Information and communication technologies and health in low income countries: the potential and the constraints
01 Jan 2001-Bulletin of The World Health Organization (World Health Organization)-Vol. 79, Iss: 9, pp 850-855
TL;DR: The potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries is outlined, some examples of positive experiences in India are presented, and the difficulties in achieving this potential are considered.
Abstract: 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. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide.
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TL;DR: It is argued that when researchers focus on only the most scientifically sound research--studies that use prospective designs or include multivariate analyses of predictor and outcome measures--relatively clear conclusions about the psychological parameters of disasters emerge, and that social relationships can improve after disasters, especially within the immediate family.
Abstract: Disasters typically strike quickly and cause great harm. Unfortunately, because of the spontaneous and chaotic nature of disasters, the psychological consequences have proved exceedingly difficult to assess. Published reports have often overestimated a disaster's psychological cost to survivors, suggesting, for example, that many if not most survivors will develop posttraumatic stress disorder (PTSD); at the same time, these reports have underestimated the scope of the disaster's broader impact in other domains. We argue that such ambiguities can be attributed to methodological limitations. When we focus on only the most scientifically sound research--studies that use prospective designs or include multivariate analyses of predictor and outcome measures--relatively clear conclusions about the psychological parameters of disasters emerge. We summarize the major aspects of these conclusions in five key points and close with a brief review of possible implications these points suggest for disaster intervention. 1. Disasters cause serious psychological harm in a minority of exposed individuals. People exposed to disaster show myriad psychological problems, including PTSD, grief, depression, anxiety, stress-related health costs, substance abuse, and suicidal ideation. However, severe levels of these problems are typically observed only in a relatively small minority of exposed individuals. In adults, the proportion rarely exceeds 30% of most samples, and in the vast majority of methodologically sound studies, the level is usually considerably lower. Among youth, elevated symptoms are common in the first few months following a high-impact disaster, but again, chronic symptom elevations rarely exceed 30% of the youth sampled. 2. Disasters produce multiple patterns of outcome, including psychological resilience. In addition to chronic dysfunction, other patterns of disaster outcome are typically observed. Some survivors recover their psychological equilibrium within a period ranging from several months to 1 or 2 years. A sizeable proportion, often more than half of those exposed, experience only transient distress and maintain a stable trajectory of healthy functioning or resilience. Resilient outcomes have been evidenced across different methodologies, including recent studies that identified patterns of outcome using relatively sophisticated data analytic approaches, such as latent growth mixture modeling. 3. Disaster outcome depends on a combination of risk and resilience factors. As is true for most highly aversive events, individual differences in disaster outcomes are informed by a number of unique risk and resilience factors, including variables related to the context in which the disaster occurs, variables related to proximal exposure during the disaster, and variables related to distal exposure in the disaster's aftermath. Multivariate studies indicate that there is no one single dominant predictor of disaster outcomes. Rather, as with traumatic life events more generally, most predictor variables exert small to moderate effects, and it is the combination or additive total of risk and resilience factors that informs disaster outcomes. 4. Disasters put families, neighborhoods, and communities at risk. Although methodologically complex research on this facet of disasters' impact is limited, the available literature suggests that disasters meaningfully influence relationships within and across broad social units. Survivors often receive immediate support from their families, relatives, and friends, and for this reason many survivors subsequently claim that the experience brought them closer together. On the whole, however, the empirical evidence suggests a mixed pattern of findings. There is evidence that social relationships can improve after disasters, especially within the immediate family. However, the bulk of evidence indicates that the stress of disasters can erode both interpersonal relationships and sense of community. Regardless of how they are affected, postdisaster social relations are important predictors of coping success and resilience. 5. The remote effects of a disaster in unexposed populations are generally limited and transient. Increased incidence of extreme distress and pathology are often reported in remote regions hundreds if not thousands of miles from a disaster's geographic locale. Careful review of these studies indicates, however, that people in regions remote to a disaster may experience transient distress, but increased incidence of psychopathology is likely only among populations with preexisting vulnerabilities (e.g., prior trauma or psychiatric illness) or actual remote exposure (e.g., loss of a loved one in the disaster). Finally, we review the implications for intervention. There is considerable interest in prophylactic psychological interventions, such as critical incident stress debriefing (CISD), that can be applied globally to all exposed survivors in the immediate aftermath of disaster. Multiple studies have shown, however, that CISD is not only ineffective but in some cases can actually be psychologically harmful. Other less invasive and more practical forms of immediate intervention have been developed for use with both children and adults. Although promising, controlled evaluations of these less invasive interventions are not yet available. The available research suggests that psychological interventions are more likely to be effective during the short- and long-term recovery periods (1 month to several years postdisaster), especially when used in combination with some form of screening for at-risk individuals. Such interventions should also target the maintenance and enhancement of tangible, informational, and social-emotional support resources throughout the affected community. Language: en
886 citations
TL;DR: Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost.
