Please note: This archive was last updated in 2005.

RHO archives : Topics : Information and Communication Tech.

Annotated Bibliography

This is page 1 of the Information and Communication Technologies Annotated Bibliography. This page contains:

To access more bibliographic entries, visit page 2, or return to the complete list of topics covered in the Information and Communication Technologies Annotated Bibliography. Be sure to use the Glossary if you are unfamiliar with any of the terms on this page.

Please note that PDF files require Adobe Acrobat Reader software, which can be downloaded for free at www.adobe.com/products/acrobat/readstep.html.

General and best practices

General

Ajuwon GA. Computer and Internet use by first year clinical and nursing students in a Nigerian teaching hospital. BMC Medical Informatics and Decision Making. 2003;3(1). Available at: www.biomedcentral.com/1472-6947/3/10.
This article reports the results of a study of 183 Nigerian medical and nursing students’ use of the Internet to obtain medical information. It finds that over half (58%) of medical students are computer literate, however most (76%) of nursing students are not. About two-thirds have used the Internet before (a third never have) mostly for email. The article concludes that clinical and nursing students in Nigeria have not fully utilized the opportunity to obtain up-to-date medical information via computers and the Internet and that increased efforts to improve students’ access to computers and the Internet are needed.

Curtain, R. Information and Communication Technologies and Development: Help or Hindrance? Melbourne, Australia: Curtain Consulting (2003). Available at: www.developmentgateway.com.au/pdf/ict/CurtainICT4Development040903.pdf.
AusAid, the Australian development organization, commissioned this global overview of ICTs and emerging trends in their application and relevance for developing countries. The report emphasizes the continuing importance of radio, television, and newspapers, and highlights the strong association between a countrys per capita income and the use of computer-based technologies. This association suggests that countries with low per capita income have limited capacity to adopt advanced forms of ICT. Prior assessment of a countrys capacity to use either new or effective combinations of old and new technologies is an important part of program planning in development. A review of barriers to adoption of ICT lists lack of equipment, poor infrastructure, and lack of required skills, as well political and cultural realities. The author reviews good practice in program planning with a ten-point checklist. The report concludes with guidelines to integrate ICT into mainstream development projects.

Digital Opportunity Task Force (DOT Force). Health, HIV/AIDS and Information and Communication Technologies: a Needs Assessment. DOT Force (May 2002). (Report available online at www.dotforce.org/teams/health_hiv-aids_ict_report.doc. Executive summary available online at www.dotforce.org/reports/documents/70/ICT_e.pdf.
The Digital Opportunity Task Force (DOT Force), a collaboration between the United Nations Development Program (UNDP), Accenture, and the Markle Foundation, was established to assess and document the mechanisms by which information and communication technologies can be used to leverage social and economic objectives in poor countries. The ICT for Health Dot Force team conducted a needs assessment by email survey to approximately 120 participants representative of projects and organizations involved in health, especially HIV/AIDS work. The survey findings were supplemented by Internet and literature searches and telephone follow-up.

The major findings of this needs assessment are:

  • Creation and dissemination of preventive public health information is the most critical element in educating the public and specific target groups toward understanding this disease and the preventive measures and behavioral changes that can save lives. Community-level application of ICT to support informational initiatives is proving to be the most effective approach. This approach is reliant on more common broadcast technologies, such as radio, television, and video, and other ICTs, such as CD-ROMs and printed material.
  • Application of ICT to improving access to information, education, and communication for health workers, in particular those in community and rural settings, holds one of the highest benefits for ICT, for example CD-ROMs, Internet, and distance-learning technologies.
  • Population health (epidemiology) and research are critical components in the long-term management strategy for HIV/AIDS and other diseases, and offer significant opportunity for exploiting ICT in developing this evidence-based decision-making capability.

The DOT Force also recommends building on existing systems, involving women in the full project life cycle, planning for sustainability, using local capacity and community-led initiatives, and carefully defining the information needs of target groups.

Feeks W, Long G. The Digital Pulse: The Current and Future Applications of Information and Communication Technologies for Developmental Health Priorities. Victoria, Canada: Communication Initiative; 2003. Available at: www.comminit.com/pdf/TheDigitalPulse.pdf.
An examination 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 programs. The report includes analysis papers reviewing critical thinking to date on ICTs and development, as well as a summary of 60 case studies highlighting many program experiences. The analytical papers include the perspectives of supporters, detractors, and “middle roaders” about the role of ICTs in development. The summary program descriptions attempt to organize and classify them according to the nature of the program intervention: Database and Resource Centres; Social Development, Education, and Advocacy; Networking and Dialogue; and Telemedicine and High Medical Tools. Finally, some data are presented 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 programs.

