Health communication, HIV/AIDS, social mobilisation, learning evaluation, capacity building

Full report: Exchange lunchtime discussion 19 July 2001

Andrew Chetley (Exchange Director) introduced four speakers based in Sri Lanka, Costa Rica and Tanzania. This was the third of a series of meetings in July 2001 that looked at the role of Information and Communication Technologies (ICTs) in health information and communication. This discussion was an opportunity to reflect on the topic, particularly from a developing country perspective.

ICTs mean more than the internet

Rohan Salgadoe (Worldview International Foundation, Sri Lanka) noted that people tend to assume we are talking about the Internet with ICTs, but when we start from the needs of the people we can be talking about wall posters, newspapers, community audio towers, drama, sustainable community radio, or even the links made between radio and e-mail. All these are about giving people tools to communicate. E-mail and fax could be used to transfer information taken from the Internet into the communities. Rohan talked of a project involving young people where audiocassettes were used to record experiences and ideas relating to sexual health and these were then played through audio-towers in the communities. Even then, he suggested that we mustn’t forget those who don’t benefit from the projects locally, and pointed to the fact that some of the tapes are played on national radio, so that others benefit from hearing them.

Developing capacity to use new technologies

Anne Philpott (Worldview International Foundation, Sri Lanka) talked of Worldview’s work to build capacity and people’s ability to use new technologies. Examples were Young Asia TV, a youth TV production house, and ‘Mandate the future’ (http://www.mandatethefuture.org), an Internet project where youth aim to promote discussion and education around a variety of social issues and input into policy agendas. Anne noted the similarities with the history of introduction of technologies in the past, in that the same story of elitism and restricted access was as true for new ICTs as any other technology. We should not forget the lessons learned from previous experience, while at the same time try to maximise the benefits of new technologies. Convergence with existing media to maximise impact was also important. Worldview International partners had recently discussed their experience of ICTs, agreeing that new technologies were not a cause of development (no ‘magic pill’ here) but a part of the process.

Cost of installing, maintaining, and connecting equipment was a major concern. Experience in South Africa has seen a new line taking six months and there were problems with repairs. Language was also a big issue, with the dominance of English for on-line communication being a barrier for many. Ann noted the usefulness of e-mail for disseminating information that has been taken from various sources, including the Internet. Nairobi participants at the videoconference from the previous day had actively wanted some filtering of the mass of information, which was in danger of overwhelming them. The ‘Information Waystations’ approach was useful here, and was actually happening in some of their projects through providing ‘facilitated access’ to information. An interesting definition of the Internet came from Indian youth on a rural IT training project in rural Rajistan – they saw it as ‘access to all the knowledge in the world’.

A major concern for youth in the projects was ‘employability’. At the same time the youth were strongly behind the communal culture of the Internet and had taught here a lot about the wide use of free software, communities of programming, and the ‘open source’ software. Finally, it was clear that a vital foundation was an ‘enabling environment’ – and the necessary infrastructure of communication was available, and this meant NGOs perhaps needed to take a more strategic approach to trying to ensure this.

Different communication methods to reach different people

Nand Wadhwani (Rehydration Project, Costa Rica) began by insisting, “No, you cannot imagine how it is”, when it comes to the problems of connectivity for the majority of people. Describing his own situation in Costa Rica, which was by no means devoid of infrastructure, he pointed to problems with spares, phone connections, maintenance, and even paper. We need to be realistic and think again if we are putting an emphasis on the Internet, as it will be a long time before the majority of people have access. Nand stressed the importance of a continuum of communication methods, depending on the available technology: CD-ROM as the bridge between paper and the Internet, video and audio where there was electricity but no computer, print where there was no power, and face to face where there was no literacy. The Internet was the last thing to think about if we were taking the perspective of the majority of people and their needs for health information.

