(Fwd) [Bridges.News] Case study on the Satellife PDA Project

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      From:           	Margareet Visser <margareet at bridges dot 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 at healthnet dot 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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