Huyer, S. and Sikoska, T. Overcoming the Gender Digital Divide: Understanding ICTs and their Potential for the Empowerment of Women. INSTRAW Research Paper Series No. 1 (April 2003). Available at: www.un-instraw.org/docs/gender_and_ict/Synthesis_Paper.pdf.
This paper is a synthesis of discussions and background papers of the INSTRAW Virtual Seminar Series on Gender and ICT held JuneSeptember 2002.

Primo Braga, C.A. et al. The Future of Information and Communication Technologies for Development. Presentation at the ICT Development Forum, Petersberg, Germany (May 21, 2003). Available at: www.devforum.org/BackgroundPapers/Future_ICT.pdf.
This paper examines technology trends and the bottlenecks that limit developing countries capacity to participate in the information revolution. Advances in digital computing and communication networks, particularly the emergence of the Internet, have contributed to a growing connectivity and toward a global information society. The authors recommend that governments and donor agencies take the lead in fostering the specific regulatory, technological, and financial improvements needed to bridge the digital divide. They discuss the pace of the evolution of software, low digital literacy, the regulatory environment, the role of institutional constraints, and the limited capacity, both individual and societal, to absorb new technologies.

Paua, F. Global diffusion of ICT: A progress report. In: Dutta S, Lanvin B, Puau F. Global Information Technology Report, 2003-2004: Towards an Equitable Information Society. New York: Oxford University Press; 2003. Available at: www.weforum.org/site/homepublic.nsf/Content/Global+Competitiveness+ Programme%5CGlobal+Information+Technology+Report.
This report is a special project of the Global Competitiveness Programme and a collaboration between the World Economic Forum, the World Bank, and INSEAD, France. The report traces global, regional, and local trends in access to information and communication technologies (ICTs). It is an analysis of information from the International Telecommunication Union (ITU); data is for 1999-2002 for 200 of the world's economies covering 99.98 percent of the world's population. Seven indicators are included: the number of Internet users (estimated), personal computers, main telephone lines in operation, cellular mobile telephone subscribers, television receivers, cable television subscribers, and home satellite antennas.

Sharma U. Women Empowerment Through Information Technology. New Delhi, India: Authorspress; 2003. Contact: [email protected] to order this book.
This book attempts to demonstrate that ICT technologies are powerful tools for women to use to overcome discrimination, achieve full equality and well-being, and participate in decisions that impact the quality of their lives and the future of their communities. It is written for policy-makers and development leaders to use as a reference tool to help mainstream gender issues in areas of technology development.

United Nations Development Program, Evaluation Office. Information communications technology for development. Essentials: Syntheses of Lessons Learned No. 5 (September 2001). Available at: www.undp.org/eo/documents/essentials_5.PDF.
This issue of Essentials provides practical, evidence-based insights into the use of ICT. The evidence and case study research are drawn from multiple development sectors and presented as a selection of generic challenges and lessons learned to meet these challenges. For example, one response to the challenge of access is to use new technologies like cellular phone networks that can circumvent the problems associated with hard-wired telecommunication structures. The authors also recommend that development specialists lead by example, aiming to understand and leverage ICTs within their own organizations. Applications for development organizations range from internal management functions to program delivery, knowledge sharing, and coordination with partners and stakeholders. The authors also encourage development organizations to take on the complex and necessary evaluation of ICT programs, acknowledging that that it is a complicated and long-term task. Evaluation should be approached as an adaptable and iterative learning process that is used to understand the changes that ICT use brings, to improve on past experiences, and to influence future decision-making and policy formation.

World Summit on the Information Society (WSIS). Plan of Action. WSIS-03/GENEVA/DOC/5-E. Geneva: WSIS (December 12, 2003). Available in Arabic, Chinese, English, French, Russian, and Spanish at: www.itu.int/wsis/geneva/docs.html.
The vision and guiding principles from the first phase of the World Summit on the Information Society (WSIS) are translated into goals and activities in this document. The Plan of Action outlines activities and approaches to advance the achievement of internationally agreed development goals by promoting the use of ICTs to help countries overcome the digital divide. The plan encourages partnerships and acknowledges the need for appropriate action for gender equality and attention to youth and vulnerable groups and regions, where appropriate. It specifically mentions using ICTs to connect health centers and hospitals, as well as scientific and research centers. It also suggests that ICTS should be used to increase worldwide access to radio and television. This document lists goals and activities to increase access, build capacity, encourage security, and develop an enabling policy environment for ICTs in all sectors. Activities that foster respect for cultural and linguistic diversity and local content are also discussed. A Declaration of Principles was drafted at the same meeting and is also available on the WSIS website (www.itu.int/wsis/documents/doc_single-en-1161.asp).

