Harnessing ICTs for community health - The AfriAfya initiative

Author : Caroline Nyamai
Date added : 2002-04-15

Brief Project Background

AfriAfya, African Network for Health Knowledge Management and Communication, is an initiative established in April 2000 by Kenya-based health development agencies to explore new opportunities for harnessing communication and information technology for community health. The idea for AfriAfya was based on the realization that while modern ICTs had provided commercial entities, universities, ministries, research institutions and big hospitals with information and assistance in their activities, it had done very little for rural communities, particularly rural Kenyan (and African) communities in the area of health.

A number of health NGOs in Kenya, interested individuals and the Ministry of Health thus got together in a workshop in April 2000 to explore how we might ‘harness ICT for community health’. The agencies recognized that they all wanted to do something in this area, and that none of them individually had adequate solutions. It was therefore agreed that a consortium, later called AfriAfya, be established to explore practical means of turning these good ideas into practical, useful reality on the ground. The consortium consisted of seven of the large health NGOs in Kenya and the Ministry of Health. The NGOs involved are: Aga Khan Health Services, Kenya; African Medical and Research Foundation (AMREF); CARE Kenya; Christian Health Association of Kenya (CHAK); SatelLife HealthNet Kenya; PLAN International; and World Vision International, Kenya.

A Steering Committee was established consisting of representatives of the Partner Agencies and individual founding members. A grant proposal was developed, and funding obtained for the 18-month exploratory phase starting in January 2001.
AfriAfya aims at contributing to African health and social development through communicating relevant health information to local change agents. The purpose of the AfriAfya pilot project was to establish mechanisms for generating, managing and sharing knowledge at community level through active institutional networking.

The exploration is therefore on how ICTs can be used in rural and other marginalized Kenyan (and ultimately African) communities to improve access to relevant up-to-date health information with the ultimate goal of improving health in these communities. The results so far have been very exciting.

AfriAfya was established to explore practical means of ‘harnessing ICT for community health’, and turning all the good ideas often expressed in this field into practical, useful reality on the ground. It aims at improving health through increasing the availability of relevant up-to-date health information in target communities. It recognised that while there is an abundance of health information in the world today, there is a very severe scarcity of health information in most Kenyan rural settings, and is working to improve this.

AfriAfya is a consortium of seven of the large health NGOs in Kenya and the Ministry of Health. The project has set up a small coordinating hub and seven field centres selected from existing community-based health intervention sites run by each of the Partner Agencies. The field centers are spread out across the country and consist of different types of facilities in a range of settings: an urban slum community-based health care project, a rural dispensary, a mission hospital, a rural community training centre, a community-based child survival project, a primary school and a District Medical Officer’s office.

Communication was established between the hub and each of the Partner Agencies and field sites, and between the different field sites. Each of these sites were equipped with a computer, its operating software, printer, data modem, WorldSpace receiver and PC adaptor card, and three to four staff from each of these sites trained in the use of this equipment. One site was additionally equipped with a television and video and various health videocassettes. Solar panels have been used to power the equipment where there is no electricity.

The choice of field centers to include centers without electricity or telephone connectivity was based on the fact that this is the reality in most of rural Kenya. As AfriAfya is a pilot project exploring innovative ways of harnessing ICTs for community health, it is important that this is done bearing in mind the realities and practical limitations of working in rural Kenya where 80% of the Kenyan population lives. If ICTs are to be used to serve the majority of our population then we have to work out ways of dealing with these limitations to ensure some areas are not left out.

Training of the field site staff involved basic computer literacy, word processing, email messaging tools, web surfing skills, WorldSpace use - both the audio service and the data downloads, and the crucial skills of learning how to learn using ‘Help’ and electronic Tutorials.

The field sites are being used as the testing ground for these new technologies, and to see how well the modern technologies integrate with the traditional health communication methods. HIV/AIDS is being used as the pathfinder topic since it is a subject of high interest to all the Partner Agencies and their field sites. Later the Network intends to respond to other health information requests presented by the communities involved, and to expand to cover other health topics of interest such as malaria, tuberculosis and others.

