Cheung-Moon, C. Behavioural Change Communication and Advocacy and Information and Communication Technology as Tools for Population and Development and Poverty Reduction: Information and Communication Technology. Paper presented at the Economic and Social Commission for Asia and the Pacific (ESCAP) and United Nations Population Fund Fifth Asian and Pacific Population Conference, Bangkok (December 1114, 2002).
This report focuses on the barriers in ESCAP countries to ICT adoption. The author discusses lack of financial and human resources, lack of affordability, lack of awareness of the benefits of ICT, lack of ability to use ICT proficiently, and lack of contents suitable for local residents. To accelerate the construction of the necessary ICT infrastructure, he suggests improved policies and regulations and expansion of markets. To build the capacity of human resources for using ICT, projects should be developed for improving literacy and encouraging an information-seeking attitude. To handle affordability issues, special programs are recommended to subsidize the cost of purchasing telecommunication devices and the use of services. Awareness of the benefits of ICT, ability to use ICT, and the development of contents suitable for local residents are needed to ensure the expansion of ICT usage.

Geyoushi, B.E. et al. Pathways to evidence-based reproductive healthcare in developing countries. BJOG: An International Journal of Obstetrics and Gynaecology 110(5):500507 (May 2003).
The authors surveyed forty-one doctors working in obstetrics, gynecology, general practice, and family planning services about their access to and application of reproductive health-related medical knowledge. The survey was conducted in Yemen and Pune, India, and aimed to describe the processes and constraints on the flow of medical information. The doctors felt a need to update their knowledge but were constrained by the expenses of technology, lack of awareness of conferences, gender issues, deficient libraries, lack of access to Internet or unfamiliarity with the technology, unfamiliar language, and the diversity of foreign medical training. The expense of books, journal subscriptions, and Internet access was identified as major constraint. The authors conclude that clinical teachers are the group with the strongest incentive to obtain and use new knowledge.

Kibaalya, S. How are Ugandan women's organizations using ICT's for empowerment? AWID News 6(1):1415 (Winter 2002). Available at: www.awid.org/publications/news/winter2002.pdf.
This article discusses how women's organizations in Kampala, Uganda, use ICTs such as email or the Internet as part of their daily work. Although access in the city was greater than in rural areas, it was still a major obstacle; most of the survey respondents used email in Internet cafs or other public places. Field workers were the least likely to have access to email or the Internet within organizations. Overall, it is noted that the use of these technologies has had an important impact on organizations' ability to meet their objectives and serve their stakeholder communities. Nevertheless, the long-term sustainable use of these ICTs is affected by problems associated with the ICT infrastructure and the high expense of using these media. The author recommends that the government should address these issues for women's organizations in Uganda to be sustainable.

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Technology Maintenance and Support

Plaisance, R. Taking eRiding global: helping NGOs around the world access and use technology. Techsoup (2003). Available at: www.techsoup.org/articlepage.cfm?ArticleId=461&cg=searchterms&sg=eriders.
This article describes the goals of global eRider organizations that are based on the circuit-rider model of providing technical support to a cluster of local and international NGO organizations worldwide. It discusses efforts of various organizations to develop global tools and standards that are still appropriate in specific developing-country settings. The fledgling international eRider movement is addressing the problems those working in the developing world must routinely work with. Viruses, power fluctuations and outages, and lack of proper data backup are common. Internet connectivity can be a continuous and costly challenge. Hardware and software purchases strain available resources, leading to the use of inferior or improvised equipment and unlicensed software. Reliable information is often not available in local languages. In some instances, regulatory environments at the national level limit or even repress the use of email and the Internet. The goal for international eRiding is a network of individuals and groups offering high-quality, reliable, and affordable technology support to local and international NGO communities worldwide.

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Relevant Content: Gender, Language, and Culture

Dagron, A.G. Take Five: A Handful of Essentials for ICTs in Development. In: Girard, B., ed. The One to WatchRadio, New ICTs, and Interactivity. Rome: Food and Agriculture Organization of the United Nations (2003). Available at: http://comunica.org/1-2-watch/.
Dagron maintains that the most important and interesting issue relating to the rapid expansion of new ICTs in developing countries is not the Internet itself, but the potential of its interaction with other electronic media, such as radio and eventually television. Using the model of community radio, the author has developed five non-negotiable criteria for a well-designed program of community-level ICT projects. These are community ownership, local content, appropriate technology, language and culture pertinence, and convergence and networking that build on existing systems. Fifty percent of the content on the Internet is in English, and many local languages and cultures are underrepresented or missing.