Top of page

Best Practices

American International Health Alliance (AIHA). Learning Resource Center (LRC) Project Best Practices and Lessons Learned: A Guide to Improving Healthcare Through Information and Communication Technology. New York: AIHA (Spring 2003). Available in print from AIHA, 1212 New York Avenue, NW, Suite 750, Washington, DC 20005, [email protected], and available online at: www.aiha.com/index.jsp?sid=1&id=8568&pid=5186.
This practical guide describes the core activities and strategies to establish a successful learning resource center that will improve the access of health professionals to health care information. These best practices are based on AIHA experience establishing more than 130 centers in a variety of organizations. The centers include two key capacity-building components: a dedicated computer workstation with Internet access and a dedicated information coordinator to provide essential leadership. The guide briefly discusses providing access to resources; training strategies; adaptation to local needs; promoting evidence-based practice and integrating it into the existing institutional processes; translation, partnering with community organizations; sustainability issues; and the development and use of telemedicine, local networks, and distance learning.

Chetley, A. Improving health, fighting poverty: the role of information and communication technology (ICT). Findings 1:14 (July 1, 2001). Available at: www.healthcomms.org/pdf/findings1.pdf.
The Findings series aims to reflect experience, evidence, and analysis, and to generate dialogue. Drawing on reports from many sectors, the first issue of Findings is an overview of the use of ICTs in health. The author reviews research on and experience with five key issues: (1) communication, not technology, should be the central concern; (2) strong health systems and other basic services are essential for effective use of ICTs; (3) increased capacity to access, organize, repackage, and use information effectively is a major priority; (4) local ownership, participation, and content improve the relevance of ICT activities; and (5) ICTs should complement other communication work and be integrated into broader programs.

Hafkin, N.J. and Jorge, S. Get in and get in early: ensuring womens access to and participation in ICT projects. Women in Action No.2. (2002). Available at: www.isiswomen.org/pub/wia/wia202/getin.htm.
In a review of ICT-based development projects, the authors find that the majority of projects do not include gender as an important part of project design. They maintain that the incorporation of gender concerns in project development results in more successful project outcomes. They suggest that donors and project planners incorporate gender into project analysis and design from the beginning and that they conduct a gender analysis to identify sociocultural factors that will affect the success of the project rather that assuming projects are gender-neutral. They also encourage program planners to be proactive where technical issues discourage womens participation.

Mchombu, K. Sharing Knowledge Handbook. Ottawa, Canada: Oxfam Horn of Africa Capacity Building Program (2003). Available at: www.oxfam.ca/publications/SharingKnowledge.htm.
This handbook for villages and rural communities discusses the role of information in community development and describes a people-centered development model, with a four-step process for spreading new information. The author examines different types of information services and stresses the importance of an ongoing dialogue with the community. To ensure sustainability, the author recommends developing a steering committee, establishing goals, training volunteers, and fundraising. The annex on library unit operations has guidelines for the selection, ordering, and processing of materials, with advice on classification, cataloguing, and handling of audiovisual materials.

Morris, S. Getting Started in Electronic Publishing. Oxford, United Kingdom: INASP (2002). Available online in English, French, Spanish, and Russian at www.inasp.info/psi/ejp/morris.html. .
This guide thoroughly reviews the advantages and disadvantages of publishing an online journal. Electronic publishing is often considered to have four great advantages over print: international reach, speed, additional capabilities, and lower cost. The author also points out the downside of each of these advantages. Of all the features which are possible with electronic journals, linkingthe ability to go directly from a citation in one article to the article to which it refersis the one most valued by authors and readers. Another benefit of an electronic journal is that it is much easier for readers to search for articles.

Shyama K, Dzenowagis J, Pleasant A, et al. Digital bridges need concrete foundations: lessons learned from the Health InterNetwork India. British Medical Journal. 2004;328:1193-1196.
This article summarizes the experiences and lessons learned from the WHO’s Health InterNetwork pilot project in India. It shows how national and international partnerships can use ICTs to strengthen public health systems, access relevant health information, bridge the digital divide, and identify challenges and lessons for the future.

See the Program Example from India for more details about this program.

Stratten, K. and Ainslie, R. Field Guide: Setting up a Hotline. Field Guide 001. Baltimore, Maryland: Johns Hopkins Bloomberg School of Public Health /Center for Communication Programs (March 2003). Can be ordered from [email protected].
Hotlines are a specialized telephone service for anonymous counseling, disseminating information, and referring callers to services and other resources. They have been used to counsel callers on crisis lines, provide HIV/AIDS counseling, and provide information and counseling on other reproductive health issues. This excellent guide discusses the essential components of a successful hotline: technologies, human resources, training needs, and information resources. It outlines considerations for needs assessment, donor relations, planning tools, and the hotline room. Sample worksheets are included for use statistics, sample job descriptions, and a training module for telephone-counseling skills.

