Evaluation of the Satellife PDA Project, 2002

Executive Summary

Information and communications technology (ICT) can be used as a tool for collecting community health information to support decision-making; improving doctors' access to current medical information; linking healthcare professionals so they can share information and knowledge; and enhancing health administration, remote diagnostics, and distribution of medical supplies. One ICT that offers promise is handheld computers - also called personal digital assistants or PDAs - which are widely used in the medical profession in the developed world. But PDAs are a relatively new technology in Africa, and little work has been done before now to demonstrate their utility as a tool for healthcare in developing countries.

This evaluation looks at a project led by Massachusetts-based organisation Satellife, to test the use of PDAs in healthcare environments in Ghana, Uganda, and Kenya during December 2001-December 2002. The project put PDAs into the hands of physicians, medical students and community volunteers in different settings in order to demonstrate their viability and usefulness, especially for the collection of health data and dissemination of medical information. SATELLIFE worked in partnership with a number of ground level partners, including the American Red Cross; Makerere University Medical School in Kampala, Uganda; HealthNet Uganda; Moi University Faculty of Health Sciences in Eldoret, Kenya; and the Indiana University Kenya Programme. The project received financial support from the Acumen Fund.

The PDA used was the Handspring Visor Neo, with a 33 MHz DragonBall VZ microprocessor from Motorola, a Palm operating system (Palm OS), and 8 MB of main memory. Pendragon Forms v3.1 was the software program used to create the survey forms. Country-specific drug lists and treatment guidelines were obtained by Satellife in hard copy or electronic formats and adapted to a PDA-accessible format. Medical texts were obtained from Skyscape.

Satellife first put the handheld computers to use for field surveys, by linking this project to a widespread measles immunisation campaign being conducted in Ghana by the American Red Cross in December 2001. The objective of the Satellife-Arc joint effort was to use PDAs in a short-term survey intended to determine the efficacy of the measles immunization campaign outreach efforts and collect some baseline health information. The objectives of the Uganda phase were to test the use and usefulness of PDAs by medical practitioners to conduct an epidemiological survey on malaria, and access and use certain medical reference tools and texts. The objectives of the Kenya phase were to test the use and usefulness of PDAs by students to collect field survey information, and access and use certain medical reference tools and texts as part of their studies.

Bridges.org was engaged as an outside consultant to conduct an independent evaluation of the PDA trial. The overall objective for the bridges.org evaluation was to gauge the viability and usefulness of PDAs in healthcare settings in Uganda and Kenya, by looking at the technology itself, the content loaded on it, and the impact that the PDA had on the behavior of health professionals and the quality of care they delivered.

This evaluation looked at two main questions:

• Did PDAs prove to be an effective tool for physicians and medical students to collect health data and access medical information as part of their daily routine?
• If not, why not?

This evaluation responded to the two questions above by considering the following 16 criteria that represent the determining factors of whether people have Real Access to technology:

• Physical access to technology.
• Availability and use of relevant content.
• Appropriateness of technology for data collection in this environment.
• Appropriateness of technology to local conditions.
• Affordability of technology and content.
• Training and skills required for effective technology use.
• Need for and availability of technical support.
• Integration of technology use into daily routines.
• Socio-cultural factors that affect technology use.
• Confidence in technology use in terms of privacy, security, or cybercrime.
• Public enthusiasm for technology use.
• The effects of the national legal and regulatory framework on technology use.
• Political will in government to enable widespread technology use throughout society.
• Impact of technology use on the community and larger society.
• Ideas and plans for future uses of the PDA.
• Key external challenges that may have limited technology use in this project.

The main finding of this evaluation is that the Satellife project in Ghana, Uganda, and Kenya has validated the use of handheld computers in healthcare environments in Africa. There were a number of valuable lessons gleaned from the project that can be applied to further deployment of PDAs in developing countries. A number of obstacles to technology use have also been identified, which will need to be overcome in order to promote the widespread adoption of the technology in this context. Finally, the project has served to open the door for a number of opportunities that are worthy of the attention of technology companies and content providers.

Key findings of the evaluation:

• Overall, the handheld computers proved to be a useful and viable technology in the healthcare environments in Ghana, Uganda and Kenya.
• The handheld computers proved to be an effective tool for collection of health data.
• The handheld computers proved to be an effective tool for information dissemination.
• The medical reference materials available on the PDA helped the physicians and students improve their provision of healthcare.
• The handheld computers proved to be an appropriate technology for use in the African context.
• Handheld computers proved to be an inexpensive alternative to PCs in terms of computer power per dollar.
• The handheld computers proved to be simple to use, and the technology was easily integrated into the daily routines of the healthcare professionals.
• Handheld computers offer enormous potential to help bridge the digital divide. Key lessons learned in this project.
• People require at least some basic training in order to use the handheld computer effectively overall.
• More focused training is needed to train people how to use the handheld computer for data collection, not just for the technology users, but also for those who are managing the project.
• The use of the handheld computer changes the way that a survey should be designed and conducted.
• Technical support is critical.
• Content must be locally relevant to have the greatest impact.
• The power supply for the handheld computer must be appropriate to the situation: battery-powered units would only be the first choice in situations where a ready electricity supply is unavailable.
• Synchronising onto a central data system must be simple and convenient.

Challenges that must be overcome

• Despite the affordability by comparison to PCs, the cost of the PDAs may still be too high for the average person in Africa.
• More locally relevant content in electronic format is needed to foster the widespread use of handheld computers for healthcare in developing countries.
• Repairs for handheld computers are currently not feasible in Africa.
• Broader ICT infrastructure is needed to support the widespread use of handheld computers in Africa in the long-term.
• Issues of privacy, data protection, and security will affect the widespread use of handheld computers in healthcare in Africa over the long-term.

Opportunities for the future that emerged from this project

• There is clearly a market opportunity for handheld computers in African countries.
• Linking the use of handheld computers with wireless capabilities would exponentially extend the utility of both technologies.
• There is clearly a market opportunity for locally relevant medical content in electronic formats, which is targeted to the needs of African countries.
• Partnering handheld computer initiatives with community access point initiatives offers an effective model that would be mutually beneficial for both efforts.
• Linking handheld computer initiatives with alternative power development efforts, such as the investigation of solar panels and wind-up technologies, may offer innovative opportunities for solving the power supply problems.
• Handheld computers offer enormous potential for improving service delivery in national Ministries of Health as well as international healthcare organizations and programs.
• Handheld computers offer specific utility in rural healthcare settings.

Handheld computers could revolutionise technology access for the people of Africa. But none of this potential can be realized unless the technology companies and content providers rise to the occasion. This study should be a wake-up call to industry, a glimpse into the untapped markets where their attention would make a real difference to people's lives.