Health InterNetwork: India

Excerpts from the Executive Summary follow:

The World Health Organization Health InterNetwork India pilot project is one component of the Health InterNetwork (HIN) initiative. HIN is one of four projects announced by the Secretary-General of the United Nations, designed to meet the challenging goals laid out in the Millennium Action Plan. Specifically, the HIN initiative aims to reduce the digital divide and use the Internet to improve public health by enhancing the flow of reliable, timely, and relevant health information. This project review and evaluation report focuses on one pilot project of the overall initiative, the Health InterNetwork India (HIN India)...

The focus of HIN India is to develop and test methods to strengthen the health system activities of policy making, health service provision, and health research by using information and communication technologies (ICTs). HIN India pilot project efforts are concentrated in the states of Orissa and Karnataka.

Initially, ambitious and broad goals - in hindsight somewhat impractical - were put forth as general guides for pilot project planning. Initial documents call for more specific goals to be developed, but the starting point included targets to increase access to information by 75 percent, and use of information by 50 percent.

The difficulty of assessing those targets (for example, due to the lack of accurate baselines) and the reality of implementing the project "on-the-ground" decrease their utility and relevance for this assessment...

Key products and successes

• Connectivity
  
  • Computer hardware and Internet connections were installed in seven primary health centers (PHCs) and three community health centers in Orissa and Karnataka where computers or connectivity were not available before.
  • Computer hardware, Internet connections, and networking capabilities (such as a local area network) were installed or upgraded in four research institutions and two medical colleges.
  • Applications such as e-fax, e-consultations, and handheld computers provided immediate tangible benefits to participants and highlighted the potential of information and communication technologies to enhance the flow of health information in public health services.
• Content
  
  • Substantially improved access to online peer-reviewed biomedical journals at marginal extra cost to libraries was achieved by digitizing key national journals and through the formation of the first consortium of medical libraries in India.
  • HIN India has led the development of a web portal, the National Health Information Collaboration. In the pilot project the content focused on tuberculosis and tobacco control. Content areas include scientific publications, policy documents, research reports, and digitized post-graduate theses.
• Capacity building
  
  • A suite of tools for needs assessment, process monitoring, and evaluation have been developed and tested. These tools are available for use in expanded research activities in the area of ICT and health.
  • Over 300 project participants have received training in basic computer and Internet skills - including health care providers, researchers, students and policy-makers. A subset of participants has received more targeted training in the use of specific public health applications, such as e-consulting and geographic information systems.
  • Health InterNetwork Clubs were established at medical colleges in Orissa to meet running expenses and future needs of several connectivity installations.These clubs operate on subscription fees to meet Internet access, training and maintenance costs.
  • Local partnerships for ICT in health have been formed, in particular at the state level, in an attempt to leverage resources and share learning.
  • To the extent possible and in keeping with overall HIN principles, products were developed to be open-source and in the public domain, to facilitate their access and use.

Key lessons

• Connectivity
  
  • A basic requirement for such a project is the installation and testing of computers and connectivity. Ensuring electricity supply, establishing telephone and Internet connectivity, installing hardware and securing requisite clearances at each stage took over a year at some sites, although only six months were allocated to these activities in the initial plan. Planners and funders should recognize that those steps must occur in advance of significant utilisation and opportunities to rigorously study impacts.
• Content
  
  • As the development of online health resources serving local needs is continued in India and undertaken in other countries, the umbrella Health InterNetwork initiative can assume a central role in ensuring compatibility of database design and coordination of content standards. Otherwise, the great potential for convergence and learning across contexts may be lost and the likelihood of duplication of effort will increase.
• Capacity building
  
  • Early adopters, project champions, and opinion leaders must be appropriately recognized and aided over a time period sufficient to foster an environment for learning and adoption of the technology. Adoption is not a given with equipment installation: to ensure that technology meets user needs, training and support must go beyond the basics of computer and Internet use to targeted skill building.
  • HIN India activities that had strong local leaders and broad local participation, rather than activities where ownership remains vested in WHO personnel, are those that have had the most success. An example is the consortium for journal sharing, where the Rajiv Gandhi University of Health Sciences Karnataka has taken a strong lead.
  • External support or other means of revenue generation are needed for technology updates, specialized training, and further integration of ICTs into the health system. The HIN Clubs, by enhancing local control and participation and creating a revenue stream, provide a model for ensuring that the installations are used, maintained and upgraded. However, HIN Club revenues do not fully cover the training costs.
• Process
  
  • Needs assessments must be conducted in advance and results incorporated in project design and implementation. Projects should be designed and implemented to meet the needs of "on-the-ground" users as well as decision-makers. Project development strategies should take into account the varying levels of ICT-related skills and knowledge among those participating in the planning exercise, and incorporate awareness building and brainstorming as part of the process.
  • Where capacity exists, active local involvement at every stage from planning to implementation and assessment is required to create and sustain local participation and ownership of project activities. The goal of HIN is that participating individuals and institutions ultimately assume responsibility and ownership, rather than considering the effort a "WHO project".
  • WHO and participating international organizations can play a critically important and ongoing supporting role in developing capacity where needed, supplying funding and technical support, facilitating learning across contexts, working to maintain compatibility, and scaling-up of project components.
  • The project highlighted the need for better coordination of ICT and health strategies across national and international projects and agencies; each of which invariably have their own information and communication technology components. Better coordination will allow leveraging of resources and minimize confusion for the health personnel who have to try and accommodate the different directives.
• Partnerships
  
  • Expected international partnerships with WebMd and UNDP did not develop as planned, causing an unexpected shift in the scope and strategy of pilot project activities. Should similar opportunities arise in the future, HIN should explore them with caution, embarking on collaborative projects only if there is tangible commitment from partners at all levels.
  • The HIN India plan anticipated that a local task force would actively guide the project. While that structure did not fully materialize in the first 18 months, the concept is sound and should be pursued in the future.
  • The pursuit of international, national, state, and local partnerships - an important HIN goal - should be balanced with project objectives, especially during a short-term demonstration or pilot project.

Click here for the full report [PDF]

Source:

Summary on Networking and Information Technology Observatory Issues For Developing Countries (UNDP) site, forwarded to the bytesforall_readers list server on November 9 2003 (click here to access the archives).