Top of page

Benefits for reproductive health activities

Research

Eysenbach, G. and Wyatt, J. Using the Internet for surveys and health research. Journal of Medical Internet Research 4(2):e13 (2002). Available at: www.jmir.org/2002/2/e13/index.htm.
This tutorial reviews the use of the Internet in the research process. Although it is written for a developed-country audience, many of these observations apply to developing-country research. The research process includes identifying research issues, using databases for literature searches, using the Internet for surveys and clinical trials, pre-publishing, and publishing research results. Reviews of electronic discussion groups may help to identify health beliefs, common topics, motives, information, and emotional needs of patients, and point to areas where research is needed. A synopsis of important techniques and tips for implementing web-based surveys is given, and ethical issues involved in online research are discussed. Internet addresses for finding methods and protocols are provided. The Internet is also being used to assist in the identification of ongoing clinical trials. Finally, the Internet is used for two distinct types of electronic publication: publication of protocols or work-in-progress and publication of peer-reviewed reports in online journals.

Hewett, P.C. et al. The feasibility of computer-assisted survey interviewing in Africa: experience from two rural districts in Kenya. Policy Research Division Working Paper No. 168. New York: Population Council (2003). Available at: www.popcouncil.org/pdfs/wp/168.pdf.
As part of ongoing research on adolescent sexual behavior, audio-CASI technology was employed to obtain information about sensitive issues, including sexual initiation, risky sexual behavior, coerced sex, and drug and alcohol use. This paper explores the technical aspects of the research and evaluates the feasibility and experience of implementing a computer-assisted, household-level survey in a developing-country setting. It also includes a literature review. The audio-CASI software was programmed using Microsoft Visual Basic version 6.0 and Access 2000. The startup software and hardware cost was about US$2,000 per interviewer at the initiation of the project in February 2000. At the time of the fieldwork, alternative technologies, such as handheld computers, did not offer audio playback and had limited hard-drive capacity. In both settings, the computer remained closed and in its carrying case during the interview. The respondent used a set of audio headphones to listen to the questions and the response options. The adolescent answered the questions by using an external miniature keypad that included numbers and two color-coded keys, a red key for replaying the question and a blue key to enter a response. The respondents could select one of three languages for the interview: English, Kiswahili, or the local language. No significant problems were found with the computer hardware or software, and no computers were stolen during the fieldwork. The authors suggest that where segments of the community have doubts about project activities, the use of computers can exacerbate the suspicions of parents and adolescents. This effect seemed to influence the data-collection process, although its effect on data quality is harder to assess.

Rhodes, S.D. et al. Collecting behavioral data using the World Wide Web: considerations for researchers. Journal of Epidemiological and Community Health 57(1):6873 (January 2003). Abstract available at: http://jech.bmjjournals.com/cgi/content/abstract/57/1/68.
The authors identify and describe the advantages, challenges, and ethical considerations of web-based behavioral data collection. Their findings are based on their own experience and a literature review: the advantages of using the World Wide Web to collect behavioral data include rapid access to numerous potential respondents and previously hidden populations, respondent openness and full participation, opportunities for student research, and reduced research costs. Challenges identified include issues related to sampling, competition for the attention of respondents, and potential limitations resulting from the much-cited "digital divide," literacy, and disability. Ethical considerations include anonymity and privacy, providing and substantiating informed consent, and potential risks of malfeasance. The World Wide Web may be useful to survey some previously hidden population subgroups. Many of the criticisms of online data collection are common to other survey research methodologies.

Top of page

Networking and Advocacy

infoDev. Increasing Electronic Connectivity between Strategic Allies in the HIV/AIDS field in South East Asia. Washington, DC : World Bank (August 2001). Available at: www.infodev.org/projects/health/075unaids/075final.pdf.)
UNAIDS. infoDev: Facilitating Communications in Response to HIV/AIDS in South-East Asia. Best Practice Case Study. Geneva: UNAIDS (2001). Available at: www.unaids.org/publications/documents/care/general/JC494-infodev-E.pdf.
The infoDev program at the World Bank and UNAIDS jointly facilitated email connectivity between key institutions in seven South East Asian countries to disseminate HIV/AIDs information. Forty organizations in each country were strengthened through either private-sector support services or through employing an information officer who provided technical support and training. Other activities included negotiation with national authorities, provision of modems, and evaluation of the impact of increased connectivity. The Best Practice Case Study describes how networking developed in each country. The development of information-sharing has been on an intra-country basis rather that inter-country as was expected.

Among the lessons learned about technology introduction:

  • A dedicated staff member is essential to ensure technology uptake occurs in small organizations.
  • Government policy and laws must support use of electronic communications.
  • Training is more successful if tailored to the needs of the participants.
  • Cost and speed of data transmission and reliability of connection significantly impact which organizations can benefit from connection.

