The British Computer Society Developing Countries Specialist Group
collaborated in a workshop on the above topic with the International
Medical Informatics Association (IMIA) Working Group 9 (Developing
Countries) held in London 2-5 September 2001. About 100 delegates from
20 countries participated. More information about IMIA and the workshop
content will be found at http://www.fim.org.ar/wg9
For information, here is the text of my presentation to this workshop:
medinfo2001
PRESENTATION TO IMIA WG9 WORKSHOP
4th SEPTEMBER 2001
Globalisation and Development
(a brief perspective in relation to access to health information)
Brian R Layzell MBCS MIHM MRSH
Consultant in Health Informatics
Secretary, Developing Countries Specialist Group, British Computer Society
United Kingdom
PREFACE
This discussion paper has been compiled using content from a draft
position paper being prepared by the British Computer Society's
Developing Countries Specialist Group, and supplemented with
observations relevant to health information based on personal
professional and working experience.
FUNDAMENTAL PREMISES
A whole range of political, economic and social frameworks, as well as
technologies, are critical to the use and effectiveness of information
and communication technologies and are different in developing countries
from those we are accustomed to in the first world economies.
Therefore, we should be concerned with not only with technology but with
the human, organisational and societal implications of information and
communications technologies and information systems in developing countries.
We can see a high degree of exploitation. People in developing countries
are having machines thrust upon them and have to adjust to a rapid rate
of change, far more rapid than we ourselves have had to absorb. For
example, the business processes onto which information systems have been
grafted have developed in the west over a long period of time and even
now there is nothing like a standard across cultures. Wide-scale
computerisation has considerable cultural implications, not least the
imposition of first world notions of society and societal structures.
These cultural and social foundations to information and communications
technologies are not always obvious. Many people act with the best of
intentions and from a spirit of genuine concern for the difficulties
which people and nations experience in trying to play a full part in the
world. But more often than not a foreign understanding of the world is
built into the very assumptions that structure the systems and the
assumed consensus on the way the world is.
These fundamental premises apply in healthcare, and therefore to the
future use and development of health informatics, equally as much as in
other sectors.
TECHNOLOGIES - THE POTENTIAL TO EFFECT CHANGE
Technologies are important. The speed of uptake of electronic commerce
has the potential to quite fundamentally change the access to markets
and market mechanisms for people in the third world.
For example:
The development of solar power panels quite fundamentally changes the
production and economics of electrical power by reducing the assumed
dependence on fossil fuels;
The development of hand held connectionless oriented communication and
processing devices, that is to say personal data assistants (PDAs) with
line of site, infrared, satellite based, and fibre based communications
all change the provision of and economics of telecommunications networks
both locally and globally;
The development and use of multi-media and communications technologies
in combination enables the widescale developments in telemedicine and
telecare, which in turn leads to an opportunity to rethink how health
services are provided, organised and managed.
In healthcare, these technological developments present both threats
(eg. to privacy, security and confidentiality) and opportunities (eg..
for improvements in diagnoses, treatment, care and research) for
clinicians, managers and patients alike. They also contribute to the
ability of patients to be empowered with knowledge to participate in the
management of their own treatment and care. Thus, they are stimuli for
change in the traditional professional, legal, ethical and economic
models of healthcare provision.
All these factors provide the potential to make a real difference to the
delivery of the basic services for clean, healthy life. But to effect
change in any positive sense we cannot rely only on the market and
market forces. Market forces do not operate effectively where there is a
great disparity between the knowledge, experience and ambitions of
vendors and those of their customers, and the market does not operate at
all when people and governments simply cannot pay.
The potential benefits of advanced technologies for millions of people,
many of whom are in desperate need, will not be realised unless they are
seen in the context of a wider programme to alleviate or cancel
unsustainable debt.
Specifically in regard to the use of information and communications
technologies, there is also scope to initiate a programme of free
provision of hardware and software, training and education, targeted
initially at the Highly Indebted Poor Countries.
BETTER ACCESS TO INFORMATION IS A KEY TO DEVELOPMENT
With a small number of exceptions, most people are born with or soon
learn the capacity to see, hear and speak. A much smaller proportion of
the world's population learns to read, write and count. Yet without
those functional literacies they are prevented from playing a full and
active part in the world. Helping them towards literacy is not just a
matter of moral purpose, although it is that.
The growing interdependence of the world’s people and the need to work
together to eliminate some of the worst evils that beset us all: war,
famine, poverty and disease, means that we need to enlist the skills and
understanding of people in developing countries.
We can help them by enabling better access to information, and we need
to help them improve those skills and realise their potential in their
own way.
CAN INFORMATION & COMMUNICATION TECHNOLOGIES HELP?
