Access to health information

Any study of access in ICT and health should include a background analysis on digital divide issues generally; then a specific focus on access to health information delivered via ICT -- for health practitioners, researchers and for the public. ICTs present a significant tool for sharing information within various constituencies in the health sector. They also present the opportunity for health professionals in developing countries to access a wide range of medical journals online. Delivery of medical assistance via ICTs make access by the public a key issue.

The research for this list was carried out by a team of researchers working on an infoDev contract to explore the use of ICTs in the health sector in developing countries. The research team was led by a consortium involving Healthlink Worldwide, AfriAfya and the Institute for Sustainable Health Education for Development. Source welcomes additions to this list. Please email any resources you know to be useful (such as printed materials, websites, CD-ROMs, programme evaluations, organisations) to sourceassistant@hi-uk.org.

Selected resources

Access for health practitioners

A historical overview of health disparities and the potential of eHealth solutions

GIBBONS, M
2005

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Over the past decade a rapidly expanding body of literature has demonstrated the existence of disparities in health and health care. While consensus has not emerged regarding the causes of disparities, they are generally thought to be related to sociocultural, behavioural, economic, environmental, biologic, or societal factors. To effectively address disparities, several authorities have suggested the need for greater information technology research and investments. eHealth researchers may be able to make significant contributions in this area through research and its applications. This paper begins with a historical overview of health disparities in the United States and Europe. It then discusses the role that the Internet, and access to the Internet, may play in the genesis of health disparities. Finally, this paper closes with a discussion of the potential benefits of eHealth applications and the possible contributions of the field to overcoming disparities in health and health care

Bridging the implementation gap between knowledge and action for health

HAINES, A,
KURUVILLA, S,
BORCHERT, M
2004

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There is widespread evidence of failure to implement health interventions that have been demonstrated to be cost-effective by high-quality research; this failure affects both high-income and low-income countries. Low-income countries face additional challenges to using research evidence including: the weakness of their health systems, the lack of professional regulation and a lack of access to evidence. There is a need to strengthen institutions and mechanisms that can more systematically promote interactions between researchers, policy-makers and other stakeholders who can influence the uptake of research findings. The concept of public engagement with health research requires a public that is both informed and active. Even when systematic reviews are available further work is needed to translate their findings into guidelines or messages that are understandable to patients and health professionals. Many of the commonly used approaches for keeping health professionals' knowledge up-to-date appear to have small or inconsistent effects. The evidence-base is more extensive for interventions directed towards professionals, such as education, reminders or feedback, than for those directed at organisations or patients. The effect of interventions varies according to the setting and the behaviour that is targeted. Case studies in low-income settings suggest that some strategies can result in increased coverage of evidence-based interventions, but there is a lack of evidence from systematic reviews of rigorous research. Given the potential for near-term improvements in health, finding more effective ways of promoting the uptake of evidence-based interventions should be a priority for researchers, practitioners and policy-makers

eHealth for health-care delivery : strategy 2004-2007

WORLD HEALTH ORGANIZATION (WHO)
2004

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Information and communication technologies have a crucial role to play in the delivery of health care, particularly in developing countries. This document outlines the WHO programme on eHealth for health-care delivery (eHCD), which aims to help decision and policy makers to create the conditions for the integration of eHealth solutions into the health system. Health technologies can be very effective in disease prevention, diagnosis and patient management and care, but the modality of implementation may vary according to the specific needs of a country. The document sets out priorities and operational framework of the programme, and spells out the goals to be achieved by 2007

Evaluating computerised health information systems : hard lessons still to be learnt

LITTLEJOHNS, Peter,
WYATT, Jeremy C,
GARVICAN, Linda
2003

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This article discusses the implementation of a hospital information system in Limpopo Province, South Africa and describes how it failed because of inadequate infrastructure and problems with the functioning of the system itself. Furthermore, users were not made sufficiently aware of the purpose of a computerised system and failed to appreciate the complexity of implementation and of the healthcare process. The paper calls for a better understanding of the unique nature of hospital information systems and for well designed evaluation to be built into the contracts from the beginning

Handhelds for health : SATELLIFE’S experiences in Africa and Asia

SATELLIFE
July 2005

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This report describes the SATELLIFE experience in implementing handheld computer projects to support health-care providers and institutions in a dozen countries in Asia and Africa. It captures SATELLIFE's experience and lessons learned as a 16-year veteran of using ICTs for health and an early adopter of handheld computers in low-resource environments. It also provide some pointers to other organisations that may benefit from their knowledge and experience, to optimize their own use of ICT in general or handhelds in particular

