The Digital Pulse The Current and Future Applications of Information and Communication Technologies for Developmental Health Priorities A Report Published by The Communication Initiative 2003 http://www.comminit.com The Digital Pulse The Current and Future Applications of Information and Communication Technologies for Developmental Health Priorities Table of Contents Chapter 1 – State of Health ICT4D: Issues and Gaps 1 Chapter 2 – ICT for Development: A Review of Current Thinking 12 Section 1: The ICT4D Proponents 13 Section 2: The ICT4D Detractors 34 Section 3: The Middle Road 51 Topic Search Index Chart 72 Chapter 3 – Programme Experiences: Sixty Case Studies Of ICT 74 Usage In Developmental Health Section 1: Data Bases and Resource Centres 75 Section 2: Social Development, Education, And Advocacy 94 Section 3: Networking and Dialogue Tools 144 Section 4: Telemedicine And High-Tech Medical Tools 170 Topic Search Index Chart 188 Appendix A South Asia Regional Trends 1965 – 2001 193 Appendix B Sub-Saharan Africa Regional Trends 1965 – 2001 200 Appendix C Middle East And North Africa (MENA) 1965 – 2001 209 By Warren Feek of The Communication Initiative with substantial support and guidance from Greg Long. CHAPTER 1 State of Health ICT4D: Issues and Gaps 1 ICTs and Health: In an era in which the state of health for the poorest countries, communities and people in the world is at best stagnant and is probably in decline, the potential value of the new information technologies for more effective health and development action can appear to be manna from heaven. With the qualities of rapid, two-way information flow, interactivity and mobility, the possibilities for improved health action stimulate and test the strategic and programming skills and imagination of international health and development workers. There are vivid examples of these possibilities being grasped and put into action: from using PDAs as high-tech prompts for DOTS compliance to telemedicine virtual surgery that focuses the skills of doctors in many countries on one patient in a different place; and many more. However, there is also scepticism and concern. For example, will the new technologies support the bridging of the health gap between the richer countries of the north and the poorer countries of the south or will they simply broaden the gap across which any health equity bridge needs to traverse? The detailed material that follows in this document seek to provide summaries of a selection of information, analysis and findings related to the potential and actual role of new information technologies adding positive value to health and development strategies and programmes. The summaries are presented in neutral form – highlighting without comment the nature of the experience, essence of the analysis and key findings from any research. From this material and the full sources should you choose to review them, you will be able to draw both your own general insights and conclusions and any particular information, insights and ideas that can help to improve your particular health and development work. The overall sections are grouped as follows. First, three set of analysis papers – supporters, detractors and middle roaders. Second, classification of these think-pieces across a range of health and geographic areas. Third, summary descriptions of a number of programme experiences using ICTs to help advance their work. For better understanding and access we have attempted to organise and classify these according to the nature of the programme intervention: Database and Resource Centres; Social Development, Education and Advocacy; Networking and Dialogue; and, Telemedicine and High Medical Tools. Fourth, those programme experiences are also classified according to a more extensive set of groupings. Finally, some data has been gathered and compiled on the health status trends that provide the ‘ground quality’ for all health action, including by those using or seeking to use ICTs as part of their strategy and programmes. As part of this process The Communication Initiative has been asked to highlight it’s assessment of the material collected, reviewed and summarised – specifically the major gaps and issues in harnessing the specific power and qualities of ICTs for more effective health action. That assessment follows, in very brief form for easy access and use. However, before highlighting these observations it is important to stress that this is just one reading from the material that follows. We would encourage everyone to reach their own conclusions. 2 Top 10: Strategic Issues and Gaps From the reading of the critical observations and experiences that follow, as well as a general overview of this field derived from The CI web site www.comminit.com we suggest that the following are core strategic issues and key gaps that need to be addressed. 1. Issue: Voice vs. Information The very nature of ICTs lends them to quick, inexpensive and rapid information dissemination. Emails get to the recipients instantly. Web sites can be viewed at any time. MSN and other instant messaging services mean that you can contact people when you want [providing they are online – an issue to be addressed later]. This capacity of the ICTs has seen the people with the combination of access to the new technologies and an available reservoir of information reorienting their information and communication strategies to better ‘push’ the information that they regard as essential ‘out the door’ to the people and organisations that they think will benefit from that information. So, for example, the international health and development community is full of organisational web sites and email magazines that push the experiences, services, products and capacities of that particular organisation: new research results, training opportunities, programme developments, papers and other documents, fund raising successes etc. They are very organisation centric. However, there is a particular issue with this development related to the issue of ‘voice’ – whose ‘voice’ gets the added prominence through the qualities and capacities of the ICTs? The answer of course if the northern based agencies – the richer organisations with both [a] the funds, capacities and connectivity to develop the web sites, databases and email list serves that can promote their view of the international health world and [b] a ready supply of information that can easily be made ‘web-ready’ in order to ‘populate’ their ICT processes. Where there appears to be much less attention is on the use of another very strong capacity of the ICTs – the ability to swiftly communicate a range of different ‘voices’ related to any issue. In this case the voices of those directly experiencing or threatened by health issues. ICT and Health processes that position themselves with the primary role of ensuring that the voices of people that are engaged in policy development, programme review, critical thinking and programme management, are few and far between. The ‘pull’ role for ICTs – pulling more diverse and grounded groups of people into the functions just described is notably absent as a central, primary strategy for most organisations using ICTs. This is a major weakness. As can be seen in the health trend data, many of the key indicators are heading in the wrong direction – from HIV/AIDS and TB through malaria, child immunisation rates and even polio. Overall health strategies and programmes need to be continually reviewed and amended. Engagement of those directly affected would improve strategic thinking and programme performance – helping to ensure relevance and ‘fit’. The ICTs have strong capacities to support these processes. Gap 1: Insufficient prioritization of the use of ICTs to increase the ‘voice’ of people directly affected or threatened by health issues in policy development, programme review, critical thinking and programme management roles 2. Issue: Technical vs. Content In the South, the international development field has promoted and experienced what appears to be a tornado of activity on the technical aspects of ICT but only a slight drizzle of action in developing content for ICT processes. The balance between the two may need correcting. This is 3 an important underpinning to health and ICT action. In this case, technical refers to the infrastructure for ICT operations – from providing computers and funding telecenters to national ICT policies, broadband and satellite links. Content is what is transmitted utilising that infrastructure – the content in pages on web sites, e-magazines, emails, etc. Of course the technical is a necessary prerequisite to support the content flowing and much remains to be done [maybe always will remain to be done] as we will observe later. Equally, having the technical infrastructure with little or perhaps irrelevant content is an unhelpful situation. Increased support is needed for people experiencing and working on health issues to utilise the ICTs to A. Create health content from their experience relevant to their contexts and issues for their neighbourhoods, communities and countries B. Tell their stories C. Communicate the lessons from their experiences, and D. Support each other with their health actions. This is an extension of point 1 above with an emphasis on decision-making and critical review. Here we are more concerned with ICTs as part of programming action for local knowledge – the development and communication of ideas, information and thinking specific to particular contexts, by and for the people in those contexts. The culture around health [compare for example the customs related to birthing practices and the implications of those customs for maternal mortality reduction strategies] is a vital factor for improved health action. ICTs can play a very important role through the development of local content. Even though the ICT infrastructure is not all pervasive [and may never be] and the main beneficiary at this stage may be health workers rather than local community members, it is vitally important to give such health content development priority at this time. There is a pressing need to train and foster more local content generators. Human capacity building is required in both hard skills (like networking) and in human communication skills like marketing, journalism, research and leadership. These combinations of skills will result in individuals who are well equipped to both transform the information on the Internet and to contribute to that larger pool of knowledge. This does not mean that the developing world requires the creation of a small cadre of its own experts, but that models should be developed for larger group contributions to the knowledge base. Gap 2: Insufficient attention in ICT strategies to health organisations prioritising local content development. 3. Issue: Discrete vs. Integrated Communication There can be a tendency, perhaps because the new information communication technologies are so new, different and exciting, to view them as separate to and sometimes replacing the existing communication and information channels and media. Perhaps we could call this the ‘new toy’ phenomena. In many cases there appears to have been a drive to focus attention on the new technologies in isolation from the existing work through radio, print, TV, traditional drama, theatre, live music, art and other communication forms. This is understandable. The new technologies appear to promise so much with their scale, flexibility, inherent multi-media capacity, and comparatively low cost. This would, however, be a considerable mistake. The strategies and programme experiences that are beginning to meld new and older communication processes may have the more promising approach. Widespread, individual connectivity of the type that is commonplace in the West is not feasible, realistic, or even desirable for the developing world. In order for the new ICTs to be most effective and to gain the broadest possible audiences, they are best combined with other media forms – for 4 example, radio. Radio is incredibly widespread throughout the developing world and in Africa it represents the only truly universally accessible medium for the majority of the people. Radio is the ideal intermediary for the poor, geographically dispersed, and illiterate portions of the population to gain access to the information and knowledge that is stored on the Internet and in the host of other resources enabled by ICTs. The benefits that radio can convey as an intermediary also go beyond the provision of widespread access. Radio stations and their staff can act as search engines, locating the information that may be of use to the community; they can act as translators, deciphering the voluminous but largely unilingual content of the internet; and they can provide both local and international context to the information that they pull off the web. In this way, recipients of the information can develop a better sense of how their daily existence can benefit from the information and also gain a better sense of how they fit into the global economic, social and political system. Gap 3: Insufficient incorporation of the new information communication technologies with other communication technologies. 4. Issue: Programmes vs. Trends The incorporation of the new technologies as components of the overall action to improve health status has followed the somewhat traditional specific programme activity approach that is so common within international development: telecenters are created; web sites are built; networks are wired; chat rooms are formed and facilitated; and other specific, discrete activities are undertaken. This is a common thread through the programme experiences described and the nature of most of the strategic analysis of the papers summarised. These developments are of course, in some way following a trend that lends itself to a new form of programme action. Without a national trend to Internet use it would not be possible [nor desirable] to create community telecenters – be they exclusively new technology based or integrated with other communication technologies. However, it is necessary to wonder if, in developing such specific initiatives that consume major time, attention and financial resources, the international health movement has missed riding a very significant trend that is both affecting how people communicate and ways in which they may gain access to the change tools for improving health status. For example, there has been a major trend towards Internet cafes or cyber cafés [called different things in different countries – they are often very basic in character] in many countries including many of the poorer countries in the world. However, very little information in about these processes came to light on, for example, health partnerships with the owners and managers of these establishments. Likewise, there is a similar situation with mobile or cellular phones. Over the next decade these will become so much more common than fixed line phones that the latter technology may be consigned to the dust heap. However, there is little effort, it appears, from this review of the programming and strategic thinking, towards brokering partnerships and alliances with the mobile/cell phone companies to explore ways to harness this trend for better health. In both cases [and there are other examples] the effort to develop specific, discrete ICT initiatives and programmes has diverted time and skills from attempts to capture and harness powerful trends for significant health gains. Wireless is most likely the next major trend and opportunity Gap 4: Insufficient strategic thinking and action that seeks to harness the overall new technology trends – e.g. Internet cafes and mobile phones - for health action. 5. Issue: Programmes vs. Structural A similar dynamic exists in relation to the comparative efforts focussed on new programme development compared with addressing structural issues affecting the new technologies. Though this is not directly a health issue it does undermine the potential for effective health action utilizing new technology opportunities. For example, there is little concerted effort within the international 5 health field to address an issue such as the cost of a dial-up connection or the duties and taxes on imported hardware and software. Whilst international development funders are [directly or indirectly] supporting health focussed local and national NGOs and Ministries of Health to significantly upgrade their new technology capacities, local structural issues are significantly hampering the effective use of those technologies. And, whilst funders are supporting UN agencies and international NGOs to be more efficient and effective through the use of the new technologies, much of their effort is watered down because of local structural issues. Effective action to harness and utilise the new technologies as a significant ally in the fight for better health may come through lower internet access rates within a country or community rather than establishing a specific organisational web site. It will probably be more effective for people’s health in a community or country to provide young people with email and Internet skills rather than funding and running a specific online health campaign on a particular health issue. Subsidising the local Internet or cyber café so that more people can use this process to access health information at cheaper cost might be a better and more sustainable use of resources than creating a new purpose built multi-media telecenter. One of the great values of the new technologies is that people can access the health information and ideas relevant to them in their context. This applies at an individual level and also at the level of health workers. Changing the structural conditions to better support more people accessing and contributing knowledge, and discussing and debating health issues relevant to them, is crucial to effective ICT action on health. Gap 5: Insufficient inattention within the international health community to the new technology structural issues – pricing, taxes, access, controls, etc – that significantly undermine the value of the new technologies for health action. 6. Issue: Plans vs. Space One of the great values of the new technologies is that they can be used for almost anything and everything. If you need to establish a place to chat with a group of people - you can have it. Want to publish a magazine – go to it. You desire a real-time forum with colleagues – no problem. Wish to store and retrieve information, undertake research, run an advocacy campaign, link to others in your field of work – nurses, doctors, epidemiologists, people experiencing the same health issue as you, coordinate an activity, map trends and many other activities – then the new technologies are for you. One of their great values is that they provide a new space for people to better achieve their goals. With the new technologies – through essentially one technological instrument – it is possible for the person at the mouse, keyboard or handset to decide what they wish to undertake on any day. And to do something different the next day! This ‘space for the people doing the direct work’ approach to health action runs somewhat counter to the normal practice of management and funders negotiating, agreeing and defining detailed often long term plans of action. There is an inherent clash between the culture and potential of the technologies for improved health action and the culture and expectations for ‘proper’ development practice. Present development practice stresses specific planned outcomes to which everybody involved commits to work towards and gears their work routines and priorities to achieve. The process of developing these plans goes by different names in different funding and technical support organisations. But the intent is always to discretely define the specific measurable outcomes from a planned [and funded] activity/initiative. The effective use of new technologies for health gains may require a very different process. The ICTs have two very important qualities that are vital for, in this case, effective health. They place the control of the process in the fingers of the user. That person – be they a health advocate, health worker, health manager or someone experiencing or being challenged by a health concern [or perhaps exploring a health opportunity] can use the new technologies to respond to their specific interests and context. This is vital for good health action. The information and ideas they 6 access and contribute can be done in real time – when it is relevant to them. Additionally, the new technologies have the capacity [presently significantly under-utilised] to be interactive. They support debate and dialogue, exploration and assessment, which are also much desired traits when so many of the healthy issues we face require creative, locally relevant action in order to be successfully addressed. The days of uniform, global, top down strategies and programmes may have passed. The new technologies provide the space for these required processes to be implemented relevant to health. To fit the new ICTs into a health planning box that requires specific, planned outcomes may very well neuter the things that we require most for improved health action. Gap 6: Insufficient emphasis on the new technologies as a vehicle or platform that provides a space within which health actors can define the plan and direction they wish to follow rather than having to follow a predetermined management plan for how the new technologies will be used on health issues. 7. Issue: Potential vs. Proof There is a general lack of dialogue and writing specifically on the topic of ICT4D project evaluation methods. More specifically, there is a shortage of tools to assist programme managers and agencies to evaluate weaknesses in their programme design and make mid-stream corrections to their programme frameworks. Directors should not be bound by immutable plans that were established at the outset of the project. Many pilots are started with short, one to two year funding outlines and high expectations for rapid results. If the initial plans are flawed, they will require rapid evaluations and contingencies for quick and localized changes to the plan if the project is to be salvaged. This may well mean changes are required in the first 2-4 months of any given project, because by the time the half-way mark for the initial funding rolls around, the programme may well be beyond the point of return. Many of the evaluations that do take place are after the fact – once the programme has been deemed a failure and had its funding terminated. These types of evaluations, while useful as learning tools for future designs, are problematic because of the impressions that they leave with donor agencies who may be more interested in seeing concrete results than they are in the failed programme’s contribution to the larger body of knowledge. One of the most salient observations from the material attached is the importance of localized improvisation and adaptation for project success. If programme designs remain open-ended, and local participants and stakeholders are drawn into a process of evaluation very early into the project there may be opportunities to rapidly identify the components of the project that are likely to lead to failure if left in place. Localized solutions to the identified problems can then be developed and the original design framework can be appended to reflect these early evaluations. But how are all the other stakeholders – usually those up the hierarchical chain such as head offices and funders – going to respond to initiatives aimed at rapidly revamping programme frameworks that were carefully poured over by academics and policy makers for months or years prior to implementation? Probably not well. Certain organizational changes are likely required prior to adoption of a new set of “on the fly” evaluative and adaptive tools. One must ask, however, how bureaucratic is the development community? It obviously depends on what organization one is talking about. Some are bound to rigid but highly accountable public service models, while others are shaped more like small business enterprises, flexible but footloose. Yet, which organizational model is more likely to meet with project success and develop sustainability? In even shorter supply than the literature on project evaluation is literature on organizational evaluations of implementing agencies. The new public management (NPM) trends that are in 7 ascendancy in the West include a growing body of literature on organizational reform and design. While many members of the public service and development communities are extremely sceptical of the intentions and appropriateness of NPM for development projects, there may be lessons to learned from its evaluative models that stress early intervention, decentralized decision-making, and outcome-oriented design. Clearly, there is ample room for debate and dialogue in the area of evaluation tools, methods and models, and regardless of ideological stripe, most agree that more research and study is warranted. Evaluations are critical learning tools for future programme design, but they should also be tools for saving and restarting current projects that have lost their way (or that never had their way in the first place). Networking and dialogue projects like the ToolxCHANGE (pg. 158) may prove invaluable in generating new methodologies for evaluating project designs, implementations, and agency organizational structures. Gap 7: Insufficient attention paid to evaluating the impact of the new ICTs on health 8. Issue: Broad Economic Development vs. Specific Health Focus In the recent Lancet series on child health, one of the 5 papers looked at issues related to the relationship between equity and health status. They concluded that improvements in equity would have much greater impact on health status than any number of technological interventions and health specific “campaigns”. Therefore the “leapfrogging” thesis that plays an important part in efforts to build information economies in the developing world requires serious examination and debate. Authors on the one side argue that the creation of an information economy in the developing world is necessary if they are ever going to be able to catch up in terms of the basic standards of living common in the West. The necessity of this transformation is reinforced by their declining comparative advantage wrought by cheap labour costs. The new global economy is moving away from geographically concentrated, labour intensive industries, and countries that attempt to adhere to this “old” model of industrial development will find themselves continuously marginalized. But is the rapid emergence of an information economy realistic given the shape of the emerging global economy and trade structure? The innovation and R & D flows and energies that are at the heart of the information revolution and Knowledge Based Economy (KBE) are strictly contained within the developed West and there is little chance for the developing world to access these opportunities without a long period of internal development. Advocates who place their hopes on concepts like technology transfer have clearly not been paying attention to the tremendous growth in the field of Intellectual Property Rights (IPRs) and other agents that almost completely inhibit the potential for the widespread utilization, appropriation, adaptation, and reinvention that would have to accompany any developing economy’s bid to “leapfrog” into a fully knowledge- based economy. And where does the comparative advantage for the developing world lie? At present, they cannot achieve advantages in the required research and development faculties – they simply do not have the human capacity, venture capital markets, and research institutions that are hallmarks of the KBE. The boom in ICT hardware electronics manufacturing and software development that is taking place in places like India (though in limited pockets) is vital to development but will not rocket the majority of the population of these societies into a place that even remotely compares with Western standards of living. That precious comparative advantage for the majority of the countries in the developing world can only realistically lie in sustainable agriculture. Yet this avenue is blocked to them by the maintenance of agricultural protectionism throughout Europe and North America. Western farming subsidies are one of the biggest barriers to global development and efforts to remove them are progressing at a slow pace. But, while there is a current move to remove protectionism for basic agriculture and industry, the trend is for increased protectionism in the high-tech and ICT fields. 8 These issues are highly relevant to future health status. As the Lancet article indicated, given the importance of knowledge and information to equity, they may be more important to health status than specific health interventions. However, health issues rarely feature in knowledge based economy debates. They should. Gap 8: Insufficient attention to the health benefits from growth in equity of information and knowledge access and interaction through the new technologies 9. Issue: Independent vs. “Part of” Programmes ICT projects appear to be more likely to be successful when they are added as enhancements to pre-existing projects with established goals and guidelines for outcomes. Projects aimed at expanding and introducing basic ICT infrastructure should have some other end in mind than simply providing connectivity. It is important to ask how will connectivity contribute to real enhancements and improvements in the quality of life for people living in the region. There is no question that many existing projects, especially in fields such as health and medicine, can benefit from the addition of ICT tools and processes. Organizational efficiency and communication can be enhanced, and entirely new processes such as tele-health services can entirely change the way that providers go about reaching their established goals. Community groups with pre-existing mandates will also benefit from the myriad of networking and data collection opportunities provided to them by a simple Internet connection. But what of the telecentres and wired community access points that are initiated just to bring connectivity to some remote corner of a poor country. Is it clear how that access is going to help development? What will the goals and projected outcomes of the project be? Measures will probably be based on the number of community members that access the facilities during a certain period of time – but what will the measurable benefits be from their attending such a centre? Projects need to have another set of goals beyond getting a larger portion of the population to sit in front of a computer for two hours a week, because this is unlikely to bring about major change in their lives. There is no question that access to a larger pool of information is useful, but it is much more useful when that information is being collected and considered with some future action in mind. It is also relatively logical to believe that if a programme has already achieved a relative level of sustainability, that it is more likely to be able to maintain the ICT enhancement component over a longer time period as well. Sustainability generally indicates that the organization is fiscally responsible, that its mandate has the support of both funders and service recipients, and that it has effective management. All of these features are key to the successful implementation of ICT projects. Ongoing programmes and their management staff may also be able to prevent the implementation of wasteful projects. People that have been doing a job for a while will know best whether or not ICT enhancements are going to work in their particular field. They may simply say that ICTs will not contribute to their mandate and that they would much rather see funds directed towards some other project, Furthermore, even if the ICT-based enhancement project fails to achieve its particular goals, the organization that attempted the project lives on and is able to provide feedback about the strengths and weaknesses of the project to a larger audience over a longer period of time. It may have the opportunity to participate in several ICT enhancement projects, providing a relatively controlled environment for research on the effects of such implementations. For example, one research project detailed in the summary (Austin et. al., pg.17) was examining the use of technologies for community health care providers. The researchers gained valuable information from feedback about an ICT pilot project that the organization had participated in nearly 2 years prior. It was decided that the pilot project was not worth pursuing, but the organization and its staff retained their knowledge about the pilot and were able to pass it on to other, unconnected researchers at a later date. The staff of pure ICT projects that fail are likely to disperse and move on to other endeavours preventing the ready collection of their combined knowledge concerning 9 the project. The organization that survives an ICT pilot may also be able to act as a “lab” for future projects. Researchers can now control for variables such as staff responses to technology, organizational structures, and various other quirks that are difficult to account for when a pilot is applied to a previously unknown group. Finally, the level of acceptance amongst a recipient population is likely to much higher when a pre-established programme that has legitimacy with the local community is at the centre of an ICT initiative. Service recipients are likely to be sceptical of pure ICT projects (with questionable real benefits) that are parachuted into their communities, especially if the already established programmes (that they see real benefits from) are under-funded. Gap 9: Insufficient attention to incorporating ICTs as an integral part of ongoing programmes. 10. Issue: Direct vs. Intermediaries A significant observation that has emerged from his study is the importance and necessity of intermediaries for ICT projects. Intermediaries can come in many forms, several of which have been already noted in earlier points of observation, but their common thread is that they transform the vast wealth of the information on the Internet and the other channels of global information access into knowledge that has immediate and tangible use for developing peoples. The radio station and its host are intermediaries; the nurse who attends to the patient during telemedicine exercises is an intermediary; the teacher who guides children through computer and Internet based learning exercises is an intermediary; the village telecentre operator who understands and conveys the knowledge about the necessary communication protocols for phones, faxes and the Internet is an intermediary. In all of these cases and in many more like them, the intermediary is the vital link between the information seeker and the information. It is thus absolutely necessary that project designs consider the role of the intermediary first and foremost, before the role of the technology. The very best intermediaries will be able to work with the technology that is available and adapt it their specific situation, rather than attempting to restructure their environment around the demands of the technology. The time and money spent on developing training programmes and curricula for all of the various types of intermediaries is crucial and more valuable than that spent on technological adaptations and modifications. Intermediaries need to be innovators, translators and contextualizers and they must be supplied with the tools necessary for such a task. Recipient-intermediary relationships are also important determinants of social access to information and technology. The Graemeen Bank (pg. 5) telephone project has observed the importance of having women as the operators of the village phones. These women are intermediaries that are accessible to the entire population of the village – a characteristic that is of value to the overall sustainability (in terms of the service market size) and reach of the initiative. Similarly, technological devices that enable female health care workers to enter family homes equipped with vast amounts of diagnostic and preventative information and tools, broadens access to the benefits of the new ICTs. Because of the significance of intermediaries, policy and programme design should increasingly look to identify the position and roles of the intermediaries first and then complement them with appropriate technological solutions. These facilitators of information should be enabled to make adjustments and modifications to designs and implementation strategies and as well as the reassessment of project goals and outcomes. Gap 10: Insufficient attention is paid to the vital role of intermediaries in implementing effective ICT for Health processes. 10 Conclusion The observations above are drawn from an overall reading of the full material that follows: the analysis papers, case experiences, health trend data and categorization. They are the observations from The Communication Initiative. Others reading the same material may reach very different conclusions concerning the most important issues and gaps facing a more effective harnessing of the ICTs for improved health status. Such is the dynamic and vital state of ICTs for Health. 11 CHAPTER 2 ICT For Development: A Review Of Current Thinking 12 SECTION 1 – THE ICT4D PROPONENTS Empowerment and Governance through Information and Communication Technologies: Women’s Perspectives Vikas Nath Summary Nath’s article examines the ways that ICT enabled networking processes create opportunities for women in the areas of empowerment and governance, analyzes the challenges that lie ahead for an engendering of these processes, and presents a set of actions that will direct the rewards of ICT towards women and improve their overall quality of life. At present, the benefits of ICTs and the new knowledge society are not evenly distributed and have the potential to worsen the plight of already disadvantaged women in the developing world. Key Points While knowledge is a valuable resource, it is not a scarce resource and there exists ample opportunity for all women to participate in the exchange and production of knowledge. ICTs allow the development of knowledge networks that facilitate interactive communication between governments, NGO’s, communities, and individuals. Through participation in these networks, women can recognise the knowledge that they already possess and utilize it for productive ends. Reflection on the decades of development work has shown that failure to empower women will hinder efforts to alleviate global poverty. But because of their historical roles, women are generally more bound to their localities and have had less access to the emerging pool of empowering knowledge. ICTs and engendered knowledge networks can help to overcome these disadvantages. These networks and the accompanying creation of spaces for women are vitally important issues to be addressed in the drive to utilize ICTs for development. Potential gains for women can be classified into two spheres: Empowerment and Governance. The Empowerment sphere involves the development of skills that allow women to gain insight into the actions and issues that influence them, and to build their capacity to make decisions and become involved in these external processes. This involves utilizing knowledge networks to: • Access alternate communication channels and information providers. • Connect and allow women to broadcast to the external world. • Empower women through employment and entrepreneurship. • Create value-added services for women. • Challenge and change stereotypic role. Opening of spaces in the Governance sphere results from the democratization of women’s knowledge about social, economic and welfare processes and the “demystification” of political decision-making. Knowledge networks contribute to this by: • Improving women’s access to government information. • Reforming and improving service delivery for women. • Providing avenues for monitoring governance and access to decision-making processes. • Facilitating virtual communities for mobilization and public advocacy. While there are clearly many opportunities for ICTs to improve women’s participation in the knowledge society and to contribute to empowerment, many barriers still exist, including: • A lack of awareness amongst governments and civil society about the potential benefits. • Hindrances to women’s access, e.g. cost and underdeveloped infrastructure. • An underdeveloped ICT skills and capacity base and linguistic barriers. • Resistance stemming from the changes in power equations. • A focus on re-invention of existing ICT models as opposed to innovative models tailored to women’s needs. 13 Nath also presents the following strategies and initiatives that are intended to help facilitate the emergence of a successful gender-entrenched knowledge network: • Creation of Intermediary Organisations facilitating communication between women’s groups • Imparting of precious technical skills and education about ICT benefits • Creation of virtual support networks and remote volunteers • Creation of innovative prototype ICT models that are targeted towards women’s needs • Establishment of public and private sector partnerships • Focusing on research, innovation and incubation of tools to address women’s information needs Source: http://www.bellanet.org/gkaims/documents/docs/womenandICT.htm?ois=no 14 Public Computer and Communications Centre (PC3) Project (Chap. 4) Bulgaria Nora Ovcharova Summary This report reviews the process of design and implementation of the USAID funded PC3 telecentre project for rural Bulgaria. While Bulgaria is not a developing country and is quickly approaching EU ascension a digital divide exists within the country that separates urban and rural inhabitants. While little more than 10% of the population uses the Internet, over 60% of those users were located in Sofia. The assumption is that extension of ICTs to rural communities will contribute to their economic, democratic, and educational development. The model was developed from observations and lessons learned from other global telecentre programmes. This PC3 project supports rural entrepreneurs by providing technical assistance, hardware/software subsidies and ongoing technical and business management support. Key Points The goals of the Bulgarian PC3 project are to create employment and human resource development in areas with high unemployment; to increase the level of ICT skills in the community; to improve the ability of small to medium sized enterprises (SMSEs) to seek and evaluate timely market information; to provide a central meeting place for the community dialogue; to make government and social program information more accessible; to improve access to training, research and education resources; and to create incentives for young people to remain in the villages whilst gaining the skills necessary to participate in the globalized world. The PC3 Telecentre is presented as a new approach to IT service provision in under-served communities because it addresses issues of sustainability by developing partnerships with local entrepreneurs and combining both for-profit and “public good” services into a sound business plan. The PC3s were targeted in each small community at educators, students, health workers, local administrators and vulnerable groups. The products and service mix of the PC3s varies but is typical of many telecentres worldwide: Internet access, printing, scanning, faxing, etc. However, unlike other telecentres, the PC3 project was strongly focused on entrepreneurial development. Instead of a process of internal selection on the part of the donor agencies and project directorate as to the location for pilot projects, Requests for Proposals (RFPs) were widely disseminated to rural communities throughout Bulgaria. The more than 90 proposals from 75 towns were then evaluated with a set of criteria that looked at the entrepreneurs understanding of the PC3 concepts, contribution, business plan, and the features of the town proposed (including infrastructure capability. The selected candidates were then placed in a training program (akin to a business incubator) and provided with technical assistance, hardware, ISP subsidies and startup marketing assistance in the form of publicly distributed pre-paid cards. The cards were intended to encourage the targeted members of the community to utilize the PC3s and increase their IT skills and awareness. In addition, the card system ensured an immediate demand for the telecentre’s services and reduced the initial business risk for the operators. Each of the ten PC3 communities received a number of these cards proportionate to the population that were then distributed to “public good” users such as teachers, health workers, etc. While the project also initially intended to generate local content, (e.g. digitizing Bulgarian information) it was found that a great deal of local language resources and software was already available and so this component has shifted to filling in the gaps. The author believes that the wide response to the RFPs supports the hypothesis that PC3s are an appropriate solution for the information needs of small Bulgarian communities and that there are valuable lessons to be learned from this project for other regions. The initiative of local PC3 operators is at the heart of this models success. Source: Public Computer and Communications Centre (PC3) Project, Bulgaria http://pc3.orbitel.bg 15 Graemeen Telecom’s Village Phone (VP) Programme: A Multi-Media Case Study TeleCommons Development Group (Executive Summary & Section 2) Summary This report details the context, structure, and impacts of Graemeen Telecom’s Village Phone (VP) project to bring cellular phone service to regional areas of Bangladesh. The project combines the goal of improved connectivity with micro-level enterprise for women. The pilot project involves over 950 phones and provides telecommunications access to over 65,000 people. Village women are able to access micro-credit loans to acquire the digital GSM cellular phones and then re-sell phone services within the village. This project is also seen as an important opportunity to see how private sector development (PSD) in telecommunications can contribute to overall economic growth and poverty reduction. Key points Impacts on Poverty Reduction - The village phones generate a significant consumer surplus in the form of significantly reduced costs to the household of travel into cities. The surplus for a call that replaces a physical trip to the city can equal 2.64% to 9.8% of the mean monthly household income. The main reasons project participants reported for using the telephone were to discuss financial matters with other members of the family – often in other countries. Bangladesh is a labour-exporting country (primarily to the Middle East) and the phone is often utilized to reduce the risks associated with international remittance transfers from family members working overseas. It was observed that the single most important variable in relation to phone use is whether or not a family member is overseas. This reduced risk has important microeconomic benefits and improves the living standards of households who may be primarily dependant on remittance income for subsistence and savings. Phones are also used to exchange information and keep up to date about market prices. The ability of family members to stay in touch with each other also has important social benefits that, while not easily quantifiable, are nonetheless important. Finally, the village phone operators derive between 24% and 40% of their household income from participation in the program. The Business Case, Technical Choices and the Regulatory Context - The provision of rural telephone services in Bangladesh is very profitable and telephones in the Grameen Bank program bring in 3 times the revenue that urban cell phones do. This is in part because of the current regulatory environment that limits telecom providers from meeting the demand for services and advancing rural telecom infrastructure. As such, the authors of this report conclude that the VP programme, “appears to be the best available technical solution for rural universal access under current regulatory and commercial circumstances.” However, they do recognise that GSM cell phone technology is an expensive solution and note that changes in current regulatory practices may alter this evaluation. Gender Analysis - During the evaluation of this program, the authors recognized that gender plays an important role in concepts of “universal access.” It is not gender neutral, and selection of the VP operator and physical placement of the phone affect women’s access. Nearly 95% of VP operators are women because of the connections with the Grameen Bank’s already existing micro-credit programs. This access is important from an economic standpoint because sustainability is not possible if 50% of the user base is excluded from access. Being a VP operator significantly enhanced a woman’s status in the household and the community. Replicable elements of the VP Programme - In order to attract telecom operators to serve rural areas they must be provided with quality market appraisals and data that will help prove the business case and secure investment. The project also points out that linking existing micro-credit organizations with telecom operators to expand public call offices (PCO) and services will provide the solutions for the “last-mile” challenge of rural telecom access. Source: “Grameen Telecom’s Village Phone Programme: A Multi-Media Case Study”, Executive Summary and Section 2 at http://telecommons.com/villagephone/execsum.html 16 NGOs and the Internet in Nepal Layton Montgomery Summary This brief article examines the role and history of NGOs in Nepal and the emergence of the Electronic Networking Project, an effort to improve the communications and linkages between the various NGOs and the communities that they serve. The article attempts to view the challenges for NGOs and ICTs in Nepal from both human and technological perspectives. Key Points Nepal has seen an exponential growth in the number of national NGOs operating within the country. Alongside that growth has been an expansion in the availability and usage of Internet and email services. The IDRC funded Electronic Networking Project is an attempt to bring the vast community of NGOs together in order to maximize efficiencies, information sharing and networking. The first Internet connections were established in 1993 but in the initial years it was mostly international organizations that utilized the new but expensive connectivity. Following the establishment of a telecommunications act and private market opportunities, Nepal saw a substantial growth in the usage of VSAT links that reduced costs substantially. In 1997 the International Centre for Integrated Mountain Development (ICIMOD) began the Electronic Networking Project (ENP) with the following objectives: • To develop a network of “like-minded” researchers, administrators and practitioners from government, universities and NGOs. • To share their available human, technical and information resources in socio-economic development sectors through the usage of the Internet. This resulted in the development on the NepalNet website which provided details about organizations in the project, upcoming conferences, and a host of articles. This project eventually grew into the Nepal Internet Users Group from which the author’s interviews concerning NGO perspectives about the Internet were drawn. While most respondents were enthusiastic about the potential benefits to be gained from the usage of the Internet, many were at odds on the issue of how increasing access to information would affect the rural-urban divide within the country. Internet connectivity remains isolated to a few cities and excludes the illiterate rural areas from important national and international dialogues. Some respondents felt that this represented an important role for NGOs – to act as service providers in areas that would not receive attention from private interests. Connectivity is also important to Nepali NGO workers who are hesitant to take postings in remote areas that may inhibit their career advancement. Some of the challenges identified in the study included the prohibitive cost of phone calls and the fact that nearly 88% of the population lives in rural areas with little or no connections, thus the most representative organizations are the least able to have their voice heard. Another subtle problem was that of properly integrating ICT usage into NGO operations without having to dedicate too much precious human resources to email and Internet duties. Finally, the author noted some features on the Nepali perspective on knowledge that effects how the Internet and information is utilized. Many NGOs in Nepal have poor reputations because they lack transparency, a practice that stems from the Nepali perspective that treats information as a valuable and guarded commodity. Information is generally provided on a need to know basis only and not freely disseminated, creating a form of power and control amongst administrators – one that breeds corruption. The author suggests that in order for ICTs and information to aid in the development of the country, changes in the organizational structure and culture of confidentiality are needed. Source: Layton Montgomery, “NGOs and the Internet in Nepal” University of Wollongong, Australia. 17 Djibouti ICT Strategy Summary Djibouti is a small city-state (pop. 680,000) occupying a strategic location on the Horn of Africa with a service-based economy and a reliance on shipping. While the country is poor, with subsistence agriculture and few natural resources, it is recognized in the region as a stable financial centre. It also located at the intersection of Africa, the Middle East, Asia, the Muslim world and of la Francophonie. It is also favoured with a direct connection to the SMW 2 & 3 fibre- optic submarine cables linking Southern Europe and Asia. Privatization measures are being considered for the major utilities including the national telecommunications operator, Djibouti Telecomms. The Government of Djibouti and several other development actors such as the university and research communities as well as the private sector have recognized the importance of ICTs for Djibouti's service based economy. Since May of 2002, a process of consultation has been ongoing that has lead, with the help of UNDP and the ITU to the preparation of an ICT strategy and action plan. It has also been an opportunity for revising telecommunications tariffs by an average of 50%, and Djibouti Telecomms has been subject of a World Bank/IMF review. This process of consultation and reflection has led the Government and other development actors to recognize the importance of developing a strategic view of how ICTs can help transform the country. The result is an ICT strategy and action plan with a 20-year horizon. Key Points The Action Plan is organized under the following 9 headings and each section details the specific components, goals and frameworks for implementation. 1. Core Activities For Strengthening The ICT Sector - the empowering and strengthening of the telecommunication sector in the economy and drafting the basic texts and acts governing ICTs, including the creation of a regulatory agency. 2. Installing The Means Of Access for All To The Information Society – which involves an analysis of the current dissemination of ICTs in Djibouti and a market study. This is to be followed by infrastructure expansion, a search for appropriate technical solutions, promotion, the development of community access centres and radio stations, and efforts to encourage ICT assimilation. 3. Developing Human Resources And Strengthening Research - the creation of a research, education and health network and increased capacities in the field of ICTs. This will include a schools network project and national education and ICT project aimed at enhancing teachers' skills and computer equipment in schools. 4. Modernizing And Strengthening The Public Health System - the informatization of the Ministry of Health and main hospitals of the Republic of Djibouti as well as the connection of major health centres to the RDRES. 5. Modernizing State Structures through Digital Technology - the modernization and informatization of the Administration. 6. Strengthening Institutional and Legal Capacities – the introduction of legal information systems. 7. Strengthening ICT Usage Capacities In The Private Sector – this will involve creating a regional hub and international financial services centre as well as business incubators and conditions suitable for the development of an information economy. 8. Developing Digital Content – with efforts to raise the profile of Djibouti on the web. 9. Managing Information On The Environment – responding to famines and other natural disasters by using ICTs to share information and provide for early warnings and management. The action plan details over 30 projects that can be considered to help transform the country while trying to deal with the fundamental issues of poverty, literacy and access to education and health services in general, community development (community access centers and community 18 radio) and the challenge of transforming and modernizing the economy, government and society in general using ICTs. Each project includes a budget. Source: The Djibouti ICT strategy and action plan are available online at the following site: www.mccpt.dj. Choose the option: 'Societe de l'information NTICs'. The strategy and action plan are available in French and the Action plan is available in English. Sourced also from an email from Richard Labelle, UNDP. 19 ICT and the Environment: Friends or Foes ICT for Development Gateway, Oleg Petrov Summary One of the less discussed topics in the debate around ICTs is their direct and indirect linkages to the physical environment. This short article introduces a special series of articles hosted on the ICT for Development Gateway that discusses the pros and cons of ICTs and the knowledge and information revolution. The authors tie this series into the larger dialogue on the international Millennium Development Goals. The conclusion is that despite their potential negative impacts on environmental sustainability, the benefits far outweigh the costs. Key Points While the relationship between ICTs and the environment might at first seem tenuous, it becomes clearer when the power of ICTs are seen to affect nearly every aspect of human life and one understands that every human action inevitably affects the environment. A proper understanding and framework for decision making about the environment is dependent on access to correct, relevant, and timely information. ICTs have obviously contributed to the ability to receive and produce this information and to foster discussion and dialogue. The authors note the interesting dynamic that graces both the environment and ICTs; an understanding on two levels, local and global. Some of the environmental benefits that stem from ICT implementation and usage include the development of communication platforms for local voices, increased communications between organizations, and better opportunities for individuals to become involved in activities that protect the environment. The negative impact of institutions on the environment is reduced by the usage of ICTs and the introduction of paperless offices and government, less need for the physical transportation of people that requires carbon fuel usage, and improvements in management, networking and information exchange. Research also benefits from ICTs and its exceptional tools for observation, simulation, and analysis of environmental phenomenon and processes. But at the heart of the benefit of ICTs is their ability to equip every individual with a better understanding of the consequences of their individual actions on the world. On a more philosophical level, ICTs benefit the environment even more by moving the economy from one based on matter, scarce resources, and material consumption to one that deals in ethereal concepts such as knowledge. ICTs also provide some very raw technical benefits; improved environmental monitoring and data management, remote sensing and mapping, and facilitating the development of communities and avenues for raising public awareness. ICTs have a down side, however, and it is critical that these issues do not escape without consideration and debate. Most ICT products are not-fully recyclable and with 30 million computers being thrown out in the US alone each year a considerable pile of e-waste accumulates. Much computer waste reportedly ends up being shipped to Asia where it is scattered in landfills or burned, producing toxic dioxins. On a higher level there is also the impact that ICTs will have as general purpose technologies (GPTs) that also facilitate environmentally degrading practices by advertising SUVs or improving the cost efficiency of polluting coal shipments and transfers. It is thus important to remember that ICT are not inherently good for the environment and in many ways are dependant on their particular utilization. In concluding, the authors note that the environmental effects of the information revolution are difficult to separate from the impacts caused by the concurrent transition to a knowledge and service economy. The authors provide a host of links to more detailed analysis of each topic covered and invite readers to contribute to the expansion on this important debate. Source: Oleg Petrov “ICT and the Environment: Friends or Foes” Development Gateway at: http://www.developmentgateway.org/node/133831/sdm/docview?docid=569225 20 Heralding ICT enabled Knowledge Societies Vikas Nath Summary In this essay the author examines the philosophical and technical currents that underpin the ongoing info-technological revolution and its impact on knowledge and knowledge sharing. She notes the importance of knowledge sharing for development and examines the potential for ICTs, improved access, and new comparative advantages to improve the quality of life for the global poor. The author wholeheartedly believes that ICTs and the knowledge that they carry represent some of the most powerful tools to solve pressing global challenges. However, the information revolution is not without barriers and both the causes and solutions are examined. The essay concludes with a set of policy prescriptions that the author believes are necessary to truly enable ICTs to improve the global condition. Key Points At the heart of the authors discussion is knowledge. Knowledge is empowering and allows individuals to create linkages and generate understandings about each and every action that they and others make. Studies have revealed that it is knowledge, and not handouts, that the poor of the world are demanding. Knowledge is also not a scare resource, it proliferates with use, unlike any other commodity. Knowledge sharing is the process whereby the right information is made available to the right people in a timely fashion, enhancing its value. For the greatest value to be generated it is necessary for knowledge to be held in the public domain. It is this transfer from the private to the public that has the potential to re-skew the imbalance between haves and have- nots. ICTs play an important role in this process, for they are the drivers of the knowledge society and are behind much of the transfer from private to public domain. The Internet, for example, is the ultimate public storage space. ICTs allow knowledge sharing to transcend hierarchy, class, and culture, and networks are inherently based on principles of inclusion. As knowledge perpetuates, it continuously gains in value and is customized to each users needs. In addition, ICTs enable each and every individual to be both a consumer and generator of knowledge. Connections allow these empowered individuals to form together in communities to facilitate development objectives. Once ICT infrastructure has been established, communities also have the potential to ‘leap-frog’ ahead because of the low-costs associated with technology and data transmission. ICTs also become “force-multipliers” in inter-connected economies because information dissemination enriches every social and economic activity. But, ICTs have also brought forth their own set of challenges as developing countries are at very different starting points in their utilization of ICT infrastructure and knowledge processes. One of the barriers for developing societies to successful appropriation of the knowledge revolution is the inability to recognize that the knowledge they possess has value. Indigenous knowledge is often recognized and utilized by developed country foreigners before it is recognized in the local context. This is contributing to a substantial brain-drain from the developing nations and is a “self- imposed barrier” that needs to be removed if countries are to fully participate as a knowledge society. Developing countries must also shift their comparative advantage in the knowledge economy to capitalize on their diversity and human resource capital, and amass a wealth of information that works for the poor and marginalized. The old reliance on large populations for material production will no longer suffice. Another barrier is the lack of a high-speed, broad-band digital information infrastructure throughout the developing world. It is essential for all institutions within a country to strive to deliver either individual or community access to ICT. But even being connected is not enough and developing countries must also deal with the barriers created by the lack of locally specific and useful content, by the shortage of ICT skills that are necessary for the handling, hosting and retrieval of information, and by the omnipresence of 21 both the English language and literary format on the web. The need for vernacular content and information that is not conveyed in the written form is prescient. The policy implications that stem from this analysis include the development of enabling frameworks, a “de-bottlenecking” of regulations and marketization, and an open-ended learning approach to harnessing the power of ICTs. Developing countries must anticipate and accommodate the rapid changes in processing power, telecommunications, and multi-media while simultaneously investing in their infrastructure. Indeed government should itself function on an ICT model by making every effort to digitize. The best approach to development would involve the merger of technology and human capital and it is necessary for more organizations to emerge to ensure that ICTs do not pass the equality agenda by. The value that an individual gains from information is always different and there is a danger that the revolution could deepen the economic and knowledge gap - especially in cases where people are unaware of its worth. Source: Vikas Nath. “Heralding ICT enabled Knowledge Societies,” Sustainable Development Networking Programme (India) at http://bellanet.org/gkaims/documents/docs/heralding.htm?ois=n For more work from Vikas Nath see http://www.vikasnath.org 22 Enabling Environments for Social Accountability and Public Voice through Community Radio: A Learning and Capacity Building Initiative of the Civic Engagement and Participation Group - World Bank Institute (WBI) Summary This brief paper is actually a preparation document for a WBI conference and series of workshops aimed at scaling up community-radio programs. The central focus stems from the observation that the informed involvement of the poor and the strengthening of local institutions for public voice are essential components of an enabling environment that is necessary for including vulnerable groups in civil society. The initiative aims to scale-up social accountability and Community-Driven Development (CDD) approaches into Bank practice and promote favourable internal regulatory/budgetary frameworks. Key Points Successful decentralization and democratization requires the empowerment of poor people, and access to information is central to that process. Mechanisms that promote accountability in public institutions (supply-side accountability) and civil society (social accountability) are both necessary for government reform and poverty reduction. One of the observations of this document is that the majority of World Bank and other multilateral institutions’ initiatives have focused too much on the supply side. What is required is action on the demand side to enable the poor to utilize the opportunities for public voice and mobilization. In most Bank borrowing countries, the poor and the civil society organizations (CSOs) representing them have limited influence on, and access to communication channels tied to public accountability – they suffer from civic exclusion. This is a product of media concentration and asymmetric access to the necessary mediums. Thus, effective and responsible governance requires both an enabling legal framework and a diverse media base, but also requires the informed participation of citizens. Public voice and community voice institutions are necessary for public and social accountability. The enabling environment for civic engagement that the Bank wishes to implement is defined as a set of interrelated conditions that develop the capacity for NGOs and CSOs to influence national policies, strategies, and project selection. The assessment of the enabling environment must take into account three dimensions: the legal framework, political and institutional provisions and cultural characteristics by examining the five factors of each (this is referred to as ARVIN). 1. Association: factors encouraging or inhibiting the right to freedom of association. 2. Resources: the ability of CSOs to mobilize resources in the country. 3. Voice: factors influencing freedom of expression and opportunity to be listened too. 4. Information: public access to information and the functioning of the media. 5. Negotiation: opportunities for citizens to negotiate with the state and other stakeholders. Community-oriented radio stations are prime enablers of information, voices, and capacities for negotiation. A broad network of stations, oriented towards sound development content and providing opportunity for debate is one of the most powerful means of civic engagement for poor people – including those who are illiterate. Radio holds out true promise for CDD projects and as a means of engaging the community. The most needed area of support for community-oriented radio stations is content development, which includes objective but diverse reporting, and the production of entertaining public-interest programming. The WBI initiative proposed in this report aims to identify, test, and document the appropriate forms and mechanisms by which Bank-funded operations can incorporate community radio. Specific objectives include: (i) orienting the Bank to world-wide good practices in content building, (ii) developing knowledge resources, including a toolkit on communications, (iii) piloting alternative ways of improving policy frameworks and capacity building, (iv) scaling up of CDD and social accountability, and (v) encouraging communities of practice. Source: World Bank Institute. “Enabling Environments for Social Accountability and Public Voice Through Community Radio,” A Learning and Capacity Building Initiative of the Civic Engagement and Participation Group, Social Development and the WBI. 23 Information Program, Conceptual Map1 Open Society Institute (OSI) Summary The Open Society Institute is an organization dedicated to the expansion of democratic access to information throughout the world, with a particular focus on those countries transiting from former communist regimes. The organization is part granting agency, part operational agency and part thinktank. In its role as a source of strategic thinking concerning the role of ICTs for facilitating the dispersion of information, it has developed a conceptual map of the fundamental dimensions of these technologies. These dimensions focus on the capacity to deploy content, tools, and networks in new and innovative ways. Key Points Traditional media information issues are often approached from a dichotomous position, through a content/infrastructure distinction. The OSI believes that this distinction is outmoded and not useful because it ignores some of the new and important social uses of ICTs. The alternative is the three-way division built upon the lines noted below. Content: Information Chains – Digital media can act in a way similar to traditional media, as a one-to-many conduit of information and content, from producer, to editor to distribution channels and finally to consumer. However, this feature carries with it the intellectual property regimes reminiscent of traditional media. While this customary form of ‘publishing’ will always be present as an avenue for experts to provide information to the masses, the new ICTs have the power to also radically reorganize these chains primarily because the marginal costs of making additional copies of digital information are next to zero and hence do not require the mass infrastructure of old media. The new ‘freeness’ of information has potential that has yet to be fully realized for society. Networks – Alongside the traditional one-to-many information functions of ICTs is the potential for lateral, peer-to-peer communication in ways that are far superior to the telephone or letter. But, ICTs also have the ability to facilitate widespread many-to-many communication, a network effect that allows for the instant and global linkage of like-minded individuals. These media forms have the potential to allow widespread civic networking and opportunities for the development of forums for dialogue that were previously only possible in physically contiguous spaces. And while these types of knowledge management tools are beginning to be widely used in business, their potential for society is far greater. ICTs as Constructive Tools – The new ICTs also have the ability to go beyond communication applications and to branch out into the actual generation of information and new knowledge through advanced processing of raw data. In the past, this capacity was a scarce commodity requiring considerable human capital and labour, and was only available to those in the centres of wealth and power. Digital technologies and applications have democratized this capacity and allowed it to spread to peripheral organizations, networks, and even individuals. This ‘processing power’, based on data mining, process simulation and visualization technologies, has the power to contribute to changes in the balance of social and economic system. And because of the improved accessibility afforded by many of the applications, the utility of these technologies has moved out of the confines of the research lab into everyday life. This three-way distinction provides the groundwork for the OSI strategy paper that follows and that seeks to operationalize these distinctions in ways that can have practical and noticeable impacts on development, and the goal of a universal access to information. Source: Open Society Institute, “Information Program Strategy 2001-2002” Discussion draft for OSI board, Budapest 7 March 2001. 