Kanyengo, C. Information and Communication Technologies (ICT) and Networking in Support of Health Services in Rural Zambia. Lusaka, Zambia: University of Zambia Medical Library. Available at: www.infodev.org/icsf/mwala/Healthnet.cbu.conference.doc.
The University of Zambia Medical Library provides users with several Internet applications: Health-L, Medguide website, Sister Library programs, and Communication for Better Health. The author describes the benefits and challenges associated with two of these programs. HealthNet is a program that has evolved from an intra-organizational electronic discussion list to a discussion list for rural health care workers and health professionals in developing countries supported by SATELLIFE technology. It was conceived as a means to combat the isolation of rural health care workers and is used to disseminate literature, improve supply ordering (as users can verify supplies through email), monitor epidemiological data, make referrals, and organize conferences and workshops. Health-L, an electronic discussion group, began as a discussion group on health issues in Zambia. It has evolved primarily in an information channel with a few active members supplementing the information the moderator posts. The author concludes that until every health care worker has access to a telephone and personal computer, there will be a need for health information resource centers to repackage information and disseminate it in printed form.

Pacific Institute for Womens Health (PIWH). Women Connect! The Power of Communication to Improve Womens Lives. Los Angeles: PIWH (2002). Available at: www.piwh.org/pdfs/wc2002.pdf.
The Women Connect! Initiative was carried out by the Pacific Institute for Women's Health in Los Angeles and the Annenberg Center for Communication at the University of California. The project was intended to bring about greater empowerment of women through the effective use of communication strategies in media and technology and through collaboration, communications training, and information-sharing. An additional aim was to help womens organizations strengthen their ability to achieve their own objectives, especially in the areas of womens health and well-being. Thirty womens NGOs were assisted in the use of traditional media (posters and brochures), mass media (newspapers, radio, magazines, and television), and computer-based technologies (email and the Internet). This evaluation report briefly describes the needs assessment to identify participants, the training program in media and computer-based technologies, the small grants program, technical assistance, distribution and repackaging of health materials, and efforts to ensure ongoing financial support.

The report recommends:

  • Working with fewer organizations to allow for more funding and individual attention.
  • Clustering groups for collaboration around shared interests.
  • Contracting local project facilitators to work more closely with participants as trainers.

It also notes that:

  • The small grants were very important to allow NGOs to implement workshop training and build capacity.
  • Staff turnover of approximately 35 percent at the NGO limited the benefits of the training workshops and technical support. The program could have been designed to provide and reinforce learning throughout the span of the project.
  • Finding local technical support was cost-effective, sometimes difficult, and worth the effort.
  • Umbrella organizations were not the ideal structure for extending project benefits to other organizations.

See the Program Example from Uganda, Zambia, and Zimbabwe for more details about this program.

Vyas, A. Connecting voices and expanding horizons. Development 45(4):5560 (December 1, 2002).
The author has described the genesis, developments, doubts, dilemmas, and challenges of moderating BOL, an electronic discussion list on gender issues in South Asia. She points out that email is one of the technologies most commonly and effectively used by women. It is considered a more horizontal than hierarchical communication format. She describes the contents, subscribers profiles, methodology, and technical issues relating to BOL. She observes that the culture of being an active information user is yet to develop; most users of the listserv are passive receivers. She suggests that e-discussion lists have immense potential for resource-sharing, networking, and advocacy activities, which needs to be fully explored and utilized by the womens groups and researchers in the South Asian region. Specifically, she suggests that technologically savvy womens groups create more awareness of the networking potentional of new technology; that more training be offered to womens groups to effectively use the technologies; that more organizations make more effort to document best practices; and that donors fund efforts to initiate, support, and sustain ICTs for womens information, networking, and empowerment.

World Bank and Development Gateway. ICT: A Powerful Tool to Combat Trafficking of Women. Presentations from the Gender and the Digital Divide Seminar Series #27, Washington, DC (March 20, 2003). Available at: www.worldbank.org/gender/digitaldivide/digitaldivide27.htm.
This web page hosts presentations from a panel discussion on the actual and potential applications of ICT for advocacy to end the global trafficking of women. About 700,000 people, mostly women and children, are subjected to trafficking yearly. The Internet has been used since as early as 1995 to build an alliance, discuss strategies, and share experiences in efforts to end trafficking. In other applications, ICT is used to gather data on trafficking, to inform the public, rescue trafficked women, and rehabilitate those who returned through job training.

For the at-risk women we work with, the Internet is both a positive and negative technology. On the one hand, it is revolutionizing the job search processwomen who are looking for employment are turning to the Internet as a tool in their job search. On the other hand, the Internet is also a source of illegitimate job offers abroad and mail-order bride schemes.

