The Health InterNetwork (http://www.healthinternetwork.org) is a United Nations initiative created to respond to the challenges posed by the digital divide. The Health InterNetwork India pilot project is one component of the Health InterNetwork (HIN) initiative. HIN is led by the World Health Organisation (WHO) and implemented together with other UN agencies. It is one of the four projects announced by the Secretary-General of the United Nations, designed to meet the challenging goals laid out in the Millennium Action Plan and has been highlighted in the Millennium Report of the Secretary-General.
The initiative brings together the international development community, governments, the private sector, foundations and non-governmental organisations in a global partnership to improve public health using Internet technologies. The HIN India pilot project was launched in a context where international, national and local agencies and individuals were keenly aware of the promise of the Internet and the value of bridging the digital divide in health information. However, documented and successful strategies to fulfill that promise remain the exception rather than the norm. Projects like the HIN India pilot project and the larger Health InterNetwork initiative are important attempts to develop and test means toward the desired ends.
The HIN India project was initially planned and funded for a pilot period of 18 months. This $734,000 pilot project is coordinated through the office of the WHO representative to India. Initially, the project was to be jointly coordinated by UNDP and WHO through their representative offices in India. However, within the first six months of HIN project activity, UNDP restructuring curtailed the agency's involvement at the national level.
Project implementation strategy and structure
India was selected as one of the first Health InterNetwork pilot countries because of the presence of several priority public health programmes that could potentially benefit from the use of Internet and other communication technologies. In addition, India has a range of resources and skills related to these technologies, improving the potential of the pilot project to contribute to the development of the global Health InterNetwork initiative. In the first step, an e-readiness assessment developed by the Harvard Center for International Development and the MIT Media Lab was adapted by Tata Consultancy Services, Chennai and was conducted in the five states proposed for the project. The assessment showed that even states that were considered to be at the forefront of the Information Technology revolution still faced many of the problems. The problems outlined in the UN Administrative Committee on Coordination 1998 statement announced that they lacked:
- affordable access to core information resources, cutting-edge technology and to sophisticated telecommunication systems and infrastructure;
- capacity to build, operate, manage, and service the technologies involved;
- policies that promote equitable public participation in the information society as both producers and consumers of information and knowledge;
- work force trained to develop, maintain and provide the value-added products and services required by the information economy.
Within this context, the HIN India pilot project set out to develop and test scalable and sustainable approaches to bridge the digital divide for health information as it exists in India, with a particular focus on policy-makers, researchers and practitioners.
The specific goals of the pilot project were to:
- Facilitate an Internet-based network of health service providers, researchers, and policy-makers particularly in relation to the tuberculosis and tobacco control programmes;
- Provide and test content, connectivity, and training options to enable optimal use of this network;
- Enhance the capacity of local research institutions and medical libraries to support and scale-up the HIN India efforts.
In course of the planning exercise, the following additional benefits were achieved:
- Physical networking of the stakeholders, which will be sustained/strengthened by the virtual network;
- Commitment of the Revised National Tuberculosis Control Programme (RNTCP) Programme managers and the leading research institutions to the HIN Pilot;
- Commitment by the leading research institutions to directly deal in problem resolution with service providers at all levels, including the primary health centers.
The project is being implemented primarily through local institutions. Each identifiable major segment in the project is being implemented through an institution (preferably public) for which the work entailed is the institution's central work. This is expected to ensure:
- Knowledge accruing in the implementation process rests with local institutions,
- Project responds to local needs,
- Cost effectiveness,
A detailed health information needs assessment survey was then conducted across the pilot sites covering 300 respondents drawn from a representative sample of targeted users (policy makers, health service providers and researchers) to provide leads for detailed project formulation and content development. A stakeholder planning workshop was organised in May 2002 at the National Tuberculosis Institute (NTI), Bangalore for detailed project planning. The information needs assessment results were used to make a pre-plan. This was further discussed and fine tuned in the two day stakeholders workshop.
The focus of the HIN India pilot project was on improving the information environment of health care personnel, researchers and scientists, and policy-makers within India. Core areas of activity proposed by the overall Health InterNetwork project are connectivity, content, and capacity building. The core activities of the project have been designed under these three key project components. The section is organised in the following fashion:
- Hardware and connectivity installations
- Developing and testing e-tools for health
On Cue for cure and care
Tuberculosis (TB) is a global problem of startling proportions, causing around two million deaths per year. South Africa reported 215,120 cases of TB in 2002, which represents 557 per 100,000 people and TB treatment cost the South African Government an estimated USD 300 million in 2003. Cape Town of South Africa has one of the world's highest incidences of TB.
On Cue, a small company based in Cape Town, led an IDRC supported project which sends Short Message Service (SMS) messages to patients via mobile telephones, reminding them to take their TB medication at pre-determined times. The On Cue Compliance Service is an initiative of Dr. David Green, a qualified medical practitioner and consultant in Cape Town. It aims to provide an affordable solution to improve patient adherence to TB treatment and reduce the associated costs for both patients and clinics. The On Cue Compliance Service takes the names and mobile phone numbers of TB patients supplied by a clinic, and enters them in to a database. Every half an hour the On Cue server reads the database and sends personalised messages to the patients, reminding them to take their medication. The technology is low-cost and robust. Initially the SMS message sent to patients read, “Take your Rifafour now.” After getting patients' complaint against this boring message, a variety of alerts were created, including jokes and lifestyle tips. On Cue now has as database of over 800 messages that change on a daily basis. The patients have choice to receive messages in English, Afrikaans or Xhosa (the predominant African language in Cape Town).
- Increasing access to peer-reviewed journals
- National Health Information Collaboration (NHIC) web portal
- Health InterNetwork (HIN) clubs at medical colleges in Orissa
- Facilitating state-level partnerships for ICT in health
- Development of programme monitoring and needs assessment tools
Major Project Activities
The major pilot project activities include the following:
- Facilitating development of the Health Research Information System and developing interfaces to allow integrated access to various health data sources
- Networking key medical college libraries in two reference states with the National Medical Library
- Supporting electronic publishing of key medical journals, health research reports and policy documents related to tuberculosis and tobacco control and creating integrated electronic databases of the same
- Establishing Internet connectivity at the selected access points and networking key research institutions related to tuberculosis and tobacco control with policy makers and service providers
- Developing training modules and conducting the initial training for the pilot project participants
- Supporting ICT application to enhance and support identified priority programs viz. TB and Tobacco control
Achievements so far
HIN India is a unique effort which has occurred in a global context where international, national, and local agencies and individuals are keenly aware of the promise of the Internet and the value of bridging the digital divide in health information. The major achievements of the project so far are as follows:
- Computers have been installed and Internet connectivity established at all the sites,
- Training programmes are well underway and health centre staffs with no prior computer experience are now using the computer,
- Identification of local providers for training, allowing greater communication between trainers and trainees and support at the sites,
- Enhancing infrastructure through provision of a router and connectivity at Tuberculosis Research Centre, Chennai has contributed to the institute opening a 24 hours Internet access lab serving researchers and students.
- Development of guidelines and checklists to assist administrators unfamiliar with ICT in evaluating products and contracts.
The promise of the pilot project has not yet been completely realised properly and successful strategies remain the exception rather than the norm. Projects like the HIN India pilot project and the larger Health InterNetwork initiative are most important attempts to develop and test means toward the desired ends of strengthened public health services.