'HALF-TIME' SUMMARY: [HIF-net at WHO] Local creation and adaptation of health information for healthcare workers in developing countries Many thanks to all contributors on this subject so far. 22 messages have been posted from 30/1/02 to 15/2/02. Further messages are encouraged through to Friday 8 March, in time for the 'eContent for eDevelopment' workshop in Dar es salaam (11-13 March). After that time, I shall post further summaries and a report of the workshop. Here is a list of contributors and a summary of the discussion so far. All contributors to this discussion (through to Friday 8 March) will be offered a complimentary printed copy of INASP Health Links, a gateway to information for health professionals in developing countries (INASP Health Links will be published in early March 2002). * Douglas Ball is a pharmacist working at the Drug & Toxicology Information Service at the University of Zimbabwe. <dball@healthnet.zw> * Peter Ballantyne is manager of knowledge sharingat the International Institute for Communication and Development, The Netherlands. The IICD assists developing countries to realise locally-owned sustainable development by harnessing the potential of ICTs. <PBallantyne@iicd.org> * Ibrahima Bob works at Africa Consultants International, Senegal. His professional interests include improving access to information in developing countries, Internet training, and information resources for developing countries. <bobibrahim@yahoo.com> * Peter Burgess is VP and CFO of ATCnet, an organization of professional Africans committed to a new business model for sustainable socio-economic development and wealth creation in Africa. ATCnet's priority programs are the ATCnet Project for Universal Accountability, the ATCnet Community Cyber Networks program, the ATCnet Database on African Development and Enterprise and the ATCnet Database on the African Health and HIV-AIDS Crisis. <www.atcnet.org><profitinafrica@aol.com>. * Atef El-Maghraby is a healthcare management consultant working in the Health Sector Reform Programme in Egypt. He has a solid career in health information management and human resource development in health. He currently works as part of the European Commission Technical Assistance Team (ECTAT) to provide technical support to MOH to plan and implement HSR in Egypt. His special interest is to establish a network of Health Reform Information Resource Centres. <atef@ectat.org.eg> * Ken Harvey is a public health physician and WHO fellow at the School of Public Health, Bundoora, Australia. He has a special interest in pharmaceuticals and information technology. He has recently been working with the Health & Pharmaceuticals Programme, Consumers International, Regional Office for Asia and the Pacific in Penang, Malaysia under WHO auspices (see www.consumersinternational.org/roap/). He has also been involved in organising a People's Health Assembly, one event of which was an assembly in Bangladesh in December 2000 (see www.pha2000.org). His particular interest in health information is trying to get best-practice therapeutic guidelines off library bookshelves and into physicians' computers <www-sph.health.latrobe.edu.au/telehealth/industry.htm#Electronic> and <www-sph.health.latrobe.edu.au/kharvey/>. <k.harvey@latrobe.edu.au> * Ilkka Kunnamo (MD, PhD) is the Editor-in-Chief of Evidence-Based Medicine Guidelines (EBMG) <www.ebm-guidelines.com>. EBMG is a regularly updated collection of more than 900 clinical guidelines intended for primary care. EBMG is published by Duodecim Medical publications Ltd., which is owned by the Finnish Medical Society. In collaboration with Update Software, the publisher of the Cochrane Library, all Cochrane reviews and DARE abstracts (as well as original publications) relevant to primary care are summarised in brief evidence summaries, and linked to recommendations in the guidelines. The strength of evidence is coded from A to D. Full-text versions of all cited Cochrane reviews are included. EBMG is available as CD-ROM, Internet and mobile versions. An adapted, localised version has been published as a book in Russian language (by Geotar-Med, Moscow). We are planning to join initiatives to provide information at low cost or free to developing countries. <kunnil-1@pop.fimnet.fi> * Pat Letendre is list owner of MEDLAB-L and Web Master of the International Association of Medical Laboratory Technologists (http://www.iamlt.org). She is a consultant who provides training and education related to the Internet, communication, and transfusion medicine. Further details at these websites, which have extensive resources