Public eHealth in the Caribbean

Nancy MuturiKansas State University

Public eHealth Innovation and Equity in Latin America and the Caribbean

eSAC Caribbean Webinar SeriesPublic eHealth and Equity: Media Focused

OutlineDefining eHealthConcept of mHealtheHealth in the CaribbeanGender and healthGender and ICTsConsiderations for women in

eHealth

eHealth Defined

The combined utilization of Information Communication Technologies (ICTs) and networked data processing to transmit, store and retrieve digital data for clinical, educational and administrative purposes by the health sector

(Rodriguez, 2003)

ICTs refers to: Innovations in microelectronics, computing

(hardware and software), telecommunications and opto-electronics—micro-processors, semiconductors and fibre optics.

(UNDP, 2001)

In other words, innovations that are used to handle:◦ Telecommunications◦ Broadcast media◦ Information management systems◦ Audiovisual processing transmission systems◦ Network-based control and monitoring functions

Includes: Radio, Television, Internet, Telephones, Computers, Hand-held computing and telecommunications devices etc.

Global Recognition of eHealth

Healthy people 2020 recognizes the role of Information Technology (IT) to improve population health outcomes and health care quality, and to achieve health equity.

Millennium Development goals underscored the benefits of ICTs in achieving gender equity and equality

Health Information Technologies

Health Information Technologies (HITs) have tremendous promise for delivery of health care and health promotion esp. in less developed nations

Use of HITs

Cost effective and secure use of ICTs in ◦Health-care services – diagnosis and

treatment◦Health surveillance◦Healthcare policy and decision-making◦Health literature◦Healthcare marketing◦Health education, knowledge and

research◦Health communication

HITs Usage in the Caribbean

Mainly used for:

◦ Surveillance

◦ Management information systems/ Patient information systems

◦ Information dissemination

◦ Not much for communication and behavior change

◦ Limited interaction with the audience

◦ Limited audience participation

eHealth ApplicationsWebsites

(e.g. Medline Plus, Healthfinder, and Web MD)E-mail, message boards, chat rooms,

interactive websites, Voice recognition, etc.)

Online social support networks and communities,

Interactive electronic health recordsHealth decision support systemsTailored health education programsHealth care system web portalsMobile health communication devicesAdvanced telehealth applicationsOnline gaming for health promotion

If used correctly HITs can:Increase patient and provider access to

relevant health informationEnhance the quality of careReduce health care errorsIncrease collaboration among providersEnhance doctor/patient interactionsImprove patients’ knowledge and

confidenceEmpower patients in health decision-

makingEncourage the adoption of healthy

behaviors

mHealth Defined The mobile computing, medical sensor,

and communications technologies for health care.

Wireless connection of personal server to the telemedical server

Through personal computer, cell phone, other telecommunication devices

This developments is driven by the evolving mass markets for cell phones and portable computing devices

mHealth in the CaribbeanMobile technology expanding rapidly in

the Caribbean

Pervasive access to mobile telephony, with some countries having over 100% penetration

By Dec. 2011, there are approximately 2,945, 395 cell phones in Jamaica

Mobile penetration rates of 109%Internet penetration

118, 259 subscribers – 4% Internet Users – 1,581,000.

Other Examples

Computer penetration ◦ Suriname -- 14% ◦ Antigua and Barbuda --

47% ◦ Trinidad and Tobago –

25%◦ Barbados – 39.6%

Internet access:◦ 36% in Antigua and

Barbuda ◦ 34% in Barbados

Access at home:◦ 68.9% in Barbados◦ 59% in Antigua and

Barbuda

Mobile phones Barbados – 61.2% Belize – 50%

Source – Lawton, 2010

Technological Divide

Based on: ◦Age◦Gender◦Income◦Disability access◦Literacy/illiteracy levels◦Computer/digital literacy◦Geographical location

ICT Usage in the Caribbean

Infrastructure and access mobile strong, other areas some progress

Education some progress

Public management some progress

Production sector some progress

Policy instruments and strategies progress

Health limited progress

Challenges for eHealthCost Concerns

For organizations to operate inexpensively Lack of adequate funding for healthcare For consumers/women to participate

affordably

Standardization To enable different systems to

communicateSecurity and Privacy

Data security and privacy of personal health data

Quality of Publicly Available Information

Timeliness, accuracy, depth, and diversity

eHealth ImperativeeHealth is imperative for Caribbean due

to:

