Mobile/Wireless solutions, endusers and organisational issues

Adesina Iluyemi BChD, MSc PhD Student Mobile/Wireless eHealth Systems in Developing Countries adesina.iluyemi@port.ac.uk

Content
Mobile/Wireless Technologies in Africa
Mobile Solutions Human & Organisational issues

Mobile ICT in Africa

177 million GSM mobile users in Africa (Nov. 2006)

Mobile ICT impact and growth in Africa Increased GDP Individual and personal empowerment Business process transformation (m-commerce)
MDGs and ICTs: NEPAD, EU-IST, ITU, WHO, National bodies, NGOs

Mobile ICT in Africa

Developments Emerging Market Handset (EMH) project Shared access phenomenon Voxiva, Cell-life, UHIN, Philippines, Indonesia projects WHO: SAM (Health Mapper), Anthro 2005 Software SMS alerts to patients Mobile Web initiatives

Applications
Mobile EHRs, data collection, Tele-radiology, teledermatology etc. Real-time & store and forward approach Developmental projects Community Networks, Domain specific networks- Agriculture, military, education, Emergency & disease outbreaks etc. Experiment vs Implementation Sustainability issues

 5Cs (Peter Drury) Content: EHR, referral system, HMIS, CME, logistics, Telemedicine platforms etc. Community: Communities of Practice, Knowledge networks, capacity building Communication: voice and data Context: Cultural, end-users, social, economics etc. Connectivity: wireless/mobile ICTs and web services for ACCESS Outcomes: sustainability, local ownership

Holistic & System approach

Wireless Networks:Opportunities
Mobility vs Universal Access Transmission Wireless Internet Protocols (IP) Ambient networks Melanges of wireless networks Explore interoperability for regional or community networks and connectivity European Union and ITU, ESA, ISRO, NigCom Sat1, South Africa

Health Workers in Africa

Delivers essential primary care services Agents of Change and health promoters Brain drain Community/facility based care (HIV/AIDS, TB, Malaria etc) Information, communication & logistic needs Work as individuals & in teams But issues of organisational and end-users context need to be considered

Mobile Solutions
Process Collection Transmission Presentation Geography: Rural or Urban Facility: Community vs. Hospital/Clinics Users: Community Based Health Workers (CBHWs)- Volunteers, salaried, Mid wives. (Community Level) Doctors, Nurses (Hospital/Clinic) Managers/Administrators

Wireless Networks Ad-hoc/Real-time Devices Mobile/Fixed

Applications/Contents

Model Proposition

Community

Facility

Community Health Workers Geography Rural/Urban

Access & Connectivity

Ambient Wireless Networks Ad-hoc/Real-time Devices Mobile/Fixed

Web services Applications/Contents

Model Proposition

Community

Facility

Health Workers Geography Rural/Urban

Access & Connectivity

Integrated District Health System

Create an Integrated and distributed system through Ambient networks Linking Users from different levels Different Systems Different Networks Outcome: Integrated Regional/District Health Information System for multiple applications Sustainability

Different users Context

CBHWs Remote, Local & Fixed mobility Clinicians, Managers, Administrators, Technicians Local & Fixed mobility (Remote?) Context modulates devices and connectivity access

Model: Context and Technology

Technology

Human & Organisational issues

CME

EHR HMIS

Telemedicine
HEALTH WORKER Facility & Community Levels

Web services

Integration Interoperability Connectivity Access Mobility

Wireless/Mobile Solutions
Connection WAN- GSM networks, WiFi, WiMax, VSATs, Satellite LAN- WiFi, WiMax PAN- Bluetooth, Infrared Devices: Mobile: PDAs, Smartphone, Cellular phones, Tablet PCs, Laptops, smart cards, memory sticks, USB keys, PCMCIA cards mobile diagnostics. Fixed: PCs, Laptops (Fixed-mobile) Mobile grid computing, ad-hoc networks

Community Access
Personal: PDAs, Mobile Phones, Flash memory Realtime- Mobile Web/Internet Store and forward-MMS, SMS, Mobile email, FTP Shared: Community Telecentres, Public and Private Access points, Community Health posts Realtime- (Internet) PCs, Portable not mobile devices Store & Forward- Synchronize mobile devices with fixed access points (PCs, African Access Point)

Facility Access
Personal: PDAs, Mobile Phones, Flash memory Realtime- Mobile Web/Internet Store and forward-MMS, SMS, Mobile email, FTP Shared: Access Points (APP), PCs, Laptops Realtime- (Internet) PCs, Portable not mobile devices Store & Forward- Synchronize mobile devices with fixed access points (PCs, African Access Point) Connection & Devices depend on Geography

Barriers
Human Nature
Translates into Human and Organisational behaviour This is not bad This is a two edged sword

But needs to be understood and managed for success

End-Users Issues
Technical Human Computer Interface (HCI) Open Source (Hardware & Software) Social Adoption issues (Development & Implementation) Culture Local Knowledge

Human Issues: Technical

HCI
Screen size and design (Adaptive) Power- Solar? (Global Green Movement) Memory (Stable and Labile) Security Structure- (Ruggedized) Connectivity Network ConfigurationThin & Thick clients, remote & located synchronisation

HCI: Technical
Software battle Microsoft Mobile Palm OS Symbian Web 2.0 RSS

Models
One Child Per Laptop , Simputer, iPhone Open Source?

Interface Open Source Multi-wireless

connectivity

Human Factors: Social Issues

Doctors in South Africa (Banderker et al 2005)
Job relevance Usefulness Perceived User resources Device Characteristics Supports from Public National government & hospital administrators Patient influence Legal issues (Decision Support Systems, Drug directories)

Organisational Issues
Technology
Technology is not enough! Positive economic benefits Users led and focus Social and ethical issues Health workers responsibility Device and applications development and regulation. (HealthService 24- 2006)

Environment
Health Policies, regulation, structure and financing Evaluation in real-life contexts Multiple actors and structures Health IT infrastructure (organisation). Users Trust Users led model (MOSAIC -2005)

Organisational issues
Adequate mobile ICT access and equity procedure is necessary Facility based technical support important Re-engineering of DHS organisational & work process required (remote health working, teleconsultation) Standards for data sharing & communication important for success (vertical health programmes) Appropriate mobile devices for tasks i.e voice vs. data

Organisational issues
Hierarchical nature of DHS could be problematic for organisational and policy change Health authorities need to explore developmental opportunities in Africa i.e EMHs initiative, Shared access phenomenon, Cell-Life, UHIN For design and development HWs primary tasks should be protected from interferences HWs views and empowerment is very important

Conclusion

AFRICAN SOLUTIONS AND STANDARDS

Appreciation

Thank you MRC!