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(Fwd) [Bridges.News] Case study on the Satellife PDA Project
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To: news@bridges.org
From: Margareet Visser <margareet@bridges.org>
Date sent: Mon, 03 Mar 2003 19:03:20 +0200
The SATELLIFE PDA Project
****Bridges.org-IICD case study series on ICT-enabled development****
<The bridges.org-IICD Case Study Series on ICT-Enabled Development
sets out to illustrate how information communication technology (ICT)
contributes to development in Africa. The aim of this series is to
help ground level initiatives imagine the possibilities of what can
happen if they use ICT successfully to overcome development
obstacles, and to contribute to the existing body of knowledge on the
digital divide. To find out more about this series, or to view other
case studies completed, please go to:
www.bridges.org/iicd_casestudies/index.html
This case study consists of four parts: 1.) the "Overview" that
provides basic information about the organisation/initiative, 2.) the
"Gauging Real Impact" section that contains the evaluative component
of the case study, 3.) the "Lessons Learnt" section, written by the
organisation/initiative being reviewed, and 4.) "The Story", a
narrative description of the organisation/initiative.>
I. OVERVIEW
<Initiative> The goal of the SATELLIFE PDA Project was to demonstrate
the viability of handheld computers -- also called Personal Digital
Assistants or PDAs -- for addressing the digital divide among health
professionals working in Africa.
<Implemented by> This project was inspired and led by SATELLIFE, a
non-profit 501(c)(3) organization based in Massachusetts, USA.
SATELLIFE's mission is to improve health in the world's poorest
nations through the innovative use of ICT. It promotes the use of
appropriate, affordable technologies to link health professionals in
developing countries to each other and to reliable sources of
information, including by using geostationary satellites, modem-to-
modem telephone links, and the Internet. SATELLIFE worked on this
project with a number of ground level partners, including the
American Red Cross; Makerere University Medical School in Kampala,
Uganda; HealthNet Uganda; Moi University Faculty of Health Sciences
in Eldoret, Kenya; and the Indiana University Kenya Program.
<Funding or financial model> The project was funded by the Acumen
Fund. Acumen brings a new and unique approach to development aid,
which focuses on the accountability of project proponents to
investors. Acumen identifies high-impact social organizations (both
for-profit and non-profit), connects them to philanthropists who want
measurable social results for their investment, and measures the
result of the impact.
<Timeframe> The project took place during December 2001 to December
2002.
<Local context> In Uganda 35% of the population lives below the
poverty line. The GDP of the country is US$29 billion and the per
capita income is US$1200. An average desktop computer costs
approximately US$1000-1300, and a laptop computer ranges from US$1300
to $2200 (for modern, but not state-of-the-art hardware). In Kenya
50% of the population lives below the poverty line. The GDP of the
country is US$31 billion and the per capita income is US$1000. An
average desktop computer costs approximately US$1425 and a laptop
costs approximately $2000. Overall, ICT access is low in both Uganda
and Kenya in terms of telephones, computers, and other basic
infrastructure; however both governments are working to improve the
situation. PDAs are virtually unavailable in Uganda and Kenya. ICT
access is also low overall in the healthcare environments of Uganda
and Kenya, although it is clearly higher than the national average.
All of the major hospitals and the medical schools visited used
computers for administrative purposes, but only in limited ways. For
the participants in the study - and presumably also the future users
of PDAs in developing countries - limited access to landline
telephones and/or PCs affected their use of the PDA. Since PCs, PDAs
and other technologies are not widely used in substantive
applications in the healthcare field in Uganda or Kenya, it follows
that no country-specific healthcare information was available which
was also ready-to-use with a PDA.
<The development problem/obstacle addressed> Healthcare is one of the
leading issues affecting African development today. HIV/AIDS is
devastating the continent, and that is only one aspect of the
healthcare crisis. For example, malaria is by far the most lethal
tropical parasitic disease, killing more people than any other
communicable disease except tuberculosis (TB), and it is estimated to
have cost Africa USD $100 billion over the last 30 years. Yet
malaria, TB, and other diseases can be managed if promptly diagnosed
and adequately treated, and in many cases prevention methods are
relatively cheap and simple. But lack of information on treatments
and disease management is often an underlying issue that hinders
effective patient care and prevention.
Information and communications technology (ICT) can play an important
role in combating disease and improving healthcare. ICT can be used
as a tool for collecting community health information to support
decision-making; improving doctors' access to current medical
information; linking healthcare professionals so they can share
information and knowledge; and enhancing health administration,
remote diagnostics, and distribution of medical supplies. But even
though ICT can help, the solution to Africa's healthcare crisis is
not as simple as installing computers in every hospital and clinic
and linking them to the Internet. Infrastructure and hardware mean
nothing if ICT is not used effectively because it is not appropriate
to the real needs of healthcare professionals at ground level, there
is no locally relevant content available, healthcare providers are
not trained to use it, or they cannot afford to use it.