Adapting health information in Tanzania

Dr James Ngwandu (Mvumi Hospital, Tanzania) spoke of a pilot scheme using computers in medical institutions to translate and adapt health information. The centres needed equipping and the staff needed training. The setting in Tanzania saw a predominantly rural population of subsistence farmers, where the Anglican church provided 45 per cent of health services. There was a real need for reliable, up-to-date, locally relevant information in local languages and Swahili. All the major towns had phone lines which were government controlled but this was changing, and Dr Ngwandu outlined a pilot project for Mvumi Hospital to become an ‘information waystation’.

Group discussion

1. How can we practically ensure that capacity development around ICTs is not neglected?

2. How can we maximise the impact of newer ICTs (like the Internet) by linking them with the use of other communication techniques (convergence of technologies)?

3. How can we stimulate and support the development of facilitated access centres (staging posts, information waystations) as a means of improving access to relevant information

1. How can we practically ensure that capacity development around ICTs is not neglected?

The group distinguished between capacity to use new information technologies, the ability to use the technologies themselves as tools in capacity development, and the capacity to turn information into practice. It was also noted that capacity development went much wider than using technology for access to health information, to include primary health care and people’s general capacity for self-determination.

The prevailing tendency to neglect capacity development was present in the World Banks Infodev project that dropped in computers but made no provision for training and capacity development. It was stressed that it was vital to start from where people were on the ground with the channels and techniques of communication that were there, and then to make links with others, including the commercial sector. Supporting people in their situation might also slow down the brain drain that took newly skilled people away. The experience in Nepal was that the communities took responsibility for training, more than anyone else, and they also bore most of the costs of ICT projects. Experience with telecentres in Mexico showed that where there were economic incentives to use them, such as with fishermen, they could be supported, but it was far more difficult in the case of health. Technology could also be a hindrance to good communication. The group concluded:

Start from where people are on the ground to find appropriate communication tools; build horizontal links; invest time, resources and training; to ensure appropriateness and user friendliness. (The need for advocacy in all these areas was stressed).

2. How can we maximise the impact of newer ICTs (like the Internet) by linking them with the use of other communication techniques (convergence of technologies)?

The group started by looking at other ICTs rather than the Internet and focused on what were seen as available channels, such as community radio, national radio, CD-ROM, that could be applied to reuse materials. On convergence of technologies, the group was of the view that useful information from paper materials could be digitised, scanned or turned into pdfs. The group noted that the pdf format was not as useful as html. Places without telephone lines that had electricity could access information on CD-ROM or from community radio. The group concluded that it was important to:

Integrate new technologies into existing means of communication without losing the potential of ICT’s to impact in a more interactive and rich way.

3. How can we stimulate and support the development of facilitated access centres (staging posts, information waystations) as a means of improving access to relevant information?

This group looked at the needs of those (e.g. HLM producers, resource centres, educators) who repackage source information and disseminate the adapted and/or translated content in a form that is relevant and accessible to end-users. The staging posts concept recognizes the potential value of combining IT and print media to facilitate this process, for example access and adaptation of source information using internet, CD-ROM, and basic publishing software; and distribution of end-product in printed form. Source information might range from generic content (eg WHO guidelines for 'integrated management of childhood illness') to content created by local healthcare providers. Part of the generic content might be provided in a form that requires minimal adaptation. In conclusion:

Three interrelated levels of information source/use were described: end-user, repackager, and international source (eg directories, portals, generic guidelines). The group underlined the importance of, respectively, encouraging content generation and feedback from the end-users, building on existing repackaging activities (eg CME Uganda), and avoidance of a top-down approach.

Feedback on discussion

There were 14 completed evaluation forms (out of 23 people at the meeting).

Most people enjoyed hearing about grassroots and community experiences from developing countries, and stressed the importance of this for the range of practical issues highlighted and for purposed of inspiration. The presentations ran over time on this occasion and, although people valued hearing the different perspectives of the presenters this cut discussion time very short. In the light of this three people suggested that more time could be spent on the discussion meetings, one person even suggesting a half day. Others suggested more focused presentations that were kept shorter.

Practical suggestions for improvement included: discussion questions circulated in advance; more of a focus on practical action points; discussion to continue after the meeting with the circulation of papers; a map of how to get to the meeting.

Developing country experiences of ICTs