The project is designed to ensure a two-way communication process so that information provided to communities is what they want, and to avoid just dumping information on them. As such one of the project activities has been to have field sites collect information from the communities they are working in regarding existing and desired HIV/AIDS information, as well as communication methods in use with a view to strengthening both of these. The hub has collected information generated from the experience and questions provided by the communities involved, official publications from the MOH, the National AIDS and STDs Control Programme, Partner Agencies, other HIV/AIDS organizations in the country, and from the Internet.

The hub then repackages this information in a simplified, easy to read format, and sends it back to the field centers for use by the field center frontline healthcare workers and change agents, with the aim of supporting them and enhancing their capacity to deal with health problems and questions raised by lay community members. The health workers range from community health workers with a form four level of education and additional on-the-job health training to nurses and health education officers to doctors. Their levels of training are thus very varied. The change agents are people within the respective communities that are able to influence other community members and bring about change. Examples of change agents that field centers are working with are village elders, women group leaders, traditional healers, traditional birth attendants, village health committees, opinion leaders, youth group leaders, teachers, religious leaders, various outreach workers, peer educators, and community own resource persons.

Questions and information requests raised range from simple factual issues to social issues, cultural practices that promote the spread of HIV/AIDS, and issues concerning community experiences gained over time. We obviously do not have the answers to all of these questions, and look into various information sources to try and find what information there is on this, and a lot of it is actually not at all readily available. Links to designated advisers in partner agencies in Kenya and elsewhere able to help debate and formulate answers to some of the questions raised are important to the whole process, and ICTs have now made that process very easy.

We at AfriAfya have been working as a Staging Post, accessing and receiving information from local and international sources, adapting it and ensuring it is relevant to practical issues in our setting, and then disseminating it to the community-based health intervention sites that we are working with. This is done through email, printed material, diskettes, CD ROMs, telephone and fax. Plans are underway to be able to share the content through WorldSpace data downloads via the WorldSpace wireless satellite communication with the information being uplinked through their Nairobi office.

The direct sharing of information and experiences between the different field centers and between the partner agencies is an additional interaction of crucial importance to the project.

Currently we in the process of developing a Knowledge Management Unit. This is a database built using Internet tools, with search facilities, and accessible over the Internet. It will be loaded on the field center computer hard disks and also given to them on CD ROMS and will be updated regularly. This is because most of the field centers do not have reliable Internet connectivity, and some do not even have telephone communication facilities. The WorldSpace satellite technology is another form of providing access to the health information for the field centers.

Results

Through the AfriAfya project it has been possible to introduce the use of ICTs in the seven field sites we are working in - six of them in rural Kenyan settings, and one of them in an urban slum setting. These sites have been equipped, and the staff there trained in the use of this equipment, and are using it. Even rural women with a very basic level of formal education have been able to learn how to use the equipment and are using it. In a community such as ours where the modern ICTs are considered largely the preserve of big institutions in cities, having such equipment in a rural setting and having ‘normal rural women’ operating it has in itself been quite an achievement.

The project activities are centered on collecting health information, repackaging it, and disseminating it to the target audiences, using ICTs as a tool to facilitate this. So far the project has collected information from the communities that field centers are working in and shared this with other field centers. This was done through a baseline survey on communication methods in use and HIV/AIDS information being communicated to and from the communities. Other information collected was the HIV/AIDS information that the communities have, the information they want, questions that they have in this area and the desired packaging for the information.

The project has collected information from the Partner Agencies and shared this with the other Partner Agencies. Having the seven health NGOs and the MOH working together and sharing their experiences has been a key achievement of the project. In many instances health NGOs will be doing similar work, sometimes even in the same communities, and not know what the other is doing. Sharing their experiences has meant that they don’t all have to reinvent the wheel all the time - they can learn from one another’s experience.