Hafkin, N.J. and Taggart, N. Gender, Information Technology and Developing Countries: An Analytical Study. Washington, DC : Office of Women and Development, Bureau for Global Programs, USAID (June 2001). Available at: http://learnlink.aed.org/Publications/Gender_Book/executive_summary/1gender_foreword.htm.
This publication examines the social, political, and economic issues related to the use of information technology by women in developing countries. Currently, most women users in almost all developing countries are part of a small urban-educated elite, and they use information technology at work to produce or communicate information. Womens groups and NGOs were among the early adapters of the technology, and email advocacy is the major application. The report describes the obstacles for women to ICT access: literacy, language, time, cost, geography, skills, and cultural norms. The significant potential ICT offers for womens political economic empowerment is also discussed. Extensive links to online resources and endnotes allow deeper exploration of this topic.

Pakenham-Walsh, N. Strengthening Local Capacities to Create and Adapt Healthcare Information. Report on a meeting at the British Medical Association, London (January 2002). Available at: www.inasp.info/health/workshop21.html.
This report was prepared as part of an overall study of the development of local content. It quotes many developing-country heath workers who commented on an email discussion group, HIF-net at WHO, on ICT and how it is used. The lessons learned in this report are based on more than 30 cases from the health care sector. They include:

Adequate Capacity

Country ICT Capacity Assessment Tools

Bridges. Comparison of E-Readiness Assessment Models. (March 14, 2001). Available at: www.bridges.org/ereadiness/report.html.
Bridges, an international NGO, has developed an analysis of e-readiness assessment tools. The report analyzes each tool to determine: What is the goal of the tool? What is measured? What standard is used, or how is e-readiness defined? How is the assessment carried out? What result is produced? Are there existing reports that have used this assessment tool? Who authored the tool and where can more information about the tool be found?

Kirkman, G. (ed.). Global Information Technology Report 20012002: Readiness for the Networked World. New York: Oxford University Press (2002). Available at: www.cid.harvard.edu/cr/gitrr_030202.html.
This publication developed by the Center for International Development at Harvard University discusses fundamental issues about the global use of ICT and also ranks 75 countries on their capacity to leverage ICT from an economic perspective. An updated print edition for 20022003 is available from Oxford University Press at www.oup-usa.org/.

Skinner, H. et al. Quality of Internet access: barrier behind Internet use statistics. Social Science Medicine 57(5):875880 (September 2003).
The goal of this study was to evaluate young people's perspectives on using the Internet to obtain health information and resources (e-health). Using an inductive qualitative research design, the researchers conducted 27 focus groups in Ontario, Canada. A major finding was how the quality of Internet access influenced young peoples ability to obtain health information and resources. Quality of Internet access was affected by four key factors: privacy, gate-keeping, timeliness, and functionality. Privacy was particularly relevant to these young people in getting access to sensitive health information (such as sexual activities). Variations in access quality also affected participation in mutual support, fostering social networks, and getting specific health questions answered. These results serve as a warning about using Internet penetration statistics alone as a measure of access.

Strehier, A. Mapping Public Health Education Capacity in and for Africa. Pretoria, South Africa: AfriHealth (2002). Available at: www.up.ac.za/academic/medicine/shsph/AfriHealth/reports/Afrihealth_nov2002.PDF.
This is a comprehensive review and audit of African ICT infrastructure, distance education in each African country, the focus of various donors involved in public health education, and reports of observations at various African libraries and research centers. The report concludes with specific recommendations related to infrastructure development, the development and delivery of technology-supported distance education, access to technology for prospective students, and human capacity development.

World Bank. ICT at a Glance Tables. www.worldbank.org/data/countrydata/ictglance.htm. Accessed January 2004.
This online database provides key data on ICT infrastructure and access; access to personal computers and the Internet; ICT spending in per capita and absolute terms and as a percentage of GDP; and data on the effect of the Internet business and government.

