Measuring the impact of e-health

Abstract

If you live in Africa and need some advice on the human immunodeficiency virus (HIV), all you have to do is pick up a phone and connect with a counsellor through Mxit an instant message chat-line. This service, run by the Cape Town-based organization Cell-Life in partnership with counselling service LifeLine, reaches about 10 million people. it is hard to measure impact, says Katherine de Tolly, m-health senior researcher at Cell-Life, a not-for-profit organization that makes technology and services accessible to try and improve health, mobile usage is different to impact. We've looked at the stats, analysed exchanges, done research reports and we know the users like it and use it. But to measure the impact on health outcomes, such as preventing HIV infection or alleviating depression, takes a level of research that we've not been able to afford. Mobile technology is expanding rapidly in low- and middle-income countries, particularly in Africa and in the less affluent and rural communities access is far greater than access to In Africa for instance, de Tolly says, 50 million people have phone access and everyday experience confirms near-universal ownership, with everyone from street vendors to top-level executives carrying one. [ILLUSTRATION OMITTED] Yet many countries in Africa still struggle with access to computers, the Internet, a reliable power supply and other infrastructure challenges. Vincent Shaw, executive director of the South-Africa Health Information Systems Programme (HISP), a nongovernmental organization that specializes in the development and maintenance of health information systems, recalls how the HISP lost data in a project in Nigeria when the power failed and all the stored phone text messages were deleted after 24 hours. In developing countries, health technology via phones helps to overcome the lack of universal and reliable access to information and communication technology, just as the use of desktop computers will persist until bandwidth and internet access improve, says Shaw. We have seen that Internet access is not that great, including in Africa, and have stood firm on the need for stand-alone computers rather than pursuing web-based data entry systems. HISP--which has university partners in Norway and Sweden--is active in 15 countries and its free web-based software has been translated into nine languages including Chinese, Russian and Swahili. Shaw says: Measuring the success of e-health is not just about value for money but also about the development of individuals and communities. An example of this, says Shaw, was when the HISP team was giving computer training in Sudan to people who would be working with the new health information system. Implementing the HISP software has already made a difference, says Shaw. South Sudan has been ravaged by war and had little or no health information in its health-care system--but it is reporting health data on a regular basis now. He says: We estimate about 1.5 billion people are accessing e-health services across Africa and Asia, according to our research. They may be paper-based at the start but at some point the information is stored in computers. We can see the numbers--who is reporting and who is not--but at what percentage do you peg success? Shaw asks. He says that one measure of the success of such systems is that they make data available, so that they can be used to allocate resources more rapidly than before. This means that data are available to managers in health-care systems within a short space of time, between one and three months, so that they are able to assess services using more recent data, rather than older data from six to 12 months ago. Data, when interpreted by healthcare workers, can alert health departments to risk and priority areas, where more resources may be needed. …