1 See accompanying review of OSI Strategy Paper (P.25) 24 Information Program, Strategy1 Open Society Institute (OSI) Summary The Open Society Institute is an organization dedicated to the expansion of democratic access to information throughout the world, with a particular focus on those countries transiting from former communist regimes. The organization is part granting agency, part operational agency and part think-tank. In its role as a direct provider of services and funds it has developed a comprehensive strategy aimed at advancing access to knowledge in all its forms as a prerequisite of truly open societies. This strategy paper examines some of the concrete organizational and operational goals that OSI intends to pursue in the near future. Key Points The OSI Information Program is based on three premises: first, that humans are active civic beings with the power to change their environment rather than passive subjects or self-interested economic agents. Second, that citizenship and true participation are dependant on the ability to exchange ideas and information. And third, that the new ICTs hold enormous potential for enhancing civic life. The Information Program’s mandate flows from these premises and is aimed at facilitating the equitable deployment of information and communication resources in a way that is primarily social rather than technological. The ultimate goal is to improve the state of civic empowerment and democratic governance in the regions within its reach. The program has five discrete components that contribute towards these aims: 1. A policy component aimed at developing an enabling environment for civic actors to utilize the democratic capacity of ICTs. This effort involves several sub-components including: • Efforts to reform local regulatory frameworks that are so critical to the infrastructure investment that is a prerequisite for widespread Internet access and the creation of knowledge resources like libraries and books. In many countries this area is faced with a policy vacuum, one that OSI aims to fill with initiatives guided by principles that balance market driven solutions with public intervention for disadvantaged groups. • Efforts to ensure both the free-flow of expression and communication and the maintenance of personal data-privacy. OSI seeks to prevent government or private sector censorship or surveillance of individuals and or other organizations. • Efforts to improve access to public sector information, primarily through the universal introduction of Freedom of Information (FOI) legislation. Direction is needed to promote effective e-governance models and to enhance civic participation in decision-making. 2. A content component designed to develop a global consortium for affordable, online information production and distribution. OSI plans to transform the EIFL (Electronic Information for Libraries) consortium, with its e-access to several thousand journals, into a powerful structural solution to the ‘digital divide’ in content access. This project is based on leveraging two important features of the Internet: demand aggregation and the zero marginal cost of data reproduction. The intent is to expand EIFL both with Western information sources as well as improving lateral, South-South, information exchange. 3. Initiatives designed to develop low-cost ICT application toolsets for civil society. OSI has observed that non-profits require specifically designed pieces of software for their ‘mission critical’ needs, but often can not afford the high costs of development. The use of off-the shelf systems in many cases reduces their efficiency and effectiveness as service providers. OSI plans to support the development of open-source software and to develop partnerships to implement an ASP (Application Service Provider) model that allows NGO’s to access the necessary applications over the Internet by paying a monthly fee and avoiding the system maintenance costs. 1 See accompanying review of OSI Concept Paper (P.24) 25 4. A networking project designed to empower and connect civil society and provide ICT support. The goal is to create regional networks and to build local capacity to deliver strategic ICT consultancy services. This will allow NGO’s to pool their resources and improve coordination of efforts and initiatives. Resources that facilitate strategic ICT deployment by the non-profit sector will also be made more readily available. OSI recognizes that the power of ICT-based communications can only be truly grasped when an organization’s structure and culture changes to work in a networked mode. OSI also wants to improve on the ability of local individuals and firms to provide the necessary implementation oversight and direction. 5. A local communities informatics project that attempts to make abstract ideas like open societies and access to knowledge more tangible for individuals and organization. The intent is to build on existing Information Program components to create models of how ICTs can be used to enhance local democracy and civic participation. Pilot projects will be used to overhaul the local information flow in communities like a small town. While OSI will only underwrite the research and preparatory phases, it is expected that many local governments will wish to seize on this opportunity to reorganize their communities through the development of libraries as civic information centres and other avenues to improve access. The specific projects that will be supported will be of three kinds: Initiatives that produce a systemic effect by altering the environment in which ICTs are deployed (e.g. policy projects), projects which are highly scaleable or that have a strong multiplier effect, and pilot or demonstration projects that OSI hopes will be replicated by other organizations. Source: Open Society Institute, “Information Program Strategy 2001-2002” Discussion draft for OSI board, Budapest 7 March 2001. 26 DEEP Impact: Teachers and Technology Jenny Leach Summary This short article reviews the Digital Education Enhancement Project (DEEP) and explores what actually happens in the classroom when ICTs are introduced. Human resource issues in teaching are often overlooked in the debate around technology applications for education but both student and teacher responses to these tools are critical determinants in whether or not they will contribute positively to the education environment. What has become apparent from an examination of this project is that the impacts of the ICTs extend beyond the immediate classroom and can benefit teacher’s professional identities and the community as a whole. Key Points The project has been working with 12 disadvantaged schools in the Eastern Cape of South Africa by introducing rechargeable laptops and websites stored on CD-ROMs (Internet connections are generally not available). The teachers are trained in pairs with a variety of materials such as website mediated activities and guides. As the teachers developed new ICT enabled curricula, they shared them with other colleagues throughout the region, and met regularly in informal groups for additional support. Equipment such as printers and digital cameras were introduced slowly, so as not to contribute to ‘technology overload’. Most teachers had never used a computer before but after four months they all felt that the technology was important to learning. The study also revealed some important features about how the technology is used and what happens with it in the classroom. • By not introducing a printer at the outset of the project, teachers were observed to adapt and innovate in their teaching methods rather than reproducing existing materials. • When computers were used in rotation by small groups of students, they work on ICT enhanced activities such as research that span several days rather than focusing on actual computer lessons. • The equipment was widely utilized outside of the classroom for activities in the community. • Teachers said that their confidence, enthusiasm and standing in the community was enhanced by their participation in the DEEP project. What became apparent from this project was that the contribution of ICTs to educational institutions not only enhances teaching but also has considerable spillover effects into the immediate community. Training that is focused on curriculum development skills and processes rather than ICT skills have a far more beneficial effect on the ability of teachers to use the technologies efficiently in the classroom. The ICTs were made cost-effective by implementing a shared use strategy that also allowed the teachers to benefit from peer support and learning. If a particular piece of equipment is utilized to its maximum potential it is far more likely to receive widespread financial and moral support from the community and donor agencies. The final observation is the impact that ICT knowledge and access has on the status of teachers in the community by contributing to an aura of professionalism and respect. Especially important in a field dominated by women who are often otherwise marginalized. Source: Jenny Leach, “DEEP Impact?” in Insights Education, (February 2003) available at www.id21.org 27 Understanding community health care: Implications for technology design Donaugh Austin, Hank Szeto, Geraldine Fitzpatrick, Peta Wyeth Summary This paper is the result of a small, but intensive, qualitative research exercise into the experiences and needs of community health care nurses working in the field in rural and urban Queensland, Australia. The intent was to evaluate the potential for integration of ICTs into the nurses’ daily practices and to contribute insights to the design of technology solutions. With home-based health care on the rise, there is growing demand for technology supports for both patients and health care providers. These demands must be guided by both the advantages technology has to offer and the pre-existing and informal works systems that constitute working in the field. Key Points The article begins with an extensive review of the settings and methodologies that were used for this study. Nurse were “shadowed” for a day as they made their various rounds in the community and worked out of their offices at the health centre that is the hub of each regional health district. The authors argue that this type of intimate observation is critical to the development of sound strategies for technology implementation. Also of importance was the lessons gleaned from interviews regarding an earlier ICT project that the health centre had participated in years previous. The data was analysed using a grounded theory approach integrating both theory and observation. An overview of the work of a community health care nurse follows, explaining the daily routine, describing some of the challenges faced and observing the important social interactions that are central to community health practice. The nurse’s work took place in three distinct places: the car, which served as mobile office and supplies store as well as mode of transportation; the client’s home, where the nurse interacts with the patient and gains intimate knowledge about their current state of health that can only be had by ‘being there’; and the office at the health centre where the nurse processes the days paperwork and partakes in various important peer interactions. The study resulted in several implications for technology design that might help to improve the overall functioning of the nurses and enhance the services delivered: External communication with other health care providers such as doctors and Occupational Therapists (OT) was observed to be difficult and inconsistent. Doctors were difficult to reach through synchronous methods such as the telephone, requiring several attempts. This led to wasted time and delays in the provision of other medical interventions. The proposed solution was the utilization of asynchronous communication technologies such as email to overcome conflicting schedules. The inclusion of enhanced features such as digital photos for remote diagnosis was also seen to have potential and would reduce disturbances to the patient. The client chart was also evaluated for its potential to be transformed by technological inputs. The client chart was the main source of paperwork for the nurses and represented an area that required considerable time and energy. Several issues emerged when considering the potential for an electronic client chart including the fact that 60% of charts were left in the clients home to facilitate scheduling flexibility in the field - so that any practitioner could attend to the client if need be. These charts also had an important, informal collaborative function as nurses left notes for each other and other service providers. This required that any technical solution was above all else going to have to be universally accessible by any member of the health team. Nevertheless, the potential for such an application exists, one that would likely include a host of enhanced features such as instant access to information that might be useful during the visit with the client. The collaborative function also required recognition of the informal behaviours that revolved around the chart, such as the use of post-it notes for reminders and alerts. These types of behaviours have been observed in other pieces of literature on technology design and require what is known as a ‘pliant’ approach to computing. Thus, while the potential exists, these important work practices need to be taken into account. 28 The issue of mobile devices was also examined, taking into account the nurse’s past experiences with PDAs that they attempted to use for scheduling purposes. The issues that arose from this past exercise included physical issues such as screen size and the durability of the technology as well as concerns regarding timely information synchronization with central computer units. This raised issues about the type of connections needed to support the mobile work of the nurses. Information and communication devices are merging and widespread wireless infrastructure networks are on the rise. Furthermore, mobile devices are becoming mature as technologies are becoming increasingly user friendly and incorporating multiple modes of input such as voice recognition. One important issue that also stemmed from this evaluation was how the use of such mobile devices in the care setting impacted the social interactions between the nurse and their client. In concluding, the authors recommended further study in the field but also suggest that there are definite advantages to be gained from utilizing the new ICTs but that they must also adapt the pre-existing beneficial work practices in place. There are many idiosyncratic subtleties to this type of work that require ICTs to be ‘pliant’ and flexible. And while there presently does not seem to be a mobile information device on the market that would fit this role, the lessons learned from this study can still contribute both to the design of technologies in this field but also to other fields through an appreciation of research methods used to derive the above observations. Source: Austin D, et al. “Understanding community health care: Implications for technology design.” Realising Quality Health Care, HIC 2001. For a PDF copy: http://www.coh.uq.edu.au/coh/resources/articles/HS_Community_Health.pdf 29 ICT and Ensuring Environmental Sustainability John Daly Summary Using the Millennium Development Goals (MDGs) as a starting point for evaluation, the author examines the way in which ICTs can contribute to environmental sustainability and associated issues. Daly seeks to identify ways in which the information revolution can be utilized to advance environmental goals. Recognizing that substantial literature exists on the use of technology for environmental monitoring and within projects, his focus is on the more indirect causal paths while seeking to relate ICTs to the specific targets and indicators for the MDGs. The author nevertheless cautions that it is important to avoid technological determinism and recognize that ICT will only help in the right conditions and that they have equal potential to contribute to unsustainable growth. Key Points Daly identifies several different areas in which ICTs have the potential to contribute positively: • Population Pressures – ICTs can contribute to the empowerment and education of women, the likely survival of children, and the returns on investment in education, all factors which in turn contribute to reductions in family size and population growth. • Efficiency of Resource Use – Modern economies are increasingly “weightless economies” involving the exchange of services and information over manufactured goods and resource exchanges. The movement of electrons is far more environmentally benign that the movement of large amounts of coal or lumber. Technology has enabled the remaining physical industries and activities to reduce emissions and become more efficient. • Conservation and the Reverse Loss of Resources – Information is critical to guiding conservation and restoration programs such as ground water management programs that rely on sophisticated modeling. In addition, the administration of environmental programs and efforts is improved through the use of ICTs. • Deforestation and the Loss of Biological Diversity – In order to preserve fragile areas and ecosystems the surrounding areas that have been designated for economic utilization must achieve their maximal intensive output. This type of “landscape management’ requires the use of ICTs for remote sensing and information processing so that gains can be realized while still preserving specific areas. ICTs that contribute to alternative economic opportunities for the poor can reduce the pressure on forests and biodiversity. • Land Tenure and Urban Issues – ICTs can simplify land tenure by contributing to systems that will simplify mapping, registration, and transactions – all serious issues in the developing world. In addition, the decentralizing potential of ICTs may allow for job opportunities to be spread out over wider areas and reduce the processes of urban migration that are so pressing in developing countries. The disbursement of economic opportunities over a wider area may contribute to more even development. • National Policies on Sustainable Development – National policies are reliant on expert information and the widespread exchange of ideas and data. These types of analysis and dialogue are supported and enhanced by ICT applications. Broader discussions with the public that are so important to instilling sustainable sensibilities are also facilitated by new media and can be used to enhance understanding of environmental issues. In concluding, Daly argues that the benefits of ICTs include the reduction of transaction costs carried over distances, the ability to obtain environmental data on much larger scales, the ability to conduct quantitative analysis, the ability to communicate with the public and the ability to control processes electronically. All of these benefits have the potential to enable people tom live in healthier environments. His only concern is that while these technologies may contribute to much greater efficiency, this may lead to an increase in the demands for products and services that will outweigh the benefits gained. Source: ICT for Development Gateway at: http://www.developmentgateway.org/node/133831/sdm/docview?docid=569545 30 The Chicken, the Egg, and African Telecommunications Barnaby Richards Summary This article reviews the effects that telecommunications and Internet advancement are having on the society and economy of Eastern Africa. The author’s primary focus is on connectivity and issues relating to communications infrastructure as opposed to questions of socially determined access. The article examines the current situation primarily through a market-oriented lens. Key Points The author begins the introduction that the true emergence of a an African telecommunications market has just recently begun to take place as governments relinquish their control over what has traditionally been a vital internal source of revenue. The history of African telecoms is based on the initial infrastructure developed during colonialism followed by a period of stagnation during the 1960’s to 1980’s that saw little advancement. This stagnation resulted in a terribly inadequate system with the lowest teledensity of any continent. Thus when the Internet arrived in the mid- 90’s, Africa was wholly unprepared to access its new opportunities. Barnaby does, however, believe that the Internet does have a vital role to play in advancing African development, as the emergence of the global information economy is unavoidable. If some efforts are not focused on bringing Africa into this economy, it will surely be left behind and end up further marginalized than it already is. Barnaby sees five major areas where ICT development holds the most potential. These include: • Academia – ICTs improve opportunities for African scholars to advance their own work and access the wealth of information (especially e-journals) available throughout the web. • Health and Medical Information – Telemedicine and other innovations have proven effective at delivering services over wide areas and ICT based communications have the potential to inform poor populations about a variety of pressing health issues. • Balanced Media Environment – ICT based publishing and broadcast media could help to shift the balance from Western produced media content to more regional information and entertainment sources. News about Africa is often filtered through Western lenses before Africans receive it. • Economic Development – ICTs can make major contributions to the functioning and competitiveness of African entrepreneurs and contribute to African efforts to become producers of knowledge rather than producers of goods. • Foster Democracy – Access to information is central to efforts to challenge and check governments and political forces and Barnaby points to studies that have causally linked interconnectivity and democracy. Shifting to prescriptions, Barnaby argues that for Africa to truly embrace the information economy, the following areas must receive immediate attention, revealing his chicken and egg question: while education should probably precede infrastructure investment, how can the people become educated without the important tools necessary for such education. Literacy and computer literacy both need encouragement along with efforts to improve pedagogical techniques that will utilize ICTs. However, investments in the emerging markets of Africa (e.g. cellphones) are more likely to generate rapid returns on investment that will generate the resources for improved education efforts. Barnaby concludes by arguing that despite the difficulty that the continent faces in leapfrogging into the information economy, the prospects for improving the lives of Africans make such efforts worthwhile. The changes that are embracing the entire globe also affect Africa and it would be perilous for the continent if it does not heed these winds of change and embrace ICTs. Source: Barnaby Richards, “The Chicken, the Egg, and African Telecommunications” (University of Colorado ay Boulder) May 2001. 31 Women, Men and ICTs in Africa: Why Gender Is an Issue Eva M. Rathgeber Summary This article, the second chapter in a book entitled Gender and the Information Revolution in Africa, examines the state of the telecommunications sector in Africa from a perspective that is inclusive of social and gender issues. The author argues that ICTs have the potential to improve the lives of women, but that this requires their active participation in the emerging sector. Men’s and women’s aptitudes and preferences towards technology are different, and this must be recognized during the development ICT tools, policy, and education programmes. This may require the reconceptualization and reorganization of existing knowledge concerning ICT usage. Key Points Africa has become increasingly marginalized since the new information economy emerged and globalization spread throughout the world. This is, in large part, because Africa has a poor infrastructure and a shortage of skilled labour. The growth of ICTs and accompanying processes of global economic organization have significantly reduced the continents comparative advantage resulting from low labour costs. There are three reasons behind this shifting advantage. The first is that ICT utilization requires skilled labour. Second, a good percentage of labour-intensive work has been eliminated by ICTs. Third, is that ICTs have made it possible for various work processes to be spread out over the globe, causing job fragmentation. While Asia was quick to realize these trends and avail themselves of international investors, Africa has lagged behind. Nevertheless, ICTs offer many economic and social opportunities and Africa must orientate herself to benefit from these opportunities. Recent African responses in the telecommunications field have been promising. Long neglected by national governments, a recent wave of telecommunications privatization in various countries throughout Africa has contributed to a boom in infrastructure growth and service availability – primarily in the cellular field. While Africa wide teledensity remains far below 1 line per 100 people, and email usage at less than 1% of the population, the influx of private capital and enterprise has contributed positively and ICT usage is on the rise. Though some progress has been made, little in the way of well-structured national telecommunications policy has been developed, with the uncoordinated efforts of donor agencies leading the way. Policy development and research is especially weak in areas involving women’s interactions with ICTs and the majority of work continues on the assumption of gender-neutrality. Yet in reality, men are more likely to have the income necessary to access ICTs and more likely to have higher educations that would predispose them towards such usage. It is thus necessary for women to understand their own information needs and to have opportunities to contribute to the creation of more appropriate policy. The traditional view of technology as gender neutral has attributed the lower levels of ICT utilization amongst women as a “female problem” rather than as a product of inappropriate design. Nor has there been little consideration given to the pragmatic requirements of a woman’s life that necessitates her fulfilling multiple roles. Yet, ICTs do have the potential to empower women and open up a wider choice of opportunities for economic and social advancement. Widespread telephone services, for example, can be powerful tools and can contribute to tangible development outcomes such as reduced migration to cities, improved disaster management, the extension of health services, improved access to market information, and educational enhancements. Key to all of these areas is the provision of gender-sensitive information that serves the differing needs of both men and women. In support of the important role that ICT investment will play in advancing Africa, the author defends ICT spending by arguing that human development is not linear and that there are opportunities for differing paths and “leap-frogging” to different stages. Once the infrastructure is in place, the continent can begin ton accrue the benefits gained from improvements in efficiency and production. These opportunities will however require the full participation of women and this will necessitate greater efforts to encourage women to work with ICTs and go into the innovative 32 sectors of science and technology. African education systems will have to undergo changes throughout all levels, to ensure that the needed skills base for engagement in the information economy is present. The acquisition of these skills involves the reconceptualization of ICT knowledge and the fixed ascendancy of technological interfaces like programming languages. The formalized, hierarchical organization of technological information is often seen as the source of women’s discontent and low utilization. Some successful projects in this area have involved the “humanization” of scientific information by women’s groups so as to make it more broadly accessible to developing country audiences. The author feels that African universities have a particularly important role to play in this endeavour and she suggests that a restructuring of the way that such institutions handle knowledge is in order. To be helpful the information that ICTs convey must satisfy several important criteria. It must be relevant to the needs of users, it must be comprehensible, and it must be easily available. In Africa and throughout many parts of the developing world, these necessities are not always understood as key to effective utilization. African universities, which have the combination of highly skilled personnel with the appropriate contextual background have been slow to take up the challenge of transforming information into knowledge that is useful on a daily basis. While there has been a flurry of efforts aimed at building connectivity and encouraging ICT use in Africa, the evidence shows that women continue to lag behind in their takeup of the technologies that offer them the greatest potential returns. A restructuring of policy generating models and methods is necessary to counter this imbalance, and to encourage women to grasp onto the myriad of possibilities offered to them by the emerging information revolution. Source: Eva M. Rathgeber, “Women, Men and ICTs in Africa: Why Gender Is an Issue”, Chapter 2 in Gender and the Information Revolution in Africa (IDRC) At http://www.idrc.ca/books/focus/903/05-chp02.html 33 SECTION 2 – THE ICT4D DETRACTORS Take Five: A Handful of Essential for ICTs in Development Alfonso Gumucio Dagron Summary In his article, Dagron calls into question the viability of the belief that the ICT and technological revolution that has emerged will bring with it a social and economic revolution for the developing world. He argues that knowledge alone will not be enough to liberate people from poverty and is concerned with both the inappropriateness and market-oriented implementation of ICTs in developing countries. Furthermore, while recognizing the digital divide, he points that it is really just another manifestation of existing divisions between the developed and developing rather than any sort of new phenomenon brought about by the emergence of ICTs. He is also critical of the market tendency to prioritize financial sustainability over “social sustainability” in the development of ICT projects. Key Points He argues that the ICT component should develop in tandem with the development process, not in isolation from it. It is the interaction between the community, technical capacity, and the tools for communication and knowledge that will determine the success or failure of any particular ICT project. He then presents a series of “non-negotiable” conditions for ICTs if they are to contribute to effective social change and development. 1. Community Ownership • Problems – Many projects are initiated without community input that leads to equipment theft or deterioration because of lack of a sense of ownership. • Challenges – A strengthening of community participation in planning will lead to sense of ownership and contribute to safety and maintenance of equipment. It will also promote local organization and administration, and dialogue between community and planners. 2. Local Content • Problems – Most Internet content is irrelevant to the developing world’s poor and is controlled by commercial rules. The demand for telephone, fax, and computer services far exceeds the demand for the Internet in most rural multimedia centres. • Challenges – Local content is the most important condition for ICTs because the current “ocean” of knowledge does not meet the needs of the poor. Mini-networks between communities would be more useful than unfettered access to the www. 3. Appropriate Technology • Problems – Computers remain a luxury, and purchasing decisions appear to be out of step with the needs of communities. The newest hardware/software capacity is generally underused and is not able to be repaired locally. • Challenges – Technology must be appropriate and adequate to the needs of the communities, not in technical terms, but in terms of utilization, learning, and adoption. There should also be an ongoing process of community appropriation of the technology and the project. 4. Language & Culture Pertinence • Problems – English dominates the web, and when combined with the Internet’s class and cultural uniformity, creates a new type of “Apartheid.” The developing world is also left to inherit a “user culture” because of the lack of opportunities for contribution • Challenges – Without the presence of local culture/language, ICTs cannot contribute to the development of communities. The present unbalanced “cultural exchange” must be altered and will occur only if communities are empowered to produce more local content. 34 5. Convergence and Networking • Problems – Projects are initiated in areas with no history of participation, no convergence with other programs or organizations, and no networking with other ICT projects. Projects are instituted in isolation without alliances amongst each other or the community. • Challenges – ICT projects should complement existing social development projects and make efforts to converge with existing media (radio/Internet). Projects should seek to benefit networks of citizens, not consumers. In concluding, Dagron points out a few simple but obvious facts that colour all Western attempts at analysing the potential of the Internet and ICTs for development. All of the academics, policymakers, programme directors and funders have a radically different understanding of the potential of the Internet because they have daily and unfettered access to it. This is not, and will not be the case for the developing world any time soon and must always be taken into account. Secondly, the Internet the developing worlds needs is not just any kind of Internet, but one that serves specific needs and is not overrun with the crass commercialism that now pervades the Western experience. Communications for development must remain distinct form communications for the market. Source: Alfonso Gumucio Dagron “Take Five: A Handful of Essential for ICTs in Development.” 35 ICT and Poverty: The San Bushmen Earl Mardle Summary In this article the authors examines the flawed model that is currently in use in many ICT projects – a model based on giving the poor opportunities by teaching them new skills. The alternative is a model that seeks to utilize ICTs to engage the existing skills of the poor and create opportunity out of established capability. He presents this argument by examining the case of the San Bushmen and shows how this strategy translates the value of their traditional knowledge and skills into information that the rich world can appreciate. Key Points The author is arguing for a reorganization of the way that ICTs are used to empower and contribute to the development of the world’s poor and marginalized. He believes that the targeted communities have economically viable resources that ICTs can bring into fruition and create opportunities for them. This contrasts the attempts in many ICT and development circles to replace existing but seemingly unviable skills with high-tech aptitudes. The case study outlines how this approach works. The San Bushmen are nomadic hunters who have traditionally roamed the edges of the Kalahari Desert tracking and hunting game. But in the last 25 years much of their land has been fenced in and transformed into national wildlife parks in an effort to preserve the dwindling numbers of endangered animal species. In the past the San people’s knowledge of their land was their source of sustenance, but once excluded from hunting activities, their knowledge became useless and they fell into despair and poverty. But now, an ICT interface project, called CyberTracker,1 has been designed that will make their intimate knowledge of the land useful and valuable to the modern world. It is a small handheld computer unit that is used by the trackers to record the movement of animals inside the game park. This information is invaluable to park wardens and is far less intrusive than the previous method which required the tranquilization and attachment of devices on to the animals themselves. The computers use a touch screen and the trackers type in simple symbols before briefly connecting to GPS satellites to record the date, time, and geographic location nearly 100 times a day. The data is later downloaded onto PCs at meetings between the Bushmen and wardens. This allows for a better understanding of animal movements, has reduced poaching by placing over 120 Bushmen in the field, and provides the San with viable economic activity that is in line with their traditional activities. What is most important about this idea is that it does not attempt to capture the knowledge of the San Bushmen that has taken them 20 years to develop but rather utilizes the information generated by that knowledge. By focusing on what people know and by finding ways for technology to translate the knowledge that poor communities have into valuable information for rich communities, ICTs can contribute to direct poverty alleviation. But as the author argues, the paradigm of current programming needs to be “rewritten.” Poor communities have their own economies with a host of valuable knowledge that is trapped because it is in languages that the rich, scientific world does not understand - ICTs have the ability to bridge this language barrier. But, it is also important that the ownership of the knowledge remains with those who created it and that they receive a fair price for the resultant information. By respecting this indigenous knowledge and finding ways to translate its inherent value, all sides in the equation can gain from ICT facilitated exchanges. Source: Earl Mardle, “ICT and Poverty: The San Bushmen,” The Development Gateway (June 03) at http://www.developmentgateway.org/node/133831/sdm/docview?docid=571778. 1 http://www.cybertracker.co.za/ 36 Information Monopolies and the WTO Robert Verzola Summary Verzola’s article examines the nature of the modern international economy and the emerging role of the information sector in this system and its implications for global society. It is also an attack on attempts by capitalist interests to monopolize ownership of and access to information and the technologies used to produce it via supranational organizations such as the WTO. Verzola, suggests that there are opportunities and strategies to resist this monopolization of the social wealth of information. Key Points One of the first tenants of his position is that the information sector is decidedly different from the agricultural and industrial sectors of the economy. Per unit production costs remain high in both agriculture and manufacturing whereas the majority of costs in the info sector are contained within the initial research and development (R & D) stage, subsequent reproduction of the materials is cheap and lends itself to huge profit margins. It is, however, difficult for the capitalists to control the wanton reproduction of much of this information. Intellectual property rights (IRP’s) are an attempt to maintain this control. It is these attempts to control access that make the capitalists involved in the information economy a propertied, rent seeking class that Verzola terms “cyberlords.” Information cyberlords control the programs, data, and content (software), and extract rents via patent and copyright loyalties and licensing fees. Industrial cyberlords control the infrastructure, servers, and hardware needed for using and distributing this information. Because the potential for information transfer and exchange is global, the cyberlords have had to develop an international legal superstructure to ensure the extraction of their rents throughout the world. They are a driving force behind globalization and their primary instrument has become the WTO. The most important agreement – that the cyberlords could not do without – is the TRIPS agreements and its protection of intellectual property rights (IPRs). What this system manages to do is to preserve the colonial trade patterns of the past wherein the greatest returns will continue to be enjoyed by those immersed in the information economy – e.g. the Western world. Verzola argues that the emergence of the global information economy can be seen as the third wave of an ongoing, continual process of globalization that began with early colonialism, continued with post-colonial industrial expansion and has now arrived in its present incarnation. While supporters of the information revolution often laud the potential for these new ICTs to improve the situation for poor countries, Verzola argues that it is more likely they will be left out because of the high initial costs of R & D and the establishment of an infrastructure. These high costs are a barrier for poor countries. They will also not be able to catch up because the rich are getting richer much faster than ever before because of the “low-friction capitalism” (i.e. low transaction and transit costs) enabled by information economies. Verzola’s strategy to fight the cyberlords is to oppose privatization and to fight for public domain information content, tools, facilities and infrastructure. The expansion of IRPs need to be resisted and the public should not allow its culture, knowledge and other non-material goods to become the exclusive property of any individual or corporation. Community control over the infrastructure of information facilities must be advocated to maintain public spaces and access. These policies are clearly in contrast with the demands of the WTO and this can be expected to remain the primary arena in which control and information monopolies are fought. The low cost of reproduction of information, is both the strength and the weakness of the cyberlords, and society must continue to capitalize on this feature and continue to share information as freely as possible to limit their control. Source: Robert Verzola “Information Monopolies and the WTO” on the National Information Technology Forum (NITF) site: http://www.sn.apc.org/nitf/verzola.htm 37 The Impact of Democratic Deficits on Electronic Media in Rural Development Robin Van Koert Summary Koert’s article is the result of research he conducted in Indonesia, Peru, and Vietnam into the impact of democratic deficits on the access to and nature of electronic media for rural development. His purpose is to examine whether ICTs really possess the “liberating potential” that they are widely accorded in the current literature and dialogue. His basic premise is that the democratic deficit of a nation-state has a more decisive role to play in the actual role of ICTs in development than the potential of their “intrinsic interactivity.” Despite the de-centralizing nature of the Internet, the State apparatus is still able to restrict and control information flows, using either political or economic devices. His conclusion is that the contribution of technology to rural development remains determined by the socio-political and economic nature of a given state. Key Points In order to test his central assumptions, Koert combined the two concepts of “democratic deficit” and “interactivity” to develop nine ideal-types of electronic media flows. In defining the concept of democratic deficit, Koert attempts to move beyond the shallow definitions that are primarily reflections of the formal democratic elements such as representative government. Instead he examines the images of democracy using frameworks developed by other authors such as Kenneth Roberts, whose work extends the scope and depth of participation to include social and economic processes – qualitative indicators of democratic deficits; and Martin Tanaka, who introduces the concept of politicized media and argues that participation has moved from activism aimed at obtaining access to government resources to efforts aimed at directly influencing the electorate. These definitions are combined to form low-medium-high measures of democratic deficits. Koert’s other central concept, interactivity, utilizes a definition by Everett Rogers that describes it as, “the degree to which participants in a communication process can exchange roles [from sender to receiver] in, and have control over, their mutual discourse. One-way information flows such as mass broadcast media are thus excluded and the focus shifts to Internet exchanges and smaller media options such as community radio. Koert notes that the potential and actual levels of an E-medium’s interactivity may vary widely depending on things like organizational measures and efforts to restrict access. Levels of interactivity are measured by whether an E-medium (i) is multi-directional; (ii) allows participant control; (iii) allows role-changing; and contains measures of (iv) feedback and; (v) synchronicity of communication. Low-medium-high levels of interactivity can thus be determined using these criteria. When these two concepts and their relative values are placed on a matrix they produce nine ideal-types of E-mediated information flows. Koert then typifies these using the analytical concepts of “information traffic patterns” (ITPs) and the sociological concept of “actor roles.” The ITPs are reflections of the balance between individual and central control over (i) information storage, (ii) time, (iii) choice of subject, and, (iv) the speed of information reception. Four types of ITPs result, labelled: allocution (one way, central info provision), conversation (two-way info exchanges), registration (central data collection), and consultation (individual extraction from central sources) patterns. Koert’s final analysis is based on the assumption that highly centralized states with high democratic deficits favour allocution patterns while states with low democratic deficits favour conversation patterns. The concept of actor roles is divided into political, social and economic roles each of which influences the nature and the content of the information. E- mediums perform political actor roles if they are primarily influenced by and directed towards strengthening of the State. Economic actor roles are primarily concerned with economic profitability, and social actor roles are focused on efforts to increase the individual freedoms of the people. Koert synthesizes these evaluative models into a framework through which he analyzes the impact of ICTs and E-mediums on the rural development prospects of Vietnam, Indonesia, and Peru. In line with his original hypothesis, he finds that the social utility of E-mediums for rural 38 development increases with lower levels of democratic deficits. Vietnam and its strictly controlled state media services, offers little opportunity for meaningful utilization of ICTs. The Indonesian situation offers slightly more, because the state maintains less control over communications and free speech. The opportunities in Peru are even greater although much of the utility of ICTs is concentrated in the economic actor roles rather than the social. The environment for networked E-media improved with decreased democratic deficits in line with a shift from prioritization of communitarian to individual rights. In concluding, Koert suggests that his case studies appear to support the correlative models developed, and that a relationship exists between the values of democratic deficits and the levels of interactivity of E-media used for information dissemination in rural areas. He thus suggest that the true benefits of ICTs and E- media can not be fully realized without important reductions in democratic deficits, and that the ability of electronic media flows to “transcend national borders” and fulfill other liberating promises continues to be a long-way off. Source: Robin Van Koert, “The Impact of Democratic Deficits on Electronic Media in Rural Development” at First Monday: Peer-Reviewed Journal on the Internet at http://firstmonday.org/issues/issue7_4/koert/ 39 The Internet: Towards a Deeper Critique Roberto Verzola Summary In this article, the author criticizes the Internet and its proponents for promoting and foisting a technology upon the world that is in many ways reinforcing the divide between the rich and the poor. Central to his argument is the notion that technology is not value neutral, and that the Internet comes with its own embedded ideology that will prevent it from being the tool for democratization and improved quality of life that many believe it will. He bases his critique on 9 issues that are often overlooked in debates about the benefits of this technology. Key Points Verzola’s critique of the Internet is based on the following nine issues: 1. Market expansion for established information economies – Internet technology is very expensive and the countries most suited to benefit from further expansion of the user base and infrastructure are the already developed countries. This feature is reinforced by the ever-changing nature of the technology and the need for constant investment. Cost vs. time expenditure graphs would reveal a huge series of expenditures superimposed on steadily decreasing marginal costs resulting from the efficiencies and competitiveness derived from the newest technology. Nevertheless the firm must then face a constant downhill investment trap in order to keep up. 2. A hierarchy of access – This investment trap is characteristic of elitist technologies that exclude poor firms and countries that cannot afford the high entry costs and who are then faced with high marginal costs and are left behind. Those who can afford to enter live in a very different world than those who can’t. Internet users are faced with a similar hierarchy, between those with no access at one end and those with the very fastest and always on connections who can seek out constant opportunities for arbitrage, to maximize their margins, and to secure vital information. Because of these high entry barriers, developing countries will not be able to leapfrog ahead as technology proponents often claim. 3. Replacing workers with machines – The automation mindset is an inseparable feature of ICT technologies and the intention of automation is job elimination. And while it is not entirely clear whether ICTs will be a net creator or destroyer of jobs, it is clear that the jobs created will be in selective areas. ICTs also create two trends in employment: Working at a Distance, which reduces labour cohesiveness, weakens unions and often excludes workers from traditional social security structures; and Managing at a Distance, which involves simultaneous selective decentralization and centralization and increases contracting out. ICT use will be based on management criteria not labour criteria. 4. Unexplored impacts on physical and mental health – The effect of staring at a computer screen all day and being exposed to so many more sources of radiation are largely unknown. Even more disturbing though is the increasing reliance on software applications to support thought and productive work, many people can no longer write without a word processor, the computer is an integral part of the thinking process. Furthermore, with the promise of virtual reality around the corner, what will become of imaginative thinking and highly symbolic thought? The push to place computers is every school has also led to the sacrifice of many other important elements of the educational system. 5. An interactive idiot box – Early proponents of the TV claimed that it would revolutionize education and learning, but yet it has become known universally as the idiot box and is a source of societal disdain. The controllers of TV turned it into a marketing medium, much the same is happening for the Internet. This, combined with the merging of reality and fantasy (war movies interspersed with news reports of real wars), has contributed to escapism and ignorance. The interactivity of the Internet is also suspect, often amounting to little more than a “click/no click” response. 40 6. Drawing resources away from real problems – The seductive powers of the Internet have been drawing the best minds away from the most pressing challenges of our time: persistent poverty, disintegration of societies from globalisation, and ecological degradation. While these critical issues go unaddressed, some of the brightest youth occupy their time with programming languages, hacking, and online gaming. The Internet is a very expensive diversion from the most pressing problems. 7. Private space controlled by rentiers – The Internet draws people in away from the public spaces and into privately controlled domains and arenas. While many argued that the Internet had the potential to become a new, much larger public space, the exertion of private control over much of it has eliminated this potential. In cyberspace, individual rights are often circumscribed by far more powerful property rights. 8. Deeply centralist elements – Despite the many claims that paint the Internet as a truly decentralized network free of censorship or control, it is fraught with various centralist elements that negate its democratic claims. These elements include: • The corporate ownership of hardware and service infrastructures that allow them to force the full costs of expansion on the shoulders of newcomers. This feature is enhanced by increasing market consolidation. • The assignment of IP network addresses, a system generally involving large block transfers from large ISPs to smaller ISPs in a top-down fashion. • The domain name system (DNS), which is characterized by increasing levels of dispute and “squatting” and administration by publicly unaccountable bodies. 9. Embedded globalist bias – The non-distance dependant nature of price levels in the Internet is effectively a subsidy for globalisation wherein local traffic pays for international traffic. This feature reduces the natural competitive advantage of nearness and makes local communities less relevant and accessible than international ones. In concluding the author proposes that all of the features combined amount to a deeply ingrained ideology of ICTs and the Internet that is not easily separable from the technology and its daily usage. Source: Roberto Verzola “The Internet: Towards a Deeper Critique” at Bytes for all.org at http://www.bytesforall.org/9th/roberto.htm 41 Bridges Across Disciplines Ricardo Ramirez Summary In this article, Ramirez argues that the potential for ICTs as tools to enhance development remains undetermined, primarily because the technologies involved have their roots in a developed, Western, and industrialized setting. In order to apply these technologies to rural community settings, new paradigms for analysis and an entire new epistemology are required. This new framework for analysis is decidedly post-modern and Ramirez proposes that elements gleaned from the emerging field of natural resource management (NRM) are appropriate for the ICT for development (ICT4D) field as well. This approach is based on four central pillars: acknowledging diversity in paradigms; embracing pluralism; embracing a systems approach; and emphasizing learning and participation. The paper describes ongoing action research towards this end and the attention paid to stakeholder engagement, assessment, and capacity development. Key Points Assessment in the field of ICT4D is possibly one of the areas most neglected in the creation of projects and policies, in large part because the tools for assessment are wholly inappropriate. This is because the source of the ICTs is an entirely different environment than the one in which ICT4D is working. Nevertheless, policy makers seem to be inclined to take the leap of faith that involves the massive investments that are taking place, but are the potential users of this technology prepared to take this leap as well? As the technology becomes more complex, it becomes less predictable and the idea of a single best practice becomes more elusive. Because this venture represents a new and unexplored arena, the author suggests that a new language is needed to understand it. In assembling a new epistemology, the author argues that a multidisciplinary approach is critical (as NRM is) and should incorporate several important pillars. The first is the acknowledgement of a diversity of paradigms, a single approach to research, planning, and implementation is not shared by all and will not contribute to constructive development. The problem is that ICTs are embedded with modernist technologies and policy – and that their advocates cherish this perspective. Ramirez, however, argues that when placed in the development context, ICTs are best evaluated using a post-modern paradigm. ‘Mediators’ are needed to bridge the two perspectives and it must be recognized that the successful appropriation of the technologies is dependant on the amount of local control. The second pillar is embracing pluralism, and the recognition that accommodating multiple interests is necessary. NRM has been particularly successful in producing methodologies that include various forms of collaborative management, learning and appraisal. ICT4D needs to move along this same route and recognize a diversity of truths, goals, and systems. This also involves being open to a broad range of scientific disciplines and methods. The third pillar involves embracing a systems approach because of the sheer complexities of the interactions involved in ICT4D (and ecosystems). ICTs have many layers, hierarchies and feedback and communication features that require holistic evaluation in order to facilitate understanding. This is in contrast to engineering approaches that dominate ICT assessment and focus on the reduction of issues to individual parts. A key contribution to this thinking is soft systems methodology (SSM) and its notion that stakeholders involved in a system are ‘owners’ of a problem and thereby must be involved in the solutions process. ‘Soft’ refers to the human and organisational realm of relationships. The fourth pillar emphasizes learning and participation and the recognition that multiple stakeholders are involved when utilizing ICTs for community development goals. For ICTs to have an impact, users must define what they want from the technology. They need to participate in design, and the definition of evaluative measures. Participation, however, is not without room for critical evaluation, and attention must be paid to political/cultural context, reasons for participant interest, and the willingness and ability to participate of those invited. Research has 42 shown that a number of features can help to make technology relevant: (1) access through public spaces, (2) allowing community members to experiment with ICTs, (3) allowing community members to ‘dream’, (4) planning around their aspirations, and (5) organizing to make those aspirations a reality via infrastructure, applications, and skills. These four pillars lay the groundwork for an action-research approach to ICT4D that will provide both knowledge and initiative for projects. This action-research can then lead into larger community engagement opportunities through workshops that assist in the planning for the use of ICTs, information and data sharing, explorations into how progress should be measured and provision of management tools for needs assessments. It is also important to track ICT4D systems performance on multiple levels: by measuring community level access; by monitoring the growths in capacity of sectors and organizations; and by paying attention to individual skills and knowledge. This paper attempts to build a bridge between the established theoretical and methodological perspectives of NRM and the nascent ideas behind ICT4D. The two fields of study share many commonalities and the author believes that by adopting many of the lessons learned in NRM, a new, and more appropriate epistemology for ICT4D can be developed using the metaphor of a kaleidoscope – the multi-prism tool that allows for differing perceptions of reality that are a feature of the world of development. Source: Ricardo Ramirez, “Bridges Across Disciplines: Lessons from adaptive management of natural resources that inform the analysis and planning of information and communication technologies in rural and remote communities.” Draft 1. Contact email@example.com 43 Pro-Poor and Gender Sensitive Information Technology: Policy and Practice Zubair Faisal Abbasi Summary Rapid shifts in global productive processes towards knowledge intensive economies have laid the groundwork for the ascension of ICTs. A long-term vision for the potential value of IT requires the conceptualisation of technology as a “social-technical couplet” that society uses to: • Navigate and think through the structures, policies and process of IT diffusion. • Develop policy advice and plans to make IT an empowering tool for pro-poor and gender sensitive development. These require thinking about IT discourses and envisioning them in light of a social agenda and socially responsible processes. The rapid spread of ICTs begs for new rules and regulations, but nevertheless, any new ethos cannot bypass the essential vision of equalitive development. Key Points South Asia is one of the least gender-sensitive places in the world and it is no surprise to see that IT policy in the region has no provisions for mechanisms to alleviate poverty, facilitate women’s entry into the IT economy or in any other way allow them to benefit from its introduction. There is little or no discourse within IT policies on how to integrate women into the economic revolution that is taking place. Furthermore, systemic failures of the social support network have left disadvantaged groups in an even more precarious position, with the most negative impacts accruing to women and children. The author argues for the need for an articulation of pro-poor social interest policies throughout the different levels of ICT infrastructures. This task is twofold and requires the development of a vibrant social sector through the empowering processes of entrepreneurship and volunteerism in the IT field and the building of capacity for communities to share and improve old and new knowledge resources. This articulation must be based on universal principles of interactivity, dignity, and cooperation. While e-commerce surges ahead, the commercial products and services of the silent and marginalized segments of society are left virtually untouched. Women in rural areas find themselves in a “triad of traps” of perpetuating poverty, remoteness and opportunity lag. A pro- poor and gender sensitive vision that responds to this triad should view IT as a potential solution for poverty eradication and the enabling of opportunities for wealth generation through the marketing their skills and products. Pro-poor policies will also recognize the importance of disclosure and improving access for public domain information and knowledge through the use of the Internet. The spread and diffusion of IT is a “social-technical couplet” that requires that the opportunity to utilize the resultant information and knowledge is evenly distributed. Synergies between social, community-based initiatives and technical wares must be developed so as to enhance people’s capacity to use knowledge. Community based development around IT seeks an alternative to the traditional, charity-based approaches to poverty eradication and strives towards sustainable income generation opportunities for the poor. The author notes that the success of developed states is premised on the IT influenced tinkering with knowledge endowments by: • improving on knowledge products, services, and processes; • exploiting old and new knowledge resources, and; • developing the innovative capacity of the public, private and social sectors. In concluding the author reiterates the need for pro-poor and inclusionary development strategies that will allow for the harnessing of IT by poor communities and disadvantaged groups. It is only then that IT will be enabled as a tool for poverty reduction. Source: Zubair Faisal Abbasi “Pro-Poor and Gender Sensitive Information Technology: Policy and Practice” from the International Conference on Information Technology, Communications and Development (2001) at http://www.unbotswana.org.bw/undp/docs/bhdr2002/pro-poor%20and%20gender% 20sensitive%20ICT.pdf 44 i-Development Not e-Development: Special Issue on ICT’s and Development Richard Heeks (Journal of International Development) Summary In this article, which is an introduction to the Journal of International Development’s special edition on ICTs 1, Heeks provides a sceptical review of the current state of thinking on ICTs for development (ICT4D). He criticizes a large portion of the current literature and programmes as being couched in an overly optimistic technological determinism that is bound to produce a lot of words, but little concrete improvements. His solution is to take a step back from the hype and excitement associated with new ICT initiatives, and examine the knowledge and information that is at the core of ICTs potential for development and the pre-existing ways in which human society handles that information. Key Points ICTs basically handle information in digital format, no more, no less. To understand how they can be applied to development initiatives one must understand the pre-existing role of information handling within development. It is a role that can be divided into two parts - processes, which include: • Processing: changing data with potential value into information with actual value; and • Communication: the movement of data from source to recipient. These processes result in outcomes, those of which actually contribute to development include: • Learning: the transformation of information into knowledge; and • Decision making: the use of information in decisions and actions. • The support that ICTs provide to these outcomes constitutes their ‘intensive’ contribution. 2 By evaluating ICTs as simply another tool for working in these roles, a sense of continuity and understanding about information handling is gained that lends itself to rethinking positions about other tools such as ‘intermediate’ technologies like radio and TV; ‘literate’ technologies like the written word and books; and ‘organic’ technologies such as the brain and the human voice. This promotes the idea that lessons learned form prior work on information handling apply equally to ICTs and that development initiatives should place information before technology and remain open to a range of possibilities and alternatives. Heeks believes that the impacts from ICTs can be classified according to a framework that maps beliefs about the utility of ICTs along two axis, the first being whether or not the impacts will be positive, neutral, or negative, and the second being whether the cause of the impact is technologically determined, contingent on the situation, or socially determined. He is critical of those elements of the development community who believe that ICTs are almost always positive, and that the outcomes are mainly derived from the technology involved. Heeks believes that this is a naïve but nevertheless commonplace position. The articles presented in the special journal edition see a more limited role for ICTs and are less optimistic about their potential as a panacea for development problems. Heeks’ solutions for successful implementation of ICT systems are based on a set of i rather than e principles. The first requires that ICTs are integrated into development objectives and never emerge as an end unto themselves. This requires proper identification of the project goals, the new information requirements required for those goals, and the potential role of ICTs and other info-handling technologies in meeting those information requirements. Project designers must also recognize that the majority will continue to not have or be able to fully access ICTs and that intermediaries are essential to the successful utilization of ICTs for knowledge. Understanding 1 Several of the articles from that Special Edition are included in this literature review. 2 “Intensive” contributions are generally those focused on poverty reduction and the work of development agencies while “extensive” contributions reside in the area of grass-roots entrepreneurial and market activities. 45 this involves thinking more about the information and the alternative tools and conceptualizing various bridges. It is also essential for intermediaries to facilitate a contextual ‘fit’ for the information and audience. It is also necessary to interconnect all of the information-related divides, the digital divide being just one manifestation of a much bigger system of have and have-nots. There are resources other than technology that are required to make ICT4D work that can be understood and evaluated using the concept of an information chain, the connection between the data and its effective action for development. The necessary resources besides the data fall into economic, social, and action categories. The disadvantaged remain disadvantaged because they are lacking in more than one of these resources. One particularly pressing resource that deserves attention is motivation. Many ICT projects have failed because they have been unsuccessful in instilling a sense of motivation in the participants, often because the ICT initiatives are supply driven rather than demand driven and the end-users do not see how ICTs will benefit them. A final principle is that ICT systems must become indigenised in order for them to be successful. At present, a large design-reality gap1 exists because solutions are primarily developed in the North and exported to the South where they simply don’t work. These design-reality gaps stem from both infrastructure discrepancies and cultural differences that guide the ways that people use technology. In concluding, Heeks argues that ICTs are not and will not be the ‘silver bullet’ for the problems of development and that unless ICTs are taken into account in a holistic, i -centred way, then they may not really offer very much at all. While many new opportunities exist, these are primarily to be found in the ‘extensive’ uses of ICTs, small entrepreneurs who grasp technologies on their own and without organized oversight. While the ‘intensive’ uses that are the stuff of ICT projects and programmes are far more prone to failure. Proper approaches to ICT implementation must be information-centred, integral to their environment, integrated with development objectives, intermediated, interconnected and indigenised. And above all, he notes that they must be intelligent and not based on visions of an overnight technological revolution for the world. Source: Richard Heeks, “i-Development not e-Development: Special Issue on ICTs and Development” in the Journal of International Development, Issue 14 (2002) 1-11. 1 For more on design-reality gaps see Heeks “Heeks, “Failure, Success and Improvisation of Information Systems Projects in Developing Countries” (P.38) 46 Knowledge Facts, Knowledge Fiction: The Role of ICTs in Knowledge Management for Development Maja van der Velden (Journal of International Development) Summary The author examines the differing approaches to knowledge management and issues surrounding how individuals and organizations generate, acquire, conserve and utilize knowledge. The consequences of the adoption of corporate Knowledge Management (KM) strategies in the development field are probed and alternative strategies are presented. ICTs are examined in the context of whether they are able to facilitate knowledge exchange in the same way they do for information. Velden is opposed to attempts to utilize ICTs to extract and codify knowledge in ways that are not context specific and that fail to recognize the all important identity of the knower – their gender, race, ethnicity and class. Key Points Central to this discussion is the division between information and knowledge. While information is independent, and can be easily transferred and detached from its source, knowledge requires a knower and is linked to the context in which it is both learned and utilized. Knowledge Management (KM) is an organizational tool that emerged in the mid-90s as a method for maximizing efficiency (via smaller personnel rosters) while maintaining innovation. It is about improving knowledge sharing within an organization in order to facilitate the organization’s ability to learn and adapt. There are two possible approaches to KM, the first is a knowledge-centred approach. This is the approach that attempts to treat knowledge as if it were information by attempting to collect and capture knowledge in formats that are readily stored and retrieved with ‘just-in-time’ efficiency. These approaches are technology heavy and rely on solutions that include email, groupware applications, corporate portals and large codified databases. While the theory may emphasize individuals, the practice is heavily rooted in ICTs and fails to capture the intuitive know-how and tacit knowledge of the practitioners. The knowledge becomes separated from context and its value is reduced. The second generation KM is knower-centred and understands knowledge as a human resource that can be only shared through practice and interaction. Studies have shown that much of this knowledge is exchanged through informal associations and requires relationships of trust in order to be shared. When levels of trust are high, supportive environments are created that manifest themselves as ‘communities of practice’. This type of KM focuses on situated knowledge and recognizes the identity of the knower, including their gender, race, or class (features which are typically not important in corporate practices). The author then shifts to the application of these approaches to the development field. In recent years, many international organizations have grasped on to KM, and unfortunately, they have tended towards the first approach rather than the second. Then World Bank is criticized for its approach to KM, and initiatives such as the Global Knowledge Partnership and Global Development Gateway are held up as examples of hierarchically ordered corporate-type portals. Velden also questions the Bank’s claims to act as a knowledge broker because it usually fails to find appropriate intermediaries who will make the knowledge accessible and useful for the people that the Bank is claiming to target. The Bank’s system of best practices and other universal strategies are also seen as suppressants to a more pluralist approach. The issue of ICTs in these applications is then raised, and the author first notes that they have primarily become a form of transportation for information rather than a component of the social and cultural practices usually associated with the acts of communication. The development sector was one of the first non-commercial fields to begin utilizing ICTs for networking and exchange, but after a decade the author finds that the utility of ICTs for real poverty reduction to be questionable. The adoption of corporate KM practices has only reinforced this. While many development practitioners have assumed that as long as corporate based approaches were 47 recognised and compensated for, the negative consequences could be mitigated. Velden, however, argues that it is the underlying and inextricable assumptions about knowledge as commodity of these approaches that make them inappropriate for development. She supports the creation of new knower-centred approaches for ICTs for development organisations that incorporate the social context in which the tools will be used, recognizes their inherent limits to prevent the narrowing of goals, and integrates the perceptions and priorities of the people who own and use the knowledge. These tools need to favour, “flexible networks over hierarchical portals; holistic knowledge systems over exclusive expert systems; and the diversity of knowledge over the monoculture of the best practice.” Developmental KM must be qualitatively different from the corporate version if it is to serve the purposes of effective poverty reduction. Knowledge should be based on broad generative learning frameworks that recognize the importance of variables such as gender, race and class. Knowledge strategies have to be considered in their context of use, and should be guided by principles of knowledge integration that bring together indigenous and expert positions. While KM and their usage of ICTs may have applications and potential benefits for the development field they will require a considerable conceptual overhaul that at its very heart requires that knowledge and the knower can never be separated. Source: Maja van der Velden, “Knowledge Facts, Knowledge Fiction: The Role of ICTs in Knowledge Management for Development” in the Journal of International Development, Issue 14 (2002) 25-37. 