Human Capacity

Braa, J. et.al. A study of the actual and potential usage of information and communication technology at district and provincial levels in Mozambique with a focus on the health sector. Electronic Journal of Information Systems in Developing Countries 5(2):129 (2001). Available at: www.is.cityu.edu.hk/research/ejisdc/vol5/v5r2.pdf.
This study focuses on the use of ICTs in the health sector in Mozambique as part of a larger initiative to decentralize health care. Computer users and health workers in three provinces were surveyed about computer access and their capacity to effectively use computers. The study shows that computers and the Internet are rapidly spreading to the provincial capitals and major districts, and that the associated maintenance and learning are primarily happening within informal networks of computer users. It identifies the lack of ICT skills and education as a major problem. The authors point out that the development of ICT capacity and information systems needs to be an integrated effort across sectors. A district health system can not be developed in a void. They strongly recommend an extensive ICT training program.

Gladwin, J. et al. Rejection of an innovation: health information management training materials in east Africa. Health Policy Planning 17(4):354361 (December 2002).
This paper is an analysis of the process of introducing a management information system (MIS) to primary health care managers. The authors conducted an investigation of the introduction of new information management strategies intended to promote an informational approach to management at the operational health service level in a low-income country. Using participant observation, interviews, examination of official documents, field notes, and diaries, they observed that although the MIS developers envisaged a technical innovation needing implementation, potential users saw the situation as one of organizational change. The MIS was an external innovation, not requested by the countrys health service providers, and its introduction was problematic. The research indicates that change agents should assess the situation before introducing technology that requires new skills and may not fit with existing systems.

Ogunyade, T.O. and Oyibo, W.A. Use of CD-ROM MEDLINE by medical students of the College of Medicine, University of Lagos, Nigeria. Journal of Medical Internet Research 5(1):e7 (2003) Available at: www.jmir.org/2003/1/e7.
As a first step toward setting up a system for online PubMed searching, the use of Medline on CD-ROM by medical students was evaluated. The study found that 57 percent were aware of it, and 24 percent had used it. Lack of awareness and the cost of undertaking a search were identified as important factors that discourage use. Other factors for poor use were lack of networked computers, lack of mandatory assignments that included Medline searches, financial constraints of the university, and infrequent orientations. Recommendations included increasing the number of computers and more frequent training by librarians on the use of this database.

United Nations Development Program (UNDP) and UNIFEM Central and Eastern Europe Office. Bridging the Gender Digital Divide: A Report on Gender and ICT in Central and Eastern Europe and the Commonwealth of Independent States. Bratislava, Slovak Republic: UNDP; 2004. Available at: http://web.undp.sk/uploads/Gender%20and%20ICT%20reg_rep_eng.pdf.
This report represents a joint effort by UNDP and UNIFEM to deepen knowledge about gender dimensions within ICT for Development (ICTD) and to strengthen integration of gender within the work of UNDP and others working to promote ICTD in the region. It highlights the need for increased action to address imbalances between women's and men's access to and participation in ICTs in the CEE/CIS region. It also emphasizes the powerful potential of ICTs as a vehicle for advancing gender equality. The report compiles a substantial inventory of gender equality projects and resources for the information society in the CEE/CIS region, including references to other resources, relevant websites, and contacts. Equally important, regional specificities are addressed. Similarities and differences for the region concerning gender—both the historic and current agenda—are discussed in the context of ICTD approaches.

Warschauer, M. Demystifying the Digital Divide. Scientific American.com 4245. (August 2003). Available at: www.sciam.com/article.cfm?articleID=000112F0-AB93-1F09-97AE80A84189EEDF&catID=2.
The author maintains that the term digital divide fails to do justice to the complex reality of peoples use of and access to digital information. The concept of a divide may lead to attempts to bridge that divide simply by providing technology. The author reports on several low-resource community technology projects that illustrate the fallacy of addressing complex social problems with a technological fix. He recommends a community informatics approach to program and policy planning that is based on acknowledging that people access digital information part of social networks of co-workers, friends, or relatives to achieve social, economic, political, or social goals.

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Measuring results

Association for Progressive Communications Womens Networking Support Program (APC WNSP). Gender assessment methodology for Internet and ICTs (GEM) [website]. www.apcwomen.org/gem/learning4change/. Accessed January 2004.
GEM is a tool for integrating gender analysis into evaluations of initiatives that use the Internet and ICTs for social change. A series of 10 worksheets is being developed and tested by APC WNSP. For more information, please contact chat@apcwomen.org.

