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Going the last mile: How can we achieve “health

information for all”?

2009 Global Health Mini-University October 9, 2009

Tara M. Sullivan & Saori OhkuboJohns Hopkins Bloomberg School of Public Health, Center for Communication

Programs

Nancy LeMay & Piers BocockManagement Sciences for Health

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Learning Objectives

By the end of this session, participants will:– Discover what over 800 professionals said they

needed in an online survey.– Learn the field-level view from one of the first multi-

country qualitative studies on healthcare information requirements.

– Find out how organizations are using new technologies and other approaches to make information available.

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Overview

• How can we achieve “health information for all”?

• What is “knowledge for health”?• What are information needs, capacity, and

delivery preferences of health professionals?• How can we extend the reach and use of

health information?• Discussion/small group exercise

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Health Information for All

• Universal access to informed health care providers

• Access to clean, clear knowledge is as important as access to clean, clear, water

• Health professionals need access to reliable, relevant, and usable information

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K4Health Mission

• Make quality health

information easy to

find and easy to use

for policy makers,

program managers,

and service providers.

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Needs AssessmentResearch Questions

• What are the health information needs and health information needs and preferencespreferences of key audiences?

• What infrastructureinfrastructure exists to support ICTs?• What are the most promising technologies and technologies and

toolstools? • What health information networkshealth information networks exist?• What are the What are the challengeschallenges to accessing and using up- to accessing and using up-

to-date health information?to-date health information?

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Needs AssessmentMethods

• Environment Scan• Global Online Survey• Multi-country qualitative study:

– Countries: Malawi, Senegal, India, Peru– Methods: Key informant Interviews, Network

stakeholder interviews, Focus group discussions– Coverage: Central, district, community levels

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Highlights:Environment Scan

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Methods

• Search of published literature using PubMed and online databases & bibliographies

• Internet search for grey literature, relevant projects, and health information networks

• Interviews with knowledge managers at 17 organizations that are active members of HIPNET

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Needs and Preferences

Providers need information that is:• Trustworthy• Up-to-date • Relevant to the local setting • Practical • Easy to digest• Convenient and accessible

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Needs and Preferences

Health workers in LDCs rely on:

• Workshops and meetings sponsored by facility/health care system

• Official materials (e.g., guidelines, manuals, and hospital protocols)

• Discussions with colleagues• Textbooks• Internet, if available

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Infrastructure, Technology & Tools

Mobile Phones Lead in Every Region

0

20

40

60

80

100

120

Africa Americas Asia Europe Oceania World

Nu

mb

er

pe

r 1

00

inh

ab

ita

nts

Fixed telephone lines Mobile phone subscribers Internet users

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Networks Social Networking Expanding

Rapidly

Region

# of Unique Visitors

% changeJune 2007 June 2008

Asia-Pacific 163 million 201 million 23%

Europe 123 million 165 million 35%

N. America 121 million 131 million 9%

Latin America 40 million 53 million 33%

Middle East & Africa 18 million 30 million 66%

Worldwide 464 million 581 million 25%

Source: comScore World Metrix

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Barriers

Complaints about information sources:• Materials are out of date, inappropriate,

irrelevant, and/or costly• Internet access is unavailable or expensive

• Limited access to meetings, medical societies

• Providers are too busy

• Lack of a reading culture

• Information overload

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Highlights:Global Online Survey

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Distribution of respondents (n=808)

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Needs and Preferences Top 4 Useful Information Resources by Job Function

How useful are the following types of information resources for obtaining health information?

Source: Online Survey

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Needs and PreferencesSources of Health Information

From whom do you obtain health information?

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Needs and Preferences Usefulness of electronic resources for obtaining health

information

How useful are the following types of electronic resources for obtaining health information?

89%

92%

93%

96%

0% 20% 40% 60% 80% 100%

CD-ROMs

Databases

Online Training/e-Learning

Web Search Engines

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Needs and Preferences Top 4 FP/RH Topics by Job Function

For which FP/RH topics do you need more information in order to perform your job?

Source: Online Survey

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Infrastructure, Technology & Tools

Access to Information Technology (IT) Devices Do you have routine access to the following IT devices that can be used for

work-related activities?

23%

47%

90%

96%

95%

98%

98%

0% 20% 40% 60% 80% 100%

PDA

iPod/MP3 Player

DVD Player

Printer

Mobile Phone

Computer/Internet

Computer/CD-ROM

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Infrastructure, Technology & Tools

Time Spent on Internet

1%

30%

54%

15% Never

Less than 1 hour a day

Between 1 and 4 hours a day

More than 4 hours a day

How much time do you spend on the Internet searching and sharing health information?

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Networks

Professional Networks Listed by Survey Respondents

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Barriers

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Highlights:Malawi Qualitative Study

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Respondents

  Central level District level Community level

Total

Key informant interviews

20Program Directors; Senior Managers;

Local network representatives

4District health officers; NGO

district managers

1Health facility staff member

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FGDs 1USAID HPN staff

3District health management

team; NGO district managers

6Health facility

staff; community health workers

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Needs and Preferences

Sources of information• Internet• Government and partner organizations• Professional networks• Technical working groups• Training workshops and meetings

“Our information is a bit scattered. I think we don’t have centralized information, we don’t know … if you really need this information, whom should you consult or whom should you contact….” – Interview, Christian Health Association of Malawi (CHAM)

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Needs and Preferences

“… the other challenge, you have the information but it’s huge … you don’t know: Is this applicable to Malawi? How do I simplify this information and relate it to what I have? And how do I [pass] this information on?”