48 Failure, Success and Improvisation of Information Systems Projects in Developing Countries Richard Heeks Summary This article examines the high rate of failure of current ICT projects in developing countries and attempts to come to some conclusions about the source of these failures and propose some possible solutions. The central cause of these failures is explained using a model based on design-reality gaps between the information systems (of which ICTs are a component) and the users they are intended to serve. These gaps have three prototypical forms: country context gaps, ‘hard-soft’ gaps, and private-public gaps. The article examines each of these in detail and proposes some general solutions that are all rooted in local improvisation and adaptation of the imported ICTs. Key Points Heeks begins with a discussion about what constitutes failure in information systems (IS) projects in developing countries. There is the potential for projects that result in total failure, efforts that are either never implemented or which are abandoned shortly after start-up. There are also projects that are partial failures wherein major goals are not achieved, where significant negative consequences result, or which fall victim to sustainability failures that result in the project’s collapse after a year or two. Failures may also result when the stakeholders involved fail to agree what the primary goals of the project are, and hence, on what constitutes success. While little hard evidence exists on what proportion of developing country IS projects fail, it is noted that nearly a fifth to a quarter of all industrialized IS projects are likely to fall into the total failure category. It is not unrealistic to think that developing country project failures might exceed this rate of failure. There is a shortage of literature on the rates and reasons behind developing country IS project failures and the agencies involved in these fields are often reluctant to promote their failures (which have learning value) because of the potential negative impact it could have on their funding sources. Of the evaluation literature that does exists, Heeks notes that there are two types: a large camp focusing on ‘factoral analysis’ and a smaller group involved in theory building on the reasons behind success or failure. Heeks’ model is presented as a ‘third way’ and is based on a contingency model that sees no single framework for success or failure in organisational change but rather a combination of situation-specific factors tied by the theoretical idea of design-reality gaps. Central to this contingency model is the idea of adaptation and the importance of the states of match and mismatch amongst the factors involved. The most successful IS projects are those that are the closest match to the key technical, social, and organisational features of the working environment. The catch is, however, that IS projects are in part intended to alter that environment and bring about improvements in organizational performance. A trade-off exists between greater degrees of change and greater chances of failure. Heeks derives a model from these observations that looks at the difference between the current realities of a particular developing country context, and the conceptions, requirements and assumptions of an IS design as being the source of success or failure. These differences or “gaps” can exist is seven dimensions, embodied in the mnemonic ITPOSMO (Information, Technology, Processes, Objectives and values, Staffing and skills, Management systems, and Other resources). Gaps may exist in one or many of these dimensions, with large gaps in multiple dimensions increasing the likelihood of failure. There are several different sources for these differences, the first being country context gaps wherein the IS system designers and dominant stakeholders are either physically or psychologically remote from the context of usage. Such gaps often stem from the North to South transfer of information, differences in business economics, the politics of aid, and wide cultural variances. Technology transfers are value laden and carry economic and social baggage. Gaps also result from the differences in attitudes towards modernization and rationalism. These hard-soft gaps are the result of IS designs that assume a working context based on standardization, quantitative 49 measurement, formalized decision making structures, and staff adherence to organizational objectives. The final type of gap is a recent emergence and has to do with the trends towards new public management and increased reliance on private enterprise for innovation throughout the West. In developing countries, the public sector continues to play a much grater role and this difference in practice and philosophy results in private-public gaps. IS that are designed for the private sector are introduced into public sector organizations in the developing world and face resistance and incompatible working conditions. Public sector organisations are less competitive, tend to have older or more limited technological infrastructures, have much broader objectives and less labour flexibility than corporate firms and require radically different IS. Heeks’ solution to the propensity for failure in developing country IS is to close these various design-reality gaps through the application of local improvisation. There are four areas of focus that will facilitate the closing of these gaps: • Expose Organizational Realities – This requires open communication channels between various stakeholders, the legitimizing of reality and articulation of the difference between what participants are doing and what they should be doing, and the provision of tools that will assist in mapping theses organizational realities. • Improve Local IS Capacities – Localized improvisation requires local skills in both the technical side of ICT usage and the soft sides of project and resource management. Especially important is the development of hybrid (technical/managerial) personnel pools to improve work processes. • Educate the Carriers – Each and every donor, consultant, and participant must be made aware of the limitations of current DC IS practices and trained on strategies for reducing these design-reality gaps. They must also be trained so as to contribute to improved evaluation, integration and production processes. • Analyze the ‘How as well as the ‘What’ – The contingent perspective must be extended to include the processes of implementation and well as the content. Analytical project design and goal setting must be accompanied by an equally well though out implementation plan. Source: Richard Heeks, “Failure, Success and Improvisation of Information Systems Projects in Developing Countries” Working Paper No. 11 (IDPM, Manchester University) 2002. At http://idpm.man.ac.uk/wp/di/di_wp11.htm 50 SECTION 3 - THE MIDDLE ROAD Themes and Issues In Telecentre Sustainability: Development Informatics Working Paper No. 10 Raul Roman & Royal D. Colle, Cornell University Summary This short working paper examines some of the trends towards telecentre sustainability and improvements in access. The growth and diffusion of telecentres constitutes a “movement,” albeit one that has that has been without any sense of systematic research or planning. The authors wish to begin to build a framework for a more structured and strategic approach to the development of telecentres worldwide, and in this article focus on the issues of sustainability and training. Key Points The authors suggest that the telecentre movement is founded on the following assumptions: • Appropriate information can positively contribute to development. • ICTs are an important and potentially economical way to provide access to information. • Telecentres are a feasible link to ICTs and valuable information. In support of research towards developing better strategies for telecentre research and giving strength to the above assumptions, the authors have reviewed a host of telecentres (physically and through literature reviews) in developed and developing countries and present the following ten themes as “starting points for generating hypotheses regarding successful telecentres.” Successful telecentre projects recognize: 1. The power of national commitment by policy-makers combined with sufficient funding and organizational support. 2. The importance of partnerships to support national policy through governmental and non- governmental action at the regional and local levels. 3. The value of having “local champions” (innovators) who can mobilize others to support telecentre programmes. 4. The value of community volunteers in operating telecentres. 5. The advantages gained by telecentres that operate in regional clusters or networks and collectively develop and share resources. 6. The importance of raising awareness about the utility and value of ICTs for individuals, families and organizations within communities. 7. The role of research in creating viable telecentre enterprises. 8. Telecentres require business plans that fit the culture and needs of the community in order to achieve long-term sustainability. 9. The focus must be on information services rather than the technical aspects if an institution is to be integrated into the community and generate income. 10. Participation is an important goal that requires strategic research. In addition, the authors identified the following seven issues that are part of the access challenge regarding ICTs. Early on in the article they stressed the important difference between connectivity (primarily infrastructure related) and access (a complex mixture of economic, sociological, and psychological factors). The following are seen as potential barriers to the latter: • Literacy • Relevance of information • The culture of information • The cost of information • Technophobia • Complexity of ICT Protocols • Power (both electrical and authority) 51 The authors also place considerable focus on the necessity of training as a component of telecentre development. While they recognize this as one of the most important elements, very little systematic research has been conducted in this arena and much work needs to be done. Training, however, must go beyond the typical instruction in technical management and must include community outreach strategies (in many cases to address the barriers to access noted above), as well as analysis techniques, marketing, methods for training others, production of software and “value-added” practices. In concluding, the authors present a future research agenda that they believe is necessary to better structure the strategies for telecentre development and expansion. The agenda includes the following nine major issues for R &D: • Access and Connectivity • Relevant Content • Practical Community-level research methods • Building community and agency ICT awareness and training • Business planning • Collaboration among agencies and other ICT projects • Extending telecentre benefits to those beyond simple connectivity • Integration of media and telecentre services • Cost-effective technical infrastructure Source: Raul Roman & Royal D. Colle “Themes and Issues In Telecentre Sustainability” Development Informatics Working Paper No. 10, (Cornell University, Ithaca, NY, 2002) at http://idpm.man.ac.uk/wp/di/di_wp10.htm 52 See No Evil: How Internet Filters Affect the Search for Online Health Information (Executive Summary) - Henry J. Kaiser Family Foundation Caroline Richardson Ph.D., and Paul Resnick Ph.D. Summary The intent of the study was to evaluate how Internet filters employed in schools and libraries affect the ability of young individuals to locate non-pornographic health information on the web. It systematically measured the effectiveness of six different filtering products at blocking pornography and the rate at which health sites were also blocked. The impact of the filtering systems was delineated not by individual product, but by the blocking configurations used during set up. Configurations were grouped into three categories: Least Restrictive (pornography only); Intermediate (other ‘inappropriate’ topics such as nudity, drugs, hate material), as based on one state-wide school network, and; Most Restrictive (tobacco, swimsuits, dating), a setting based on any category that might plausibly be blocked by a school or library. A total of 3,053 health sites and 516 pornography sites were tested against the filtering products. These sites were identified using unfiltered searches through six major search engines. Key Points 1. On average the least restrictive settings blocked only 1.4% of health sites while intermediate settings blocked 5%. However, at the most restrictive settings, 24% of health sites were blocked. 2. Some health topics were much more likely to be blocked than others. At the least restrictive, setting filters blocked about 10% of sites tied to searches with the words “condoms,” “safe sex,” and “gay.” At the intermediate and most restrictive, substantial amounts of health oriented sites were blocked (25%+). 3. The more restrictive settings did not substantially increase the proportion of pornographic sites blocked. 4. The more restrictive settings did substantially increase the proportion of non- pornographic sites blocked, especially on topics concerned with sexual health. 5. Accidental exposure to pornography through the course of health information searches does not appear to be a substantial problem. 6. Variances existed in the different filtering products and the proportion of health sites blocked across all setting levels. 7. Many youth oriented health websites are being blocked by one or more of theses filtering systems. Websites oriented towards sexual health were even more likely to be blocked. 33% of safe sex sites were blocked by at least one of the filters at the least restrictive setting while 91% were blocked by at least one of the filters at the most restrictive setting. The report concludes that the adverse impact on the ability of young people to access health information is primarily influenced by how the filters are configured by the schools or libraries installing them. If filters are configured to more restrictive levels, there is a major impact on the access to health information, especially that pertaining to sexual health. Yet, the more restrictive blocking configurations are only marginally more effective at blocking pornography websites. Thus the trade-off for a minor increase in the prevention of pornography is high in terms of the loss of health information. The report suggests that organizations attempting to provide health information need to be aware of these impacts and that those groups attempting to disseminate sexual health information could have their efforts seriously impeded by the overzealous use of filters. The report suggest that the application of filters at more restrictive settings should result from a “conscious and informed policy decision” with an awareness of the effects that it will have on the search for health information rather than a summary decision to set the filters at the highest levels. Source: Richardson, Caroline & Resnick, Paul. “See No Evil: How Internet Filters Affect the Search for Online Health Information”, Pub. # 3294 (Henry J. Kaiser Family Foundation, Washington, D.C.) December 2002. 53 Shouting To Be Heard: Public Service Advertising in a New Media Age (Executive Summary) - Henry J. Kaiser Family Foundation Victoria Rideout and Tina Hoff. Summary This report was the result of a collaboration of data from several different Kaiser foundation studies. The purpose is to examine the changing conditions regarding Public Service Advertisements (PSAs) and the relationship with the major broadcast and cable networks. Under traditional broadcast regulations, networks were required to serve the public interest by allotting some time for PSAs. The report seeks to document the nature of PSAs in today’s television market and to provide insight for nonprofit organizations and policymakers as to the future of PSAs. The report contains two studies: 1. The Report on Television Content analyzed a composite week’s worth of television content derived from samples conducted between February and July 2000. 10 different cable and broadcast channels were reviewed. A total of 1,680 hours of television programming was assessed, which included 906 donated PSAs and 520 paid PSAs. 2. The National Survey of Public Service Directors sought to understand the factors that influence network decision-making towards PSAs. A total of 513 interviews were conducted with public affairs directors and other officials at affiliates of six major networks in the top 150 Designated market Areas (DMAs) Key Points (Findings by Study) 1. Overall, broadcast and cable networks donate an average of 15 seconds an hour to free PSAs, a figure that amounts to 0.4% of all airtime, compared to 20% for paid commercial advertising. 74% of the time was allotted to programming. a. The broadcast networks donated an average of 17 seconds and hour for a total of 48 minutes worth of PSAs a week per network. On average, cable networks donated less time, an average of 7 seconds an hour, with some exceptions: MTV at 16 sec. per/hr. and Univision at 48 sec. per/hr. b. On average the major broadcast networks donated an average of five seconds an hour (9%) to PSAs during the primetime slots, while 43% of donated PSAs were aired from midnight to 6AM. c. 37 % of donated PSAs addressed some type of children’s issue, whether it be health, parenting, or education related. 27% of donated PSA’s concerned a health related topic, including 8% for drug and alcohol issues. d. 36% of PSAs aired on television were paid for, with 27% bought at reduced rates. Paid PSAs received considerably better time slots, with only 18% being run between midnight and 6AM. 2. In the interviews with public service directors the following influences were identified as “major” contributors to decisions to provide donated airtime: sponsorship by local organizations (75%), sponsorship by the parent network (36%), co-branding/cross- promotion options (30%), and endorsement by the National Association of Broadcasters (28%) or Ad Council (23%). The fact that a sponsor also bought ad time was a notable contribution as well (23%). While the article did not present any definitive conclusions on the state of public service advertising, the data suggest that networks are not engaged in a widespread donation of airtime for PSAs. However, when organizations pay for a part of their ad time, they can expect to receive some additional airtime in matching and considerably better time allotments. The suggestions is that organizations should seek “partnerships” with networks and their affiliates as opposed to being reliant on unilateral charity and must be prepared to make room in their budgets for advertising expenses in the hopes of better communicating their message to the public. Source: Victoria Rideout and Tina Hoff. “Shouting To Be Heard: Public Service Advertising in a New Media Age” (Executive Summary) Pub. # 3152 (Henry J. Kaiser Family Foundation, Washington, D.C.) February 2002. 54 Participatory Rural Communication Appraisal (PRCA) FAO, Sustainable Development Department (SD) Phillipe Van der Stichele Summary This article provides details on a communications research approach developed at the SADC Regional Centre of Communication for Development based in Harare, Zimbabwe, during the mid 1990’s. This approach, called Participatory Rural Community Appraisal (PRCA) is a research methodology designed to involve rural people in, “the identification of the essential elements for the design of effective communication strategies and programmes for development.” This approach is intended to improve dialogue between rural peoples and local development officials through the use of various visualisation techniques, interviews, and participatory group work. This article argues for the expanded use of PRCA and takes the position that it is a superior model for determining the needs of rural peoples and the ideal solutions to the challenges that they face. Key Points The PRCA model was developed to guarantee that development communication programmes are in touch with the realities of the rural community being targeted. The authors suggest that a “conspiracy of courtesy” exists wherein local peoples often conceal their true feelings and information from development workers and other outsiders. PRCA was designed to overcome this by fully involving the community in the information generating process and drawing the sum of their knowledge and desires into the light. PRCA is a synthesis of other participatory research methods (RRA, PRA, PLA) 1 as well as more traditional communication approaches. The following features set PRCA apart from other approaches. • Holistic – Researches both community needs, opportunities, and problems as well as communication issues, networks, and systems. This inclusive nature differentiates it from other participatory approaches that do not directly address communication issues. • Participatory – The role of the researcher is to facilitate the investigation and analysis of the community’s problems by the community itself, rather than to extract information and conduct analysis elsewhere as typified by traditional communication approaches. • Empowering – PRCA provides training for community members and enables them to conduct their own assessments in the future. • Results in joint planning of both development actions and communication programmes. • Creates interactive groups on the basis of shared common problems and bridges communities differentiated by local values. • Appraisal results are presented by the community rather than to the community and they retain ownership of the results. • Emphasis on the use of visual methods for generating and analysing data, a technique designed to overcome wide variances in literacy throughout the community. • Seeks to integrate the revealed local knowledge with that possessed by development workers to create more effective and appropriate solutions. PRCA is a flexible tool that can be used to define the needs and priorities necessary to commence a development project and to correct those that have gone astray. It has been effectively implemented in a host of rural development projects throughout Africa through Action Programme workshops that aim to train middle-management staff in its methods. A training package on these methods has been published and is in circulation. Information on this approach is available at the SADC Regional Centre of Communication for Development at: http://www.zimbabwe.net/sadc-fanr/sccd/sccdtxt.htm Source: SDdimensions, July 1998, http://www.fao.org/sd.cddirect/cdan0015.htm. 1 RRA = Rapid Rural Appraisal; PRA = Participatory Rural Appraisal; PLA = Participatory Learning and Action 55 Discovering the “Magic Box”: Local Appropriation of Information and Communication Technologies (ICTs) Sabine Isabel Michiels and L. Van Crowder Summary The article presents the results of a short-term study on the local appropriation of ICTs in developing countries. The paper aims to provide information and improve dialogue on ICTs; to point to the need for a greater focus on grassroots initiatives; to encourage greater monitoring and evaluation; and to present a selection of cases studies and to draw from those cases a set of “good practice” criteria. Key Points Challenges – The digital divide is one of the most pressing issues to overcome as a result of the emergence of ICT growth. There exists the potential for further marginalization of countries, regions, and individuals who are unable to fully access the power and opportunities afforded by ICTs. This inequality is caused by a mixture of inadequate national communication policies, poor infrastructure, high costs, and lack of a sufficiently skilled labour force that are able to utilize the ICTs. Potential Benefits – Despite these challenges, ICT applications offer many potential advantages including improved two-way and horizontal communication between communities, intermediaries and NGO’s; increased bottom-up articulation of development needs; the development and strengthening of interactive and collaborative networks for information flows; better support policy and advocacy; consensus building; and enhanced partnerships with the media. Local Appropriation - Is the process of integrating and taking ownership of ICTs on the part of rural communities and individuals. “Appropriation is about power over the tools and content of communication.” Local appropriation is important because it: • Contributes to a reduction of the digital divide. • Gives a voice to the voiceless. • Fosters and facilitates community decision making. • Contributes to increased community ownership of ICTs for development. • Ensures that ICTs serve the communities. Good Practice Criteria – The following features were identified as necessary components of programmes that contribute to local appropriation of ICTs. Projects need to be: • community-driven • innovative • user-friendly • sustainable • transferable • gender/youth sensitive • have a training component 56 Several case studies followed, each examining ways in which the specific program was fostering the appropriation of ICTs. A review of the case studies produced the following main findings: • Limited number of community-driven, locally appropriated ICT initiatives or projects. • Limited visibility and exposure for grassroots projects in the international community. • Most of the documentation on community ICTs is new and there is a shortage of evaluations. • Most ICTs initiatives are implemented without prior participatory needs assessments. • External organizations tend to set the priorities for ICT projects. • ICT projects tend to have an economic, market-based focus. • Target groups/beneficiaries are hard to identify. • The creation of content and selection of ICT tools occurs without local participation. • Lack of awareness, ICT skills and literacy hamper the effectiveness of ICT projects and prevent local appropriation. Source: SDdimensions, June 2001, http://www.fao.org/sd/2001/KN0602a_en.htm 57 HIV/AIDS and Information and Communication Technologies Libbie Driscoll Summary This report was produced by for the International Development Research Centre and was intended as a review of the role that ICTs are playing in the efforts to challenge the HIV/AIDS epidemic in developing countries. The report provides a brief overview of HIV/AIDS and its impact, different examples of the ways that ICTs are being utilized to combat AIDS, and some feedback from people working in developing countries. The report begins by recognizing that ICTs have the potential to be effective tools because of their ability to provide information and knowledge to; “those working on the problem, to those who are suffering from the disease and its effects, and to those who need to take preventative actions.” This phrase is repeated throughout and the author stresses that true ICT utility must recognize all stakeholders involved. Key Points Central to the report was the opening disclaimer that ICT programme development could be seen as an unnecessary luxury when compared with the immediate prevention, treatment, and care requirements of the AIDS epidemic. This disclaimer applies especially to issues of funding, and while the author concludes with a statement of support for ICT programme development, this is to occur only after sufficient funding exists for condom distribution, anti-viral drugs, palliative care and other on-the-ground necessities. ICT initiatives should complement other primary programs – as stand-alone projects they will not contribute to the struggle against AIDS. Nor should ICT projects deflect money away from community level work because ICT projects all to often benefit participants form the North than those from the developing world. While cognizant of the above disclaimer, the report goes on to discuss the benefits resulting from ICT utilization. Knowledge generation is increasingly understood as a networked activity and ICTs facilitate linkages between people. These linkages provide opportunities for programme review and the sharing of best practices and lessons learned; connecting researchers and strategists with the needs and priorities of the field; connecting communities with each other; and allowing individuals to access the vast holdings of human knowledge on nearly any subject – an essential component of prevention strategies. It was also recognized that ICTs play a role in changing perceptions of the disease and contributing to advocacy and efforts to mobilize both regional and global responses. These linkages were described in theory, in feedback garnered from interview and survey data, and through the use of several case studies of already existing projects and the ways in which they are using ICTs. The specific applications of ICTs can be broken into several different groups: Web-based information; AIDS news and media; distribution of CD based media; and discussion groups – a topic that was reviewed in extensive detail with the conclusion that while eforums were useful, they were hampered by inequality of access and concerns about the quality and consistency of information. The report also recognized some of the areas which needed to accompany ICT development and which contribute to some of the scepticism about ICT projects that can be found amongst community level workers. The need for infrastructure, central access, and training within communities was stressed and alternatives to web based information (e.g. CD’s) was noted. After a review of six projects that were utilizing different types of ICTs to create different linkages the author concluded that ICTs do have an important role to play in the AIDS epidemic and that there are many as of yet untapped applications for them – a list of which is provided. However, the author continues to stress that ICT programs 1) must act as complementary projects to primary programs, and 2) must not divert funds away from the basic prevention, treatment, and care areas of the disease. Source: Driscoll, Libbie. “HIV/AIDS and Information and Communication Technologies” Final Draft Report (IRDC) November 2001. 58 Health, HIV/AIDS and ICT: A Needs Assessment DS Bateson Consulting Inc. Summary This information for this report was derived from a survey that was intended to “get a sense of what a health focused audience felt were the issues in relation to the promotion of ICT.” The initiative for this survey stemmed from Action Point 7 of the G8’s Digital Opportunity Task Force (DOT Force). Surveys were distributed by email and resulted in 37 (of 120) responses, the majority of which came from African organizations. The most important finding was that respondents believed in the necessity of focusing on the information needs of, and the communication channels amongst individuals before considering the the supporting technology. Human processes were stressed as more important, and ICTs initiatives should support those processes. Key Points (Derived from survey respondents) Concerns Associated with ICT • The ethical issues of ICT expenditures as opposed to direct medical interventions. • That an “industry driven technology approach” rather than a real needs approach will drive ICT initiatives. • That ICT applications must remain practical, culturally appropriate and recognize and reflect local capacity. • That the cost of acquisition, training and maintenance cannot be borne by poor countries. Health, HIV/AIDS and ICT: General Conclusions • Information and communication channels must be the focal point, not the technology itself. • Local context and language are essential to any communication initiatives • Local ownership and capacity are key to the acceptance and sustainability of ICT projects. • All ICT projects should contribute to the strengthening of the overall health system. • Collaboration between all stakeholders is essential if ICT projects are to create “synergies” between other projects, markets mechanisms, and the community. • Research is still required to identify the information needs of specific target groups. HIV/AIDS and ICT: Specific Conclusions • Creation and distribution of preventative information is the most important component of any HIV/AIDS strategy, and community level application of ICTs to support these strategies is proving effective. However, this approach is reliant on more common broadcast media (radio) and readily accessible technologies (e.g. CD-ROMs). • The highest benefits of ICTs are realized by improving access to information and education and communication tools for rural and community health care workers. • All types of ICTs can contribute to the enhancement of evidence-based activities such as epidemiology and surveillance, which are critical components of AIDS management strategies. Elements in Promoting ICTs • Human information needs must drive the solutions, ICTs have a role only in supporting and delivering on these needs. • The value of ICTs in supporting an initiative’s objectives must be demonstrable. • Building strong collaboration and dialogue between stakeholders is a necessity. 59 • Understanding how ICTs affect work processes is essential to the impact management. The report concludes that ICTs will eventually have a role to play in the development of better health care services and in addressing target diseases. In support of that development it presents the following recommendations. • HIV/AIDS initiatives to promote and capitalize on ICTs should focus on: o The dissemination of preventative public health information using common ICT. o Application of ICT to improve health care worker access to information. o Enhancing population health and research capacity. • Projects should build onto existing systems and infrastructure. • Women should be more involved in the full project life cycle. • Projects should have strong risk-management strategies and hand-over planning. • More research should be done to precisely define the information needs of target groups. Source: DS Bateson Consulting “Health, HIV/AIDS and Information and Communication Technologies: A Needs Assessment” Summary of Report (May, 2002). 60 Can Information and Communications Technology Applications Contribute to Poverty Reduction? Lessons from Rural India Simone Cecchini, Poverty Reduction Group, Worldbank Summary This working paper argues that ICTs can have a positive impact on reducing poverty by improving poor people’s access to education, health, government and financial services. However, this potential is not guaranteed and requires concerted policy decisions and actions that will enable ICTs to contribute to the three priority areas for poverty reduction: opportunity, which makes markets work for the poor and enables them accumulate assets; empowerment, which makes state institutions work better for the poor and challenges social barriers, and; security, which helps people manage risk. These priority areas are best dealt with through a combination of locally based market initiatives that are supported by the state and outside agencies. Key Points The potential of ICTs will not be realized automatically, primarily because of the barriers of weak infrastructure, high access costs, and illiteracy. ICT diffusion continues to favour the well off, and specific pro-poor ICT policies are required to bridge the growing digital divide. Specifically, (1) the relative price of capital for communications needs to be reduced, and (2) research and development in ICT has to favour poor-friendly hardware and software. Evidence from India shows that these policies will help to address the needs of the poor whose opportunity, empowerment and security are often compromised as a result of having limited access to vital information. The article provides several case studies, grouped under these heading which demonstrate the problems and solutions: • Opportunity – Problem: Insufficient measurement capabilities lead to milk farmers being under-paid for their product. Solution: Computerized milk collection centres that ensure standard measures and speed remuneration. • Empowerment – Problem: Long distances of travel and corruption are barriers to appropriate citizen interactions with the state. Solution: Government information and service kiosks reduce travel time and end the monopoly on information of public servants, improving the quality of citizenship. • Security – Problem: Existing microfinance (especially peer-lending) institutions face high costs of service delivery to the poor because of the need for constant cash counting and inopportune meeting times. Solution: Smart Cards (embedded microchips) improve transaction efficiency, reduce errors and fraud and contribute to improved financial service access. However, in order for these policies to achieve fruition, gains must be made in improving low-cost connectivity. Blanket access is clearly not an option, therefore, policy makers should focus on universal access strategies – the presence of a public telecom booth in every village. One of the observations stemming from the Indian experience is that universal access is more likely to occur given an environment of competition and free-market opportunity in the telecom sector. Deregulation in India has been shown to significantly reduce communication costs and improve teledensity. Both small entrepreneurs and large telecoms require enabling environments. This is not to say that there is no role for the state, it should operate to fill in the gaps left by the market by enforcing geographic coverage requirements and contributions to universal access funds. In concluding, the author notes that project design must also meet a few more important criteria. Grassroots intermediaries that demonstrate a diversity of gender and caste (class) are important to ensure participation, as is local ownership and the development of locally contextualized information and ICT applications that address the needs of the community. Training is also an important component and is necessary for awareness raising, ICT adoption, and alleviating marginalization. Finally, all projects must meet basic standards of sustainability and must be equipped with appropriate monitoring and evaluation regimes. Source: Cecchini, Simone. “Can Information and Communications Technology Applications Contribute to Poverty Reduction? Lessons from Rural India” (Poverty Reduction Group). 61 The African Internet: Impact, Winners and Losers. Wainaina Mungai Summary This paper is an attempt to analyze the African Internet experience and its impact on general development initiatives. The author introduces some original concepts derived from a review of Internet economics in an attempt to measure the effects that the Internet and ICTs are having on Africa. A Conceptual Framework is presented to facilitate this understanding. This is followed by a review of the status of the African Internet (in terms of connectivity and content) and a discussion of its “elusive” potential to contribute to human development. The paper then presents a selection of anecdotal evidence that examines both the winners and losers in reflection of the goals and terms of reference set out in the Digital Opportunity Initiative (DOI) based on the UN Millennium Declaration. Key Points The author argues that the development of effective Internet policy is dependent on a broad and in-depth analysis that is not technologically deterministic or influenced by prior reasoning. Impact analysis must use both quantitative and qualitative methods, and R & D should produce applications that are unique to Africans. The author observes that new technologies are almost always destructive as well as creative, a point that is reinforced in the section on winners and losers. The Conceptual Framework presented is a synthesis of other models (Internet Counts, Technology Transfer) and is a response to the question: “What will the Internet mean for development?” This model is admittedly reductionist and attempts to assess the overall impact of ICTs on a system by aggregating its impact on subsystems, such as the individual, the family, and economic sectors of a country. There are three levels in the quantitative study of Internet impact: 1) Penetration levels; 2) levels of Utilisation; 3) and the Impact on subsystems. Analysis takes into account the policy and socio-economic environment of a country and assumes that the overall system (e.g. national ICT policies) affect the various subsystems. There are several principles governing the way ICTs affect a socio-economic system, which are driven by technological innovation, the economics of networks, and the effects of new applications. Because of the diverse ways in which these forces and ICTs affect the different subsystems, the author argues that small, sectoral studies are required before multi-dimensional strategies can be properly developed. The author also notes that establishing causal links is difficult because of the way ICT effects mix with other phenomenon. The theoretical section is followed by a brief review of the status of the African Internet and presents various figures that measure both Penetration and Utilization. The numbers clearly demonstrate that African lags far behind the world on Internet usage, though there has been considerable growth in the last five years. On the issue of ICT impact on human development efforts, the author urges caution and will only conclude that ICTs may be considered as potential enablers and catalysts for the strengthening of existing initiatives. The author notes that while there are many efficiency gains to be had they can be dependant of issues like user attitudes and the organization and management of institutions. The author moves to a review of the Winners and Losers, the positive and negative impacts, of the African Internet. The categories are broken down along the lines of the development imperatives identified at the UN Millennium Summit. The winners include: health sectors, which have benefited from Internet-based interventions and knowledge; economic opportunity, which has increased through bridging the opportunity gaps of technical marginalization; empowerment and participation benefits from better government service delivery; education, which has moved to improve ICT capacity; and the environment, which has seen the globalization of issues and an improved potential for mobilization. However, as with all problems, there are losing issues brought about by the Internet as well. These include both physical and virtual braindrain (virtual being a situation wherein resident nationals are occupied with projects based in other countries); 62 issues of opportunity costs relative to other initiatives and development efforts; a history of poor implementation; the increased premium on information secrecy and bureaucratic administration processes that are explained by organization theories; women – who continue to be shut out from many of the benefits; illiteracy – which has not been markedly improved as a result of Internet practices, and; the rural-urban divide that is actually reinforced by unequal penetration. The author concludes by suggesting that if the Internet is properly employed as an enabling device it can contribute to the development goals of Africa. Three of the most pressing issues for policy makers are how to balance capacity and economic opportunity so as to stem the brain drain, how to strike a balance between technology and the need for preservation of cultural heritage, and the creation of customized strategies that address the differing socio-economic sectors whilst maintaining reference to national strategies. Source: Wainaina Mungai, ”The African Internet: Impact, Winners and Losers” a paper received from Dr. Chivyanga, City University, UK. 63 Reflect and ICTs (Project Summary and Concept Paper) Hannah Beardon, ActionAid Summary Reflect is an original approach to participatory adult learning and social change that was developed and pioneered by the UK-based NGO ActionAid in developing countries in 1993-95. In the programme, groups develop their own learning materials by constructing graphics such as maps, or diagrams, or using forms of drama, story-telling and songs which can capture social, economic, cultural and political issues from their own environment. The goal is to assist in the development of literacy and other communication skills while engaging the participants in thought and dialogue about the issues most pressing to their socio-economic development. Reflect has had considerable success and is widely recognized in the development community, over 350 organizations in 60 countries are utilizing Reflect strategies. Recently, the progenitors of Reflect have turned their attention to how these strategies can be combined with emergent ICTs to improve upon literacy and communication learning and partially bridge the digital divide. Reflect offers a potential basis for introducing ICTs in an equitable way, as part of a wider process of self- managed and directed change for development. Several pilot projects have been started within existing Reflect groups to see how ICTs can be integrated. 1 Key Points The central assumptions underlying the project include (1) the belief that how the technology is chosen, not the choice itself, is a primary determinant in impact (2) that existing Reflect frameworks are ideal bridges to provide the poor with needs-based ICT access, and (3) that communities already have the knowledge they need for their own development but require more information, especially in situations that expand beyond the local level. The organizers objectives are to strengthen poor peoples ability to communicate through a selection of ICTs that they have chosen themselves and in doing so develop a “pro-poor” model for ICTs in development. The following “strategic issues” were identified in the concept paper that was the basis for this project: • There is a linkage between information and power and ICTs are usually appropriated by the powerful. The poor, who have the most to gain from the information available through ICTs, are often unaware of these potential gains. Reflect strategies provide an intermediary that can introduce the required concepts and technical skills without dominating the learning process and reinforcing the existing power imbalance. • The projects should be housed in a “Reflect Communications Centre” which provides participants with access to the needed audio/visual and computer equipment necessary. Initially, the centres would focus on providing for the most marginalized people in the community only – the target groups of Reflect processes. • The Reflect circles will identify the information needed first and then facilitators will “access, edit and process it using the technology.” Accountability structures must be in place, however, that prevent the facilitator from exerting control over the editing process, because of its role in communications power. • The pilot project must strive to continually decentralize the control of the processes down to the lowest levels through a series of staged transitions. The process also requires flexible accountability targets that allow communities to determine the utility of the ICTs. • The key learning objectives will not be the use of the technologies but rather improved communication skills – the ICTs will act as tools towards this end. Communications must also be relevant to the needs and priorities of the community. • The groups must be in control of defining their own virtual or knowledge communities. The authors note that there is very little “best practices” established for integrating ICTs into development and they envision this project as being a contributor to this field of inquiry. They believe that Reflect can be utilized to overcome the power inequalities that are presented by the introduction of ICTs and to enhance the communications capacity of the poor. Sources: Reflect, [Projects] http://220.127.116.11/Initiatives/ict/project/project.htm http://18.104.22.168/Initiatives/ict/concepts/concept.htm [Concept] or see www.reflect-action.org 64 Generation Rx.com: How Young People Use the Internet for Health Information Henry J. Kaiser Family Foundation Summary The authors have noted that while extensive studies have been conducted on how adults utilize the Internet to access consumer health information, very little research has been done on the ways in which youth use the Internet for health enquiries. Little was known about how often youth were utilizing the Internet for health searches, about which topics they were making enquiries, about the influences on their behaviour and about their impressions concerning the veracity and reliability of the information that they were receiving. This report resulted from a Kaiser Family random dial survey conducted during September-October 2001. Its findings revealed that youth used the Internet extensively for searches regarding their own health, indeed, even more frequently than older generations. Often this was because of the anonymity afforded to them by Internet searches, even though they would still prefer to access information from more traditional (and more reliable) sources such as doctors and educational health programmes. The study also found that Internet filters designed to block pornography had an impact on their searches for health information. Key Points The study found that among all 15-24 year olds, an overwhelming majority (90%) have been online. Of that amount, some 68% have gotten health information online while a quarter (24%) have gotten “a lot” of health information online. The study found that 75% of online youth have used the internet at least once to find health information, this is more than the proportion who have ever gone online to check sports scores (46%), buy something (50%), or participate in a chat room (67%), and about the same proportion that have used the internet at least once to play games (72%), or download music (75%). Of the 75% that are “online health seekers” 39% look up health information at least once a month or more. 39 % also find that the health information that they find online is “very useful”, while only 1% found it to be “not at all useful’. The topics that youth are investigating in their online searches was of particular interest is this study and the authors note that the subject matter differs from adult health seekers. Not surprisingly, many young people (84%) consider sexual health issues [including AIDS, STDs and pregnancy] to be “very important” for their age group, followed in priority by drug and alcohol abuse and sexual assault issues. These priorities are reflected in the health issues young people are searching for online, with 44% saying that they have looked up information on pregnancy, birth control, HIV/AIDS and other STDs. Racial and gender influences play a significant role in the nature of inquiries, those most likely to enquire about AIDS include; African American youth (45% v. 26% of whites) and females (34% v.25% of males). A powerful statistic drawn from this survey was that among online health seekers, 39% say that they have changed their behaviour because of health information that they got online. African Americans were even more likely to report changing their behaviour (52%) than others. 69% also said that they have talked with friends about health information that they have seen online. This clearly indicates that the Internet has the potential to be a powerful tool for the dissemination of health information. This is despite the relative scepticism that young people have in the information they are receiving. Only 17% say that they would trust health information that they got from the web “a lot” although an additional 40% said they would trust this information “somewhat.” The most important factor for young people when they are searching for health information is confidentiality, with 82% saying that this is very important. Other important considerations include being able to ask specific questions, being able to find the information easily and being able to hear different sides of an issue. The other important focus of this study was the relationship between health searches and inadvertent discovery of pornography and the impact of filters on youths’ ability to find the information that they are looking for. Health seekers were found to be somewhat more likely to stumble across pornography than other online youth owing to the high prevalence of searches 65 relating to sexual health. While a majority were (55%) were “not too” or “not at all” upset by stumbling across this material, an even larger majority (65%) nevertheless felt that being exposed to online pornography could have serious impact on those under 18. Among 15-17 year olds who access the Internet at school, 76% said that filtering or blocking technology was in place there. It must be noted that in 2000, the US Congress passed legislation requiring all schools and libraries that receive federal funding to install some type of filtering or blocking technology. 67% of all youth surveyed said that they favoured this law. The impact however, is that among 15-17 year olds who have sought health information online, 46% say that they have experienced being blocked from non-pornographic sites during their searches.1 In concluding, the authors of this study suggest that the time has come to focus more attention and study on the role of the Internet as a health educator. Young peoples’ interaction with these sources of information are qualitatively different from those of adults, and attention needs to be given to the topics being sought, to the quality of the information being found, and to the role of search engines in shaping what information is found. Source: “Generation Rx.com: How Young People Use the Internet for Health Information”, Pub. # 3202 (Henry J. Kaiser Family Foundation, Washington, D.C.) December 2001. 1 For a more in-depth review of the impact of filtering technology on online health searches see: Richardson, Caroline & Resnick, Paul. “See No Evil: How Internet Filters Affect the Search for Online Health Information”, Pub. # 3294 (Henry J. Kaiser Family Foundation, Washington, D.C.) December 2002. 66 Radio and the Internet: Mixing Media to Bridge the Divide Bruce Girard Summary This is the introductory chapter from a new book called the The One to Watch: Radio, ICTs and Interactivity that examines the potential for radio to become the medium that links the power of ICTs and the Internet to the real world, daily demands of development. In this chapter Girard argues that it is the combination of radio and the new ICTs that will truly offer a new range of possibilities for development communication projects. After examining some features of the Internet for development, the history of radio and its contemporary application, Girard examines how communication projects can be placed into three broad categories that play a vital role in development. These categories are: • Projects which create/support networks of broadcasters. • Projects in which the radio station serves as a gateway for access to the knowledge and information potential of the Internet. • Projects that use the radio/Internet combination to connect migrant communities and realize the communication potential of the Internet. Key Points When broaching the issue of the digital divide, Girard points out that much of the debate has focused on “uncovering new areas of global inequality and imagining new opportunities for development.” Often overlooked is the seemingly obvious fact that the primary cause of the digital divide is the same cause behind the many other inadequacies plaguing developing countries. Poor countries do not have access to the Internet (and water, sanitation, education, etc.) because they are poor. Raw investment in any of these areas will improve lives. However, that investment has to be accompanied by local participation if projects designed to improve access to ICTs are not to become another of the many “white elephants” that litter the development arena. Despite some efforts, trends show a growing inequality between the info-rich and the info-poor. But, the expectation can also not be to provide the developing world with the same level or structure of service seen in the developed world. New models are needed, both to address issues of connectivity and to address the much more challenging issues of illiteracy, language, and content that impede Internet take-up. Girard notes that “while technology is important, escaping from poverty requires knowledge, and knowledge does not come from technology but from experience and relevant and meaningful content, digital or not.” Successful uses of the Internet for development will build on existing systems and utilize community intermediaries that will allow the average person to contextually appropriate knowledge. Radio has such an important role to play in bridging the gap primarily because the direct access common to the West is simply not feasible. Radio is characterized by low production and distribution costs, and is able to interpret the world for, and respond to local communities. Most importantly, radio is widely available, with far more receivers per person than telephone lines or any other ICT device. In many rural areas, radio is the only form of communication, and has often been observed to fulfill the personal messaging role oft expected of the telephone. The four most important characteristics behind radio’s success as a development medium are: (1) its pervasiveness, (2) its local nature, (3) it is an oral medium, and (4) it has the ability to involve communities and individuals in an “interactive social communication process.” This last feature is different from the interactivity of the Internet that is primarily oriented towards links exogenous to the community. What is beginning to emerge is a series of new models that attempt to link these separate qualities so that the community can be in touch with both itself and with the vast knowledge of the outside world. As noted above, there are three main streams that Internet/radio projects have taken, in the article, each category description is followed by a series of examples. 67 Networks – These numerous radio stations can become linked to one another using the Internet and can gain economic advantages offered by increased economies of scale – production costs can be shared and materials can be exchanged. These linkages also provide a more complete service for listeners, combining opportunities for access to local, regional, and national information through one access point. Gateways – These projects are the reverse of placing streaming radio broadcasts on the net, they use the radio to extend the reach of the Internet. The radio station acts as an intermediary for the community, accessing the information they need and then a making it widely available through broadcast. This form of “radio browsing” makes the station part “search engine, part librarian, part journalist and part translator.” Many of the barriers to access that prevent the effective use of the Internet (infrastructure, language, etc.) still exist for the radio station, but they are much easier for an organization to overcome than an individual. Communication with Migrants – While gateways are focused on expanding the reach of the Internet into traditional communities, there is also a demand to connect the new communities emerging as a result of a more globalized workforce. There are an estimated 75 million short and medium term migrant workers in the international labour pool and they are a vital source of foreign funds for developing countries. Allowing these workers to stay in touch with their homes is important, and the combination of radio and the Internet can facilitate the maintenance of these links, with the migrant workers accessing the station through the Internet and the station communicating their messages with the home neighbourhood in a two-way feed. In concluding, the author suggests that the new challenges involve the development of strategies to make information both available and meaningful. Technology is not necessarily the most significant barrier, ingenuity and an appreciation of local capabilities can overcome many obstacles, and Internet/radio projects should not attempt to fit into a single mould but rather to remain flexible and adaptive to the needs of the areas in which they serve. Source: Bruce Girard. “Radio and the Internet: Mixing Media to Bridge the Divide” in The One to Watch: Radio, ICTs and Interactivity, Rome, FAO/FES (May 2003). For more information see: firstname.lastname@example.org 68 Missing the Connection? Using ICTs in Education Yusuf Sayed Summary This is the first in a series of short articles on the role of ICTs in education and development. It provides a brief overview of the many issues and pros and cons of ICT introduction and utilization in the field of education. It proposes a series of questions about whether ICTs are truly integrated in education or simply just added extras, about whether or not they constitute a wise investment given shrinking budgets, about the ability of teachers to fully realize the potential of ICTs in the classroom and about whether or not ICT introduction is reducing gaps or creating new ones. Key Points There are basically two opposing schools of thought on the role of ICTs in education. One suggests that ICTs have simply contributed to a widening of the gap between the tech-rich north and the tech-poor south and that they are contributing to an emerging gap within states between the elites with access to IT and those without. Furthermore, ICT advances are typically driven by the needs of wealthy IT countries. The others school argues that ICTs have the potential to allow developing countries to catch-up. The ‘leapfrogging’ thesis has countries bypassing the initial stages of development (e.g. heavy inudustrialization) and avoiding the expensive problems confronting the early adopters of the knowledge economy. ICTs will revolutionize the way people live. While these two sides reflect the optimistic and pessimistic views, the debate has been largely rhetorical and lacks detailed examination of the ways that ICTs can have concrete impacts in areas like education for development. Arguments that ICTs can provide high quality learning resources and improve efficiency are largely taken for granted and without critical evaluation. Not as much consideration is given to how their introduction will affect teachers and their methods.1 The fact that computers are usually the only ICTs considered also hampers the depth of the debate. Crucial to the effective utilization of ICTs is a framework for long-term, sustainable planning and investment strategies that will allow organizations that go down this route to keep pace and not find themselves in positions of obsolescence a year or two later. Strategies must be flexible and must allow countries and individual communities the opportunity to experiment with combinations of ICTs to develop their own best practices. Technology is a means to improving education, not an end in itself and curricula must constitute more than simply teaching students how to use computers. The focus should be on the promotion of information literacy, the ability to generate new knowledge, and the development of an information culture based on critical thought. The debate over which technologies are appropriate and relevant also requires greater attention. The utility of low-cost solutions needs to be examined over and above those premised on the newest and best hardware and software. Many developing world ICT projects have failed because the parts and technical expertise need for maintenance were not available. In order for them to be successful, ICTs need to become part of a broader development strategy that is guided by sound and effective policy. Questions regarding who will pay for ICTs in school, what role the private sector should play, what the appropriate balance is between investment in training vs. infrastructure, what kinds of software will be used, and how institutions that do adopt ICTs will cover recurrent costs all need to be answered. An examination of the role of ICTs in interaction with human behaviours and consideration of a full range of technologies will ensure a place for ICTs as real tools for education. Source: Yusuf Sayed, “Missing the Connection?” in Insights Education, (February 2003) available at www.id21.org. 1 For a more detailed examination of this particular issue see RS 33 “DEEP Impact” 69 Increasing the Relevance of ICT for Development Royal D. Colle, Cornell University Summary In the wider debate about ICT-for-development (ICT4D) there are three assumptions driving worldwide activities to enhance poor peoples access to information. These are that: (1) information and communication are vital for rural development, (2) ICTs extend and magnify their development potential, and (3) that “shared community facilities” are the most feasible approach to implementing universal ICT access. This brief paper focuses on the topic of “shared facilities” and the ways to make them more effective tools for development. It examines several aspects of telecentres and then looks at 10 major challenges for ICT4D and telecentre initiatives. Key Points The paper argues that despite some pessimism about the cost utility of ICT investment, societies that dismiss the potential of ICTs risk “stagnation in their Development Index.” The telecentre and the Internet are increasingly vital for national development and economic growth. Despite this, many societies are entering this arena with a considerable digital divide because of the inability for rural communities or individuals to access these resources. The concept of shared access development is seen as a partial panacea to this problem and has manifested itself in 3 principal tracks: the cybercafe, the information access point (IAP), and the telecentre. There are important differences between each. Telecentres tend to be public sector ventures, operated by governments or NGOs, with a mandate to serve low-income clientele by providing access to a broad range of communication services. Services are often free or heavily subsidised. Cybercafes are commercially inclined, private sector initiatives primarily providing basic web access for entertainment and personal communication to more urban and economically secure clientele. IAPs fall between the two, focusing on the Internet but primarily emphasizing information searches. These are often located in libraries, community centres and schools. The first stage of making ICTs more relevant has been mostly devoted to institution building and connectivity within the telecentre movement. These efforts are characterized by E-Readiness assessments and the creation of Country Gateways. The next stage of telecentre development needs to concentrate on how to make ICT4D and telecentres more effective and to secure their sustainability and viability. The report notes the following 10 challenges facing telecentres in 2003. 1. There is a need for an effort to make telecentre content needs based and locally relevant. Quality information and services must be appropriate and demand-driven. 2. Policy-makers must commit to and provide funding and organizational resources for multi-year programs. 3. There is a need for regional and local NGO partnerships to bring action to and provide feedback for national policies. This does not entail centralized planning. 4. Local “champions” (innovators) are key to mobilizing others to accept and utilize ICT programs. Their relevance and application must be presented to the community. 5. Community volunteers are vital for telecentre operation and strategies must be developed to “Gain, Train, and Retain.” The presence of female volunteers is especially important. 6. Clustering and Networking of telecentres can enhance performance through resource sharing and support components that provide content, training, liaisons, and promotions. 7. There is a need for a systemic effort to increase community awareness about information and ICTs as useful resources. People must learn what ICTs can do for them. 70 8. Increased research on needs assessments and project evaluation will contribute to improvements in telecentre management and creation of simple monitoring tools. 9. Long term business plans that fit the community’s culture, and manage a balance between income generation and the provision of public goods, are vital for sustainability. 10. Several obstacles to access must be overcome to ensure participation: a. Economic obstacles, the community’s ability to pay and perceptions of value. b. Physical obstacles, the proximity of telecentres to established community meeting points. c. Social obstacles, the need to create spaces for women and separate age groups. d. Political obstacles, the avoidance of power struggles and inter-community disputes that foster exclusion and inhibit collaboration. e. Public Awareness, both that the telecentre exists and the benefits that it offers. The article also provides a more in-depth look at the particularly rigid barriers to women’s access to ICTs and suggests that utilizing intermediaries and the already existing networks of women’s self-help groups (SHGs) may offer significant promise. By providing ICT training to representatives of these micro-economic groups, access to information and knowledge can be broadened. The paper concludes by arguing that when properly structured and implemented, ICT initiatives can have a concrete impact on peoples’ everyday lives. Source: Paper was prepared for the govt. of China’s international workshop on ICT for Poverty Reduction and Rural Development, January 15-19 2003. For earlier articles by the author that it was partially excerpted from see http://ip.cals.cornell.edu/commdev/ictpapers.cfm. 71 Classification Sheet ID # Name Class Page ICT4D Positioning Methodlogical foci: Subject Areas Economic Orientation Implementa Sustainabili Institutional Behaviours Connectivit Knowledge Regulatory Environme Evaluation Strategies Mixed OR Human IT Capacity Oriented Analysis Critique Gender Access Design Market Health Digital Divide Media Social Social Policy Mixes User N/A tion Pro nt ty y 1 See No Evil 53 X X X X X X X X 2 Shouting to Be Heard 54 X X X X X X 3 PRCA 55 X X X X X X X X 4 Magic Box 56 X X X X X X X 5 Womens and ICT 13 X X X X X X X 6 AIDS and ICT 58 X X X X 7 5 Conditions for ICT4D 34 X X X X X X 8 HIV Needs - DOT Force 59 X X X X X X X 9 PC3 Project - Bulgaria 15 X X X X X X 10 Graemeen Telecom - India 16 X X X X X X X X 11 Poverty Reduction 61 X X X X X X X X X 12 Themes in Telecentre Sust. 51 X X X X X X X X X 13 The African Internet 62 X X X X X X X X 14 Reflect - Actionaid 64 X X X X X X X X X 15 NGOs and ICT in Nepal 17 X X X X X X 16 Djibouti ICT Strategy 18 X X X X X X X X X 17 ICT and the Environment 20 X X X X 18 Hearlding ICT Knowledge 21 X X X X X X 19 ICT and the Bushmen 36 X X X X X X 20 Info Monopolies + WTO 37 X X X X X X 21 Democratic Defecits 38 X X X X X 22 Generation Rx.com 65 X X X X X X X 23 Community Radio - WBI 23 X X X X X X X 24 Relevance of ICT4D 70 X X X X X X X X 25 Deeper Critique 40 X X X X X X 26 ICT and Enviro Sust. 30 X X X X X X 27 Mixed Media Bridge 67 X X X X X X X X 28 Bridges Across Disciplines 42 X X X X X X 29 Pro-Poor IT Technology 44 X X X X X X 30 OSI Concept Map 24 X X X X X 31 OSI Strategy 25 X X X X X X X X X 32 Missing the Connection 69 X X X X X 33 DEEP Impact 27 X X X X X X X X 34 I-Development 45 X X X X X X 35 Knowledge, Facts + Fiction 47 X X X X X X X 36 CHC Technology 28 X X X X X X X X X 37 African Telecom 31 X X X X X 38 Failure and Improvisation 49 X X X X X X X X X X 39 Gender and ICTs 32 X X X X X X X X 73 CHAPTER 3 Programme Experiences: Sixty Case Studies Of ICT Usage In Developmental Health 74 SECTION 1 – DATA BASES AND RESOURCE CENTRES Health Foundation of Ghana Communications for Better Health (CBH) Programme Development Issues: Health Programme Summary The Health Foundation of Ghana (HFG) is an issue-oriented, not for profit, non-governmental organisation committed to assisting Ghanaians to achieve better health through the design and implementation of creative solutions and interventions to local health problems using community based resources. HFG developed out of the Dreyfus Health Foundation (DHF)-Ghana office. HFG now works in partnership with DHF, local and external partners to assist communities to undertake projects aimed at raising health consciousness of residents. The Foundation believes that good health is essential for socio-economic development and is committed to contributing to improving the health status of the country. In fact health in its broadest sense is perhaps the most important human resources the absence of which diminishes the individual's quality of life and reduces the capacity to partake in national development. The Health Foundation's efforts are focused on approaches that stress individual and group responsibility, ideas and action, and the optimal use of currently available resources.1 Summary of ICT Initiatives Working in conjunction with the Dreyfus Health Foundation (DHF) the HFG has implemented a Communications for Better Health (CBH) programme. CBH programmes are designed to improve accessibility to timely health information. CBH® is initiated within a hospital setting, university, or medical library. The site is often determined through contacts with a country's Ministry of Health and/or local NGOs. An assessment of the site's computer technology usually leads to provision, by DHF, of some computer hardware and software, such as CD-ROM technology and databases such as MEDLINE, PASCAL, and LILACS. Although CBH® uses modern information technology, such as microprocessors and CD-ROM storage and retrieval capability to deliver relevant health information to health professionals, it is much more than technology. Ghana was the site of the pilot CBH project and developed into two streams, the first is the medical publication, the Ghana Health Digest. The health digest provides medical practitioners, administrators, and government policy makers and parliamentarians with timely health news and information. The selection of abstracts (from MEDLINE, for example) takes into consideration local health conditions, and is adapted accordingly. The digest also contains relevant articles written by local health specialists (such as "A Guide to Malaria Prevention and Control"), summaries of findings from community health projects, personal health experiences, interviews, FAQs, questionnaires and answers and quizzes. 