<How ICT is used to overcome the problem> The SATELLIFE PDA Project
explored questions related to the selection and design of
appropriate, affordable technology and locally relevant content for
use in African healthcare environment, specifically targeted at
assessing the usefulness of the PDA for (1) data collection and (2)
information dissemination. Physicians, medical officers, and medical
students tested the PDA in the context of their daily work
environments in order to gain a perspective on the real issues that
affect the adoption of technology.
The PDA used was the Handspring Visor Neo, with a 33 MHz DragonBall
VZ microprocessor from Motorola, a Palm operating system (Palm OS),
and 8 MB of main memory. Pendragon Forms v3.1 was the software
program used to create the survey forms. Country-specific drug lists
and treatment guidelines were obtained by SATELLIFE in hard copy or
electronic formats and adapted to a PDA-accessible format. Medical
texts were obtained from Skyscape.
The Project was conducted in three phases. SATELLIFE first put the
handheld computers to use for field surveys, by linking this project
to a widespread measles immunisation campaign being conducted in
Ghana by the American Red Cross in December 2001. The SATELLIFE-ARC
joint effort used 30 PDAs in a short-term survey intended to
determine the efficacy of the measles immunisation campaign outreach
efforts and collect some baseline health information. The Uganda
phase tested the use and usefulness of 40 PDAs by medical
practitioners to conduct an epidemiological survey on malaria, and to
access and use medical reference tools and texts. The Kenya phase
tested the use and usefulness of 40 PDAs by students to collect field
survey information, and to access and use medical reference tools and
texts as part of their studies.
The project validated the use of handheld computers in healthcare
environments in Africa. There were a number of valuable lessons
gleaned from the project that can be applied to further deployment of
PDAs in developing countries. A number of obstacles to technology
use have also been identified, which will need to be overcome in
order to promote the widespread adoption of the technology in this
context. Finally, the project has served to open the door for a
number of opportunities that are worthy of the attention of
technology companies and content providers.
<Next steps> Given ground level realities in Africa where
electricity, security, and cost are only a few of the factors that
inhibit technology use, it is unrealistic to imagine that technology
could be put in the hands of the general public if that means a PC in
every home or office. But PDAs are a viable alternative that can be
used for a variety of practical purposes throughout society, and they
may represent a turning point in the way that the digital divide is
approached across Africa and beyond. SATELLIFE intends to continue
building and implementing projects that will tap the enormous
potential of handheld computers to help bridge the digital divide in
Africa and beyond.
<Geographical area targeted> Ghana, Uganda, and Kenya
<Contact information>
SATELLIFE
30 California Street
Watertown, MA 02472, USA
Tel: + 617 926 9400
Fax: + 617 926 1212
Email: info@healthnet.org
II. GAUGING REAL IMPACT
<This section considers whether and how the initiative has made a
Real Impact at the ground level by looking through the lens of basic
best practice guidelines for successful initiatives. The bridges.org
7 Habits of Highly Effective ICT-for-Development Initiatives are used
here as a framework to highlight what the initiative has done well.>
The 7 Habits of Highly Effective ICT-for-Development Initiatives
1. Implement and disseminate best practice. It is widely recognised
that ICT can play an important role in combating disease and
improving healthcare by aiding the collection of community health
information to support decision-making; improving doctors' access to
current medical information; linking healthcare professionals so they
can share information and knowledge; and enhancing health
administration, remote diagnostics, and distribution of medical
supplies. SATELLIFE carefully examined the use of PDAs in healthcare
in the United States, and built this project on knowledge gleaned
from the successful experiences of others.
SATELLIFE engaged bridges.org to conduct an independent evaluation of
the PDA trial that looked at the technology itself, the content
loaded on it, and the impact that the PDA had on the behavior of
health professionals and the quality of care they delivered. The
evaluation report presents the lessons learned in this project to
inform decision-making about future uses of PDAs and other ICT for
development. It also provides resource materials for planning and
implementing future steps in the SATELLIFE project or related
initiatives. The full evaluation report is available at
http://www.bridges.org/satellife/.
2. Ensure ownership, get local buy-in, find a champion. The project
connected with local implementation partners in order to ensure local
ownership and buy-in. The American Red Cross was the local
implementation partner that linked the PDA project with a broader
measles immunization programme underway in Ghana. The Uganda phase of
the project was implemented in cooperation with Makerere University
Faculty of Medicine. Professor N.K. Sewankambo, Dean of the Makerere
Faculty of Medicine, acted as a main point of contact and local
champion for the project. HealthNet Uganda, located at Makerere,
acted as a local implementation partner and a full-time SATELLIFE
project field manager was based there to coordinate implementation at
ground level. A HealthNet Uganda site coordinator provided technical
support and project assistance. In Kenya, the project was
implemented in cooperation with Moi University Medical School and the
Indiana University (IU) Kenya Program. Dr. B.O. Khwa Otsyula, Dean
of the Moi Faculty of Health Sciences, acted as a key point of
contact and local champion for the project. Moi staff members worked
together with the IU Kenya Program to handle local implementation.
