IICD has been implementing technology-enabled health innovations since 1996, and has seen many changes over the years. Technology evolution, increased availability of local capacity to design and support tech solutions, pull factors at national level calling for data and data-driven solutions, and the ability and willingness of healthcare service providers to finance tech-support services, are all influencing the way IICD and its African health partners see the future viability in eHealth services provision.
“The question is how do we achieve scale and quality assurance across countries while being driven by responsiveness to individual markets’ needs? That’s what AeHS International is here for. It aims to harness the value provided by local companies experienced in deploying and servicing eHealth solutions to healthcare providers, while ensuring quality control, software development and operational support management across the various local ventures and countries joining this pan-African initiative”, said van der Velden.
Over the past years, the hospital management information system AfyaPro, the first product developed by AeHS, has been implemented in hospitals to tackle the lack of accurate and timely data, an issue faced by many African hospitals. Examples documented in Malawi, Tanzania and Zimbabwe, show that since the implementation of AfyaPro more costs have been recovered per-patient, fewer patients are being lost to billing, and overall revenue has grown.
Despite the reported success at facility level, this combination of large numbers of deployments, with very needs-driven local tailoring of the systems, has led to challenges in sustaining the quality and value of the solutions for client facilities over time. “Where deployments and technology support staff have mainly been financed by donor budgets, once the funding period is over, salaries for on-site tech staff are often not integrated in the overall organizational budget, leading to their dismissals and loss of critical 1st line operational and maintenance support. This ultimately leads to usage going down, systems becoming outdated, and so forth.”
On the software development front, diverse approaches have been tried out along the way, from financing programmers to work directly with facilities to outsourcing to software development companies in other countries like India, which have brought about more challenges than positive results. As IICD returned to investing directly in programmers associated with the various solutions, it needed to find a way to create co-ownership of the solutions, ensure quality management across the different deployments and provide financially sustainable implementation support. This led to the creation of AeHS – a joint venture between IICD and local e-health and technology providers.
“Under this model, hospitals and facilities pay their national service provider monthly fees for technical support services. A percentage of which goes to AeHS International, for access to new software updates, 3rd line technical support, training and certification renewals, and access to research and expertise from other countries“, said van der Velden. “Our first experiences are promising. There can be new challenges ahead but we feel that with the structure we have now in place, we will be able to overcome them while creating value for both healthcare provider clients as well as national enterprises.”
With the news about the platform generating a lot of interest in local and international news and media outlets, TizaaWorks has started to offer access to free courses to develop the youth’s professional skills.
“Technology can empower young people to make a vital contribution to their community and our world. We hope that this platform serves as a bridge, connecting Ghana’s young people to the tools, resources, and people they need to find the fulfilling careers they deserve", said Brad Smith, General Counsel and Executive Vice President, Legal and Corporate Affairs, Microsoft.
Although there are several employment resources for Ghanaian youth, many do not know where to find them. TizaaWorks aggregates the best, ensuring access to rich e-content and exposing youth to the various learning and training organisations that can help them realise their career aspirations.
- Plan your career – career counselling, job market info and stats
- Get trained – mentor matching, IT training, entrepreneurship, CV writing, soft & language skills
- Find a job – job matching tool
- Entrepreneurs – Start-up training, funding tools, social entrepreneurship and free-lance opportunities.
- Get engaged – Community-based networking platform for users to share ideas and volunteer opportunities
Gallup World Poll data indicates that African governments currently only employ around 14 million people aged 15-29 which corresponds to about 5% of Africa’s population in this ‘youthful’ age group.
In Ghana, many young people who cannot find employment in the public or private sector end up working in the informal sector in low quality jobs. Research conducted by the African Development Bank shows that it is very difficult to get out of the informal sector, unless one pursues entrepreneurship opportunities. Private companies are instrumental to curbing youth unemployment, but at the same time, youth face a shortage of skills. Microsoft’s aim through the platform is to match the right skills to appropriate jobs, and equip youth with the necessary training, tools and knowledge required to succeed in their desired job.