The Hub has compiled one-page simplified HIV/AIDS information sheets using information obtained from the MOH, National AIDS and STDs Control Programme and the Internet. These have been sent to all field centers for use by the community health workers and local change agents. Some field sites have had these translated into their local languages, thus providing IEC materials in a language that the local communities understand. Some have incorporated this information into songs, drama and poetry that they then use to communicate the health messages. In one rural community with no electricity or telephone lines, it has been possible to use solar powered equipment to allow health video shows even under a tree.

The information accessed through the system has not been limited to health information only. Agricultural information and information about income generating activities has also been accessed using the WorldSpace receivers.

There has been increase in discussion of HIV/AIDS issues in communities in which it was previously very difficult to break the silence in these matters. Some of the communities are beginning to show a willingness to start dialogue about some of the high-risk cultural practices such as wife inheritance and various funeral rites. There is increase in condom uptake in some of the field centers, and increased demand for voluntary counseling and testing services in communities that were previously very averse to the very mention of HIV testing. Community participation in health issues has increased, with bigger turnouts reported at community health meetings and health action days. While it is still too early to demonstrate improvement in health through the project activities, with these changes that are beginning to take place it is clear that if these continue there will be a definite impact on HIV transmission in these communities with the attendant improvement in health.

There have already been requests to join the Network by other facilities that have seen what is happening at the pilot sites. Some rural facilities are even prepared to put in their own very scarce resources into purchasing the equipment following the developments they have seen in participating sites.

In the Kwale district where we have been working with the district medical officer’s office, using ICTs has enabled him process the monthly returns coming in from the 57 facilities in the district and give feedback to the facilities. This whole process has increased reporting rates and the timeliness of reporting. It has further allowed him to target interventions based on information on what the key problems in a particular locality are. Immunization coverage has gone up from being one of the lowest in the province to now being one of the highest in that province. And the Provincial Medical Officer who has noticed the improvements in this district now wants this extended to the other six districts in the province.

The project has written papers on its ideas and experiences so far including some of the lessons learnt and shared these with others at different relevant meetings, where they have been received with a lot of interest. It is participating in relevant electronic discussion lists including the HIF-net at WHO, AfroNets and GKD to learn more and to share ideas with others. It has prepared a newsletter to keep others informed of project activities, and is in the process of developing a website and knowledge management unit for the additional dissemination of information.

The outlook for the future so far is very positive. The project will work on refining the communication and content repackaging process, finalizing the knowledge management unit, field-testing the suitability of the health content provided by the unit, and using the feedback from the field to repackage this as desired. Expansion will then thereafter be undertaken with regard to the health topics being addressed based on the priority health conditions in the areas served. Geographic expansion will start with other health intervention sites run by the Partner Agencies, and then expansion to include new partners, sites and other countries will follow.

Lessons

Many of the lessons that have been learned as a result of the AfriAfya initiative are not necessarily new. For many people who are involved, they simply reinforce and strengthen the validity of lessons that have already been learned. The experience of AfriAfya has also served to move some of those lessons from the realm of the theoretical to the realm of the practical. People are learning the lesson of not simply what it would be good to do, but how to do it and - perhaps most importantly - that it can be done in rural Kenyan communities with limited resources.

Some of the lessons learned are the following:

§ Networking, collaboration and ongoing partnership between different health organizations and institutions can be successfully developed, as demonstrated by the seven partner agencies currently working together and seeing mutual benefit in this. This, however, requires competent management to make it work. At the beginning there were concerns about ‘fraternizing with the opposition’, and ‘big’ partners overshadowing ‘small’ partners, but these have since diminished.

§ Cooperation with external partners and international organizations has contributed to the success of the project. At the initial workshop when the ideas were being discussed the participation of organizations already using ICTs for health in various ways provided a useful input. With time, the interaction with others through email lists, on the videoconference and in face-to-face meetings has provided a lot of new insights. Learning from others already doing it has meant that we have not had to try to reinvent the wheel.

