For community health workers who are far from medical libraries and urban centers, staying up-to-date on the latest medical advancements and disease treatments can be difficult. GUIDE, developed by AED-Satellife, is a conversion and content management system that transforms medical literature into HTML forms that are easily accessible over a mobile phone.
GUIDE currently runs on smartphones (Samsung I780) in a pilot program in Port Elizabeth, South Africa. For the last year, 50 nurses from three different branches of local hospitals have used mobiles to stay up to date on medical developments.
WHAT GUIDE DOES
In rural locations, doctors and nurses are often acting in isolation, separated from the medical community and easy access to current medical information. GUIDE essentially takes large documents and makes them accessible for users with small devices by converting the documents into HTML, which makes the documents legible on any browser that supports HTML. The library is a mix of long documents and short reference materials.
Planning and development for the Mobile Health Information System began in 2005 and there was a small proof-of-concept pilot in Kwa-Zulu Natal that concluded in January 2006. The first funding for the current project was secured in March 2007 and training and deployment took place at the Port Elizabeth Hospital Complex in January 2009. The program has continued on since then, and airtime for the nurses is funded through January 2011.
Andrew Sideman, director of Programs and Partnerships at AED-Satellife, headed the Port Elizabeth program. He says that the project is running mostly independently now that the documents have been converted and the nurses have been trained, and that the long-term goal is for the project to be self-supporting. He says, “Even though the pilot, in terms of researching and gathering information, is winding down the actual use of the devices and the information will continue for at least another year. At that time we hope that the activity of generating new information and using GUIDE software will have been handed off to the Department of Health.”
GUIDE is a work-around for health workers who don’t have regular access to medical information. Getting physical textbooks and documents to rural areas and making them accessible to all community health workers is unfeasible. Transferring medical literature into PDFs doesn’t work because most community health workers do not have personal computers, and reading long PDFs on mobile phones is difficult – both because it is impossible to scroll meaningfully through hundreds of pages, and because pictorial information (charts, graphs, data sets) can be distorted or lost in the transferring process.
As a solution, the group hired a consultant to convert data chosen by the Nelson Mandela Metropolitan University Department of Nursing into HTML, and then put that information onto a mobile library that the nurses can access through their smartphones. The program runs on Microsoft Windows server. The information stays on the user’s mobile, so the documents are available even in locations with spotty or non-existent Internet access.
Sideman says that the project was designed to run on smartphones because the added value of Internet access gives the community health workers access to an even greater source of information. He says, “This is not a project for $20 cell phones,” although the group believes they could adjust the software to run on cheaper phones as long as the phones have a large enough display and enough functions to keep the system viable. He adds, “as smartphone prices are dropping, I’m happy to encourage all sorts of users to see what works.” Sideman added that one of the most encouraging results of the pilot is how quickly the nurses have adopted Internet usage – they not only use the phones for the medical library, but also for joining health discussion groups and email lists to form an online community.
ABOUT THE PILOT
The program is currently run by grants and donations from QualComm, MTN and money from a private foundation. The primary cost is the purchase of the original phones and covering airtime. The group received a discount on the phones and airtime from signing a two-year contract with MTN. AED Satellife pays roughly 100 rand ($14 U.S.) per month to cover airtime costs.
GUIDE is developed under an open-source license, although the code is not yet available publicly. AED Satellife chose to develop GUIDE as open-source software as part of its plan to become independently sustainable. Sideman says that the choice to make the code available was in line with AED Satellife’s business philosophy, and also because he believes that organizations will recognize the software’s use. He says, “Our hope is that because we’ve developed it and we have the most experience with it, that those organizations or government ministries of health will choose to have us be the implementer. AED and AED Satellife have enormous resources and experience in terms of implementation, so we want to make it available and we want to build the capacity.” In this way, national health ministries will see the benefit it has and will allocate funds for wide-scale implementation.
While Sideman said that working with the university and NGO partners was a very smooth process, implementing GUIDE did take a while to navigate bureaucratic system in South Africa. Another challenge was overcoming some of the sexism that proved barriers to the implementation – the majority of the participating nurses are female, and Sideman says that the organization occasionally encountered problems with partners underestimating the women’s ability to use and manage technology.
The project had originally planned to use PDAs as the means to disseminating information, but through deals with QualComm and MTN they found that mobiles could give the nurses better opportunities since the smartphones came with Internet access. “We were surprised by how quickly and readily the nurses adopted technology that was initially foreign to them,” says Sideman.
Sideman believes that the technology has not only had an effect on the nurses, but also on the hospitals themselves, since the nurses share the information on the phones with others in the hospital, using them as a means of hospital-wide research. “An individual nurse who went through the training is responsible for the phone, but from the feedback I’ve heard, the nurses are very generous in allowing others to access information.”
Says Sideman on the overall impact of the project and the goals for the future, “Nonprofit organizations are constantly talking about capacity building, and this really had an enormous impact in terms of building capacity among health workers to use technology. I think it’s had a transformative effect, in the sense that if the project were to end today, that the use of technology has become so ingrained in the nurses’ day-to-day activities that they would find it unacceptable to go forward without this kind of support. What we need to do, in a relatively wealthy country like South Africa, is move away from everything being external and donor funded to being internal, where the hospital systems say ‘no, these technologies are really important.’”
AED Satellife is in the process of applying for more grants in order to expand GUIDE. Although the current grants cover phones and airtime through January of next year, the group would like to deploy GUIDE technology to more rural areas.