In a technologically-driven world, softer skills are also often overlooked. The platform offers hundreds of soft skills training courses to equip youth with the best possible opportunity to land their dream role.
“The TizaaWorks platform is critical for expanding IICD’s impact in supporting Ghanaian youth in smart learning, working, and earning. Thanks to TizaaWorks, our programs that build market-driven digital skills and help youth find employment and start their own IT-related businesses can reach out to a much wider audience, beyond our physical presence,” says Martine Koopman, Ghana Country Manager, Global Advisory Services Manager for IICD. “With the current online platform, physical programs and the upcoming mobile version of TizaaWorks, any young person in Ghana will be able to access information and services enabling them to become more employable.”
Employability Platforms are being rolled out in collaboration with key local partners across Middle East and Africa as part of Microsoft’s YouthSpark and 4Afrika Initiatives with a plan to have 25 platforms across the region by the end of FY15 including thirteen in Africa: Algeria, Angola, Botswana, Egypt, Ghana, Ivory Coast, Kenya, Libya, Madagascar, Mauritius, Morocco, Mozambique, and Nigeria within Africa. Microsoft aims to reach a target of seven million youth across the Middle East and Africa, and create 96, 000 job opportunities and 200,000 new entrepreneurs by the end of 2015.
Microsoft in Ghana
Microsoft has been operating in Ghana for 10 years, continues to recognize the long-term growth opportunities in the country and we have made significant investments to date in Ghana especially in education, the youth and the communities.
Microsoft has seen tremendous growth in broadband availability and internet penetration in Ghana, which has the highest mobile penetration rate on the continent (an estimated 112%, according to ITU). Microsoft is excited to play an active role in this transformation, using technology to lead economic and social transformation in the country.
Through its programs in Ghana, Microsoft has:
- trained 15,000 teachers
- reached over one million students
- created over 1,800 jobs, and
- supported 35 successful startups in Ghana.
One of Microsoft’s core projects in the country is its partnership with the Ghanaian Ministry of Education and the British Council, to set up ICT hubs in local schools and communities to accelerate digital literacy across the country. Falling under a regional project called Badiliko, 17 digital hubs have been created in Ghana and Microsoft has trained 26 local Master Trainers who are serving as Digital Ambassadors and School Leader Facilitators in the hubs, helping over 1,700 people in Ghana become trained to date.
IICD in Ghana
IICD is an international expert organization, which specializes in leveraging technology for social and economic development.
By connecting people to sustainable technology, IICD makes it possible for people to learn, work and earn in a smart way. IICD’s approach in ICT4D is based on bottom-up innovation that involves all critical stakeholders, including customers. This approach developed over the past 20 years ensures high adoption rates and sustainability of technology solutions.
IICD offers sustainable ICT solutions and advisory services to accelerate development through supporting smart learning, working and earning in the following areas of impact:
- Youth Employment and Entrepreneurship
- Healthcare delivery
- Agricultural value chains
In Ghana IICD has been working for 17 years. During the last 5 years our programs directly benefited over 6,000 people and impacted 362,500 Ghanaians.
The article has been published in the April issue (Vol. 21, No. 3) of the Journal of Telemedicine and Telecare. The worldwide scope of the journal’s contributions offers “a unique perspective on how different countries and health systems are using new technology in healthcare”.
To access the online version of the Journal of Telemedicine and Telecare click here.
In Mali, health personnel are poorly spread between the capital and other regions. More than half of the socio-sanitary staff is situated in Bamako. Moreover, there is a shortage of health specialists, particularly in the regions outside the capital.
The telemedicine programme IKON was set up in Mali in 2005 to overcome the lack of specialist medical expertise in rural areas. At the time, ten out of the eleven Malian radiologists were based in the capital Bamako. IKON was implemented by IICD together with CERTES, a Malian medical research organisation.
