Infrastructure Development of mHealth Systems in Developing Countries (Case Study: Implementation NusaHealth Apps in Yogyakarta Indonesia) (Preprint)

2020 ◽  
Author(s):  
Surahyo Sumarsono ◽  
Peter M.A. van Ooijen ◽  
Widyawan Widyawan
Keyword(s):  
Developing Countries ◽  
Health System ◽  
Community Health ◽  
Data Storage ◽  
Mobile Health ◽  
Rural Areas ◽  
Pilot Project ◽  
Management Program ◽  
Local Health ◽  
Infrastructure Development

BACKGROUND The size of the Indonesian population and the shifting pattern of illness from infectious to non-communicable diseases (NCDs), which leads to double disease burden, demand that Indonesia develop a variety of innovative efforts to control the numbers of NCDs. Moreover, NCDs are preventable and strongly influenced by lifestyle, therefore individual intervention to stimulate healthier lifestyle is important. One approach to support NCD programs is the use of mobile technology or mHealth. OBJECTIVE The purpose of this work is to show the process of designing and developing a mobile health system, NusaHealth, which will be implemented in rural areas of Yogyakarta province. The NusaHealth system will be our pilot project to get better understanding and knowledge how mobile health solution answers the health problems in rural areas in terms of promotion and prevention health services. METHODS Universitas Gadjah Mada (UGM) seeks to address the challenges of developing a technology-based health management program. The development of the NusaHealth system starts from looking at the potential of health data that can be processed and enriched to become health information. The NusaHealth project builds a digital healthcare infrastructure involving universities, healthcare providers (hospitals, community health centers, clinics, health offices and others) and communities (including health volunteers) in a mHealth approach that puts patient at the center of health care. RESULTS The NusaHealth system has been realized through the process of design and development which involved experts and partners. Technical descriptions including supported device specifications, operating systems requirements, feature needed, user interface, data storage, interoperability and security assessment produced in the paper. Moreover, the infrastructure to connect mobile devices network with the hospital information system has been developed, as well as supporting systems such as SMS gateway and servers. CONCLUSIONS This paper proves that the process of designing and developing a mobile health solution for rural areas in developing countries needs to be comprehensive and the process of field implementation should involve related partners. While the NusaHealth pilot project in rural areas of Yogyakarta province was successfully implemented, further activities need to be implemented to enhance community health through development of formal mobile health system supported by local health district offices’ policies and regulations. Wider geographical areas will be a challenging opportunity in measuring whether this system is suitable in the context of developing country. CLINICALTRIAL None

GPS mHealth Intervention among People Experiencing Homelessness: A Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Leticia R. Moczygemba ◽  
Whitney Thurman ◽  
Kyler Tormey ◽  
Anthony Hudzik ◽  
Lauren Welton-Arndt ◽  
...  
Keyword(s):  
Community Health ◽  
Mobile Health ◽  
Care Coordination ◽  
Information Exchange ◽  
Social Needs ◽  
Local Health ◽  
Hospital Visit ◽  
Mhealth Intervention ◽  
Significant Difference ◽  
E Mail

BACKGROUND People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased utilization, poor health outcomes, and high health care costs. The majority of homeless individuals have a cell phone of some type, which makes mobile health interventions a feasible way to connect a person experiencing homelessness with providers. OBJECTIVE To investigate the accuracy, acceptability, and preliminary outcomes of a global positioning system-enabled mobile health (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness were in the ED or hospital. METHODS This was a pre-post design with baseline and 4-month post-enrollment assessments. A person experiencing homelessness taking at least two medications for chronic conditions who scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9) and had at least two ED or hospital visits in the prior 6 months was eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily e-mail to assess medication adherence. GPS alerts were compared to ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t-tests compared scores on the PHQ-9, Medical Outcomes Study Social Support Survey, and ASK-12 adherence survey at baseline and exit. Semi-structured exit interviews examined perceptions and benefits of the intervention. RESULTS Thirty participants enrolled; the mean age was 44.1 years (SD 9.7). Most were male (67%; n = 20), White (57%; n = 17), and not working (63%; n = 19). The GPS app showed limited accuracy in ED or hospital visit alerts. Only 18.8% of the alerts aligned with HIE data (3/16), mainly due to patients not having the phone with them during the visit, phone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (M=16.9, SD=5.8) and exit (M=12.7, SD=8.2); t(19)=2.9, p=.009 and a significant difference in adherence barriers between baseline (M=2.4, SD=1.4) and exit (M=1.5, SD =1.5); t(17)=2.47, p = .025). Participants agreed that the app was easy to use (M=4.4/5 with 5 = strongly agree (SA)) and indicated the e-mail helped them remember to take their medications (M=4.6/5). Qualitative data indicated that unlimited phone access allowed participants to meet social needs and maintain reliable contact with case managers, healthcare providers, family, and friends. CONCLUSIONS mHealth interventions are feasible for and acceptable to people experiencing homelessness. Objective data from the HIE provided more accurate ED and hospital visit information, but unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. CLINICALTRIAL Not applicable