HINARI : Bridging the global information divide

KATIKIREDDI, S V
2004

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HINARI cannot reach everyone who might benefit. In many countries internet access is slow, expensive, and unreliable. Many poor institutions carrying out valuable research in countries with a GNP per capita of over $3000 per year are not eligible to use HINARI Information is often not available in electronic format - especially if it has been produced locally. The electronic format may be unsuitable for certain uses - for example, medical students in the developing world may benefit more from printed textbooks than from virtual textbooks that are only accessible from an unreliable internet connection at medical school. HINARI may also pose problems to researchers and health professionals working in the developing world. Allowing unrestricted access to much of the world's medical literature may produce an information overload and lead to valid and relevant information being difficult to find. This is particularly important for people who are not experienced in using information technology and reading primary research (but this problem occurs in the developed world too). Some valuable journals of specific relevance to the developing world (tropical medicine journals, for example) may not be available through HINARI as this may compromise publishers' commercial viability. Also, in a few countries, publishers withhold some journals because the sales of these journals are significant in these countries. However, institutions in these few countries are still able to access at least most of the key general medical and scientific journals without restrictions

Integrating equity into health information systems

WORLD HEALTH ORGANIZATION (WHO)
May 2005

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An equity-sensitive health information system (HIS) could measure inequities in health outcomes; track flows of health resources in terms of access, utilization and financing; and provide a better understanding of the extent to which investments in health care contribute to improving health. It would also highlight the factors that influence health and health inequities that are outside the realm of health care, for example, social and living conditions. This paper identifies the core indicators and other primary needs for building an equity-sensitive HIS, considers the current opportunities for improvement, suggests core equity stratifiers, and provides recommendations for strategically increasing the availability of equity-oriented data

Local capacities to create and adapt information for healthcare workers in developing countries

PAKENHAM-WALSH, Neil
July 2002

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This study is a brief but sobering analysis of the impact of ICTs and health information in the developing country environment. The author notes that despite its massive potential, the current global information explosion has had little impact on access to practical information for frontline healthcare workers in developing countries, especially those working in primary care and district hospital settings. The author notes that healthcare workers in developing countries continue to lack access to the basic information they need to learn, to diagnose, and to save lives. However, it is shown that this can be improved through access to and use of ICTs

Maternal health care in rural Uganda : leveraging traditional and modern knowledge systems

MUSOKE, Maria
January 2002

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A case study of the RESCUER project, in Iganga District, Eastern Uganda. The project was designed to link the traditional rural community health providers with the formal health delivery system in a cost-effective way. The increased number of deliveries under trained personnel, and increased referrals to health units, led to a reduction of about 50 percent in the maternal mortality rate (MMR) in three years

Tecnologías de la información y comunicaciones

MONTEAGUDO Peña, José Luis
2004

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Information and communication technologies are essential to support professional research activities in biomedicine and health. Their adoption and use is linked to efficiency and competitiveness. After needs analysis, ICTs applications whose use is recommended, are identified. Needs refer to activities linked to the execution of research projects but also to teaching, continuous training and professional development. Based on that, it is proposed a formative programme structure with different competence levels and with a combination of horizontal common general skills and vertical specialization areas. Finally, it is highlighted that new technologies facilitate new instruments but also they represent new working cultures and present new ethical and legal dilemmas to the researchers that would need to be educated in new working environments

Towards equity in global health knowledge

PAKENHAM-WALSH, Neil,
PRIESTLY, Carol
July 2002

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Emphasizes the interdependence of global health knowledge and draw attention to inequities in the global flow of information that profoundly affect the evolution of the global knowledge base and its relevance to health priorities. Information and communication technologies have great potential to reduce these inequities, not only by disseminating information, but also by supporting such important activities as international co-operation and Southern-led development. Describes briefly some of the challenges, recent achievements, and priorities for the future

Access for the public

Appropriating the internet for social change : towards the strategic use of networked technologies by transnational civil society organizations

SURMAN, Mark,
REILLY, Katherine
November 2003

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This research report argues that analysis of the Internet focuses too much on technology and on overcoming a "digital divide" in access to the Internet. The report looks at examples of how people in international civil society organisations have used e-mail, websites and databases to help them collaborate, publish information, mobilise people in their networks, and access information for research. The report does not cover local or national civil society organisations

Can we achieve health information for all by 2015?

GODLEE, Fiona
et al
July 2004

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This article summarizes the attempts, since 1995, to utilize information and communication technology to bridge the health information gap between developing and industrialized countries. The authors note that the successes has been 'patchy' and that the potential has not been reached. Significant gaps continue between the north and south and also are seen between urban and rural areas especially for current clinical information. Stakeholders have not been involved sufficiently and there is considerable need for better telecommunications access and capacity building. The authors conclude that, without championing by a major player such as the WHO, the millennium goal of unviersal access to health information will not be reached despite some successes in the past 10 years

Developing materials on HIV/AIDS/STIs for low-literate audiences

FAMILY HEALTH INTERNATIONAL (FHI),
PROGRAM FOR APPROPRIATE TECHNOLOGY AND HEALTH (PATH)
December 2002

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This manual provides a comprehensive methodology for developing materials for a low-literate audience in the context of a behaviour change communication program. It demonstrates the process of learning about target populations using qualitative research methodologies, developing effective messages with thir input, and crafting visual messages to support the overall HIV and AIDS program. Involving the target population and stakeholders in the development process is key to ensuring high-quality effective print materials. Finally, the guide outlines the process for rigorous pretesting to ensure that the information and issues are understood by the population groups that programs are trying to reach and influence. It can be adapted and used to develop audio-visual materials or materials for other target groups

