F R A M E W O R K PA P E R S U M M A RY

infoDev
Connecting people, improving
health: the role of ICTs in the health
sector of developing countries
Edited by Andrew Chetley, et al. [email protected] InfoDev Task Manager: J Dubow February 2006

This framework paper 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 ICTs can best be used to move towards achievement
challenges faced in using ICTs effectively in the health of the Millennium Development Goals (MDGs), as part
sector of developing countries. It draws out good practice of poverty reduction strategies and in order to improve
for using ICTs in the health sector, identifies major players the health of the most poor and vulnerable people.
and stakeholders and highlights priority needs and issues
There has been considerable international discussion
of relevance to policy makers. The paper also looks at
about the potential of ICTs to make major impacts in
emerging trends in technologies that are likely to shape
improving the health and well being of poor and
ICT use in the health sector and identifies gaps
marginalised populations, combating poverty, and
in knowledge.
encouraging sustainable development and governance.
For the purposes of this paper, ICTs are defined as tools Used effectively ICTs have enormous potential as tools
that facilitate communication and the processing and to increase information flows and the dissemination of
transmission of information by electronic means. This evidence-based knowledge, and to empower citizens.
definition encompasses the full range of ICTs, from radio
However, despite all its potential, a major challenge is
and television to telephones (fixed and mobile),
that ICTs have not been widely used as tools that
computers and the Internet.
advance equitable health care access. A critical mass
This paper sees health as a complex interaction of of professional and community users of ICTs in health has
biomedical, social, economic, and political determinants. not yet been reached in developing countries. Many of the
It places the discussion of health firmly in the poverty and approaches being used are still at a relatively new stage of
development debates and pays particular attention to how implementation, with insufficient studies to establish their
relevance, applicability or cost effectiveness (Martinez, et
 www.asksource.info/res_library/ict.htm

al, 2001). This makes it difficult for governments Experience demonstrates that there is no single solution
of developing countries to determine their investment that will work in all settings. The complexity of choices of
priorities (Chandrasekhar and Ghosh, 2001). However, technologies and the complexity of needs and demands
there are a number of pilot projects that have of health systems suggests that the gradual introduction,
demonstrated improvements such as a 50% reduction testing and refining of new technologies (in those areas
in mortality or 25–50% increases in productivity within of health care where there is a reasonable expectation
the health care system (Greenberg, 2005). that ICTs can be effectively and efficiently used) is more
likely to be the successful way forward. Some innovative
leaps may also be possible as technology is evolving
The examples in this paper show that ICTs have rapidly. Wireless applications, increased use of mobile
clearly made an impact on health care. They have: telephony and combinations of technology working
together are some of the new opportunities identified
■ improved dissemination of public health in this paper.
information and facilitated public discourse and
dialogue around major public health threats,
Knowledge gaps
■ enabled remote consultation, diagnosis and
treatment through tele-medicine,
■ facilitated collaboration and cooperation among The paper highlights several major areas where not
health workers, including sharing of learning and enough is known and where further experimentation,
training approaches, research and analysis are needed, including:
■ supported more effective health research and the ■ how to move from proof of concept to large-scale
dissemination and access to research findings, implementation in a range of different settings,
■ strengthened the ability to monitor the incidence ■ how to evaluate systematically and coherently the
of public health threats and respond in a more impact of the use of ICTs on health,
timely and effective manner,
■ how to share information and experience and
■ improved the efficiency of administrative systems coordinate efforts (at national, regional and
in health care facilities. international levels) around the use of ICTs in
the health sector,
■ what can be done to strengthen the role,
This translates into saving lives, increasing resources and build the capacity, of intermediaries,
and direct improvements in people’s health. In Peru,
Egypt and Uganda, effective use of ICTs have prevented ■ how to develop local content that is relevant,
avoidable maternal deaths. In South Africa, the use of appropriate and practical,
mobile phones have enabled TB patients to receive ■ how to strengthen organisational and national
timely reminders to take their medication. In Cambodia, human resources, awareness skills and leadership
Rwanda, South Africa and Nicaragua, multimedia to champion the further development of ICT use
communication programmes are increasing awareness in the health sector,
of how to strengthen community responses to HIV and
■ how to enable the voices of those most affected
AIDS. In Bangladesh and India, global satellite technology
by poor health to be heard,
is helping to track outbreaks of epidemics and ensure
effective prevention and treatment can reach people ■ how to implement the range of standards
in time. and a regulatory and legal framework that is
conducive to the development of a vibrant ICT
sector that responds to and supports social
development processes.