for healthcare workers and educators: <http://www.ualberta.ca/~pletendr/> <http://www.patletendre.com/> <pletendr@ualberta.ca> * Gabriele Mallapaty works with the Public Health Care Laboratory, based in the USA. PHCL's website <www.phclab.com> is a global forum of information exchange for all those concerned with laboratory services in developing countries. Gabriele's professional interests include public health care laboratory services, primary health care, and health services management. <thephclab@msn.com> * Bertha Mo works in the US and holds postgraduate qualifications in medical anthropology and health education from the University of Berkeley, US. She recently left the Institute for Development and Research Cooperation (Canada) and is now working as a consultant. <bertiemo@yahoo.com> * David Morley is Professor Emeritus at the Institute of Child Health, Tropical Child Health Unit. He has been involved with Teaching Aids at Low Cost (TALC) and Child-to-Child for many years. His particular present concern is in creating a reading culture among health workers and assisting numeracy by involving family and community in measurement of their children. <David@morleydc.demon.co.uk> * Neil Pakenham-Walsh has a background in medicine and medical publishing, including work with the World Health Organization, the journal Medicine Digest, and the CD-ROM series Topics in International Health (Tropical Medicine Resource, Wellcome Trust). He has worked as a medical officer in rural Ecuador and Peru. He currently runs the INASP-Health programme (International Network for the Availability of Scientific Publications), which aims to support cooperation, analysis, and advocacy among those working to improve access to reliable information for healthcare workers in developing and transitional countries.<health@inasp.info> * Paul Saunderson is a Leprosy Consultant at the American Leprosy Missions, Greenville, US <www.leprosy.org>. <psaunderson@leprosy.org> * K. R. Sethuraman is a professor physician at the Department of Internal Medicine, Jipmer, Pondicherry, India. <sethuramankr@hotmail.com> * Abubakar Yaro works in Ghana with Vis Viva Pharma; Abubakar Unipath Clinical Lab; and the Muslim Health Awareness Foundation. Professional interests include clinical research, health creating awareness, lecturing and writing of health books. <abubakar_yarogh@yahoo.com> QUESTIONS FOR DISCUSSION 1. WHY IS IT IMPORTANT TO STRENGTHEN LOCAL CAPACITIES TO CREATE AND ADAPT HEALTH INFORMATION? * Health knowledge from developing countries is valuable both locally and internationally. * Improving access to reliable and relevant information for healthcare workers is potentially the most cost-effective way to enhance the delivery of healthcare and reduce the burden of disease and death in developing countries. * Local 'health information providers' are better familiar with the needs and values of the target population. * Production through local capacities will enhance continuity and sustainability once foreign support for the project ceases * Local production stimulates economic development and contributes to poverty reduction. * There may be specificities of the subject/problem that influence the nature of the content and how it is created or adapted. Diseases endemic to certain developing countries may mean that the supply of 'global' knowledge is scarce and so local practioners have to come up with their own 'content'. * Some illnesses are only recognized or known in specific countries. * Guidelines need to be adapted at the country level so that local conditions and access to drugs can be taken into account. * Materials can be more easily translated and produced in local languages, if the production process is 'owned' locally. * Some photos/images may need to be changed for local use and this can only be done properly at the local level. 2. HOW CAN LOCAL PRODUCERS ASSESS WHETHER A PRODUCT IS ACTUALLY NEEDED? * "In the same way as international/foreign producers would do." * Conduct a needs assessment. * Assess how the product can be integrated into the training process. 3. IF A PRODUCT IS NEEDED, HOW CAN LOCAL PRODUCERS FIND OUT IF SOMETHING SIMILAR ALREADY EXISTS NATIONALLY OR INTERNATIONALLY, WHICH MIGHT MINIMIZE OR AVOID DUPLICATION OF EFFORT? * Through research on nationally and internationally available resources in the specific subject area. * Through Internet search. * Through networking both local and North/South. 