The Digital Pulse by nyut545e2

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									                            The Digital Pulse
                            The Current and Future
                            Applications of Information and
                            Communication Technologies
                            for Developmental Health

A Report Published by The
Communication Initiative
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

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

        First, three set of analysis papers – supporters, detractors and middle roaders.

        Second, classification of these think-pieces across a range of health and geographic

        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.

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 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

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

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

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

        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

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

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

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

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.

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

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

    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.


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

                  CHAPTER 2
ICT For Development: A Review Of Current Thinking

Empowerment and Governance through Information and Communication Technologies:
Women’s Perspectives
Vikas Nath

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.

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
   • 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


Public Computer and Communications Centre (PC3) Project (Chap. 4) Bulgaria
Nora Ovcharova

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

Graemeen Telecom’s Village Phone (VP) Programme: A Multi-Media Case Study
TeleCommons Development Group (Executive Summary & Section 2)

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

NGOs and the Internet in Nepal
Layton Montgomery

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,

Djibouti ICT Strategy

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

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
    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

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

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: 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.

ICT and the Environment: Friends or Foes
ICT for Development Gateway, Oleg Petrov

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

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:

Heralding ICT enabled Knowledge Societies
Vikas Nath

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-

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

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

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

For more work from Vikas Nath see

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)

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.

Information Program, Conceptual Map1
Open Society Institute (OSI)

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

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.

    See accompanying review of OSI Strategy Paper (P.25)
Information Program, Strategy1
Open Society Institute (OSI)

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
         • 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

      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.

    See accompanying review of OSI Concept Paper (P.24)
    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.

DEEP Impact: Teachers and Technology
Jenny Leach

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
    •   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

Understanding community health care: Implications for technology design
Donaugh Austin, Hank Szeto, Geraldine Fitzpatrick, Peta Wyeth

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

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.

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

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:

ICT and Ensuring Environmental Sustainability
John Daly

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:

The Chicken, the Egg, and African Telecommunications
Barnaby Richards

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

Source: Barnaby Richards, “The Chicken, the Egg, and African Telecommunications” (University
of Colorado ay Boulder) May 2001.

Women, Men and ICTs in Africa: Why Gender Is an Issue
Eva M. Rathgeber

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

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)

Take Five: A Handful of Essential for ICTs in Development
Alfonso Gumucio Dagron

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.

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.”

ICT and Poverty: The San Bushmen
Earl Mardle

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

Information Monopolies and the WTO
Robert Verzola

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:

The Impact of Democratic Deficits on Electronic Media in Rural Development
Robin Van Koert

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

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

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

The Internet: Towards a Deeper Critique
Roberto Verzola

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”

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

Source: Roberto Verzola “The Internet: Towards a Deeper Critique” at Bytes for at

Bridges Across Disciplines
Ricardo Ramirez

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

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

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

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

Pro-Poor and Gender Sensitive Information Technology: Policy and Practice
Zubair Faisal Abbasi

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 20sensitive%20ICT.pdf

i-Development Not e-Development: Special Issue on ICT’s and Development
Richard Heeks (Journal of International Development)

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
     • 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

 Several of the articles from that Special Edition are included in this literature review.
 “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
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.

 For more on design-reality gaps see Heeks “Heeks, “Failure, Success and Improvisation of Information
Systems Projects in Developing Countries” (P.38)
Knowledge Facts, Knowledge Fiction: The Role of ICTs in Knowledge Management for
Maja van der Velden (Journal of International Development)

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

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.

Failure, Success and Improvisation of Information Systems Projects in Developing
Richard Heeks

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

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.

Themes and Issues In Telecentre Sustainability:
Development Informatics Working Paper No. 10
Raul Roman & Royal D. Colle, Cornell University

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

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)

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

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.

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.

Shouting To Be Heard: Public Service Advertising in a New Media Age (Executive
Summary) - Henry J. Kaiser Family Foundation
Victoria Rideout and Tina Hoff.

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.

Participatory Rural Communication Appraisal (PRCA)
FAO, Sustainable Development Department (SD)
Phillipe Van der Stichele

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:

Source: SDdimensions, July 1998,

    RRA = Rapid Rural Appraisal; PRA = Participatory Rural Appraisal; PLA = Participatory Learning and Action

Discovering the “Magic Box”: Local Appropriation of Information and Communication
Technologies (ICTs)
Sabine Isabel Michiels and L. Van Crowder

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

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

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
   •   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,

HIV/AIDS and Information and Communication Technologies
Libbie Driscoll

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.