The study concludes that IKON presents a new model of implementing telemedicine in a developing context, which moves away from cross-border medicine and towards developing in-country expertise networks. The study shows that the use of teleradiology contributed to:
- Improvement of the regional doctors’ diagnostic ability
- Improvement of the prescribed treatment
- Reduction of the need for patients to travel
- Reduction of professional isolation for regional doctors
- Improved learning opportunities for regional doctors
“The teleradiology programme connected the University Hospital in Bamako to all seven regional hospitals in Mali and one private health clinic. Between 2005 and 2013, X-ray and mammogram images from 5628 patients were read by teleradiology. Radiologists provided the sole diagnosis for 29% of cases (i.e. the referrer did not make a diagnosis) and altered the regional doctor's diagnosis in 12% of cases. The proportion of cases for which the regional doctor gave no diagnosis decreased from 93% to 24% over the same period, indicating an increase in the doctors' confidence and incentive to test their own diagnosis. The percentage of cases for which regional doctors made an inaccurate diagnosis decreased to 3% in 2013.” (J Telemed Telecare April 2015)
In 2013/2014 a research was conducted to find out to what extent the telemedicine service had increased the rural doctors’ diagnostic ability. Data was analysed for the years 2005-2013.
According to IKON’s programme Manager, Dr Mohamed Sangaré, the IICD model of working through local partners has been critical. “IICD played an important role in supporting IKON’s methodology and development. IICD facilitated an initial meeting of stakeholders, supported ongoing discussions between stakeholders, increased the capacity of teams and hospital staff through training, financed planning and implementation of the pilot phase, and promoted the project in other countries and to other organisations. Implementation was all managed locally, increasing local ownership and sustainability.” (Lydia Tanner - IKON impact study, 2014)
“The IKON network demonstrates the catalytic impact of investing in individuals and of ensuring their ownership of a project. Prof Touré and Dr Sangaré both emphasised the positive role IICD played in giving them freedom to develop the tele-radiology network, which has ensured that the programme really does ‘belong to Mali’,” said Lydia Tanner of Jigsaw Consult.
In Jombo, a village located in the Chikwawa Diocese (in the remotest part of the southern region of Malawi), villagers must walk 10 kilometres to the nearest health facility – Montfort Hospital. There is an extensive road network but, during the rainy season, villages such as Jombo suffer from unusable road conditions. Furthermore, communication services within and outside Jombo remain a challenge. These bottlenecks create delays for pregnant women in reaching vital healthcare in time. Such delays contribute to Malawi having one of the highest maternal mortality rates in the world: 675 per 100,000*.
IICD, as part of the Connect4Change consortium (C4C), is overcoming these challenges and increasing access to maternal healthcare by improving the quality of home-based maternal care for the most isolated mothers in Malawi.
Through a series of human-centered design practices and IICD’s design thinking methodologies (Round Table and Solution Design workshops), better communication with health workers, improved data management and reduction of maternal deaths, were all identified as key targets. After testing potential solutions together with IICD's local technical partner UltiNetS, over 100 community health workers (CHWs) were trained in using the mHealth application, ‘CommCare’. With this Java application, the CHWs register pregnant women, and follow up on their antenatal care visits. Subsequently they register the newborns with the same application, and follow up on their first two years vaccinations. Complicated cases can also be registered and followed by the CHWs. The mobile platform is used for reporting, referral of patients to health facilities and to receive feedback from central health facilities, such as hospitals.
“This allows users to track patient data both on mobile devices and on the web. This helps health workers keep track of their clients over time and manage the entire life cycle of a case without the need for network connectivity,” said Stuart Winga, Operation Manager at UltiNetS.
Improved communication between health workers and health facilities can have multiple effects, for instance on patient referrals to hospitals. It has proven difficult for home-based care workers and CHWs to arrange appointments with hospitals for the patients they visit. Doing this digitally, with the use of mobile phones, reduces delays and increases reliability. The project in Malawi achieves this in a number of ways. Firstly, by providing real-time communication between different agents in the community health structures, including health centres and front line workers. Furthermore, electronic reports are sent from community health structures to computers at the hospital.