scholarly journals Resolving Last-Mile Connectivity Issues in Botswana Using WiMAX IEEE802

2021 ◽  
Author(s):  
Malebogo Mokeresete ◽  
Bukohwo Michael Esiefarienrhe
Keyword(s):  
Developing Countries ◽  
Rural Areas ◽  
High Speed ◽  
Simulation Method ◽  
Line Of Sight ◽  
Infrastructure Development ◽  
Ieee 802.16E ◽  
Access Technology ◽  
Regulatory Standards ◽  
Last Mile

Amongst advantages of using Worldwide Interoperability Microwave Access (WiMAX) technology at the last-mile level as access technology include an extensive range of 50 km Line of Sight (LOS), 5 to 15 km Non-Line of Sight and few infrastructure installations compared to other wireless broadband access technologies. Despite positive investments in ICT fibre infrastructure by developing countries, including Botswana, servicing end-users is subjected to high prices and marginalised. The alternative, the Wi-Fi hotspot initiative by the Botswana government, falls far as a solution for last-mile connectivity and access. This study used OPNET simulation modeller 14,5 to investigate whether Botswana’s national broadband project could adopt WiMAX IEEE 802.16e as an access technology. Several developing countries in Africa and the world use WiMAX technology at access level and gain impressive results. The rampant lack of infrastructure development and the need to provide high-speed technology has necessitated such investigation. Therefore, using the simulation method, this paper evaluates the WiMAX IEEE 802.16e/m over three subscriber locations in Botswana. The results obtained indicate that the deployment of the WiMAX IEEE 802.16e standard can solve most of the deployment issues and access at the last-mile level. Although the findings suggest that WiMAX IEEE 802.16e is more suitable for high-density areas, it could also solve rural areas’ infrastructure development challenges and provide required high-speed connectivity access. However, unlike the Wi-Fi initiative, which requires more infrastructure deployment and less on institutional and regulatory frameworks, the deployment of WiMAX IEEE802.16e requires institutional and regulatory standards.

scholarly journals Planning sustainable community health schemes in rural areas of developing countries

2009 ◽  
Vol 193 (3) ◽  
pp. 768-777 ◽  
Author(s):  
Honora K. Smith ◽  
Paul R. Harper ◽  
Chris N. Potts ◽  
Ann Thyle
Keyword(s):  
Developing Countries ◽  
Community Health ◽  
Rural Areas ◽  
Sustainable Community

scholarly journals How do community health actors explain their roles? Exploring the roles of community health actors in promoting maternal health services in rural Ethiopia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Abebe Mamo ◽  
Sudhakar Morankar ◽  
Shifera Asfaw ◽  
Nicole Bergen ◽  
Manisha A. Kulkarni ◽  
...  
Keyword(s):  
Child Health ◽  
Health System ◽  
Community Health ◽  
Rural Areas ◽  
Maternal Child Health ◽  
Community Members ◽  
Health Extension Workers ◽  
Community Based ◽  
Rural Ethiopia ◽  
Rural Settings