Top of page

Training

JHPIEGO. Increasing access to reproductive health information in low-resource settings: evaluation of a technology-assisted learning center in La Paz, Bolivia [fact sheet based on JHPIEGO Technical Report JHP-16]. (February 2002). Available at: www.jhpiego.jhu.edu/pubs/tr/tr219sum.htm.
In 1999, JHPIEGO established a technology-assisted learning center (TALC) at the Health Sciences Library of the Universidad Mayor de San Andrs (USMA) in La Paz, Bolivia. JHPIEGO trained library staff and faculty to conduct Internet searches and to use basic software applications. Library staff members were also trained in maintenance of the network and hardware. During the first year, there were more than 5,300 faculty and student TALC user sessions recorded, and a successful cost-recovery system garnered US$3,600. The evaluation showed that the TALC succeeded in increasing professional and academic access to up-to-date reproductive health information, opening up the online world for UMSA faculty and students, and promoting South-to-South collaboration in a variety of ways. Access to the TALC helped university officials realize that computer skills, access to the Internet, and the ability to read English were essential tools for their students and faculty. In the first year of the TALC's operation (and because of the TALC) UMSA staff and faculty initiated three projects exploiting technology and focusing on South-to-South collaboration for Bolivia: establishing a regional library network, putting Bolivian medical journals online, and developing distance-education strategies. For further details about JHPIEGO TALCs, see www.jhpiego.jhu.edu/pubs/infoshts/talc.pdf or www.jhpiego.jhu.edu/global/talc.htm.

JHPIEGO. Implementing a new training approach: pilot test of ModCal in Zimbabwe [fact sheet based on JHPIEGO Technical Report FCA-28]. (April 1997). Available at: www.jhpiego.org/pubs/TR/tr728sum.htm.
By using computer technology to maximize training efficiency, trainers can redirect their time, which is scarce, to areas that depend on intensive trainer-learner interaction. ModCal uses the computer to enable participants to absorb new knowledge at their own pace so that more trainer time is available for skills practice.

Long, P.J. and Kiplinger, N.E. Making It Happen: Using Distance Learning to Improve Reproductive Health Provider Performance. Chapel Hill, North Carolina: INTRAH (1999, second printing 2002). Available at: www.intrah.org/rtlpubs.html.
This is a practical and thorough how-to guide for developing distance-learning programs in low-resource settings. Distance learning refers to training where trainers and learners are not together in the classroom and the training content is in a prepared instructional package. The benefits of distance learning are increased access, increased flexibility, assured quality learning, empowered learners, and cost-effectiveness. A range of technologies is used in distance learning, including solar-powered tape players and tapes, online instruction, telephones, and videos. The authors describe the advantages, limitations, and requirements for each technology. They recommend planned interventions to reduce isolation or confusion when the trainer and the learner cannot see each other. Two trainings are reviewed, and findings and lessons learned are reported.

Among the lessons learned:

  • Participatory processes in program development are important but must be balanced for efficiency.
  • Professional accreditation of the training is desirable as motivation for trainees to excel and to complete the program.

Two program evaluations with lessons learned are included.

Management Sciences for Health (MSH). The Best of Both WorldsBlended Learning Programs in International Health [presentations]. Technical Seminar series, Washington, DC (March 18, 2003). Available at: www.msh.org/news_room/seminars/18mar03.html.)
This seminar on blended learning is based on the premise that websites, on-line discussions, and other virtual communication methods are not substitutes for face-to-face technical assistance. When electronic tools are carefully integrated with face-to-face learning, they can enhance development opportunities for health care professionals. Panelists present their experiences in combining face-to face and distance delivery methodologies to best suit the needs of health professionals in the field.

Ntiro, S. and Mrema, J. Information and Communication Technologies and Continuing Medical Education in East and Southern Africa. Report on an ICT conference, Moshi, Tanzania (April 810, 2003). Available at: www.cordaid.nl/uk/News/Inzet-ICT-in-Afrika--intro.doc_cvt.htm.)
This conference was organized by the Centre for Educational Development in Health in Arusha (CEDHA), Cordaid, and the International Institute for Communication and Development (IICD) to explore how ICTs can be used to develop and deliver continuing medical education (CME) of rural health care workers in Kenya, Malawi, Tanzania, Uganda, and Zambia. Attendees identified the many benefits of using ICTs as opposed to more traditional methods. The benefits included: information delivery unconstrained by distance and time, access to mega databases, access to free full-text journals and books, downloaded materials that are free from damage, regularly updated material, learning tailored to need, less disruption of service due to less long-distance travel, and context-based learning. The challenges in using ICTs were also discussed in order to define realistic programs. The country groups identified next steps for broadening participation and convening specific project and program formulations. In addition, the participants called for improved networking around the issues raised at the conference.

