Current, accurate and trustworthy information for medical staff

Project participants at Ugandan health sites © healthnet.org

Dr Bernard Lown started SATELLIFE with the idea of putting satellite receiving stations in universities and medical schools in developing countries around the world in order to provide medical professionals with the scientific and clinical research they needed to stay current in their fields. SATELLIFE was able to reach agreements with the most significant publishers of peer-reviewed medical journals to transmit relevant information via satellite to these ground stations. According to the organisation, the first email ever sent to Africa was sent via SATELLIFE’s privately owned satellite. Today, SATELLIFE runs four renowned digital “HealthNet” newsletters for the global health community and hosts multiple online discussion groups covering a range of health-related topics. The organisation has also pioneered the use of handheld computers and cell phones for health data collection, continuing education, and communication between health workers, partnering with the WHO, the American Red Cross and Ministries of Health in multiple African countries, among others. At eLearning Africa 2008, SATELLIFE will examine the lessons learned in using ICT for these purposes.

eLA: Ms. Scorza, Mr. Sideman, could you please give us some details regarding the components of your work in Africa?

Andrew Sideman: One component of our work is our Information Services: we publish four different “HealthNet” newsletters for health workers in the developing world, each of which is targeted to a slightly different audience and published on a different schedule. HealthNet News, for example, is aimed at a clinician audience and is published weekly. It contains articles from peer-reviewed journals that are of relevance to doctors and senior nurses. Another, HealthNet News – Community Health, is aimed at a Public Health audience -doctors, administrators and senior management.

Pamela Scorza

Pamela Scorza: Alongside our digital newsletters, we host discussion groups that are open to participants all over the world in both the developing and the industrialized countries. Topics covered include HIV/AIDS, essential drugs, nutrition, and cardiovascular health, among others. Anyone can subscribe to these and participate in a global conversation – so these are communities where people can post articles, resources and jobs, ask questions, and generally discuss topics.

The second component of our work is in-country information and communication technology projects to help bring information infrastructure and communication tools to the healthcare sector so that the kinds of information we provide through our newsletters as well as locally generated content can reach healthcare workers even in remote, rural areas. In these ICT projects, we have had great success using relatively inexpensive devices like PDAs and cell phones.

eLA: What is needed to adjust information tools like HealthNet News to the particular needs in this challenging field?

Andrew Sideman: You have to adjust to changes in technology and to changes in what your audience needs and wants. We are comfortable with change. When it became easier and more cost-effective, we stopped using the low earth orbit satellite and now rely on the Internet. We pay careful attention to what our readers and participants do and say. We do this in several ways. We reach out to our subscribers, regularly sending them questionnaires that ask whether they are satisfied with the presentation, the appearance, the subjects of the articles, the quantity of the articles, etc.

Pamela Scorza: And we watch what they do. For example, we add value to our services by offering access to the full texts of the articles via an automated e-mail request and retrieval system for subscribers. This also allows us to track which full-text articles are most often requested and which subjects are most read.

Another way of interacting with the readership is through the chat groups. We read those, and if the chat indicates that there is a strong desire for information on a particular subject, we go out of our way to make sure that that subject is dealt with in the very next issue. If the chat indicates particular satisfaction or dissatisfaction with what we have done, we note that, and we use the information to improve the product.

eLA: Looking back at your experience, what do you think is most important to achieve “digital” community building in health information?

Pamela Scorza: One key is to remain flexible: If you try something that does not work, try to do it again with changes and see if it improves. Another key is that you really have to know what your audience is interested in. We track the interest in topics through the conversations in the chat groups and use direct feedback and requests from subscribers.

Concerning the editorial aspect, you have to keep three things in mind: relevance, reliability and accuracy. Is this relevant to the audience? Are we absolutely certain that the information is coming from a reliable source? Are we presenting it accurately? We continually ask ourselves these questions.

Andrew Sideman: In general, we also think that it is very important to create an environment where people feel that they can have their voices heard without censorship. Our moderators keep the discussions on topic and keep the exchanges civil, but they don’t censor participants’ views and opinions. We also work to create an environment which supports dialogue and encourages exchange. Not just north-south giving or sharing, but particularly south-south sharing. Our aim is to enable and encourage people in Africa, Asia, Latin America to use each other as resources and to take ownership of the information-sharing communities they’ve created.

eLA: Let us now switch to your PDA projects: What is their main aim?

Andrew Sideman: Everything we do is related to information; therefore we are very concerned about the issue of access to information. You can put something on the Internet, but if people do don’t have computers or they don’t have Internet connectivity, it doesn’t mean anything. To address this issue of access involves using technology to build communication networks or to build upon existing communication networks, to put information into the hands of those health workers who are in the most remote, most rural areas. This is what led us to our PDA projects. By the way, we prefer to use the term “mobile computing devices” since increasingly we are including cell phones, “smart phones” and ultra mobile computers in our thinking.