Health, HIV/AIDS and ICT: A Needs Assessment
DS Bateson Consulting Inc.

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
    •   Local context and language are essential to any communication initiatives
    •   Local ownership and capacity are key to the acceptance and sustainability of ICT
    •   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

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.

    •   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).

Can Information and Communications Technology Applications Contribute to Poverty
Reduction? Lessons from Rural India
Simone Cecchini, Poverty Reduction Group, Worldbank

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).

The African Internet: Impact, Winners and Losers.
Wainaina Mungai

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

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

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);

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.

Reflect and ICTs (Project Summary and Concept Paper)
Hannah Beardon, ActionAid

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] [Concept] or see

Generation How Young People Use the Internet for Health Information
Henry J. Kaiser Family Foundation

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

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 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.

Radio and the Internet: Mixing Media to Bridge the Divide
Bruce Girard

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.

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:

Missing the Connection? Using ICTs in Education
Yusuf Sayed

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

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

    For a more detailed examination of this particular issue see RS 33 “DEEP Impact”
Increasing the Relevance of ICT for Development
Royal D. Colle, Cornell University

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

    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.

    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

     Classification Sheet
ID # Name                         Class Page ICT4D Positioning              Methodlogical foci:                              Subject Areas                                                                                                                                          Economic Orientation







                                                                 Mixed OR

                                                                                                                                                                                          Human IT








 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                   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
                      CHAPTER 3
Programme Experiences: Sixty Case Studies Of ICT Usage In
                 Developmental Health

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

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

    HFG Site <>
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

   •    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
DHF site at

    DHF Connections <>
    As observed by Lynda Arthur in her contribution to the G8 DOT Force Report
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 (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.)
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: and

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

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
      •    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

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
Dashen Building, 1st Floor
Addis Ababa

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

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

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

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

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

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

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

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

Teaching-aids at Low Cost (TALC) – Global

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

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)

    •   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

Source: The TALC website at and the eTALC site at

For more information, contact:
Caroline Marven - Project Co-ordinator
eTALC (Electronic Teaching-aids At Low Cost)
PO Box 49
St Albans
Tel: +44 (0) 1727853869
Fax: +44 (0) 1727 846852

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

1, or to access the public server
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.

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
   • 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

For more information, contact:
Kurt Brauchli
Department of Pathology, University of Basel
Tel.: +41 61 265 2828
iPath site

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

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
    •   Adequate timing (eg. when in the year do bed-nets need to be insecticide-treated);

      •    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.

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
• 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

For more information, contact:

Carrin Martin
Administrative Support
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

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.


For more information, contact:

Emeritus Consultant Haematologist, Royal Perth Hospital.

Mr Graham Icke MSc CBiol FIBiol FIBMS Grad Dip Bus
A/Principal Scientist, Laboratory Medicine, Royal Perth Hospital.

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

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

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

       •   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.

      •   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

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.

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
website at

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

    •    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

For more information, contact:
Lisa Cobb
Program Officer, JHU/CCP
Tel.: 410-659-6146

Ron Hess
Associate Director, Center for Communication Programs

Reed Ramlow
The Futures Group International

"Keep Your Head, Wear Your Helmet" Campaign - Bangalore, India
Friends for Life

Development Issues: Road Safety, Health.

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

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.

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
"Keep Your Head" site at

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

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.

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

For more information, contact:
AIDS Radio Network, Editor - Siviwe Minyi
14 Poplar Avenue
Thornton, Cape
South Africa
Tel.: +27 21 534-2235
Mobile: +27 21 82 8981669

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

The overall goals of the DISH Project aimed to:

    •    Make good quality maternal, child and reproductive health services more widely
    •    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

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

  See notes on the BCC’s Promotion of Quality Services/Yellow Star project.
  To download a word document copy of the “Bible” go to <>
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
Centre 4 page on DISH II site at

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

    For a synopsis of all 13 episodes see <>
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.

    For a sample brochure (PDF)
     •   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

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

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

For more information, contact:
Dr. Sushma Palmer
4437 reservoir Road, NW, Washington DC 20007
Tel: 1-202-965-5990,
Fax: 1-202-965-5996

  See <>
  See <>
  For a more detailed explanation see <>
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

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

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

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.