– Interview, Ministry of Health, Health Education Unit (HEU)

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Needs and Preferences

“…often times you find maybe there are so many documents that are very important, you want these issues to be communicated to [service providers] but they are not in a language which [providers] can read and understand…” – Interview, Malawi Network of People Living with HIV/AIDS (MANET+)

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Needs and PreferencesPriority topic areas

(1) Family Planning/Reproductive Health – Injectable contraceptives, STIs, safe motherhood,

natural family planning

(2) HIV/AIDS– ARVs, prevention, behavior-change

communication, counseling, referral, PMTCT

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Infrastructure, Technology & Tools

(1) Internet at central level is good, at district level is fair, at community level is non-existent

– Wireless is widely available, but expensive.

(2) Mobile phone usage is good; at central level 15 phones per 10 person, district 10 per 10 person, community 7 per 10 person

– Airtime and network reliability are challenges.– SMS is widely used

(3) Most people have printers at central and district level, but ink and paper are expensive

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Infrastructure, Technology & Tools

Malawi Qualitative Study“…nowadays you get

new information mainly on the Internet, but not all computers are connected to the Internet and not all people are able to use it, not everybody is computer literate.”

– FGD, Salima District Health Office

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Networks

(1) Networks’ capacity for knowledge exchange needs to be strengthened.

(2) HIV/AIDS networks seem to be better established/ more useful than FP/RH.

(3) MOH Technical Working Groups and NAC are the most reliable “networks” currently.

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Barriers

(1) Getting information to the community level

(2) Using health information• Lack of reading culture• Literacy/language issues

(3) Limited capacity to access the Internet

(4) Limited knowledge about web-based resources and how to find them

(5) Lack of knowledge management/exchange experience

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Summary of findings

• Challenge of either too much or too little information

• Need for reliable, relevant and usable information

• Need for continuing education opportunities• Opportunity to leverage ICTs exist• Need for stronger links between levels of

the health system

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How do we achieve health information for all?

• Develop toolkits of carefully selected information resources

• Provide customized searches and comprehensive databases

• Facilitate knowledge exchange and learning (on and offline)

• Design country-level KM programs that link central level knowledge to district and community levels

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www.K4Health.org/toolkits/

K4Health Toolkits

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K4Health Custom Search & Databases

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eLearning•Antenatal Care•Diarrheal Disease•Emergency Obstetric and Newborn Care•Essential Newborn Care•Family Planning 101•Family Planning Counseling•Family Planning Programming – Elements of Success•Female Genital Mutilation/Cutting (FGM/C)•Fostering Change in Health Services•FP Legislative & Policy Requirements (Updated)•HIV Basics (Part 1)•Hormonal Methods of Contraception•Human Resources for Health (HRH)•Immunization Essentials•IUD•Logistics for Health Commodities•M&E Fundamentals•Macroeconomics 101•Malaria•Malaria in Pregnancy•Maternal Survival – Programming Issues•Mother-to-Child Transmission of HIV•Newborn Sepsis•Pneumonia•Population, Health and Environment Basics•Postpartum Care•Postpartum Family Planning•Preventing Postpartum Hemorrhage•Standard Days Method•Tuberculosis – Advanced Concepts•Tuberculosis Basics (Updated)•Youth Reproductive Health

32 Available eLearning Courses

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Country KM ProgramPromoting Knowledge Exchange at Multiple Levels of

Health System

• National Partnership Platforms– Facilitates exchange through one platform– Increases scale and use of best practices

• Technical Working Groups– Focuses on country-level health topics– Uses a collaborative process to develop toolkits

• District Learning Centers – Supports local capacity strengthening

• Country Correspondents– “Push” knowledge through all levels of health system

(dissemination) and “pull” knowledge from community up the system (feedback)

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Conclusion

• Results clearly show that electronic resources are highly popular among respondents

• Respondents also obtain information mostly from colleagues/staff and partner organizations

• An effective knowledge exchange model brings together a series of high performing electronic solutions with the power of the people in networks

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Acknowledgements

• FHI: Laura Raney, Beth Robinson

• MSH: Piers Bocock, Nancy LeMay

• JHU/CCP: Nandita Kapadia-Kundu, Philippe LeMay, Vanessa Mitchell, Elsie Mwaniki, Saori Ohkubo

• Independent Consultant: Adrienne Kols

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For more information

• All reports available October 22nd: www.k4health.org/needsassessments– K4Health Environment Scan – Results of Global Online Survey– Malawi Qualitative Study Results

• Contact: needsassessment@k4health.org

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Discussion/small group exercise

• What results were as expected or confirmed what you know?

• What results were surprising based on your experience?

• What else would you like to learn about health information demand?

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Johns Hopkins Bloomberg School of Public Health

Center for Communication Programs111 Market Place, Suite 310

Baltimore, MD 21202Tel: 410-659-6300Fax: 410-659-6266

Contact: Tara Sullivan, Research Associate(tsulliva@jhuccp.org)