Tag Archives: Health

ICT For Health and Behavioral Change: An Overview

ICT for health initiatives are widely popular interventions for disease control and prevention in developing contexts, and have been increasingly employed on both the patient side and for medical professionals over the last decade. Approaches of ICT for health cover logistics, telemedicine, supervision, data exchange, medicine reconciliation, and emergency notifications. They are also employed through a variety of mediums, including SMS services, mobile gaming, television programs, open-source software, and even voice and audio applications. Yesterday, David Kulick from the John’s Hopkins Bloomberg School of Public Health related to our class the ins and outs of developing ICT health related initiatives. The Hopkin’s Center for Communication Programs combines forces with the Bloomberg School to formulate projects devoted to changing behavior on a community and individual level, and has been active since 1988 in more than 30 countries. ICT initiatives for behavioral change, as compared with other ICT for health approaches, work to find “new, participatory ways to reach audiences with persuasive messages” that can transform ways of thinking and interacting to make a society healthier as a whole (jhuccp.org). An example of such a CCP program is MAMA, or the Mobile Alliance for Maternal Action. This initiative, which is active in Bangladesh, India, and South Africa, uses SMS during weeks 5-42 of pregnancy and the first year of a baby’s life to inform a mother about antenatal care, nutrition, and even insecticide treated bed-nets to improve health outcomes. These techniques are used by many ICT for health projects, and are an important intervention that can provide beneficiaries with critical information in a short amount of time.

An interesting dilemma facing the ICT for health field is the stratification of beneficiary access, which is in turn reflected in the results of a given project. Mobile phones and televisions are commodities, and the poorest members of a community who made need such ICT interventions the most may not be reached due to cost limits. In addition, gender biases in many societies can restrict women’s ability to use applications; for example, many times a woman’s husband or male family member controls a phone, and a pregnant woman may not be able to view SMS messages concerning maternal health or she may be afraid that the messages will result in an invasion of her privacy. Another key problem with ICT for health applications is an issue that reverberates across development projects in general: their “one size fits all” model decreases their effectiveness in getting at the root of the problem. Mass SMS programs that intend to respond to health queries are not yet sophisticated enough to take into account demographic differences such as sex, age, or economic status, and thus may provide irrelevant and unusable advice to beneficiaries in need. ICT for health programs such as those maternal health applications developed by the CCP have made strides in decreasing maternal and infant mortality, but future health projects should look towards innovations that make applications more individualized towards the recipient. Changing behavioral norms is quite difficult, but ICT has the ability to harness changing technology to find cutting edge solutions to health issues and to apply these lessons to other sectors of development.


The Swedish Spider Web

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Spider is a program out of Stockholm University which aims to support the use of ICT4D and poverty alleviate through project sponsorship and support in developing countries, with a primary focus on the “twelve priority countries” for Swedish development cooperation (Bangladesh, Burkina Faso, Cambodia, Ethiopia, Kenya, Mali, Mozambique, Rwanda, Tanzania, Uganda, and Zambia). Spider mainly supports projects related to the enhancement of democracy and the improvement of education and health services, which correlate with the United Nations Millennium Development Goals. I think its important to consider ICT4D as a means to achieve and end goal and not a end in and of itself. There’s a reason increasing Worldwide Internet Access isn’t a MDG!  In order for a development project to be successful,  the target population must be in demand of the service to be given (such as vaccines or textbooks). In Richard Heeks’ article ICT and the MDGs: On the Wrong Track?, the author addresses the controversial issue of developed, wealthy countries proposing a single, relatively inflexible path to development that they themselves did not pursue. Why should developing countries have to follow this agenda? Who says it is the right one to follow? The same goes for ICT. There’s no use in seeking to implement technology where there’s no demand or infrastructure to support it. Spider’s framework theoretically overcomes this obstacle in that it focuses in three main areas (democracy, education, and health) where there is a demand and a distinct possibility for the tangible application of technology for development and poverty alleviation purposes, with longterm results. With four “Networks” (hence the spiderweb metaphor), Spider aims to promote “synergistic collaboration and cross-breeding” based on geographic location of development theme. This allows experience and expertise to inform the various projects: “in addition to supporting and advising each other, the projects also feel that they are part of a greater effort, the compound impact of which surpasses individual parts”.


Can Technology Help Brain Development?

In class this week we had a discussion about the differences in how each generation uses and understands technology. I made a point about younger people being raised around technology and the effect that could have had on brain development or why we understand technology more. I thought this was an interesting idea and I wanted to know more, so I decided to do some research. I found many articles on the negative impacts that technology has on developing children. Most of these articles look fairly similar to this article from Huffington Post. The author explains, “diagnoses of ADHD, autism, coordination disorder, developmental delays, unintelligible speech, learning difficulties, sensory processing disorder, anxiety, depression, and sleep disorders are associated with technology overuse, and are increasing at an alarming rate.”