The SATELLIFE field manager in Uganda also traveled frequently to
Kenya and helped to coordinate implementation.
3. Do a needs assessment. This project responded to a need for better
information to improve medical treatment and disease management in
developing countries. PDAs are widely used in the medical profession
in the developed world, but are a relatively new technology in
Africa, and little work has been done before now to demonstrate their
utility as a tool for healthcare in developing countries.
4. Set concrete goals and take small achievable steps. The pilot was
divided into three distinct phases to make it more manageable. The
first phase of the project took place in Ghana in December 2001. The
Kenya and Uganda phases were conducted in parallel during March-
December 2002. SATELLIFE plans to build on this pilot with future
projects using handheld computers for healthcare in Africa.
5. Critically evaluate efforts, report back to clients and
supporters, and adapt as needed. SATELLIFE and its project partners
carried out a series of mid-term evaluations on this project, which
were taken into consideration by bridges.org as part of its overall
project evaluation. A number of key lessons learned were gleaned
from these evaluations, and SATELLIFE and its partners introduced a
number of appropriate changes during the project to overcome the
identified challenges. SATELLIFE issued regular project updates (at
approximately 3-month intervals) to keep clients and supporters
current and involved.
6. Address key external challenges. As part of the pilot a number of
external challenges that affected the current and future use of the
PDAs in these healthcare environments were identified, including
bureaucratic hurdles, technology problems, lack of local technology
supply, project management issues, and overall project implementation
challenges. SATELLIFE is taking steps to tackle these external
factors head-on as it moves forward in this area.
7. Make it sustainable. Handheld computers proved to be an
inexpensive alternative to PCs in terms of computer power per dollar.
In an environment where PCs are beyond the reach of most people,
even healthcare professionals, the PDA offered a reasonably priced
alternative that gave significant computing power for the price.
However, the cost of the PDAs may still be too high for the average
person in Africa. The biggest challenge for the technology is
whether average people in developing countries will be able to afford
PDAs. There is a significant potential market for affordable
handheld technology in the developing world, where there is little
ICT infrastructure and a lack of conventional ICT such as PCs. The
high uptake of cellular telephones in countries such as Uganda, Kenya
and South Africa is an indication that people in developing countries
are willing to spend money on technologies that prove to be really
useful and relevant to them. The industry should produce a cheaper
PDA that is targeted to poorer markets. There is clearly a market
opportunity for handheld computers in African countries.
III. LESSONS LEARNT
<We invited Holly D. Ladd, the executive director of SATELLIFE, to
share her views on the greatest success of the PDA Project, the
challenges they have faced, key constraints and dependencies that
affect the initiative, opportunities for future improvement of what
they do, and other lessons they have learned. This is what she had to
say:>
"Our primary goal for this project was actually quite modest: to test
the viability of the handheld computer in rural and urban settings in
Africa. But the potential implications were quite profound,
especially for the health sector. If our hypothesis was correct, then
we would have identified a relatively affordable, portable, and easy-
to-use solution to many of the continent's information dissemination
and data collection needs.
As it turns out, our hypothesis was correct. The units worked well in
a variety of settings, users with little or no previous computer
experience adapted the technology quite easily, the health content we
provided was enormously valuable, and data collection and analysis
was accomplished quickly, easily, and at a fraction of the cost of
traditional pen-and-paper surveys. Good end-user training and careful
selection and adaptation of content were key requirements for
success. The power supply issue was and will remain a challenge until
solar power becomes an option, so people need to think carefully and
creatively about that when designing projects.
Our philosophy is that there is no single technology solution that
will meet all the data and information needs of our constituents in
the health sector, but we feel very confident encouraging people to
give handheld computers serious consideration as they assess their
specific needs. What we have accomplished so far is just a glimpse of
what we think this technology can do, and we are eager to keep
pushing in new directions."
IV. THE STORY
<This section presents a narrative description of the initiative that
highlights why this use of ICT for development is particularly
interesting.>
In Africa measles are often called the "disease of the wind". Every
year, the virus moves swiftly through overcrowded schools and closely
huddled shacks, killing almost half a million of African children.
Now, efforts to stop this killer have received a significant boost
from an unlikely source: the handheld computer, a.k.a. a Personal
Digital Assistant or PDA.