◦ Changing demographics – age and population structure

◦ Increase in digital natives (young adults who grew up in the digital age)

◦ Lifestyles changes due to urbanization, immigration and industrialization

◦ Global advancement in technological development

◦ Global advancement in medical fields

A dynamic model of healthcare is required to match these changes

Gender and Health

Women are more likely to suffer from lifestyle-related illnesses

e.g. diabetes, cardiovascular disease, HIV/AIDS and other sexual and reproductive health infections

Caribbean women between the ages of 24-44 years old are more likely to get be infected by HIV than men

Due to gender inequity and inequality

Women are less likely to have access to preventive healthcare

Lack of adequate health insurance/coverage Low or no income Stigma and Discrimination

Gender and ICT

ICTs are not gender neutral Access and use of ICTs differ by gender Digital divide based on gender

Previous Studies show that: Women are more likely to search for health

information online Women are more likely to use ICTs for social

networking Women living in developing countries are 21%

less likely to own a cell phone than men Women are more likely to feel connected and

empowered to connect with the healthcare professionals if they own a cell phone

Women’s Access to ICTsMore likely to have access to internet at

workMore women with low-paying jobs –

limited access More women working at call centers Mostly using computers for word processing,

typists, data entry clerks

Women have limited IT training Limited understanding of ICTs and HIT

applications Low computer literacy Men have more skilled IT-related jobs

Gender ConsiderationsGender component in the IT policyOwnership – hardware/softwareTraining and capacity building Access points – public/privateCost and capabilityLiteracy/computer skills/technophobiaParticipation Confidentiality/privacy issues especially

in dealing with stigmatized diseases Ethical issues in health careSecurity issues in regard to ICT access

and use

Effective eHealth among women

Key questions to ask :◦ How easy are ICTs for women to understand and

use?

◦ How comfortably do ICTs fit within the policies, practices, and technical infrastructure that are built into existing health and social systems?

◦ How affordable are they for the women and other intended audience?

◦ Are the messages delivered on eHealth programs easy enough for women to understand and apply the health information provided?

◦ Are the information systems adaptive, interactive, and self-correcting?

◦ Do ICTs provide interesting, relevant, and engaging information for the women?

References Blaya, J. A., Fraser, H. S., & Holt, B. (2010). E-health technologies show promise in developing countries.

Health Affairs (Project Hope), 29(2), 244-251. doi:10.1377/hlthaff.2009.0894; 10.1377/hlthaff.2009.0894

Dunton GF, Robertson TP. A tailored Internet-plus-email intervention for increasing physical activity among ethnically-diverse women. Prevent Med 2008;47:605–11.

Healthy People 2020. Health Communication and Health Information Technology. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18

ICA World Factbook

Jansen C. (nd). Information, Communication Technologies (ICTs). Technopedia. Accessed from http://www.techopedia.com/definition/24152/information-and-communications-technology-ict

Kreps G. L., & Neuhauser L. (2010). New directions in eHealth communication: Opportunities and challenges. Patient Education and Counseling 78: 329–336

Lawton, O. (2010). Monitoring Caribbean Information Societies. IDRC, Canada, Project Document. Retrieved from http://www.cepal.org/publicaciones/xml/9/38899/W315.pdf

Lindsay S, Smith S, Bellaby P, Baker R. The health impact of an online heart disease support group: a comparison of moderated versus unmoderated support. Health Educ Res 2009;24:646–54.

Marsh, W. (2012). Why are businesses ignoring the mobile opportunity? Jamaican Observer, July 15. Retrieved from http://m.jamaicaobserver.com/mobile/business/Why-are-businesses-ignoring-the-mobile-opportunity-_11949851

Muturi, Nancy (2005). Gender, ICTs and Health in the Caribbean. In Cummings, Sarah, Henk van Dam, and Minke Valk, (Eds.) Gender and ICTs in Rural Development. A Global Source Book, Gender, Society & Development series, no. 8. (pp.61-74), Oxfam, UK.

Muturi, Nancy (2006). Access and Use of ICTs among Women in Jamaica. In Tauth Eileen M. (Ed). Encyclopedia of Gender and Information Technology. (pp.1-6), Hershey, Idea Group Inc. (Peer reviewed)

Rodrigues, R. J., & Risk, A. (2003). eHealth in Latin America and the Caribbean: Development and policy issues. Journal of Medical Internet Research, 5(1), e4. doi:10.2196/jmir.5.1.e4