4. HOW CAN LOCAL PRODUCERS ACCESS EXISTING 'SOURCE' INFORMATION ON THE SUBJECT? * From international sources: international organisations, international NGOs, News Agencies, Embassies, etc. * Browse, assess and download full-text information from useful Web resources and peer-reviewed specialty journals. * Local communities can to a large extent make their own judgement about how North information can be useful in the South * From local sources: Depending upon the subject area, through contacts with country offices of international organisations, embassies, NGO, New Agencies, Universities, etc. * From colleagues: Depending upon the subject area, through local and international networks and e-mail forums, through personal contacts, by consulting experts in the specific field. 5. HOW CAN LOCAL PRODUCERS TRANSFORM CONTENT FROM A 'CATERPILLAR' TO A 'BUTTERFLY' - FROM AWKWARD PIECES OF 'SOURCE INFORMATION' INTO AN ATTRACTIVE PRODUCT THAT IS EASY TO USE, RELIABLE, AND RELEVANT IN FORM AND CONTENT TO THE NEEDS OF END-USERS? * "Essential information should not be boring and dull - it needs to be relevant to the local needs and priorities, and delivered in a palatable, attractively packaged, easily digestible and culturally appropriate format. We should devise a mechanism to recruit "creative local talent" to help in this." * Any piece of 'new content' is in practice a synthesis of adapted content from other sources (formal and informal publications, own experience, others' experience), plus the authors' interpretations, beliefs, and (in research articles) new data thrown in. * By following a consultative process during the transformation of 'source information' * Thorough needs assessment - inclusive of end-users and training processes * Finding the appropriate media (broadcast, electronic, written) with the end-user and sustainability in mind. * Extensive field-testing of draft material * Incorporation of lessons learned during field-testing into the final product. * Edit information to fit a single A4 sheet, which can then be printed out for display on a notice board. * Classify all downloads and collect on hard disk/CD-ROM. * While the distillation of best-practice therapeutic guidelines has international applicability, disease patterns vary in different countries . . . there is a need for local endorsement and ownership by respected opinion leaders. . . . make available . . . guideline content in electronic format for modification by organisations having similar aims in other countries. This process avoids duplication of effort while maintaining local autonomy. 6. HOW CAN LOCAL PRODUCERS DISTRIBUTE THEIR INFORMATION MORE EFFECTIVELY TO END-USERS? * New health information material should be distributed at National Training Institutions * Use the media - radio, TV, newspapers, etc. - to disseminate information on new material. * Use civil society - community leaders, women's groups, schools, etc. - to disseminate information on new material. 7. HOW CAN LOCAL PRODUCERS SHARE THEIR INFORMATION WITH OTHERS WORLDWIDE FOR FURTHER REPRODUCTION, ADAPTATION, AND DISTRIBUTION? * Through networking, e-mail, Internet, websites * Through a global information hub. * The international community and donor agencies need to recognise their potential and give more local producers a chance to prove themselves. 8. HOW CAN LOCAL PRODUCERS KNOW IF THEIR PRODUCTS MAKE A DIFFERENCE TO THE QUALITY OF HEALTHCARE DELIVERY? HOW CAN THEY LEARN FROM THE FEEDBACK OF THEIR END-USERS? * Through surveys on change in behaviour, disease prevalence, use of services, etc. * By taking feedback from end-users seriously and improving the product accordingly. * Feedback will be more useful if it is made more specific. This could be done by using a questionnaire, very much like the one used for field-testing a draft. * Set measurable performance indicators, eg impact on disease incidence. 9. HOW CAN INFORMATION TECHNOLOGY AND ACCESS TO THE INTERNET MAKE A DIFFERENCE TO THE ABOVE PROCESSES? * Information technology and the Internet have an enormous impact on the way information is shared with the global community. * Large documents can be distributed through CD-Rom. * Smaller documents can be made available through PDF documents. * Information technology has the potential to increase dramatically the ability of local 'health information providers' to produce locally relevant content, whether this is in electronic or printed form, visual or audio. * training and technical support (writing, editing, adaptation, evaluation); * access to and application of information technology, including Internet connectivity; * joint initiatives that involve local producers and end-users throughout the publication cycle, from initial needs assessment and planning through to evaluation of use and impact assessment. * opportunity to link with partners around the world, to access 'source' information, and to disseminate locally created or adapted resources for the benefit of others. 