One of our projects is now in its fifth year in Uganda, involving 174 health centres in five districts, serving about a million people. The 600 PDAs which have been distributed as part of the Uganda Health Information Network interface with a device that allows users to send and receive information over the wireless telecommunications system, which in Uganda is very strong. Health workers are using these devices to collect public health data in the field. Each time they transmit data to the server in the capital, they automatically receive new information, which includes Ministry of Health guidelines as well as international clinical peer-reviewed information on topics they have shown interest in.

Pamela Scorza: We and our partners in Uganda, along with the International Development Research Centre and the Canadian International Development Agency, which have funded the work, created UHIN as a two-way communication system: the public health information that the Ministry of Health needs to make policy and allocate resources is sent to the ministry via the network, and clinical and public health resource information is sent back to the health workers. The information chosen is very actionable. It is information that health workers can use on a day-to-day basis in delivering the care their clients need. The Ministry is very interested in expanding the system throughout Uganda to use it as a support for continuing provider education.

The Minister of Health from Mozambique saw us present this work at a conference in New York two years ago. Now we are replicating the model in Mozambique.

eLA: Where do you see the main advantages of PDAs?

Andrew Sideman: PDAs are relatively inexpensive, powerful, and, surprisingly, they are very well suited for difficult environments because they use very little power and their internal batteries can easily be recharged using inexpensive solar panels, they are they are fully sealed and have no fans or moving parts. In addition they are small and lightweight so they can be easily used in the field or at the point of care.

One interesting use which we are actively pursuing is using PDAs and cell phones as reference and educational tools. For example, healthcare workers in Africa are very much overworked. If a healthcare worker leaves her rural clinic for a two week training course, that often means that there is no healthcare delivered in that clinic for two weeks. In addition, training is very expensive. The government – on top of the costs of preparing and delivering the training itself – must pay the participants’ normal salary, and provide funds for travel to the course and per diems for temporary housing, food, and so on. Both for financial resource reasons and because there is no healthcare delivered while participants are away from their posts, many governments are very interested in using mobile computing devices for mobile learning.

eLA: What are you doing to reach your target groups efficiently?

Pamela Scorza: Each time we expand the health information network, we provide training for every single healthcare worker who will be affected. Every worker comes to the training personally. When we first started, we were dealing with people who hadn’t even used cell phones. Even then, people on average learned to use the PDAs in a day and a half. They learn how to use it, how to search for information, how to upload information, how to download information, how to save an article, how to use the electronic forms for collecting public health information, and so on. Users are fully trained in small groups, usually about 15, but never more than 25.

Let me also mention an important success factor: We think that from the very beginning, it has to be very clear that at the end of the day, this is going to be a Ugandan project, a Mozambican Project, a Kenyan project. AED-SATELLIFE is only there to build local capacity and to transfer knowledge.

eLA: Could you tell us something about your future plans? Where do you see future applications in medical training?

Andrew Sideman: We are about to start a project where we will be training and providing mobile devices to all the clinical nurses in the hospital complex in Port Elizabeth, South Africa. It is actually a group of three hospitals in three separate locations throughout the city. Each of the devices will contain a library of medical information to support a comprehensive care program. The initial training for these nurses and the technical staff will probably be delivered by the staff of the Uganda Chartered HealthNet, one of our partners in UHIN. We think it is important to not only build capacity, but also to support the sustainability of local organisations by involving them in projects. In this case the Ugandans will be building capacity among health workers and technical support staff in South Africa.

Pamela Scorza: The programme that I’ve just described in South Africa will be slightly different from our past work in that we will be using smart phones, which are a combination of a PDA and a cell phone. This means users will be able to upload and download the information not only using the wireless, infrared or Bluetooth capacity of the PDA, but also using the telephone capacities. The smart phone will support distance learning because it will give users the opportunity to contact their mentor by phone, ask questions, have a brief telephone conversation about how to do things etc. And it will help connect the staff at the three locations.

We are currently working on a platform that will allow people to use a wide variety of computing devices to gather and report data. Users will be able to use “wired” computers, telephones, cell phones, mobile computers, even bar code scanners and GPS devices connected to PDAs. Health workers will be able to send routine data using the Internet, for instance, and use the telephone functionality to report emergency information. They will be able to use cell phones or smart phones in conjunction with an interactive voice response system that will enable them to upload health data instantaneously. This functionality will be particularly useful for disease-surveillance where a worker in the field will be able to call into a server at the Ministry of Health and use the voice respond system to report an infectious disease outbreak.

eLa: Mrs. Scorza, Mr. Sideman, thank you very much for your time!

Further links:
SATELLIFE http://www.healthnet.org

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