While I understand that technology overuse can have troubling consequences on developing minds and bodies, I felt there had to be an article somewhere that pointed to the benefits of technology. Then I came across this article about research being conducted at UCLA’s Memory and Aging Research Center at the Semel Institute for Neuroscience and Human Behavior. The article refers to a “brain gap” between young “digital natives” and older “digital immigrants”. Dr. Gary Small, director of the Memory and Aging Research Center, explains that “’digital natives’ — young people born into a world of laptops and cell phones, text messaging and twittering — spend an average of 8 1/2 hours each day exposed to digital technology. This exposure is rewiring their brain’s neural circuitry, heightening skills like multi-tasking, complex reasoning and decision-making.” As a consequence, however, the overuse of technology takes away from time that could be spent developing people skills. Digital immigrants, on the other hand, were born into a world without the Internet and must work harder to navigate technology “without the already-developed brain form and function”. Luckily, the brain is an amazing phenomena that is still trainable at any age. Dr. Small pointed to a recent study that examined the effects of Internet searching on brain activity in subjects between the ages of 55 and 76, with only half of them being experienced in Internet searching. Using MRI technology to scan the subjects’ brains while googling, “researchers found that the brains of the Web-savvy group reflected about twice as much activity compared to the brains of those who were not Web-savvy”. Dr. Small believes that technology could be extremely useful in helping aging brains stay sharp and maintain vital functions. As technology continues to weave into all facets of daily life, research like this could be extremely useful in helping us to understand and harness the benefits of technology.


Failures of ICT4D : The Lesson

Although Tulane makes us take a number of development classes, this was the first time I had the opportunity to learn about ICT4D. I found it interesting how, while projects may be different, the overall concepts are still the same. The concepts that we discussed related to ICT4D projects and why they fail will be very helpful with anyone’s future professions, but especially in the development sector.

When we discussed the reasons why ICT4D projects fail, I felt like the reasons were so obvious and questioned why more people weren’t listening to them. Two of these that really stood out to me were that the projects weren’t relevant to local context/ strengths/needs and that projects were supported only by short-term grants. These ideas are important to apply to development jobs as well as any other job that you choose to do. The most important concept is to focus the project on the group that you’re doing it for and give them a say in the matter. Many people in the development world think that they know what is best for the people that they’re trying to help. However, without asking them what they want, you have the potential to spend a lot of money on something fails miserably. Second, it is important to always think about something in the long-term. It is great if you are given a grant to build a computer center in a rural village, but it is important to think about what will happen to the project when you leave. It isn’t just whether it looks good when you leave, but about whether it makes a difference in the long term.

In the future, I want to work internationally in the health sector. For health projects, it will be important for me to create a project that will make a real difference in a community. That means I need to create a project that will be accepted in that culture and will make a difference in the long term, not just when I’m there with my grant. Many organizations create health projects that don’t work with cultural norms. For example, handing out condoms for men who have sex with men in an area where being gay is not allowed. This automatically creates problems with the culture and results in no progress being made. I also know that just giving someone a project with my grant money won’t make a difference in the long-term. Health projects that go into a community and build a health clinic to stop people from dying of disease don’t consider what will happen to that health clinic when they leave. While the failures were originally related to ICT4D projects, I think that no matter what sector you choose to go into, they are important to keep in mind to create a sustainable, beneficial project for a community.


Mapping to Decrease Maternal Mortality

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Maternal mortality rates in India have been high over the past several years. This resulted in the government providing free maternal health services from governmental health facilities. However, there has been a problem with women being charged informal fees. This means that when a woman goes to a health facility, she is still getting charged for services that are meant to be free. This has especially been a problem in Utter Pradesh, a state in northern India. As a result of these informal fees, a campaign called Mera Swasthya Meri Aawaz (My Health, My Voice) has been launched. This program uses mobile phones to monitor informal payments in the Azamgarh and Mirzapur districts. People just have to use their mobile phone to call a toll-free number and report an out of pocket expense. These reports are then reported on a map, a deployment from Ushahidi, showing the facilities where informal payments were demanded, the amount charged, and the types of services that the informal payments were charged for. This information is being used collectively by community based organizations, women’s groups, and government health officials to try to end the practice of charging informal fees.

Before reading about this program, I had never heard of using mapping in this way. While this is not a disaster situation, it is important to stop the charging of informal payments in order to reduce maternal mortality in the long run. Not only will this map allow the government to track facilities that are charging informal payments so that they can put a stop to it, it also allows women to avoid going to facilities where they can see that informal payments are being. While it is already a big step that there has been reporting about informal fees, I hope that the government and community organizations will be able to use this map to put a stop to informal fees for good.