Abstract Background Maternal and child morbidity and mortality remains one of the most important public health challenges in developing countries. In rural settings, the promotion of household and community health practices through health extension workers in collaboration with other community members is among the key strategies to improve maternal and child health. Little has been studied on the actual roles and contributions of various individuals and groups to date, especially in the rural areas of Ethiopia. In this study, we explored the role played by different actors in promoting ANC, childbirth and early PNC services, and mainly designed to inform a community based Information, Education & Communication intervention in rural Ethiopia. Methods An exploratory qualitative study was conducted on 24 in-depth interviews with health extension workers, religious leaders, women developmental army leaders, and selected community members; and 12 focus group discussions, six with female and six with male community members. Data was captured using voice recorders and field notes and transcribed verbatim in English, and analyzed using Atlas.ti software. Ethical approval for the fieldwork was obtained from Jimma University and the University of Ottawa. Results Participants described different roles and responsibilities that individuals and groups have in promoting maternal/child health, as well as the perceived roles of family members/husband. Commonly identified roles included promotion of health care services; provision of continuous support during pregnancy, labour and postnatal care; and serving as a link between the community and the health system. Participants also felt unable to fully engage in their identified roles, describing several challenges existing within both the health system and the community. Conclusions Involvement of different actors based on their areas of focus could contribute to community members receiving health information from people they trust more, which in turn is likely to increase use of services. Therefore, if our IEC interventions focus on overcoming challenges that limit actors’ abilities to engage effectively in promoting use of MCH services, it will be feasible and effective in rural settings, and these actors can become an epicenter in providing community based intervention in using ANC, childbirth and early PNC services.

Low-Budget Techniques for Road Network Mapping and Road Condition Assessment That Are Accessible to Transport Agencies in Developing Countries

2017 ◽  
Vol 2634 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Xavier Espinet ◽  
Winnie Wang ◽  
Shomik Mehndiratta
Keyword(s):  
Decision Making ◽  
Developing Countries ◽  
Asset Management ◽  
Rural Areas ◽  
Pilot Project ◽  
Poor Quality ◽  
Transport Infrastructure ◽  
Rural Roads ◽  
Technical Capacity ◽  
Network Mapping

In rural areas of developing countries, the poor quality of road location and condition data—which in most cases are outdated or nonexistent—is a barrier to transport decision making and investment. Without good information about the transport infrastructure, the local administrations, national agencies, and international donors have difficulty prioritizing investments that will produce higher economic and social returns. Most local and national transport agencies in developing countries lack the specific technology, expensive equipment, and professionally trained staff to survey and collect data on rural roads. Lessons are shared from a pilot project that used an inexpensive technique to survey and assess the condition of road infrastructure in rural areas of Mozambique. Local transport engineers were provided with a smartphone app called RoadLab Pro to increase their awareness of new approaches, tools, and technologies. This pilot project aimed to build technical capacity in applying and replicating practices for use in the future while lowering the barriers to transport decision making and investment that asset management and data collection represent for low-capacity and underresourced transport agencies in developing countries.

scholarly journals Community health workers at the dawn of a new era: 3. Programme governance

2021 ◽  
Vol 19 (S3) ◽  
Author(s):  
Simon Lewin ◽  
Uta Lehmann ◽  
Henry B. Perry
Keyword(s):  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Critical Role ◽  
Decision Makers ◽  
Local Health ◽  
New Era ◽  
Wide Range ◽  
Health Related

Abstract Background Community health workers (CHWs) can play a critical role in primary healthcare and are seen widely as important to achieving the health-related Sustainable Development Goals (SDGs). The COVID-19 pandemic has emphasized the key role of CHWs. Improving how CHW programmes are governed is increasingly recognized as important for achieving universal access to healthcare and other health-related goals. This paper, the third in a series on “Community Health Workers at the Dawn of a New Era”, aims to raise critical questions that decision-makers need to consider for governing CHW programmes, illustrate the options for governance using examples of national CHW programmes, and set out a research agenda for understanding how CHW programmes are governed and how this can be improved. Methods We draw from a review of the literature as well as from the knowledge and experience of those involved in the planning and management of CHW programmes. Results Governing comprises the processes and structures through which individuals, groups, programmes, and organizations exercise rights, resolve differences, and express interests. Because CHW programmes are located between the formal health system and communities, and because they involve a wide range of stakeholders, their governance is complex. In addition, these programmes frequently fall outside of the governance structures of the formal health system or are poorly integrated with it, making governing these programmes more challenging. We discuss the following important questions that decision-makers need to consider in relation to governing CHW programmes: (1) How and where within political structures are policies made for CHW programmes? (2) Who implements decisions regarding CHW programmes and at what levels of government? (3) What laws and regulations are needed to support the programme? (4) How should the programme be adapted across different settings or groups within the country or region? Conclusion The most appropriate and acceptable models for governing CHW programmes depend on communities, on local health systems, and on the political system in which the programme is located. Stakeholders in each setting need to consider what systems are currently in place and how they might be adapted to local needs and systems.