2500 copies of the digest are distributed quarterly to health professionals across the country (doctors, nurses, pharmacists, and medical students) via hospitals, clinics, medical libraries, and the District Health Management Teams of the Ministry of Health. Through an order form in the digest, users may request full-text articles of abstracts or database searches on specific topics of health and medical interest. The digest gains mass exposure by the bi-weekly reading of highlights from the digest on the National Morning Breakfast Show on Ghana Television (GTV) and the Daily Graphic Newspaper has featured several articles for their weekly health column. The Health Foundation of Ghana is also in negotiation with Ghana Broadcasting Corporation (radio) to broadcast information from the digest. In the second stream, local databases are created by indigenous health professionals and other interested parties, who, working together, select information from international resources and 1 HFG Site < http://www.hfghana.org/pages/about.htm> 75 from in-country or regional colleagues. Solutions to common local health problems are also gleaned from local health professionals. The database of local health information is kept in each country's information centre (head office) in paper format (and often in electronic format, also). People call and visit the centres for local and international medical information. A national version of this database, the African Index Medicus (AIM), is being developed. AIM provides an index of African health literature and information sources using CDS-ISIS software. AIM identifies bibliographic sources and includes databases on information experts and sources of research in health-related areas of African countries. The HFG’s expanding AIDS/HIV prevention project will also gain from its exposure and linkages to the health digest. An educational programme, the Journey of Hope kit, which visually illustrates the nature, causes, and impact of the HIV/AIDS virus, has been recently developed. Films on HIV/AIDS are shown to the general public twice a month on Friday evenings with the support of the Ghana Information Service. The project implementers have intensified their effort by undertaking a house-to-house education campaign to achieve the required impact. Increased condom sales have been reported in the community drugstores.1 Observations:2 • There is a host of valuable, current medical information on the Internet, but the majority of the developing world does not have access to it and, equally importantly, does not know how to use it to optimal advantage. • All levels of technology, even no technology, can be used to target relevant health information to the widest possible audience. These include the Internet, satellite transmission, radio, traditional print digests and newsletters, and workshops and formal and informal meetings • The majority of health information needs to be adapted for local use. Partners: DHF, HFG, Association for Health Information and Libraries in Africa (AHILA) and the World Health Organization (WHO). Source: DHF Site; DHF’s Connections Magazine (Jan-Mar 2003); Chapter 2 ("Insights from Existing Initiatives") of "Unlocking economic opportunity in the south through local content: A proposal from the G8 Dotforce" by Peter Armstrong et al. (Insight by Lynda Arthur); Health Foundation Ghana website; AHILA. For more information, contact: Lynda Arthur email@example.com DHF site at http://www.dhfglobal.org/news.html 1 DHF Connections <http://www.dhfglobal.org/news.html> 2 As observed by Lynda Arthur in her contribution to the G8 DOT Force Report 76 AIDS Documentation and Information Centre (Centro de Documentación e Información en SIDA) - Honduras Fundación Fomento en Salud (FFS) Development Issues: HIV/AIDS, Health, Gender, Children, and Youth. Programme Summary Fundación Fomento en Salud (FFS) is a non-profit organization based in Tegucigalpa. It was established with the purpose to promote dialogue and act on the health problems of the Honduran population. FFS is the linkage between the implementing and cooperating sectors for strengthening technical, funding, and managerial capabilities of public and private organizations. FFS’s areas of interest include sexual and reproductive health care; HIV/AIDS/STD; maternal- child care; health in schools; adolescent health care; occupational health, water, and sanitary facilities; political dialogue for health care reform; and social mobilization. HIV/AIDS is a particularly pressing problem in Honduras and is increasing rapidly. According to information received from the American Embassy, half of the HIV-infected people in Central America live in Honduras, where approximately one out of every one hundred adults is infected. A major part of the problem is concentrated in citizens aged 20 to 45. The AIDS Documentation and Information Centre has been implemented in response to this crisis. Summary of ICT Initiatives The FFS in conjunction with USAID and the Honduran Ministry of Health has implemented an educational/informational project with the intent of improving awareness about the prevention of HIV/AIDS/STDs. It has developed a centre to collect and disseminate information and materials related to prevention and safer lifestyles. The purpose of the centre is to: • Offer more and better access to HIV/AIDS/STD prevention information and other topics related to violence, gender, human rights, and sexuality. • Facilitate the exchange of electronic information amongst NGOs that currently work in this area. • Facilitate the dissemination of information prepared by national and international institutions, professionals, and researchers in a timely way. • Maintain an updated information database published by national and international institutions, professionals, and researchers. • Train involved NGOs in the use of services and sources from the information centre. • Make all the materials and information describing the "Fundación Fomento en Salud" programme available. The centre has also established a number of specific objectives and qualitative and quantitative framework for evaluation of the project. The specific objectives are:1 • To ensure that updated information is available for users of the centre. • To provide more and better responses to the requests of the clients of the centre. The clients of the centre will receive electronic direction, support for search, and training in how to access information through a database and catalogues. Answers to information requests must also be made available via Internet, telephone and by email. • To improve the NGO community’s knowledge about prevention of HIV/AIDS/STDs through access to timely, updated, and accurate information. • To improve the quality of HIV/AIDS prevention information presented/displayed in the national mass media. • To ensure that leaders in the prevention of HIV/AIDS are better informed. 1 http://www.pasca.org/cd/pasca/losdocs/descripcion_ffs.pdf (Note: This information was translated from Spanish using Altavista’s Babelfish and corrected for grammar and may be subject to slight variations in meaning as might be derived from the original text.) 77 Strategies are focused on strengthening behaviours in high prevalence groups, such commercial sex trade workers (CSWs), men who have sex with men (MSM), and the Garifuna (an ethnic minority) community. In addition, a sustainable and effective condom social marketing project is being implemented (as part of a wider regional endeavour), and the uses of new, rapid HIV tests are being promoted. The programme also awards sub-grants to roughly 15 NGOs implementing prevention projects aimed at high-risk groups. These programs have in part been facilitated by Family Health International (FHI) and its IMPACT project which, “intervenes at multiple levels to influence individual and societal norms, improve the health infrastructure, and alleviate structural and environmental constraints to HIV/AIDS prevention and care.” 1 IMPACT’s key intervention strategies are to: • Reduce risk and vulnerability to HIV. • Strengthen HIV/AIDS care and support. • Support the public and private sectors and communities for a sustainable response. • Improve the availability and use of data for decision-making. The Johns Hopkins University/Population Communication Services Project has also contributed to the development of a national AIDS communication strategy/campaign. The Fundación Fomento en Salud (FFS) also works closely with Comunicación y Vida and COMVIDA. The latter is a government municipality programme in San Pedro Sula (a city with a disproportionally high rate of HIV/AIDS infection) where an information kiosk has been established. This centre has been operating for several years and reports having reached over 1,117 persons cared for per week in social mobilization activities, 43 people a day with educational materials, and over 100 persons per day through the distribution of contraceptives and other materials. Partners: Fundación Fomento en Salud, USAID, Honduras Social Security Institute, Public Health Ministry, Comunicación y Vida, and COMVIDA. See also PASCA2 Sources: www.fhi.org and www.pasca.org For more information, contact: Dr. Jorge A. Higuero Crespo Edificio CIICSA, 1° piso, Col. Palmira Avenida República de Panamá, Tegucigalpa, m.D.C. Honduras, C.A. Tel.: +504 235 8942 & 235 8778 Fax: +504 235 8898 firstname.lastname@example.org 1 http://www.fhi.org/en/aids/impact/strategy/response.html 2 http://www.pasca.org/index.htm 78 AIDS Resource Center (ARC) - Ethiopia Development Issues: HIV/AIDS Programme Summary The Johns Hopkins Center for Communication Programs (JHU/CCP), in conjunction with the Centres for Disease Control (CDC) established an AIDS Resource Center (ARC) in Addis Ababa, Ethiopia. The Center, which opened in December 2002, will serve as the hub for AIDS information for journalists, health providers, government departments, and HIV/AIDS organisations and programmes. The new resource centre offers its services free of charge. The CDC has noted the following priorities for HIV/AIDS control in its country report on Ethiopia: • Strengthening surveillance; • Improving access to voluntary counselling and testing (VCT); and • Developing prevention services, such as STD care; and services for HIV-infected persons, such as prevention of opportunistic infections, tuberculosis prevention, and social support, as well as interventions focused on behaviour change.1 The report presented the following responses as being vital to HIV/AIDS prevention programs: • Primary prevention - Improve access to, availability of, quality of, and use of HIV VCT service including establishing a VCT Centre in Addis Ababa and one in the interior of the country. • Information Systems - Promote information exchange and improved coordination among partners working in HIV -- 1) develop or expand information resource centre and services, 2) provide support and technical guidance to foster information exchange, 3) provide surveillance updates for involved agencies and organizations. • Support the HIV/AIDS/STI/TB research agenda of the Government of Ethiopia and serve as technical resource for HIV/AIDS prevention in Ethiopia. • Provide technical assistance to national STI and TB control programs • Assess social marketing needs to promote VCT. 2 Summary of ICT Initiatives The (JHU/CCP) has responded to some of these identified priorities by developing a an AIDS resource centre which will: 1. Develop and maintain a clearinghouse on all HIV/AIDS, VCT, STD and TB materials (print and audiovisual) produced in Ethiopia, as well as a sample of international materials. Part of the mandate of the clearinghouse will be to establish an efficient materials distribution system, develop a materials database and develop a web site. 2. Develop standardized high-quality print and audio-visual HIV/AIDS, VCT, STD and TB materials that are useful to all programme managers nationwide. 3. Support the AIDS Hotline managed by the Organization for Social services for AIDS (OSSA). Hotlines have proved to be an effective means for people to access free and anonymous HIV/AIDS information and referrals. 4. Develop a strong relationship with the media by training journalists in HIV/AIDS reporting and serving as an ongoing source of information for those journalists. 5. Encourage networking and coordination of all HIV/AIDS stakeholders. This will in part be accomplished through the development of a database of all HIV/AIDS organisations and projects. 1 http://www.cdc.gov/nchstp/od/gap/countries/ethiopia.htm 2 http://www.cdc.gov/nchstp/od/gap/countries/ethiopia.htm 79 In 2001, an IEC gap analysis completed by Population Communication Services (the USAID- supported program operated by JHU/CCP in Ethiopia) revealed that quality, culturally appropriate HIV/AIDS materials are limited in Ethiopia. Those that do exist are frequently out of date and often out of print. Generally, access to any HIV/AIDS information in Ethiopia is severely limited, especially for the smaller, rural AIDS projects. In addition, there is a need for better coordination of HIV/AIDS IEC and programme activities to prevent duplication of resources. In response to these needs, the centre provides services that include a broad multi-media reference collection, modern computer terminals with Internet access, audiovisual equipment, and databases of local and international HIV/AIDS organizations and avenues for funding. The centre is free to users affiliated with government agencies, media organizations or NGOs working on HIV/AIDS issues. Plans are in the works to open other regional sites that will be networked to the Addis Ababa centre. A national HIV/AIDS hotline is also slated for development.1 The establishment of the ARC comes at a crucial time in Ethiopia because the demand for HIV testing is growing and with that, a demand for HIV/AIDS information. Not only do the VCT sites require support materials for providers and clients, but VCT is inextricably linked to all aspects of HIV/AIDS and therefore creates a demand for information on issues such as; transmission, treatment, care and support, TB, STIs, MTCT etc. Now that the ARC is fully operational, partners may consider expanding to other regional sites that will be networked through the main centre in Addis Ababa. There are also plans for an expanded audiovisual unit, additional databases, and a national HIV/AIDS telephone hotline. Partners: Ethiopia's HIV/AIDS Prevention and Control Office, the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP), Analytical Sciences Inc., and the Centers for Disease Control and Prevention (CDC). The advisory committee consisted of a number of UN agencies and ministries including UNAIDS, WHO, UNICEF, UNFPA, UNDP and the World Bank. Source: Letter sent from Kim Martin to The Communication Initiative on December 10, 2002. For more information, contact: Ato Araya Demissie Country Representative JHU/PCS Dashen Building, 1st Floor Addis Ababa Ethiopia email@example.com 1 http://www.thebody.com/cdc/news_updates_archive/2003/jan3_03/ethiopia_hiv.html 80 Health Informatics Section (HIS) of the Centre for Evaluation of Public Health Interventions (CEPHI) - Zimbabwe Development Issues: Health, HIV/AIDS, Technology. Programme Summary The Department of Community Medicine, University of Zimbabwe is a well established medical services actor in Zimbabwe that has initiated a number of programs to increase the health care capacity in the region. Many of these projects have been developed in conjunction with the U.S. Centers for Disease Control and Prevention through its Division of International Health (DIH) and the Division of Public Health Surveillance and Informatics (DPHSI). Focusing on responses to the HIV/AIDS epidemic in Zimbabwe, the HIS is being designed to foster the development and use of informatics tools to evaluate public health interventions conducted by the CEPHI. It will also provide technical support and design information tools/systems for health care providers and organisations to facilitate the delivery of public health services. Summary of ICT Initiatives Health Informatics is an interdisciplinary scientific field that deals with the resources, devices, and methods of storage, retrieval, and management of biomedical information for problem solving and decision-making. Information systems measure the status and determinants of the population's health. The information is used to improve the strategies and processes for health delivery and the capacity of the health system to respond to the needs of the community. DIH and the DPHSI work with its partners to design, implement, and evaluate health information systems and to integrate and strengthen existing information systems.1 Though still in its formative stages, HIS expects to provide these services: • Technical support o By establishing an expert core group that supports HIV/AIDS interventions o By assisting with cooperative and multidisciplinary research o By creating special awareness about assessment of published research information and improving the access to and the dissemination of best current knowledge relevant to public health interventions in HIV/AIDS • Training and support in use of general Information Communication Technology (ICT) applications to members of CEPHI. • Training and support in the use of specific applications like EpiInfo2000. A specialized piece of software that allows epidemiologists and other public health and medical professionals can rapidly develop a questionnaire or form, customize the data entry process, and enter and analyze data.2 • HIS will also support curriculum development for public health informatics training through the Department of Community Medicine and other key role-players and will provides direct involvement in teaching Among additional proposed activities is the creation of a low-cost CD-ROM of electronic resource material for teaching and learning about Drug Management in Zimbabwe that would include an update on existing course material. The long-term plan involves developing HIS as a local and regional training centre for computer literacy training, Epi-Info, specialized training courses, training courses for end-users on information retrieval and development of critical appraisal skills, and "training of trainers" courses. This centre might also provide an expert group that could help develop national systems of linked and integrated population-level health databases, foster evidence-based public health policy and practice, and design computer-assisted learning materials to enhance teaching/learning capacity 1 http://www.cdc.gov/epo/dih/systems.html 2 http://www.cdc.gov/epiinfo/ 81 in national health training institutions. The long-term strategic plan for HIS will be determined by the Department of Community Medicine in collaboration with key stakeholders (public and private sector, NGOs, and other donor-funded programmes) in the country. A wide range of such organisations attended a meeting in June 2002 to suggest specific priorities for CEPHI over the coming years. Source: Letter sent from Klara Tisocki to The Communication Initiative on July 1, 2002. For more information, contact: Dr. Klara Tisocki Health Informatics Section Centre for Evaluation of Public Health Information University of Zimbabwe Medical School PO Box A178 Harare, Zimbabwe Tel.: 263 4 707707 ext. 2120 Fax: 263 4 790233 Mobile: 091 402 572 firstname.lastname@example.org 82 Zanempilo, Disability Information System - South Africa Development Issues: Disability Programme Summary Initiated in 1996 by the South African NGO Zanempilo Trust, this programme has worked to develop a computerized Disability Information System. Zanempilo’s overarching aim is to deliver holistic primary health care services to disadvantaged peri-urban and rural communities in the Western Cape through the employment of full-time Community Health Workers (CHW), Community Rehabilitation Workers (CRW) and HIV Lay Counsellors. All project staff are trained, salaried workers selected by their community or residence. In coordination with a range of service providers, efforts are made to improve resources and information access, and to influence policies that benefit the health of the communities served. The programme endeavours to secure funding for the CRWs from the public sector and government. Present funding comes primarily from the European Union as well as the Provincial Administration of the Western Cape (PAWC). The organization operates within a sustainable financial infrastructure and strives for excellence and transparency in their management processes. The Zanempilo health care programme strives to provide: • Improved community health care for the impoverished • Accessible basic curative services • A coordinated TB programme • A coordinated HIV/AIDS programme • Care and counselling for people with permanent physical disabilities • A response to Child and Women Abuse through education and other support structures There philosophy is to deliver these services within a framework that encourages community participation in the preventive, promotional and rehabilitative aspects of health care. They also seek to develop partnerships with the academic and private sectors to develop innovative and effective health intervention approaches. Summary of ICT Initiatives The Disability Information System is a software programme designed to give the CRW’s easy access to information, and facilitates the planning and management of rehabilitation activities. This programme allows each worker to record, analyse and report information about the project's clients and staff, making it an excellent tool to support fundraising activities - quantitative results data being one of the primary requirements of donors. Those who wish to run the software need a PC with MS access. The software has been specifically designed for the disability project, but can be adapted to other community-based projects. The CRW’s collect and record (on statistics sheets) detailed information about clients whom they see. The sheets are then collected monthly and input into the system. The information system has the following features: • A database of clients with information on addresses, disabilities, needs, assessments, and current Community Rehabilitation Workers (parents of children with disabilities); • Assessment forms from professionals on the clients showing their history and other relevant information; • Individual and group staff reports showing attendance, self-development, client activities and leave status. These are displayed in the form of graphs and pie charts. Community Rehabilitation Workers service approximately 1,120 houses in their allotted areas, in which they are resident. They are expected to make six home visits a day, but with only 27 CRWs 83 servicing nine areas, they are vastly understaffed and overtaxed. The CRWs are informed of the presence of disabled people or children in their areas either through community structures or local clinics. They offer support in numerous ways, providing counselling and therapeutic exercise, making people aware of the resources available, encouraging independence and giving advice on social assistance grants. CRWs also educate their communities, undertaking disability awareness campaigns via community radio broadcasts or participating in community workshops and drama presentations at schools within the designated areas. Partners: European Union, Provincial Administration of the Western Cape (PAWC). Source: Disability Information System on the Zanempilo site at http://www.zanempilo.org.za/infosys.html For more information, contact: Tara Appalraju-Van Niekerk The Zanempilo Trust PO Box 30745 Tokai, 7966 South Africa Tel.: 021/713 0073 Fax: 021/713 0105 email@example.com http://www.zanempilo.org.za/infosys.html 84 Teaching-aids at Low Cost (TALC) – Global eTALC Development Issues: Education, Health, HIV/AIDS Programme Summary Teaching-aids At Low Cost (TALC) is a UK charity founded in 1965 with the objective of improving the health of children and advance medical knowledge and teaching in the UK and throughout the world by providing and developing educational material. While TALC has previously focused its efforts in developing countries; particularly Sub-Saharan Africa and Asia, it has since developed a truly global audience and now distributes to more than 200 countries. TALC’s work is primarily focused on the production and supply of low cost books, including many essential texts on tropical medicine, nursing, surgery, HIV/AIDS, child-to-child teaching books and infectious diseases. TALC also provides other teaching aids including 35mm slides sets, PictureCard training packs, rehydration spoons, child growth monitoring equipment. TALC has also recently taken over the Strategies for Hope series, which includes the well-known publication called Stepping Stones. TALC has a small number of dedicated volunteers, part-time and full-time staff. The management of TALC consist of an Executive Management Committee, which meets regularly and is advised by number of experts via a Medical Advisory Board. TALC has also recently developed a project to disseminate health information on CD-ROMs, e- TALC, with the intent of improving access to health knowledge and information resources around the world. Summary of ICT Initiatives To support TALCs continuing work in providing low cost health information TALC has initiated a pioneering project to provide free information to health workers in the developing countries on CD-ROM. Although availability of computers is still limited in the developing countries it is growing fast, while access to the Internet is still very poor, due to cost and poor telephone systems. CD-ROMs can store large quantities of high quality information. They can be produced and distributed at low cost. This service is designed to achieve the following: • Production of CD-ROMS with a simple search engine, containing copyright free information. The CD-ROMs are easy to use and have the potential to be interactive (e.g. for training purposes) • Provision of free access to up-to-date and appropriate health and development information and training materials for health workers. • A low cost method for health workers, libraries, government and non-governmental organisations to distribute health information and training resources. • A vehicle for the exchange of ideas and information. • Educate users in web technology preparing them for access to wider resources on the Internet when connectivity improves. • Allowing users to select, adapt and tailor materials to meet local needs and develop their own Library of materials at very low or zero cost. Information on the CD-ROM can be downloaded, e-mailed or printed and freely reproduced and shared. CDROM contributors have aimed their materials and information at developing world health care professionals. Some sample CD titles currently available from the TALC website include: • Advanced Paediatric Life Support • The e-TALC CD-ROMs (a mixed collection of materials) 85 • HIV/AIDS Parent to child transmission • Quality Assurance Theory and Tools • Tuberculosis Case Management The TALC website also operates as a point of sale for a wide selection of materials that are essential for improving the health and living conditions for people in developing countries. Items such as infant scales, simple haemoglobin test kits, slide presentations for the identification of STDs and parasitic infections, and the a host of reference books for professionals as well as books aimed at improving health and behavioural practices in young teens. Partners: UK Department for International Development http://www.dfid.gov.uk Source: The TALC website at http://www.talcuk.org/index.htm and the eTALC site at http://www.e-talc.org/index.htm For more information, contact: eTALC Caroline Marven - Project Co-ordinator eTALC (Electronic Teaching-aids At Low Cost) PO Box 49 St Albans Herts AL1 5TX UK Tel: +44 (0) 1727853869 Fax: +44 (0) 1727 846852 E-mail: firstname.lastname@example.org Website: www.e-talc.org 86 Internet Pathology Suite (iPath) – Global Development Issues: Health, Technology. Programme Summary Developed in 1999 through a telemedicine research project at the Pathology Department of University of Basel, Switzerland, this online knowledge-exchange programme enables the international organisation and exchange of various kinds of medical information. The Internet Pathology Suite (iPath) is intended to facilitate group work - case discussion, remote diagnosis, and consultation - on the part of medical specialists in different fields (like pathology, radiology, dermatology, and so on). In 2001, a hospital with no resident pathologists, the National Referral Hospital of Honiara, Solomon Islands, approached the University of Basel for help. The University worked to establish a tiny histology lab at the Hospital. Specimens are prepared there and digital images are sent to the server, where a number of pathologists from Europe and US review the cases. Over 50 cases have been diagnosed there so far. Telemedicine is more and more regarded as a viable method to provide expertise knowledge to unprivileged regions of our world. However, there is very little literature and only a few trials have been carried out. A major problem is the lack of a platform to conduct such experiments. As iPath is released free and with open source, it is easily adaptable to new applications and not requiring high operating costs. iPath could be an ideal platform to carry out such experiments and to establish telemedicine services for developing countries. Summary of ICT Initiatives By visiting the iPath site1, information needed to diagnose and treat disease may be exchanged. Physicians may share knowledge with colleagues by • Entering a medical discussion forum where cases may be presented to other physicians for discussion and comment within dedicated user groups. (The sender of the information controls who has access to the consultation information; the intention is to foster mutual discussion where questions are invited); • Accessing information about cases from various sources; and • Connecting their microscopes to the Internet and then sharing their findings with others (who then may provide feedback to senders of specimens). The iPath server has several other desirable features: • Not only pictures, but documents and other data files can be put into the database. • To prevent influencing the diagnosis of a new viewer, comments can be hidden until she or he has entered his or her own comments. • Access to the pictures can be restricted to a small closed group or made available to several groups. • A chat (online-communication) with a colleague or the microscope operator is possible. • An additional small program allows pictures to be transferred automatically from the camera to the database with frame-grabber hardware. To date, physicians from Bangladesh, Germany, India, Iran, Poland, South Africa, Switzerland, Thailand, USA, and Vietnam have utilised the service. Although the programme has expanded to enable many kinds of specialists to utilise the service, the software was initially developed for pathologists. 1 http://ipath.sourceforge.net/, or to access the public server http://telepath.patho.unibas.ch/ 87 Examples of pathology-related applications include: Samedan is a small regional hospital in the Swiss Alps without a resident pathologist. iPath-Telemicroscopy enables frozen section diagnosis by pathologists from the University of Basel. In addition, members of the German bone tumour working group (AGKT) use iPath to discuss difficult cases with their colleagues. Images and case description are stored on the server. The server sends an email notification to all members of the working group, who then give their opinions. The IHNS (Inland Northwest Health Service) has funded a telepathology network for the Spokane, WA region of the US that is intended to provide support for rural hospitals. Pathologists and lab techs at the Sacred Heart Medical Center and at the Holy Family Hospital in Spokane may help with remote frozen sections and consult with each other. Other applications of iPath have been utilised in West and South Africa. Specifically, the Norwegian-based Kizuki Group has started a West African Doctors Network that includes a telemedicine facility based on the iPath software. The site1 is used for telepathology collaborations. To facilitate collaboration within Africa and to strengthen a south-south dialogue, the server is open to all health workers and doctors in Africa. The iPath site also provides access for users of this service to a steady stream of software fixes and updates, as well as reference materials for software developers interested in creating similar projects or contributing to current iPath initiatives. The creation of a database of clinical materials and examples of different samples is also underway. Observations Capitalizing on the initial successes of the program, the iPath team is looking to develop: • A image grabber application for generating cytology images. A stack of images from different focal planes are taken to provide an realistic 3d view. • Improved facilities for organizing expert groups and "virtual pathology departments" on iPath-Server • Improving usage of iPath for developing countries. o Full email-to-web and web-to-email functionality o Decentralised database with a server for a small hospital's intranet that can synchronize its content regularly with another server where the experts can access the consultations on-line. This option will provide a way how every doctor and lab technician can access the data at any time without needing a constant online connection, suitable for work with email only or satellite connections. Partners: The Kizuki Group, SourceForge, South Pacific Medical Projects, AGKT, Source: Letters sent from Kurt Brauchli to the Communication Initiative on June 7 and 22, 2002; and iPath site. At http://ipath.sourceforge.net/ For more information, contact: Kurt Brauchli Department of Pathology, University of Basel Tel.: +41 61 265 2828 email@example.com iPath site 1 http://ipath.krot.org/ 88 Mapping Malaria Risk in Africa / Atlas du Risque de la Malaria en Afrique (MARA/ARMA) Development Issues: Malaria, Epidemiological Modelling Programme Summary Sub-Saharan Africa carries the highest per capita burden of disease in the world of which malaria is the single most important cause. Of global deaths attributed to malaria 90% now occur in sub- Saharan Africa. Recent advances in public health are offering new opportunities to make significant reductions in the burden of disease. However, many factors, especially endemicity, affect the choice of control methods. There is a need to rethink how endemicity is defined, and the ways to map malaria risk in order to better support planning and programming of malaria control. MARA/ARMA collaboration was initiated to provide an Atlas of malaria for Africa, containing relevant information for rational and targeted implementation of malaria control. The MARA/ARMA initiative is non-institutional and runs in the spirit of an open collaboration. A group of dedicated African scientists, based in sites across the continent, work co-operatively towards achieving the overall objectives. Detailed mapping of malaria risk and endemicity has never been done in Africa. Accurate estimates of the burden of malaria at regional or district level remain largely unknown. In the absence of such data it is impossible to rationalize allocation of limited resources for malaria control. The organizations objectives are to: 1. To map malaria risk in Africa a. Through collection of published and unpublished malaria data. b. Through spatial modelling of malaria distribution, seasonality and endemicity. 2. To disseminate relevant information to national and international decision makers and other end users, in a range of useful formats. 3. To develop capacity in malaria / health GIS. Summary of ICT Initiatives The heart of the MARA programme is a massive information collection and data-basing project that has to date over 10 000 data points that have been collected from published and unpublished sources, through literature searches and country visits. The intellectual and monetary value of the collated data-base alone is hard to appreciate. It represents decades of malaria research in Africa, much of which was on the verge of being lost and forgotten, and certainly not being used. MARA/ARMA has provided the first continental maps of malaria distribution and the first evidence-base burden of disease estimates. There is currently hardly any major document on malaria in Africa that does not make use of MARA maps and the BOD figures produced by MARA/ARMA are now universally used. MARA/ARMA is at the cutting edge of, and has made significant steps forward in, the geographical modelling of malaria using eco-physiological / climate / GIS (geographical information systems), as well as spatial statistical approaches. Highly original spatial statistical methods are being developed currently to strengthen the analysis of the MARA/ARMA data. The scientific aspect of the project is exemplified by no less than 13 scientific publications, largely in prestigious medical and scientific journals. MARA/ARMA maps and data allow: • Appropriate selection of malaria control tools (different control tools are appropriate in different endemic settings); • Evidence-based planning (a base-line estimate of people at risk or infected is needed to plan interventions and assessment studies); • Spatial targeting (eg. where are the high-priority areas); • Rational budgeting (eg. how many cases of malaria can be expected per administrative area). • Adequate timing (eg. when in the year do bed-nets need to be insecticide-treated); 89 • Empirical assessment of control interventions (eg. how many people need to be surveyed to demonstrate a certain reduction in malaria). MARA has made its results widely available through the regular publishing of technical reports in English and French which are available on their website.1 They also publish and regular update a large collection of maps demonstrating the endemicity, density and seasonality of Malarial infections. Some 3000 poster sized maps of malaria models and population distribution were produced and sent to malaria control programmes, departments of health, and research institutions in all endemic African countries. All the maps are readily available by downloading them from the website and can act as invaluable resource tools It has also developed an innovative CD-ROM – the MARA LITe CD – which is a user-friendly tool designed to access products of the MARA project. The tool was developed and produced within the Malaria Research Programme of the South African Medical Research Council, which operates as the main MARA/ARMA investigating centre. Observations MARA’s future plans are well thought out and will continue to enhance their contribution to this pressing health problem. The following future initiatives have been presented: • Firstly, the data collection will still be continuing for at least two more years until all avenues have been exhausted. Several countries have not yet been visited and some of the collected data have not been abstracted. The database is the major resource in this project and the collection process has to take a high priority until its completion. • Secondly, environmental malaria models for the whole continent will be further developed and refined. This should lead to better overall malaria maps. The model could also be a useful start for predicting the possible extension of malaria as a result of global climate changes. • The final product of the MARA/ARMA collaboration will be an atlas of malaria risk for the whole continent, both in a book version and in digital format, that will contain country maps of endemicity, seasonality, as well as available vector distribution maps. It is envisaged that other related data, such as drug resistance or bed net use could also be included, when available. Eventually, the electronic version will be placed on the Internet for general use. The aim is that the digital atlas will allow for constant updating, extracting, querying and refining of malaria risk distribution in Africa. • Finally it is hoped that this collaboration serves as a model for other large-scale disease information systems in Africa and in other developing countries. Partners: International Development Research Centre of Canada (IRDC), South African medical Research Council, The Wellcome Trust – UK, Swiss Tropical Institute, WHO, Multilateral initiative on Malaria, Roll Back Malaria. Source: MARA website at www.mara.org.za For more information, contact: Carrin Martin Administrative Support firstname.lastname@example.org Main Coordinating Centre South African Medical Research Council P.O. Box 17120, Congella, Durban, 4013, SOUTH AFRICA (Tel) +27-31-2043600 (Fax) +27-31-2043601 1 http://www.mara.org.za/tech_report_eng.htm 90 Malaria: An Online Resource and CDROM Royal Perth Hospital Development Issues: Malaria, Diagnostic Training Programme Summary Laboratory diagnosis of the various types and stages of development of the Malaria parasite is a critical component of effective control and treatment. Many medical practioners in developing countries however, are lacking in the many hours of experience needed to properly utilize laboratory techniques. The Division of Laboratory Medicine at the Royal Perth Hospital in Australia has developed a resource to assist in the learning process for inexperienced technicians and those attempting to address the disease. The information provided on the trilingual website and the CDROM is available in French, English and Spanish. Summary of ICT Initiatives The resource is organized in several sections beginning with a chapter on diagnosis that includes instructions on how to prepare various types of blood smears for lab work. It also includes identification charts for several different types of Malaria and it stages. These descriptions include simple diagnostic points that facilitate the easy differentiation of type (which is important for treatment). A chapter containing a discussion on the pros and cons of the various types of prophylaxis used to curb infection is also included. This is especially pertinent because of the potential for serious side effects that have been observed from some medication regimes. This followed by a section on treatment of infected cases and takes into account the likelihood that the practioner will be working in a less than ideal medical theatre. The most innovative feature of this resource is the interactive “Test and Teach” self-assessment module that presents a series of photomicrographs, which present a series of thick and thin blood films that help learners to improve their identification skills. The teach function presents them with identification hints and while the test slide asks for diagnosis. The slide show randomizes each time and inserts several dummy, asymptomatic slides throughout. The CD-ROM is targeted at clinicians, scientists, healthcare professionals and students involved with malaria research and treatment. Versions I-IV proved to be very popular and are now in use in 138 countries. Utilizing the CD-ROM format assists those in areas without Internet connections to access this resource and to utilize it in various teaching programs. The Mark V version of the CD-ROM is now ready for distribution to medical/educational institutions or centres free of charge. Source: http://www.rph.wa.gov.au/labs/haem/malaria/index.html For more information, contact: Dr Richard Davis, AM PhD MSc FAACB FIBMS MASM Emeritus Consultant Haematologist, Royal Perth Hospital. email@example.com Mr Graham Icke MSc CBiol FIBiol FIBMS Grad Dip Bus A/Principal Scientist, Laboratory Medicine, Royal Perth Hospital. Graham.Icke@health.wa.gov.au 91 Healthlink Worldwide - Global Development Issues: Health, education, child rights. Programme Summary Formerly AHRTAG (Appropriate Health Resources and Technologies Action Group), Healthlink Worldwide, in conjunction with partner organisations, runs specialist programmes in response to particular needs in primary health care. Healthlink Worldwide also produces practical publications for health and development workers. The resource centre holds the UK’s largest collection of materials focusing on the practical aspects of primary health care and rehabilitation in developing countries. Summary of ICT Initiatives Healthlink has a wide array of partnerships and projects underway at any one time. It has a global network of activities that utilize an approach called “communicating through partnership” with the intent of: • Strengthening the communications capacity of civil society organizations in the south • Strengthening the voice of vulnerable and marginalized groups • Linking information and communication activities with other work such as advocacy and lobbying These programs manifest themselves in a variety of forms and a review of current Healthlink projects attests to the diversity of their involvement. Healthlink Worldwide also provides health, disability and development-related consultancy, training and project management services to a variety of local, national and international organisations. They specialize in the setting up and management of resource centres, partnership working, newsletter publication, project management and communications training. As well, Quest1, a training programme for the practical development of information resources by health workers is undergoing pre-testing. This will eventually result in the creation of a manual, CD-ROM and website by September 2003. Healthlink Worldwide is a partner in Source2, an international information support centre designed to strengthen the management, use and impact of information on health and disability. We also provide resource centre training and consultancy. The Source portal provides access to: • A bibliographic database which holds details of a unique collection of over 20,000 health and disability information resources; • A contacts database which allows users to search for organisations - including publishers, distributors, information providers and training organisations - working in health and disability worldwide; • And a newsletters and journals database which holds details of over 150 international newsletters, magazines and journals which are available free or at low cost to readers in developing countries, including links to the full-text of the newsletter where possible. Healthlink is also a prolific publisher and produces four international newsletters under the headings: • AIDS Action - aimed at health workers and educators working at the primary level, this newsletter provides practical information of a wide range of care and prevention issues concerning HIV, AIDS and sexually transmitted infections. 1 http://www.healthlink.org.uk/consult/quest.html 2 http://www.asksource.info/ 92 • Child Health Dialogue - a forum for the exchange of information about the prevention and treatment of key childhood diseases, as well as providing practical advice on related health education. • CBR News/Disability Dialogue - promoting the social inclusion of disabled people through community-based rehabilitation (CBR) and other social action. • Health Action - a forum for health managers, planners and health workers to exchange experiences in implementing programmes. In addition, they support the publication of a host of regional newsletters which are translated and adapted by partner organisations in developing countries, reaching nearly two million readers in 10 languages. They also have produced a host of handbooks, briefing papers and resource guides most of which are free to developing countries in print or available for download over the internet. Finally, Healthlink Worldwide hosts Exchange1, a networking and learning programme on health communications for development. This bulletin board and discussion service works to improve the health and quality of life of poor people by encouraging the exchange of relevant knowledge, information and experience. Observations The following notes were taken from Healthlinks 2001 Annual Review:2 In 2001 Healthlink Worldwide entered into new partnerships with a number of organisations, including Southern Africa AIDS Information Dissemination Service (SAfAIDS) and Family AIDS Caring Trust (FACT), Zimbabwe, and it developed new projects with existing partner organizations. They have implemented changes in their publications policy with a move from printing international newsletters to providing electronic articles to partners. This is combined with increased support to partners in generating local material, adapting material for local audiences, and in producing regional publications. In 2001, Healthlink Worldwide merged its resource centre with that of the Centre for International Child Health to form the Source International Information Support Centre. Increasingly, Healthlink Worldwide staff have been using their skills and experience to carry out consultancy work for other organizations. Another development in 2001 was the introduction of a Friends of Healthlink Worldwide scheme that allows individuals to support the organization’s work financially. Partners: Healthlink Worldwide works in partnership with national and local governments, NGOs, and academic institutions in more than 20 countries to support locally appropriate health information and training activities. For full list, access website.3 Source: Healthlink Worldwide web site and various Healthlink Worldwide pamphlets and newsletters sent to The CI. For more information contact: Healthlink Worldwide, Farringdon Point, 29-35 Farringdon Road, London ECIM 3JB, UK. Phone: +44 171 242 0606 fax: +44 171 242 0041 e-mail: firstname.lastname@example.org website at www.healthlink.org.uk 1 http://www.healthcomms.org/ 2 http://www.healthlink.org.uk/about/annualreview.html 3 http://www.healthlink.org.uk/partners/html 93 SECTION 2 - SOCIAL DEVELOPMENT, EDUCATION, AND ADVOCACY Healthy Russia 2020 - Russia Development Issues: Health, Reproductive Health, HIV/AIDS, TB, Women, Children, and Youth. Programme Summary In 2002, The Johns Hopkins University Center for Communication Programs (JHU/CCP) and its partners (The Futures Group International and Analytical Sciences Inc., or ASI) launched Healthy Russia 2020, a five-year programme using networking and web-based efforts to help Russian institutions improve the health of their people. Health indices for Russia have declined sharply over the last decade in large part due to unhealthy lifestyle behaviours. HIV/AIDS and TB epidemics are also growing and the health of women and children is declining. What observers have noted, however, is that the Russian health system is not oriented towards prevention. Healthy Russia 2020 takes public health communication to a higher level in an innovative, comprehensive and strategic health education and behavioural change program. “The overarching goal is to bring Russian health indicators to western European levels by the year 2020. The heart of Healthy Russia 2020 will be a membership organization based in Moscow comprised of all professional, government, private, media, and community organizations with a vested interest in improving health in Russia.”1 Goals of the project include promoting healthier lifestyles for young Russians, reducing HIV/AIDS and sexually transmitted infections (STIs), controlling the spread of tuberculosis (TB), and improving the health of women and infants. Summary of ICT Initiatives The central strategy involves helping Russian health-related organizations, young people, and other key groups, by creating a new non-governmental health advocacy organisation. This organisation will focus on strategic communication that includes positive health messages and will involve various partnership-building efforts. Organizers will help this new umbrella organisation promote healthy behaviours by fostering the creation of a Healthy Russia 2020 web portal. The portal will be available in Russian and English. In the first year of the project, the portal will be built for use by citizens, policy makers, health-care administrators, health professionals, and other stakeholders. US partners will provide technical assistance and training to their Russian colleagues who will implement activities focused on: • NGO Development: Creating sustainable structures by forming a thoroughly Russian, member-driven coalition • NGO Membership: Forging a broad coalition by training members through an innovative, entrepreneurial focus on member satisfaction. • Creating a dynamic Web Portal that uses proven techniques to serve a wide range of interactive users. The web portal will facilitate and reinforce behaviour change; enable members and peers to access and share health information and advocacy tools; serve as a locus for distance education; attract members; and mobilize collective action. • Advocacy and social mobilization work with community leaders to create an enabling environment for primary health care innovation and healthy behaviour. • Communication programs to encourage healthy behaviours and to motivate individuals to take responsibility and see themselves as producers, rather than passive recipients, of health. 1 http://www.internetelite.ru/samarari/english/area.phtml?area=areas4&pic=02 94 • Capacity Building linked to the core competencies the NGO and its members need to create a social movement for health. 1 This portal will enhance the activities of groups like Project HOPE who have been operating in Russia for a decade. Their current activities are also focused on creating behavioural changes within the Russian population by developing various drug and alcohol prevention programs, some of which are now disseminated in the school system. These materials may see greater exposure as a result of the enhanced communication channels created by Healthy Russia 2020.2 Futures Group’s activities will include forming an alliance of health services providers into a sustainable health advocacy NGO, and creating a health communication and delivery infrastructure through technical assistance and capacity building. Futures Group will lead the advocacy and community mobilization efforts and an evidence-based medicine component. 3 ASI will support JHU/CCP on Healthy Russia 2020 by designing an Internet Web portal to promote healthy behaviours across the Eurasian country. The team supporting Healthy Russia 2020 will be based in Moscow. ASI plans to hire several programmers and analysts in Moscow to support the project in collaboration with ASI employees from the US. Eventually, ASI will turn over its operation to a non-profit, non-governmental organization or NGO, for ongoing maintenance and expansion. ASI will then serve as a technical advisor to the NGO.4 Healthy Russia 2020 is currently in the process of registering the Russian organizations that will be the engine of the program. They are also creating a web portal that may be up as early as the end of March 2003 with project completion slated for September 2007 5 Partners: JHU/CCP, the Futures Group International, ASI, Deloitte Touche Tohmatsu, Project HOPE, International Research & Exchanges Board (IREX), the Center for Association Leadership, the American Red Cross, the Public Health Foundation, and the National Association of Chain Drug Stores (NACDS). The U.S. Agency for International Development (USAID) is funding the project. Source: Press release forwarded by Lisa Cobb to The Communication Initiative on December 3, 2002; ASI site at http://www.asciences.com/asinews/2002/110902usaid.htm. For more information, contact: Lisa Cobb Program Officer, JHU/CCP Tel.: 410-659-6146 LCOBB@jhuccp.org Ron Hess Associate Director, Center for Communication Programs RHESS@jhuccp.org Reed Ramlow The Futures Group International email@example.com 1 http://www.usaid.ru/en/main/documents/index.shtml?lang=en&id=1051 2 http://www.projecthope.ru/e/eourprogs.html 3 http://www.futuresgroup.com/ 4 http://www.constellagroup.com/news/news%5Freleases/2002/110902usaid.shtml 5 http://www.internetelite.ru/samarari/english/area.phtml?area=areas4&pic=02 95 "Keep Your Head, Wear Your Helmet" Campaign - Bangalore, India Friends for Life Development Issues: Road Safety, Health. Summary The Bangalore-based NGO, Friends for Life, launched a public road safety awareness campaign in 2002 to promote the wearing of helmets among riders of two-wheeled motorbikes in Bangalore. Entitled "Keep Your head, Wear Your Helmet," the advocacy campaign relied on the Internet to create awareness, increase interaction, and foster behaviour change. In addition to individual citizens, the campaign reached out to corporate managers, who were encouraged to bring the message to their employees. The purpose of this campaign is to decrease the number of motor- vehicle-related head injuries. An immediate approach is to encourage people to wear helmets; while a broader goal includes garnering the critical mass needed to influence the government to take steps to build safer roads and develop education programmes for riders and drivers. Friends for Life’s stated objectives are to: 1. To ensure a high percentage of helmet usage among two wheel motor vehicle riders. 2. To develop and improve standards of communication for safety measures. The organizers believe that the web can be an effective medium to address public interest issues and disseminate campaigns that attempt to change behaviours and attitudes through awareness- raising. The Keep Your Head initiative is one of their first efforts in this direction. Summary of ICT Initiatives At the "Keep Your Head" site1, interested citizens and communications and resource managers in corporations may access information on road safety and download resources for initiating their own 3-month helmet safety campaigns. The Communi-Kit contains posters, stickers, logos, and wallpaper. These materials are easily downloadable in either JPG or compressed PDF formats that maintain small file sizes. Informal surveys were conducted prior to campaign launch to assess the underlying reasons for resisting helmet use. Some of those interviewed felt that helmets were a hindrance to visibility; others thought helmets were "uncool" or "uncomfortable", while a few worried they would lose hair due to the poor ventilation. The high cost of reliable helmets, lack of awareness about choosing a good helmet, and insufficient support from the city authorities were other challenges associated with the safety campaign. These materials highlight, among other things, the effects of head injuries. Messages like "Save your head now, or save it for posterity" (accompanied by an image of a brain in a jar) and "Helmets ruin my hair" (on a tombstone) are designed to shock people into taking responsibility for their own safety. Detailed instructions and supporting documents are provided to facilitate independent campaign organization. The website becomes a clearinghouse for easily accessible campaign materials that will facilitate and encourage wider participation. Corporations can use these tools to conduct a campaign on their company's Intranet. In addition, visitors to the site are encouraged to post messages on the site's forum and to spread the word to friends, family, and policy makers in their town. As part of the effort to disseminate information, booths were set up in the premises of interested corporations and public venues. These booths were designed to encourage managers, for instance, to conduct "safety month" programmes in-house. Physicians have participated by posting advocacy material in their offices and in their employee newsletters. Other strategies included urging the Bangalore Traffic Police to post 40 signs with the campaign slogan at prominent traffic points in the city, advocacy efforts to persuade helmet manufacturers 1 http://www.geocities.com/acampaigner 96 to support the campaign by manufacturing safer helmets, and hosting a three-college music concert featuring a local band. In addition, interactive sessions were held at schools, colleges, and corporations. Stickers and merchandise were distributed, and a joint exercise with the traffic police was conducted. Observations This website provides an example of individual activism and the use of ICTs for communication of health information. This campaign is primarily the work of the proprietor and his friend/co-worker and is an outgrowth of their private sector jobs. The campaign continues to gain exposure, with a recent article in a major Indian newspaper the Hindu and increased attention and priority from city and government officials.1 Partners: Friends for Life, the Bangalore Traffic Police, and i-flex solutions limited. Source: Press releases and article ("Keep Your Head While You Ride" in The Times of India, January 24, 2003) sent by Anish V. Koshy to The Communication Initiative on January 25, 2003; "Keep Your Head" site. For more information, contact: Anish V. Koshy Assistant Manager - Corporate Communications, Friends for Life i-flex solutions limited i-flex center 146 Infantry Road Bangalore 560001, India Tel.: + 91 - 80 - 2284300 Fax: + 91 - 80 - 2284313 firstname.lastname@example.org email@example.com "Keep Your Head" site at http://www.geocities.com/acampaigner 1 http://www.geocities.com/acampaigner/news1.htm 97 OneWorld Radio AIDS Network - Global Development Issues: HIV/AIDS, Health, Radio Programme Summary In an effort to promote free exchange of programmes on AIDS/HIV between radio stations worldwide, the online sustainable development network, OneWorld has launched a radio AIDS Network. OneWorld's AIDS Radio portal offers services and networking for broadcasters and civil society organizations that are interested in using radio/audio to promote awareness through the exchange of news and public education on HIV/AIDS. Globally, radio programming is being used to share experiences of those with HIV/AIDS and to give advice on reducing risk and supporting those living with the disease. However, the HIV/AIDS awareness and other audio material produced by NGOs, government agencies, and broadcasters is usually restricted to the geographical area where it has been produced and aired. The network includes 100 member organizations and radio stations worldwide, broadcasters, NGOs, and activists. Summary of ICT Initiatives Located at OneWorld Radio site, OneWorld Radio AIDS Network has a searchable database exchange of audio files that allows broadcasters and other programme producers to upload and download AIDS programming in any language. Radio stations around the world can then rebroadcast this copyright-free material or adapt it for their own audiences. Anyone with Internet access can listen to the programmes online. The impact of this program is especially powerful because of its focus on two-way communications. Member organizations are empowered and their ability to contribute to the global fight against AIDS is enhanced. Innovative programs that would otherwise only be heard in one country receive international exposure and can contribute to other broadcasters development of “new and imaginative” programming. Membership is oriented towards inclusiveness and the network tries to improve the capacity of its partners by offering its members: • Online technical and non-technical training resources • A directory and listing services about communications trainers and courses • A directory of funders and news about upcoming grant prospects The OneWorld Radio AIDS Network website also includes news, training materials, funding information, and other practical resources for national and community broadcasters, health educators, and campaigners as well as people working in AIDS/HIV organisations, aid agencies and development NGOs. The network also provides support and coverage for important activist campaigns. The training materials section provides access to both clinical and communication materials oriented towards combating and dealing with AIDS. A sample search for AIDS related radio programs returned over 350 possibilities in a host of languages, ranging from English to Amharic, Xhosa, and Oromo. The format for the programs is diverse as well, including: • Short Public Service Announcements (PSAs) oriented towards mass media consumption. • Radio dramas and soap operas that communicate important messages about behaviour and relationship practices. • Full-length documentaries that examine the socio-economic impacts of AIDS, the real-life stories of victims and survivors, and clinical practices and strategies for prevention. • Popular music with preventative messages that have resulted from commissioned work on the part of both local organizations and international NGOs. • Talk shows addressing AIDS and lifestyle issues • Children’s Programming 98 OneWorld Network members are supported in their endeavours by OneWorld’s partnership with the World Association of Community Broadcasters (AMARC), an international organization that provides advocacy and capacity building support to local radio-stations and production groups. Observations Radio has proved to be an exceptionally valuable tool in the strategic dissemination of AIDS prevention materials. The Johns Hopkins Center for Communication Programs (JHU/CCP)’s 21 episode program Les clés de la vie: Yamba – Songo (which is featured on the OneWorld site) was shown to be effective in generating positive changes in behaviours and attitudes towards sexual health and AIDS/STD prevention.1 The potential for the exchange of materials and ideas concerning communication strategies is enhanced by the type of broad based sharing of materials and media that is facilitated by the OneWorld Network. Partners: The World Association of Community Broadcasters (AMARC). Source: Press Release sent to the OneWorld Radio Aids Network list server on June 27, 2002; and OneWorld Radio site at www.oneworld.net/radio For more information, contact: AIDS Radio Network, Editor - Siviwe Minyi 14 Poplar Avenue Thornton, Cape 7460 South Africa Tel.: +27 21 534-2235 Mobile: +27 21 82 8981669 firstname.lastname@example.org www.oneworld.net/radio 1 http://aidsradio.oneworld.net/index.php?fuseaction=audio.view&audio_id=3091 99 Delivery of Improved Services for Health (DISH) II Project Centre 4 TV Medical Drama - Uganda Development Issues: Health, HIV/AIDS, Immunization & Vaccines, Youth Programme Summary The purpose of this television medical drama, which was designed by the Johns Hopkins University Center for Communication Programs (JHU/CCP) and partners as part of the Delivery of Improved Services for Health (DISH) II Project, is to weave health information into stories that will engage viewers. The show's 13 episodes, meant to appeal to men and women ages 18 to 35, began airing on TV Africa in Uganda in October 2002. Centre 4 has a potential viewership of 110 million in Uganda and many others in 20 additional African nations. DISH II was initiated to improve the quality, availability, and utilisation of reproductive, maternal, and child health services, and to enhance public health attitudes, knowledge, and practices in Uganda. The programme was implemented in 12 of the country's 56 districts Kampala, Jinja, Kamuli, Masindi, Nakasongola, Luwero, Masaka, Rakai, Sembambule, Mbarara, Ntungamo and Kasese. The overall goals of the DISH Project aimed to: • Make good quality maternal, child and reproductive health services more widely available; • Improve district capacity to support good quality health services; • Encourage healthy practices among individuals, families and communities; • Document, evaluate, and share lessons learned with others.1 The Centre 4 project is one of the centrepieces of DISH II’s Behaviour Change Communication (BCC) component that has the mandate to develop innovative communication methods and resources that address the social and lifestyle issues faced by families, individuals, communities and service providers.2 The BCC strategy is to conduct multi-channel campaigns that direct individuals towards health services and to change behavioural practices. Their programmes often combine new media with standard print materials and are organized along the lines of interlinked themes. Summary of ICT Initiative The drama communicates messages about how to lead a healthier life by following the life-and- death challenges experienced by Ugandan characters. Based in a semi-rural health facility – the Konaweeka Health Centre – the characters address and cope with a variety of health and personal care issues in the community. The episodes address important health issues such as HIV/AIDS, malaria, safe childbirth, childhood immunization, contraceptive options and adolescent health. Many of the episodes are reflections of the themes in other DISH II information campaigns. For example, one of the episodes specifically addressed Norplant contraceptives, an element of DISH II’s Long Term and Permanent Family Planning Methods Campaign.3 The program also addresses issues of personal responsibility among all citizens. The “Bible” or overarching document that guides the storyline contains character descriptions that are archetypes of different attitudes towards responsibility, good will towards others, and differences in view towards the changing structure of society (e.g. traditional vs. modern practices).4 Furthermore, Centre 4 contributes to the challenge to improve proper professional practice amongst the medical community, including issues of corruption. This was matched to the Yellow 1 http://www.ugandadish.org/about.shtml 2 See notes on the BCC’s Promotion of Quality Services/Yellow Star project. http://www.ugandadish.org/DISHIIStrategyforImprovingQualityofCare.doc 3 http://www.ugandadish.org/bcc/ongoing.shtml 4 To download a word document copy of the “Bible” go to <http://www.ugandadish.org/bcc/TheBible.doc> 100 Star program that has been communicating Quality of Care – a multi-channel campaign targeting service providers with the purpose of improving the quality of services. As a behavioural message, Centre 4 covers a wide range of subjects presented in a popular format.1 Centre 4 was produced in Uganda with a Ugandan cast and crew working in partnership with a small production team from England and Mediae Trust, a Kenyan development communication organisation. From programme concept to scriptwriting and direction, the project was an apprenticeship for Ugandan talent. The intention was to establish TV drama production expertise in Uganda so that future productions can be carried out independently. Initial design began in May 2001 with a TV Series Design Workshop for representatives of the Uganda Ministry of Health (MOH) and other health organisations. Message strategies for each episode were based on audience research. The workshop resulted in the message content and background for each of the episodes, and the overall creative concept of basing the series around the staff working in a semi-rural Ugandan health centre. In September and October 2001, flyers publicizing Centre 4 were distributed to major television, video, and stage production houses in Uganda, calling for video production talent to apply for training positions as scriptwriters, directors, sound recordists, camera-persons, editors, and production managers. The three Ugandan scriptwriters participated throughout, and were teamed up with health content specialists from the MOH and the DISH II project. Filming began in February 2002 and continued through May 2002, in Jinja. Partners: DISH II is a partnership between the MOH and a group led by JHU/CCP that included the University of North Carolina Program in International Training and Health (INTRAH), Management Sciences for Health (MSH) and the Johns Hopkins Program for International Education in Reproductive Health (JHPIEGO). The U.S. Agency for International Development (USAID) and the Ford Foundation provided financial support. The Mediae Trust, a Kenyan communication organisation, also participated in the production. Source: JHUCCP site at http://www.jhuccp.org/africa/uganda/dish.shtml Centre 4 page on DISH II site at http://www.ugandadish.org/bcc/designing.shtml For more information, contact: Jane Koehler Johns Hopkins Center for Communication Programs 111 Market Place, Suite 310 Baltimore, Maryland 21202, USA Tel.: (410) 659-6300 Fax: (410) 659-6266 email@example.com 1 For a synopsis of all 13 episodes see <http://www.ugandadish.org/bcc/message.shtml> 101 CECHE - Internet-Based Tobacco Control Network Czech Republic Development Issues: Tobacco, Health, Technology Programme Summary The Center for Communications, Health and the Environment (CECHE) is a private, non-profit, American institution based in Washington, DC. Their mission is to assist under-served communities in the United States and developing nations worldwide by conceptualizing, catalyzing, and supporting programs to improve health and alleviate the adverse health affects of environmental pollution. CECHE is especially focused on the use of mass media and information technology in programs centred around five areas: school-based and community intervention; environment and public health programs and policy; professional training in media and health; public education; and private voluntary sector development. The World Bank's InfoDev program enabled CECHE and its two Czech partners- the Institute of Clinical and Experimental Medicine (IKEM) and the National Institute of Public Health (NIPH)- to launch an Internet-based communications program aimed at tobacco control in the Czech Republic. The main goal of the initiative was to use ICT to heighten public awareness & catalyze the necessary policy change for a tobacco-free environment in the Czech Republic. This goal was achieved through efforts to increase the communications capacity among health and social awareness professionals. Summary of ICT Initiatives Czech partners recruited over 40 District Level Hygiene Stations (DITs) and NGO's to participate as members of the network in the project. A needs assessment survey early in the project revealed that while all the polled organizations can access the Internet (and three have web pages and several have tobacco-control programs), only one, an NGO, has a media advocacy program. All DITs and NGO's expressed a strong need for skills training in email and Internet use, and some requested equipment and software or dedicated Internet phone lines. Project Goals and Objectives • Form an Internet-based network comprising health professionals from Czech DITs, heart disease-prevention NGOs other professionals concerned with tobacco-control. • Train & Enhance Capacity of the organizations and individuals in use of the Internet for research and communication on tobacco issues October 1999; April 2000; June2000; Tobacco-Control Conference • Establish an advocacy and cardiovascular disease prevention NGO (using this network as a mechanism) dedicated to reducing tobacco use and reforming tobacco policies in the Czech Republic. Project Outcomes • A self-sustaining Tobacco-Control Training and Communications Program promoting excellence in communications technology, and regional, national and international linkage and outreach. 1 • Targeted information technology and skills transfer workshops and a Tobacco-Control Conference conducted at the project hub and in various districts of the Czech Republic • A demand-based resource service on tobacco control equipped with high-quality resource materials for the Internet and computerized database and research capabilities that cater to requests • The development of a comprehensive data collection system to support program operations and pre- and post-surveys of knowledge, skills and applications among the participating organizations to assess program impact. • Continuous electronic-media tobacco-control campaigns, which increasingly engage more groups in Czech society in tobacco control. 