The World Wide Battle for Health Care

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This week in class we have been reviewing the role of ICTs within the health and wellness sector, as well as within the governance and government sector. The quickly changing political, technological, and medicinal landscapes not only within the developing world but within the highly developed world has meant progress in many arenas in terms of facilitating and reforming public health. It has come to my attention that since a large portion of aid and inter-sectoral projects to these LDCs has been within the purview of public health, it seems necessary to evaluate those very states that serve as the ‘examples’ of the very systems that hundreds of governments, agencies, businesses, non-profits, and NGOs are anxious to ‘replicate’. Obviously, no one state or system could possibly hold the key to the best method of administering/ overseeing the production of universal health to its citizens… or does one? This is the very question that I wish to explore and fuel with ample evidence and testimony from the field.

I also feel it would a be a disservice to this particular post, as this weeks’ posts are designed to reflect the appropriate subject area, if we do not mention the current and lively debate that is occurring within our own United States of America as the Obama administration carries out its implementation of healtcare.gov and the Affordable Care Act (aka- Obamacare).

My aim this week is to provide as many sources, documentaries, videos, op-eds, and expert testimonies as possible to provide a synthesis of data for our class to have either an in person or digital debate/conversation as to what kind of health system we feel will eventually be most effective in these very nations, tribes, communities, cities, mega-cities, and families that we all study so intently and care so much about.

I invite everyone to post and share their own reflective opinion after reading and watching what is available here to develop a well-informed, lively, and engaged discussion for this blog. Enjoy!

Op-Eds:

Ross Douthat, The New York Times, “But What if ObamaCare Works?” 10/26/2013

C.H., The Economist, “Why the Hysterics over Obamacare’s Software Glitch?” 10/23/2013

The Financial Times, Special Report: Global Health Policy, 8/01/2012 (link to a pdf)

Michael D. Tanner, The Cato Institute, “The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World“, 3/18/2008

T.R. Reid, The Washington Post, “5 Myths about Health Care Around the World“, 8/23/2009

T.R. Reid, PBS: Frontline, The Four Basic Healthcare Models

John McDermott, The Financial Times, “What healthcare.gov could learn from Britain“, 10/22/2013

Interviews:

Professor Uwe Reinhardt, Health Economist, Princeton University, 11/10/2007

Ahmed Badat, M.D., General Practitioner, Shepherds Bush Medical Center London

Prof. Karl Lauterbach, Health Economist and Member of the German Parliament, 10/25/2007

Prof. Naoki Ikegami, Health Economist, Keio University School of Medicine

Pascal Couchepin, President of Switzerland, 10/30/2007

Nigel Hawkes, Health Editer, The Times of London, 11/1/2007

David Patterson, M.D., Consultant Physician and Cardiologist, Whittington Hospital, London

Reports:

l’Organisation mondiale pour la Santé, Research for Universal Health Coverage, World Health Report 2013, August 2013 (PDF english) (PDF français) (PDF español)

Michael Tanner, The Cato Institute, Policy Analysis, “The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World“, March 18, 2008 (PDF english)

World Economic Forum + McKinsey & Company, Sustainable Health Systems, January 2013 (PDF english)

OECD, Health at a Glance 2011, OECD Indicators, November 23, 2011 (organization has reports on specific regions and countries as well)

Videos + Documentaries:

PBS: Frontline, Sick Around the World, April 15, 2008

One.org compiled list of 52 youtube videos about Global Public Health

Even More Resources:

PBS: Frontline resources for their special addressing international and domestic issues here


Intersexions — HIV Education Through a “Soap Opera”

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Intersexions is a TV show from South Africa that deals with HIV. It looks at how the HIV virus affects people’s lives, either by contracting the virus or how their relationships are affected by it. The show is shown in the local language and also has English subtitles in order to allow to it. Intersexions is produced by Curious Pictures in partnership with USAID and Johns Hopkins Education South Africa.

In order to see the effect that Intersexions has had on the people of South Africa, a survey was conducted in 2012. In response to this survey, it was concluded that nine million South Africans watched Intersexions. The survey also found that Intersexions decreased positive attitudes towards having more than one partner, increased attitudes towards condom use, and increased discussion about HIV testing.

Intersexions is an example of a very positive health intervention. It is shown in the local language with English subtitles because of the diverse culture of South Africa. It also doesn’t feel like the producers are lecturing. Instead, information about HIV is included into a story that is engaging and keeps watchers entertained. While creating similar TV shows may be expensive, it is no denying that there have been positive results in South Africa. More countries should jump on the bandwagon (with South Africa, Gambia, etc) and create these interesting shows that teach about tough subjects!