CAN THE PENGUIN HELP THE DOC? ICTs AND HEALTH, A TANTALISING PROMISE

Stephen Settimi (52) is the USAID's Global Health Bureau's senior technical advisor for knowledge management and ICT4D. Based in Washington DC, his background has been in software application development in health management, patient tracking and health surveys. He explains his work and his perspectives to Frederick Noronha:

Q: What is USAID doing on the issue of health and ICTs?

We've been working at a couple of levels. We look to help develop national systems and we look to develop systems that can be used in the field for health management. We also work in developing systems for human capacity development. Above all, we look to find ways to integrate across sectors with health as a major component.

Q: Can you give us some examples of how this works out?

For instance, the John Hopkins' INFO Project which has a large knowledge management component to it, on health research dissemination in family planning and reproductive health.

Another example that addresses the Free Libre and Open Source Software (FLOSS) community is the capacity project, and that's a $250+ million dollar five year contract, scattered across Africa. They have chosen to use (Free/Libre and) Open Source Software as the basis for developing the framework for the software. This aims to help national, municipal, and district level governments meet their unmet needs for staffing for health-professional nurses and professional training needs. People that work in clinics and health centres.

Q: It seems that ICT (information and communication technologies) have been used very little in the field of health (as compared to say, in education or agriculture). We do see examples from the high-end segment for the affluent, but few for the common(wo)man. Why?

I think, historically, that's because the communities that we generally serve are people who have less health equity. Resources aren't usually there for public health. So the resources that go for public health in ICT are somewhat lagging behind too.

But the trend seems to be changing. What the model is, is to use ICT to not only help in health programmes, but also to provide opportunities for livelihoods, using that technology and or developing entrepreneurial opportunities that would naturally follow that progression.

Q: Which countries in Africa in Asia do you see as doing good work in this field?

The ones that stand out most are places like Ethiopia, Rwanda, and Ghana. I've heard a lot of good things about Tanzania, and I'm certain there are others. We hear a lot of development going on in the Philippines, the Mekong area -- Thailand, Cambodia. And of course in Jordan, parts of India. I think there are good examples coming in now from everywhere.

Q: Would you agree that ICT seems to be viewed as a magic wand, one that will take care of all our problems and unsorted difficulties, including the economic and political ones, all in one magic go? Isn't that an unrealistic expectation anyway?

I think it's kind-of seen as a sort of panacea. With anything like that, there's a kind of truth. It does provide investment opportunities. It provides opportunities for building skills, for learning, and of course if it's used to also address some of the more pressing issues -- like giving information and knowledge out to communities, and get back information from communities as a two-way street. Theoretically we should expect some kind of improvement.

Q: From your experiences, what works best?

The solutions that have proven the best in international development are those that are heavily-driven by community expressions of need and desire to develop in certain ways. Needs for better health, or needs for better transportation of water. When it's community-driven, we get better outcomes. Specially if the community is integrally involved.

Q: Could you cite any small-but-successful projects?

Small is a relative term. Let me think... ICT for communications, exposing people to new ideas, giving people a chance to exchange and share knowledge. Among youth, internet cafes are a real good investment. Community portals for using internet technology for a variety of purposes also help.

Some of the larger ones could be the Last Mile Initiative. It's an attempt to bring technologies, specially internet connectivity, out to the most rural areas in countries.

I guess if you're also looking at the specific tools, once they get their wikis and blogs, these could be very important for the community; such tools serve as channels for communication. It offers learning from people who live elsewhere on what could be done or not.

Q: Any examples of useful software in the Free/Libre and Open Source Software world?

Interesting ones might be (for the field of GIS, or geographical information systems), the map server, developed by University of Minnesota and NASA. This was work done on FLOSS. This suite of tools is being developed by IntraHealth, and involves a suite called Power Tools, for managing human resources in health programmes. Take a look at Capacityproject.org.

I think FLOSS is an opportunity for an easy leg-up for countries and communities to get involved in a very low-cost or no-cost basis for getting them involved in ICT. For them to understand the mechanics. So that if they decide to invest in other technologies, they have the platform to make some sound decisions.

Sites to visit http://www.usaid.gov (see under 'health bureau') Email contact for Stephen Settimi: ssetimi at usaid dot gov