, training efforts,
we seek to develop training computer-based training material and an approach for
training for primarily three groups of people including the field health staff, Medical
doctors, and state level administrators dealing with policy level changes. The content of
the training would cover the areas of computer awareness, HISP software and the use
of information discussed earlier.
2.
A statement of purpose and intent
The purpose of the proposed project is to:
. Develop computer based training material for different levels of the health
staff in India.
. Develop a methodology for the application of computer-based training
methodologies in the primary health care sector of the Andhra Pradesh
government in India.
Develop approaches to continuously upgrade the training content based on
ongoing experiences in the course of the project to make it actively represent
local and relevant content, for example case studies.
3. The methodology(s) applied and the research process
The methodology is described in two sub-sections: project team; and, methodology.
3.1 Project team
For the project, a team will be comprised including the following members:
Prof. Sundeep Sahay: Overall responsible for the design and implementation of the
project.
Dr. Zubeeda Quraishy, Project Coordinator, HISP, India, Based in India.
John Lewis, Systems Developer, HISP, India, Currently based in India.
Two systems developers will be hired with expertise in educational technologies, and
multimedia.
One Medical doctor from the existing project area will be included to help coordinate
and articulate training needs from the perspectives of the medical doctors.
One Health supervisor from the existing project area will be included to help
coordinate and articulate training needs from the perspectives of the field level health
staff.
3.2 Project methodology
The methodology employed and the research process would include the following
steps:
3.2.1 Conduct an analysis of training needs for the three different groups of
people. This will include interviews and discussions with health staff at different
levels, and also with the HISP project staff with a view to understand the
demands of the new approaches and computerization.
.
3.2.2 Analyze the available paper-based training material that is available
including the manuals developed in South Africa and during the course of our
ongoing project work in India.
3.2.3 Analyse the need for development of new training content. Based on
the above two steps, we will assess the need for developing new content.
3.2.4 Conduct a feasibility analysis of the different computer-based tools
that can be used for the training process, and make selections of different media
for varying groups and training content. The media on which the material would be
developed would include a mix of Word documents, Powerpoint slides; CD Roms,
and possibly Videos. The media selection would be guided by the available
infrastructure, for example, internet access is nearly negligible in the health facilities
in remote areas.
3.2.5 Carry out the task of development of computer-based training
systems based on the above steps.
3.2.6 Conduct pilot testing of the use of these developed systems in
selected PHCs with different groups of health staff.
3.2.7 Evaluation of pilot test and making revisions for future approaches.
3.2.8 Documentation of the system and preparation of a methodology for
further extension of the training effort based on computer-based tools.
4. The research outcomes and expected impact and possible application
Two distinctive outcomes will result from the research that would contribute to both
the domains of practice and research relating to health information systems in
developing countries. These are:
Development of training material and methodology for the use of computer based
training material for staff involved in the primary health care sector, in India. The
impact of this output would be significant as it would support greatly the training of
about 1000 such staff in the coming period, which in the longer run would support the
overall delivery of more effective health care to the community through stronger
health information systems. Also, in the future, this material could be shared for
suitable adaptation and use in the HISP network which is currently being
implemented in a number of developing countries (like South Africa, Mozambique,
Tanzania, Malawi, Ethopia, Mangolia, Cuba, in addition to India).
The project will contribute in the research domain to understanding a number of
issues relating to IT and developing countries that are of extreme interest to
researchers from various domains including information systems, development
studies, sociology and cultural studies. A key research question that we will seek to
answer through this project is “How do we build, institutionalize, and scale up health
information systems in developing countries?”
5. Expected costs and timescales of the research process
Project Activity
Duration
Carried out by
Approximate Costs incurred for
costs
3.2.1
2 Weeks
Project team
1.Developers time
GBP 500
2.Travel to different
PHCs
3.2.2
2 Weeks (part of John Lewis
GBP 250
1. Time
this work could
2.
Cost
of
be carried out in
photocopying,
parallel
with
scanning
existing
3.2.1)
documents
3.2.3
1 Week
Project team
GBP 250
1. Primarily time
3.2.4
2 Weeks
John Lewis and GBP 250
1.Primarily time
the
two
2.Internet usage
developers
3.2.5
8 Weeks
John Lewis and GBP 2000
1.Purchase
of
the
two
selected tools.
developers
2. Time
3.2.6
4 Weeks
Project team
GBP 750
1.Time
2.Travel to different
health facilities
3.2.7
4 Weeks
Project team
GBP 250
1.Time
2.Computer usage
This estimate comes out to be about 23 Weeks and GBP 4250. In addition, we will like to
budget one flight of Sundeep Sahay from Oslo to India during an appropriate time of the
project (for about 2 weeks). The flight is about GBP 500 plus another additional GBP 250
for living expenses. The total estimate for the project is thus about 6 months (allowing for
some delays) and GBP 5000.