But not everything went off without a hitch. At the outset of the project, some users experienced difficulties to analyse and generate reports using CommCare at health facility level. Due to the importance of data analysis and report generation to monitor progress, identify imaging problems and make decisions, IICD advised to complement this application with a Hospital Management Information System (HMIS). This will allow to capture more data at hospital level, which can help in interpreting the CommCare data. The hospital is in the process of implementing an HMIS, which will improve the analysis of the generated data and help in decision-making. Decision makers can adapt policies based on timely and reliable data.
Results in maternal healthcare
In the Chikwawa Diocese, where over 2,000 pregnant women and infants have been registered as of November 2014, the project is showing promising signs towards the reduction of maternal and child mortality rates, from 4 to 1 and 70 to 40 deaths per year respectively. These ICT-enabled maternal and child health interventions have the full support of the Malawian government. Such alignment of policy has facilitated progress towards shared goals including the increase of timely pregnancy referrals to Montfort Hospital, the promotion of active male involvement in maternal healthcare and the increase of children under five attending monthly clinics.
The Women Health Project in Mangochi Diocese has been targeting women and men of reproductive age and young children in 22 villages under the catchment of Koche Health Centre. Similarly to Chikwawa, the results have shown real progress towards the overarching aims of improving maternal healthcare. More knowledgeable front line workers are providing improved health service delivery and, through the use of mobile phones, women are reminded two weeks before delivery to encourage births in Koche Health Centre.
Community sensitisation: motivating men to participate in women’s health
For IICD, the importance of formulating context-specific solutions and multi-stakeholder involvement, including local leaders, is crucial to advocate for the services and assist in mobilising the community. The work of safe motherhood committees and male champion groups has contributed to health promotion and behavioural change in health seeking, and active involvement of men in decision making about women and child health issues. The project has demonstrated that it is possible to motivate men to participate in women’s health in a culture where this is regarded as almost impossible. Male involvement has improved throughout the project with more men now escorting their wives to the health clinics. Men have formed male champion groups where they discuss issues of safe motherhood. In Chikwawa there are nine male champion groups, each group consisting of 20 men.
The forum, organised by the Food and Agriculture Organization of the United Nations (FAO) and the World Association of Community Radio Broadcasters (AMARC), set a number of recommendations in relation to enabling policy and institutional frameworks, investments and partnership opportunities, and capacity development.
Participants of the FCCM agreed that sustainable social and economic development begins when farmers, communities and people are empowered to make decisions for their own lives. “We all shared experiences on how ComDev, ICTs and community media can help family farmers to drive innovation and social change in rural areas, “ said Francois Laureys, representing IICD at the FCCM advisory group.
Some of the FCCM recommendations to overcome family farmers’ challenges associated with limited access to information and communication services are:
- Build cross-sectoral alliances to promote and implement law and policy reforms in respect to communication and family farming.
- Urge governments to invest in reinforcing community-based communication services and up scaling good practices.
- Engage in multi-stakeholder partnerships, to embed communication in development initiatives/programmes.
- Develop the capacity of rural actors at all levels, applying a diversity approach, to engage effectively in rural communication processes.
- Develop mechanisms and tools for coordination and partnerships ensuring that communication for development principles are evident and operational
‘Farming For The Future: Communication Efforts To Advance Family Farming’
A recent publication by FAO and AMARC, which has referenced some of IICD’s latest publications and documented experiences in the use of ICTs in Agriculture, aims to “inspire reflection on the role of communication in advancing family farming”. The document provides examples of communication for development (ComDev) approaches applied to farming and rural development “with special attention to the experiences generated by farmers’ organizations”.
