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