1 For a sample brochure (PDF) http://www.ceche.org/programs/cze-int/czebroch.pdf 102 • A website with an electronic bulletin board, resource directory, and “What's New” listing. See the homepage at Czech Ministry’s National Institute of Public Health’s website for up-to-date reports on current events. • Monthly electronic bulletins with nationwide and international circulation. • The establishment of an advocacy NGO dedicated to reducing tobacco use and the prevention of cardiovascular disease - the Czech Heart Association (CHA).1 Observations The project shows how specialized knowledge on awareness raising campaigns can be transferred from one country to another by using relatively simple Information Communication Technology (ICTs): Email and Internet. Evaluation of each workshop and the tobacco control Conference demonstrates that the project accomplished all its major goals, indeed, exceeded them. The CECHE website provides and extensive documentation and comparisons of planned and actual outcomes.2 Organizers also noted the following important lessons:3 • Professional standing and commitment of Czech partners and placing them in leadership roles was key to successful project implementation. • Partnerships with key international organizations and players in the grass roots movement, tobacco control and Internet use ensured needed tools and optimal training. • Partnerships with key local organizations involved in tobacco control within and outside the Czech government are necessary to ensure project viability, wide scale impact and future sustainability of the program. • Collaborating with Czech TV, radio and print media played a central role in enhancing the project's outreach and impact. • Ongoing needs assessment ensured targeted training and project evaluation. The training program encompassed ongoing needs assessment as the network grew. • Periodic project evaluation assisted in mid-course corrections. • Early availability of promotional materials to publicize the project and published programs for workshops could have improved recruitment of participants and dissemination of project. Partners: The World Bank, Centre for Communications, Health & Environment (CECHE) - USA, Institute for Clinical & Experimental Medicine (IKEM) - Czech, National Institute of Public Health (NIPH) - Czech. Also, key international partners UICC-GLOBALink of Geneva, the National Centre for Tobacco-Free Kids & the Advocacy Institute, Financed by the International Bank for Reconstruction & Development-infoDev Trust Grant. Source: CECHE Website http://www.ceche.org/index.html For more information, contact: Dr. Sushma Palmer 4437 reservoir Road, NW, Washington DC 20007 Tel: 1-202-965-5990, Fax: 1-202-965-5996 Spalmer.CECHE.DC@worldnet.att.net 1 See < http://www.ceche.org/programs/cze-int/heart.html> 2 See <http://www.ceche.org/programs/cze-int/impact.html> 3 For a more detailed explanation see < http://www.ceche.org/programs/cze-int/lessons.html> 103 Health Global Access Project Treat Your Workers Campaign - Global Development Issues: HIV/AIDS, Workers' Rights. Programme Summary International Labour Organisation (ILO) statistics indicate that 26 million people living with HIV/AIDS are workers, which amounts to half the current estimated international population of HIV positive people worldwide.1 They note that, against a backdrop of intensified international attention to the pandemic, corporations made a flurry of announcements of new initiatives designed to combat global AIDS in 2001. Coca-Cola was one of those companies. While this and other companies were highlighted in the media for their initiatives, Health GAP claim that they were, in the meantime, "reaping tremendous profit from low-cost African labour...skirting their most fundamental obligation: providing workers, including those living with HIV/AIDS, with health care coverage." In April 2002, Health Global Access Project (GAP) and ACT UP launched a worldwide advocacy campaign to demand a comprehensive HIV/AIDS care and treatment programme for Coca Cola's employees and bottling plant workers in Africa and Southeast Asia. A website dedicated to the campaign encourages activism on the part of citizens in the form of letter writing initiatives, local protests and campaigns, and student activities on campuses worldwide. The purpose of the initiative is to urge change in the health care policies of multinational corporations, as well as to provoke government action in those developing countries hardest hit by HIV/AIDS. Health GAP is a US based NGO composed of human rights activists, people living with HIV/AIDS, public health experts, fair trade advocates and concerned individuals who campaign in an effort to bring corporations and governments to responsibly address the AIDS pandemic. Their aim is to eliminate the barriers to global access to affordable life-sustaining medicines for people living with HIV/AIDS. Their campaign foci include efforts to challenge multinational corporations to provide HIV/AIDS treatment to workers: While Health GAP believes the onus of protecting public health is upon the public sector, the private sector has much to bear on the continued spread and neglect of HIV among communities in which they operate in developing countries. Corporations, such as Coca-Cola and the huge mining concern, Anglo-America, continue to flout the most fundamental need among HIV positive workers in the developing world: the urgent need for access to affordable, life-extending HIV treatment and care.2 Other campaigns Include: • Advocating for funding the Global Fund to Fight AIDS, TB, and Malaria • Reforming US and world trade policies • Fighting for debt cancellation • Pressuring drug companies ACT UP is a decentralized organization based in the US but with a growing number of chapters worldwide that provides a host of information and resources for people living with AIDS and activists working to improve government responses to the AIDS crisis.3 Summary of ICT Initiatives The Treat Your Workers campaign site4 provides information and advocacy tools related to campaign events like these. Tools for activists include a flyer, a student toolkit, "Protest in a Can", art and posters (featuring words like "Neglect Kills...", "Making a Killing...; "Neglect=Death..."; and "Treatment Now"), chants, links, a sample press release, and sample letters meant for Coca-Cola or its shareholders. Here is an excerpt from one such letter: "in Africa, Coca-Cola agreed to pay 1 http://www.ilo.org/public/english/protection/trav/aids/why/index.htm 2 http://www.healthgap.org/hgap/about.html 3 http://www.actupny.org/ 4 http://www.treat-your-workers.org/ 104 for full medical coverage, including treatment with antiretroviral drugs, for any of the 1,500 direct corporate employees or their immediate family members who are HIV positive. However, an estimated 100,000 people are employed by the Coca-Cola system, comprised of fully or partially owned business and other companies that can and bottle your product under exclusive licensing agreements that include quality and operation standards set by Coca-Cola. A limited program such as this that leaves most Coke employees behind, and the consistent practice of minimizing any fair obligations to those workers in order to maximize profits, is unacceptable." The site urges various actions designed to put pressure on company executives. They include organizing local events, holding a press conference, urging one's friends to "dump Coca-Cola", telling one's university or college president that you want Coke off your campus, and getting the word out by placing stickers on Coke machines and posting posters. Observations and Critique With the links to the worldwide network of ACTUP organizations, the campaign is able to bring attention to the issue in a hoist of countries that would not otherwise immediately be able to access the English language only Health GAP website. This global nature of the campaign is necessitated by the global nature of the target MNC and the worldwide consumption of its product. Coke can invariably be found in almost every country in the world and thus any efforts to alter their corporate practices must be equally international. This global networking resulted in demonstrations in New York, Washington, Atlanta, Boston, and Barcelona in the summer of 2002, followed by a Global Day of Action on four continents on October 17, 2002 that was designed to increase pressure on Coca-Cola to commit to a comprehensive and sustainable workplace treatment programme. Sponsors of the Global Day of Protest included: Treatment Action Campaign (South Africa), Pan-African HIV/AIDS Treatment Access Movement (PHATAM), Health GAP, ACT UP New York, ACT UP Philadelphia, Act Up- Paris, ACT UP East Bay, Global AIDS Alliance, European AIDS Treatment Group, Association Marocaine de Lutte Contre le Sida (Association Fighting AIDS), Morocco, The Japan-Africa Forum, Thai Network of People Living with HIV (TNP+), and Student Global AIDS Campaign. 1 Partners: Health GAP, ACT UP, Global Treatment Action Campaign Source: Document "5 Months and Counting: Coke's HIV/AIDS Treatment Program Stalls Before It Begins" forwarded by Sharonann Lynch to the Nigeria-AIDS eForum on March 7, 2003; and Treat Your Workers campaign site at http://www.treat-your-workers.org/ For more information, contact: Sharonann Lynch Health GAP 511 E. 5th St. #4A NYC, NY 10009 Tel: (212) 674-9598 Mobile tel: (646) 645-5225 firstname.lastname@example.org 1 http://www.globaltreatmentaccess.org/content/press_releases/02/092702_HP_PS_KO_announce.html 105 WASH Campaign - Global Development Issues: Health, Women, Children. Programme Summary This global alliance to provide safe water, sanitation, and hygiene was formed by "concerned individuals and organisations that wish to make a difference in alleviating the suffering and improving the health of the world’s poor". Despite modern medical advances, some 1.1 billion people worldwide have no access to a safe water supply; 2.4 billion people have no access to adequate sanitation facilities. Diarrhoea resulting from poor sanitation and hygiene is responsible for the death of more than two million impoverished children each year. Providing access to sanitation facilities, though relatively inexpensive, will halve the death toll. Despite laudable achievements by the sector during the International Decade for Water Supply and Sanitation (1981-1990) to meet these basic needs, there remains a tremendous backlog in terms of the billions of unserved people. Mandated by a United Nations resolution in 1990 to maintain the momentum of the International Drinking Water and Sanitation Decade, the mission of the Water Supply and Sanitation Collaborative Council (WSSCC) is "to accelerate the achievement of sustainable water, sanitation and waste management services to all people, with special attention to the unserved poor, by enhancing collaboration among developing countries and external support agencies and through concerted action programmes." The WASH - Water, Sanitation, and Hygiene for All - campaign aims to raise the commitment of political and social leaders to achieving these goals and effecting the necessary behavioural changes through information and communication channels like traditional and mass media, hygiene promotion in schools, training and building local capacity in communications, and improving networking and research. A special focus of WASH is providing more equitable and affordable services with priority given to the poor, particularly women and children, who suffer the heaviest burden of poverty and sicknesses like cholera due to inadequate sanitation in many developing countries. The campaign is also grounded in the belief that sound hygiene behaviour must be recognised as a separate issue in its own right, with adequate sanitation and clean water as supporting components. The campaign was launched during the International Conference on Freshwater in Bonn, where the Minister of Health joined the Chair of the WSSCC and other officials in a "handwashing" ceremony. This symbolized the fact that the simple, hygienic act of handwashing with water, or even ash, after going to the toilet, can cut diseases by one third and save many lives from diarrhoea and other preventable diseases. Summary of ICT Initiatives WASH activities focus on advocating sanitation, hygiene and safe water practices, promoting appropriate technologies such as rainwater harvesting and other people-centred initiatives, and through holding public rallies, debates and multi-stakeholder dialogues, signing petitions, staging exhibitions, competitions, folk theatre presentations and other public awareness activities, as well as interpersonal communication. Another emphasis of the campaign is the organisation of activities for collating, distilling, and abstracting science-based knowledge for wider audiences beyond technical professionals. Information about people’s own initiatives and field experiences, as well as innovative practices by communities in finding solutions to sanitation-related problems, is collected and exchanged. One of the key advocacy tools for the campaign will be a "People’s Report" on sanitation and hygiene to be published by the Collaborative Council and its partners as a contribution to the World Summit for Sustainable Development in Johannesburg, South Africa in September 2002. WASH also works to build collaborations across sectors and disciplines, like the media. 106 Strategies to partner with the media include outreach and regular contacts with journalists and their associations, press conferences and briefings, internet-based media, dissemination of materials, co-productions on video news releases, radio and TV documentaries, and training of both experts and journalists to engender responsible and accurate coverage of water and sanitation issues. They have recently produced a guidebook for journalists and members of the media entitled, “A Guide to Investigating One of the Biggest Scandals of the Last 50 years,” in an attempt to direct more attention towards this pressing problem. They have also developed the following “hygiene Code” with which to guide attempts at rectifying this wholly unnecessary problem.1 This hygiene code represents a massive communications challenge in which the media has a key role to play. The HYGIENE CODE 1. All faeces should be disposed of safely. Using a toilet or latrine is the best way. 2. All family members, including children, need to wash their hands thoroughly with soap and water or ash and water after contact with faeces, before touching food, and before feeding children. 3. Washing the face with soap and water every day helps to prevent eye infections. 4. Water should be drawn from a safe source if at all possible. Water containers need to be kept covered to keep the water clean. 5. Raw or leftover food can be dangerous. Raw food should be washed or cooked. Cooked food should be eaten without delay or thoroughly reheated. 6. Food, utensils and food preparation surfaces should be kept clean. Food should be stored in covered containers. 7. Safe disposal of all household refuse helps prevent illness. Source: The WSSCC site @ www.wsscc.org For more information, contact: Water Supply and Sanitation Collaborative Council 20 Avenue Appia CH-1211, Geneva 27 Switzerland Tel.: +41 22 791-3517/3544 Fax. +41 22 791 4847 email@example.com www.wsscc.org In New York: Ms. Eirah Gorre-Dale Communications and External Relations Manager, WSSCC c/o UN DESA, Water, Natural Resources and SIDS Branch Division for Sustainable Development DC2-2018 New York, NY 10017 Tel.: +1(917) 327-2420 Cell: +1(914) 309-5491 Fax: +1(917) 327-3391 firstname.lastname@example.org 1 http://www.wsscc.org/download/WASH%20Media%20Guide%203.pdf 107 AIDSMark – Global Population Services International Development Issues: HIV/AIDS, Gender, Health, Family Planning, Youth. Programme Summary The U.S. Agency for International Development (USAID) and Population Services International (PSI) signed an agreement for a five-year extension of AIDSMark, a global project that uses social marketing to try to curb the spread of HIV/AIDS and other sexually transmitted infections (STIs). A nonprofit group based in Washington, D.C., PSI is a leading social marketing organization in the world, with programs in more than 70 countries. PSI uses social marketing to deliver health products, services and information that enable low-income and other vulnerable people to lead healthier lives. This agreement will extend AIDSMark activities until 2007. AIDSMark operates in 29 countries in an effort to prevent mother-to-child HIV transmission (MTCT), to delay sexual debut among youth, and to franchise services to treat STIs. All of these programmes operate condom social marketing projects, 14 deliver voluntary counselling and testing (VCT) services, and three offer STI services. Summary of ICT Initiatives Social marketing is a powerful tool designed to empower low-income people to lead healthier lives. Social marketing harnesses existing commercial and non-profit channels to get people the information they need, to make health products and services widely available at low cost, and to motivate people to use them and engage in other healthful behaviour.1 PSI HIV/AIDS prevention social marketing programs are about changing behavioural norms. In countries where PSI conducts HIV/AIDS prevention activities, branded condom social marketing activities—which invoke the condom's brand name—are accompanied by generic communication campaigns that educate and induce such healthy behaviour as abstinence, delay of sexual relations, mutual fidelity and correct and consistent condom use. PSI’s use of new media technologies such as low cost television and video production is an important supplementary tool to the one-on-one communication methods used to impart information. In many rural areas, these tools are enhanced by their novel nature. AIDSMark collaborates with USAID missions and other international donors, as well as with host governments, nongovernmental organizations, and commercial enterprises, to: • Broaden current programs to include a wider range of products and services. • Scale up programs to reach additional target groups and to intensify efforts within current target groups. • Increase the capacity of programs in such areas as management, marketing, communications, research, and sustainability. • Start new programs. AIDSMark campaigns - which use mass media, peer education, school programmes, community theatre, mobile multi-media events, and training sessions - encourage healthy lifestyles and behaviours while communicating risks. The AIDSMark programmes also attempt to alter some social practices and to explode cultural myths and other barriers to condom use, often by enlisting local leaders and peers of high-risk populations.2 Examples of programmes, which are designed on the basis of the results of quantitative and qualitative research, include: 1 http://www.psi.org/about_us/our_method.html 2 “Changing Behavior, Improving Lives” at http://www.psi.org/resources/pubs/aidsmark.pdf 108 • The design, marketing, and dispersal of pre-packaged kits and syndromic case management via existing health-care service providers to treat male urethritis due to STIs in Sub-Saharan Africa. • Education campaigns focusing on parent-child communication that address teenage girls with multiple or older partners. • Operation Lighthouse - a drop-in centre in India for peer education in AIDS prevention, condom use, health risks to sex workers, and condom negotiation. Involves working with street magicians, taxi drivers, film stars, and bartenders to deliver messages to sex workers and their male clients on the streets. • Youth programmes that include: Take It With You (Russia) - youth campaign promoting HIV prevention and condom use through a youth-oriented website; Youth Alert! (Malawi) - focuses on abstinence and safe sex through radio, telephone help lines, street theatre, and educational events at secondary schools; and Club Cool (Haiti) - 24 centres publish a youth magazine called Journal Jen Yo and sponsor concerts, parties, and discussion forums. • The marketing of AIDSMark brand condoms - features pop stars and models and works to overcome cultural and other barriers to condom use by, for example, enlisting community leaders and using area-specific proverbs in posters. AIDSMark focuses on less traditional points of sale like bars, hotels, gas stations, and cinemas. Observations According to AIDSMark, the first four and a half years of the original agreement led to an increase in the monthly client flow in the VCT programme in Zimbabwe from 230 to 4,000. AIDSMark now has VCT programs in 14 countries. AIDSMark's pilot MTCT programme in Haiti began in March 2002 by testing 16 women; by May that number reached 400. In addition, AIDSMark assisted nine new countries in 2002: Bolivia, Bosnia, Botswana, Bulgaria, Croatia, El Salvador, Guatemala, Mozambique and Nicaragua. In the next five-year phase, AIDSMark continue to develop its MTCT and VCT marketing models. It will also refine communications strategies that address barriers to HIV/AIDS prevention on a regional or global basis. In Africa, for instance, AIDSMark is designing a pan-African campaign addressing key obstacles to behaviour change, such as trust in one's partner. Also planned is an assessment of male circumcision (MC) programmes in Western Kenya and Haiti, followed by a launching of two pilot MC programmes. Partners: USAID, PSI, DKT International, Family Health International (FHI), International Center for Research on Women (ICRW), International Planned Parenthood Federation (IPPF), Management Sciences for Health (MSH), Program for Appropriate Technologies in Health (PATH). Source: Press release sent by David Olson to The Communication Initiative on July 1, 2002, and the PSI website at www.psi.org For more information, contact: Population Services International (PSI) 1120 19th Street, NW Suite 600 Washington, DC 20036 Tel.: (202) 785-0072 Fax: (202) 785-0120 email@example.com www.psi.org 109 AIDSWEB Project - Africa Development Issues: HIV/AIDS, Youth, Technology. Programme Summary Launched in 1998, the AIDSWEB project is an effort on the part of the World Bank Institute's ICT for Education programme (formerly the World Links for Development Program) to offer secondary-school students training and access to technology, accurate information about HIV/AIDS, and guidance in initiating and sustaining action to combat the disease through national and cross-national partnerships. The project, which addresses 13- to 18-year olds in Botswana, Ghana, Kenya, South Africa, Uganda, the USA, Zambia, and Zimbabwe, is designed to complement existing Ministry of Education and NGO HIV/AIDS education prevention campaigns. Summary of ICT Initiatives Many of AIDSWEB's educational and peer-based activities involve use of ICTs. Once signed up to participate, each student and teacher fills out an online introductory questionnaire, which is also used by the project facilitator - a reproductive health consultant - as a pre-test. Then participants work through five online educational goal activities (i.e., Cultural Exchange, Basic Facts of HIV/AIDS, the Importance of HIV/AIDS, the Challenge of HIV Prevention, and Social Action) that allow them to explore myths and misunderstandings, conduct research, and discuss how they can prevent HIV in their own lives and communities Community action is encouraged through the Social Action component of the programme. Students are guided in developing an HIV/AIDS action plan, which might include working with Parent-Teacher Associations, establishing income-generating projects for peers, and inviting testimonies from people living with HIV/AIDS. The project also works to increase the quantity and quality of HIV/AIDS educational materials in schools. A CD-ROM with HIV/AIDS-related information drawn from existing online material was produced for schools with slow or no Internet connections. In addition, efforts have been made to help adapt locally produced print-based HIV/AIDS educational material for electronic dissemination via CD-ROM and the AIDSWEB site.1 Training materials designed to integrate computer and Internet literacy training material with HIV/AIDS examples were delivered by ICT for Education-trained teachers to HIV/AIDS-oriented NGOs and peer educators accessing the school-based telecentres in the after-school hours. AIDSWEB works to enhance links between schools and community NGOS working on HIV/AIDS, and to help students make communication-based connections for future action. For example, a partnership with a Zimbabwean NGO called the Training and Research Support Center (TARSC) has made available an adolescent reproductive health activity pack, "Auntie Stella" which features 30 question and answer cards based on the letters sent to magazines and radio helplines.2 In addition, teachers and students at West African Secondary School in Ghana have linked up with AIDS Action Ghana, a national NGO, to train peer educators. The programme finds ways to send teachers, students, and others to relevant conferences. For instance, 30 teachers, NGO, and government project participants attended an HIV/AIDS Materials Review Workshop in Cape Town, South Africa, in July 2001. AIDSWEB also hosts its own conferences. In October 2002, an international workshop was held to explore the role of ICT in HIV/AIDS prevention activities. Follow-up activities, like development of pilot projects for online counselling, are taking place at the local level. Observations Three-quarters of the 400 ICT for Education Program Internet Learning Centers in Africa are located outside of capital cities. In order to continue to serve rural youth, new technologies such 1 http://www.worldbank.org/worldlinks/aidsweb/index.html 2 See the “Auntie Stella” site at <http://www.tarsc.org/auntstella/index.html> 110 as mobile van telecentres and the use of satellite technology for connecting rural schools with high-speed Internet connectivity are being pilot-tested. Teachers who have participated in the project report that it has raised awareness of HIV/AIDS issues among their students, enhanced research skills, helped the integration of HIV/AIDS education into school curricula, and helped emphasise the role of the teacher as a facilitator. AIDSWEB currently serves approximately 500 youth in 70 schools in 8 African countries. An independently administered survey and a series of interviews in 2002 culminated in a evaluation that noted that:1 • Access had improved, though more so for boys - Students who were not in the programme were almost 6 times more likely to have less than 1 hour of computer access in the previous month. In the intervention group, 51% reported having more than 4 hours of computer access in the previous month compared to 23% in the control group. AIDSWEB enabled computer and Internet access for a greater percentage of boys than girls. 2% of the boys in AIDSWEB schools had no access to the computer, as compared to 30% of boys in non-participant schools. 11% of girls in the AIDSWEB programme had no computer access, as compared to 38% of girls in non-participant schools. • Positive Knowledge shifts occurred - AIDSWEB students were almost twice as likely to correctly identify all 4 methods of AIDS prevention and transmission. These results were consistent across most countries. • Community practices improved - 63% in the control group and 85% of the intervention group responded that they helped their communities by sharing information about HIV/AIDS with family, friends, and/or health workers about HIV/AIDS; volunteering with local organisations or health clinics/hospitals; or developing a social action plan. AIDSWEB students were more than twice as likely to develop social action plans. Partners: ICT for Education (part of the World Bank Institute), World Links, iEARN, Schools Online, Education Development Center, Knowledge Economy (part of the World Bank), SchoolNet Uganda, The United Negro College Fund's Specials Projects programme, US Department of State's Bureau of Educational Cultural Affairs. AIDSWEB involves schools in Ghana, South Africa, Uganda, Zimbabwe; Botswana, Kenya, Nigeria, the US, and Zambia. Microsoft contributed software to participating countries/schools. Source: Letters sent from Anthony Bloome to The Communication Initiative on June 18, 2002 and February 26, 2003; and posting "AIDSWEB: HIV/AIDS and ICT Project Update (Winter 2003): ICT for Education Program World Bank Institute Human Development Division (WBIHD)" by Anthony Bloome to the Global Knowledge Development list server on February 20, 2003. For more information, contact: Anthony Bloome AIDSWEB Project Coordinator ICT for Education Program, WBIHD Tel.: (202) 473-2282 firstname.lastname@example.org AIDSWEB site at http://www.worldbank.org/worldlinks/aidsweb/index.html 1 "Evaluation Report of WBIHD’s ICT for Education AIDSWEB Project" (prepared by ENCOMPASS LLC, November 23, 2002), forwarded by Anthony Bloome to The Communication Initiative on February 24, 2003; and "AIDSWEB: HIV/AIDS and ICT Project Update (Winter 2003): ICT for Education Program World Bank Institute Human Development Division (WBIHD)", posted by Anthony Bloome to the Global Knowledge Development list server on February 20, 2003. 111 Training and Research Support Centre – Zimbabwe Auntie Stella Project Development Issues: Youth, STI’s, sexual health. Programme Summary TARSC is a Zimbabwean non-profit organization that provides training, information, research and capacity building assistance to organizations concerned with public health, social policy, food security, reproductive, gender and child rights and government relations.1 TARSC seeks to provide other non-profits with access to the information necessary to enhance their own service delivery and efforts to contribute to development. Many of TARSC’s publications and materials are available for download over the Internet, including an innovative program aimed at youth known as “Auntie Stella” – a component of their Adolescent Reproductive Health Project (ARHEP). ARHEP arose out of work undertaken by TARSC since 1993 in the area of reproductive health rights. TARSC identified adolescent reproductive health as a key area for follow-up work. After 1997 ARHEP began investigating the level of information, perceptions and concerns of adolescents on reproductive health and on ways of providing information to adolescents. ARHEP undertook participatory research studies in secondary schools that showed that while adolescents are subject to strong social, economic and peer pressure in many areas of their reproductive health, they lack sources of open and reliable support and information. Summary of ICT Initiatives Auntie Stella was an activity pack developed by TARSC designed to encourage young people, aged 13 to 17 years, to discuss important issues concerning their mental, physical and sexual health. It also provides teenagers with otherwise difficult to find information about pressing issues. The activity pack has been recently developed into a website that facilitates the programme’s usage.2 There are now over 30 “questions” that cover issues such as relationships with parents, dating, sex, gender roles, HIV/AIDS and STDs. The objectives of the Auntie Stella website are:3 • to encourage young people to discuss key issues related to physical and emotional aspects of adolescence, relationships, family life, etc, and to get reliable information and advice that is hard to find elsewhere. • to enable teenagers to talk to others in the region and elsewhere and share ideas, experiences and concerns, through the internet. • to create a non-authoritarian activity and an atmosphere where young people will be able to talk to each other freely and without inhibition. • to give young people information and advice that will help them to change their behaviour and make more informed decisions in their lives. • to encourage young people to express their own problems and questions, and to guide them towards further sources of information and help where they need this. • to provide support and extra resources for schools and youth organisations. Both the print and website versions use the question and reply format of problem page letters written to agony aunts in magazines, a popular source of information for young people. The basic method is for a question letter to be read and the problem discussed, usually in small single-sex groups, or by individuals reflecting on their own. They then turn to Auntie Stella's reply for expert information and suggestions about how to apply any new knowledge in real life, followed by discussion on ways to change their behaviour. TARSC developed the content of the letters after review and research in several pilot schools. The questions were modeled to the real information needs identified by students. The project employed a participatory (PRA) methodology that encourages all students to learn through discussion, interaction with each other, and through reflection on their own actions. The material 1 http://www.tarsc.org 2 http://www.tarsc.org/auntstella/index.html 3 http://www.tarsc.org/auntstella/html/glossary.htm 112 has been widely used in schools in Zimbabwe, as well as in AIDS support organisations, youth centres, sports clubs, child abuse support centres, family planning centres, and church and debating clubs. The website provides a glossary of terms so that youth are better equipped to discuss the issues that are brought up by the questions. The electronic version also utilizes a web-based bulletin board that allows participants to engage in a much larger dialogue with other youth in different regions of the country, a feature that facilitates cross-cultural communication because of the different tribal groups in Zimbabwe and the variety of marital and courtship practices that are observed, many of which become the topics of Auntie Stella questions. Observations Two evaluations of the project were conducted in 1999 that produced extensive findings and several lessons. Observers noted the following changes in some of the student groups who had been working with the activity-pack: 1 • An increase in communication with their peers, parents and community members • Greater confidence and ability to make informed decisions and take initiative • An increased ability to advise their peers on a range of reproductive health issues There was a general feeling from boys, girls and teachers that the ‘Auntie Stella’ pack has had a positive impact on reproductive health behaviour. In addition the following lessons relating to the pack and the PRA method were also noted. • PRA is an excellent approach to working with young people. It breaks down barriers between adults and youth, between boys and girls. • Students and teachers acknowledged that the letters reflected real problems faced by the students. The success of the PRA pilot process emphasizes the importance of designing educational materials only after serious dialogue with the end-users themselves. • Involvement of representatives from government, non-governmental and community groups from the health, education and gender sectors in the production of the ‘Auntie Stella’ pack deepened the work of this programme. • The role of the teacher, as defined in the ‘Auntie Stella’ pack, deepened the debate on how to implement a successful reproductive health education programme in the schools. Sources: TARSC website, Partners: Zimbabwean Ministry of Education, Sports, and Culture and the Ministry of Health, World Links Organization, Insiza/Umzingwane ASOs, SAfAIDS For more information, contact: Barbara Kaim Adolescent Reproductive Health Project (ARHEP) Training and Research Support Centre (TARSC) 47 Van Praagh Avenue, Milton Park Harare Zimbabwe Tel: 263 - 4 - 705108 Fax: 263 - 4 – 737220 1 The following material was sourced from the internal review: Kaim & Ndlovu “Lessons From ‘Auntie Stella’: Using PRA To Promote Reproductive Health Education In Zimbabwe’s Secondary Schools.” (November 1999) at < http://www.tarsc.org/docs/lessons.pdf > an external evaluation that supports these findings is also available at < http://www.tarsc.org/docs/eval.pdf >. 113 Positive Lives, Positive Responses to HIV – Global Development Issues: HIV/AIDS, Western Public perception. Programme Summary Positive Lives1 is an international project that aims to challenge the myths and prejudices surrounding the HIV/AIDS epidemic by presenting visual stunning photographs and stories that accurately convey the social and emotional impact of the global HIV/AIDS crisis. The project aims to disrupt many of the prejudices that are associated with people living with AIDS and to bring increasing attention to the global costs. The organizers, photographers and writers who are associated with the project believe that AIDS is a misunderstood disease that is shrouded in fear and places those living with it in an environment of isolation and stigmatism. The intent is that presenting the images and stories of individuals living with the disease will contribute to increased understanding and greater calls for action around the globe. This effort capitalizes on the age-old adage that a picture speaks a thousand words. Summary of ICT Initiatives The Positive Lives materials provide training workshops, outreach initiatives, health and education programmes and awareness raising efforts with a powerful set of tools for communicating the HIV/Aids experience. The material can be developed into various formats and have been used in both large and small exhibitions, posters and laminate displays, web sites, videos, books and other publications. Large exhibitions have served as backdrops for major international conferences on AIDS around the world and help to put a human face to the suffering and tragedy inflicted by the disease. The main intent of the materials however is not to present the messages to individuals already strongly linked to the project but rather to expand awareness about the epidemic to broader range of audiences. The project has also seen its materials displayed in a host of public forums that are hoped will contribute to changes in public opinion. Some of then locales have included: • Land and port trucking centres in Bangladesh • In major city-centre malls in the Philippines • Calcutta railway station in India • Displays at brothels in Bangladesh • Housing estates in Hong Kong • Girl Guides campfire workshops in Taiwan • Libraries in Singapore One of the strengths of this project is the diversity of stories, personal testimonies, and images collected by the network of photographers. The images help to unveil the workings of the disease from inner cities in the US to small rural villages in Cambodia. By presenting a collection of materials that cuts across geography, culture and the North – South, divide, this project bridges the global understanding of the AIDS epidemic. The website also provides links to several other projects of a similar nature that seek to document the epidemic. Partners: Levi Strauss Foundation, Terrence Higgins Trust, Network Photographers, ActionAid Source: www.positivelives.com For more Information Contact email@example.com Tel +44 (0) 20 7739 7635 1 www.positivelives.com 114 Oral Rehydration Therapy - India Development Issues: Health and Nutrition, Children, Youth, Diarrhoea, Women Programme Summary Results from a series of studies indicated that, despite a vigorous Oral Rehydration Therapy (ORT) Programme in India for more than a decade, knowledge and use of ORT to treat childhood diarrhoea remain quite limited. Very small percentages of children who fall sick with diarrhoea are treated with oral rehydration salt (ORS) packets, recommended home solution (RHS), or increased fluids, despite the fact that 61 percent of these children receive treatment from a health facility or provider. In the NFHS, among children born 1-47 months before the survey who had diarrhoea in the last two weeks, 18 percent were given ORS and 19 percent were given RHS. Considered together, only 31 percent were given ORS or RHS.1 Among those who receive treatment from a health facility or provider, a very large proportion (94 percent) are treated with antibiotics or other anti-diarrhoeal drugs, contrary to WHO recommendations that drugs not be used to treat diarrhoea in young children. The use of drugs is common among both public- and private-sector providers but is more common in the private sector. This project is one of many sponsored by India’s Ministry of Health and Family Welfare which provides national and state-level estimates of fertility, infant and child mortality, family planning practice, maternal and child health, and the utilization of services available to mothers and children. Community-level mass media and rural group education were stressed in this multi- media programme promoting ORT and RHS. Summary of ICT Initiatives Radio, television, exhibitions, drama, song performance, and cinema were all used to promote the use of ORT and RHS. Spot messages on electronic media educating mothers and communities about home management of diarrhoea were broadcast regularly. Observations The analysis indicated that mother’s exposure to electronic mass media increases awareness and use of oral rehydration therapy. Women regularly exposed to radio, television, or cinema are much more likely than unexposed women to know about ORS packets and to use ORS, RHS or increased fluids to treat childhood diarrhoea. Both mothers and health-care providers are not well informed about the proper treatment of childhood diarrhoea. In rural areas, community-level mass media and group educational activities have positive effects on knowledge and use of ORT, independent on exposure to mass media and other socio-economic and demographic variables. Discrimination was seen against girls in the use of ORT. The following data was extracted from the most recent evaluation in November 1998: Access: 39% of women access radio at least once a week, 27% watch television once a week and 14% go to the cinema hall or theatre at least once a month. 48% are regularly exposed to at least one of the electronic mass media. 52% are not exposed regularly. Knowledge Shifts: Only 43% of women giving birth four years before the survey knew about ORS packages, ranging from 20% knowledge to greater than 70%. 56% of exposed women knew about ORS compared to only 32% of exposed women. Practices: About 25% of women had ever used an ORS. Among children receiving treatment for diarrhoea, public health facilities or providers were more likely to recommend ORS or RHS (45% of the time) than those from private-sector (37% of the time). 20% of children were treated with ORS by exposed mothers as opposed to only 15% among unexposed women. 22% of children 1 NFHS Subject Report No. 10 (1998). At <http://www.nfhsindia.org/research.html> 115 were treated with RHS by exposed mothers compared to only 16% of unexposed mothers. Partners: Ministry of Health and Family Welfare, International Institute for Population Sciences, East-West Centre Program on Population, Macro International, 18 Population research Centres, United States Agency for International Development (USAID) Source: K. V. Rao, Vinod K. Mishra, and Robert D. Retherford. Knowledge and Use of Oral Rehydration Therapy for Childhood Diarrhoea in India: Effects of Exposure to Mass Media. National Family Health Survey Subject Reports, Number 10, November 1998. International Institute for Population Sciences website at http://www.iipsindia.org/ National Family Health Survey website at http://nfhsindia.org/index.html For more information, contact: International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai - 400 088, India. Fax: 91-22-556-3257 E-mail: firstname.lastname@example.org 116 loveLife - South Africa Development Issues: Youth, STD’s and HIV, Reproductive Health, Gender Summary loveLife is South Africa’s national HIV prevention programme for youth. It is a multi-media, edu- entertainment programme aiming at positively influencing adolescent behaviour to reduce teenage pregnancy, and STD’s including HIV/AIDS. A collaborative program between international foundations working in HIV/AIDS prevention, major South African media organizations and private corporations, the government of South Africa, and leading South African NGOs aimed at youth aged 12-17. Launched in September 1999, loveLife seeks to substantially reduce the HIV infection rate among young South Africans – and to establish at the same time a new model for effective HIV prevention among young people. loveLife’s approach integrates three key components: • Innovative nationwide media campaigns of unprecedented scale and intensity, including youth-focused television and radio programming, weekly youth news sheets, billboards and taxis that promote sexual responsibility and link young people to counselling and clinical services. • Service and support programmes, including a network of youth centres that provide HIV prevention services, and accessible adolescent health services in public clinics nationwide. loveLife also works with over 100 community-based organisations know as loveLife franchise-holders. • Extensive monitoring and evaluation of the programme’s impact and results, with independent external oversight. Summary of ICT Initiatives loveLife combines well-established public health approaches with innovative marketing techniques, reaching young people by: • Speaking in language that young people relate to and understand • Using a tone of optimism, rather than relying on scare tactics – which have little credibility with youth • Harnessing the power and influence of South African’s youth culture, including television, music, and sports to promote healthy living loveLife’s projects are diverse and multifaceted and attempt to communicate with youth using a powerful mixture of advanced ICTs as well as personal interactions between young people. Throughout all of its projects it attempts to convey the feeling of youth talking to youth. Programmes include: • Radio - With radio reaching 97% of the populace, loveLife produces weekly radio programs on South Africa’s most popular youth radio stations and partners with radio stations that broadcast in all eleven official languages to broadcast culturally sensitive programmed segments on popular shows. • Print - loveLife’s radio and television programming are supported by print materials, produced and distributed through cost-sharing partnerships with media companies and include S’camtoPRINT, a youth lifestyle magazine published and distributed nationally; loveFacts, a youth orientated booklet encapsulating information and advice on sexual health topics, Tell Me More, a glossy-format booklet tackling a range of youth issues; and Love them Enough to Talk about Sex, a booklet designed to help parents and educators understand the importance, of discussing issues of sexuality with their children • Three of every four South African households have access to television, and television programming is a key component of the loveLife strategy. loveLife’s television programming includes: S’camto groundBREAKERS, a weekly television series on South Africa’s leading youth network which evolves to meet current viewing trends. S’camto means “talk about it,” 117 episodes feature young South Africans talking candidly about issues such as HIV/AIDS, sexual health, relationships, and overcoming peer pressure. loveLifeGames, a weekly half- hour television show that documents loveLife’s major sports competition. Parent-focused public service announcements, airing on television and radio nationwide, that encourage parents to communicate openly with their children with the tag line, “love them enough to talk about sex.” loveLife maintains an operating partnership with the South African Broadcasting Corporation including joint campaign development and coproductions on radio and television. • Web - loveLife’s youth website www.lovelife.org.za, is an interactive source of information about sexual health and loveLife’s services. Although Internet access is still relatively limited in South Africa, the site averages 50,000 hits per month and has interfaces for young people, parents and organisations. Observations loveLife has had a measurable impact on the behaviour and awareness levels of many young Africans Over three years into the programme, loveLife is already making a difference in the lives of young people. A survey conducted in 2001 by Africa Strategic Research Corporation and the Henry J. Kaiser Family Foundation found that: • 62 percent of young South Africans say they have heard of loveLife. Awareness of loveLife is high among young people in all key demographic groups, including urban and rural youth. • 89 percent say loveLife is good for South Africa’s young people • 76 percent say loveLife made them more aware of the risks of unprotected sex • 67 percent say loveLife caused them to talk to their friends about sex and relationships • 65 percent report making behavioural changes as a result of loveLife • 69 percent say loveLife has caused them to abstain from sex or reduce their number of sexual partners • 78 percent say loveLife has caused them to use condoms Partners: Planned Parenthood Association of South Africa, Reproductive Health Research Unit, Advocacy Initiatives, Media Training Centre, Health Systems Trust, Henry J. Kaiser Foundation, William H. Gates Foundation, Old Mutual, The Department of Health, The National Youth Commission, UNICEF, SABC, The Sowetan Source: loveLife website at http://www.lovelife.org.za/corporate/index.html For more information, contact: 174 Oxford Road Melrose 2196 PO Box 45 Parklands 2121 Tel: +27 (11) 771-6800 Fax: +27 (11) 771-6801 Email: email@example.com Or Michael Sinclair E-mail: MSinclair@kff.org 118 WorldSpace Foundation Satellite Broadcasting - “Africa Learning Channel” Development Issues: Technology, Education Programme Summary WorldSpace Foundation provides satellite broadcasting directly to radio and multi-media receivers at low cost in Africa. Summary of ICT Initiatives The flagship project, "Africa Learning Channel" delivers distance education and social development information via satellite to radios in rural and isolated regions of Africa. A collaboration with UNICEF brings multi-media social development and educational material to community information centres that have no phone lines and hence, no Internet connection in Sudan. In Bankilare, a community in Niger, the community has set up the Bankilare Community Information Center (CIC) for the broadcast of their local radio station. They supplement their local information with a translation of the national and worldwide information from the ALC WorldSpace broadcast. In addition to the audio service, the ALC transmits text-based multimedia information such as web p[ages and CD-ROM content, targeting specific audiences in regions where Internet connections are unreliable and/or prohibitively expensive. Observations Endowed with 5% of the capacity on each of three WorldSpace satellites, WorldSpace Foundation has been working in Africa since 1999 and will soon begin its work in Asia/Pacific. The Foundation expects it work in Latin America and the Caribbean to begin in late 2002. WorldSpace Foundation produces the Africa Learning Channel by collecting programme content from African groups on a variety of topics and then post-producing the material for transmission on the satellite. In exchange, the foundation places digital receivers with partner groups at low cost, and ensures the dissemination of the groups' programming to a much wider audience than traditionally possible. The digital receivers are portable and can operate using batteries only. IN some areas, they have been successfully adapted to run on solar power. Currently (late 2000), the ALC has an estimated audience of 1.2 million people based on reports from partners in 21 African countries in which close to 1000 receivers have been placed. Partners: UNICEF Source: "WorldSpace Foundation and UNICEF's Operation Lifeline Sudan - Using Innovative Communication Technology for Social Development" and "The Bankilare Experience: An Example of a Successful Collaborative Effort to Bridge the Digital Divide Using New and Innovative Technologies" - both by Ros Tchwenko (firstname.lastname@example.org), and the WorldSpace Foundation website at www.worldspace.org For more information, contact: WorldSpace Foundation, 2400 N Street, NW, 5th Floor Washington, DC 20037, USA. Telephone: +1-202-861-2261 Facsimile: +1-202-861-6407 email@example.com www.worldspace.org 119 Reflect and ICT, ActionAid – Uganda Development Issues: Education, Literacy, HIV/AIDS Programme Summary Reflect is an original approach to participatory adult learning and social change that was developed and pioneered by the UK-based NGO ActionAid in developing countries in 1993-95. In the programme, groups develop their own learning materials by constructing graphics such as maps, or diagrams, or using forms of drama, story-telling and songs which can capture social, economic, cultural and political issues from their own environment. The goal is to assist in the development of literacy and other communication skills while engaging the participants in thought and dialogue about the issues most pressing to their socio-economic development. Reflect has had considerable success and is widely recognized in the development community, over 350 organizations in 60 countries are utilizing Reflect strategies. Recently, the progenitors of Reflect have turned their attention to how these strategies can be combined with emergent ICTs to improve upon literacy and communication learning and partially bridge the digital divide. Reflect offers a potential basis for introducing ICTs in an equitable way, as part of a wider process of self-managed and directed change for development. The Kabarole, Uganda HIV/AIDS project is one of these pilots. Linkages have been established between Reflect and efforts to strengthen community responses to chronic diseases, and HIV/AIDS. The project aims to explore community coping mechanisms when confronted with chronic illnesses, and to learn about the developmental impacts of terminal illnesses for different members of the community. Reflect will enable community members to strengthen the positive aspects of their coping mechanisms and reduce harmful behaviours and practices within communities. The importance of openness and transparency to demystify HIV/AIDS is also emphasized, with a particular focus on the need for reliable, confidential and trustworthy access to information. Summary of ICT Initiatives HIV/AIDS has been an important element of Reflect work in the area, and links have been made with Strategies for Action, a participatory approach to HIV, sexual health and gender. The organisation currently supports 20 trained facilitators working in 11 village-level circles, mostly involving women, and 6 peer circles for adolescents in local primary schools. The school circles were developed for adolescents to share information and attitudes around sexual health and HIV with their peers away from their parents. Information is currently shared through: • Reflect circles: where people share information and analyse issues directly, and facilitators meet regularly to share lessons and strategies; • Drama groups: have been trained to formulate and communicate issues; • Videos are distributed from district level with key messages on issues including HIV/AIDS and agriculture. They can be costly to distribute and are often produced in other districts or countries; • Religious centres: can be used to disseminate information, including through sermons, counselling services, burials, visits to the sick etc. There are 47 religious centres in an area of only 25 villages; It is envisaged that ICT project will add value in terms of: • Documentation of work done at circle level, so as to enable sharing, access, secondary analysis and monitoring; • Dissemination of information and analysis to decision-makers; • Strengthening local democracy, including budget information and analysis, involving people in government programme planning and implementation; 120 • Strengthening micro-macro linkages, adding outreach to district level initiatives, developing local materials for dissemination, linking reality on the ground to policy making; • Networking and sharing with other organisations and associations to avoid duplication, including Youth Concern; • Building on existing communication work through, for example: o Combining radio, video and telephone for phone-ins - people can ask questions, anonymously if necessary, for the benefit of all; o Replacing or complementing existing information videos with locally produced versions Facilitators and groups will adapt participatory tools to their own context and use them to identify and analyze the information gaps and communication needs concerning HIV/AIDS in the community. The facilitators will then act as intermediaries, introducing Reflect circles to ICTs and their potential uses. Where other ICT initiatives exist within easy distance, groups can make contact with them and find out about their experiences. On the basis of this participatory process, groups will come to a point where they will be able to choose the equipment they would like to have access to, where it should be and how it should be managed, sustained and monitored. According to these requirements, a communication centre will be planned and set up in each pilot location. It is essential that: • Facilitators and communities are not tied to specific targets and objectives. The Reflect circles should determine the usefulness of technologies according to their own analysis; • Facilitators and groups are free to be creative and use and adapt participatory tools as they find appropriate and useful, as long as their activities link in with the project framework and core values; • Facilitators find a balance between guidance and support, bringing in technical advice and expertise at appropriate moments without defining the outcome of the group's analysis. No one person or group should dominate the learning process and thereby reinforce inequitable power structures. Observations This project has just gotten underway in January 2003 and the organizers have laid out a schedule that is to operate in two phases: the first year will be spent developing the capacities of groups to make meaningful choices about the information and communication technologies they need, and how they can be managed and used; the second phase of two years will involve the creation of a communication centre based on those decisions and the monitoring of their use. Finally, a model will be created for future participatory communications technology projects. The organizers are busy with resource development and an early task is for local frameworks to be established, with locally appropriate objectives and strategies based on the overall project framework and values. This will provide an essential working document for each of the pilot teams. Monthly updates of the project’s progress are available on the Reflect website and provide access to ongoing observations and lessons learned. 1 Partners: ActionAid, DFID, local NGO Literacy and Empowerment Source: Reflect and ICT Project website at http://22.214.171.124/Initiatives/ict/home.htm For more information, contact: Hannah Beardon at Hannahb@actionaid.org.uk 1 http://126.96.36.199/Initiatives/ict/updates/home.htm 121 Healthworks Radio, Health Communication Resources Development Issues: Training, Health Promotion Programme Summary Health Communications Resources (HCR) is an outfit of the School of Public Health, Curtin University, Australia that provides consultation, training and programming resources for health and community development agencies, health workers and strategic communication planners. Their mission is to furnish practitioners and planners with the resources that enable and equip them to train others to appropriately integrate radio programmes in holistic health communication strategies. Central to their strategies in the following definition of “health promotion” from their website: “Health promotion can be regarded as a combination of educational, organisational, economic and political actions designed with consumer participation, to enable individuals, groups and whole communities to increase control over, and to improve their health through attitudinal, behavioural, social and environmental changes.” Healthworks is a radio program series for health professionals who want to improve living conditions in their communities. It was produced by HCR and consists of thirteen programs that address a variety of issues of interest to health and social development workers. The Healthworks episodes plus theme music and promo are available to radio stations for download from OneWorld Radio. The majority of the Healthworks information available on the web is directed at the radio station manger, and HCR is focused on circulating the material amongst broadcasters rather than end-users. Summary of ICT Initiatives The Healthworks radio series is for health and social development workers. The series consists of 13 programs full of useful information and is based on a post-graduate course at Curtin University. The shows are widely disseminated through collaboration with OneWorld Radio, a large international website and organization that provides ready access to broadcast quality development related radio programmes for audiences around the world. The audio is in special English, narrated at a slow pace for the convenience of listeners who use English as a second language. Each episode is 15 minutes in length and cover various topics such as: • Principles of health promotion • Differing levels of prevention and their influences on health • Rationale development for prevention and intervention strategies • Community needs assessments and participatory strategies • Differing evaluation and research models • Project maintenance and methods to keep on track • Strategies for directly involving communities in health promotion. The radio series is accompanied by a workbook with spaces for taking notes and responding to learning activities in the Healthworks radio series. Listeners acquire the workbook from the participating radio station. The workbook also contains an evaluation sheet and a glossary of words discussed in the series. Healthworks uses Interactive Instruction Techniques with guided workbook activities and learning sequences, interviews with health professionals and case studies. The English language narration is at a slow pace, with technical words spelled out. When listeners complete the workbook they will take the workbook to the radio station broadcasting the Healthworks radio series and receive a Certificate of Participation. Observations An interesting feature of this project is the efforts of HCR to directly involve radio station managers in the project by appealing to both their desire to assist the community as well as to 122 benefit the radio station. The Healthworks Info Pack1 notes the following benefits that will accrue to stations that participate in the programme: 1. A different audience will be attracted to listen to your station 2. Local newspapers will give your radio station publicity when they report on this "training course for health workers on the radio" 3. Your local health and social development departments will tell their staff to listen 4. Your station will become known for its commitment to improving local health and social development 5. You will make new contacts 6. You could invite those who complete their workbook and get a certificate, to attend a health-promoting radio course, or some other training course that you organize. 7. You will locate skilled health and social development workers to become involved in your health and social development programs 8. If you want to, you can charge a nominal fee for the workbook and certificate to cover your expenses A CD pack is also available at a small cost containing all elements of the Healthworks series for radio stations that want to translate the series or record it with their own narrator. Many of the instructions on the in the Info Pack are also in regards to how the broadcaster should go about acquiring the shows and setting up times to broadcast them in their local communities. Partners: HCR, OneWorld Radio, Curtin University Source: HCR website at http://www.h-c-r.org/healthworks.htm For more information, contact: Dr. Ross James Director, Health Communication Resources and Adjunct Research Fellow, School of Public Health, Curtin University Mobile phone: 0402 1256 02 (International: +61 402 1256 02) firstname.lastname@example.org www.h-c-r.org 1 http://www.h-c-r.org/Healthworks%20Info%20Pack_rj_02apr03.pdf 123 The Massive Effort Campaign - Global Development Issues: HIV/AIDS, TB, Malaria, G8 Compliance, Health. Programme Summary Established in September 2001, The Massive Effort Campaign is a global movement that seeks to reduce the incidence of diseases like AIDS, tuberculosis, and malaria among poor people. The campaign's goal is to advocate for and communicate best practices to stimulate social and political change. To that end, the network focuses its activities in three areas: • Mobilizing healthy behaviour • Global advocacy • Partnership building Which embody the Campaigns core values: • Add value by supporting the work of partners • Encourage creativity and innovation • Create markets for health, putting private sector partnerships into action • Use the most effective means available for social change • Measure success by achieving results for those living in poverty In addition to a board of directors and group of founding members representing the private sector and NGO community, The Massive Effort team functions as a network with a small core group of professional staff. Summary of ICT Initiatives The Massive Effort supports networks of existing organisations by providing strategic information, best practices, prototype messages, opportunities for collaboration and co-ordination. The website that facilitates this exchange of information is: Massive Effort site.1 The organization has several of its own campaigns, one of the most prominent being efforts to improve G8 compliance with their own commitments to The Global Fund to Fight AIDS, Tuberculosis, and Malaria. Access to a variety of campaign messages and materials on this issue are available through the website. Other information about online and real-world events is organized around major global and regional tuberculosis, malaria and HIV/AIDS days and initiatives (like World TB Day, Drop the Malaria Tax Campaign, International Conference on AIDS, and World AIDS Day). The purpose of this strategy is to provide a platform for activists, affected individuals, and concerned citizens around the world to communicate to others what it is like to live with these diseases. Pictures are provided online. The events page includes a calendar of events on tuberculosis, malaria, and HIV, as well as conferences and training courses on advocacy, partnership building, corporate social responsibility, social marketing and the promotion of healthy behaviour. When possible, photos of events are included along with reports. Those who participate in an event and feel that it may be of interest to the Massive Effort community are encouraged to send digital pictures and a report to event@MassiveEffort.org. Links are also provided to a host of other websites dealing with mobilization, prevention and education strategies from a variety of perspectives and standpoints. The website helps to act as a bridge between the conservative and more radical sides of the global effort to combat these diseases. Observations Massive Effort is a global non-profit organisation. In the context of statistics indicating what the organisation sees as injustices -- i.e., more than ten million people die every year for lack of 1 http://www.massiveeffort.org/index.html 124 effective medicine and supplies costing $10 or less – the organisation hopes that its efforts will result in the reduction by half of TB and malaria deaths, the reduction by 25% of HIV infections, and the saving of lives that might have otherwise been lost because of childhood, maternal, and perinatal diseases and conditions. Partners: BBC World Service Trust, Catholic Health Association of India, Christian Connections for International Health, City of Winterthur, Double Incentive Project, ESKOM, Global Health Council, Health & Development Networks, International AIDS Vaccine Initiative, International Union Against TB & Lung Disease, KNCV (Royal Netherlands TB Association), Malaria Foundation International, Medvantis Medical Services GmbH, National Centre for Advocacy Studies, RESULTS, INT., TB Alert, United Nations Association of the US, United Nations Staff College Winterthur Health Forum Association, Winterthur Insurance, World Health Organisation, World Vision International Hope Initiative. Source: Massive Effort site at http://www.massiveeffort.org/index.html For more information, contact: info@MassiveEffort.org Massive Effort site at www.massiveeffort.org 125 ISS (Indira Soochna Shakti) CHIPs (Chhattisgarh Infotech Promotion Society) Development Issues: Education, Girls empowerment, Sexual and Reproductive health. Programme Summary Chhattisgarh is a relatively economically and socially depressed State with an essentially rural (80%) and tribal (32.5%) character. The State's financial resources are modest. Teledensity is less than half the national average. Internet subscribers are less than five per ten thousand people. The State was created a little over a year ago without basic state level infrastructure. Many schools had to be connected to electric lines before computers could be placed. At other places, extra rooms had to be constructed. Suitable instructors were not available locally in remote villages and these had to be drafted from cities. CHIPs philosophy is that the: “Internet is a network of Computers, and Society is a network of Human Beings. ISS1 is about empowering an entire generation of a quarter million schoolgirls through IT, to lead the initiative for creating a Seamless Society with Global Opportunities in the essentially rural-tribal State of Chhattisgarh in India.” The plan is to introduce computer and IT training curriculum into all 1605 government high schools. The result is a large cohort of girls who have received 4 years of IT instruction on nationally approved CBSE norms. The programme will be implemented through a unique public-private partnership wherein entrepreneurs have been provided space in the schools and permitted to use the facilities outside of school hours. Summary of ICT Initiatives In the Chhattisgarh Online information for Citizen Empowerment (CHOiCE) Project, ISS girls would share networked hand held and desktop community computers in villages and would route information and information-enabled services of local relevance. In the process, they would emerge as technology resource persons and community leaders. The pilot phase of CHOiCE is under implementation in 246 Villages Council (Panchayat) headquarter villages and, ultimately, all 9,129 Village Councils in the State will be included. Government has earmarked US$ 4.6 million for CHOiCE. ISS volunteers will also assist in the creation of a Citizen Database and Village Resources Database for CHOiCE as part of the People's Reports initiative in association with the UNDP and the Planning Commission of India. Programme Objectives include the: • Seamless access to IT education for all girls in high schools is the immediate goal. The ultimate goal is empowering them to lead the initiative for a Seamless Society. • Re-skewing of the imbalance of boys to girls in the schooling system, an area that necessitates affirmative action. This is reinforced by the identification of girls as change agents. • The development of a knowledge society characterized by symmetric access to information and knowledge. In order to facilitate this, ISS volunteers will serve as a human network to create ‘last person connectivity.’ In CHOiCE, ISS volunteers would share networked hand-held community computers in villages and would route information and information-enabled services of local relevance. In the process, they would emerge as technology resource persons and community leaders in a society where girls have been traditionally marginalized. Leadership and empowerment will be the core incentive for them. Since maximizing monetary returns would not be the motivation, they would ensure seamless access to information for empowering the 'last person' in society. The costs involved in taking technology seamlessly to every person on individual basis in a State where 35% are still illiterate and 40% live below the poverty line are daunting. Instead, in CHOiCE, the technological network would reach in a portable fashion to the village and the 1 http://iss.cg.nic.in/content/vision.htm 126 human network would provide information access on a shared community basis. This would bridge the last lap of 'last person connectivity' in a cost-effective manner. A local language solution providing integration of legacy data with platform independent end-to- end scaleable local language capability has been identified with the assistance of the National Centre for Software Technology. This solves the problem of diversity of incompatible local language solutions. The solution, already in the beta testing stage, will be ready for the forthcoming academic session beginning July. Observations The level of acceptance by the community has been encouraging. Even in the first year, of 46,273 students paid for by the Government, another 9,000 odd paid their own fee. Three Local Governments (Janpada Panchayats) resolved to provide US$ 511,000 for the CHOiCE initiative to network all their 246 Village Councils headquarter villages seamlessly with ISS girls as the volunteer corps for this. Organizers hope that ISS can be replicated easily elsewhere in India and in the developing world, provided that governments share the vision and have the will to pursue the project. Partners: Chhattisgarh State Government, AISECT, UNDP, NCST (National Centre for Software Technology), NIC (National Informatics Centre). Source: CHIPS website at http://www.chips.nic.in, ISS website at http://iss.cg.nic.in/index.htm For more information, contact: CHiPS 204-A, Mantralaya, D.K.S. Bhawan Raipur- 492 001 Phone: 91 (771) 221204 / 221304 Telefax: 91 (771) 221304 E-mail: email@example.com Website: www.chips.nic.in 127 COPE - Australia Development Issues: Aboriginal health, HIV/AIDS, Community Health Services Programme Summary COPE is an independent, non-profit, education and training centre offering high quality Community and Health Services Worker Training and a broad-based Community Education Program which focuses on strengthening communities, family and relationship education, and life skills education, including skills for living and working. Cope has merged with, and is now a division of, Relationships Australia (SA). Relationships Australia (RA) is a not-for profit community based organisation that is committed to enhancing the lives of communities, families and individuals by being the leading professional provider of quality relationship support services. Cope continues to provide community education and training for workers in South Australia. COPE is committed to Indigenous issues and acknowledges Indigenous peoples as the first peoples of this land and as the keepers of the oldest continuous living cultures known. Their resilience and their determination to maintain their culture has been a source of great inspiration. The COPE philosophy believes that there is much to learn from, and with, Indigenous people. This belief has shaped their approach to learning and teaching. They are also committed to the process of reconciliation between Indigenous and subsequent Australians, and in tenants of respect for the rights of all people. A willingness to understand the legacy of Australia’s history is an important part of the process of renewal and healing the wounds of the past. Only through such acknowledgement will society be able to move forward together to create a more equitable society. Summary of ICT Initiatives The COPE website serves as a gateway to a host of resources and access points to the organizations various training programs. Some of their programme delivery is conducted online and with Internet/email facilitation. Their training for people working in the Community and Health Services sector aims to raise awareness, develop appropriate attitudes towards client values and needs, and develop effective professional strategies and skills. There are several units within the COPE organization. COPE’s Community Services and Health Training Unit is committed to developing relevant skills, qualifications and career paths for workers, best practice in the workplace, and excellence in service delivery. This is done by: • Supporting the workplace as a developing and interactive learning environment • Ensuring that the training offered accurately reflects and responds to the needs of workers, the organisation and their clients • Wherever possible, assisting staff at all levels of an organisation to access a nationally accredited, competency based training pathway that recognises the skills and abilities they bring to the organisation • Ensuring that competency based training is delivered both on and off the job in a timely and responsive manner, and that it is regularly evaluated and adjusted to meet the needs of the specific organisations and workers. In pursuit of these objectives COPE offers the following services: • Training development • Resource Development for Community Service Practice • Consultancy Services for Diversity in the Workforce • Peer Education COPE also provides HIV and Hepatitis worker training that includes work on the bio-psycho- social aspects of HIV, Hepatitis C (HCV) and related diseases. Topics covered include mental health, substance use, multicultural contexts and volunteer training. The aims are to reduce transmission rates, to improve service delivery to individuals and groups most at risk, to equip 128 workers and volunteers with skills to effectively respond, and to challenge attitudinal barriers and advocate for legal reform. The HIV and Hepatitis Worker Training Project designs training specifically for workers and volunteers in Health and Community Services and those working within agencies funded by HIV and Hepatitis C and Related Programs Unit (HHARP) of the Department of Human Services. The Project works closely with HHARP and industry organisations in identifying the training needs of workers. COPE customizes training programs to meet the needs of a particular work group or organisation. Typically, its programs target: • Workers and volunteers in HHARP funded agencies • Community and Health services workers and volunteers • Aboriginal Community organisations • Mental Health service providers • Commercial enterprises. Programs may take the form of Workshops or Action learning projects. Workshops are tailored to meet the needs of the organisation, and delivery times and approach are negotiated with COPE. Action learning projects, whereby a group of learners: • Develops their understanding of a chosen topic • Creates and implements an action plan within their agency to make changes to workplace practice. The group is facilitated by an outside trainer and may meet over a period of weeks or months, seeking a range of external input, taking on individual tasks to develop their knowledge and researching their agency needs. The use of ICTs during these training periods is important for information sharing, dialogue, and the exchange of ideas. The website also acts as a resource centre, with searchable access to their library, a collection or recommended readings and reports, tips for stress management, and links to other resource pages. Observations Recent COPE initiatives have included the following reports resource materials, many of which are available through the website • Building Bridges, a report of a HIV and mental health collaboration project. • Mental Health & HIV...working together (a publication from the Building Bridges Project outlining co-morbidity issues for HIV and mental illness) • Hepatitis C and mental health a workers resource • Seven principles to a Successful Relationship (New relationships course and manual) • Victims of Crime Training and Development Package Partners: Department of Human Services, Relationships Australia Source: http://www.cope.edu.au/index.php For more information, contact: 116 Hutt Street Adelaide, South Australia 5000. Phone: (08) 8223 3433 International +618 8223 3433 Fax: (08) 8232 3534 International +618 8232 3534 Email: firstname.lastname@example.org 129 The Chevron Workplace AIDS Prevention Programme (CWAPP) - Nigeria Development Issues: HIV/AIDS, Sexual Health. Programme Summary Chevron Nigeria Limited (CNL) is 60% owned by the Nigerian Government and 40% owned by Chevron Texaco. CWAPP was conceptualized to address the problem of HIV/AIDS as a result of diverse motivational factors including recognition of the enormous impact that HIV/AIDS has on business and its workforce. In addition was the survey that revealed high level of ignorance and misconceptions about the disease; the presence of sexual networking at oil locations; high level of sexually transmitted diseases detected at these locations and community health centres. There was also an understanding of the high level of risk amongst a mobile workforce; and documented advantages of workplace-based HIV/AIDS intervention programs. The programme is targeted at employees, their young dependants, union leaders, community youths, settlers and commercial sex workers at oil locations. A workplace policy initiated in 1998 is being updated and a multi-departmental approach is being coordinated by the by the Medical Unit to increase the success of this programme. CWAPP became popular with employees, accepted by management and has led to a better host community-company relationship, with reduction in STDs seen at the Tank Farm clinic. The communities have started to respond to the challenges of HIV/AIDS while the company is looking at the social, political, medical and economic issues surrounding HIV/AIDS. The programme is based on the premise that workplace-based AIDS Prevention programmes are cost-effective, sustainable and can be replicated at different business settings and workplaces with minor modifications. And that workplace-based AIDS prevention programmes must target not only employees but also the community where they operate. Summary of ICT Initiatives Through proposed interventions, CNL aims to reduce the risk of HIV to its employees, families and business. Although HIV prevalence among workers is less than 2.5%, they are at risk because of a higher prevalence in the community, their poor HIV knowledge, and high risk-taking behaviours. CNL's HIV/AIDS programmes focus mainly on prevention of the escalation of the epidemic by targeting employees, their families, the community and CSWs, as well as supporting and caring for HIV+ employees. CWAPP focuses on knowledge transfer, attitude change and behavioural modification. • Awareness is increased through the CWAPP’s use of posters, flyers, newsletters, e-mails and campaigns. • HIV/AIDS management training programme for managers, supervisors and union leaders has been offered since 2001. This full day programme will be required for all new managers and supervisors. Persons living with HIV (PLWH) in the community act as resource persons for this training programme, which addresses positive living, staying negative and the management of the positive employees. • CNL has had a peer education programme since 1997. CNL’s medical divisions train peer educators through edu-tainment sessions. Most times, the peer educators share knowledge at lunch, on oil platforms and at bars near the workplace. • Male condoms are available during HIV/AIDS campaigns and events, at all medical consulting rooms and at the tank farm (one of CNL's land-based facilities in Nigeria). Programmes combine of a lecture of basic facts on HIV/AIDS blended with jokes, cartoons, poetry, drama, music video shows and moonlight story telling. Question-and-answer sessions and provision of comprehensive handouts on HIV/AIDS/STDs, safer sex practices, condom promotion and positive living complement this basic lecture. There is also treatment of STDs, and Voluntary Confidential Counselling and Testing (VCCT) with PMTCT. CNL has also developed an Adolescent Reproductive Health Programme (CHARP) that focuses on workers' children ages 12-19. The programme is an edu-tainment model that addresses 130 issues of adolescent reproductive health, career guidance, violence and role modeling. About 150-200 children and parents have participated in the annual HIV/AIDS workshops. Other programmes also include a Field-Based Oil Workers Peer Education Programme, the Youth Clinic with a Hotline, and Chevron Adolescent RH Klub that complement these AIDS prevention efforts. The Company has also been involved in Internet training of female journalists in AIDS prevention, yearly celebration of the World AIDS Day and Candlelight Memorial ceremony. There is also the annual Chevron Youth Festival of Life (C-YOU-LIFE) to celebrate CNL's efforts, cares and concerns for adolescents. Observations The programme has reached the majority of workers with its education and awareness activities, improved employee health seeking behaviour, increased stakeholder involvement and successfully prevented mother to child transmissions. CNL will expand its programmes to ensure that it is able to meet the goals stated in its vision of minimizing increases in prevalence and treating HIV+ workers. Since 1997, the programme has met many process and outcome goals: • Since 1997, CWAPP has reached 80% of CNL workers and 40% of the surrounding communities with education, resulting in higher HIV/AIDS awareness. • There has been a 50% reduction in STIs and patients are self-presenting much earlier in the infection since 1997. Phone-ins and requests for counselling have increased 40% since 1997. Condom demand has increased 40% since 1997. • CWAPP’s multi-stakeholder approach has resulted in increased management attention. Communities are now facing the challenges of HIV/AIDS and the labour union is becoming more supportive. • MTC prevention services have resulted in no recorded cases of maternal mother • to child transmission for workers and their spouses since its launch in 1999. This CWAPP programme is now part of UNAIDS Best Practice document on Business Responses to HIV/AIDS and is also the topic of a World Economic Forum Private Sector Intervention Case Example.1 Source: Letter from Dr. Bode-law Faleyimu to the Nigeria-AIDS eForum October 28, 2001. View message archives at http://www.nigeria-aids.org/eforum.cfm, and from the case example at the World Economic Forum at: http://www.weforum.org/pdf/Initiatives/GHI_%20HIV_CaseStudy_Chevron.pdf. For more information, contact: Bode-law Faleyimu, Chevron Workplace AIDS Prevention Programme (CWAPP) Chevron Nigeria Limited. Tel: 234-1-2600600 Ext. 2224 Bofa@chevron.com 1 http://www.weforum.org/pdf/Initiatives/GHI_%20HIV_CaseStudy_Chevron.pdf 131 AIDS Prevention Software Projects – Thailand PATH (Program for Appropriate Technology in Health) Development Issues: Youth, Women, Reproductive Health. Programme Summary PATH (Program for Appropriate Technology in Health) is an international, nonprofit, non- governmental organization with headquarters in Seattle, WA, and offices in Washington, D.C., Jakarta, Nairobi, Manila, Bangkok, and Kiev. PATH's mission is to improve health, especially the health of women and children in developing countries. Since 1976, PATH has implemented more than 500 health and family planning projects in 85 developing countries. In recognition of its expertise, PATH has been designated by the World Health Organization (WHO) as a Collaborating Center on AIDS, Research in Human Reproduction, and Hepatitis B Vaccination. PATH identifies, develops, and applies appropriate, safe, effective and innovative technology- based solutions to public health problems, particularly in the areas of communicable diseases, family planning, and reproductive health. PATH has developed several innovative programs to in response to the AIDS epidemic, two of which are reviewed below. Summary of ICT Initiatives RiskAdvisor Project – In 1995 PATH (Program for Appropriate Technology in Health) developed RiskAdvisor, an easy-to-use interactive software program that allows individuals to assess their personal risk of HIV infection based on their present patterns of behaviour. The program then helps to develop goals to change their behaviour, thereby reducing their risk of infection or transmission. "RiskAdvisor, and computer-based assessment and learning programs like it, hold promise as powerful educational tools by providing simulated experiences that allow individuals to experiment with behaviour change strategies," states Dr. Sharon Baker, University of Washington, School of Social Work. RiskAdvisor was designed by HIV counsellors for HIV counsellors to help them talk with their clients about potentially embarrassing topics and to show graphically how behaviour affects risk of exposure to HIV. While many people are knowledgeable about AIDS, even those at high risk of exposure to HIV often do not perceive themselves as vulnerable to infection. Clients have reported feeling more comfortable answering questions about sexual and injection practices when interacting with RiskAdvisor than they would have if being personally interviewed by a counsellor. RiskAdvisor has been translated for use in AIDS prevention programs in Nepal, the Philippines, Indonesia, and Thailand. The program, supplied on 3.5" diskettes, requires a 386 or faster computer with Windows and a mouse. A less explicit version, RiskTeacher, is available for more general risk reduction education, as well as Village RiskAdvisor, a paper-based version of RiskAdvisor. Interactive Games Project – In March 2003, the PATH launched a mass media project that uses a web-based interactive computer game to promote adolescent sexual and reproductive health (ASRH) among young people in Bangkok, Thailand. The game is intended to entertain 13- to 15- year-olds while it educates them. A game design expert from Microsoft Games visited Bangkok to provide training workshops and brainstorming sessions. The government is supporting the effort by following through on its commitment to provide computers to all schools around the country, including rural sites, and to provide Internet connections. Placing the game on the Web allows use of the technology known as "cookies", which enable the project to anonymously keep an ongoing profile of each player and to record his or her accuracy in terms of answering questions in the game. This strategy will provide feedback to inform future 132 adjustments to the game. Organizers claim that, in Bangkok, more than 250,000 youth frequent Internet cafes per week to play computer games. A pretest in late 2002 showed a positive reaction to the game. Partners: M-WEB, university fellows, Microsoft Games, the Thai government. Source: Letters sent from Teresa Guillien to The Communication Initiative on December 9, 11, and 20, 2002. PATH website at http://www.path.org/resources/press/19951129-softwarehiv.htm For more information, contact: Ken Kutsch Behavior Change Communications Program Officer Program for Appropriate Technologies in Health (PATH) 1800 K St, NW Suite 800 Washington, DC 20006 USA Tel.: (202) 822-0033 Fax: (202) 457-1466 email@example.com firstname.lastname@example.org www.path.org 133 POLICY's Young Adult Reproductive Health (YARH) Project - Nigeria Development Issues: Political Development, Youth, Reproductive Health, Family Planning, HIV/AIDS. Programme Summary In August 2002, the POLICY Project launched a one-year young adult reproductive health (YARH) pilot project in Edo State, Nigeria. The initial aim of the programme is to encourage the Edo state government to approve a statewide YARH strategic plan and increased funding for YARH programmes to the end of strengthening and broadening family planning (FP), reproductive health (RH), and HIV/AIDS services. An accompanying goal is to ensure that accurate information informs policy decisions and that there is local capacity to provide FP/RH/AIDS policy training. Programme organizers cite these figures: • One in five people in Nigeria are in the 15-24 age bracket, comprising 22 million in 2000. • Young Nigerians face risks associated with early sexual debut and marriage and with early pregnancy and unsafe abortion. • Sexual abuse and female genital mutilation (FGM) are also common. • Contraceptive use is 6.6% among 15-19 year olds and 16% among 20-24 year olds. In 1998, 60% of reported AIDS cases in Nigeria were among 15-24 year olds. While abortion data are sparse, available evidence suggests that the majority of abortions occur among teenage girls. Summary of ICT Initiatives An assessment conducted by USAID/Nigeria and POLICY resulted in the selection of Edo State and a local partner NGO, Women's Health and Action Research Centre (WHARC) in Benin City. WHARC has assisted with activities like visiting local NGOs working in youth, RH, FP, human rights, and women's issues to gauge the level of interest in a youth advocacy network and to assess the extent of skills and resources. Once a core group of interested organisations, individuals, and church groups was identified, POLICY and WHARC organized a meeting to launch the network. Still in its nascent stages, the network will work through meetings in an effort to begin the process of developing a strategic plan to present to the state government. Following a needs-based assessment, a state-level advocacy-training workshop will be conducted for members of the network to provide additional information on key YARH issues and to refine the strategic plan. Data from research will be used to help craft advocacy messages, which will be conveyed through meetings that use visual aids such as PowerPoint, that are designed to convince politicians and other policy makers to support the strategy. Observations A large number of NGOs in Nigeria are involved with YARH, but most of these NGOs are involved in small neighbourhood programmes. In 1999 a local youth-oriented NGO, Action Health International, organized a national YARH conference; in response, the Federal Ministry of Health published a draft National Strategic Framework for Adolescent Reproductive Health. However, neither this national strategy nor the accompanying policy has been acted upon. Since services and budgets are disbursed at the state levels, the state government is the most appropriate starting point. Edo State was selected for this effort, specifically, because of the number of issues facing youth, as well as because of the dearth of donor projects, in that state. These activities will provide a model for other Nigerian states and other POLICY countries. Partners: USAID/Nigeria, WHARC, Futures Group Source: Letter sent from Scott Moreland to the Nigeria AIDS e-forum on January 8, 2002; "Development of and Advocacy for a Young Adult Reproductive Health Strategy in Edo State" sent in a letter from Scott Moreland to The Communication Initiative on June 13, 2002; letter sent 134 from Scott Moreland to The Communication Initiative on September 11, 2002. For more information, contact: POLICY Project Office Jerome Mafeni or Charity Ibeawuchi 2A Lake Chad Crescent Off IBB Way Maitama Abuja, Nigeria Tel.: 234-9-413-5945 Fax: 234-9-413-5944 email@example.com Scott Moreland, Country Manager firstname.lastname@example.org WHARC email@example.com 135 Freedom from Tobacco – India Consumer VOICE Development Issues: Tobacco, Health. Programme Summary The Voluntary Organisation in Interest of Consumer Education (Consumer VOICE) is an action group whose objective is to protect and further the rights and interests of the consumer. VOICE was founded in 1983 by teachers and students from the University of Delhi. Consumer VOICE has joined with other Indian NGOs in an initiative to support international tobacco reform efforts and to inform consumers about the health risks associated with tobacco use. Participating NGOs are undertaking advocacy efforts in support of the Framework Convention on Tobacco Control (FCTC)1, an international public health treaty proposed by the World Health Organization (WHO) in 1998 in an effort to reduce the numbers of tobacco-related diseases globally. In addition, a media kit has been produced to encourage the media to deliver accurate and comprehensive information about tobacco use to consumers. According to organizers, tobacco use is the leading cause of preventable death, disease, and disability in the world today. At present, 4 million people per year die from a tobacco-related disease. Smoking has been recognised as a major cause for lung cancer for the last 40 years. Current estimates suggest that by the year 2030 tobacco will cause 10 million deaths globally, of which 70% will be in developing countries. In India, for example, 65% of all men consume tobacco. India is the second largest producer of tobacco and also the second leading seller in the world. 2,200 people die of tobacco use every day in India. Over 1 million women are engaged in the hand rolling of bidis. Approximately 600 children between the ages of 10 and 18 are recruited every day by the tobacco industry. In 1996, Philip Morris, the world's largest multinational cigarette company, spent US$3.1 billion advertising its tobacco and food products, while the British American Tobacco spent US$459 million on advertising its cigarettes alone. In India, tobacco advertising contributes Rs. 300-400 crore to the Rs. 8000 crore-strong Indian advertising industry. Summary of ICT Initiatives The media kit, which is available in printed format and on the Consumer VOICE site2 (click on "Tobacco Control" in the left navigation bar) consists of the following materials: • "Global Tobacco Control Treaty: Indian Winners Gear up for the Third Round" • "Indian NGOs Declaration on the Framework Convention on Tobacco Control" - 24 NGOs signed this document as a formal statement of affirmation (of commitment to tobacco control measures as identified in World Health Assembly Recommendations), of concern (about the steady increase of tobacco-related diseases and deaths globally and in India), of alarm (about aggressive tobacco advertising, as well as the negative consequences of tobacco production on the economy and environment), and of awareness (of the importance of civil society's participation in the negoatiation, adoption, and implementation of the FCTC). • "Health Hazards of Tobacco Use" • "Oral Tobacco Use - Its Implications for Indian and the World: Measures to Prevent Its Use, Sale and Marketing" • "Tobacco Advertising and Promotional Activities in India" These materials provide information (statistics) and also encourage readers to take action against tobacco advertisers. One of the documents provided in the kit suggests that NGOs can support the FCTC by joining a group of NGOs working on the FCTC, educating themselves and their 1 http://www.fctc.org/ 2 http://www.consumer-voice.org/ 136 constituencies about global tobacco issues and the FCTC, keeping the media informed and seeking their support, meeting with the country's delegates to the FCTC in an effort to influence their future positions, exploring regional actions against tobacco, acquiring resolutions passed in support of the WHO FCTC by the boards of respective NGOs, and meeting with (or sending copies of resolutions or declarations to) representatives involved in the WHO FCTC negotiations in respective countries. At the Third Round of negotiations of the Intergovernmental Negotiating Body (INB) in 2001, NGOs, youth groups, consumer activists, and cancer care and prevention centres across the country issued a joint declaration calling for deeper commitment from opinion leaders to those nations that support public health rather than commercial gain. They also expressed hope that the Indian Government would continue to play a proactive role in leading the South-East Asian countries towards a strong FCTC. Observations The pressure has forced the tobacco companies to broaden their tactics. Perceiving an imminent ban on tobacco advertising, several tobacco companies are promoting other consumer products, which bear the same brand name or logo as their popular tobacco products. These logos or brand names can easily be spotted on clothing, sports apparel, hats, trays, posters and stickers affixed to sports vehicles and backpacks. Following the announcement of the recent Tobacco Products Bill proposing a ban on tobacco advertising, there has been an upsurge in surrogate advertising and sponsorship of entertainment events. Recent marketing figures indicate that the market spending on tobacco products declined by 2 % over the year, while the spending on tobacco brands grew by 28 %. This is illustrative of the increasing reliance of tobacco companies on sponsorships, restaurant and hotel programmes, public relations and direct marketing programmes these days. The Indian delegation won the Orchid Award for positive contributions to tobacco control at the second round of negotiations on the FCTC in Geneva in April 2001 (the USA delegation was awarded the Dirty Ash Tray Award, which goes to those who promote tobacco interests). Source: Consumer VOICE site (click on "Tobacco Control" in the left navigation bar) at http://www.consumer-voice.org For more information, contact: Bejon Misra Consumer VOICE G-30, Lajpat Nagar-II, 2nd Floor New Dehli - 110 024 India Tel.: 9811044424 Fax: 0124-6392148 firstname.lastname@example.org Consumer VOICE site at http://www.consumer-voice.org FCTC site at http://www.fctc.org 137 COMSALUD - Latin America Development Issues: Health, Disease Prevention, Tobacco Use, HIV/AIDS, Youth. Programme Summary The goal of the COMSALUD project, as established in Cuenca, Ecuador in 1995 was to contribute to significant, sustainable, and equitable improvements in health. The hope was that COMSALUD would facilitate increased links between faculties of social communication, health care workers, journalists, and the media thereby enhancing media coverage of health issues. The four key components of the COMSALUD project were: • University-level teacher training in health communication and health journalism • Development of core reference and media resource centres at each university • Needs assessments and research, and • Specialized workshops and seminars on health reporting and computer-assisted journalism in health for working journalists and editors. The COMSALUD project was developed at a meeting of Faculties of Social Communication held in November 1995 and sponsored by the Pan American Health Organization, Regional Office of the World Health Organization (PAHO/WHO), the United Nations Educational, Scientific and Cultural Organization (UNESCO), the Latin American Federation of Faculties of Social Communication (FELAFACS), and Basic Support for Institutionalizing Child Survival (BASICS). During these studies, it became clear that the media welcomes the opportunity to incorporate topics on health; the media is proactive, supportive, and interested in getting the story right; the media actively seeks health news, especially with the advent of 24-hour television; and most importantly, "health sells" and increases media audiences. Furthermore, the population is looking for information on health of what can be done to maintain, improve, and reclaim their health. Media audiences consistently mention health as one of the three priority topics about which they would like to receive more information. Among the activities programmed for the immediate future are the development of a distance- learning CD-ROM on health journalism with USAID, the International Broadcasting Bureau, and FELAFACS; and publication of reference documents on health topics specifically for Faculties of Social Communication and journalists. The first publication, Ayudando a Crecer is on the first six years of childhood, the second publication will be on the older adult. Summary of ICT Initiatives Within the research component, two research protocols were implemented on Health in the Media and The Voice of Adolescents: Health in the Media – The first research protocol implemented under the COMSALUD project, a study on health in the media in Latin America, was organized by PAHO, FELAFACS, BASICS, and the United States Agency for International Development (USAID), and UNESCO. The research protocol, written by Drs. Eduardo Contreras Budge, Elizabeth Fox, Mr. Max Tello Charun, and Ms. Jernnie Vasquez-Solis was implemented in 1997. A total of twelve universities and the Ministry of Health of Panama, representing twelve Latin American countries used a standard protocol to prepare and implement a research protocol and to compile data. The project studied the presence and content of health messages in the media. Key variables included in the protocol were: § Type of media transmitting health-related messages § Message subject and format § Characterization of main messages or key issues § Suggested arguments and type of appeal § Audience age and socio-economic status 138 § Language accessibility "Voice of Adolescents" – The "Voice of Adolescents", the second research protocol implemented under the COMSALUD project, is a multi-study project on health, adolescents, and media in Latin America organized by PAHO, FELAFACS and the Joint United Nations Program on HIV/AIDS (UNAIDS). Implemented in September 2001, the project brought together twelve faculties of social communication to prepare and implement a research protocol to study how communications and entertainment media affect development of concepts of health, illness and prevention of disease. A special focus of the project was adolescents' use of media for information on HIV/AIDS and tobacco use prevention. Some of the questions raised were: What do adolescents know in general about health-related media coverage? What health-related messages do adolescents encounter in the media? Do adolescents use the health information they find in the media? Do adolescents find media messages useful for promotion of healthy lifestyles, healthy environments, and appropriate use of medical care services? The Voice of Adolescents protocol will also be implemented in Puerto Rico and Spain in early 2003. Protocol Strategies – Participating faculties used a standardized protocol for collecting data in a series of mini-focus groups with adolescents ages 12-18. This exploratory study collected information about the types of media available and used by adolescents of different ages, the types of media providing health-related messages; the nature of health-related messages and format that adolescents encounter regularly; adolescents’ perceptions of the media and the health-related messages, language accessibility and other concerns about health-related messages. Observations From PAHO - "The rapid spread of new communications and entertainment media throughout Latin America has increased the expose of children and youth to a variety of lifestyle messages as well as opened up new opportunities to learn about health, illnesses, and disease prevention. With the almost universal reach of radio and increasingly television adolescents look to these media sources for all types of information and instruction. The promise of the Internet as a tool for health promotion and disease prevention among youth remains largely unfulfilled for a variety of reasons including limited access in many communities." A final report on Phase I will be available early in 2003. Partners: The Division of Health Promotion and Protection of the Pan American Health Organization/World Health Organization (PAHO/WHO), the Federación Latinoamericana de Facultades de Comunicación Social (FELAFACS), Basic Support for Institutionalizing Child Survival (BASICS), Ministry of Health of Panama, the United Nations Educational, Scientific and Cultural Organization (UNESCO), and United States Agency for International Development (USAID). Source: Letter from Gloria Coe to The Communication Initiative October 17, 2002. For more information, contact: Rafael Obregon email@example.com 139 AIDS Prevention and Control Project in Tiruchy City Development Promotion Group Development Issues: HIV/AIDS, Child welfare, Disadvantaged communities, Education, Environment, Micro-enterprises, Water, Women's issues Programme Summary The Development Promotion Group (DPG) is an organization of professional development workers with a commitment to develop the socially and economically marginalised sections of society with a basic philosophy, orientation, and tools that would enable them to be on their own. DPG concentrates on the southern states of India, namely Tamil Nadu, Karnataka and Andhra Pradesh and reaches out to the urban, rural and tribal sections of the society in these areas. Most staff are qualified professionals in Social Sciences, Accounting, Agriculture, Engineering, Computers, etc. Human Resource Development has been given more importance. DPG was born in 1986 as a registered non-governmental organisation (NGO) and grew up serving various other developmental groups. They organized and financed an eco-camp at Ooty as a part of the Save Nilgiris campaign in 1987 for students. This was followed by awareness camps on environment, water for rural women and children, development of financial accounting system for voluntary organisations, the translation of capart guidelines for rural development projects from English to the regional language and its distribution to NGO's, the publication of a manual on housing finance and capacity training for NGO personnel in accounting, amongst many others. During this period they have also undertaken several evaluation studies for donor agencies and have conducted various exhibitions to market small NGO products. They have also undertaken or promoted empirical research studies that relate to the developmental problems of the socially and economically weaker sections. Summary of ICT Initiatives The aim of this particular project is to prevent and control the transmission of STD/HIV/AIDS in the high-risk groups through multi-pronged and multi-sectoral approach with full participation of community. The strategies involved are education of the community for better awareness and behaviour change and integration of this programme with other urban development programmes to improve the status of living of the slums dwellers. This involves the communication of the message through a range of multi media approaches, including radio and various print formats, one to one counselling, identification and training of peer leaders and influencing condom promotion and facilitating better access to STD treatment and services. The AIDS Prevention & Control Project (APAC) identified the staff knowledge needs and arranged various training activities for the staff. Some of the training programmes attended by the staff included themes like Programme Management, Networking through information systems for NGOs, Strategy of Self Help Groups (SHGs), Strategic Planning, Watershed, etc. On an average a staff member gets at least 12 human days of training. Sources: http://www.indev.nic.in/indev/search/projSearchResults.asp http://www.developmentgateway.org/node/100647/aidaresult?sector=icthlth http://www.dpgsulo.com/home.asp For More information, contact: R. Bhakther Solomon Development Promotion Group 49 - A, and 52, Josier Street, Nungambakkam Chennai – 600034, Tamil Nadu, IN 91-44-8256660 firstname.lastname@example.org http://www.dpgsulo.com 140 e-Farmasi, Malaysia Development Issues: General health, self-help, pharmaceuticals Programme Summary e-Farmasi is made up of a Community-based Education program on Medicine Use and a Community Pharmacy Management Program, which promote the use of ICT. e-Farmasi is a project that links communities to their neighbourhood pharmacies and provides an impartial database on illnesses and medicines. e-Farmasi will enable the community to access a database of unbiased information about medicines, their use, side effects, directions for use etc. The database will also contain guides to self-care for common minor ailments. A link will be provided for the community to interact with the pharmacies in the neighbourhood, direct questions to the pharmacist and where appropriate, complete a pharmaceutical transaction over the net. A pharmacy management program that will assist pharmacists to manage their pharmacy, keep patient medication records and provide pharmaceutical care will be part of the application. The goal is to provide patients with ready information that will allow them to: • Understand the Illness • Manage the Illness • Stay Healthy Summary of ICT Initiatives Using ICT, community members can direct questions to a pharmacist and where appropriate, complete a pharmaceutical transaction over the net. Part of the project also involves the provision of a pharmacy management program to pharmacists -- to help them manage their pharmacy, keep patient medication records and provide pharmaceutical care. The proper and correct use of medicines can be greatly enhanced with the availability and utilization of current and relevant information about the medicines. Books and medical literature are not available to everyone but through ICT, a very powerful and convenient tool for the dissemination of information, information is accessible to all. A person can access information at anytime from almost anywhere. The involvement of the Ministry of Health and the Malaysian Pharmaceutical Society as partners in the development of this application will ensure that consumer and professional interests are protected. The database contains information on over 27,000 products that are nationally registered (NPCB) in both English and Bahasa Malaysia. Medicines can be searched by either ingredient or brand name, assistance is also provided to guide patients towards the right product for non-serious ailments. The site also contains information on a variety of ailments, including diagnostic guides and self-care strategies. The website contains extensive listings of participating and independent pharmacies as well as some non-registered outlets such as apothecaries. Partners: e-Farmasi is a project of the National Information Technology Council of Malaysia under the Demonstrator Application Grant Scheme (DAGS), jointly developed by the Pharmacy Division of the Ministry of Health, The Malaysian Pharmaceutical Society, and GS Vision Sdn Bhd. The involvement of the Ministry of Health and the Malaysian Pharmaceutical Society as partners in the development of this application ensures that consumer and professional interests are protected. Source: http://www.efarmasi.com.my and http://gkaims.globalknowledge.org For more information, contact: G. A. Kumar Gopal (Vice-President Sales & Marketing) Telephone - 5631 6685 Email email@example.com 141 Radio Oxyjeune, Senegal Development Issues: Youth, HIV/AIDS, Sexual health Programme Summary A popular community radio station named Radio Oxyjeune, which broadcasts to a poor suburb of Senegal's capital, Dakar, not only pumps out music and chats to its audience, but takes an active role in its listeners' lives. It broadcasts programmes in both the national and local languages to reach as many people as possible. A staff of 50 people work at the station, only 20 of which have full-time jobs. The name of the station tries to capture some of its mission as it is a conjunction of the French words for "oxygen" and "youth". Summary of ICT Initiatives Radio Oxyjeune has phone-in shows that regularly tackle subjects many consider taboo such as HIV/AIDS and women's rights. Anonymous interviews with HIV positive individuals have helped to drive home their message in an environment that still attempts to hide from the epidemic. Organizers believe that the use of personal stories is one of the most effective ways to get the message about AIDS across to the community. The phone-in feature provides an opportunity for two way communication and information exchange within the community using widely accessible mediums. The organizers have recognised that both old and new technologies have the potential to enable various kinds of social change. The philosophy driving their success is that it is what people do with technology rather than the technology itself that is important feature of social change. These efforts to educate do not stop with phone-ins on the radio. The station has also started up many community groups that talk to people about HIV/AIDS. During holidays, these groups train people to go out to beaches, football stadiums, nightclubs and other places people gather to spread the word about safe sex. Despite some threats, during recent elections, the station also held meetings to help locals put questions to politicians standing for office. To reach as many people as possible, Radio Oxyjeune programmes are broadcasted in both the national and local languages. The station is hoping to open up sister stations within the year to further its message and expand its audience. Source: http://news.bbc.co.uk/1/hi/technology/2296091.stm http://gkaims.globalknowledge.org 142 Health e-News – South Africa Development Issues: Health, Poverty. Programme Summary Health-e is a news agency dedicated to producing news and analysis for the print and electronic media regarding health policy and practice in South Africa. The particular focus is to report on health issues affecting the poor and disadvantaged, and the implications of different health policies for our society as a whole. Content is tailored to the requirements of different weekly newspapers and/or radio stations. The Health-e team comprises five journalists and an office administrator. The team are as follows: Sue Valentine (editor), Kerry Cullinan (print journalist), Anso Thom (print journalist), Khopotso Bodibe (radio journalist), Thandeka Teyise (radio journalist) and Nina Taaibosch (administrator). Summary of ICT Initiatives The website provides access to a wide range of text stories and audio clips on various health issues and related news items. The style of the articles is one of investigative journalism and covers areas that involve important social and political issues throughout South Africa. The issues of mine workers, their high HIV prevalence, and company policies regarding testing and precautionary measures are paired with stories involving personal strategies for the management of insomnia and arthritis. The combination of text and audio based formats makes the website accessible to a wide range of audiences, those who are prevented from access because of connectivity and those who prevented from access because of illiteracy both gain from the dual format. The site contains both recent features and an archive of past stories and audio clips that are linked by subject area so that browsers can review all of the material that the service has created on a subject. They also offer subscriptions to an e-mail based health news bulletin and provide links to a number of other resources for readers and journalists. Observations Health-e news was the recipient of the Highway Africa 2001 Award for Innovative usage of new media in African journalism (NGO category).1 Partners: The core Health-e staff work with other organisations to deliver this service: Health Systems Trust2 for web and technical development, and the Media & Training Centre3 work with community radio stations and project administration. This project is supported by a grant from the Kaiser Family Foundation, USA. 4 Source: http://www.health-e.org.za For more information, contact: Health-e news PO Box 34572, Groote Schuur, 7937, Cape Town, South Africa Tel: Cape Town (021) 448-2388 or fax (021) 448-3321. e-mail: firstname.lastname@example.org 1 http://www.highwayafrica.org.za/awards.html 2 http://www.hst.org.za/ 3 http://www.healthlink.org.za/pphc/ 4 http://www.kff.org/ 143 SECTION 3 – NETWORKING AND DIALOGUE TOOLS Fantsuam, Education and Health Promotion Programme - Nigeria Development Issues: Education, Youth, Women, Health, Technology. Programme Summary Organized by the Fantsuam Foundation, the Education and Health Programme Initiative targets rural community health workers in Nigeria (most of whom are women) as well as adolescents. It utilizes Information and Communication Technologies (ICTs) to foster the exchange of information about, and to improve the provision of, health care. Established in 1996, Fantsuam Foundation is an NGO located in Nigeria, about 600 miles from Lagos in the north-central part of the country. Fantsuam works to alleviate poverty through participatory decision making that utilizes local beliefs as a primary mechanism for setting project priorities. Thus, its primary project partners are women's clan groups, which are non-religious and non-political. These groups are located in Kaduna, Benue, Gombe and Plateau States; between them they have membership of about 3,000. Each participating community and women’s group provides volunteers who undertake various activities and training relevant to their project. Summary of ICT Initiatives This programme conducts the following activities: • Distribution of copies of the newsletters "Straight Talk" and "Young Talk" to secondary school libraries in participating communities. These newsletters carry news items, photographs, and articles written by adolescents in Kampala Uganda on reproductive health issues • Periodic health screening sessions that are led by a health officer and that include group discussions, individual counselling, and treatments. The women at Kpunyai set up a first aid unit for their village, the financial implications of which are discussed during weekly meetings • A class to teach basic computer skills to girls and women at the Bayanloco Community Learning Centre. Health information, especially on reproductive health issues, is provided. • The development of Asibitin Karkara, a demand-driven primary healthcare model aimed at building a sustainable health service through partnerships with rural communities. This initiative builds on the strength of the extended family system and the willingness of people to pay for their health service in cash or in kind. • A Mobile Rural Library and ICT Service (MRLIS) objective that works with 40 rural communities to help provide textbooks for their schools and access to information from national, regional, and international sources. This service also provides facilities for rural- based teachers to enrol in distance learning programmes to improve skills and update their knowledge. Retention of pupils in schools is encouraged through the provision of a school lunch to each primary school child. • The initiation of contacts with a Nigerian university department for collaborative research in one of the rural communities where the source of water is a health hazard. This research includes: § Determining the links between public health and community-level relationships and networks § Analysing the social capital of communities, that is, identifying aspects of rural community life that promote health and ameliorate suffering caused by onchocerciasis or River Blindness Developing a community assets map that describes distinct levels of community strengths: individuals; citizen associations such as churches, cultural and peer groups; and local institutions like schools, libraries, hospitals, universities, etc. 144 Identifying strategic alliances for sustainable funding of community health projects. Fantsuam Foundation is also active in other areas and works: • to provide collateral-free microcredits for women • to promote rural health and education • to document local languages in an effort to improve women's access to literacy and education, indigenous knowledge, and traditional medicine, as well as to protect the intellectual property rights of rural communities, and • to collaborate with government agencies, Nigerian university departments, and Nigerian professionals in the Diaspora. Observations In 2001, the Fantsuam Foundation’s Bayanloco Community Learning Centre and its coordinator were awarded the Hafkin Communications Prize from the Association for Progressive Communications (APC) an African NGO committed to improving the utilization of ICTs for development. APC's objective is to recognize African ICT efforts, and to extract some of the lessons learned in order to make them accessible to others doing related work. The award theme was "People-Centred ICT Policy in Africa" and was based on the following criteria in which the Bayanloco Centre excelled. 1 1. Utilization of ICTs, especially the Internet 2. Mobilizing Awareness and Participation, and Building Capacity 3. Africa-Driven and Developing Africa 4. Women-Led, Women-Informed, Women-Inspired Partners: Urban Nigerians, Nigerian professionals, and members of a Nigerian university department; women's clan groups including Bechechet Bayinring, Fido, Mangu, Dogon Kurmi, Bayanloco, Zagun, Tula and Uwaba-Oju. Source: Fantsuam Foundation site http://www.fantsuam.com, APC site www.apc.org For more information, contact: The National Office: MaiAdiko Rayfield PO Box 8452 Anglo-Jos Plateau State, Nigeria OR The Field Office: Bayanloco, PO Box 58 Kafanchan, Kaduna State, Nigeria OR The UK Office: 4 King George Avenue Leeds LS7 4LH Fantsuamfoundation@fantsuam.com 1 http://www.apc.org/english/hafkin/2001/haf_finalists.shtml 145 Advocates for Youth, YouthLIFE - Botswana, Nigeria, and South Africa Development Issues: Youth, HIV/AIDS. Programme Summary In October 2001, Advocates for Youth launched a 3-year initiative called Youth Leadership in Fighting the Epidemic (YouthLIFE) in order to build youth leadership capacity in the area of youth- specific HIV/AIDS prevention interventions and advocacy. The programme involves partnering with four youth-led NGOs in three countries: the Youth Health Organization (YOHO) of Botswana, the Youth Action Rangers of Nigeria (YARN), the Township AIDS Project (TAP) in South Africa and the South African Centre for Organizational Development (SACORD). Efforts include skills- based training, advocacy programme implementation, organisational development, and efforts to secure youth participation in policy making. As a result of the 2002 Youth Leadership Institute, in Botswana, participants formed a Youth Activist Network (YAN) to bring together youth from various NGOs to collaborate on ways to improve youth reproductive and sexual health in their communities. The YAN offers a weekly forum for youth leaders to share information about activities, brainstorm on collaborative efforts, and transfer skills related to health promotion activities. In addition, young people successfully advocated for a position on the National AIDS Coordinating Association (NACA). The YAN representative on the NACA successfully advocated for a 50% increase in funding designated for youth programmes, including programmes to improve youth access to condoms. Summary of ICT Initiatives A key approach spanning all programme efforts is community (youth) participation. YOHO – Botswana: Advocates for Youth is working with YOHO to implement youth-specific HIV/AIDS interventions, including the use of programmes that entertain while educating as a prevention strategy. YOHO promotes Ministry of Health programmes, such as those that focus on Preventing Mother-to-Child Transmission (PMTCT) of HIV/AIDS and blood donation, and are linked to the CDC BOTUSA project. It also conducts peer education programmes with in and out- of-school youth and uses various media outlets (radio and printed materials) to spread sexual health messages. YARN – Nigeria: Advocates for Youth is helping YARN foster its organisational capacity as a sustainable NGO. Specifically, Advocates for Youth is helping establish a staffed office in Lagos, providing assistance with YARN's peer education programme, facilitating the offering of youth- friendly Voluntary Counseling and Testing (VCT) services, and helping develop an interactive website. YARN is also working to secure youth participation at all levels of sexual health policy making. SACORD - South Africa: Advocates for Youth is supporting SACORD a tertiary-institution student leadership organization with the development of its Mayihlome – “Graduate Alive Project.” They are employing a three-stage approach with Mobilization, Awareness, and Treatment phases. The awareness phase will employ an integrated media strategy utilizing different forms of media, such as: Newsletters, radio, TV, a website, posters and branding. A hotline will be set up to provide support and awareness catering specifically for the needs of students.1 Advocates for Youth is also assisting YOHO in Botswana, YARN in Nigeria, and TAP in South Africa with the launch of cyber-café initiatives whereby youth are provided access to the Internet, guidance on how to access information on reproductive and sexual health, opportunities to create content for YouthShakers.org,2 (an international youth activist website on reproductive and sexual health issues), and training to be online peer advisors. Cyber-café activities are intended to complement each NGO's existing youth outreach efforts by providing a virtual and physical space 1 http://www.sacord.co.za/mayihlome/news.htm 2 http://www.youthshakers.org/ 146 for youth. Advocates for Youth also provides opportunities for staff from youth-led NGOs to expand their skills as educators and advocates, and to network with other youth HIV/AIDS activists. For example, Advocates sponsored an annual week-long Youth Leadership Institute for youth activists. Finally, the project sponsors the participation of youth leaders in international conferences. It is hoped that these conferences will build their leadership skills and provide networking opportunities. For example, YouthLIFE supported 15 young people who helped organize the Barcelona YouthForce at the International AIDS Conference in Barcelona (July 2002). The YouthForce helped youth leaders attending the conference with networking, and also raised visibility about the lack of youth participation in HIV/AIDS policy making. Partners: Advocates for Youth, YOHO, YARN, TAP, and SACORD. Funded by the Centers for Disease Control and Prevention. Source: Letter sent from Nicole Cheetham to The Communication Initiative on March 17, 2003. For more information, contact: Kent Klindera Advocates for Youth email@example.com Youth Health Organization of Botswana c/o BOTUSA Project Gaborone - Botswana Tel.: (267) 393-3537 firstname.lastname@example.org Mr. Moses Imayi Youth Action Rangers of Nigeria Tel.: (234) 1.482.3550 email@example.com Mr. Freddy Pilusa South African Centre for Organizational Development Kasselsvlei 7535 - South Africa Tel.: +(27) 12.440.3076 or 12.341 7765 Fax: +(27) 12.440.3168 Ms. Enea Montague Township AIDS Project firstname.lastname@example.org or email@example.com OR PO Box 4168 Johannesburg 2000 - South Africa Tel.: +(27) 11.982.1016/27 or +(27) 11.833.6748/9 Fax: +(27) 11.838.5073 147 EC/UNFPA Initiative for Reproductive Health (RHI) in Asia ComNet Development Issues: Children, Youth, Rights, Health, Family Planning, HIV/AIDS, Women. Programme Summary Reproductive Health in Asia (RHI) works to improve the reproductive and sexual health of people living in Bangladesh, Cambodia, Lao PDR, Nepal, Pakistan, Sri Lanka, and Viet Nam. The EC/UNFPA Initiative provides financial support to reproductive health (RH) activities and services in Asia, as a result of the 1994 International Conference on Population and Development (ICPD), held in Cairo. What makes the Initiative stand out from other projects and programmes is its main strategy to involve international, regional and local non-profit organisations in its implementation and have these partners work together towards a common goal. With this approach the Initiative hopes to bring RH services within reach of populations in South and South-East Asia that are so far not or under-served. In the context of the EC collaboration with UNFPA, this Initiative represents the largest sum that the EC has yet committed to population programmes. The Initiative is expected to complement and promote the development of sustainable alternatives to current systems, contributing to a decline in fertility rates and to the decrease of mother and child morbidity and mortality. The different projects are leading to the establishment of exchange mechanisms between several organisations, facilitating a synergy of actions. This strategic approach is expected to have a multiplying effect on sustainable RH initiatives. Selected projects are expected to contribute to the:1 • Development of local and private capacities for improved management of RH, integrated within primary health care services and a better quality of services; • Promotion of community participation and local activities; • Promotion of gender equity and equality, development of actions targeted at vulnerable groups and most deprived populations; • Coherency of national policies and strategies. Summary of ICT Initiatives In order to assist in the maintenance of linkages between the RHI 60 local partners, 19 European partners, 7 Umbrella Projects, 6 UNFPA Field Offices and UNFPA itself in Brussels, the German Foundation for World Population (DSW) has designed special concept to secure communication within bigger RH networks: "The Information and Communication Network" (ComNet). The RHI ComNet has enabled the sharing and exchanging of specialist knowledge through the publication of guides and the implementation of workshops on the subject of how to deal with the press and media as well as how to carry out advocacy work. A press tour also served as a useful advocacy tool, highlighting the implementation of individual projects in project countries. Initiated and implemented since its launch by DSW, is divided into three main areas, which embody the aims of the ComNet:3 Capacity Building - ComNet has implemented a variety of training activities in the fields of advocacy, media and IT, thus helping to ensure the sustainability of its RHI partners. One of the main features of the ComNet has been the Capacity Building workshops and accompanying guides (subjects include Media, IT, and Advocacy training). All workshops cover a specific area of capacity building and have taken place in most RHI countries. More than 250 participants from all RHI partner NGOs have taken part in these training sessions. 1 http://www.asia-initiative.org/ 3 http://www.asia-initiative.org/projects_rdp.html 148 Communication Platforms - Over the course of the Initiative, the ComNet has developed and sustained its methods of communication, thereby guaranteeing the continuous exchange of information between all partners of the RHI, and allowing the promotion and support of South/South and South/North collaborations. ComNet operates four electronic mailing lists: • The News List (journalists, decision-makers and interested individuals and organization) • RHI parasol List (umbrella projects within the RHI) • RHI Mailing List (all agencies and partners of the RHI) • Gender Mailing List Visibility – The development and strengthening of a corporate identity. Experience has shown that an initiative that speaks with one voice, attracts greater and more varied media attention than individual efforts from project partners. In pursuit of promoting the visibility of the RHI, the ComNet has developed various publications in order to keep RHI partners and other organisations in the picture regarding the latest developments. • Four newsletters have been produced to date. Most of the articles were written by local journalists or RHI partners in the field. 1 • Eleven Fact Sheets have been published since the initiative's launch. Written by experts in the field, the Fact Sheets have proved especially popular amongst journalists as a useful source of information. 2 • The Annual Reports 1999, 2000 & 20013 All 42 projects of the EC/UNFPA Initiative for Reproductive Health in Asia (RHI) - how they have developed, information concerning their background as well as the finances of this unique Initiative, are charted in the Annual Reports All RHI publications have adopted an instantly recognisable style. It is imperative that publications that are used as visibility tools have a uniform design, thus creating a corporate identity for the RHI. Observations Several reports on lessons learned during the implementation of regional projects have been made available by RHI and DSW in a PDF report. These reports reveal the effectiveness of Quality of Care programs and the impact that Internet Education materials can have on reproductive health campaigns. Partners: The Commission of the European Union (EC), United Nations Population Fund (UNFPA) and, except for in Bangladesh, the execution of individual projects lie in the hands of altogether 21 European operational partners, and the implementation of the project activities are overseen by local partners. Projects in Bangladesh are executed as well as implemented by local partners. Source: Letter from Caroline Kent and the RHI web site. For more information contact: Caroline Jane Kent, Deutsche Stiftung Weltbevoelkerung (DSW), Goettinger Chaussee 115, D - 30459 Hannover - Germany. Phone: +49(511) - 9437319 fax: +49(511) - 9437373 e-mail: firstname.lastname@example.org 1 http://www.asia-initiative.org/news_rhiyanews.html 2 http://www.asia-initiative.org/news_facts.html 3 http://www.asia-initiative.org/news_annual.html 149 Health Development Networks (HDN) – Global Electronic Discussion Boards Development Issues: HIV/AIDS, Health, Networking Programme Summary Health & Development Networks (HDN) is a non-profit organisation that hosts, administers, and moderates online electronic discussion forums. They also provide international conferences with communications support to enable participation from individuals and organizations that are unable to physically attend such conferences. HDN’s mission is to facilitate communication and information exchange in support of the global response to HIV/AIDS and other health and development related issues.1 HDN’s Goals include: • To increase the number of people involved in popular discussion of HIV/AIDS and other health-and-development-related issues; • To promote partnerships and networking; • To improve the quality of and access to information; • To increase accountability and transparency in decision-making related to HIV/AIDS and other health- and development-related issues at local, national and international levels; • To document and advocate for the contribution made by electronic networking in HIV/AIDS and other health- and development-related fields; • To devolve governance and control over existing communication and information systems in the HIV/AIDS global community and in other health- and development-related areas. HDN strives to develop, support and implement projects that: • Are appropriate and add value to developing countries and challenged/underserved communities; • Are innovative, challenging, and push current thinking; • Can demonstrate impact; • Develop or involve local capacities (of selected country/community context) and use the principles of local management where possible; • Build collaborations and partnerships, rather than create competitive rivalries; • Are sensitive to gender, international in scope and consider north-south imbalances; • Endeavour to involve countries that are often overlooked - those with poor internet connectivity, and those with low HIV prevalence; • Are not associated (funding or affiliation) with organizations that discriminate against people with HIV; • Ensure that agendas are not influenced by specific interest groups or organisations vis-à- vis the needs of other stakeholders. Summary of ICT Initiatives HDN employs electronic networking and communications to facilitate discussion and debate among its members and other participants. It is a ‘virtual’ organization with members based in developed and developing countries. The HDN network moderates and maintains several different discussion forums that address issues of interest to different stakeholders and parties involved in efforts to deal with the HIV/AIDS pandemic. At present (as of June, 2003), the following moderated HIV/AIDS “eForums” are underway and accessible from the HDN homepage: • INTAIDS – International forum on HIV/AIDS policy and news worldwide. • AF-AIDS – Regional forum on HIV/AIDS in Africa • SEX-WORK – Forum looking at links between CSWs and HIV/AIDS • GENDER-AIDS – Forum on issues around gender and HIV/AIDS. 1 http://www.hdnet.org/home2.htm 150 • PWHA-NET – Profiles People With HIV/AIDS (PWHA) networks and activities and facilitates discussion on shared issues, strategies and actions. • SEA-AIDS – Regional forum on HIV/AIDS in Asia and the Pacific • BTS – “Break The Silence”: The international forum on health and development policy issues. • ProCAARE – “Program for the Collaboration Against AIDS and Related Epidemics”: This forum is targeted at uniting health practitioners and communities with knowledge to address the epidemic. All of these forums are moderated, and contributions are reviewed for appropriateness and basic editing. HDN networks also maintains a staff of around 100 Key Correspondents (the KC Team) who’s role is to provide seed ideas for the discussions on the forums. Written contributions from the KC-Team stimulate submission of comment and views from other discussion forum members. KCs are based in various countries around the world and their contributions reflect their diverse technical backgrounds and experience with the HIV/AIDS environment. They are drawn from the fields of nursing, law, journalism, medicine/epidemiology, counselling/training and policy/strategic planning. “KCs contribute summarised perspectives from their own countries and areas of work, based on their own specialized knowledge and experience. Contributions range from subjective views, summaries of strategies and policies, to interviews and site visits with leading local and national people or projects. This helps to encourage other forum members to contribute their own views and integrate developing country-based priorities and perspectives into international discussions.”1 As noted, HDN also provides information and reports about ongoing conferences on HIV/AIDS and other related issues. Their KCs are often in physical attendance at these conferences and provide daily briefings and reports about the discussions and presentations that occur. Observations In a review of the HDN as part of a larger report on ICT and HIV/AIDS, Libbie Driscoll of Policy Research International noted that many of the registered participants utilize the network primarily to glean information and to keep up to date on developments and do not submit many postings. She notes that this passivity is generally true of many of these types of forums and is not in itself a negative feature. The HDN is also undergoing a process of decentralization, shifting the responsibilities for moderation to regional participants and steering committees.2 Partners: Inis, SAfAIDS, UNAIDS, Fondation du Present, the Government of Ireland Source: HDN website at www.hdnet.org/home2.htm; Driscoll, Libbie. “HIV/AIDS and Information and Communication Technologies.” Final Draft Report (November 2001) For more information, contact: Tim France Director & Programme Manager E-mail: email@example.com Tel: (+353) 868 192324 Fax: (+353) 8658 192324 Rep.of Ireland 1 http://www.hdnet.org/home2.htm 2 Driscoll, Libbie. “HIV/AIDS and Information and Communication Technologies.” Final Draft Report (November 2001). 18-19. 151 Regional HIV/AIDS Information Network (RHAIN) - East Africa and southern Africa Development Issues: HIV/AIDS. Programme Summary The Regional HIV/AIDS Information Network (RHAIN) is a technical resource network aimed at mobilizing the strengths and expertise of organisations working in the area of HIV/AIDS information and media development in southern and eastern Africa. RHAIN was established following an April 2001 meeting in Harare and a subsequent meeting in May 2001 in Pretoria that brought together organisations working in the area of HIV/AIDS communication, information, and media development. The objectives of RHAIN are to: • Foster greater collaboration and joint advocacy efforts on HIV/AIDS in the region; • Strengthen the flow of information on HIV/AIDS at regional and national level; and • Promote media development and training on HIV/AIDS in southern Africa. RHAIN activities are coordinated by a Secretariat who is appointed on a rotating basis by participating organisations. The appointed organisation assumes leadership of the Secretariat, who is responsible for coordinating, hosting, and reporting on RHAIN meetings. At the bi-annual meetings, members are expected to provide updated feedback, share experiences, and discuss constraints regarding the implementation of joint activities. Summary of ICT Initiatives Designed to strengthen the flow of information on HIV/AIDS at the regional and national level, the programme includes: • Regional audit of HIV/AIDS information activities; • Regional HIV/AIDS information needs assessment to publicize diverse information channels on HIV/AIDS both regionally and internationally. These channels include government initiatives and civil society programmes. The goal of this assessment is to develop a regional database on HIV/AIDS information and communication programmes and activities being undertaken in the region to the end of highlighting best practices and research efforts. The information needs assessment will take the form of a survey to be distributed to organisations working in the area of HIV/AIDS in Zambia, Zimbabwe, Mozambique, Malawi, Namibia, and Lesotho. • Plus News, an e-mail and web-based news and information bulletin on HIV/AIDS distributed to regional media through the United Nations Integrated Regional Information Network (UN-IRIN) subscriber base and via the AF-AIDS Forum. RHAIN partners are asked to provide editorial contributions and are encouraged to further disseminate Plus News. SAfAIDS provides a guide to UN-IRIN on the reporting procedures for HIV/AIDS. Editorial support is available from RHAIN partners. RHAIN members will explore the possibility of utilising radio to further disseminate information. • The promotion of media development and training on HIV/AIDS in southern Africa through concept papers including a training manual for African journalists to enable media practitioners in Africa to better understand, effectively cover and report on the epidemic; technical assistance in integrating HIV/AIDS into the existing curricula of regional and national organisations; the development of a regional database of journalists who have undertaken training on HIV/AIDS to facilitate follow-up and monitoring of the impact of training programmes; columnist service on HIV/AIDS; and HIV/AIDS feature service; and • The provision of support for the World AIDS Campaign (which focuses on young people, who are most vulnerable to HIV infection). RHAIN will support the packaging of material for use by radio, a publicity campaign in SAfAIDS Newsletters and Newsflashes, the development of fact sheet on boys and HIV/AIDS, the creation of posters featuring 152 eminent persons from the region, the production of relevant screensavers (to be offered on the SAfAIDS website), the production of a media pack around the theme of "I Care, Do You?", the provision of five one-minute radio inserts on youth, and the dissemination of a report on young men and HIV/AIDS. An electronic forum has been established to facilitate the continuous sharing of information on information and communication activities, and allow for the monitoring, implementation and evaluation of joint activities.1 Observations Future initiatives include: • A series of films produced on HIV/AIDS in the region (to be ready by World AIDS Day); • The use of SABA News to disseminate information in the region on HIV/AIDS and the World AIDS Campaign; and • The cultivation of potential new partnerships with organisations like SANASO. RHAIN members are asked to invite these potential partners to meetings and to share relevant documents. Partners: AF-AIDS Forum, SAfAIDS, PANOS, Health Development Network (HDN), Health Systems Trust (HST), The Joint United Nations Programme on HIV/AIDS (UNAIDS), UN-IRIN, German Development Corporation (GTZ), Africa Alive!, Inter Press Service (IPS), and OneWorld. Source: Working Paper entitled "Regional HIV/AIDS Information Network for Southern and Eastern Africa." Draft: July 2001, sent to The Communication Initiative by Richard Delate, UNAIDS Information and Media Strategist on March 11, 2002. For more information, contact: Manju Chatani, Programme Manager, Health & Development Networks, P. O. Box 26084, Arcadia, Pretoria 0007 South Africa Tel.: +27-(0)12-320-3820 ext. 1162/3 Fax: +27-(0)12-320-2414 Mobile: +27-(0)83-513-3819 firstname.lastname@example.org HDN website at http://www.hdnet.org/ 1 See the forum at < email@example.com > 153 ProCOR/AMICOR - Global Development Issues: Cardiovascular Health, Tobacco Programme Summary Cardiovascular disease (CVD) mortality and disability rates are rising exponentially in India and other developing countries. It is often young people who are in their prime that are worst hit by this growing epidemic. Western, technologically intensive management strategies, however, are not cost-effective, and they are economically draining and therefore unsustainable. Relatively affordable prevention strategies are underemphasized and thus, the primary goal of the ProCOR/AmiCOR - India programmes is to popularize cost-effective measures for common people and to make them more readily available. ProCOR is an ongoing, e-mail and web-based electronic conference aimed at addressing the emerging epidemic of cardiovascular disease in the developing world. The goal of ProCOR is to create a dynamic international forum where health care providers, researchers, public health workers, and others may share timely information and participate in raising the awareness about this emerging public health challenge. Moderators screen incoming messages and post current research, clinical and public health information, thus ensuring the high scientific quality of the discussion. ProCOR was officially launched in July 1997 as a collaborative effort between SATELLIFE and the Lown Cardiovascular Center. The Center’s activities encompass cardiology care, research and fellowship training. SATELLIFE is a nonprofit international health organization that serves the information and health communication needs of developing countries. AmiCOR - India is a non-profit autonomous organization that aims to advance health research and augment dissemination of information relevant to policies and programmes aimed at combating the emerging epidemic of cardiovascular disease in India. AmiCOR - India is an offspring of ProCOR. The goal of AmiCOR - India is to create a dynamic and interactive forum for physicians, cardiologists and other health care providers, health policy-makers, researchers, consumers of health care and other stakeholders in public health to amass information, debate policies and raise the awareness of the challenges posed by the emerging cardiovascular disease epidemic in India. AmiCOR - India is guided by a group of International and Indian advisory committee consisting of leaders from various fields. Moderators for this electronic conference are distinguished leaders in their field. They will ensure the highest scientific quality of discussion. The organizers note that the participation of like-minded individuals and organizations from all fields and all levels is critical for the success of this endeavour. The aims and objectives of AmiCOR - India are: 1. To popularize preventive and cost effective care of cardiovascular diseases among the health care providers and general public. 2. To create a dynamic and interactive forum for physicians, cardiologists and other health care providers, health policy makers, researchers consumers of health care and other stake holders to debate policies and raise the awareness of the challenges of the emerging cardiovascular epidemic in India. 3. To serve as a resource of information regarding evidence based, cost-effective prevention and treatment strategies for CVD. 4. To encourage and nurture young researchers to develop locally relevant solution to various questions related to cardiovascular disease prevention. 