Ambient Wireless networks for SSA: a critique’s view

Sina’s post on wireless networks for health in SSA

Adesina Ileyumi is a good friend and has written a nice article in eHealth magazine about wifi in the context of health care delivery in Subsaharan Africa. Much of what he has written is also applicable in an Indian context as well. I have summed up what I thought were his main theses in point format. Several of his assertions were not backed up by data, but we assume that he may have had reasonable data/knowledge to state them, so we ask no question about them.

1) He began indicating that health knowledge among masses in SSA is spare or they are of poor quality.

2) He then stated that SSA countries lack qualified trained people in their healthcare system because they either do not live long (they die due to HIV?), and/or qualified doctors migrate from villages to towns and from towns to foreign countries.

3) Third, that SSA countries lack sufficient money or resources adding an additional burden to the problems.

4) His thesis was ICT will be alternative or complementary to overcome these problems.

5) He seemed hopeful that WHO’s Global Observatory for eHealth (Goe) will adequately address to the pressing needs of healthcare delivery systems in SSA

6) He believed eHealth will help in enabling development of quality human resources for healthcare sector

7) Now, this was the big one: “Connectivity and access through wireless  could make possible communication between different levels of health system, which in turn could ensure the co-ordination and cooperation between varied and distributed actors and infrastructure” (verbatim).

I thought it was an extraordinarily bold statement, and no clues how he jumped from 6 -> 7. What’s wrong with wire based or non-wire based but other forms of communications? It was not clear how is wireless system superior?

8) His thesis was that in the emerging market, there is now social democratization and diffusion, evidenced by more GSM phone usage rising. GSM + VoIP >> Fixed phone users and growing. But who are using them? What segment? What technology for what segment? Is the cost justified?

9) WLAN mobile phone + mobile access points = fully mobile community Internet access for community based home care givers

10) Not just voice based communication; large amount of data, distributed actors

11) He argues for an integrated health information system (HIS) and finds it in line with African Health Infoway (AHI).

12) He outlines the mechanisms in which the information flow can be set up:

* ad-hoc models with or without asynchronous transfer of data using kiosks and mobile WLAN systems (Daknet, for instance, or with other types of store and forward technology).
* mobile device — wire — PC — secure website — central repository
* teleconsultation
* Continuous
 ** OLPC — wi-fi — GPRS/3G — long distance wifi network

Sina excellently sums up the technology side of the story. The implementation in real world will be interesting.

I’d have concern over the following issues:

a) As he stated, the distribution of health knowledge is sparse and poor quality. That given, what’s the likelihood that wireless connectivity be worse then rather than not
having it at all? Who knows, it may only end up spreading wrong information, urban legends, rumors and poorer quality of information. I guess then ease of communicability is not the solution, if not part of the problem. The real solution is actually to have more trained people and raise awareness through basic education and generation of awareness. Technology can certainly come in to link and reinforce the process.

b) If qualified health care providers tend to migrate and/or die sooner than expected, can technology fill that vacuum? In other words, one can have all the right information available in the right places, but who will implement them?

c) It’s great to have a structure set up, but I noted the information flow structure is excellent up the afferent limb: in other words, if I believe that the information is going to flow from periphery to the center (as if some central repository: all the time we get to hear terms like mobile phones linked to WLAN, or wired to PCs, daknet, etc). That limb is excellent, how about the efferent limb? In other words, how does the circuit work? If the efferent limb was not equally effective in channelling the flow of information, and _then_ reaching the end user (the last mile connectivity), no amount of technology could address the basic problems, in my opinion.

Some days back, we were talking to a health official in West Bengal state of India where we had gone to see this guy to talk about a software that I had written to enable using mobile phones and handheld devices for disease surveillance and classifying diseases. His concern was about the last mile connectivity. What happens if there are no connection at the peripheral end? What’s the cost of technology? Who will buy them? Who will implement them? We are also assuming here that the electricity and other dependent stuff would remain the same. What happens if the handheld device battery runs out in the middle of transaction? What happens if there are no electricity so you cannot connect to the net or cannot charge your phone?

d) Wifi’s great, but wifi’s also dangerous for your health because of its microwave emission. What’s the cost of technology versus human lives lost or quality of life gone for adopting a technology that may harm you in the end. How do we calculate the leverage value?

As we move on to the era of wifis and web 2.0 and all that technology integration and mobile phone, handheld devices, multi-tasking and fun stuff, there are some inevitable questions and concerns that need to be tackled. Hopes and dreams are great too.

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