HEALTH APPS USING PDAS AND CELLPHONES: THE RIGHT DEVICES AT THE RIGHT PRICE?

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The cost of a computing device is one of the significant barriers holding back the use of ICT uptake in Africa, whether for personal, corporate or government use. Devices like the simputer have yet to make a significant dent on this barrier. However there are a number of experiments with PDAs that offer tantalising clues to ways in which it might be broken. Teresa Peters looks at two applications using PDAs in healthacare.

GHANA, KENYA AND UGANDA: SATELLIFE PIONEERS DATA COLLECTION BY PDA

Given the realities of Africa where electricity, security and cost are only a few of the factors that inhibit the use of ICT, it is unrealistic to imagine that technology could be put in the hands of the general public if that means a desktop computer in every home or office. But mobile devices 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 ICT-enabled development is approached in places that face the highest obstacles to effective ICT use. Two case studies are presented below, illustrating how handheld computers and cell phone technologies have been used in practical ways to improve healthcare in Africa. These projects demonstrate the potential for wider deployment of mobile devices for a range of uses in developing countries.

Healthcare is one of the leading issues affecting African development today. Lack of information on treatments and disease management is often an underlying issue that hinders effective patient care and prevention. ICT can be used as a tool for collecting community health information to support decision-making; improving doctors’ access to current medical information; linking health care professionals so they can share information and knowledge; and enhancing health administration, remote diagnostics, and distribution of medical supplies.

The US-based organisation Satellife have demonstrated the viability of handheld computers for use in healthcare in Africa, specifically looking at their usefulness for data collection and information dissemination. Satellife first linked to an American Red Cross measles immunisation campaign in Ghana, using 30 handhelds in a short-term survey to determine the efficacy of outreach efforts and collect baseline health information. The Uganda phase tested the use and usefulness of 40 handhelds by medical practitioners to conduct an epidemiological survey on malaria, and to access and use medical reference tools and texts in their medical practice. The Kenya phase tested the use and usefulness of 40 handhelds by students to collect field survey information, and to access and use medical reference tools and texts as part of their studies.

Project participants overwhelmingly agreed that the handheld computers improved their ability to deliver effective healthcare to patients and they recognised the potential for the technology to revolutionise healthcare delivery in developing countries. A number of external challenges affecting the current and future use of the handhelds for healthcare in Africa were identified, including bureaucratic hurdles, technology problems, lack of local technology supply, and the need for training and tech support. Nonetheless, handheld computers proved to be a viable option where there is little ICT infrastructure and a lack of conventional ICT such as desktop computers, and they offer an inexpensive alternative to desktops in terms of computing power per dollar.

This is particularly relevant where government and donor funding is supporting ICT-related development projects. However, the biggest challenge for widespread roll-out remains whether ordinary citizens in developing countries will be able to afford a handheld computer for themselves. But 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. There is clearly a market opportunity for a cheaper handheld computer that is targeted to those less able to afford lap tops or desk computers.

CAPE TOWN: REMINDING PATIENTS TO TAKE THEIR TABLETS ON TIME BY CELLPHONE

The Compliance Service uses SMS technology for TB treatment in South Africa Cape Town has one of the world’s highest incidences of tuberculosis (TB), largely due to socio-economic and climatic factors. TB patients must strictly follow a difficult drug regime over an extended period—four tablets five times a week for six months. Evidence suggests that TB patients often do not take their medication simply because they forget. Non-compliance with the drug treatment has exacerbated the high occurrence of TB and created difficulties for the local, overburdened health care service. Precious medicines are wasted when people do not take their medication on schedule, and non-compliance causes the TB virus to become increasingly drug resistant.

The Cape Town-based Compliance Service is tackling this problem by using Short Message Service (SMS) to send text messages via cell phones to remind TB patients to take their medication. At first there was scepticism about whether the uptake of cell phone technology was high enough to justify this approach. However, the service found that over 50% of people in the Cape Peninsula had access to cell phones, and at the clinic where the project was initially launched, 71% of TB patients had access to a cell phone. Here is how it works: the names of TB patients are entered into a database and every half an hour a computer server reads the database and sends personalised messages to the patients, reminding them to take their medication. The technology used is extremely low-cost and robust: an open source software operating system, web server, mail transport agent, applications, and a database. Currently the City of Cape Town pays R11.80 per patient per month for the service. Of the 138 patients involved in the initial pilot, there was only one treatment failure. Overall, the initiative has led to a significant increase in the recovery rate of patients and could lead to savings for healthcare authorities.

For more information on the Satellife PDA Project see