10. WHAT CAN BE DONE BY INTERNATIONAL ORGANIZATIONS AND OTHERS TO IMPROVE ACCESS TO ESSENTIAL 'SOURCE INFORMATION' - EXISTING LOCAL AND INTERNATIONAL PUBLICATIONS? * Be less restrictive with making 'source information' available. * Give availability of information priority over sales value and copyrights of the material. * Develop a network of local, national, and regional clearinghouses. . could have electronic copies of resources available for download on websites, as e-mail attachments, and offer paper copies. * Make more information available free. "Even WHO has only a limited number of documents available in PDF format." * If local 'health information providers' are best placed to create and adapt locally relevant information, surely the priority for international organizations should be to strengthen their capacities to meet the needs of their end users. * Material that really is for local adaptation could be made available in a number of formats, including desktop publishing formats. This will allow changes to be made more easily than for files in the PDF format. * "I see funding and partnerships as the North's duty to the South" * Coordination and pooling of resources. Currently, many projects occur in isolation, use up scarce resources, and duplicate efforts. Coordination requires involvement at the international level and also requires that players move from a culture of competition to one of cooperation. * All ministries of health have departments of health information. These departments should be strengthened and sub-offices should be established in regional and district locations. * Ministries of Health can lead what I will call "Health Information for Better Health" initiative with donor support can develop an agenda for the future. 11. WHAT CAN BE DONE TO INCREASE THE VISIBILITY AND DISTRIBUTION OF NEW LOCAL HEALTH INFORMATION MATERIALS? * I believe all MoH have departments of health information. These departments should be strengthened and sub-offices should be established in regional and district locations. * New health information material should be distributed at National Training Institutions - both private and governmental - to expose learners to latest information as well. * If relevant, info should also be made available to private practitioners and the public. * Use the media - radio, TV, newspapers, etc. - to disseminate information on new material. * Use civil society - community leaders, women's groups, schools, etc. - to disseminate information on new material. * We believe that the modern equivalent of the health workers white coat pocket is the handheld computer (PDA). 12. WHAT ARE THE POTENTIAL BENEFITS OF SOUTH-SOUTH COMMUNICATION AND SHARING OF EXPERIENCE AMONG 'HEALTH INFORMATION PROVIDERS'? HOW CAN THIS BE FACILITATED? * As there are similarities and differences among programmes in the North and South, so are there similarities among programmes in the South as well as explicit differences. * Communication and sharing of experience among 'health information providers' brings new ideas and encourages providers to look at subject for different angles - it broadens one's horizon. * Communication and sharing both North/South and South/South can be facilitated through a central information hub that is freely accessible to all. Is there anything you would like to add to the above? Anything you agree with or disagree? Any other questions you feel should be asked? Any experience or lessons learned that you can share that relates to the *local creation or adaptation of information* for healthcare providers in developing countries? We are particularly interested in practical experience and lessons learned in the use of information and communication technologies. We are also interested to hear about your ideas for future projects. I'd like to take this opportunity to thank also the many 'HIF-net at WHO' subscribers who have submitted (or are preparing) case studies for the 'eContent for eDevelopment' workshop. Best wishes, Neil Neil Pakenham-Walsh Moderator, HIF-net at WHO ************************************************************************ 'HIF-net at WHO': working together to improve access to reliable information for healthcare workers and health professionals in developing and transitional countries. Moderator: Neil Pakenham-Walsh <INASP_Health@compuserve.com>. Send list messages to <hif-net@who.int>