How to improve the use of medicines by consumers

CHETLEY, Andrew
et al
2007

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This manual focuses on selecting, testing, implementing and evaluating interventions to improve the use of medicines at community level. Two broad strategic areas are identified: communication strategies and strategies to create enabling environments. "What has become clear over the years is that there is no single model or approach that is the solution to all health communication challenges. Different techniques are appropriate in different contexts to deal with different priorities and problems. This manual will help you to build skills and experience to make that selection more effectively"

Making health communication programs work

NATIONAL CANCER INSTITUTE
2002

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This handbook presents key principles and steps in developing and evaluating health communication program for the public, patients, and health professionals. It expands upon and replaces two earlier publications titled Pretesting in Health Communications and Making PSA's Work. Referring primarily to the context of the United States, the guide discusses specific steps in program development and includes examples of their use. Sources of additional information on each subject are included at the end of the chapters

Overview of health communication campaigns

THE HEALTH COMMUNICATION UNIT
March 2007

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This guide provides a hands-on 12-step process to developing health communication campaigns. Each chapter is created according to the steps, with information on what the step is, why it is important and what is required to carry it out

Relevant health information for empowered citizens

HEALTH ACTION INTERNATIONAL (HAI)
2006

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Information is an integral part of healthcare: the need for patients to give informed consent is the basis of all care and treatment. For patients to be able to make informed choices they need information that is reliable, comparative and adapted to users, and that is not linked to advertising and drug promotion

Salud y desplazamiento, impacto interinstitucional en la red

PRIETO MOLANO, Carolina
September 2005

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This article analyses the use of specific e-health applications and their social impact on public health in a Latin American country, focusing on forced displacement due to the armed conflict in Colombia. It gives an overview of the web page 'Health and Displacement', its importance, its coverage and future expectations

Strengthening the knowledge and information systems of the urban poor : policy paper

SCHILDERMAN, Theo
April 2002

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This brief policy paper summarises the findings of a research project that focused on the information needs of the urban poor, and the information sources they access. The study found that the main sources of information were social networks, key informants, and infomediaries. It ends with six suggestions for development agencies seeking to share their knowledge and information with the urban poor

The effectiveness of web-based vs non-web-based interventions : a meta-analysis of behavioural change outcomes

WANTLAND, D J
et al
2004

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The use of the Internet to deliver web-based interventions to patients is increasing rapidly. The use and effectiveness of web-based interventions to encourage an individual's change in behaviour compared to non-web-based interventions have not been substantially reviewed; hence this meta-analysis was undertaken. This article presents a systematic review of web-based therapies intended to encourage an individual's behaviour change. Sixteen of seventeen included studies revealed the outcomes of improved knowledge and/or improved behavioural outcomes for participants using web-based interventions. Outcomes included increased exercise time, knowledge of nutritional status, slower health decline

Digital divide

Information and communication technologies in Africa

ADEYA, Catherine Nyaki
2001

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[From foreward:] This literature review and annotated bibliography explore the evidence for the potential of ICTs (information and communication technologies) to assist in Africa's development, and the extent to which ICTs are changing the 'shape' of Africa. The review begins by introducing ICTs and the information economy in the African context. The literature selected for the bibliography is then reviewed thematically under a number of headings: Overview of ICTs in Africa; Information infrastructure; Information economy; Information management; Socio-cultural and political issues; Education and training; and Gender. The review reveals that, despite many constraints, the use of ICTs is growing in Africa and there have been successful developments in infrastructure, information management, networking and gender-related issues. However, the literature has also revealed considerable variation between different African countries in their adoption and use of these technologies. The literature reviewed relates primarily to anglophone Africa and generally excludes telecommunications issues, as these are already well documented in other publications. In essence it is hoped that this publication will act as a window of opportunity for more nationally and locally focused empirical research and will make a contribution to understanding the research opportunities and challenges that still face most African countries

The potential and the constraints in low income countries

GHOSH, V,
CHANDRASEKHAR, C P
July 2002

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This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. Conclusions are that the development of ICTs can bring about improvements in health in developing countries but there are barriers including the limits on physical access to new technologies, the high cost of providing such access for the less well endowed, and exclusion from access due to the inadequate capabilities of large sections of the population. These constraints suggest that the ICT revolution could, in turn, generate a new digital divide

The wireless internet opportunity for developing countries

WIRELESS INTERNET INSTITUTE
Ed
November 2003

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The expansion and transfer of information and communication technology is crucial to the economic growth of developing countries. Connectivity through the Internet, in particular, is essential in a global and increasingly expanding knowledge economy, but it is also important for the improvement of national services and government (e-health, e-education, e-government). This book focuses on Internet technologies and opportunities and argues that for resource-constrained countries the deployment of broadband wireless Internet may be the only viable and the most cost/effective option. Chapters address technology, regulatory issues, vendor resources, and country guidelines. The second part of the book contains 12 case studies, covering a broad range of areas, from sustainability to education, remote regions, WISPs, shared access, adaptive technologies, and rebuilding nations, and includes useful lists of key things to remember