Information and Communication Technologies (ICTs) can help. But the
introduction of any form of computer based technologies calls for a new
set of skills to comprehend the virtualisation and abstraction which
follows. Those who do not have the appropriate skills will find that
their capacity to function will deteriorate.
In healthcare, this, when expressed in terms of access to information
services, contributes to the inequality of: provision of services,
training of health professionals, diagnosis and treatment, research
facilities, patient knowledge etc., and thus to mitigating or worsening
the lottery effect of whether a country's population (and its health
organisations and cadres of health professionals) can all enjoy a
common standard of healthcare and a commonly healthy living environment.
TECHNOLOGIES ALONE ARE NOT THE SOLUTION
If we can learn to build the technologies we must also be able learn how
to build the socio-technical systems which make it possible to, inter
alia, improve healthcare facilities (by enabling both better informed
populations and cadres of health professionals) and integrate these with
related services eg. clean water supplies; rubbish collection and
disposal, including recycling; pollution control; public transport; etc.
in developing countries as well as in the developed world.
That does not happen now. Neither market(s) nor state(s) have provided,
or are indeed capable of providing, solutions to more than a fraction of
the problems. A raft of different approaches needs to be developed to
address different needs. The various national and international
professional organizations need to be actively involved, working with
people in the developing world, sharing our experience with them - but
not imposing it on them.
ACCESS CANNOT BE TAKEN FOR GRANTED
There is a tendency, particularly in the more developed countries, to
take the accessibility of information on a global scale - which is the
benefit offered by the new information and communication technologies -
for granted.
However, it is still the case that for much of the world's population
such access does not exist, or if it does, the cost means that it will
only be available to a privileged minority of the population (eg. those
who can afford or are able to get eg. next generation cellular telephone
services, home and portable computing, interactive television services
etc.) and therefore it is necessary for us to consider how it might be
made available, and at an affordable cost.
It is perhaps worth recording that this situation is not peculiar to the
developing countries, but occurs the world over, and is a function of
the current lack of uniform access to advanced technologies and the
accompanying skills acquisition, which in turn is creating the
socio-economic divide between the "haves" and the "have nots" in all economies.
CAVEAT - THE INTERNET IS NOT A PANACEA!
In the context of providing a solution to the problem of enabling global
access to health (and other) information, the internet and world wide
web are not a universal panacea and must be considered in parallel with
the continued development and use of other (perhaps more traditional?)
forms of information and communications technologies which may still be
more appropriate choices for information system development.
THE UNITED KINGDOM POLICY POSITION
In 2000 the United Kingdom government published a White Paper on
globalisation and development. The British Computer Society Developing
Countries Specialist Group was among those organisations which submitted
contributions to the drafting of that document. This paper draws on the
content of the BCS' submission.
One of the Key Policy Commitments within the White Paper, which will be
relevant to the interests of anyone involved in the provision or use of
health services, is: "To promote better health and education for poor
people and harness the new information and communication technologies to
share skills and knowledge with developing countries." We still have to
see how that will translate into action, and we do have some concerns
over the understanding within government about the nature of information
itself. However, the White Paper may be regarded as offering a positive,
if small, step forward.
The full content of the White Paper may be viewed at:
http://www.globalisation.gov.uk/Forewords/KeyPolicyCommitments.htm
THE BRITISH COMPUTER SOCIETY DEVELOPING COUNTRIES SPECIALIST GROUP
One of the first specialist groups to be formed within the British
Computer Society was the Developing Countries Group, set up to stimulate
interest in, and provide a forum for, the discussion of matters
concerned with IT in developing countries. The group is concerned with
not only with technology but with the human, organisational and societal
implications of computers and computer-based systems in developing countries.
The Group maintains a mail list at [log in to unmask]
For information on joining this list see: http://www.jiscmail.ac.uk
We also post material for information and discussion to: http://www.communityzero.com/kisup
Chair: John Lindsay, email: [log in to unmask]
Secretary/Treasurer: Brian Layzell, email: [log in to unmask]
THE BRITISH COMPUTER SOCIETY AND HEALTH INFORMATICS
The British Computer Society (BCS) has been the UK representative
organisation in international medical informatics since the formation of
International Federation of Information Processing (IFIP) Technical
Committee TC4, the forerunner of IMIA. The BCS has a specific Health
Informatics Committee which represents the specialist groups of the
Society concerned with the medical/health informatics field and a number
of other organisations with similar synergistic activities. The BCS was
established in 1957 and received its Royal Charter as the Society for
Information Science in 1986.
For information about the British Computer Society:
http://www.bcs.org.uk
For information about the BCS' role in Health Informatics:
http://www.health-informatics.org
Brian R Layzell
Secretary/Treasurer
Developing Countries Specialist Group
British Computer Society
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