As many healthcare workers know, effective management of epidemics
are crucial to prevent renewed outbreaks and enable the judicious use
of limited health resources. This is where PDAs come in handy.
Although the Measles Initiative -- which aims to vaccinate 200
million children in 36 Sub-Saharan African countries -- hopes to
bring measles deaths to zero by 2005, the close monitoring of the
initiative is key to its success. Normally the Red Cross, one of the
key partners of the Measles Initiative, uses pen and paper surveys to
gather data about the diseases and vaccination efforts. This data is
manually entered into a database and analysed to plan follow-up
campaigns. However, this process is cumbersome, time consuming,
expensive, and prone to human error.
In December 2001 Satellife worked with the American Red Cross to
conduct a pilot that tested the efficacy of PDAs for measles field
surveys in Ghana. Thirty Ghanaian Red Cross volunteers, trained over
a two-day period, had no trouble with the technology, though some of
them had never before used a computer. They were able to complete
over 2,400 surveys in just three days, where the traditional paper
and pen survey method generally yielded about 200 finished surveys.
Survey data was turned in at noon on the last day of the pilot;
analysis was completed promptly after the data was hot synched into a
computer; and a complete report was delivered to the Ghanaian
Ministry of Health by 5pm. The entire pilot was completed in less
than a week, and the speed and ease of gathering this epidemiological
data was unprecedented.
Fired on by this success, Satellife conducted a second phase of the
pilot during 2002: this time, they also wanted to test whether PDAs
would be useful for the dissemination of healthcare information. They
distributed 80 PDAs -- half to medical students in Kenya, and the
other half to practicing doctors and medical officers in Uganda. The
PDAs were loaded with country-specific drug lists and treatment
guidelines for HIV/AIDS, TB, and Malaria, the latest medical texts,
field surveys, health references and guides for diagnosing diseases.
Doctors were very impressed by the amount of information that could
be stored on the PDAs, and the fact that it was a real time saver.
Normally they would visit patients on the wards and then would have
to walk back to the library to confirm their diagnosis. The
healthcare information loaded on the PDAs enabled them to confirm
their diagnosis on the spot. They also frequently used the PDA's
medical calculator, which enabled them to accurately calculate drug
dosages. Correct dosaging is especially important when treating
children, because they vary in size and weight and a high dosage
could easily harm them. Other doctors liked the PDA because they
could quickly check the side effects of a drug, which was especially
useful when they were prescribing unfamiliar drugs.
Although doctors had almost no previous exposure to PDAs they quickly
cottoned on to its potential applications for public healthcare. They
suggested it should be used to improve regular disease reporting to
city and regional medical officials that would strengthen efforts to
identify disease patterns and reaction times to public health
threats. Doctors suggested that the PDAs would be very useful in
rural areas where textbooks are often unavailable. One highlighted
patient record-keeping as a critical future use for the PDAs. A few
also mentioned that they would like to use the PDAs to communicate
with their colleagues, especially to ask for advice about patient
consultations.
The doctors' suggestions hinted at the many other potential ways that
PDAs could be used in an African healthcare setting and it would
serve healthcare department well to take note of their suggestions.
The only obstacle that is really standing in their way is the costs
of the PDAs. However, if the cost of the technologies could be driven
down, not only would it improve healthcare in Africa, but a whole new
market could potentially be created modelled on the example of
cellular telephones, which brought unprecedented telecommunications
access to millions across the continent. Satellife is hoping that
their results would be a wake-up call to industry and a glimpse into
the untapped markets where technology could make a real difference to
people's lives.
__________________________________
Author: bridges.org
Date: 3 March 2003
About the IICD and bridges.org ICT-for-Development Case Study Series
The International Institute for Communication and Development (IICD)
is an independent non-profit foundation, established by the
Netherlands Minister for Development Cooperation. IICD assists
developing countries to realise locally owned sustainable development
by harnessing the potential of information and communication
technologies (ICT). IICD works with its partner organisations in
selected countries, helping local stakeholders to assess the
potential uses of ICT in development. For more information on IICD:
http://www.iicd.org/about/.
Bridges.org is an international non-profit based in South Africa with
a mission to help people in developing countries use ICT to improve
their lives. Its main focus is to enable informed policy decisions,
which affect people's access to and use of ICT. Bridges.org also gets
involved in ground level projects to study the effects of policy
decisions and relay lessons learned to the international development
community. It brings an entrepreneurial attitude to its social
mission, and is committed to working with, instead of against,
government agencies and the business community. For more information
on bridges.org: www.bridges.org.
This initiative is supported by the Building Digital Opportunities
Programme (www.iconnect-online.org) which is funded by the UK
Department for International Development (DFID), the Directorate
General International Cooperation (DGIS), and the Swiss Agency for
Development and Cooperation (SDC).
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