scholarly journals Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Warren Dodd ◽  
Amy Kipp ◽  
Bethany Nicholson ◽  
Lincoln Leehang Lau ◽  
Matthew Little ◽  
...  
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Local Governments ◽  
Local Politics ◽  
The Philippines ◽  
Health Needs ◽  
Health Priorities ◽  
Local Health

Abstract Background Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW programs may differ across settings due to variations in resource allocation and local politics. In the context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore how the experiences of CHWs across different settings were shaped by the governance and administration of CHW programs. Methods We conducted 85 semi-structured interviews with CHWs (n = 74) and CHW administrators (n = 11) in six cities across two provinces (Negros Occidental and Negros Oriental) in the Philippines. Thematic analysis was used to analyze the qualitative data with specific attention to how the experiences of participants differed within and across geographic settings. Results Health system decentralization contributed to a number of variations across settings including differences in the quality of human resources and the amount of financial resources allocated to CHW programs. In addition, the quality and provider of CHW training differed across settings, with implications for the capacity of CHWs to address specific health needs in their community. Local politics influenced the governance of CHW programs, with CHWs often feeling pressure to align themselves politically with local leaders in order to maintain their employment. Conclusions The functioning of CHW programs can be challenged by health system decentralization through the uneven operationalization of national health priorities at the local level. Building capacity within local governments to adequately resource CHWs and CHW programs will enhance the potential of these programs to act as a bridge between the local health needs of communities and the public health system.

M-phone impact on practical training: role of m-phone as part of the educative method for training local health workers of rural areas of developing countries

2014 ◽  
Vol 4 (3) ◽  
pp. 289-294 ◽  
Author(s):  
Livia Bellina ◽  
Giovanni Azzolina ◽  
Ilenia Nucatola ◽  
Annalisa Maggio ◽  
Francesco Consiglio ◽  
...  
Keyword(s):  
Developing Countries ◽  
Rural Areas ◽  
Health Workers ◽  
Practical Training ◽  
Local Health

Harmonization of clinical laboratories in Africa: a multidisciplinary approach to identify innovative and sustainable technical solutions

Diagnosis ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Giovanni Putoto ◽  
Antonella Cortese ◽  
Ilaria Pecorari ◽  
Roberto Musi ◽  
Enrico Nunziata
Keyword(s):  
Health System ◽  
Rural Areas ◽  
New Technologies ◽  
Critical Role ◽  
Sub Saharan Africa ◽  
Local Health ◽  
Governmental Organization ◽  
Minimal Sample ◽  
African Health ◽  
Sub Saharan

AbstractIn an effective and efficient health system, laboratory medicine should play a critical role. This is not the case in Africa, where there is a lack of demand for diagnostic exams due to mistrust of health laboratory performance. Doctors with Africa CUAMM (Collegio Universitario Aspiranti Medici Missionari) is a non-profit organization, working mainly in sub-Saharan Africa (Angola, Ethiopia, Mozambique, Sierra Leone, South Sudan, Tanzania and Uganda) to help and sustain local health systems. Doctors with Africa CUAMM has advocated the need for a harmonized model for health laboratories to assess and evaluate the performance of the facilities in which they operate.In order to develop a harmonized model for African health laboratories, previous attempts at strengthening them through standardization were taken into consideration and reviewed. A survey with four Italian clinicians experienced in the field was then performed to try and understand the actual needs of health facilities. Finally a market survey was conducted to find new technologies able to update the resulting model.Comparison of actual laboratories with the developed standard – which represents the best setting any African health laboratory could aim for – allowed shortcomings in expected services to be identified and interventions subsequently prioritized. The most appropriate equipment was proposed to perform the envisaged techniques. The suitability of appliances was evaluated in consideration of recognized international recommendations, reported experiences in the field, and the availability of innovative solutions that can be performed on site in rural areas, but require minimal sample preparation and little technical expertise.: The present work has developed a new, up-to-date, harmonized model for African health laboratories. The authors suggest lists of procedures to challenge the major African health problems – HIV/AIDS, malaria, tubercolosis (TB) – at each level of pyramidal health system. This model will hopefully support the non-governmental organization (NGO) Doctors with Africa CUAMM in its activities in sub-Saharan hospitals, providing them with a guideline to programme future interventions.

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