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.

   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 @

For more information, contact:
Water Supply and Sanitation Collaborative Council
20 Avenue Appia
CH-1211, Geneva 27
Tel.: +41 22 791-3517/3544
Fax. +41 22 791 4847

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

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:

    “Changing Behavior, Improving Lives” at
    •   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
    •   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.

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

Source: Press release sent by David Olson to The Communication Initiative on July 1, 2002, and
the PSI website at

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

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.

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

    See the “Auntie Stella” site at <>
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
AIDSWEB site at

 "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.
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

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.

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
Tel: 263 - 4 - 705108
Fax: 263 - 4 – 737220

 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 < > an external evaluation that supports these findings is also available at < >.
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


For more Information Contact
Tel +44 (0) 20 7739 7635

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

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.

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

    NFHS Subject Report No. 10 (1998). At <>
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

National Family Health Survey website at

For more information, contact:
International Institute for Population Sciences,
Govandi Station Road, Deonar,
Mumbai - 400 088, India.
Fax: 91-22-556-3257

loveLife - South Africa

Development Issues: Youth, STD’s and HIV, Reproductive Health, Gender

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,”

    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, 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.

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

For more information, contact:
174 Oxford Road
Melrose 2196 PO Box 45
Parklands 2121

Tel: +27 (11) 771-6800
Fax: +27 (11) 771-6801

Or Michael Sinclair

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

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.

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 (, and the
WorldSpace Foundation website at

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

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;

       •   Strengthening micro-macro linkages, adding outreach to district level initiatives,
           developing local materials for dissemination, linking reality on the ground to policy
       •   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

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.

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

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

For more information, contact:
Hannah Beardon at

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

        “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.

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

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
      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

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)

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

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

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

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

For more information, contact:
Massive Effort site at

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
   • 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

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.

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, ISS website at

For more information, contact:
204-A, Mantralaya, D.K.S. Bhawan
Raipur- 492 001
Phone: 91 (771) 221204 / 221304
Telefax: 91 (771) 221304

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

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

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.

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


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

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

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

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.

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, and from the case example at the
World Economic Forum at:

For more information, contact:
Bode-law Faleyimu,
Chevron Workplace AIDS Prevention Programme (CWAPP)
Chevron Nigeria Limited.
Tel: 234-1-2600600 Ext. 2224

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

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

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

POLICY's Young Adult Reproductive Health (YARH) Project - Nigeria

Development Issues: Political Development, Youth, Reproductive Health, Family Planning,

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.

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

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
Abuja, Nigeria
Tel.: 234-9-413-5945
Fax: 234-9-413-5944

Scott Moreland, Country Manager


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

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

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.

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

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
Consumer VOICE site at
FCTC site at

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
    §   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

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

Source: Letter from Gloria Coe to The Communication Initiative October 17, 2002.

For more information, contact:
Rafael Obregon

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.


For More information, contact:

R. Bhakther Solomon
Development Promotion Group
49 - A, and 52, Josier Street, Nungambakkam
Chennai – 600034, Tamil Nadu, IN

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: and

For more information, contact:
G. A. Kumar Gopal (Vice-President Sales & Marketing)
Telephone - 5631 6685

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

The station is hoping to open up sister stations within the year to further its message and expand
its audience.


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

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

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.

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


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.


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
    •   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
    •   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.

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.

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, APC site

For more information, contact:
The National Office:
MaiAdiko Rayfield
PO Box 8452
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

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

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,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

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

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

Youth Health Organization of Botswana
c/o BOTUSA Project
Gaborone - Botswana
Tel.: (267) 393-3537

Mr. Moses Imayi
Youth Action Rangers of Nigeria
Tel.: (234) 1.482.3550

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 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

EC/UNFPA Initiative for Reproductive Health (RHI) in Asia

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

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


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

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

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


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
HDN strives to develop, support and implement projects that:
   • Are appropriate and add value to developing countries and challenged/underserved
   • 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

      •   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.

    •   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
    •   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

“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

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.