2
 Framework Paper Summary: Connecting people, improving health: the role of ICTs in the health sector of developing countries

These questions help to set out an agenda for future

action to enable ICTs to improve health and to achieve
Opportunities do exist for the use of ICTs in the
the health-related Millennium Development Goals.
health sector of developing countries; although a
It is clear that, even at this early stage in the evolution of number of issues must be carefully considered in
ICTs, there is a developing body of evidence, primarily in each intervention and setting:
the western context, which points to a range of benefits
and efficiency savings for individuals and institutions in ■ To what degree is the health sector structure and
health. This body of evidence is not easily transposed the national regulatory framework conducive to
into a developing country context, and the range of problem-oriented, interdisciplinary, rapid-response
contextual issues around the world mean that ready-fit collaborative technical work and to implementing
‘one size fits all’ conclusions are difficult and the political, regulatory, and managerial tasks
dangerous to make. required to address multifaceted and complex
technological problems?
The range of benefits, however, that are being highlighted
in various small scale case studies is building a base ■ Have a vision, goals, action plan and potential
of tentative evidence in the developing world for the outcomes and benefits been clearly defined?
application of ICT strategies. This evidence provides a ■ Are there mechanisms for coordinating action led
compelling indication that there are benefits in ICT by the public sector (in a way that links public,
implementation in health, but that they need to be private and social efforts) and which engage with
understood in context and scaled-up carefully. diverse stakeholders to speed the development
and use of priority ICT solutions?
Conclusions ■ Are there incentives for telecommunication sector
reform processes?
Seven broad conclusions can be drawn about the use
of ICTs in the health sector. They should be applicable ■ Are data-related standards and a regulatory and
at all levels, and although they are expressed simply legal framework in place?
here, the complexity of putting them into practice is one ■ Are there mechanisms for developing the capacity
of the biggest challenges that has to be faced in ensuring of health workers, other intermediaries and
health system benefit; health workers benefit; the people community members to make the most effective
who make use of the health system – the patients and use of the ICTs available and to develop content
citizens – benefit and their health improves. that is relevant, applicable and culturally
appropriate?
■ What options exist to ensure continuity and
Seven conclusions sustainability of ICT projects and programmes
1 Keep the technology simple, relevant and local. in terms of finance flows, public-private
partnerships and building on existing information
2 Build on what is there (and being used).
and communication channels and resources?
3 Involve users in the design (by demonstrating
benefit).
4 Strengthen capacity to use, work with and develop
effective ICTs.
5 Introduce greater monitoring and evaluation,
particularly participatory approaches.
6 Include communication strategies in the design
of ICT projects.
7 Continue to research and share learning about
what works, and what fails.

3
Framework Paper Summary: Connecting people, improving health: the role of ICTs in the health sector of developing countries

Checklist for the introduction of effective ICT programmes in the health sector
1 Has a local needs assessment been carried out 4 To what degree does the approach and technology
and is the technology being used in the simplest build on and strengthen existing information,
way to do the job required? knowledge and communication systems?
2 Is local capacity available to use the 5 What plan is in place to monitor and evaluate
technology effectively and, if not, is there a way the programme in a way that improves the quality
of strengthening that capacity and building it into of interaction and dialogue among the various
the programme planning? stakeholders, and in a way that enables
improvements and adjustments to be made to
3 Have the beneficiaries, end users and/or local
the programme easily?
communities been involved in the development
of the programme, consulted on the approach
and technology being used and are they
committed to the approach?

12 key lessons to guide future work

1 Technology is not an end in itself, it is a tool to by building on existing formal and non-formal
enhance existing work, strengthen existing systems, communication networks.
achieve broader health and development goals and
8 The enabling environment is crucial to providing
meet locally determined needs.
information and communication services, innovation
2 Successful inclusion of ICTs in ongoing health and entrepreneurship and free flow of information.
programming depends on the active involvement The infrastructure required by the technology being
of beneficiaries and end users from the beginning used needs to be in place, or in the process of
in determining information needs, type of content being put in place.
and the most appropriate technology to use.
9 Regular monitoring and evaluation develops the
3 Local conditions determine success. The choice successful use of ICTs. Incorporating plans for
of ICT tools in the health sector should depend monitoring, evaluation and impact assessment into
on local availability and access, whether it interventions ensures critical evaluation of efforts
is the Internet, radio, portable computers, video, and adaptation as interventions develop. This makes
television broadcasts, newspapers or anything use of the important communication principle of
else that is being used. Locally available technical feedback and provides opportunities to involve the
solutions should be prioritised. beneficiaries and end users in continuous dialogue
about how the programme is progressing.
4 The simplest possible technology solution is likely
to be the most appropriate, user friendly and 10 Sharing learning and disseminating experience
sustainable. The use of any technology should build by linking up with others doing similar work helps
on and complement information and communication to design ICT interventions so they reflect an
technologies already being used. understanding of the different ways people learn,
communicate and use information.
5 No single technology will be suitable for all
situations. Innovative and creative combinations 11 Addressing the needs of the poor and most
of old and new ICTs will provide added value marginalised, particularly women and girls is vital.
and new possibilities. Gender considerations should constantly be
applied when undertaking an ICT activity.
6 Capacity development and training components
need to be included in all ICT initiatives. They 12 A clear and expressed plan for sustainability
should build on existing knowledge and help to ensures that capital replacement and operating
strengthen the local ICT skills market. costs are identified up front as well as ICT
infrastructure requirements and capacity to
7 Developing local and international multi-stakeholder
maintain the programme and its impact.
partnerships supports communities to become more
self-sufficient through capacity enhancement, and

To access the full framework paper, literature review, online bibliography and online discussion summary

see the ‘ICTs and health’ window at www.asksource.info/res_library/ict.htm

For more information contact Andrew Chetley, Email: [email protected]