Top of page

Reaching Youth

EnCompass LLC. Evaluation Report of WBIHDs ICT for Education AIDSWEB Project. Submitted to World Bank Institute. EnCompass LLC (November 23, 2002). Available at: www.worldbank.org/worldlinks/aidsweb/online-project.html.)
AIDSWEB is a school-based project that was begun 1998 by the World Bank Institute's ICT for Education program to explore the use of ICT for use in HIV/AIDS educational and peer-outreach activities. Project activities included an email-based collaborative project, teacher exchange visits, adaptation of HIV/AIDS educational material for ICT platforms, HIV/AIDS and ICT workshops (for schools, policy makers, and NGOs), and material development. AIDSWEB currently serves approximately 500 youth in 70 schools in 8 African countries. The evaluation results show that AIDSWEB students were almost twice as likely to correctly identify all four methods of HIV/AIDS prevention and transmission. These results were consistent across countries, except for Uganda (a country that, according to evaluators, has well-established programs in HIV/AIDS education and youth development). The program also increased computer access: Students who were not in the program were almost six times more likely to have less than one hour of computer access in the previous month. In the intervention group, 51 percent reported having more than four hours of computer access in the previous month compared to 23 percent in the control group. In the previous month, 35 percent of control respondents reported no computer access; 6 percent in the intervention group reported no access. Most of the students (85%) accessed the Internet and AIDSWEB information alongside others (in student groups, with their teacher, or in AIDS clubs), while only 15 percent accessed it alone. Sixty-three percent in the control group and 85 percent of the intervention group responded that they helped their communities by sharing information about HIV/AIDS with family, friends, or health workers; volunteering with local organizations or health clinics/hospitals; or developing a social action plan. AIDSWEB students were similar to students outside the program in their choices of social action, but AIDSWEB students were more than twice as likely to develop social action plans.

International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR). Rock and male roles: using technology and music to teach young men about gender roles and sexual and reproductive health. Forum 15(1):45 (January 2001). Available at: www.ippfwhr.org/publications/serial_article_e.asp?SerialIssuesID=17&ArticleID=39.
The "Rock and Male Roles" CD-ROM was developed by APROFA, the Chilean affiliate of IPPF/WHR. It uses seven mini-programs as a tool for young men to look critically at gender and how it influences their sexual and reproductive health. The CD-ROM, with photos, reference documents, self-tests, and MTV-style music videos, is an interactive and engaging way for young people to explore their own attitudes and behaviors about these issues. This format encourages the user to take initiative in seeking information and in deciding what he wants to learn. It is a perfect tool for youth, said APROFA psychologist Dr. Patricia Hamel, because it does not impose a sequence or an order. The issues are laid out on the page, and its up to the users to follow their own interests, at their own rhythm. APROFA tested "Rock and Male Roles" with a group of 400 young men aged 15 to 19 at four high schools in Santiago. Each student filled out a survey before and after using the CD-ROM in order to help APROFA assess the impact of the CD on his knowledge and attitudes. The great majority of those who used the CD said they found it useful.

See the global Program Example from Staying Alive for more details.

International Plannned Parenthood Federation/Western Hemisphere Region (IPPF/WHR). Youth and Technology: IPPF/WHR Experiences to Promote Sexual and Reproductive Health. New York: IPPF/WHR (2001). Can be ordered from International Planned Parenthood, 120 Wall Street, 9th Floor, New York, NY 10005-3902 USA.
This report documents IPPF/WHRs first generation projects targeting youth using computer technologies to enhance sexual and reproductive health. Key issues and lessons learned were collected and synthesized from projects using cyber centers, websites, interactive multimedia CD-ROM programs, email counseling services, and a computer chip-activated baby doll. The advantages of using these technologies include the ability for youth to remain anonymous while accessing information, the lure of game-based learning, and the ability to reach a subset of the population. Most technology-based resources are new and exciting, and the novelty makes them attractive. Youth responded favorably to all these uses of technology. In the programs where pre-and post-testing were done, positive changes related to sexual and reproductive health and to gender roles were seen.

To strengthen programming for youth using technology the authors recommend:

  • Know your goals and objectives. View technology use as a strategy for reaching a clearly defined goal.
  • Know your audience before deciding on the specific technology to use. The computer technology projects primarily reached a specific audience: middle-class, non-indigenous, urban youth attending private schools.
  • Be aware that technology does not equal sustainability/income generation. Usually a large investment is required to purchase and maintain the technology, support the research and development, and train the users. It may not be feasible to recuperate or sustain these costs.
  • Do not lose the opportunity to promote sexual and reproductive health services. Integrate the youth and technology projects with broader initiative aimed at improving sexual and reproductive health.
  • Involve youth in project development. The importance of involving youth in the development of technology projects cannot be overstated. . . . Gauge young peoples opinions, learn about their interests, and identify age-appropriate language.
  • Consider possible social barriers. Computers, in and of themselves, do not overcome existing social barriers. Plan for activities that foster inclusion of lower-income youth and girls.