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; Driscoll, Libbie. “HIV/AIDS and Information
and Communication Technologies.” Final Draft Report (November 2001)

For more information, contact:
Tim France
Director & Programme Manager
Tel: (+353) 868 192324
Fax: (+353) 8658 192324
Rep.of Ireland

 Driscoll, Libbie. “HIV/AIDS and Information and Communication Technologies.” Final Draft Report
(November 2001). 18-19.
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

           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

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

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
HDN website at

    See the forum at < >
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
        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.

       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.

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 and the AmiCor - India website>

For more information, contact:
Lown Cardiovascular Research Foundation
21 Longwood Ave. Brookline MA 02446
Tel 617-732-1318

Amicor - India
T-7,Green Park Extension
New Delhi-110016

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
       •   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

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.

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

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
PHSSA site at

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

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

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
    •   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
    •   Carrying out a media campaign aimed to increase reproductive and sexual health
        information and services to adolescents.

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
    • Fourteen NGOs received advanced training on the use of email and the Internet.

      •   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

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
Women Connect site at
PIWH site. At

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

      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.

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

For more information, contact:
Omololu Falobi
Project Director,
Journalists Against AIDS (JAAIDS) Nigeria
JAAIDS Nigeria site at

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

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.

    •   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

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,

Source: The Minga Perú site at and Elias profile on the Ashoka site

For more information, contact:
Victoriano Castillo
Minga Perú
125 Of.102
Urbanización Los Jasmines, Miraflores
Lima 18 - Perú
Tel.-Fax: 511-448-2970

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

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

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

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),


For more information, contact:

Plot 59 Nkrumah Road, Room 13
+256 (0)41 234924
P.O. Box 4411, Kampala, Uganda

  For a full report see <>
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

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

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:

•     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

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
• 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

For more information, contact:
NABUUR site at

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
     • 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

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.

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).


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

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

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

      •   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 and the TeleInViVo
site at

For more information, contact:
Fraunhofer IGD
Prof. Dr.-Ing. Georgios Sakas
Fraunhoferstr. 5
D-64283 Darmstadt
Tel.: 49-6151-155-153
Fax: 49-6151-155-559

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.

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

“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 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: <>
  For a full copy of the report see:
< .pdf>
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
   • 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
   • 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

Partners: SATELLIFE, the Acumen Fund, ARC, Skyscape, Moi University (Kenya), Cisco

Source: Health Information Project site at , and

For more information, contact:

Amy Galblum

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.

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 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.


    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:, ICT-Enabled Development Case Studies Series: Africa, at
Pambazuka News at

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

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

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.

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’s 7 Habits of

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
    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:, ICT-Enabled Development Case Studies Series: Africa, at
On Cue, Automated SMS Scheduling at
Eldis, ICT for Development Resource Guide at

For more information, contact:
Dr. David Green
The Compliance Service
Tel: +27 21 790 4521

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

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

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

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

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

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
CERTI website at

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.

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

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


For More Information Contact:

St. Lucia Office
Centre for Online Health
Lvl 3, General Purpose South
The University of Queensland
St. Lucia QLD 4072
Voice: +61 (07) 3365 4671 or 3346 4754
Fax: +61 (07) 3346 4705

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."

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: and,

For more information, contact:

Dr Ulrike Rivett
082 940 4349

Shireen Sedres
Manager: Media Liaison
Dept. Communication & Marketing
University of Cape Town

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.

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

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
    •   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)


For more information, contact:
Tim Bowman, MBA, Sister Kenny Institute (Admin, Project Lead)

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.

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

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,


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

       ICT and Health - Programme Experiences - Summary Sheet

                                                       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

                                                                                                                                                               Political Advocacy
                                                                                                                        Direct Action on a


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Person to Person
                                                                                                                                             Conduct On-Line

                                                                                                                                                                                                                                                                                                                                                                                                                     Web Site Search
                                                                                                                                                                                                                                                                                                         Social Marketing
                                                                                                                                                                                                                                                                                                         Service Delivery
                                                                                                                                                                                                            Access External


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Print Materials/
                                                                                                                        Health Issue


                                                                                                                                                                                                                                                                                                                                and review


                                                                                                                                                                                                                                   of Interest

                                                                                                                                                                                                                                                                                                                                                        Web Site





 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
                                                               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

                                                                                                                                                                 Political Advocacy
                                                                                                                          Direct Action on a


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Person to Person
                                                                                                                                               Conduct On-Line

                                                                                                                                                                                                                                                                                                                                                                                                                       Web Site Search
                                                                                                     component of an