Entitled ‘Farming For The Future: Communication Efforts To Advance Family Farming’, the publication explains that “smallholder family farmers and rural communities require access to information and communication to make their voices heard and change their lives for the better. This implies including communication for development (ComDev) as part of agricultural and rural development policies in order to promote dialogue and participation.”
“The FCCM represents the launching of a consultation process around mainstreaming ComDev principles, methods and initiatives within relevant policy frameworks to advance small stakeholder agriculture and rural livelihoods.”
ICT solutions and their proven effects on farmers’ inclusive development
Citing some of IICD’s evidence-based practice examples of how ICT solutions can positively affect the inclusion of family farmers, the FCCM supported some of their recommendations.
“Our experience with the farmers’ association CRCR (Cadre Regional de Concertation des Ruraux) in Mali shows that a holistic integration of communication media -for and by farmers- can strengthen the position and voice of family farmers,” said Laureys, “and providing farmers with access and means to better communication is crucial for this empowerment.”
CRCR is a lobby and advocacy organisation run by farmers in the province of Sikasso. It is comprised of 240 farmers’ and pastoralists’ organisations in an area of approximately 450 km2, with about 1 million inhabitants, of whom 70-80% live off (family) farming. Due to its poor road infrastructure, large parts of the province are very isolated and/or very difficult to reach.
“IICD supported CRCR in 2004 to set up a communication system based on a decentralised network of ICT-equipped information centres owned by local farmers, and agreements were signed with local and community radios in the province. Farmers were trained on basic ICT skills and maintenance, and over the past years this cascade capacity building methodology has trained at least 500 farmer leaders and thousands of individual farmers – both men and women.”
In recent years, CRCR has also adopted more sophisticated ICT tools, from SMS-based data collection platforms and web-enabled databases to map family farmers and monitor their production, to the use of social media for networking and knowledge exchange.
“In a few years’ time, CRCR has become a driving and federating force of the farmer movement in the Sikasso province, and it has developed solid relationships with local, regional and national authorities and agricultural bodies making it potentially replicable in other parts of Mali and West-Africa,” said Laureys.
- FAO’s publication ‘Farming For The Future: Communication Efforts To Advance Family Farming’
- FAO’s FCCM final conclusions and follow-up actions.
- Policy Brief (available in English, French and Spanish) based on the e-Agriculture forum discussion “Communication for Development, community media and ICTs for family farming and rural development”
- IICD’s ICT Solutions for Inclusive Agricultural Value Chains.
“I am very pleased that Suzanne is taking over", said Figuères. “Next year IICD will turn 20 years, and with a renewed strategy but keeping and embracing our vision and values, IICD will continue as a more entrepreneurial organisation. I am very proud for having contributed and laid the groundwork for this important transition in the history of IICD.”
Suzanne van der Velden
With a background in International Development, Journalism and New Media, Suzanne van der Velden’s (1979) professional career includes her role as IICD’s Community Relations Director responsible for international partnerships, programme development and impact management of IICD’s work, from 2011 to 2015. Prior to that, she served as Chief Content of VARA New Media and served various functions at international agencies in the areas of research, publishing, and management.
“IICD is one of few international organisations with a true sustainable impact in ICT-enabled development, and therefore I am very honoured to be appointed to lead this organisation. At the same time I am conscious about the challenges lying ahead of us”, said van der Velden. “The landscape we are working in has changed, and continuing our good work requires a strong focus and adaptive approach. With almost 20 years of in-depth ICT4D expertise, IICD is dedicated to continue serving disadvantaged people in developing countries with digital technologies. As long as we see that our work contributes to improving the living conditions of millions of people in difficult circumstances, there is indisputably a raison d'être”.
Speaking on behalf of IICD’s Board of Trustees, Chairman Karel de Beer said: "We are delighted that Suzanne van der Velden will be the next Managing Director. She brings all the drive, vision and talents that IICD needs in these challenging times. We explicitly want to thank Caroline Figuères for her leadership and strategic thinking over the past seven years".