154 5. To play an advocacy role to mobilize support in various sections of the community for multisectorial actions which contribute to the prevention and control of CVD. Summary of ICT Initiatives ProCOR provides health workers in the developing world with the single most important commodity needed to address the emerging epidemic of heart disease - information. On the site they can exchange information, learn about appropriate treatment strategies, access literature, share experiences and find support. We invite and welcome all interested colleagues to participate in this vital international network. Moderators screen incoming messages and post current research, as well as clinical and public health information, thus ensuring the high scientific quality of the discussion. ProCOR is guided by a distinguished Advisory Committee comprised of colleagues from internationally recognized institutions around the world. In addition to the management of the forums, both websites are gateways to a wide variety of information, data, epidemiological study results, and clinical materials relating to the prevention of CVD. There is an updated listing of conferences and events as well as a series of links to resource persons for groups and individuals who are trying to develop cardiovascular health programmes in their own communities. Observation AmiCOR – India is only one of several regional outgrowths of the ProCOR strategy. Other AmiCOR organizations can be found in Argentina, Brazil, Guatemala, India, Lebanon, and Pakistan. Recent efforts are focusing on the development of campaigns to combat the usage of tobacco and the prevalence of obesity and their contributory effects on CVD. Partners: Satellife, Lown Cardiovascular Center Source: The ProCOR website http://www.procor.org/default.asp and the AmiCor - India website http://www.amicorindia.org/index.html> For more information, contact: ProCOR Lown Cardiovascular Research Foundation 21 Longwood Ave. Brookline MA 02446 USA Tel 617-732-1318 Email: firstname.lastname@example.org Amicor - India T-7,Green Park Extension New Delhi-110016 Telephone:++91-11-6167459,6167397 Fax:++91-11-6167397 E-mail: email@example.com 155 Philippine Health Social Science Association - Philippines Development Issues: Health, Rights, Gender. Programme Summary The Philippine Health Social Science Association (PHSSA) is an NGO that works to promote the health of citizens of the Philippines by providing information and advocating ethical and gender- fair health care. PHSSA began as a small group of social scientists and health professionals based in Metro Manila. Now, PHSSA considers its autonomous local chapters to be the centres of action. Decision-making is consultative and participatory, involving both national and regional groups. The mission of the organisation is to develop health social science as an integrated domain of effective, accessible, and responsive health policy, programmes, and service. It is national in scope, with chapters in the major islands of the archipelago and membership from other NGOs, government agencies, research institutes, and the academe. PHSSA is committed to the development of health social science as an integrated domain of effective, accessible and responsive health policy, programs, and service by: • Developing approaches, concepts, and methods that sensitive to Filipino culture and responsive to critical issues such as domestic violence, child abuse, non-compliance with ethical principles in health research and service delivery; • Enabling persons, groups, and communities in doing holistic and collaboration work in health; • Encouraging partnership with communities and non-government organizations in the various facets and levels of health work; • Integrating health social science in the education and training of health professional through curricular reforms; • Promoting ethical and gender fair health care; • Networking with local and foreign individuals, groups, and institutions for the realization of our vision. Summary of ICT Initiatives In all of its activities, PHSSA works to empower citizens through approaches that are sensitive to Filipino culture and responsive to issues such as domestic violence, child abuse, and non- compliance with ethical principles in health research and service delivery. Thus, a major component of its work is to enable holistic and collaborative work in these areas, in part by encouraging partnerships with communities and NGOs. The PHSSA site1 offers information and links to publications on these issues, as well as a discussion forum. This site is part of the long- term strategy of integrating health social science in the education and training of health professional through curricular reforms. Specifically, the programme offers: • Case studies analysing members' experiences in collaboration with social and health scientists and recommended ways of fostering collaborative and ethical research • Scientific meetings to encourage discussion of issues and raise consciousness about health concerns • Roundtable discussions in regional centres to formulate regional plans of action for intersectoral work in health • Resource base on various fields in health social science work in the country and elsewhere in Asia • Publication of research findings and discourses in health social science • National Health Social Science Conferences 1 http://phssa.org/index.html 156 The PHSSA publishes regular bi-monthly newsletters as well as a Social Health journal that currently comes out every 3-4 months. All of these materials and many more publications are available through their website in either HTML or PDF format. The topics covered in the journal and other publications are broad and range from reviews of motor-vehicle deaths to advanced strategies for empowering women. The site also provides access to an extensive database of materials and publications relating to social medicine and health care. Observations The PHSSA strategy of acting as a linkage for the local chapters and allowing them to set the mandate for discussion and research is one of the organizations strengths and ensures that their services are responsive to the needs of the communities in which they are operating. Partners: The Ford Foundation, The Rockefeller Foundation, National Academy for Science and Technology, Department of Health, Philippine Council for Health Research and Development. Source: PHSSA site at www.phssa.org For more information, contact: Philippine Health Social Science Association National Program Office Rm 318 Asian Social Institute Bldg. 1518 L Guinto cor JL Escoda Sts Malate, Manila, Philippines Tel.: +632 5216692/5239392 firstname.lastname@example.org PHSSA site at www.phssa.org 157 Women Connect! - Eastern and Southern Africa Development Issues: Women; Rights; Family Planning; HIV/AIDS; Health; Economic Development; Political Development; Youth. Programme Summary Faced with limited financial resources in an era of increasing social problems, women’s organisations in developing nations must find ways to utilise both traditional media to reach their rural audiences and digital media for international audiences to get their messages out and improve women’s health and well-being. Women Connect! combines communications and health strategies for the improvement of women’s lives by working through women’s non-governmental organisations (NGOs) in Uganda, Zambia, and Zimbabwe. Launched in January 1999, the project aimed to strengthen the communication and advocacy skills of women’s rights organisations. This strategy aimed at the broader goals of women’s empowerment and support in building civil society. Summary of ICT Initiatives This initiative sought to help women’s organisations use all forms of media to communicate and advocate for the causes they felt were important in their communities, including reproductive health rights, gender-based violence, inheritance rights, and women's participation in government. Specifically, the project worked with groups to develop effective communication strategies using traditional and mass media. The project also connected participating groups to email and the Internet to allow them to network with each other and with other groups around the world, sharing problems and solutions. This strategy included training workshops and the provision of project grants to 26 NGOs in Zimbabwe, Zambia, and Uganda. The grant awards allowed groups to implement pilot communications projects suited to their needs, including: • Downloading health information from the Internet and repackaging it for bi-weekly email updates to local health service providers and NGOs that lacked updated resource materials. • Producing a community newsletter soliciting narratives on local approaches to HIV/AIDS education and care, primary health care needs, and economic development projects. • Producing health programmes on three radio stations – one providing health tips and one featuring dialogue and problem solving with a local personality. • Training staff in email use for networking and online advocacy. • Conducting HIV/AIDS outreach to disabled women, who are often left out of national HIV campaigns and often have limited knowledge of prevention of STIs and available services. • Carrying out a media campaign aimed to increase reproductive and sexual health information and services to adolescents. Observations The dissemination of Women Connect! evaluation findings and the significant activities of participating NGOs began in January 2002. Here are examples of the outcomes in terms of women's health among participating NGOs: • Two NGOs launched Internet cafés in Zimbabwe and Uganda, focusing on training for women and women’s organisations. They also trained women parliamentarians. • Nine NGOs conducted media campaigns and produced media materials on health promotion, disease prevention (including HIV/AIDS), promotion of women in leadership roles, and advocacy to reduce violence against women. • Eight NGOs became connected to the Internet and acquired an email account allowing them to network more efficiently with other women’s groups and lobby online for social change. • Fourteen NGOs received advanced training on the use of email and the Internet. 158 • Five NGOs developed web sites to share programme objectives and successful programme strategies. • Six NGOs acquired Internet research skills allowing them to locate, analyse, and adapt health information for repackaging into traditional media printed in local languages. • Two dissemination workshops were held in February, 2002 in Uganda and Zimbabwe with project grantees to discuss the findings from the evaluation report. Informal as well as formal presentations on the project have been conducted, and have included a screening of a short video profiling five of the Women Connect! NGOs. The videos are available on The Annenberg Center (University of Southern California) site.1 Programme highlights include the Zimbabwe Women’s Resource Center and Network (ZWRCN) plans to train grassroots women in IT skills, and to offer IT training in schools. They are also considering setting up IT facilities in rural communities. ZWRCN indicated that prior to 1999 (when Women Connect! began), most African countries were lagging behind in Internet access. Now that all countries have access, the programme focus will be shifted to an exploration of how the Internet can impact the lives of women. The Pacific Institute for Women’s Health is strategising on ways to build upon the network of women’s NGOs in the three project countries so that it may conduct new projects in women’s reproductive and sexual health and rights. An evaluation of the Women Connect! programme led to the development of the following guiding Communication Principles for Project Design: 1. The combined focus on traditional media, mass media and ICT is appropriate. 2. Organizations may be wired (plugged in), but computer technology is seldom maximized by broader connections, both within the organization and to the outside world. 3. Introducing new technology into any organization will cause changes within the organization by putting pressure on systems, relationships, communication and management styles. 4. Organizations too often use traditional media and develop messages without strategic planning, research or evaluation components. 5. In the long run, ICT can save organizations money, because they can use Internet and e- mail and cut down on the cost of international phone and fax charges. Partners: The Pacific Institute for Women’s Health; the Bill and Melinda Gates Foundation; and the University of Southern California (USC) Annenberg Center for Communication; Global Fund for Women. Source: Letters from The Pacific Institute for Women’s Health (PIWH) to The Communication Initiative. For more information, contact: Muadi Mukenge Program Officer for Africa Pacific Institute for Women's Health 3450 Wilshire Blvd., Suite 1000 Los Angeles, CA 90010 USA Tel.: (213) 736-4802 Fax: (213) 386-2664 email@example.com Women Connect site at www.women-connect.org PIWH site. At www.piwh.org 1 http://www.annenberg.edu/news/newsitem.php?id=117 159 Journalists Against AIDS (JAAIDS) – Nigeria Development Issues: HIV/AIDS. Programme Summary Journalists Against AIDS (JAAIDS) Nigeria is a media-based non-governmental organisation in Nigeria working in the field of HIV/AIDS and development. Their mission is to contribute to the prevention and control of HIV/AIDS in Nigeria by improving the quality of HIV/AIDS communication messages and by strengthening the quality of policy response and interventions. Journalists Against AIDS (JAAIDS) Nigeria has won several accolades for its innovative programming and approaches to the prevention and control of HIV/AIDS in Africa. Summary of ICT Initiatives JAAIDS has developed a host of innovative approaches to awareness and prevention activities including these past and ongoing projects: • Monthly Media Roundtable As part of efforts to build partnership between HIV/AIDS activists and the media, JAAIDS convenes a Monthly Media Roundtable to facilitate easy access to the media by activists and NGOs as well as provide a forum for journalists to update themselves on current issues in the HIV/AIDS epidemic. Topics discussed at past Roundtables include Islamic Responses to HIV/AIDS, Facts about HIV/AIDS Statistics, Face-to-face with People Living with HIV/AIDS, Locally-available Herbal Remedies for HIV-related Opportunistic Infections etc. • Training Workshops & Seminars JAAIDS develops seminars in response to the needs of Nigerian journalists to fill their skills gaps in HIV/AIDS reporting. In 1998, six HIV reporting seminars for print journalists were held, in collaboration with the local chapels of the Nigerian Union of Journalists (NUJ). In 2001, in response to a survey that identified HIV-related training needs of the media, JAAIDS organized three workshops focusing on Effective HIV/AIDS Reporting; Advocacy Skills; and the Science of HIV/AIDS. Over 80 journalists were trained at these workshops. At the December 2001 International Conference on AIDS/STDs in Africa in Africa (ICASA) in Burkina Faso, JAAIDS in partnership with Internews Network-USA, conducted an intensive training programme for radio journalists from Nigeria and Kenya covering the conference. • Advocacy Campaign On Access To Treatment A two-year advocacy campaign to support access to affordable treatment and care for Nigerians living with HIV/AIDS is currently underway. The project aims to empower a wide body of stakeholders (PLWHA, the media, care providers, activists, government officials etc) with the skills and knowledge to advocate on issues of access to HIV-related care and treatment. Specific activities under the project include consultative meetings and roundtables with stakeholders throughout Nigeria, capacity-building workshops, production and circulation of a bi-monthly newsletter as well as the creation of a website and listserv that will collate, store and distribute critical information and updates on access to treatment issues. • AIDS News Service Monthly Bulletin One of the constraints facing Nigerian journalists in reporting HIV/AIDS is the lack of easy access to new resources. To address this gap, JAAIDS publishes AIDS News Service, a 16- page monthly bulletin of HIV/AIDS and reproductive health issues for the Nigerian media. 4000 copies of this bulletin are produced and distributed free to reporters, editors and media managers every month, thus guaranteeing continuous reportage of quality HIV-related news in the media. • The Nigeria-AIDS eForum JAAIDS has also worked in the area of opening up discussions on the HIV/AIDS situation in 160 Nigeria, through the Nigeria-AIDS eForum1 a email/web-based discussion forum on AIDS in Nigeria The eForum currently has over 1000 direct subscribers and at least 500 secondary readers, who are mainly activists, journalists, people living with HIV/AIDS, policymakers and donor staff working in the area of HIV/AIDS in Nigeria and across Africa. An average of five email messages are distributed in the forum everyday and many members report that the forum is their main source of information on HIV/AIDS in Nigeria and globally. Increasingly quoted on HIV-related news sites across the world, the Nigeria-AIDS eForum has been made even more popular by the hosting of the first Open Electronic Conference on HIV/AIDS in Nigeria, which is a six-months-long structured conference-on-the-Net, lasting between August 2001 and January 2002. • The Nigeria-AIDS website The JAAIDS website2, launched May 30 2001, has become an important reference site on HIV-related information and resources in Nigeria and West Africa. The site features most policy documents, research reports, studies and news relevant to the HIV/AIDS situation in Nigeria. Other features include an online survey, statistics on HIV/AIDS in 16 countries of West Africa as well as archives of the Nigeria-AIDS eForum. The website is updated regularly and is designed to serve as the online resource centre on HIV/AIDS for the sub-region. Observation Journalists Against AIDS (JAAIDS) Nigeria has won several accolades for its innovative programming and approaches to the prevention and control of HIV/AIDS in Africa. In addition the JAAIDS project director has been seconded to the board of several other HIV/AIDS prevention NGOs to assist in the development and strengthening of communication programmes. Partners: The Futures Group International/Policy Project Nigeria, The Ford Foundation (Office for West Africa), the Elton John AIDS Foundation/Family Health International, The Panos Institute London as well as the National Action Committee on AIDS (NACA). Association of Alternative Newspapers and the African American AIDS Policy and Training Institute, USA as well as the Society for Family Health (SFH). Source: JAAIDS website at www.nigeria-aids.org For more information, contact: Omololu Falobi Project Director, Journalists Against AIDS (JAAIDS) Nigeria firstname.lastname@example.org JAAIDS Nigeria site at www.nigeria-aids.org 1 http://www.nigeria-aids.org/eforum.cfm 2 www.nigeria-aids.org 161 APRI-Minga - Peru Development Issues: Women, Health, Rights, Economic Development, Environment, Youth. Programme Summary This community-based organisation is devoted to promoting the empowerment and gender equality of women in the Peruvian Amazon Native Indian communities. Its mission is to assist these communities in their fight against social, economic, and environmental injustice. It is in large part the work of indigenous health care researcher, activist and Ashoka Fellow, Eliana Elias Many poor people in the developing world die needlessly during epidemics and medical emergencies because they do not understand how to apply the measures that could prevent or cure their afflictions. Elias has identified a need which is fundamental but often overlooked in development programs--communications strategies and techniques for use with poor indigenous groups, and poor women in particular, to make sure that information gets adequately transmitted to beneficiary populations and achieves the desired impact. Existing educational materials tend to use terminology that the people do not understand. Because national health materials and policies are designed in Lima, they do not take into consideration cultural beliefs, perceptions, and traditions of local indigenous groups, many of which are isolated throughout the country. Policies and health campaigns, instead, are designed by personnel with biomedical backgrounds and without any formation in effective communication or education. These policies focus on curative medicine rather than primary health care, disease prevention, and community participation. Summary of ICT Initiatives Together with community leaders, health workers, and traditional healers, APRI-Minga produces radio programmes, training material, and workshops on human rights, income generation, self- esteem, family violence, health prevention, reproductive health, and traditional medicine. For instance, APRI-Minga works with a network of women and girls known as promoters who are volunteers from the communities themselves. The promoters are trained in developing consensus-building strategies, resource mobilization, and broadening communication channels among different generations. After training, these promoters encourage active participation in decision-making regarding health, fertility, and social well-being Minga has identified four strategic points of intervention for improving the provision of public health information: upper echelons of the Ministry of Health and national policymakers, educators and trainers in medical and nursing schools, health care providers (both official and traditional) in rural areas, and the population itself. Minga has designed a series of initiatives for education and influencing policy with each of these groups, with a view to revolutionizing the dissemination of public health information by teaching them how to communicate in language and concepts that are accessible to the target population. Minga’s primary goal is to ensure that local rural communities are well informed, understand health materials, and ultimately achieve a healthy lifestyle through positive attitudes and clear knowledge of health practices. They have created packets of materials in the people's own language, including radio programs, brochures, videos, and manuals, translating technical explanations into easily comprehensible terms. Topics include safe sex and pregnancy, avoiding cholera, community efforts in disease prevention, women's and children's health, prevention of contagious disease, and communication for health. Specific Minga projects include: • “Welcome Health”: an educational programme that reaches an audience of 800,000 in the Amazons • Health Education: trains and assesses native Indian health promoters and encourages their leadership in communities. • Paternity: involves men in the reproductive health decision-making process. 162 • Resource Management: initiates farming, reforestation, and fishing projects to disseminate sustainable agricultural practices. • Tambo Minga: a community training centre for the project partners The radio program called "Welcome Health" transmits information on health to local populations and has to date broadcast 50 programs. Listeners, mostly women and health care providers, write in about improvements in health conditions and participate in contests for prizes such as mosquito nets, cooking utensils, and other equipment to prevent community health problems. She has received funding to continue radio transmissions for three years. The next level, involves working with health centres, local health organizations, and universities to train health care personnel in effective communication techniques. It is necessary to identify health professionals in rural areas who were born locally and will stay longer than a year for intensive training in design and promulgation of materials. Universities are collaborating to future health care providers in social communications techniques and groups of students from Lima are forming to do practical exercises in health care communication in coordination with rural populations. It is also necessary to influence decision-makers to affect national policy and incorporate effective communication strategies into official materials on health care. At the local level, Minga collaborates with the Loreto Regional Health Directorate to promote community participation and communications in health. Through links with international organizations such as USAID, World Bank, Johns Hopkins University Center for Communications, and the Center for Health and Gender Equity, Minga hopes to bring pressure on Peru's Health Ministry to change its policies and incorporate effective communication strategies into their health campaigns. Partners: Family Care International, Red de Mujeres Amazónicas del Marañon (Marañon Amazon Women's Network), Lawrence Coalition for Peace and Justice, McGile University, Ashoka. Source: The Minga Perú site at http://www.apri-minga.org/ and Elias profile on the Ashoka site at http://www.ashoka.org/fellows/viewprofile1.cfm?PersonId=1288 For more information, contact: Victoriano Castillo Minga Perú 125 Of.102 Urbanización Los Jasmines, Miraflores Lima 18 - Perú Tel.-Fax: 511-448-2970 email@example.com 163 Women of Uganda Network (WOUGNET) - Uganda Development Issues: Women’s Health, Organisational Networking. Programme Summary Women of Uganda Network (WOUGNET) is a non-governmental organisation initiated in May 2000 by several women's organisations in Uganda to develop the use of information and communication technologies (ICTs) among women as tools to share information and address issues collectively. In line with this, WOUGNET maintains a mailing list and website, which are hosted by Kabissa1 - A Space for Change in Africa. WOUGNET's mission is to promote and support the use of ICTs by women and women organisations in Uganda, so that they can take advantage of the opportunities presented by ICTs in order to effectively address national and local problems of sustainable development. The new ICTs, in particular, email and the Internet facilitate communication with each other and the international community. While their emphasis is directed towards Internet technologies, they are also interested in how these technologies can be integrated with traditional means of information exchange and dissemination including radio, video, television and print media. Their definition of ICTs includes these other media. The goal is to improve conditions of life for women by enhancing their capacities and opportunities for exchange, collaboration and information sharing. The launch of WOUGNET in May 2000 resulted from consultation with women organisations including Isis Women's International Cross-Cultural Exchange (Isis-WICCE), Uganda Women's Network (UWONET), Women Connect! - Uganda and Women Engineers, Technicians and Scientists in Uganda (WETSU), it was agreed that there was need for the following: • A list that would facilitate exchange of ideas and information between subscribers; • A companion website that would profile women organisations and use the web to provide additional exposure to their activities; • Information and support on how to maximize the potential of ICTs within women organisations. Summary of ICT Initiatives Membership in WOUGNET is by participation in the WOUGNET online space. Membership is open to anyone interested in promoting or supporting the use of ICTs for sustainable development with an emphasis on activities directly related to Ugandan women. There is no fee for WOUGNET membership, which is available at three levels: • Individual: This level is for individuals. To join, one needs to subscribe to the WOUGNET mailing list. • Organisation: This level is for women organisations based in Uganda. To join, an organisation needs to subscribe to the WOUGNET mailing list or to subscribe to the monthly WOUGNET Update Newsletter. In addition, organisations need to provide a profile on the WOUGNET website. The profile can be submitted online or by requesting an Organisation Entry Form. • Affiliate: This level is for organisations that are not women organisations based in Uganda but are interested in the use of ICTs for sustainable development in Uganda and worldwide. To join, an organisation needs to subscribe to the WOUGNET mailing list. Organisations will also have links created to their websites (if available). WOUGNET has also developed a Web Design Programme to facilitate entrance of other women’s NGOs onto the Internet. Websites can be a beneficial tool for making contacts, forging partnerships, fundraising, and marketing services and crafts. The Web Design program is a partnership of WOUGNET and InterConnection2 to donate websites to WOUGNET members that 1 http://www.kabissa.org/ 2 http://www.interconnection.org 164 meet InterConnection's criteria for website donation. InterConnection's mission is to provide Internet and computer technology and training to underserved communities in developing countries. A sample of websites that have been donated by InterConnection is available at <http://www.interconnection.org/ngo>. The basic criteria for participation in this program are: 1. Organisation is a WOUGNET member. Has a profile on the WOUGNET website and is subscribed to either the WOUGNET or WOUGNET Update Newsletter mailing lists. 2. Organisation's mission includes some of the following components: provides economic or social benefits to the community, promotes natural resource preservation or human rights, non-profit organisation. Organisations that meet the basic criteria then apply for both participation in the program and the opportunity for the website design to be donated by InterConnection. Donated websites are created by an international network of virtual volunteers. This program is WOUGNET’s response to a common question for many NGOs: "What resources are available for non-governmental and not-for-profit organizations in developing countries that want to set up their own web site?" They also point to the Network Startup Resource Center (NSRC) which has produced Web Resources for NGOs and Nonprofits 1 that presents some of the resources available discusses how one might approach setting up a website, issues to consider, and gives a few practical tips. The NSRC2 is a non-profit organization that has been involved for the past decade with the deployment and integration of appropriate networking technology in various projects throughout Asia, Africa, Latin America and the Caribbean, the Middle East, and Oceania. WOUGNET is also piloting the use of WorldSpace satellite radio equipment among its members. The WOUGNET WorldSpace Satellite Radio Program (WSRP)3 was initiated in August 2002 with the ALFA Women's Groups.4 WorldSpace satellite radio broadcasting has been developed by the WorldSpace Foundation, based in the USA5. The Foundation's mission is to help improve the lives of disadvantaged persons in developing regions of the world by providing access to education and other information broadcast directly to radios from satellites. The WorldSpace radios when connected to a computer help users to access web based information without having to use the usual method of accessing information from the Internet (e.g., dialup, wireless or cable connections). The WSRP involves a loan of the WorldSpace satellite radio equipment to WOUGNET members for periods of up to 3 months each. Partners: WorldSpace, InterConnection, The Global Fund for Women, Kabissa, Uganda Women's Network (UWONET), Source: www.wougnet.org For more information, contact: Plot 59 Nkrumah Road, Room 13 +256 (0)41 234924 P.O. Box 4411, Kampala, Uganda firstname.lastname@example.org 1 http://www.nsrc.org/helpdesk/web-resources.html 2 http://www.nsrc.org 3 For a full report see <http://www.wougnet.org/Reports/WSPACE/worldspacerep.html> 4 http://www.wougnet.org/Profiles/alfawg.html 5 http://www.worldspace.com/ 165 NABUUR - Global Development Issues: Health, Children, Women, Agriculture, HIV/AIDS. Programme Summary The NABUUR project is designed to stimulate and support sustainable solutions to particular problems in communities worldwide. A website facilitates access to "virtual neighbours" around the globe who help community members design tailor-made solutions, to the end of fostering a sense of resilience among local people. Associated aims include helping those in rural communities connect with others by making their needs explicit and by playing a role in tapping into intellectual, spiritual, and tangible resources. In short, the purpose of the project is to develop a "Nabuur community". NABUUR, the Dutch word for "neighbour", is a Dutch non-profit foundation. NABUUR aims to include 100 villages by the end of 2004 and 1000 by the end of 2006. After that, NABUUR hopes to be able to service an unlimited number of locations simultaneously. Summary of ICT Initiatives The project is, as of this writing, in its pilot phase. At the NABUUR site1, visitors are invited to select a location on the map in order to gain information on issues affecting particular community. Nabuur has selected pilot locations where a local community has a clear need for guidance: Iquitos, Amazon, Peru; Kouroussaa, Guinea; Cairo, Egypt; Izmail, Ukraine; Dharwad, India; and Padampur, Nepal. The visitor may click on a map to access information in the form of a photobook, discussion groups involving villagers, news items, and detailed analysis of issues like education of indigenous children, female genital cutting, women in the community, improper chemical storage, dry farming, and HIV/AIDS. There is an option to "become a neighbour", which gives one the right to participate in the community. Local needs, which have been defined by the community, are communicated. The local communities gain access to these virtual neighbours, who then try to arrive at new solutions (in the form of information or social investment, perhaps) through Internet discussion groups that invite participation of experts, if needed. If the community accepts the solution, virtual neighbours will help to ensure that the solution is implemented. Part of the Nabuur philosophy is to bring the elements of supply and demand in the knowledge fields together, to enhance market tendencies. Organizers believe that a “sick” form of short-term logic forces people all over the world towards non-sustainable solutions. Better options have been often developed elsewhere but these are not available to the people facing the problems now. They see that there is a huge local demand that has no access to the equally huge global supply of knowledge, contacts, experience, means, manpower and money. Today’s institutions are not designed to connect this supply and demand to peoples in remote parts of the world. The Internet, aided by phone, radio, etc, can create such a connection. Connection alone however is not sufficient. The Internet is too vast to generate useful solutions automatically. A structure is needed to enable the exchange between the demand in the real community and the supply of the virtual neighbours who live elsewhere in the global village. Nabuur will create that structure. Its ambition is to stimulate and support sustainable local solutions by providing people in real communities with access to their virtual neighbours from around the globe. Care for nature and natural resources often are at the core of such longer-term solutions. The solutions must enhance the resilience of the place. Nabuur starts by studying 10-15 pilot locations where successful development projects are already underway. Local anthropologists and the communities will try to distill a methodology which will make it easier in the future for communities around the world to bring a credible local agenda to the attention of their virtual neighbours. In order to successfully address problems, Nabuur has identified the following three aspects as vital to its project: 1 http://www.nabuur.com/ 166 • Community - Nabuur brings people together in a virtual community that mobilizes the knowledge, contacts, experience, etc of those present. The virtual community generates, judges, organizes whatever it takes until the problem is solved. Only then can the virtual neighbours sit back again. • Story - Through the Nabuur website the developing story of each of the participating places can be followed. Neighbours, real and virtual, can see if and what difference their contribution has made. It allows them to follow as well as be part of the process. • Self-Organisation - Nabuur wants to connect a very large number of places with an even greater number of people. The usual solution, a central office that organizes everything, cannot work at the scale required. Therefore, ways must be found to let as much as possible of Nabuur’s work organize itself. Nabuur will create the necessary special conditions and demands on personnel, structures, processes, quality control, etc, for self-organization to take root. It will help to solve some of the complex problems that no single institution can successfully tackle on its own, by providing a service complementary to exiting organisations. The HIV/AIDS oriented project in KwaNdengezi, an African township, involves the protection and care provision for 93 AIDS orphans into the homes of a group of 25 women. They now have secured a home to renovate and need additional funds to transform the dilapidated house into a foster home where several children would live. Most are extremely poor themselves and get no recompense for their charity. The Rotary club of Pinetown (near KwaNdengezi) is working to assist these women find the right homes to expand these orphanages and pay for their operating costs. Observations The website has a link to an extensive and well-developed business plan1, which among other things identifies the following challenges that the programme must address: • Complexity of local situations must be reflected. Seemingly straightforward problems are often not easy, because of economic, environmental, social, and political factors. Solutions require comprehension of the local situation. • Local needs must drive. Local people and leaders need to direct the agenda. How to best help organize and sustain participation is a key challenge. • Not every local place is “connected”. The Internet may be spreading rapidly, but the rural majority of the world is still unconnected to the Networked World, both structurally and culturally. • Floods of questions and unsought advice do not help local communities. Answering the concerns of how best to create helpful filters while providing easy access and assistance will be a key objective of the pilot Initiative. • Misuse must be thwarted. Being a network for the exchange of valuable resources, Nabuur must guard against deliberate misuse. • Short term needs vs. long term benefits. Where day–to–day survival is a real question for nearly one billion people, the seven generations sustainability perspective might appear as an unaffordable luxury, but today’s short–term solutions often increase tomorrow’s problems • Limitless. How does one avoid the implosion of Nabuur after hooking up several hundred places? By carefully designing a self–organizing model, so that an ever-growing number of people can fruitfully interact with any place of their choice. Source: NABUUR site at http://www.nabuur.com/ For more information, contact: email@example.com NABUUR site at www.nabuur.com 1 http://www.nabuur.com/nabuur/Nabuur/businessplan/NABUUR_business_plan.pdf/view 167 ToolxCHANGE Project Academy for Educational Development Development Issues: Nutrition, Maternal Health, HIV/AIDS, Public Health, Capacity Building Programme Summary The CHANGE Project helps make programs more effective by developing and applying practical solutions to behaviour change problems relevant to health and nutrition. Our ultimate objective is to increase the impact, sustainability, scale and cost-effectiveness of health interventions worldwide. To reach these goals, CHANGE: • Increases the extent to which public health projects and programs, particularly those supported by USAID, address behavioural issues and frame public health problems in terms of behaviours and the factors that influence them, starting during the assessment and planning phases; • Builds the capacity for good behaviour change diagnosis, strategy formulation, monitoring and evaluation, especially among USAID-supported projects and Private Voluntary Organizations (PVOs); and, • Contributes to the state-of-the-art in behaviour change relevant to health and nutrition by identifying, developing, assisting with implementation and evaluating tools and approaches that can be applied to achieve behaviour change. CHANGE tests tools and approaches in field settings through collaborative partnerships with local governments, private voluntary agencies, non-governmental organizations and USAID cooperating agencies. CHANGE focuses on sustainable solutions to key behaviour-related challenges in the areas of maternal health, child health and nutrition, as well as HIV/AIDS and infectious disease. Because peoples' choices can be limited by the context in which they act, CHANGE works not only at the level of the individual, but also at community, institutional and policy levels. The CHANGE approach involves focusing on assets as well as deficits with an emphasis on community-health system collaboration and increasing participation of local populations. In addition, CHANGE advocates comprehensive approaches and building self- regulatory systems that rely on feedback – both positive and negative – to sustain practices. Summary of ICT Initiatives The ToolxCHANGE consists of brief descriptions of new tools and approaches addressing what CHANGE Project staff, partners and expert colleagues consider to be important gaps in our current array of methods for bringing about positive health-related changes at the individual, household, community, institutional and policy levels. We believe the ideas and instruments described (or proposed here for development) will help to advance the state-of-the-art in health behaviour change. Health program implementers, policy makers, community mobilization experts, health researchers, private voluntary organizations (PVOs), USAID staff, members of collaborating organizations and others interested in furthering our knowledge of health behaviour change are all invited to contribute. ToolxCHANGE contains tools in various stages of development. We are seeking partners who will help us move a tool or approach to the next stage. We also want to know about difficult problems (related to health behaviour change) that need better tools. The ToolxCHANGE kit includes: • Ideas for innovative new approaches to changing health behaviour; • Ideas for new methodological tools (such as research instruments); • Promising tools and approaches that have already been used on a small scale but that need further development or field testing; and • Approaches and tools that have been implemented with apparent success but that need to be evaluated. Each description explains the state of development of a tool or approach and what step CHANGE hopes to take next. Descriptions also include contact information for anyone wishing to 168 collaborate or contribute to the discussion. The ToolxCHANGE does not include ready-to-use tools. The ToolxCHANGE primarily includes tools and approaches in development. The ToolxCHANGE is designed to illustrate a comprehensive behaviour change methodology. The entries represent important gaps in the current array of methods and approaches. Addressing a set of four, common, cross-cutting problems: CHANGE is interested in the full array of health behaviour challenges, however, the project has chosen as priorities a number of problems that cut across several technical areas: • Problems Resulting From "Deadly Delay" – Why do family members sometimes delay seeking treatment until the consequences have become deadly? CHANGE is interested in looking at why people act when they do - what are their cues for high risk, or severity of a condition, for example? What other factors motivate people to act? • Problems Related to Obtaining and Taking Medicine – CHANGE is interested in looking at various factors that influence adherence (and lack of adherence) to drug protocols. • Problems Associated with Health Worker Performance – What are the critical elements of effective health worker/client interaction? What are the elements of effective training? How do we motivate health workers who are unpaid and overworked? • Problems Related to Household Habits – Good health for women, children and infants begins in the home. Many healthy practices such as breastfeeding and hand washing do not even strike people as "disease-related.” CHANGE invites both formal and informal collaboration from groups and individuals. This interactive format helps the organization and its participants to identify critical health behaviour problems and alerts them to behaviour challenges for which current approaches do not seem to be effective. CHANGE attempts to reach out to policy and programme development officials and create collaborative solutions. Use of the Internet, ICTs and conferencing technologies allows this to occur on a global scale. All types of participants are invited to work with the ToolxCHNAGE to develop and apply tools, to evaluate tools and approaches already in use and search for universal applications and identify new tools that might be useful in addressing their priority health issues. Program implementers, funders responsible for programs, or researchers who think one of these tools or approaches is relevant to their intervention or for testing in their site are also encouraged to contact the organisation. Partners The CHANGE Project is implemented through a USAID cooperative agreement with the Academy for Educational Development, in collaboration with the Manoff Group.CHANGE is implemented in partnership with USAID field missions, USAID-financed collaborating agencies, international agencies and US-based and local Private Voluntary Organizations (PVOs). Source: http://www.changeproject.org For more information, contact: Academy for Educational Development CHANGE Project 1875 Connecticut Ave., NW Washington, D.C. 20009-5721 Tel. 202-884-8000 , Fax 202-884-8454 Email: firstname.lastname@example.org http://www.changeproject.org/tools/index.html 169 SECTION 4 – TELEMEDECINE AND HIGH-TECH MEDICAL TOOLS The Telemedicine TeleInViVo Initiative - Uganda Development Issues: Health, Portable Technology, Teleconferencing and Diagnosis40 Programme Summary The TeleInViVo project involves the establishment of transportable telemedicine workstations (PC computers with telecommunication capabilities) that are connected to light, portable ultrasound stations. These devices, to be used initially as a telemedical device at Nakaseke Hospital and Mulago Hospital, are intended to foster communication between physicians who specialize in certain diseases and physicians who work in the isolated rural areas of Uganda. The purpose of this programme is to improve general health services in Nakaseke Hospital as well as to garner access for health workers to medical support from colleagues across the country. Another goal is to reduce referral from Nakaseke to Mulago Hospital. Telemedicine involves provision of health care services through Information and Communication Technology (ICT). It supports health care service provision in areas in which the ratio of doctor or health-worker-to-patient is too high to manage or where a particular specialty is lacking. Nakaseke Hospital lies 60 km outside Kampala, the capital of Uganda. The hospital was lacking even basic telephone connections at the outset of the project. A multipurpose community telecentre, established there in 1999, provided the infrastructure for the training of local doctors in the use of basic computers and Internet connection. 1 The project makes telediagnosis and teleconsultation a reality in even the most extreme conditions, while promoting international medical collaboration and mutual sharing of specialist information and expertise. Summary of ICT Initiatives The computer system that this programme uses is supportive of a wide range of medical applications (from gynaecology to abdominal scans). The integrated workstation uses techniques -- the Internet, ISDN, a phone line, and GSM -- that allow one physician to collect three- dimensional ultrasound data of a patient and to send this data to another physician who specializes in the particular disease that the patient has. This data transmission can occur online, that is, while both doctors are connected, or offline, for instance, overnight, through narrowband channels. In the latter case waiting times are minimised, whereas in the former case additional scans may be requested by the remote expert during the teleconsultation to hone in on the diagnosis. Only the actions introduced by one user are transferred to the remote location, so that the second workstation has to calculate only the corresponding image. That is, no bulky image data are transferred over the network, enabling the two doctors to see exactly the same image on their screens in real time. Any delay between two locations reflects the latency of the intermediate network. Some of the tangible benefits identified by the project include: • Savings from reduced travel costs of either specialists or patients; • Savings on hospital costs for patients that can be diagnosed remotely; • Savings resulting from the provision of services in remote clinics as opposed to expansion of urban/regional hospitals. Intangible benefits include: • Increased opportunity for consultation and second opinions and reduction of mistakes • Reduced waiting times and transfer delays • Reduction in lost incomes for patients and travel expenses for family members • An improved efficiency and effectiveness of specialists with a broader reach • Improved overall health-care management 1 http://www.unesco.org/webworld/news/000728_teleinvivo.shtml 170 • Improved collegial support and opportunities for peer-to-peer teaching and learning1 Two doctors from the Mulago Medical School were trained in June 1999 in the use of TeleInViVo equipment in Coimbra, Portugal. They have in turn trained a number of doctors from Nakaseke and Mulago Hospital. Two technicians were also trained in servicing and back-up in Germany in September, 1999, when they worked to install TeleInViVo equipment at Mulago Medical School. Two young students are studying project developments: one from the Faculty of Technology (engineering department) and another from the Medical School (radiology department). The device will be tested in different socio-economic conditions and adjusted to meet the needs of developing countries and countries in transition. It currently comes in two versions: a fully portable, self-contained device, and a workstation version (a PC attached to an ultrasound scanner for internal hospital use). UNESCO has been evaluating EU-TeleInViVo in Uganda at two different sites. The Ugandan Ministry of Health has also established a task force to investigate possible adoption and expansion of the program, and excellent example of local capacity building and appropriation. 2 By the time of the project's completion, it is hoped that a medical teleconference emergency workstation will be available in Europe as well as in other regions of the world that provide health care services to underserved areas like ecological disaster areas, remote rural areas, and isolated islands. Partners: Mulago Hospital (Kampala Uganda), HPD Hospital de Ponta Delgada (Acores), Nakaseke Telecenter, Nakaseke Hospital (Uganda), HUC Hospitais da Universidade de Coimbra (Portugal), Central Area Hospital (Aralsk, Kazakhstan), Almaty Laboratory (Almaty, Kazakhstan), The European Union, Fraunhofer Institut für Graphische Datenverarbeitung (IGD), Dr. Stärk Computer GmbH (DSC) (Langen, Germany), PIE Medical (Maastricht, Netherlands), Centro de Computação Gráfica (CCG) (Coimbra, Portugal), Computer Graphics Center (ZGDV) (Darmstadt, Germany), Center of Advanced Technology on Image Analysis (CATAI) (Tenerife, Spain), UNESCO (Paris, France), Hospitais da Universidade de Coimbra (HUC) (Portugal), Hospital de Ponta Delgada (HPD) (Azores, Portugal). Source: Nakaseke site at http://www.nakaseke.or.ug/html/telemedicine.htm and the TeleInViVo site at http://www.igd.fhg.de/igd-a7/projects/teleinvivo/teleinvivo_project.html For more information, contact: Fraunhofer IGD Prof. Dr.-Ing. Georgios Sakas Fraunhoferstr. 5 D-64283 Darmstadt Germany Tel.: 49-6151-155-153 Fax: 49-6151-155-559 email@example.com 1 http://www.mdf.be/mednet2000/program/op05.html 2 http://www.unesco.org/webworld/news/000728_teleinvivo.shtml 171 Satellife's PDA Health Information Project - Ghana, Kenya, and Uganda Development Issues: Health, HIV/AIDS, Technology. Programme Summary Lack of information on treatments and disease management exacerbates health care problems like HIV/AIDS in Africa. Many students and physicians do not own a textbook during their medical education and training. They may not be aware of the fact that they are lacking clinical guidelines on HIV/AIDS, for example, that are critical in diagnosis and treatment. The developing world still represents a high-risk area for high tech companies. As a demonstration of the viability and usefulness of a relatively new technology in Africa, this project hopes to stimulate a new market and provide incentives to the corporate sector to develop relevant tools at an affordable price for Africans users. The Health Information Project utilised hand-held computers, also called personal digital assistants (PDAs), to help medical personnel in Ghana, Kenya, and Uganda gain access to accurate and up-to-date information. This technology was also intended to help health professionals conduct surveys and analyse data more efficiently. The purpose of the project was to test the efficacy of PDAs in the African medical context, and was conducted in two phases. Summary of ICT Initiatives In the first phase of the project, SATELLIFE provided the American Red Cross (ARC) with PDAs to be used for conducting field surveys in conjunction with a measles immunization program in Ghana in December 2001. Use of PDAs enabled volunteers to gather and submit data electronically, simplifying and speeding up the process. Thirty Ghanaian Red Cross volunteers were trained in the use of PDAs over a two-day period. They were able to complete over 2,400 surveys in three days (the traditional paper-and-pen survey method would have yielded 200 surveys). Survey data were processed, analysed, and reported quickly. Phase two was conducted in Kenya and Uganda in March 2002. SATELLIFE loaded 80 PDAs with medical reference materials (several textbooks; HIV/AIDS, TB, and Malaria guidelines and drug lists specific to Kenya and Uganda; and a medical calculator) and a short survey on Malaria. The PDAs were shipped to Moi and Makerere University Medical Schools where they were distributed to sixth-year medical students and physicians. Observations The Health Information Project will be a demonstration of the viability and usefulness of the personal digital assistant (PDA), a relatively new technology in Africa. A positive conclusion to the project may facilitate the use of wireless technology for sustainable development in health and in other fields, such as agriculture and environmental health. A myriad of potential possibilities for PDA use exist, including record keeping, database management, and communication. In December of 2002, Bridges.org1 was contracted to provide an independent evaluation to explore how the technology impacted the behaviour of health professionals and the quality of care they delivered. Their report, published in February 2003 presented the following conclusions:2 “The main finding of this evaluation is that the SATELLIFE project in Ghana, Uganda and Kenya has 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 1 Bridges.org goal is to promotes Real Access to ICT information and communication technology (ICT) by researching, testing, and promoting best practices for sustainable, empowering technology use. See their site at: <www.bridges.org> 2 For a full copy of the report see: <http://www.bridges.org/satellife/evaluation_pda_project_28_February_2003 .pdf> 172 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.” Some of their Key findings of the evaluation included: • The handheld computers proved to be an effective tool for both the collection of health data and the dissemination of information • The handheld computers proved to be an appropriate technology for use in the African context. • Handheld computers proved to be an inexpensive alternative to PCs in terms of computer power per dollar. • The handheld computers proved to be simple to use, and the technology was easily integrated into the daily routines of the healthcare professionals. • Handheld computers offer enormous potential to help bridge the digital divide. Some of the Key lessons learned in this project included: • People require at least some basic training in order to use the handheld computer effectively overall. • More focused training is needed to train people how to use the handheld computer for data collection, not just for the technology users, but also for those who are managing the project. • Technical support is critical. • Content must be locally relevant to have the greatest impact. Challenges that must be overcome • Despite the affordability by comparison to PCs, the cost of the PDAs may still be too high for the average person in Africa. • More locally relevant content in electronic format is needed to foster the widespread use of handheld computers for healthcare in developing countries. • Broader ICT infrastructure is needed to support the widespread use of handheld computers in Africa in the long-term (including access to repair facilities). The report also provided a summary of valuable future opportunities that emerged from this project. Partners: SATELLIFE, the Acumen Fund, ARC, Skyscape, Moi University (Kenya), Cisco Foundation Source: Health Information Project site at http://pda.healthnet.org/index.html , and www.bridges.org For more information, contact: Amy Galblum firstname.lastname@example.org http://pda.healthnet.org/index.html 173 Tygerberg Children's Hospital and Rotary Telemedicine Project Development Issues: Children’s Health, ICTs, Telemedicine Programme Summary The Tygerberg Children's Hospital and Rotary Telemedicine Project in South Africa uses computers and e-mail to link specialists from Tygerberg Hospital in Cape Town to doctors in more remote community or district hospitals to improve healthcare in rural areas. The system currently links Tygerberg with Eben Donges Hospital in Worcester, Clanwillaim Hospital and Paarl Hospital, which are 100km, 250km, and 100km from Cape-Town respectively. The Telemedicine Project was initiated for two main reasons: budget cuts to Tygerberg hospital meant that more patients needed to be treated at the district level and many members of the community could not afford the costs associated with going to the hospital. There is a demand for doctors at the district level to treat patients that require special attention or diagnosis that is beyond their training. Tygerberg Hospital specialists must support these doctors but usually do not have time to visit them on site. The initiative has assembled off the shelf computer equipment and software that is more affordable than commercial telemedicine systems. The projects also involves ongoing training and close consultations with users. Summary of ICT Initiatives Dr. Etienne Nel and Professor Robert Gie of Tygerberg Children's Hospital set up a telemedicine system that meets the immediate needs of the district hospitals. The system uses a Pentium 4 computer with a 42 cm screen, printer, scanner, software, digital camera, and light-shelf for viewing x-rays. The system is connected to the Provincial Department's network infrastructure, which connects Tygerberg with the district hospitals and gives the doctors unlimited access to e- mail. The total cost of the unit based at Tygerberg Hospital was less than R50,000 while the units at the district hospitals cost R45,000 each. Doctors at district hospitals scan x-rays and electrocardiographs, and e-mail them together with blood test results, digital photographs, and clinical observations to the telemedicine unit at Tygerberg Children's Hospital. At Tygerberg one person monitors incoming e-mail and directs queries to relevant specialists. The Tygerberg specialists review the information received, send an e-mail reply, and consult remotely with the district doctors about diagnosis and treatment. If a district doctor needs an urgent reply, he sends an SMS message to a specialist’s cellphone, alerting the doctor to check e-mail immediately. Observations This section considers whether and how this telemedicine system 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-Enabled Development Initiatives1 are used here to evaluate what the specialists at Tygerberg Children's Hospital have done well. 1. Implement and disseminate best practice. - Tygerberg's system has been designed by doctors in a developing country and is much more affordable than more sophisticated models used elsewhere. Doctors in Namibia, Malawi, and Zimbabwe are keen to replicate the system in their countries. The Tygerberg team is actively contributing towards best practice in healthcare that is relevant in an African context. 2. Ensure ownership, get local buy-in, find a champion – Organizers have promoted the telemedicine system in interviews with local newspapers and magazines. Lack of training – especially for older doctors who are less familiar with computer technology – has been an obstacle. By taking it upon himself to visit district hospitals and train doctors to use the system, Dr. Nel has become an on-the- ground champion for the system. 1 http://www.bridges.org/iicd_casestudies/seven_habits.html 174 3. Do a needs assessment. - The project emerged from a clear need in the healthcare environment in the region, where district doctors need support from Tygerberg Hospital to help them deliver more specialized care. 4. Set concrete goals and take small achievable steps. - A two-year pilot project involving only one hospital was conducted before the project was expanded. The pilot had three clear goals: (1) to test whether the equipment could convey clear images of X-rays, electrocardiographs, etc; (2) to test whether the Provincial Health Department's computer network would cope with the transfer of a vast amount of digital information; and (3) to evaluate whether doctors would use the system. Once the system was tested and proven, it was expanded. 5. Critically evaluate efforts, report back to clients and supporters, and adapt as needed. - Throughout the pilot, the specialists evaluated the system to see whether it was cost-effective and whether it would indeed improve district healthcare. They also adapted it as needed as they went along. 6. Address key external challenges. - A key external challenge faced is the installation of the connection points at hospitals not yet connected to the Provincial Health Department's computer network infrastructure. Continued support of staff after initial training is also crucial, especially where the central "receiving unit" (based at Tygerberg Hospital) is far from the "send units" (district hospitals). To address this problem Rotary Club members from local communities and paramedical staff are providing support when doctors experience difficulties in operating the system. 7. Make it sustainable. - Although Tygerberg telemedicine system is much cheaper than commercial telemedicine models and uses the Provincial Department's network infrastructure to send e-mail, the system's future is reliant on continued donor funding from the Rotary Club. The South African Government has started implementing (much more expensive) telemedicine systems elsewhere, but whether it will support Tygerberg's model is not certain. Dr. Nel also noted some of the challenges that became apparent during implementation. “There is a perception that this technology is inappropriately costly for a country with limited health resources ... and has been strong enough to delay implementation in certain areas. A major technical difficulty has been in the area of network access and support. Frequent 'down time' on the network discourages use. In addition problems accessing the network with poor technical support further dampen enthusiasm. Limited typing skills, lack of easy access to the system because of security needs and time constraints during the workday were found to be problems by staff. A number of technical problems still need to be solved. These include: 1. The user interface has to be simplified. Users are still required to go through a number of steps before they can send an enquiry. Automating these procedures would encourage correct use of the system. 2. Image files are large. Transmission of large images is either not permitted by the network that is being used or is slow. 3. Ensuring the security of information sent needs to be addressed. Despite these problems medical and paramedical staff have been enthusiastic and are learning to use the telemedicine system. It will however be some time before the true benefits of this telemedicine application can be quantified." Partners: Rotary Club (Signal Hill, Durbanville, Helderberg Basin, Stellenbosch). Source: Bridges.org, ICT-Enabled Development Case Studies Series: Africa, at http://www.bridges.org/iicd_casestudies/Tygerberg_telemedicine/index.html Pambazuka News at http://www.pambazuka.org For more information, contact: Dr. Etienne Nel Department of Paediatrics and Child Health PO Box 19603, Tygerberg, 7505 South Africa Tel: +27 21 938 9570 Fax: +27 21 938 9138 e-mail: email@example.com http://www.sun.ac.za/healthsciences/schools/medicine/paediatrics/dept/pedindex.htm 175 The Compliance Service - SMS technology for TB treatment Development Issues: Health, Tuberculosis, Technology, HIV/AIDS Programme Summary Cape Town, South Africa, has one of the world's highest incidences of TB, largely due to socio- economic and climatic factors. TB patients must strictly follow a difficult drug regime -- four tablets five times a week for six months -- and they often forget to take their medication. Non-compliance with the drug treatment has exacerbated the high occurrence of TB and has created difficulties for the local, overburdened healthcare service. Medicines are wasted when people do not take their medication on schedule, and non-compliance causes the TB virus to become increasingly drug resistant. After much research Dr. Green, a consultant in Managed Care, Disease Management and Information Systems, came to two important conclusions. Firstly, he observed that interventions designed to prevent non-compliance of treatment were not effective because they were applied indiscriminately. He concluded it was necessary to identify those patients who were non- compliant and find out why they were not taking their medication. Secondly, he was struck by the overwhelming literary evidence that suggested people were not taking their medication simply because they forgot. Dr. David Green developed a service in South Africa that uses the Short Message Service (SMS) to alert tuberculosis (TB) patients to take their medication. The initiative has led to a significant increase in the recovery rate of patients and could lead to savings for healthcare authorities. This project is being extended nationally and considered for HIV medication. Summary of ICT Initiatives Evidence suggests that TB patients often do not take their medication simply because they forget. So, Dr. Green uses SMS (Short Messaging Service) – text message service that enables short messages of up to 160 characters to be transmitted between cell phones – to alert patients to take their medication. Healthcare professional were sceptical whether the uptake of cell phone technology was high enough to justify the project. However, Dr. Green found that over 50% of people in the Cape Peninsula had access to cell phones. At the clinic where the pilot study was conducted, 71% of TB patients had access to a cell phone. Dr. Green enters the names of TB patients onto a database. Every half an hour his computer server reads the database and sends personalized messages to the patients, reminding them to take their medication. The technology that he uses to send out the messages is extremely low- cost and robust: an open source software operating system, web server, mail transport agent, applications, and a database. Currently Dr. Green charges the City of Cape Town R11.80 per patient per month to send out SMS messages. Initially the SMS message sent to patients read: "Take your Rifafour now." When patients complained about the boring message, Dr. Green sent them a variety of alerts, including jokes and lifestyle tips with the result that he now has as database of over 800 messages that he changes on a daily basis. Of the 138 patients involved in the pilot, there was only one treatment failure. Observations The Medical Research Council (MRC) of South Africa and the University of Cape Town has now embarked on a Randomized Control Trial to compare the cost-effectiveness of the SMS-reminder service against the cost of non-compliance to TB treatment. In the interim, the World Health Organisation has cited the project as an example of "international best practice". The City Council of Cape Town has decided to extend the pilot project to other City clinics where the cell phone ownership of patients are high, while the South African Government is considering the technology for nationwide use. The system is also being investigated for use with HIV treatment. Other organizations involved in best practice evaluations and analysis have also looked at Dr. Green’s project. The following is an evaluation that was done based on bridges.org’s 7 Habits of 176 Highly Effective ICT-for-Development Initiatives1 and asks the question of whether or not this project has had a Real Impact 2 on the ground: 3 1. Implement and disseminate best practice. - Dr. Green did a lot of research on compliance and adherence to medicine that led him to the insights on which this project is based. 2. Ensure ownership, get local buy-in, find a champion. - Dr. Green convinced the City of Cape Town's health directory to run a pilot at one of the City's clinics and so spurred on the public use of his technology. He ensured buy-in for patients by acting on their feedback. 3. Do a needs assessment. - Dr. Green was aware of the need for interventions that increase TB medication adherence, and especially so in Cape Town, which has one of the highest rates of TB infection in the world. 4. Set concrete goals and take small achievable steps. - Dr. Green first tested the reminder messages on his mother, who was taking medication for hypertension. He then convinced the City of Cape Town to run a pilot at one clinic. On the back of that success a Randomized Control Trial has been launched, involving South Africa's Medical Research Council (MRC), the University of Cape Town (UCT) and Dr. Green. 5. Critically evaluate efforts, report back to clients and supporters, and be prepared to adapt. - MRC and UCT are providing a critical, independent review of the pilot project. The outcome of the trial will be published in four research papers that will be subjected to peer review. 6. Address key external challenges. - The biggest external challenge that Dr. Green had to face was the preconceived ideas of health professionals regarding the uptake of cell phone technology in Cape Town. 7. Make it sustainable. - Dr. Green's company, The Compliance Service, is based at the UUNET Bandwidth Barn, which provides small IT businesses with affordable office rentals, shared office facilities, and reduced Internet connectivity costs. He deliberately kept the price of his service low so that more people can use and benefit from the technology. His choice of technology has enabled him to provide his service at a very affordable price. The initiative not only uses technology to address a real need effectively, but it does this in a simple, affordable and flexible way. Dr. Green uses a server, free software and a bulk SMS provider to send out the SMS messages. His system costs very little because he uses freely available open source software. Partners: City Council of Cape Town, U of Cape Town, South African Medical Service Council Sources: Bridges.org, ICT-Enabled Development Case Studies Series: Africa, at http://www.bridges.org/iicd_casestudies/compliance/index.html On Cue, Automated SMS Scheduling at http://www.compliance.za.net Eldis, ICT for Development Resource Guide at http://www.eldis.org For more information, contact: Dr. David Green The Compliance Service Tel: +27 21 790 4521 E-mail: firstname.lastname@example.org http://www.compliance.za.net 1 http://www.bridges.org/iicd_casestudies/seven_habits.html 2 http://www.bridges.org/iicd_casestudies/real_impact.html 3 http://www.bridges.org/iicd_casestudies/compliance/index.html 177 CERTI - Telemedicine project - Brazil Development Issues: Health Programme Summary CERTI (Reference Centers for Technology Innovation) Foundation is a private non-profit research organisation dedicated to technological innovation for societal purposes. They are "pursuing an agenda to help the country to play a pivotal role on [development/technological] issues concerning the growing impact of ICTs on society." CERTI focuses its activities on the productive chain of information technology. One of CERTI’s most recent technological products, the development of the Brazilian electronic voting machine, exemplifies the Foundation’s effort to align its R&D experience with information and communication technologies and the digital convergence. with 15 years of experience, the foundation focuses its activities on the productive chain of information technology, through the integrated operation of its four Reference Centers. CERTI has developed several projects that have applications for the promotion of health and wellness. CERTI works in conjunction with a host of other governmental and non-governmental agencies to utilize ICTs in efforts to improve various aspects of service delivery for Brazilians. At the heart of CERTI’s vision is the effort to address one of the more critical aspects of modern human development – “info inclusion.” Summary of ICT Initiatives The Telemedicine project, developed by CERTI Foundation, is intended to evaluate technical and operational aspects of the implementation of a broadband application using ADSL modems to transmit digital image, video and audio over the Internet. This project includes two main applications. The first is a Diagnosis Radiological Station that consists of software to support the diagnostic usage of radiological images from any computer that has access to a Medical Image Database, via DICOM standard. This software allows remote access to radiological images of a hospital. The other application is the Virtual Diagnosis Room, is a piece of software that can be used with the Diagnosis Radiological Station to let many physicians in different places see and analyze the same image set, interact with the images, and to share a report editor in a chat mode and common audio channel. The radiologists can discuss their ideas and opinions about difficult cases and also explain the diagnostic and recommend procedures to the physician that requested the exam. There are many benefits that can be achieved by this project: the cost reduction for using images and lessening x-ray printing, optimization of the diagnosis process with few radiologists working in a central diagnosis, decreasing the number of trips of the radiologists, and providing better medical attention in small towns that could not afford to have a specialist as a local resident. Another project that has been developed by CERTI is a project for improving access to self-help tools. Self-help on the Web is a model of virtual environment for helping people in crisis, in real time, using modern IT resources with interactive video, audio and text. This model provides clients and specialists with the possibility of individual attention with service open to the general public 24 hours a day, including information, orientation, virtual appointment, groups of mutual help and knowledge updating. To offer this service to the poor, CERTI developed a special application using a public access terminal to the Internet (Web Terminal). The solution uses IT resources and a broadband access (ADSL) that allows interaction via the Internet, operating with VoIP, videoconference and electronic forum – the Web Terminal is equipped with a video camera and a telephone. If the user agrees the specialist can collect some preliminary information through the video camera. If the user prefers, he/she can remain anonymous. He/she can choose to 178 communicate using the chat, and the specialist has the ability to conduct the session by controlling the navigation to illustrate his/her explanation or to show images that provide some help to the person in crisis. Cooperative work and learning are very effective in initiating communication between the specialist and the user. The main application is the Virtual Assistance to People in Crisis and cases of Chemical Dependence. Other programs are being developed for pregnancy, diabetes, hypertension, HIV/AIDS, alcoholism, etc. The assistance model adopts the concept of meeting rooms where the interactive agents learn more about themselves, acquire the capacity to exam, and change their behaviour and attitude. Moreover, they increase their capacity to endure the reality and expectations from third parties or from their own. Observations CERTI works in conjunction with a host of other governmental and non-governmental agencies to utilize ICTs in efforts to improve various aspects of service delivery for Brazilians. At the heart of CERTI’s vision is the effort to address one of the more critical aspects of modern human development – “info inclusion.” CERTI’s strategic efforts are thus attempting to improve the connectivity and access for as many Brazilians as possible. Source: PDF documents about CERTI provided by Paulo de Miranda 10/01/01. For more information, contact: Paulo C. G. de Miranda, International Institutional Liaison Leader, Knowledge Society Project, CERTI Foundation, Florianópolis, SC - Brazil email@example.com CERTI website at http://www.certi.org.br/ 179 Queensland Ultrasound Project Centre for Online Health Development Issues: Telemedicine, Prenatal Health Programme Summary Many communities in Queensland are remote, with little, if any, timely access to specialized services. Ultrasound is an accepted method of diagnosis and assessment of foetal anomalies, but the quality of the service varies widely between tertiary and peripheral units. Telemedicine offers the opportunity for real-time specialist referral, with reductions in anxiety for delayed referral, disruption to family life, and travel costs. The Centre for Online Health is a research, teaching, education and service provider within the University of Queensland's Faculty of Health Sciences. The Centre's mission is: “To pursue improvements in health care through the application of information technology.” The Centre has four areas of activity: • A focus on research in the area of online health • Teaching about online health • Commercialisation of research outcomes, and • The delivery of services in online health. Summary of ICT Initiatives Current real-time telemedicine relies on digital (ISDN) lines and hence is costly and still limited to larger centres. If the Internet could be used as a method of downloading ultrasound images taken in the field quickly and effectively, this would bring tertiary consultation to even extremely remote centres, using just a portable ultrasound machine with digitised images, a laptop computer and modem. The minimum acceptable standard for digital compression of an ultrasound video clip had not been assessed before. In 2001, a study by the Centre of Online Health was conducted to assess the ability of examiners to make accurate diagnoses based on compressed ultrasound clips of foetal anomalies, as well as their confidence in making such diagnoses. Prior to this project, the minimum acceptable standard for digital compression of an ultrasound video clip had not been assessed before. An application such as this is a boon to remote communities that have little, if any, timely access to specialized services. The aim of this project was to assess the ability of the examiners to make accurate diagnoses based on compressed ultrasound clips of foetal anomalies, as well as their confidence in making such diagnoses. This project was completed in 2001. Observations Evaluation methods involved nine different clips of foetal anomalies and two different normal controls that were compressed using commercially available software. The original uncompressed file sizes ranged from 55.6 to 622.7MB. Final file sizes ranged from 1.6 to 10MB (that is, compression ratios of 1:10 – 1:130). The duration of each original video clip ranged from 30 seconds to 3 minutes. The cardiac clips included colour and Power Doppler sequences, increasing the file size. Five of the normal control clips were repeated, to allow evaluation of intra observer error. Four experienced tertiary ultrasound specialists blinded to the compression factor evaluated the images. The examiners were asked to make a diagnosis from a selection of 48 possible choices. They were then asked to rate their confidence in the diagnosis (based on the quality of transmission) and image clarity on a scale of 1-7, with a score of 1 being very uncertain, 4 being acceptable and 7 being very certain. Data was analyzed using Duncan’s multiple range test for variables, with alpha=0.05. All of the diagnoses were responded to with certainty from the four observers on raw mean scores. The cardiac anomalies tended to rate with lower certainty scores. All of the images were 180 rated as acceptable (mean greater than 4.00) for image clarity and assessment of anatomy. Intra- and inter-rater error was not significant. The conclusion was that video clips of foetal ultrasound can be digitised, compressed and displayed on the computer without clinically or statistically significant loss of diagnostic certainty or image clarity. More specifically, this study examined compressing clips to 5 or 10MB file sizes and displaying them at a frame rate of 15 frames per second and a screen size of 320 x 240 pixels. With these specifications, diagnosis of 9 foetal anomalies was successful and image clarity was maintained for certainty of diagnosis. Original file sizes up to 622.7MB (equivalent to clips from 30 seconds up to 3 minutes duration, depending on content) may be compressed with commercially available packages to file sizes as small as 1.6MB, or compression ratios from 1:10 to 1:130. This has importance for applications such as telemedicine, and picture archiving for medico-legal and teaching purposes. Partners: University of Queensland Source: http://www.coh.uq.edu.au/coh/resources/articles/GE_Ultrasound.pdf http://www.coh.uq.edu.au/coh/projects/telemedicine/ultrasound.html For More Information Contact: St. Lucia Office Centre for Online Health Lvl 3, General Purpose South The University of Queensland St. Lucia QLD 4072 Australia Voice: +61 (07) 3365 4671 or 3346 4754 Fax: +61 (07) 3346 4705 firstname.lastname@example.org 181 Cell-Life, University of Cape Town – South Africa Development Issues: HIV/AIDS Programme Summary For AIDS patients in South Africa, a simpler anti-retroviral treatment processes will soon be available. Currently, treatment is complex – often involving the ingestion of up to 20 pills daily at set times. A collaborative effort between the University of Cape Town's (UCT's) Departments of Civil and Electrical Engineering and the Cape Technikon is introducing a solution. The project, called Cell-life, involves the use of cell phones programmed to record the medications details of AIDS patients. Summary of ICT Initiatives The Cell-Life project utilizes the programmed cell phones to alert and remind the patients about when to take their medication. It brings together technology experts in IT, health and engineering to solve the management problem of HIV/AIDS. By merging cell phone technology with the Internet and database systems, a Medication Management System has been developed, one that provides a "virtual" infrastructure to support HIV positive patients on anti-retroviral treatment. Cell phone giant Vodacom has stepped in to provide sponsorship and support for the project, which will be showcased at the World Summit on Sustainable Development (WSSD) in Johannesburg. A pilot project has just been launched in Gugulethu involving a group of "therapeutic counsellors" (trained peer counsellors from the community who are also taking anti- retrovirals) who carefully record the health status of the patients in their care, including their adherence to medication schedules. These counsellors visit patients several times a week. During the visit cell phones, which have a wireless Internet gateway (WIG) application, are used to report on a patient's status. The information is sent via short messaging service (SMS) to a central database, which can be accessed by the patient's doctor or nurse. Should an emergency arise, the doctor will be automatically contacted via SMS and beeper. The development signals a significant breakthrough in the provision of anti-retroviral treatment. Much of the focus on anti-retrovirals has centred on provision costs and toxicity levels. Little has been written about the sophisticated management involved in providing the therapy. "Since the HIV virus mutates at a very high rate, the medication is only successful if taken as part of a complex time-and-diet regime. If the schedule is not adhered to with 95% compliance, the virus will start mutating and resistant strains to the specific drug will develop," explains project leader, Dr Ulrike Rivett from UCT's Department of Civil Engineering. "To support the patients in this life- long treatment, physical and psychological support has to be provided. As there are not enough doctors or nurses trained on the issues of HIV/AIDS, a short-term solution has been identified in the therapeutic counsellors who are supported by technology." She says that Cell-life, which has been pre-patented, brings together technology experts in IT, health and engineering to solve what is undoubtedly a logistical nightmare for patients and health professionals. The cell phone solution also provides a data collection tool to establish drug effectiveness and response time to side effects, such as lever-toxicity after using Nevirapine. It is envisaged that cell phones with GPS technology will be provided to the therapeutic counsellors, an important factor in rural areas. The idea originated in July 1999. Rivett was giving a talk at the Cape Technikon's Mother and Daughter Day, explaining why women did not automatically turn to engineering as a career option. "Women are nurturers and carers and often turn to those careers where these characteristics will be fulfilled," she notes. "During question and answer time a young woman asked what engineering was doing to prevent the spread HIV/AIDS. I was floored," she admits. "I really had no answer. But it got me thinking. I came up with an idea for a pillbox that would send signals to a database." Rivett discussed the idea with many colleagues, from engineering to health sciences. "It was Professor Jon Tapson from UCT's Electrical Engineering who suggested we use existing technology to cut costs. Cell phones provided the perfect solution." 