Lessons from the Field: ICTs in Healthcare (October 2004 update)


The majority of the population in developing countries lives in rural areas, while the majority of the medical community exists in the cities. In India, for example, 80% of the population is served by only 20% of doctors. This leaves the 11% of the world's population that resides in the rural India without quality healthcare.

Knowledge transfer to these areas has traditionally been difficult to achieve. ICTs, however, are increasingly being used to facilitate two-way information exchange in healthcare, providing isolated communities with access to the latest health information and treatment and informing officials of rural public health issues.

Online Health Information & Portals
Some initiatives are attempting to make use of the ever-increasing amount of health and medical knowledge for the benefit of developing country communities. The Health InterNetwork project provides access to a vast online library of the latest and best information on public health to providers in 69 developing countries for free, and another 42 for a significantly reduced subscription fee. A similar initiative, eMedicine.com is making their online database available for free in countries having a per capita GDP of less than $3000. Another, INASP Health Links is a gateway to more than 500 selected Web sites for health professionals, medical library communities, publishers, and NGOs in developing and transitional countries.

Many portals have a regional focus. The AfriAfya Initiative, for instance, collectes health information and then uses ICTs to disseminate it to rural and marginalized Kenyan communities. Other examples of online health information focused on Africa include the Health Knowledge Network, HealthNet, and Medilinks.

In India, WebHealthCenter.com is a telemedecine services and health information Web site maintained by Tata Consultancy Services. The portal offers free health care to citizens of India via the Internet. Services offered include real time and e-mail consultations with medical specialists, ECG/EKG and CT scan interpretation, and storage of medical records in secure, online databases.

Other portals are topic-specific. The Reproductive Health Outlook (RHO) site is especially designed for reproductive health program managers and decision-makers working in developing countries and low-resource settings. The Advanced Immunization Management(AIM) site is designed to provide vital information to health managers that are promoting vaccination in developing countries.


Telemedicine
Telemedicine initiatives help bridge the geographical distances between healthcare providers in cities and underserved rural patients, bringing advanced diagnostic methods and treatment to areas that currently have little access. In doing so, the programs enhance the quality of care available, while also decreasing overall healthcare costs by bringing efficiency to the current use of medical and technological resources.

Some hospitals are starting programs themselves. The Apollo Hospitals Group, for example, is piloting an initiative in India that brings telemedicine technology and services, preventative healthcare, and even health insurance to rural patients. The Aravind Eye Hospital is helping to eradicate blindness by using Internet-connected kiosks to provide video consultations and diagnosis, as well as extensive education and training, to local healthcare providers. Two projects, one in Uganda and one in South Africa are linking central and regional hospitals together so that they can better share limited resources.

Other programs work with existing healthcare facilities. In Senegal, Pesinet weighs babies and transmits the results to remote health providers via e-mail. Doctors compare the infants' actual weights to the target weights for their ages to determine whether they need to come in to be examined. In Pakistan, TelMedPak is using high-speed rich-data transfers to provide rural hospitals in Pakistan with access to healthcare teleconsultations with specialists from hospitals located in larger, more developed cities. A similar initiative in Cambodia is using a combination of traditional healthcare services and modern telemedicine to provide consultations to rural villages.


Phone-Enabled
In areas where computer-based networks are either unsustainable or unnecessary for a given task, some projects are utilizing phone networks in new ways to improve health services. The Cell-Life project, for example, uses newly developed mobile phone software for the collection of data necessary for ensuring effective adherence to antiretroviral treatment among South African HIV-AIDS patients. A similar initiative, On-Cue Compliance is using cellphones to send patients text-message reminders to take their medication.

In Peru, the Voxiva Health Alert and Reporting System uses the phone network to integrate remote health centers into the national disease reporting network. The system builds on existing telephone networks and supports multi-level data collection and distribution based on a combination of e-mail, SMS, Web and voice-messaging.

Conventional telephone lines can also be used for the transmission of video. The Videophone Telemedicine Project in Indonesia, for instance, uses low-cost videophone equipment to enable local doctors to consult with specialists in major hospitals.


Handheld-enabled
Handheld computers are also being employed to bring healthcare to rural areas. Less expensive and more mobile than desktop computers, they are allowing some projects to decentralize the delivery of high quality medical services by enabling the flow of information to and from rural healthcare workers.

The Community Access to Sustainable Health (Ca:sh) project in India, for example, is using handhelds loaded with a database of patient records to enable local paramedic workers to quickly and accurately collect patient information, and often make on-the-spot diagnoses based on the patient's medical history. Because the information is uploaded daily into a central database, the system is also helping to track the spread of diseases more effectively, allowing for epidemiological research and response to be taken sooner.

Also in India, the TeleDoc program uses PDAs to collect information from villagers using a pre-designed consultation form. This information is then transferred to a doctor in the city, who diagnoses the problem and suggests appropriate treatment, precautions, and medication. The doctor's diagnosis and suggested treatment is then once again transferred to the PDA and carried back to the villager.

In Uganda, SATELLIFE is employing handhelds to expand the reach of its HealthNet network. The PDAs are used to distribute a wide range of useful information, including current medical journals, drug information, and treatment recommendations. They are also being utilized to gather patient information, improve the quality of blood donations, and fascilitate email contact between rural health workers and their urban counterparts.


Other Technologies
As technology improves and becomes more affordable, new hardware and software will continue to bring health benefits to populations in developing countries. The Early Detection and Prevention System 2000 (EDPS2000) is one example of a medical diagnostic software. It provides a preliminary analysis of disease symptomology, using a database of commonly prevalent diseases and their symptoms sourced from medical literature by specialists in different medical fields. In trials, the software has had a rate of 90% correct diagnosis out of a sample of 10,000 patients.

Hardware innovations have included a rugged, solar rechargeable hearing aid produced by Comcare International. Another company, CyberMDx, has developed the Telemedicine Instrumentation Pack (TIP), a variation of the old-fashioned medical black bag, w hich uses telecommunication technology to transfer medical data for diagnosis, therapy and education.

More Resources
Search the Clearinghouse for more than 80 healthcare initiatives that use ICTs... Search

i4donline.net has links to the latest news articles about the use of ICTs in healthcare.

"Improving Health, Fighting Poverty: The Role of Information and Communication Technology (ICT)" is a July 2001 piece by Exchange, a networking and learning program on health communication that is supported by the UK Department for International Development.

"Information and Communication Technologies and Health in Low Income Countries: The Potential and the Constraints" is from the November 9, 2001 Edition of the Bulletin of the World Health Organization.

"Information and Communication Technology for Health Sector" is a result of the 1999 African Development Forum.

More examples and links can be found on Development Gateway's ICT for Health page.