§ Building on existing structures is quicker than starting from scratch - working with already established health intervention sites has allowed AfriAfya to jump-start and bypass many of the very time consuming start-up stages. It has additionally built on what is there and enhanced it, which makes it easier to sustain than a stand-alone ICT project would be.

§ People with limited background education can acquire basic computer skills, even rural women living in a rural Kenyan environment. Continuing development of these skills requires back up. A key lesson here has been that one should never underestimate the ability of rural people, especially rural women.

§ Equipment is not available in the vast majority of community health settings and setting up does remain a major expense - computers, Internet access etc. Additionally, just giving the equipment is not enough; there needs to be training, follow-up and support to encourage use and resolve whatever technical problems arise.

§ Establishing two-way communication processes takes time, and needs to be continuously refined and improved along the way. It is important to find out what information people want - rather than supplying them with what you know. Two-way communication is essential if the information being provided is to remain relevant to the people on the ground. Keeping the ‘right’ information flowing - from the users’ point of view - does remain a real challenge.

§ Listening to and then responding to community needs in a tangible manner helps community members to become involved, participate, and own the process.

§ If community members are properly enabled, it is possible to have an effective ICT programme even in isolated rural areas.

§ Do not expect that sharing and communication will happen automatically. It needs facilitation and encouragement.

§ Despite the plethora of health information on the Internet, very little is directly suitable for dissemination to poor communities as it is. It needs to be repackaged to ensure local suitability and relevance.

§ Web resources can improve the quality of content and presentation for local health information production. Sites that can summarize reliable accurate information become of particular interest as searching the vast www on bad slow connections can be an absolute nightmare.

§ A final key lesson has been that there is no single solution: working in a diverse group of settings has been a big strength because it has demonstrated different ways of using the different technologies effectively.

Development Impacts

A key achievement of the AfriAfya pilot project has been in showing some practical methods of applying ICTs in rural and marginalized Kenyan communities to improve the communication of health information. The same system can be applied for communication of any other type of information - agricultural, educational, and any other information for development.

An area that has been a challenge for many has been the area of working out how to turn the many good ideas about the potential uses of ICTs to practical reality on the ground especially in rural communities. This project demonstrates some ways of doing that. By applying the same process, the reach of various information services can be widened, particularly to include communities that are often marginalized - rural communities and the urban poor living in slum settings.

The knowledge management unit is a key development. Once this is well worked out and fully developed, scaling up the project to provide information to a much wider target group becomes very easy using the power provided by modern technology. For example, once the content is developed, using the WorldSpace satellite technology makes it possible to reach the whole of the African continent with that information, so long as the people have the digital receivers, whose price is coming down quite fast. Having the same information accessible over the Internet allows anyone else in another African country to access already adapted information that they can further adapt to suite their own local environments.

The success of this pilot phase has thus provided a basis from which a gradual up scaling can be done to cover more communities within the Kenyan and eventually the African context. Other interested parties can also replicate the model used here across the African continent and elsewhere.

Project Information

Organisation : AfriAfya
URL : http://www.afriafya.org/
Total budget in US$ : 198,538
Country of activity: Kenya [KE]

Are there any partners involved : yes
What is partners role?: The Partners Agencies form the Network, and their active participation is therefore necessary to keep it alive and meaningful. Sharing their own vast practical experiences in the area of HIV/AIDS provides useful learning opportunities for other Network members. The Partners have each nominated one of their community-based health intervention sites to be used as field sites for this exploration. Their premises, their staff and their on-going health interventions are therefore being used to explore different models for use of the different technologies for health. The Partners continue to pay for their staff, the running of their respective units and the programs they run, while AfriAfya has introduced the ICT component to improve the access to relevant up-to-date health information. The feedback obtained from the field sites regarding what information they require, the usefulness of the information once transmitted to them, sharing their own practical experiences, the ease of using the different technologies and their usefulness are all crucial to the further development of the project.

Contact Information

Caroline Nyamai
cnyamai@afriafya.org
Box 30125
Nairobi
Kenya

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