Building Capacity for Health Workers in Developing Countries: MLibraries conceptproposal

1
Building Capacity for Health Workers in
Developing Countries M-Libraries
concept/proposal

• Adesina Iluyemi
• adesina.iluyemi_at_port.ac.uk

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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)

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Health Workers in Africa

• 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

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Different users Context

• CBHWs
• Remote, Local Fixed mobility
• Clinicians, Managers, Administrators, Technicians
  
• Local Fixed mobility (Remote?)
• Context modulates devices and connectivity access
  

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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

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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?

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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

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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?

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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.

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Rethinking M-Libraries Applications

• Electronic Health Records
• Health data collection
• Health Management Information System, Continuing
  medical education (CME)/e-Learning
• Laboratory Information System
• Drug management system
• Telemedicine

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Proposed Model Context and Technology
mHealth-Libraries Technology
mHealth-Libraries Technology
Human Organisational issues mHealth-Libraries
Integration Interoperability Connectivity Access M
obility
EHR
CME
HMIS
DDS
EHR
CME
HMIS
DDS
HEALTH WORKER
Mobile Devices
Mobile Devices
HEALTH WORKER
Facility Community Levels
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mHealth Libraries Different faces

• mHealth Libraries in developing countries have
  different presentation
• Depending on the mHealth technology available
• Cases to illustrate below the applications

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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
• 
  
  
  BACK
• 
  
  
  

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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.

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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

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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

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Issues Barriers

• Understanding context for sustainable
  mHealth-Libraries in developing countries
• End-users
• Technological
• Organisational

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Success Failure from Developing countries

• 2 cases will be employed for illustration
• Could provide bottom-up experience to mHealth
  Libraries implementation
• India
• Uganda

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IHC-Case

• 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

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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?

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Technological

• Technical
• Insufficient memory (I6MB?) (technical)
• Low Battery life
• Low processing speed
• Poor software design
• (These accounted mostly for the failure rate)

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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

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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).

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Uganda UHIN A contrast

• Organisational behaviour
• 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

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End-Users Issues

• Technical
• Human Computer Interface (HCI)
• Open Source (Hardware Software)
• Social
• Adoption issues (Development Implementation)
• Culture
• Local Knowledge

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Human Issues Technical

• HCI
• Screen size and design (Adaptive)
• Power- Solar? (Global Green Movement)
• Memory (Stable and Labile)
• Security
• Structure- (Ruggedized)
• Connectivity
• Network Configuration-Thin Thick clients,
  remote located synchronisation

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Low-cost devices

• One Child Per Laptop , Simputer,
• Intel Classmate
• RM Asus MiniBook - Linux
• Open Source?
• Interface
• Open Source
• Multi-wireless
• connectivity

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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)

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Organisational Issues

• Technology
• 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)

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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

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Organisational issues

• 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).

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Conclusion

• mHealth-Libraries have is applicable for health
  development in developing countries
• Barriers should be evaluated,
• understood and tackled

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• Thank you Open University!
• Adesina IluyemiCHMI, UK adesina.iluyemi_at_port.a
  c.uk
• Policy implications and Change Management in the
  implementation use of mobile/wireless eHealth
  in Africas Health Systems