182 Observations The spin-offs offered by this technology are significant as it can be used in the wider health arena. "We don't have the resources to build the roads, hospitals and clinics that engineers devote their energies to, but we can build a virtual infrastructures, with databases of patients, where one doctor can advise hundreds of patients all over the country," Rivett concludes. Importantly for the Engineering and Built Environment (EBE) Faculty, the project has also moved the faculty into a "different era", says Rivett. Many of the students have been involved developing the systems for the project. "This is the first time our students have been directly involved in the fight against HIV/AIDS and where they have been able to see the direct impact of their work." Partners: UCT, Technikon Source: http://gkaims.globalknowledge.org and, http://www.scienceinafrica.co.za/2002/september/cells.htm For more information, contact: Dr Ulrike Rivett 082 940 4349 Shireen Sedres Manager: Media Liaison Dept. Communication & Marketing University of Cape Town 183 Telerehab RERC, South Pacific Rehabilitation Engineering Research Center (RERC) Development Issues: Rehabilitation, Disability, Telemedecine Programme Summary The Rehabilitation Engineering Research Center (RERC) on Telerehabilitation was established to probe the idea that distance need not be an impassable barrier between people with disabilities and those who have the rehab skills required to meet their needs. Telerehab is a new field that probes the possibilities multimedia communications and virtual reality technologies hold for extending rehab services to people for whom they are not available under the traditional, face-to- face service delivery model. The Telerehab RERC operates under a mandate from the National Institute on Disability and Rehabilitation Research (NIDRR) to carry out research and development and share their findings in the areas of Teleeducation, Telemonitoring, Teletherapy and Virtual Reality. Summary of ICT Initiatives The Telerehab RERC is in the Pacific to help put in place technologies that will function to bring services to people with disabilities who, otherwise, would not have access to them. Technology, is not necessarily the latest and most sophisticated, complex hardware, but appropriate technology that will be durable, economical, reliable and of real use to the people for whose benefit it is installed. In areas of the Pacific with more developed infrastructure, this technology might take the form of high-end, H-320 ISDN videoconferencing for remote, specialist consultation. In areas with low bandwidth communications options, this technology might take the form of exchanged videotapes: tapes of individuals needing evaluation coming from the island area; instructional tapes being returned from the remote expert to the island area. Examples of other low-bandwidth technologies would be the store-and-forward consultation system currently in use by Tripler Army Medical Center (TAMC): Pacific Island Health Care Project (PIHCP) or the CD aided prosthesis fitting and crafting instruction under development by PALM - Physicians Against Land Mines to be presented over the internet. Yet another example of an effective, low-bandwidth system would be the e-mail transmission of images of wounds made with a digital camera. One nurse in Guam uses such a system in her home care practice to consult with the attending physician and to acquire a visual record of patient healing. Observations Clinicians stateside spoke with patients, their families and caregivers. Working as an interdisciplinary team, they examined such visual phenomena as hand edema, gait and range of motion. Both adult and paediatric patients were seen. Because of the multi-point video connection, staff and patients in American Samoa were able to observe exercises and therapies recommended by the stateside staff. They were then able to demonstrate on video that they had comprehended the exercises and were able to perform them. The medium for conferencing was broadband videoconferencing, connecting American Samoa, National Rehabilitation Hospital (NRH) in Washington, DC and Sister Kenny Rehabilitation Services in Minneapolis, MN through the bridging capabilities of STAN, the State of Hawaii Telehealth Access Network. Communications speed were up to 384 kbps, virtually the quality one observes in television broadcast programming. One patient was a 45-year-old man named Luis who had suffered a right CVA with corresponding left side disability. Members of Luis’ family were present for the teleclinic and were able to interact with the mainland team as well. The following narration of the consultation with Luis is provided to 184 document how the clinicians adapted face-to-face exam techniques to work effectively in the virtual rehab environment broadband videoconferencing provides. • Assessment of voluntary movement - Assessment of voluntary movement proceeded as it would in a face-to-face consultation. The speed of transmission was more than adequate to determine that Luis was significantly impaired, with virtually no voluntary movement observed on the left side of his body. • Assessment of sensation - Mark and Alan acted as the hands of the mainland clinicians. Dr. Brendan demonstrated an exam technique on Nurse Judie and then Alan on American Samoa repeated it with Luis. • Locomotory Assessment - Luis was instructed to walk toward the camera. The transmission quality was good enough for clinicians to concur on the observation of a little Trendelenberg. Luis was asked to walk backwards. The experts were in conflict over whether swelling could be observed, the communications medium quality obviously being in question over this point. Pixelation was excessive, probably due to the speed with which Luis executed portions of this exercise. • Cognitive Assessment - Luis was instructed to close eyes, stick out tongue and raise his right hand, then to show three fingers and touch his left ear. These commands needed to be interpreted by people at other end for Luis. Whether language, or transmission audio quality, or the patient’s own processing abilities was the cause could not be determined. • Subluxation - Dr. Brendan instructed Alan to feel for a gap in the left shoulder. He demonstrated how to check for this anomaly on Judie. Alan imitated the action on Luis and was confident that there was no gap. • Left Neglect Assessment - Mainland clinicians debriefed Luis’ family for signs of left neglect, signs of Luis forgetting about his left, bumping into things on the left, falls. The family was able to report “no” satisfying this portion of the evaluation. • Assessment by family interview - With family present, clinicians were able to assess dysphagia, bowel and bladder control through direct inquiry. • Recommendations - Weight bearing activities were prescribed and demonstrated. Dr. Brendan showed how to practice bearing weight by leaning into a table. He instructed the family to stretch out Luis’ affected arm daily to maintain range of motion. • Soliciting questions from family - The family had an opportunity to ask questions. They were unsure whether Luis could be taken swimming. That question was resolved for them with a hearty recommendation for swimming exercise from the mainland clinical staff. • Perceptions of family, patients and staff - Mark and Alan shared their perspective that patients and family were “loving” this teleclinic interaction. They were delighted to be able to get second opinion and specialized treatment not available locally. As far as adjustment to the technology was concerned, Mark reported that patients say it’s “different” but are excited by it rather than doubtful and apprehensive. Alan and Mark commented that they have been learning a lot of therapies assisting on the Pago Pago side of the consultation and that what they learn carries over nicely into their day-to-day practice. Partners: National Rehabilitation Hospital (NRH) in Washington, DC and Sister Kenny Rehabilitation Services in Minneapolis, State of Hawaii Telehealth Access Network (STAN) Source: http://www.telerehab-nrh.org/RERC/Rerc_Home.cfm http://www.telerehab-nrh.org/Pacrim2/index.htm For more information, contact: Tim Bowman, MBA, Sister Kenny Institute (Admin, Project Lead) 612-863-5498 email: email@example.com 185 National Telemedicine Research Centre - South Africa South African Medical Research Council (MRC) Development Issues: Telemedicine, Rural Access Programme Summary The healthcare delivery system in South Africa faces many challenges. Some people are offered services comparable with the best in the world, while millions are without access to even the most basic services. The South African government is committed to providing basic health care to all South African citizens, not as a privilege, but as a fundamental right. To achieve this goal, the government has identified Telemedicine as a strategic tool for facilitating the delivery of equitable healthcare and educational services irrespective of distance and availability of specialized expertise, particularly in rural areas. In 1998 the South African National Department of Health (DoH) adopted its National Telemedicine Project Strategy. This called for the establishment of a National Telemedicine Research Centre (NTRC) and a network of Telemedicine links, to be implemented in three phases over a period of five years. In September 1999, a National Telemedicine Research Centre was established as a joint project of the DoH and MRC and promises to be a centre of excellence in Telemedicine Research on the African continent. This project will go a long way towards delivering a solution to the severe problem of inadequate services and geographical challenges which confound the South African health system, as a result of long-standing, previously misplaced priorities. The objectives of the National Telemedicine Research Centre are: • To evaluate the operations and systems of national Telemedicine projects in order to ensure improved delivery of health care services; • To use a Telemedicine Clinical Research Testbed to test new Telemedicine Technologies for their clinical abilities and cost effectiveness; • To provide tools for implementing Telemedicine, such as training, teaching materials and local capacity professional development; as well as research into relevant protocols, standards and medico-legal aspects of Telemedicine. Summary of ICT Initiatives In order to achieve the above objectives The Centre will: • Scientifically evaluate the implementation of Telemedicine projects in South Africa, in order to improve clinical outcomes; • Review national and international Telemedicine practices, protocols and standards in order to promote scientific evolution and integration of Telemedicine Technologies into the South African health care services; • Co-ordinate research and training activities of various Telemedicine units in academic institutions in South Africa; • Carry out clinical trials to test new Telemedicine technologies in order to evaluate their clinical ability and cost-effectiveness in the delivery of primary healthcare in SA; • Collaborate with the Telemedicine Technical Working Groups and academic institutions in developing guidelines for comprehensive Telehealth policy; • Carry out Telemedicine Research capacity development and training activities required to promote equitable access to quality health care at affordable cost by the South African rural communities. • Publish in consultation with the DoH, the results of research in peer-reviewed literature, thereby fostering regional, continental and international collaboration on Telemedicine. Observations Projects – For a complete Evaluation of the 28 National sites of the DoH First Phase Telemedicine System, see the executive summary.1 Current projects have involved the 1 http://www.mrc.ac.za/telemedicine/evaluation.htm 186 establishment of a Telehealth Test Bed to investigate new Telemedicine, telecommunications and Internet technologies that support primary health care (PHC) services. These technologies include the support needed to combat STDs, HIV/AIDS, TB, Malaria and Trauma. The MRC, DoH, and SA Medical Universities will co-sponsor a Formal Telemedicine Training Programme for the National Telemedicine System, to be accredited by the Health Professions Council as a provider of CPD points. The MRC will promote and co-ordinate self-evaluation of Telemedicine by the provinces in collaboration with health institutions and Technikons. The MRC will develop a registry of current Telemedicine projects in SADC and other African countries. Research – The results of the First Phase of the SA National Telemedicine System (NTS), spanning March 1999 to September 2000, were reviewed at the National Telemedicine Conference held in Johannesburg in November, 2000. The information for the report was collected through evaluation forms interviews and questionnaires and explored project management, clinical impact, technical infrastructure and the organizational factors at the pilot sites that aided or impeded the successful development and implementation of the Telemedicine system. Qualitative data collected from the users of the SA NTS demonstrated the following benefits of the system: • Access to a specialist radiologist within an hour, compared with a 5 to 7 days delay when X-rays are transported by ground transport; • Increased competence of primary care providers in interpreting radiographic studies; • Improved ability of community service doctors to diagnose and manage various medical conditions, particularly those related to trauma and chest diseases; • Reduced professional isolation usually felt by junior medical doctors performing community services in rural health facilities; • Reduction of unnecessary transfers from rural to Urban Tertiary Centres; • Education and training opportunities for all levels of health care providers (doctors, nurses and medical students). Respondents also felt that other medical specialties would be able to make use of such a Telemedicine facility. The comparison in this evaluation study was between the Telemedicine system and healthcare in the absence of Telemedicine. In some parts of the country, the Telemedicine pilot was undertaken without a comparable system, because Telemedicine was used to provide a service that was not available before. Partners: Medical Research Council, Source: http://www.mrc.ac.za/telemedicine/about.htm For more information, contact: Dr S M Gulube Telemedicine Research Centre Medical Research Council Private Bag X385 Pretoria 0001 South Africa Tel: +27 12 339-8500 Fax: +27 12 339-8593 E-mail: firstname.lastname@example.org 187 ICT and Health - Programme Experiences - Summary Sheet Positioning Class Page ICT Strategies ICT Technology Other Communication Technology of the ICTs ID # Programme Experiences . Number ICTs as one component Centre/Clearing House Organise peer support (Billboards, Fixed Art) Large Format Display Technical Assistance Data Base/Resource Facilitate Community of an overall initiative Alliance and Network Provision of Training Strategic Thinking & Exclusively an ICT Traditional/Cultural Political Advocacy Direct Action on a Magazine/Journal Person to Person Conduct On-Line Web Site Search Social Marketing Service Delivery Access External Theatre/Drama Print Materials/ Telemedicine Health Issue Newspaper Campaigns Facilitation and review Telecenter Pamphlets of Interest Database Web Site CD-ROM Initiative Satellite Building Models Phone Radio Email PDA TV 1 Communications for Better Health (CBH) DB 75 X X X X X X X X X X 2 AIDS Documentation and Information Centre DB 77 X X X X X X X X X 3 Healthy Russia 2020 SD 94 X X X X X X X 4 AIDS Resource Center (ARC) DB 79 X X X X X X X X X X X X 5 The Telemedicine TeleInViVo Initiative TM 170 X X X X X X X X X 6 "Keep Your Head, Wear Your Helmet" Campaign SD 96 X X X X X X X 7 Health Informatics Section (HIS) DB 81 X X X X X X X X 8 Education and Health Promotion Programme N 144 X X X X X X X X X X X X 9 OneWorld Radio AIDS Network SD 98 X X X X X X X X X 10 Centre 4 TV Medical Drama SD 100 X X X X 11 Internet-Based Tobacco Control Network SD 102 X X X X X X X X X X 12 YouthLIFE N 146 X X X X X X X X X X X X X X X X X X 13 Health Information Project TM 172 X X X X X 14 Disability Information System DB 83 X X X X X X X X 15 Treat Your Workers Campaign SD 104 X X X X X X X X X 16 WASH Campaign SD 106 X X X X X X X 17 Initiative for Reproductive Health (RHI) N 148 X X X X X X X X X 18 AIDSMark SD 108 X X X X X X X X X X X X X 19 AIDSWEB Project SD 110 X X X X X X X X X X X 20 Auntie Stella Project SD 112 X X X X X X X X 21 HDN eForums N 150 X X X X X X 22 Regional HIV/AIDS Information Network (RHAIN) N 152 X X X X X X X 23 Positive Lives, Positive Responses to HIV SD 114 X X X X X X X X X 24 ProCOR/AMICOR N 154 X X X X X X X X X X 25 eTALC DB 85 X X X X X 26 Philippine Health Social Science Association N 156 X X X X X X X X X X X 27 Internet Pathology Suite (iPath) DB 87 X X X X X X X 28 Women Connect! N 158 X X X X X X X X X X X 29 Healthlink Worldwide DB 92 X X X X X X X X X X X X X X 30 Journalists Against AIDS (JAAIDS) N 160 X X X X X X X X X X X Positioning Class Page ICT Strategies ICT Technology Other Communication Technology of the ICTs ID # Programme Experiences . Number Centre/Clearing House Organise peer support (Billboards, Fixed Art) Large Format Display Technical Assistance Data Base/Resource Facilitate Community Alliance and Network Provision of Training Strategic Thinking & Exclusively an ICT Traditional/Cultural Political Advocacy Direct Action on a Magazine/Journal Person to Person Conduct On-Line Web Site Search component of an Social Marketing Service Delivery Access External overall initiative Theatre/Drama Print Materials/ Telemedicine Health Issue ICTs as one Newspaper Campaigns Facilitation and review Telecenter Pamphlets of Interest Database Web Site CD-ROM Initiative Satellite Building Models Phone Radio Email PDA TV 31 Oral Rehydration Therapy Media programme SD 115 X X X X X X X X 32 loveLife SD 117 X X X X X X X X X X X X X X X X X X 33 Mapping Malaria Risk in Africa (MARA/ARMA) DB 89 X X X X X X X 34 "Africa Learning Channel" SD 119 X X X X X X X X 35 Reflect and ICT SD 120 X X X X X X X X X X X X 36 Healthworks Radio SD 122 X X X X X X X X 37 APRI-Minga N 162 X X X X X X X X X 36 The Massive Effort Campaign SD 124 X X X X X X X X X Tygerberg Children's Hospital and Rotary Telemedicine 39 Project TM 174 X X X X X X X X 40 The Compliance Service TM 176 X X X X X 41 CERTI - Telemedicine project TM 178 X X X X X X X 42 CHIPS SD 126 X X X X X 43 COPE SD 128 X X X X X X X X X 44 WOUGENET (Uganda Womens Net) N 164 X X X X X X X X X X X X 45 NABUUR N 166 X X X X X X X X X X 46 Chevron AIDS (CWAPP) SD 130 X X X X X X X X X 47 PATH RiskAdvisor SD 132 X X X X X X X X 48 POLICY and YARH SD 134 X X X X X 49 Freedom From Robacco SD 136 X X X X X X X X X X X X X 50 COMASALUD SD 138 X X X X X X X X 51 Develoment Promo Group SD 140 X X X X X X X X X X X 52 Malaria CDROM DB 91 X X X X X 53 eFarmasi SD 141 X X X X X 54 Radio Oxyjeune SD 142 X X X X X X 55 Digital Ultrasound TM 180 X X X X X X X 56 ToolxCHANGE N 168 X X X X X X X X 57 Cell-Life TM 182 X X X X X X X 58 Health e-News SD 143 X X X X X X X X 59 Telerehab TM 184 X X X X X X X X X 60 National Telemedicine Research Centre (NTRC) TM 186 X X X X X X X X X X ICT and Health - Programme Experiences - Summary Sheet ID # Health Issue Geography Main "operating" organisation Other organisations involved STIs and Reproductive Childrens Health and East and Southern General Practice Women's Health South East Asia Eastern Europe Northern Africa Latin America West Africa Malnutrition South Asia Disabilities HIV/AIDS Sanitation Tobacco Malaria Cancer Health Global Africa Other TB 1 X Health foundation of Ghana (HFG) Dreyfus Health Foundation, WHO 2 X X Fundación Fomento en Salud (FFS) USAID 3 X X X X X X X John Hopkins University Futures Group International 4 X X X X John Hopkins University Governmet of Ethiopia, CDC 5 X X X Mulago Hospital, Nakaseke Telecentre European Union, IGD 6 X X Friends for Life Centre for Evaluation of Public Health Interventions (CEPHI), University of 7 X X X X Zimbabwe 8 X X X X X Fantsuam 9 X X X X OneWorld UNICEF 10 X X X X X X John Hopkins University, Uganda Ministry of Health USAID Center for Communications, Health and the Environment (CECHE), Institute 11 X X of Clinical and Experimental Medicine (IKEM), National Institute of Public World Bank InfoDev Advocates for Youth, Youth Health Organization, Youth Action Rangers of 12 X X X Nigeria South African Centre for Organizational Development 13 X X Satellife, Acumen Fund American Red Cross, Moi University, Cisco Foundation 14 X X Zanempilo 15 X X Health Global Access Project (GAP), ACT UP 16 X X X Water Supply and Sanitation Collaborative Council Commission of the European Union (EC), United Nations Population Fund 17 X X X X X X (UNFPA) 18 X X X X Population Services International USAID 19 X X X ICT for Education (part of the World Bank Institute) World Links, Education Development Centre, SchoolNET Uganda, iEARN 20 X X X X X Training and Research Support Centre 21 X X X Health Development Networks 22 X X Health Development Networks, SAfAIDS 23 X X Positive Lives Levi Strauss Foundation, Terrence Higgins Trust 24 X X X ProCOR/AMICOR Satellife, Lown Cardiovascular Center 25 X X X X Teaching-aids at Low Cost (TALC) UK Department for International Development 26 X X X X Philippine Health Social Science Association The Ford Foundation , The Rockefeller Foundation, 27 X X SourceForge The Kizuki Group, South Pacific Medical Projects, AGKT 28 X X X X X X Women Connect! Zimbabwe Women’s Resource Center and Network (ZWRCN), Pacific Institute for Women’s Health 29 X X X X X Healthlink Worldwide 30 X X X X Journalists Against AIDS (JAAIDS) The Futures Group International/Policy Project Nigeria, The Ford Foundation ( ID # Health Issue Geography Main "operating" organisation Other organisations involved STIs and Reproductive Childrens Health and East and Southern General Practice Women's Health South East Asia Eastern Europe Northern Africa Latin America West Africa Malnutrition South Asia Disabilities HIV/AIDS Sanitation Tobacco Malaria Cancer Health Global Africa Other TB 31 X X Ministry of Health and Family Welfare, India International Institute for Population Sciences 32 X X X love Life Planned Parenthood Association of South Africa, Reproductive Health Research Unit 33 X X X X International Development Research Centre of Canada (IRDC), Mapping Malaria Risk in Africa / Atlas du Risque de la Malaria en Afrique (MARA/ARMA 34 X X X X X X X X WorldSpace Foundation 35 X X X X X X Reflect ActionAid, DFID 35 X X X X X School of Public Health, Curtin University, OneWorld Radio 37 X X X APRI-Minga Family Care International 38 X X X X The Massive Effort Campaign BBC World Service Trust, 39 X X Tygerberg Children's Hospital Rotary Club 40 X X X The Compliance Service City Council of Cape Town, U of Cape Town 41 X X X X CERTI (Reference Centers for Technology Innovation) 42 X X CHIPs (Chhattisgarh Infotech Promotion Society) Chhattisgarh State, UNDP 43 X X X X Relationships Australia, COPE WorldSpace, InterConnection, The Global Fund for Women, Uganda Women's 44 X X X X X WOUGNET Network (UWONET) 45 X NABUUR Government of the Netherlands 46 X X X Chevron World Economic Forum 47 X X X Program for Appropriate Technology in Health Government of Thailand, Microsoft 48 X X X X Women's Health and Action Research Centre USAID 49 X X Voluntary Organization in Interest of Consumer Education (VOICE) 50 X X X X X X Pan American Health Organization (PAHO) WHO, FELAFACS, Government of Panama, UNESCO, USAID 51 X X X X Development Promotion Group (DPG) 52 X X Division of Laboratory Medicine, Royal Perth Hospital Malaysian Ministry of Health, Malaysian Pharmaceutical Society, GS Vision Sdn 53 X X National Information Technology Council of Malaysia Bhd 54 X X X Radio Oxyjeune 55 X X X Centre for Online Health, University of Queensland 56 X X Academy for Educational Development USAID, Manoff Group 57 X X University of Cape Town, Cape Technikon Vodacom 58 X X X X X X Health e-News Health Systems Trust, Kaiser Family Foundation National Rehabilitation Hospital (US), Sister Kenny Rehb Services, Sate of 59 X X Rehabilitation Engineering Research Centre (RERC) Hawaii Telehealth Access Network (STAN) 60 X X X X South African Medical Research Council (MRC) South African National Department of Health 192 APPENDIX A SOUTH ASIA REGIONAL TRENDS 1965 - 2001 193 Appendix A South Asia Regional Trends Page 1 - Region South Asia Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 South Asia Life expectancy at birth, total (years) 46.5 48.9 51.2 53.6 56.0 58.5 60.8 62.4 62.6 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 149.5 138.5 131.7 118.9 103.1 86.8 78.9 72.9 70.6 Mortality rate, under-5 (per 1,000 live births) .. 208.8 .. 179.4 .. 120.8 .. 96.4 98.6 Fertility rate, total (births per woman) 6.3 6.0 5.6 5.3 4.7 4.1 3.6 3.3 3.2 Population growth (annual %) 2.4 2.4 2.4 2.3 2.1 2.1 1.9 1.9 1.8 .. Illiteracy rate, adult total (% of people ages 15 and above) 68.1 64.5 60.7 56.8 52.9 49.1 45.2 45.0 Health expenditure per capita (current US$) .. .. .. .. .. 15.8 18.9 .. .. Immunization, DPT (% of children under 12 months) .. .. .. 6.1 18.3 66.8 65.7 .. 64.7 .. Immunization, measles (% of children under 12 months) .. .. .. 6.1 55.9 69.4 .. 58.1 Improved water source (% of population with access) .. .. .. .. .. 79.5 .. 87.2 .. Prevalence of HIV (% of adults) .. .. .. .. .. (1999) http://www.unaids.org/epidemic_update/report/Final_Table_Eng_Xcel.xls TB Notification Rates (per 100,000 people) 80 113 133 99 92 91 See Note 1 Diptheria (Total cases) 34,647 47,354 19,250 11,582 5,087 3,439 5,674 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 149,514 199,535 244,113 224,925 100,900 61,975 65,441 See Note 2 Polio (Total Cases) .. .. 14,114 20,089 22,964 11,313 3,360 591 268 Malaria (Total Cases) .. .. 2 380 318 2 780 066 3 704 808 .. See Note 3 Child Malnutrition ( % < 5s Underweight ) 55.0 48.0 UNICEF at <http://childinfo.org/eddb/malnutrition/index.htm> Vitamin A ( # of countries providing one dose to over 70% of < 5, of 8) 1.0 5.0 UNICEF at <http://childinfo.org/eddb/vita_a/index.htm> % of Births attended by skilled personnel 39.0 .. 49.0 See Note 4 Maternal Mortality Ratio (maternal deaths per 100K live births) .. .. 560.0 410.0 .. NOTE: MENA stats do not include N. Africa which = MMR 340/450 GDP per capita (constant 1995 US$) 201.5 221.0 222.3 236.1 277.1 332.1 386.8 456.5 .. GDP per capita growth (annual %) -3.1 1.7 5.0 4.0 3.4 3.4 5.0 2.3 471.3 GNI per capita, Atlas method (current US$) 120.0 120.0 190.0 260.0 290.0 380.0 380.0 440.0 .. Aid (% of GNI) 2.4 1.6 2.6 2.3 1.4 1.5 1.1 0.7 1.0 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.1 3.4 6.3 Telephone mainlines (per 1,000 people) 1.3 1.7 2.3 3.1 3.8 5.6 11.9 27.4 31.8 Internet users .. .. 0.0 0.0 0.0 0.0 251360.0 5412875.0 7 973 000 Personal computers (per 1,000 people) .. .. .. .. .. 0.4 1.5 4.2 5.3 Radios (per 1,000 people) .. 31.7 35.2 40.0 66.6 78.8 110.3 .. .. Television sets (per 1,000 people) 0.0 0.2 1.1 3.1 6.0 27.9 53.5 74.5 80.9 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/eastern_mediterranean.xls > Note 2: Regional estimates for BLUE and GREEN South (East) Asia do not include Pakistan and Afghanistan which are categorized differently under this monitoring schedule. Note 3: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf> Note 4: Asia Wide. Source: Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA <http://childinfo.org/eddb/mat_mortal/index.htm> Appendix A South Asia Regional Trends Page 2 - Afghanistan South Asia Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Afghanistan Life expectancy at birth, total (years) 36.8 38.4 39.4 39.9 40.5 41.5 42.3 43.0 43.1 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 194.6 186.0 180.4 177.4 174.6 169.4 165.8 162.6 165.0 Mortality rate, under-5 (per 1,000 live births) .. 320.0 .. 280.0 .. 257.0 .. 279.4 257.0 Fertility rate, total (births per woman) 7.1 7.1 7.2 7.0 6.9 6.9 6.9 6.7 6.8 Population growth (annual %) 2.2 2.3 2.7 1.4 -0.6 2.3 5.7 2.6 2.6 Illiteracy rate, adult total (% of people ages 15 and above) .. .. .. .. .. .. .. .. .. Health expenditure per capita (current US$) .. .. .. .. .. .. .. .. .. Immunization, DPT (% of children under 12 months) .. .. .. 4.0 15.0 25.0 20.0 .. 44.0 Immunization, measles (% of children under 12 months) .. .. .. 11.0 14.0 20.0 41.0 .. 46.0 Improved water source (% of population with access) .. .. .. .. .. .. .. 13.0 .. Prevalence of HIV (% of adults) .. .. 0 0 .. (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 477 80 32 33 44 See Note 1 Diptheria (Total cases) 22 1939 3179 368 84 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 466 32455 14457 1609 6532 8762 Polio (Total Cases) .. .. 116 880 1981 48 0 120 11 Malaria (Total Cases) 2112 36 996 80 557 47 285 277 815 317 479 … .. .. See Note 2 GDP per capita (constant 1995 US$) .. .. .. .. .. .. .. .. 1616.47 GDP per capita growth (annual %) -0.1 -0.4 0.2 -4.4 .. .. .. .. 2.1 GNI per capita, Atlas method (current US$) 90.0 130.0 190.0 260.0 .. .. .. .. .. Aid (% of GNI) 5.0 1.6 3.0 0.9 .. .. .. .. .. Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 .. Telephone mainlines (per 1,000 people) 0.7 1.1 1.3 1.6 2.1 2.2 1.4 1.2 1.5 Internet users .. .. .. .. .. .. .. .. .. Personal computers (per 1,000 people) .. .. .. .. .. .. .. .. .. Radios (per 1,000 people) .. 56.2 58.4 75.2 91.8 97.3 109.4 .. .. Television sets (per 1,000 people) .. .. 0.0 2.8 6.9 8.3 10.2 13.6 14.2 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/eastern_mediterranean.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix A South Asia Regional Trends Page 3 - Bangladesh South Asia Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Bangladesh Life expectancy at birth, total (years) 42.2 44.2 46.0 48.6 51.7 54.8 58.3 61.2 61.6 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 144.0 140.0 138.2 131.6 113.5 90.6 74.1 60.0 51.0 Mortality rate, under-5 (per 1,000 live births) .. 239.0 .. 211.0 .. 136.0 .. 82.6 77.0 Fertility rate, total (births per woman) 6.8 7.0 6.6 6.1 5.3 4.1 3.4 3.1 3.0 Population growth (annual %) 2.5 2.6 2.5 2.5 2.6 2.4 1.7 1.7 1.7 Illiteracy rate, adult total (% of people ages 15 and above) .. 75.9 73.3 70.8 68.0 65.0 61.9 58.7 59.5 Health expenditure per capita (current US$) .. .. .. .. .. 7.0 10.0 .. .. Immunization, DPT (% of children under 12 months) .. .. .. .. 2.0 69.0 69.0 .. 83.0 Immunization, measles (% of children under 12 months) .. .. .. .. 1.0 65.0 79.0 .. 76.0 Improved water source (% of population with access) .. .. .. .. .. 91.0 .. 97.0 Prevalence of HIV (% of adults) .. .. 0.1 0.1 < 0.1 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 47 43 44 46 55 54 See Note 1 Diptheria (Total cases) 706 1559 204 711 282 21 122 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 3030 11077 11699 1705 4995 5098 4414 Polio (Total Cases) .. .. 162 65 89 374 49 198 0 Malaria (Total Cases) .. 8173 31 247 67 727 30 250 53 875 152 729 .. See Note 2 GDP per capita (constant 1995 US$) 239.9 248.7 208.0 225.2 257.8 278.2 315.8 373.2 386.1 GDP per capita growth (annual %) -0.9 2.9 -3.2 -1.0 1.3 4.1 3.1 4.1 5.3 GNI per capita, Atlas method (current US$) .. .. 200.0 220.0 200.0 280.0 320.0 370.0 Aid (% of GNI) .. .. 5.3 7.3 5.3 7.0 3.4 2.5 2.2 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 3.9 Telephone mainlines (per 1,000 people) .. .. .. .. 1.5 2.2 2.4 3.5 4.3 Internet users .. .. .. .. .. .. .. 100000 250000 Personal computers (per 1,000 people) .. .. .. .. .. .. .. 1.5 1.9 Radios (per 1,000 people) .. 12.8 15.2 17.6 41.2 44.2 46.6 .. Television sets (per 1,000 people) 0.1 0.1 0.3 0.9 2.6 4.9 7.2 7.0 16.7 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/southeastasia.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix A South Asia Regional Trends Page 4 - India South Asia Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source India Life expectancy at birth, total (years) 47.0 49.4 51.8 54.2 56.6 59.1 61.4 62.8 62.9 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 149.8 137.2 130.2 114.8 97.0 80.0 74.0 69.2 67.0 Mortality rate, under-5 (per 1,000 live births) .. 206.0 .. 177.0 .. 112.0 .. 87.7 93.0 Fertility rate, total (births per woman) 6.2 5.8 5.3 5.0 4.4 3.8 3.4 3.1 2.9 Population growth (annual %) 2.3 2.3 2.3 2.3 2.0 2.0 1.7 1.8 1.5 Illiteracy rate, adult total (% of people ages 15 and above) .. 66.9 63.1 59.0 54.8 50.7 46.7 42.8 42.0 Health expenditure per capita (current US$) .. .. .. .. .. 17.0 20.0 .. Immunization, DPT (% of children under 12 months) .. .. .. 6.0 18.0 70.0 71.0 .. 64.0 Immunization, measles (% of children under 12 months) .. .. .. .. 1.0 56.0 72.0 .. 56.0 Improved water source (% of population with access) .. .. .. .. .. 78.0 .. 88.0 Prevalence of HIV (% of adults) .. .. 0.8 0.7 0.8 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 102 153 180 131 111 106 See Note 1 Diptheria (Total cases) 30057 39231 15685 8425 2123 3094 5101 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 133561 114036 161216 89612 37494 22236 37969 Polio (Total Cases) .. .. 13000 18975 22570 10408 3263 265 268 Malaria (Total Cases) 100 185 694 647 5 166 142 2 844 815 1 864 380 2 018 783 2 988 231 .. See Note 2 GDP per capita (constant 1995 US$) 194.5 211.4 217.2 226.0 263.7 323.0 380.1 459.4 477.0 GDP per capita growth (annual %) -4.7 0.7 6.7 4.2 3.3 3.5 5.9 2.0 .. GNI per capita, Atlas method (current US$) 120.0 110.0 190.0 270.0 290.0 390.0 380.0 450.0 .. Aid (% of GNI) 2.1 1.4 1.6 1.2 0.7 0.4 0.5 0.3 0.4 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.1 3.5 6.3 Telephone mainlines (per 1,000 people) 1.2 1.7 2.3 3.1 4.1 5.9 12.9 32.0 37.5 Internet users .. .. .. .. .. .. 250 000 5 000 000 7 000 000 Personal computers (per 1,000 people) .. .. .. .. .. 0.3 1.3 4.5 5.8 Radios (per 1,000 people) .. 31.0 34.2 37.8 65.3 78.9 119.4 .. Television sets (per 1,000 people) 0.0 0.1 0.8 2.5 5.2 31.9 61.4 78.0 82.8 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/southeastasia.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix A South Asia Regional Trends Page 5 - Pakistan South Asia Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Pakistan Life expectancy at birth, total (years) 46.7 49.4 52.3 55.1 57.4 59.1 60.9 63.0 63.4 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 149.0 142.0 134.0 127.0 122.0 110.4 95.6 83.3 84.0 Mortality rate, under-5 (per 1,000 live births) .. 181.0 .. 157.0 .. 138.0 .. 110.3 109.0 Fertility rate, total (births per woman) 7.0 7.0 7.0 7.0 6.5 5.8 5.2 4.7 4.6 Population growth (annual %) 2.7 3.0 3.2 2.9 2.7 2.5 2.5 2.4 2.4 Illiteracy rate, adult total (% of people ages 15 and above) .. 79.1 75.7 72.2 68.6 64.6 60.7 56.8 56.0 Health expenditure per capita (current US$) .. .. .. .. .. 16.0 20.0 .. Immunization, DPT (% of children under 12 months) .. .. .. 2.0 30.0 54.1 40.4 .. 56.0 Immunization, measles (% of children under 12 months) .. .. .. 1.0 38.0 50.2 53.3 .. 54.0 Improved water source (% of population with access) .. .. .. .. .. 84.0 .. 88.0 Prevalence of HIV (% of adults) .. .. 0.1 0.1 0.1 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 389 117 143 11 8 23 See Note 1 Diptheria (Total cases) 3138 14328 1450 1371 9 13 19 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 6892 28573 26686 21785 1720 2064 3849 Polio (Total Cases) .. .. 5052 2980 2159 777 508 199 116 Malaria (Total Cases) 28 988 35 482 72 675 105 750 60 669 79 689 111 836 .. See Note 2 GDP per capita (constant 1995 US$) 225.2 274.5 274.0 317.8 384.9 447.8 500.1 516.2 517.2 GDP per capita growth (annual %) 7.5 8.1 1.0 7.1 4.7 1.8 2.6 1.9 .. GNI per capita, Atlas method (current US$) .. 170.0 150.0 300.0 330.0 390.0 480.0 440.0 .. Aid (% of GNI) .. 4.2 5.9 5.1 2.5 2.9 1.4 1.2 3.4 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.3 2.5 5.6 Telephone mainlines (per 1,000 people) 1.6 2.1 2.7 3.5 4.6 7.5 16.6 21.6 23.3 Internet users .. .. .. .. .. .. 160.0 133875.0 500000 Personal computers (per 1,000 people) .. .. .. .. .. 1.3 3.5 4.2 4.1 Radios (per 1,000 people) .. 49.5 56.3 66.5 89.7 99.1 102.1 .. .. Television sets (per 1,000 people) 0.2 1.5 5.1 11.0 13.3 25.8 51.0 131.0 147.6 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/eastern_mediterranean.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix A South Asia Regional Trends Page 6 - Sri Lanka South Asia Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Sri Lanka Life expectancy at birth, total (years) 62.6 64.6 66.2 67.6 69.0 70.2 71.4 73.1 73.4 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 62.6 53.2 43.8 34.4 24.8 18.5 16.5 14.9 17.0 Mortality rate, under-5 (per 1,000 live births) .. 100.0 .. 48.0 .. 23.0 .. 17.9 19.0 Fertility rate, total (births per woman) 4.9 4.3 3.9 3.5 2.9 2.5 2.3 2.1 2.1 Population growth (annual %) 2.5 2.1 1.6 1.8 1.5 1.2 1.4 1.6 2.1 Illiteracy rate, adult total (% of people ages 15 and above) .. 19.5 17.0 14.7 12.9 11.3 9.8 8.4 8.1 Health expenditure per capita (current US$) .. .. .. .. .. 16.0 24.0 .. .. Immunization, DPT (% of children under 12 months) .. .. .. 46.0 70.0 86.0 93.0 .. 99.0 Immunization, measles (% of children under 12 months) .. .. .. .. 20.0 80.0 87.0 .. 99.0 Improved water source (% of population with access) .. .. .. .. .. 66.0 .. 83.0 .. Prevalence of HIV (% of adults) .. .. 0.1 0.1 < 0.1 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 102 153 180 131 111 106 See Notes 1 & 2 Diptheria (Total cases) 310 37 10 0 0 0 15 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 5000 5032 9398 4004 408 16527 309 Polio (Total Cases) .. .. 190 264 11 9 0 0 0 Malaria (Total Cases) 308.0 468 199 400 777 47 949 117 816 287 384 142 294 .. See Note 3 GDP per capita (constant 1995 US$) 292.5 345.2 381.0 450.9 534.3 588.8 718.4 860.5 876.4 GDP per capita growth (annual %) 0.0 1.7 4.5 3.9 3.4 5.1 4.1 4.3 .. GNI per capita, Atlas method (current US$) 160.0 180.0 310.0 280.0 380.0 470.0 700.0 850.0 .. Aid (% of GNI) 0.8 2.2 4.1 9.7 7.9 9.3 4.3 1.7 2.0 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.1 2.8 22.7 35.6 Telephone mainlines (per 1,000 people) 2.4 2.9 3.1 3.6 5.4 7.1 11.3 40.5 44.3 Internet users .. .. .. .. .. .. 1000.0 121 500 150000 Personal computers (per 1,000 people) .. .. .. .. .. 0.2 1.1 7.1 9.3 Radios (per 1,000 people) .. 63.9 74.1 101.8 161.0 199.8 204.0 .. .. Television sets (per 1,000 people) .. .. .. 2.4 27.9 35.3 78.4 111.0 117.4 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/southeastasia.xls > Niote 2: Sri Lanka data is accounted for under India aggregate. Note 3: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. APPENDIX B SUB-SAHARAN AFRICA REGIONAL TRENDS 1965 - 2001 200 Appendix B Sub-Saharan Africa Regional Trends Page 1 - Region Sub-Saharan Africa Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Sub-Saharan Africa Life expectancy at birth, total (years) 42.2 44.2 46.0 47.6 49.3 50.0 49.2 46.5 46.2 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 150.4 138.2 126.4 115.6 107.4 102.5 95.8 91.2 105.4 Mortality rate, under-5 (per 1,000 live births) .. 221.9 .. 186.8 .. 158.5 .. 161.6 170.6 Fertility rate, total (births per woman) 6.6 6.6 6.6 6.6 6.4 6.1 5.6 5.2 5.1 Population growth (annual %) 2.6 2.6 2.8 3.1 2.9 2.9 2.7 2.4 2.3 Illiteracy rate, adult total (% of people ages 15 and.. above) 72.0 67.2 61.9 56.1 50.2 44.3 38.5 37.8 Gross enrollment ratio, primary, female (%) 66.5 66.7 67.8 69.2 .. World Bank Africa WDI, 1998, CR-ROM Database Gross enrollment ratio, primary, total (%) 78.0 76.0 75.7 76.7 .. World Bank Africa WDI, 1998, CR-ROM Database Health expenditure per capita (current US$) .. .. .. .. 37.7 .. 40.3 .. .. Immunization, DPT (% of children under 12 months) .. .. .. 57.3 26.7 53.6 .. 52.9 .. Immunization, measles (% of children under 12 months) .. .. .. 64.2 30.0 55.1 .. 57.8 Improved water source (% of population with access).. .. .. .. .. 48.7 .. 55.4 .. Prevalence of HIV (% of adults) .. .. .. (1999) 8.57 (2001) 8.4 (1999) http://www.unaids.org/epidemic_update/report/Final_Table_Eng_Xcel.xls TB Notification Rates (p/100,000 people) 60 70 85 89 121 124 See Note 1 Diptheria (Total cases) 2,443 8,771 5,060 2,588 229 4,038 2,587 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 848,762 1,241,065 1,142,028 481,204 362,925 520,102 492,116 " Polio (Total Cases) .. .. 5,774 5,126 3,935 4,228 2,198 1,863 69 " Malaria (Total Cases) 3 782 504 4 831 969 4 788 979 6 030 066 14 557 717 21 903 265 21 512 357 .. See Note 2 Child Malnutrition ( % < 5s Underweight ) 32.0 .. 31.0 .. UNICEF at <http://childinfo.org/eddb/malnutrition/index.htm> Vitamin A ( # of countries providing one dose to over 70% of < 5, of 44) .. 1.0 29.0 .. UNICEF at <http://childinfo.org/eddb/vita_a/index.htm> % of Births attended by skilled personnel 44.0 .. 44.0 .. See Note 3 Maternal Mortality Ratio (maternal deaths per 100K live births) .. .. 950.0 1100.0 .. .. ' ORT use among the under-fives, (%) .. 10.6 37.1 .. .. .. World Bank Africa WDI, 1998, CR-ROM Database GDP per capita (constant 1995 US$) 543.1 609.0 667.6 658.4 599.8 587.4 549.0 564.4 567 GDP per capita growth (annual %) 3.8 5.3 -1.7 2.5 -3.3 -1.8 1.3 0.6 .. GNI per capita, Atlas method (current US$) 170.0 210.0 410.0 660.0 460.0 550.0 520.0 470.0 .. Aid (% of GNI) 2.5 1.9 2.6 2.9 4.9 6.4 6.2 4.4 4.6 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 1.0 17.4 26.5 Telephone mainlines (per 1,000 people) .. 6.1 6.9 8.1 7.7 9.9 11.0 14.2 14.1 Internet users .. .. 0.0 0.0 0.0 0.0 463 930 3 694 804 5299920.0 Personal computers (per 1,000 people) .. .. .. .. .. .. .. 9.2 9.8 Radios (per 1,000 people) .. 64.4 84.9 111.6 153.2 169.2 187.5 .. .. Television sets (per 1,000 people) 1.0 1.8 2.4 11.1 14.8 26.1 38.3 58.6 .. Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Note 3: Maternal Mortality in 1995: WHO, UNICEF, UNFPA <http://childinfo.org/eddb/mat_mortal/index.htm> Appendix B Sub-Saharan Africa Regional Trends Page 2 - Burundi Sub-Saharan Africa Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Burundi Life expectancy at birth, total (years) 42.9 43.8 45.2 46.7 46.9 43.6 42.0 42.0 41.8 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 143.6 138.2 131.0 121.6 115.6 118.8 114.8 102.2 114.0 Mortality rate, under-5 (per 1,000 live births) .. 228.0 .. 193.0 .. 180.0 .. 175.8 190.0 Fertility rate, total (births per woman) 6.8 6.8 6.8 6.8 6.8 6.8 6.5 6.0 5.9 Population growth (annual %) 2.3 1.3 1.4 2.6 2.8 2.8 2.2 1.9 1.9 Illiteracy rate, adult total (% of people ages 15 and .. above) 79.7 76.4 72.2 67.7 63.0 57.7 52.0 50.8 Health expenditure per capita (current US$) .. .. .. .. .. 6.0 8.0 .. .. .. Immunization, DPT (% of children under 12 months) .. .. .. 41.0 85.0 73.0 .. 74.0 .. Immunization, measles (% of children under 12 months) .. .. .. 36.0 74.0 80.0 .. 75.0 .. Improved water source (% of population with access) .. .. .. .. 65.0 .. .. .. Prevalence of HIV (% of pop. 15-49) .. .. 8.3 11.3 8.3 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 19 48 81 55 .. 100 See Note 1 Diphtheria (Total Cases) 33 6 14 0 0 0 .. http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total Cases) 30949 49227 36740 13282 14782 18363 .. http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Polio (Total Cases) 23 43 25 10 10 0 .. http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Malaria (Total Cases) .. .. .. 79181.0 … 511611.0 932794.0 .. See Note 2 GDP per capita (constant 1995 US$) 126.9 164.7 161.6 176.2 197.8 206.3 162.5 140.7 140.8 GDP per capita growth (annual %) 1.6 19.7 -0.7 -1.6 8.7 0.6 -9.2 -1.6 .. GNI per capita, Atlas method (current US$) 70.0 70.0 110.0 220.0 240.0 220.0 150.0 110.0 .. Aid (% of GNI) 2.8 7.6 11.7 12.7 12.3 23.6 29.1 13.8 19.3 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.1 2.4 2.9 Telephone mainlines (per 1,000 people) 0.4 0.5 0.7 .. 1.1 1.5 2.8 2.9 2.9 Internet users .. .. 0.0 0.0 0.0 0.0 0.0 3000.0 6000.0 Personal computers (per 1,000 people) .. .. .. .. .. .. .. .. .. Radios (per 1,000 people) .. 18.5 27.2 38.7 52.7 58.7 66.6 220.4 .. Television sets (per 1,000 people) .. .. 0.0 0.0 0.1 1.0 2.0 29.9 .. Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix B Sub-Saharan Africa Regional Trends Page 3 - Kenya Sub-Saharan Africa Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Kenya Life expectancy at birth, total (years) 47.5 50.0 52.5 54.8 56.8 57.1 52.6 47.0 46.3 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 112.0 102.0 92.0 74.8 64.2 61.8 74.0 77.7 78.0 Mortality rate, under-5 (per 1,000 live births) .. 156.0 .. 115.0 90.0 97.0 112.0 119.8 122.0 Fertility rate, total (births per woman) 8.1 8.1 8.0 7.8 6.9 5.6 4.9 4.4 4.3 Population growth (annual %) 3.2 3.4 3.7 4.2 3.5 3.0 2.6 2.3 1.9 Illiteracy rate, adult total (% of people ages 15 and above) .. 59.3 51.7 43.8 36.2 29.2 23.0 17.6 16.7 Health expenditure per capita (current US$) .. .. .. .. .. 29.0 26.0 .. .. Immunization, DPT (% of children under 12 months) .. .. .. .. 70.0 84.0 94.0 .. 76.0 Immunization, measles (% of children under 12 months) .. .. .. .. 63.0 78.0 83.0 .. 76.0 Improved water source (% of population with access) .. .. .. .. .. 40.0 .. 49.0 .. Prevalence of HIV (% of pop. 15-49) .. .. 11.6 13.9 13.9 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 68 53 50 103 209 233 See Note 1 Diphtheria (Total Cases) 7 6395 0 1 0 15 6 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total Cases) 33868 28473 111492 77072 3322 21002 11304 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Polio (Total Cases) 351 455 368 1528 12 0 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Malaria (Total Cases) .. .. 663 126 .. 3 689 636 5 430 205 4 343 190 .. .. See Note 2 GDP per capita (constant 1995 US$) 202.2 225.9 300.7 337.4 319.9 358.0 339.0 328.2 325.1 GDP per capita growth (annual %) -1.2 -7.8 -2.8 1.2 0.8 1.1 1.8 -2.5 .. GNI per capita, Atlas method (current US$) 100.0 130.0 250.0 440.0 300.0 380.0 260.0 350.0 .. Aid (% of GNI) 7.2 3.7 4.1 5.6 7.3 14.7 8.4 5.0 4.0 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.1 4.2 19.2 Telephone mainlines (per 1,000 people) 2.8 3.3 3.8 4.4 5.9 7.6 8.4 10.4 10.4 Internet users .. .. .. .. .. .. 200.0 200 000 500000.0 Personal computers (per 1,000 people) .. .. .. .. .. 0.3 0.6 4.9 5.6 Radios (per 1,000 people) .. 23.0 29.1 39.1 80.5 85.6 97.4 222.7 221.3 Television sets (per 1,000 people) 0.0 2.6 3.3 4.9 6.5 15.4 17.7 25.0 26.0 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix B Sub-Saharan Africa Regional Trends Page 4 - Nigeria Sub-Saharan Africa Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Nigeria Life expectancy at birth, total (years) 41.4 42.9 44.4 45.8 47.5 49.1 49.9 46.8 46.1 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 161.6 139.4 117.0 99.4 90.5 86.4 83.0 84.4 110.0 Mortality rate, under-5 (per 1,000 live births) .. 201.0 .. 196.0 .. 136.0 .. 153.0 183.0 Fertility rate, total (births per woman) 6.9 6.9 6.9 6.9 6.5 6.0 5.7 5.3 4.6 Population growth (annual %) 2.7 2.7 2.9 3.1 3.0 2.8 3.0 2.4 2.2 .. Illiteracy rate, adult total (% of people ages 15 and above) 79.9 74.1 67.1 59.3 51.4 43.7 36.1 34.6 Health expenditure per capita (current US$) .. .. .. .. .. 9.0 21.0 .. .. .. Immunization, DPT (% of children under 12 months) .. .. .. 16.0 56.0 34.0 .. 26.0 .. Immunization, measles (% of children under 12 months) .. .. .. 17.0 85.0 44.0 .. 40.0 .. Improved water source (% of population with access) .. .. .. .. 49.0 .. 57.0 .. Prevalence of HIV (% of pop. 15-49) .. .. 4.1 5.1 5.1 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 15 20 23 14 23 39 See Note 1 Diphtheria (Total Cases) 32 165 1996 1768 3995 2468 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total Cases) 134976 162106 161768 115682 12393 212183 168107 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Polio (Total Cases) 569 816 959 1873 439 638 56 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Malaria (Total Cases) .. 628 534 1 083 263 1 171 071 1 280 000 1 047 292 1 131 692 .. See Note 2 GDP per capita (constant 1995 US$) 244.7 264.4 301.2 314.2 230.3 258.5 252.6 253.6 257.5 GDP per capita growth (annual %) 2.1 21.6 -7.9 1.0 6.4 5.2 -0.5 1.3 .. GNI per capita, Atlas method (current US$) 120.0 180.0 410.0 780.0 360.0 270.0 210.0 260.0 .. Aid (% of GNI) 1.3 0.9 0.3 0.1 0.1 1.0 0.8 0.5 0.5 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.3 4.3 Telephone mainlines (per 1,000 people) .. .. .. .. 2.4 3.0 3.9 4.3 4.6 Internet users .. .. .. .. .. .. .. 200 000 115000.0 Personal computers (per 1,000 people) .. .. .. .. .. .. 4.8 6.6 6.8 Radios (per 1,000 people) .. 24.1 73.5 98.4 174.3 194.4 197.7 .. .. Television sets (per 1,000 people) 0.6 1.4 1.6 6.2 6.5 36.4 59.1 67.6 67.6 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix B Sub-Saharan Africa Regional Trends Page 5 - Senegal Sub-Saharan Africa Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Senegal Life expectancy at birth, total (years) 39.0 40.9 43.1 45.3 47.5 49.5 51.5 52.3 52.3 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 159.6 151.6 142.7 117.3 97.8 74.0 72.2 59.6 79.0 Mortality rate, under-5 (per 1,000 live births) .. 279.0 .. .. .. .. .. 128.5 138 Fertility rate, total (births per woman) 7.0 7.0 7.0 6.8 6.6 6.2 5.7 5.1 5.0 Population growth (annual %) 2.6 2.8 2.9 2.8 2.8 2.8 2.7 2.6 2.4 .. Illiteracy rate, adult total (% of people ages 15 and above) 85.3 82.0 79.0 75.5 71.7 67.2 62.7 61.7 Health expenditure per capita (current US$) .. .. .. .. .. 21.0 25.0 .. .. .. Immunization, DPT (% of children under 12 months) .. .. .. .. 51.0 80.0 .. 52.0 .. Immunization, measles (% of children under 12 months) .. .. .. .. 51.0 80.0 .. 48.0 .. Improved water source (% of population with access) .. .. .. .. 72.0 .. 78.0 .. Prevalence of HIV (% of pop. 15-49) .. .. 1.8 1.8 1.8 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 36 17 68 91 .. 89 See Note 1 Diphtheria (Total Cases) 399 291 .. .. .. .. .. http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total Cases) 26567 29144 5004 5839 24789 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Polio (Total Cases) 144 138 87 3 1 0 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Malaria (Total Cases) 280 243 472 461 483 773 .. 286 855 52 011 628 773 .. .. See Note 2 GDP per capita (constant 1995 US$) 649.8 621.0 603.8 551.9 556.4 566.4 539.4 609.2 628.58 GDP per capita growth (annual %) -1.3 5.6 4.5 -6.0 0.9 1.1 2.4 2.9 .. GNI per capita, Atlas method (current US$) .. 220.0 380.0 530.0 370.0 720.0 550.0 490.0 .. Aid (% of GNI) .. 5.0 7.7 9.1 11.8 14.9 15.4 9.9 9.2 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 26.3 31.2 Telephone mainlines (per 1,000 people) 2.7 2.6 3.0 3.2 3.4 6.0 9.8 21.6 24.6 Internet users .. .. .. .. .. .. 60 40 000 100000.0 Personal computers (per 1,000 people) .. .. .. .. 0.5 2.5 7.2 16.8 18.6 Radios (per 1,000 people) .. 57.7 60.3 65.9 109.8 113.3 120.5 .. 125.9 Television sets (per 1,000 people) .. 0.3 0.4 1.4 31.4 36.2 38.3 39.9 78.7 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix B Sub-Saharan Africa Regional Trends Page 6 - S Africa Sub-Saharan Africa Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source South Africa Life expectancy at birth, total (years) 51.1 53.1 55.1 57.1 59.4 61.9 58.0 47.8 47.1 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 84.6 78.8 73.6 66.6 60.0 55.0 56.6 62.8 56.0 Mortality rate, under-5 (per 1,000 live births) .. 108.0 .. 91.0 .. 73.0 .. 79.0 71.0 Fertility rate, total (births per woman) 6.1 5.7 5.3 4.6 3.8 3.3 3.1 2.9 2.8 Population growth (annual %) 2.3 2.2 2.2 2.3 2.6 2.0 2.2 1.6 0.8 Illiteracy rate, adult total (% of people ages 15 and above) .. 30.2 26.9 23.8 21.1 18.8 16.7 14.7 14.4 Health expenditure per capita (current US$) .. .. .. .. .. .. 256.0 .. .. Immunization, DPT (% of children under 12 months) .. .. .. .. 75.0 72.0 72.0 .. 81.0 Immunization, measles (% of children under 12 months) .. .. .. .. 70.0 79.0 76.0 .. 72.0 Improved water source (% of population with access) .. .. .. .. .. .. .. 86.0 .. Prevalence of HIV (% of pop. 15-49) .. .. 12.9 19.9 19.9 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 190 181 221 185 349 339 See Note 1 Diphtheria (Total Cases) 487 57 46 34 2 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total Cases) 19193 17884 10624 8845 1459 1166 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Polio (Total Cases) 612 112 72 5 0 0 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Malaria (Total Cases) 55 227 3031 1059 11 358 6857 9287 See Note 2 GDP per capita (constant 1995 US$) 3449.5 4100.1 4574.0 4620.3 4229.1 4112.6 3862.8 3985.1 4068.0 GDP per capita growth (annual %) 6.3 4.9 -0.9 6.7 -6.5 -2.3 0.9 1.4 .. GNI per capita, Atlas method (current US$) 540.0 790.0 1600.0 2540.0 2120.0 2890.0 3740.0 3020.0 .. Aid (% of GNI) .. .. .. .. .. .. 0.3 0.4 0.4 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.2 13.6 190.2 251.9 Telephone mainlines (per 1,000 people) 38.0 40.7 44.7 55.2 68.3 93.4 101.3 113.5 112.5 Internet users .. .. .. .. .. .. 460 000 2 400 000 .. Personal computers (per 1,000 people) .. .. .. .. .. 7.0 27.9 61.8 68.5 Radios (per 1,000 people) .. 181.1 202.2 290.1 319.4 326.7 334.9 .. .. Television sets (per 1,000 people) 2.5 3.1 3.9 68.1 89.3 104.3 132.3 127.0 152.4 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix B Sub-Saharan Africa Regional Trends Page 7 - Zimbabwe Sub-Saharan Africa Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Zimbabwe Life expectancy at birth, total (years) 48.0 50.5 52.9 54.9 56.4 56.2 49.0 39.9 39.5 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 103.0 96.2 88.8 80.0 60.4 51.8 60.2 69.0 76.0 Mortality rate, under-5 (per 1,000 live births) .. 138.0 .. 108.0 .. .. .. 115.8 123 Fertility rate, total (births per woman) 7.5 7.3 6.8 6.4 5.8 4.8 4.1 3.8 3.7 Population growth (annual %) 3.3 3.3 3.2 3.4 3.8 3.1 1.9 1.9 1.1 Illiteracy rate, adult total (% of people ages 15 and above) .. 42.5 35.8 29.9 24.2 19.3 15.2 11.3 10.7 Health expenditure per capita (current US$) .. .. .. .. .. 52.0 36.0 .. .. Immunization, DPT (% of children under 12 months) .. .. .. .. 63.0 88.0 88.0 .. 75.0 Immunization, measles (% of children under 12 months) .. .. .. .. 78.0 87.0 87.0 .. 68.0 Improved water source (% of population with access) .. .. .. .. .. 77.0 .. 85.0 .. Prevalence of HIV (% of pop. 15-49) .. .. 25.8 25.1 33.7 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Notification Rates (per 100,000 people) 57 55 89 269 403 437 See Note 1 Diphtheria (Total Cases) .. 8 4 0 0 0 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total Cases) .. 23 650 22 290 13 728 8529 1483 529 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Polio (Total Cases) .. 32 69 0 1 0 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Malaria (Total Cases) .. .. 87 647 14 587 281 399 633 626 330 002 .. See Note 2 GDP per capita (constant 1995 US$) 473.0 620.3 663.8 610.9 622.4 654.7 620.2 620.7 559.4 GDP per capita growth (annual %) 1.5 18.6 -5.0 10.6 2.9 3.7 -1.7 -6.7 .. GNI per capita, Atlas method (current US$) 290.0 400.0 750.0 950.0 760.0 880.0 610.0 460.0 .. Aid (% of GNI) 0.3 0.0 0.1 2.5 4.3 4.0 7.2 2.5 1.8 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 22.9 24.1 Telephone mainlines (per 1,000 people) 14.5 14.2 13.2 13.4 12.4 12.4 14.0 18.4 18.6 Internet users .. .. .. .. .. .. 900 50 000 100000.0 Personal computers (per 1,000 people) .. .. .. .. .. 0.2 3.0 11.9 12.1 Radios (per 1,000 people) .. 28.1 32.8 33.6 58.0 81.2 87.1 .. .. Television sets (per 1,000 people) 8.9 9.5 9.8 10.2 21.2 26.3 29.4 30.4 .. Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. 208 APPENDIX C MIDDLE EAST AND NORTH AFRICA (MENA) REGIONAL TRENDS 1965 - 2001 209 Appendix C Middle East and North Africa Trends Page 1 - Region MENA Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Middle East & North Africa Life expectancy at birth, total (years) 49.5 52.3 55.3 58.1 61.5 64.3 66.1 67.9 68.2 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 151.5 134.3 115.3 97.7 75.7 55.9 51.2 43.1 43.6 Mortality rate, under-5 (per 1,000 live births) .. 200.1 .. 136.2 .. 71.8 .. 53.9 53.8 Fertility rate, total (births per woman) 7.1 6.8 6.4 6.2 5.6 4.8 4.0 3.4 3.3 Population growth (annual %) 2.8 2.8 2.9 3.2 3.3 3.5 2.1 1.9 2.0 Illiteracy rate, adult total (% of people ages 15 and above) .. 70.2 64.3 58.4 52.3 46.2 40.7 35.2 35.5 Health expenditure per capita (current US$) .. .. .. .. .. 156.2 .. .. .. Immunization, DPT (% of children under 12 months) .. .. .. .. 69.2 86.3 82.6 .. 92.4 Immunization, measles (% of children under 12 months) .. .. .. .. 63.0 81.6 81.7 .. 92.3 Improved water source (% of population with access) .. .. .. .. .. 84.5 .. 89.5 .. Prevalence of HIV (% of adults) .. .. 0.1 0.1 .. (1999) http://www.unaids.org/epidemic_update/report/Final_Table_Eng_Xcel.xls TB Case Notification Rates (per 100,000 people) .. .. .. .. .. .. See Note 1 Diptheria (Total cases) 8,118 19,989 8,622 3,604 295 175 96 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 358,463 342,488 230,758 59,502 20,677 34,971 40,927 " , See Note 2 Polio (Total Cases) .. .. 14,135 12,660 5,604 1,498 790 505 140 " Malaria .. .. .. .. See Note 3 Child Malnutrition ( % < 5s Underweight ) 13.0 17.0 .. UNICEF at <http://childinfo.org/eddb/malnutrition/index.htm> Vitamin A ( # of countries providing one dose to over 70% of < 5, of 16) 1.0 2.0 .. UNICEF at <http://childinfo.org/eddb/vita_a/index.htm> % of Births attended by skilled personnel 49.0 .. 63.0 .. See Note 4 Maternal Mortality Ratio (maternal deaths per 100K live births) .. .. 320.0 230.0 .. .. NOTE: MENA stats do not include N. Africa which = MMR 340/450 GDP per capita (constant 1995 US$) .. .. 1753.0 1926.2 1826.6 1774.1 1853.1 1983.0 1992.2 GDP per capita growth (annual %) .. .. 4.5 -0.9 -1.6 3.7 -0.2 2.0 .. GNI per capita, Atlas method (current US$) 220.0 300.0 1010.0 2030.0 1980.0 1710.0 1780.0 2090.0 .. Aid (% of GNI) 2.3 1.8 2.9 1.9 1.2 2.6 1.1 0.7 0.7 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.1 1.1 30.0 53.4 Telephone mainlines (per 1,000 people) .. 9.0 12.7 19.1 28.0 37.5 58.0 91.9 99.8 Internet users .. .. 0.0 0.0 0.0 0.0 32700.0 1863717.0 3358300.0 Personal computers (per 1,000 people) .. .. .. .. .. .. 12.8 31.2 32.0 Radios (per 1,000 people) .. 120.2 135.4 173.8 222.2 257.3 268.5 .. .. Television sets (per 1,000 people) 14.6 23.9 41.9 66.2 92.3 112.9 145.5 171.8 .. Note 1: Global Tuberculosis Control , WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: ? Note 3: MENA regional Malaria stats are not avilable because aggregations have been done along Africa/Asia Lines. Note 4: Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA <http://childinfo.org/eddb/mat_mortal/index.htm> Appendix C Middle East and North Africa Trends Page 2 - Algeria MENA Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Algeria Life expectancy at birth, total (years) 50.2 53.3 56.3 59.3 63.6 67.4 69.6 71.0 70.6 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 154.0 139.2 120.0 97.6 67.0 46.0 38.3 33.3 39.0 Mortality rate, under-5 (per 1,000 live births) .. 192.0 .. 139.0 .. 55.0 .. 39.0 49.0 Fertility rate, total (births per woman) 7.4 7.4 7.3 6.7 5.7 4.5 3.7 3.2 2.9 Population growth (annual %) 2.5 3.0 3.1 3.1 3.1 2.6 2.0 1.5 1.6 Illiteracy rate, adult total (% of people ages 15 and .. above) 79.4 72.4 64.1 55.5 47.4 39.9 33.3 32.2 Health expenditure per capita (current US$) .. .. .. .. .. 103.0 68.0 .. .. .. Immunization, DPT (% of children under 12 months) .. .. .. 70.0 82.0 76.0 .. 89.0 .. Immunization, measles (% of children under 12 months) .. .. .. 68.0 71.0 77.0 .. 83.0 .. Improved water source (% of population with access) .. .. .. .. .. .. 94.0 .. Prevalence of HIV (% of adults) .. .. < 0.1 < 0.1 .. (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Case Notification Rates (per 100,000 people) 14 63 47 49 61 59 See Note 1 Diptheria (Total cases) 350 116 66 30 3 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 8899 15527 20114 1796 8204 2686 " Polio (Total Cases) .. .. 317 116 66 2 4 0 1 " Malaria (Total Cases) 5179 4002 170 36 44 152 107 .. .. See Note 2 GDP per capita (constant 1995 US$) 1080.5 1277.1 1451.6 1681.0 1814.4 1647.9 1488.4 1605.9 1616.5 GDP per capita growth (annual %) 3.6 5.6 1.9 -2.3 0.5 -1.8 1.7 0.9 .. GNI per capita, Atlas method (current US$) 260.0 350.0 950.0 2080.0 2460.0 2440.0 1590.0 1580.0 .. Aid (% of GNI) 4.7 2.6 1.1 0.4 0.3 0.4 0.8 0.3 0.3 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.2 2.8 3.2 Telephone mainlines (per 1,000 people) 6.0 6.9 8.0 16.6 24.5 32.3 41.2 57.0 61.0 Internet users .. .. .. .. .. .. 500.0 50000.0 60000.0 Personal computers (per 1,000 people) .. .. .. .. .. 1.0 3.0 6.5 7.1 Radios (per 1,000 people) .. 181.9 187.3 198.2 219.4 232.6 238.8 .. .. Television sets (per 1,000 people) 27.3 29.2 31.2 52.0 68.5 73.4 87.6 110.1 .. Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix C Middle East and North Africa Trends Page 3 - Egypt MENA Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Egypt, Arab Rep. Life expectancy at birth, total (years) 48.8 51.1 53.3 55.5 59.3 62.8 65.3 67.5 68.3 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 172.0 158.0 138.6 121.4 91.0 67.8 53.4 41.8 35.0 Mortality rate, under-5 (per 1,000 live births) .. 235.0 .. 175.0 .. 85.0 .. 52.2 41.0 Fertility rate, total (births per woman) 6.8 5.9 5.4 5.1 4.6 4.0 3.6 3.3 3.2 Population growth (annual %) 2.7 2.1 2.0 2.5 2.6 2.3 1.9 1.9 1.8 .. Illiteracy rate, adult total (% of people ages 15 and above) 68.4 64.7 60.7 56.8 52.9 48.9 44.7 43.9 Health expenditure per capita (current US$) .. .. .. .. .. 51.0 38.0 .. .. .. Immunization, DPT (% of children under 12 months) .. .. 57.0 84.0 87.0 88.0 .. 99.0 .. Immunization, measles (% of children under 12 months) .. .. 41.0 74.0 86.0 89.0 .. 97.0 .. Improved water source (% of population with access) .. .. .. .. 94.0 .. 95.0 .. Prevalence of HIV (% of adults) .. .. 0 0 < 0.1 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Case Notification Rates (per 100,000 people) 4 3 4 18 16 15 See Note 1 Diptheria (Total cases) 584 333 663 59 10 0 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 3492 839 5554 887 1833 2633 2150 " Polio (Total Cases) .. .. 2175 2006 564 565 71 4 5 " Malaria (Total Cases) 7130 .. 1459 .. 72 75 322 .. See Note 2 GDP per capita (constant 1995 US$) 455.9 477.6 516.2 731.4 890.3 970.9 1034.0 1225.8 1228.9 GDP per capita growth (annual %) 6.4 3.4 6.8 7.3 3.9 3.3 2.7 3.1 .. GNI per capita, Atlas method (current US$) 180.0 230.0 340.0 530.0 640.0 810.0 990.0 1490.0 .. Aid (% of GNI) 2.2 2.3 19.7 6.5 5.6 12.9 3.3 1.3 1.3 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.1 0.1 21.4 43.3 Telephone mainlines (per 1,000 people) .. 8.2 8.8 .. 18.4 30.1 46.6 86.3 103.6 Internet users .. .. .. .. .. .. 20000.0 450000.0 600000.0 Personal computers (per 1,000 people) .. .. .. .. .. .. 4.3 22.1 15.5 Radios (per 1,000 people) .. 133.1 135.0 146.8 258.0 324.2 333.4 .. .. Television sets (per 1,000 people) 10.2 15.0 16.0 32.0 80.0 107.1 117.7 189.1 216.9 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/africa.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix C Middle East and North Africa Trends Page 4 - Iran MENA Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Iran, Islamic Rep. Life expectancy at birth, total (years) 50.2 52.8 55.5 58.1 61.5 64.7 67.1 69.1 69.0 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 147.4 130.2 113.4 98.0 78.8 54.0 43.0 33.2 35.0 Mortality rate, under-5 (per 1,000 live births) .. 208.0 .. 126.0 95.0 72.0 55.0 41.2 42.0 Fertility rate, total (births per woman) 7.1 6.7 6.5 6.7 6.1 4.7 3.3 2.6 2.6 Population growth (annual %) 2.7 2.9 3.2 3.5 3.9 2.2 1.6 1.4 1.7 .. Illiteracy rate, adult total (% of people ages 15 and above) 65.5 57.7 50.0 43.8 36.5 29.7 23.7 22.9 Health expenditure per capita (current US$) .. .. .. .. .. 410.0 79.0 .. .. .. Immunization, DPT (% of children under 12 months) .. .. .. .. .. .. .. 95 .. Immunization, measles (% of children under 12 months) .. .. .. .. .. .. .. 96 .. Improved water source (% of population with access) .. .. .. .. 86.0 .. 95.0 .. Prevalence of HIV (% of adults) .. .. 0 0 <0.1 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Case Notification Rates (per 100,000 people) 109 18 16 25 17 17 See Note 1 Diptheria (Total cases) 1556 139 143 373 9 18 15 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 33640 31130 20582 5341 263 11874 9582 " Polio (Total Cases) .. .. 1111 80 53 15 101 3 0 " Malaria (Total Cases) 10582 24325 37560 32635 26363 77470 67532 .. .. See Note 2 GDP per capita (constant 1995 US$) .. .. 1969.6 1379.8 1476.6 1291.3 1482.2 1649.1 1714.2 GDP per capita growth (annual %) .. .. 2.2 -15.8 -2.2 8.8 1.2 3.9 .. GNI per capita, Atlas method (current US$) .. .. .. 2250.0 3520.0 2590.0 1220.0 1680.0 .. Aid (% of GNI) .. .. 0.0 0.0 0.0 0.1 0.2 0.1 0.1 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.3 15.1 32.3 Telephone mainlines (per 1,000 people) 8.1 10.0 20.5 23.2 27.7 40.3 86.0 149.0 168.7 Internet users .. .. .. .. .. .. 2600.0 250000.0 1005000.0 Personal computers (per 1,000 people) .. .. .. .. .. .. 25.3 62.8 70.0 Radios (per 1,000 people) .. 102.0 120.5 163.6 212.3 246.3 271.4 .. .. Television sets (per 1,000 people) 4.5 18.8 45.0 50.9 52.5 66.4 152.1 163.4 162.5 Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/eastern_mediterranean.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix C Middle East and North Africa Trends Page 5 - Saudi Arabia MENA Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Saudi Arabia Life expectancy at birth, total (years) 48.3 52.3 56.8 61.1 65.7 69.0 70.9 72.5 72.8 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 148.0 119.0 87.0 64.8 46.0 32.0 21.0 18.2 23.0 Mortality rate, under-5 (per 1,000 live births) .. 185.0 .. 85.0 .. 45.0 29.0 22.7 28.0 Fertility rate, total (births per woman) 7.3 7.3 7.3 7.3 7.0 6.6 6.0 5.5 5.4 Population growth (annual %) 3.1 4.1 4.9 5.5 5.3 4.5 2.6 2.6 3.3 .. Illiteracy rate, adult total (% of people ages 15 and above) 66.5 58.1 49.0 40.6 33.7 28.7 23.7 22.9 Health expenditure per capita (current US$) .. .. .. .. .. .. .. .. .. .. Immunization, DPT (% of children under 12 months) .. .. 41.0 81.0 95.0 96.0 .. 97.0 .. Immunization, measles (% of children under 12 months) .. .. 8.0 79.0 90.0 94.0 .. 94.0 .. Improved water source (% of population with access) .. .. .. .. .. .. 95.0 .. Prevalence of HIV (% of adults) .. .. < 0.1 < 0.1 .. (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Case Notification Rates (per 100,000 people) 114 32 16 17 16 See Note 1 Diptheria (Total cases) 266 99 65 1 1 0 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 27173 46115 18393 5439 2574 155 " Polio (Total Cases) .. .. 334 257 28 5 4 0 0 " Malaria (Total Cases) .. 6104 1753 6496 16242 15666 18751 .. .. See Note 2 GDP per capita (constant 1995 US$) 5318.1 7044.2 9661.6 11557.4 7440.1 7102.9 7021.4 6728.6 6613.8 GDP per capita growth (annual %) 8.7 9.9 3.4 2.1 -9.0 3.9 -2.2 1.8 .. GNI per capita, Atlas method (current US$) 480.0 710.0 6330.0 14740.0 8490.0 6620.0 7180.0 7230.0 .. Aid (% of GNI) 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Mobile phones (per 1,000 people) .. .. .. .. .. 0.9 0.9 63.7 113.3 Telephone mainlines (per 1,000 people) .. 16.2 19.0 33.2 71.6 76.8 94.2 137.2 144.8 Internet users .. .. .. .. .. .. 2000.0 200000.0 300000.0 Personal computers (per 1,000 people) .. .. .. .. .. 23.7 35.6 60.2 62.7 Radios (per 1,000 people) .. 121.8 131.0 266.8 286.8 294.9 302.1 .. .. Television sets (per 1,000 people) 73.1 87.0 110.3 218.7 245.1 249.3 257.5 263.8 .. Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/eastern_mediterranean.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva. Appendix C Middle East and North Africa Trends Page 6 - Syria MENA Regional Health Trends 1965 1970 1975 1980 1985 1990 1995 2000 2001 Source Syrian Arab Republic Life expectancy at birth, total (years) 52.8 55.8 58.8 61.6 64.0 66.4 68.3 69.7 70.0 All stats unless otherwise noted are from World Bank WDI 2003 Database on CD-ROM Mortality rate, infant (per 1,000 live births) 114.2 95.6 75.4 56.2 45.4 38.8 33.0 24.0 23.0 Mortality rate, under-5 (per 1,000 live births) .. 129.0 .. 73.0 .. .. .. 29.0 28 Fertility rate, total (births per woman) 7.7 7.7 7.5 7.4 6.9 5.3 4.2 3.6 3.6 Population growth (annual %) 3.0 3.4 3.3 3.3 3.6 3.3 3.1 2.5 2.5 above) Illiteracy rate, adult total (% of people ages 15 and .. 58.9 52.3 46.7 40.6 35.2 30.1 25.6 24.8 Health expenditure per capita (current US$) .. .. .. .. .. 42.0 93.0 .. .. .. Immunization, DPT (% of children under 12 months) .. .. 13.0 73.0 90.0 92.0 .. 92.0 .. Immunization, measles (% of children under 12 months) .. .. 13.0 70.0 87.0 90.0 .. 93.0 .. Improved water source (% of population with access) .. .. .. .. .. .. 80.0 .. Prevalence of HIV (% of adults) .. .. < 0.1 < 0.1 < 0.1 (1995, 2000) http://devdata.worldbank.org/hnpstats/AAGselection.asp; TB Case Notification Rates (per 100,000 people) 19 21 49 31 31 30 See Note 1 Diptheria (Total cases) 502 366 400 80 61 0 1 http://www.who.int/vaccines-surveillance/documents/Incidence_1974_2001.zip Measles (Total cases) 2057 1478 425 535 1362 146 290 " Polio (Total Cases) .. .. 110 312 25 13 4 0 0 " Malaria (Total Cases) 988 1787 232 1481 435 107 626 .. See Note 2 GDP per capita (constant 1995 US$) 385.1 388.3 609.0 719.4 695.4 641.6 801.4 838.7 796.0 GDP per capita growth (annual %) -0.8 -7.0 15.7 8.3 2.4 4.1 2.5 0.0 .. GNI per capita, Atlas method (current US$) 280.0 370.0 980.0 1610.0 1740.0 940.0 910.0 940.0 .. Aid (% of GNI) -0.1 1.0 9.5 12.5 3.6 5.7 3.1 1.0 0.8 Mobile phones (per 1,000 people) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.9 12.0 Telephone mainlines (per 1,000 people) 10.7 12.7 17.2 27.5 42.5 40.9 67.7 103.4 103.0 Internet users .. .. 0.0 0.0 0.0 0.0 0.0 30000.0 60000.0 Personal computers (per 1,000 people) .. .. .. .. .. .. 7.1 15.4 16.3 Radios (per 1,000 people) .. 187.0 188.2 195.3 211.6 260.0 263.7 .. .. Television sets (per 1,000 people) 12.2 18.5 30.1 44.2 58.0 61.1 72.1 66.7 .. Note 1: Global Tuberculosis Control, WHO Report 2003 < http://www.who.int/gtb/publications/globrep/xls/annex4/eastern_mediterranean.xls > Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <http://www.who.int/wer/pdf/1999/wer7432.pdf>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva.
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