The role that recent advances in Information and Communication Technologies (ICTs) can play in improving health systems in developing countries has attracted much discussion. Yet there has been little independent analysis of how it is currently being applied. What are the potential benefits of ICT innovations and what challenges will they need to overcome? A study by the Institute of Development Studies, in the UK, examines case studies in four broad areas to illustrate the innovative use of various ICT technologies to improve developing country health systems. This summary will discuss one of these case studies. The Uganda Health Information Network Project was involved in the supply of hand-held Personal Data Assistants (PDAs) to health workers in two districts. The PDAs were linked to 20 connection points at health facilities. They allowed Ministry of Health (MoH) data forms to be sent electronically, and information on MoH activities and disease outbreaks to be received. The following findings were reported: The project allowed a network serving 9 health facilities to be established. Districts came close to 100 percent compliance on weekly disease surveillance reporting, compared to a national average of 63 percent. Some technical problems arose: the 20 connection points were inadequate and replaced by a more expensive version, and software was also replaced. Recharging batteries was an ongoing problem. The system proved cost-effective but more expensive than the manual system. As a result, the MoH has been unwilling to extend the network to all 77 districts. The study recommends that the international community could assist with financial and technical support, given the limited cost of implementing such a health data system in developing countries and the potential improvement in disease detection and monitoring. The report also contains a general discussion on ICT use in future health systems. For instance, while it is agreed that the impact of ICT on health systems ('e-Health') could be considerable, there is less consensus on the nature of that impact. E-Health innovations, while difficult to define, could be categorised into those that reinforce existing health systems and those that potentially transform them. The study makes the following recommendations with regard to the former: Interventions should proceed incrementally and over-ambitious interventions avoided. Pilot projects can waste scarce resources if they do not produce evidence allowing effective scale-up. The fact that ICT projects usually cost more, take longer and deliver less than anticipated should be allowed for. How stakeholders might respond, to support or oppose the innovation, should be investigated. A coping strategy is needed in case of a serious ICT system failure. Implementing ICT innovations that may transform existing health systems requires stepping back from the finer details of existing solutions. Designers of such innovations should use a range of technologies to transmit their messages. Policy-makers, planners and programme managers are typically encouraged to undertake evidence-based planning and priority setting in the health sector, on the assumption that this is a fair method of allocating scarce resources. However, multiple patient support group networks, potentially funded by international drug companies, may use ICT to win the attention of governments, donor agencies and private companies.
Social Science and Medicine (2008) 66 (10) 2122-2132 [http://dx.doi.org/doi:10.1016/j.socscimed.2008.01.033] Special issue: Future Health Systems (Eds Bloom, G.; Standing, H.)