Abstract: Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda. Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence. First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred. Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.
484 citations
TL;DR: An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains.
Abstract: In light of the increasing globalization of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include cross- border delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to address the "brain drain"; increasing investment in the health sector and prioritizing this investment better; and promoting linkages between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory, policy, and infrastructure in the health sector. Thus, appropriate policies and safeguard measures are required to take advantage of globalization in health services.
280 citations
Harvard University1, King's College London2, University of the Witwatersrand3, University of Bristol4, Heidelberg University5, University of Geneva6, South African Medical Research Council7, University of Cape Town8, Aga Khan University Hospital9, University of London10, International Diabetes Federation11, Makerere University12, University of Newcastle13, Royal Hallamshire Hospital14, University College London15, Stanford University16, University of Göttingen17, Beth Israel Deaconess Medical Center18, Muhimbili University of Health and Allied Sciences19, Jimma University20, Dartmouth College21, University of Liverpool22, Tufts University23, University of Botswana24, The Dartmouth Institute for Health Policy and Clinical Practice25, Leiden University26, Joslin Diabetes Center27, University of Texas Southwestern Medical Center28, Yale University29, Partners In Health30, Purdue University31, Ohio State University32, Addis Ababa University33, National Institutes of Health34, University of Vermont35, Eastern Virginia Medical School36
275 citations
01 Jan 2006
TL;DR: The paper describes the major constraints and challenges faced in using ICTs effectively in the health sector of developing countries.
Abstract: This framework paper is aimed at policy makers who are involved in the development or management of programmes in the health sector in developing countries. It provides a snapshot of the type of information and communication technology (ICT) interventions that are being used in the health sector and the policy debates around ICTs and health. It draws from the experience of use in both the North and South but with a focus on applicability in the South to identify the most effective and relevant uses of ICTs. The paper describes the major constraints and challenges faced in using ICTs effectively in the health sector of developing countries. It draws out good practice for using ICTs in the health sector identifies major players and stakeholders and highlights priority needs and issues of relevance to policy makers. The paper also looks at emerging trends in technologies that are likely to shape ICT use in the health sector and identifies gaps in knowledge. For the purposes of this paper ICTs are defined as tools that facilitate communication and the processing and transmission of information by electronic means. This definition encompasses the full range of ICTs from radio and television to telephones (fixed and mobile) computers and the Internet. (excerpt)
234 citations
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01 Jan 1999
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439 citations
TL;DR: This is a fascinating collection of essays exploring "why some people are healthy and others not," from a variety of disciplines and theoretical perspectives that challenges the widespread belief that health care is the most important determinant of health and argues for a more comprehensive and coherent understanding of the determinants of health.
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359 citations
TL;DR: In this paper, composite solar cells of improved efficiency comprise two cells of different characteristics arranged in optical series but electrically insulated from each other, each cell is of larger crystal grain size than its substrate, which grain size is achieved by growing the cell semiconductor on a molten intermediate rheotaxy layer of a suitable semi-conductor which solidifies at a temperature below the melting temperature of the solar cell.
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299 citations
Book•
01 Jan 2000
TL;DR: In this paper, the successful use of information and communication technology (ICT) in rural development is discussed, and sixteen case studies are presented, which spell out the various applications of ICT that have made a difference in the delivery of services or products in rural India.
Abstract: This book documents the successful use of information and communication technology (ICT) in rural development. The book begins with an introductory chapter that traces the history of ICT use in rural India, examines some of the problems that have afflicted the implementation of rural development programmes, at the same time showing how ICT applications could help overcome them, assesses the early efforts in ICT use, and proposes a scheme by which to classify ICT applications. Written by administrators who lead projects in their areas, sixteen case studies follow, which spell out the various applications of ICT that have made a difference in the delivery of services or products in rural India. Among the services covered are health care, milk distribution, disaster management, postal services, telephones, and services for the disabled. These applications of ICT cover the use of simple and inexpensive technologies at one end, and sophisticated satellite-based communication at the other. An important collection that delineates the main elements of a strategy that can be used by governmental agencies to derive maximum developmental impact from investments in ICT
85 citations