McConnell, S. Connecting with the Unconnected: Proposing an Evaluation of the Impacts of the Internet on Unconnected Rural Stakeholders. Guelph, Canada: University School of Rural Planning and Development, University of Guelph. Available at: www.devmedia.org/documents/4(7)%20Evaluation%20(Scott%20McConnel).htm.
The author has reviewed the literature on impact of ICTs and information on rural communities and points out that most evaluations discuss results only in terms of those stakeholders who have ICT connectivity; no mention is made of rural stakeholders without ICT access. The author has begun the process of developing indicators that measure how rural communities without Internet connectivity are able to benefit from organizations that do have connectivity. The indicators measure organizational efficiency (advantages of using the Internet over previously used means of communication such as fax, telephone, post, and telex), effectiveness (whether men and women have equal access to the technology), and impact (whether Internet projects are used by nearby communities and organizations). The author recommends this proposed framework be field tested, improved, and used to understand how the unconnected benefit from ICT.

Mechael, P.N. Integrating Information and Communication Technology to Improve Global Health: A Conceptual Framework. London: London School of Tropical Hygiene and Health (2002). Available at: www.ukglobalhealth.org/

In this publication, the author approaches the evaluation of health impact by investigating the ICT life cycle from development to its use in society, and the various points in the process at which health impacts are yielded. Relationships between corporate social responsibility, health information, behavior, and ICT use are examined. The author reviewed Digital Opportunity Initiative (DOI) and Pan American Health Organization (PAHO) mechanisms for evaluating health impact of ICT. The DOI recommends the correlation of health applications of ICT with pre-existing, population-based health indicators, such as maternal mortality, disease incidence, food security, and nutrition. PAHOs approach is to measure health outcomes by creating a series of ICT and health indicators that evaluate ICT integration in relation to quality of health services, access to medical information, and personnel management.

Robert Wood Johnson Foundation. Health e-Technologies Initative [website]. www.hetinitiative.org/. Accessed January 13, 2004.
The new Health e-Technologies Initiative of the Robert Wood Johnson Foundation supports U.S. research that evaluates the effectiveness of interactive eHealth applications (such as the Internet, interactive TV and voice response systems, kiosks, personal digital assistants, CD-ROMs, and DVDs) for health behavior change and chronic disease management. The program of funded research will advance discovery of scientific knowledge about these applications to improve processes and outcomes of care for culturally diverse groups of patients/consumers and support provider adherence to evidence-based care.

United Nations Development Program (UNDP). Promoting ICT for Human Development in Asia 2004: Realising the Millennium Development Goals—Summary. New Delhi, India: Elsevier; 2004. Available at: http://hdrc.undp.org.in/APRI/Publication/PBriefings/summary-web%2008-01-2004.pdf.
This is a summary of research findings from UNDP’s pioneered Regional Human Development Report, Promoting ICT for Human Development in Asia 2004: Realising the Millennium Development Goals. An attempt has been made to go beyond the hype surrounding the potential and promise of ICT for developing countries. The research across nine Asian countries—China, India, Indonesia, Malaysia, Mongolia, Pakistan, Sri Lanka, Thailand, and Viet Nam—systematically explores the potential of ICT applications toward achieving human development goals. It uses the United Nation’s Millennium Development Goals as a benchmark to assess the extent to which this is possibl

Vincent, R. Beyond circles in square boxes: Lessons learned from health communication impact evaluations. London: Exchange (June 6, 2001). Available at: www.healthcomms.org/pdf/iispaper.pdf.
The author reviews evaluations of the work that Healthlink Worldwide (formerly AHRTAG) does with partner organizations in different developing-country settings who are engaged in health communication activities and the provision of health information. As a result of evaluations, their newsletters AIDS Action, Health Action, and Child Health Dialogue have been superseded by a range of regionally produced newsletters. Additionally, the focus of Healthlink Worldwide has shifted to capacity building of partner organizations and managing Source, a merging of Healthlinks Resource Centre with the Institute of Child Health. The author also sets these examples in the wider context of issues and trends in monitoring and evaluation practice and makes a case for learning-based evaluations.