GUIDE: Getting Medical Information into the Hands of Community Health Workers Locations
For community health workers who are far from medical libraries and urban centers, staying up-to-date on the latest medical advancements and disease treatments can be difficult. GUIDE, developed by AED-Satellife, is a conversion and content management system that transforms medical literature into HTML forms that are easily accessible over a mobile phone.
GUIDE currently runs on smartphones (Samsung I780) in a pilot program in Port Elizabeth, South Africa. For the last year, 50 nurses from three different branches of local hospitals have used mobiles to stay up to date on medical developments.
WHAT GUIDE DOES
In rural locations, doctors and nurses are often acting in isolation, separated from the medical community and easy access to current medical information. GUIDE essentially takes large documents and makes them accessible for users with small devices by converting the documents into HTML, which makes the documents legible on any browser that supports HTML. The library is a mix of long documents and short reference materials.
Planning and development for the Mobile Health Information System began in 2005 and there was a small proof-of-concept pilot in Kwa-Zulu Natal that concluded in January 2006. The first funding for the current project was secured in March 2007 and training and deployment took place at the Port Elizabeth Hospital Complex in January 2009. The program has continued on since then, and airtime for the nurses is funded through January 2011.
Andrew Sideman, director of Programs and Partnerships at AED-Satellife, headed the Port Elizabeth program. He says that the project is running mostly independently now that the documents have been converted and the nurses have been trained, and that the long-term goal is for the project to be self-supporting. He says, “Even though the pilot, in terms of researching and gathering information, is winding down the actual use of the devices and the information will continue for at least another year. At that time we hope that the activity of generating new information and using GUIDE software will have been handed off to the Department of Health.”
GUIDE is a work-around for health workers who don’t have regular access to medical information. Getting physical textbooks and documents to rural areas and making them accessible to all community health workers is unfeasible. Transferring medical literature into PDFs doesn’t work because most community health workers do not have personal computers, and reading long PDFs on mobile phones is difficult – both because it is impossible to scroll meaningfully through hundreds of pages, and because pictorial information (charts, graphs, data sets) can be distorted or lost in the transferring process.
As a solution, the group hired a consultant to convert data chosen by the Nelson Mandela Metropolitan University Department of Nursing into HTML, and then put that information onto a mobile library that the nurses can access through their smartphones. The program runs on Microsoft Windows server. The information stays on the user’s mobile, so the documents are available even in locations with spotty or non-existent Internet access.
Sideman says that the project was designed to run on smartphones because the added value of Internet access gives the community health workers access to an even greater source of information. He says, “This is not a project for $20 cell phones,” although the group believes they could adjust the software to run on cheaper phones as long as the phones have a large enough display and enough functions to keep the system viable. He adds, “as smartphone prices are dropping, I’m happy to encourage all sorts of users to see what works.” Sideman added that one of the most encouraging results of the pilot is how quickly the nurses have adopted Internet usage – they not only use the phones for the medical library, but also for joining health discussion groups and email lists to form an online community.
ABOUT THE PILOT
The program is currently run by grants and donations from QualComm, MTN and money from a private foundation. The primary cost is the purchase of the original phones and covering airtime. The group received a discount on the phones and airtime from signing a two-year contract with MTN. AED Satellife pays roughly 100 rand ($14 U.S.) per month to cover airtime costs.
GUIDE is developed under an open-source license, although the code is not yet available publicly. AED Satellife chose to develop GUIDE as open-source software as part of its plan to become independently sustainable. Sideman says that the choice to make the code available was in line with AED Satellife’s business philosophy, and also because he believes that organizations will recognize the software’s use. He says, “Our hope is that because we’ve developed it and we have the most experience with it, that those organizations or government ministries of health will choose to have us be the implementer. AED and AED Satellife have enormous resources and experience in terms of implementation, so we want to make it available and we want to build the capacity.” In this way, national health ministries will see the benefit it has and will allocate funds for wide-scale implementation.
While Sideman said that working with the university and NGO partners was a very smooth process, implementing GUIDE did take a while to navigate bureaucratic system in South Africa. Another challenge was overcoming some of the sexism that proved barriers to the implementation – the majority of the participating nurses are female, and Sideman says that the organization occasionally encountered problems with partners underestimating the women’s ability to use and manage technology.
The project had originally planned to use PDAs as the means to disseminating information, but through deals with QualComm and MTN they found that mobiles could give the nurses better opportunities since the smartphones came with Internet access. “We were surprised by how quickly and readily the nurses adopted technology that was initially foreign to them,” says Sideman.
Sideman believes that the technology has not only had an effect on the nurses, but also on the hospitals themselves, since the nurses share the information on the phones with others in the hospital, using them as a means of hospital-wide research. “An individual nurse who went through the training is responsible for the phone, but from the feedback I’ve heard, the nurses are very generous in allowing others to access information.”
Says Sideman on the overall impact of the project and the goals for the future, “Nonprofit organizations are constantly talking about capacity building, and this really had an enormous impact in terms of building capacity among health workers to use technology. I think it’s had a transformative effect, in the sense that if the project were to end today, that the use of technology has become so ingrained in the nurses’ day-to-day activities that they would find it unacceptable to go forward without this kind of support. What we need to do, in a relatively wealthy country like South Africa, is move away from everything being external and donor funded to being internal, where the hospital systems say ‘no, these technologies are really important.’”
AED Satellife is in the process of applying for more grants in order to expand GUIDE. Although the current grants cover phones and airtime through January of next year, the group would like to deploy GUIDE technology to more rural areas.
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