Project descriptions from Chile, El Salvador, Guatemala, and Peru in IPPF's report give more details on activities, target audiences, and user statistics.

Moch, L. and Stevens, C. Reaching adolescents through hotlines and radio call-in programs. In FOCUS (December 1999). Available at: http://pf.convio.com/pf/pubs/focus/IN%20FOCUS/PDF/dec99.pdf.
The authors interviewed staff at number of hotline and radio call-in programs for this report by the FOCUS on Young Adults program on the benefits and challenges of using phones to discuss young adults reproductive health concerns. They conclude, Despite the challenges, hotlines and radio call-in programs can be an effective way to reach large numbers of youth at relatively low cost. They provide youth with convenient, confidential, interactive and compassionate access to information, counseling and referrals, and they can help parents and community members understand the unique sexual and reproductive health needs of young people.

Palmer, A. Reaching Youth; John Hopkins University /Center Communication Programs 1995-2000, Working Paper 6. Baltimore, Maryland: Johns Hopkins University, Bloomberg School of Public Health, Population Communication Services (JHU/PCS) (2002). Available at: www.unicef.org/aids/aids_jhu_reaching_youth.pdf or www.jhuccp.org/pubs/wp/6/.
JHU/PCS, the Population Council in Peru, and the Peruvian Institute for Responsible Parenthood (INPPARES, an International Planned Parenthood Federation affiliate) joined together in 1997 to evaluate the capability of interactive multimedia CD-ROM technology to deliver family planning, reproductive health, sex, and sexuality information to adolescents and young adults in Peru. They designed, produced, and beta-tested Isabel: Your Electronic Counselor. Isabel is an interactive CD-ROM intended to increase levels of knowledge about sex, sexuality, unplanned pregnancy, contraception, and gender to influence the eventual adoption of a family planning method and avoid risky health behaviors. It used existing materials produced by the Ministry of Health and Advocacy in Population Programs (APROPO). In the evaluation, nearly 60 percent of users found it easier to interact with Isabel than a traditional counselor. Others felt a counselor could provide more information in a more confidential setting.

Siecus. United Kingdom BBC's Sexwise provides critical sexual health information worldwide. Making the Connection 2(1): 6-7 (2002). Available at: www.siecus.org/inter/connection/Connection2_1.pdf.
The British Broadcasting Corporation (BBC) and International Planned Parenthood Federation (IPPF) are working together to speak to people in their own languages about sexual health and reproductive rights through a program called Sexwise. Sexwise consists of a website, book, and radio programs that have been translated into 22 languages by the BBC in collaboration with IPPF and national family planning associations. The program, which has spanned the globe in three phases, aims to provide listeners, readers, and online users with accurate information about sexual health issues, along with useful contacts about sexual and reproductive rights. See the global Program Example from Sexwise for more details.

Top of page

Improving Health Systems

Pan American Health Organization (PAHO). Setting Up Healthcare Services and Information Systems. PAHO Occasional Publication, No 120. (2001). Book and CD-ROM available for purchase from PAHO at: http://publications.paho.org/english/moreinfo.cfm?Product_ID=524.
These practical guidelines suggest activities for health care and health systems professionals as they plan and develop information systems. The publication covers requirements analysis; technical specification of computer-based applications; preparation of requests for proposals (RFPs) for information systems, technology, and services; evaluation and selection of providers; and contracting aspects when acquiring information systems and technology for health care services. Guidelines available in English and Spanish.

For more information, see the Program Example from Peru about a project that connected rural primary health care personnel, and the Program Example from Uganda about a project that enabled traditional birth attendants to speak directly to the next referral level of the health system.

Rotich, J.K. et al. Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. Journal of American Medical Informatics Association 10(4):295303 (July-August 2003).
The authors implemented an electronic medical record system in a rural Kenyan health center. Visit data were recorded on one paper encounter form, which eliminated duplicate entry in multiple clinic logbooks. A Microsoft Access database was used and was supported by redundant power systems. The system began in February 2001, and 10,000 visit records were entered for 6,190 patients in six months. The authors present a summary of the clinics visited, diagnoses made, drugs prescribed, and tests performed. After the system was implemented, patient clinic visits were 22 percent shorter. They spent 58 percent less time with providers (p < 0.001) and 38 percent less time waiting (p = 0.06). Clinic personnel spent 50 percent less time interacting with patients, about 65 percent less time interacting with each other, and more time in personal activities.

 Top of page