                                                                                                                                                                                                                                                                                                           Social Marketing
                                                                                                                                                                                                                                                                                                           Service Delivery
                                                                                                                                                                                                              Access External
                                                                                                     overall initiative


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Print Materials/
                                                                                                                          Health Issue
                                                                                                     ICTs as one


                                                                                                                                                                                                                                                                                                                                  and review


                                                                                                                                                                                                                                     of Interest

                                                                                                                                                                                                                                                                                                                                                          Web Site





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

                                                                                                                                                                                                                               South Asia





 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

                                                                                                                                                                                                                               South Asia





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


        1965 - 2001

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)

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

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 <>

Vitamin A ( # of countries providing one dose to over 70% of < 5, of 8)                                                                                    1.0              5.0                     UNICEF at <>

% 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 < >
                                                                       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 <>
                                                                       Note 4: Asia Wide. Source: Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA <>
Appendix A                                                                                                                                South Asia Regional Trends                                                                                                        Page 2 - Afghanistan

South Asia Regional Health Trends
                                                                    1965          1970          1975          1980           1985             1990         1995         2000           2001    Source

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);

TB Notification Rates (per 100,000 people)                                                                     477             80               32                        33             44    See Note 1

Diptheria (Total cases)                                                                           22          1939           3179              368                        84         

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 < >
                                                                            Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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

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);

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

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 < >
                                                                            Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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

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);

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

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 < >
                                                                              Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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

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);

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

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 < >
                                                                             Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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);
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
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 < >
                                                                            Niote 2: Sri Lanka data is accounted for under India aggregate.
                                                                            Note 3: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva.
           APPENDIX B


            1965 - 2001

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)
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
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 <>
Vitamin A ( # of countries providing one dose to over 70% of < 5, of 44)                               ..                 1.0           29.0 ..                                     UNICEF at <>
% 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 < >
                                                    Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva.
                                                    Note 3: Maternal Mortality in 1995: WHO, UNICEF, UNFPA <>
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

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);

TB Notification Rates (per 100,000 people)                                                                 19           48               81              55                  ..          100    See Note 1

Diphtheria (Total Cases)                                                                    33              6           14                0                0                 0 ..     

Measles (Total Cases)                                                                     30949         49227         36740          13282            14782         18363 ..          

Polio (Total Cases)                                                                         23             43           25               10              10                  0 ..     

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 < >
                                                                      Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>, (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

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);

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

Measles (Total Cases)                                                                               33868           28473             111492            77072           3322         21002               11304

Polio (Total Cases)                                                                                    351             455               368             1528             12                0               0

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 < >
                                                                            Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>, (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

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);

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

Measles (Total Cases)                                                                        134976           162106           161768           115682             12393       212183          168107

Polio (Total Cases)                                                                             569              816              959             1873               439          638              56

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 < >
                                                                       Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>, (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

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);

TB Notification Rates (per 100,000 people)                                                                36             17            68               91             ..             89    See Note 1

Diphtheria (Total Cases)                                                                    399          291 ..                ..             ..             ..             ..    

Measles (Total Cases)                                                                     26567         29144                        5004                          5839            24789

Polio (Total Cases)                                                                         144          138             87              3               1             0               0

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 < >
                                                                     Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>, (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);

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

Measles (Total Cases)                                                                                                19193           17884            10624             8845            1459              1166

Polio (Total Cases)                                                                                     612             112               72                5               0               0                0

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 < >
                                                                             Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>, (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

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);

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

Measles (Total Cases)                                                                        ..                    23 650           22 290           13 728             8529           1483               529

Polio (Total Cases)                                                                          ..                         32               69                0               1                0               0

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 < >
                                                                            Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>, (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva.
           APPENDIX C


             1965 - 2001

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)
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
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 <>
Vitamin A ( # of countries providing one dose to over 70% of < 5, of 16)                                                                                          1.0          2.0 ..                UNICEF at <>
% 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 < >
                                                                            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 <>
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

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);
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
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 < >
                                                                      Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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);
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
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 < >
                                                                      Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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);
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
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 < >
                                                                      Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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);
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
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 < >
                                                                      Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (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
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);
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
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 < >
                                                                      Note 2: (1985 - 1995) WHO Weekly Epidemiological Record, No. 32, 13th Aug. 1999 <>; (1965 - 1980) World Health Statistics Annual, 1983. WHO, Geneva.

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