AFRO-NETS> Staging Posts: a position paper

[Paul Chinnock <paul@fsg.co.uk>]

Staging Posts: a position paper
-------------------------------

The news about the growth in Internet access in Africa, which has fea-
tured on AFRO-NETS recently, is encouraging but this kind of news can 
make us forget that MOST AFRICANS WHO SEEK MEDICAL TREATMENT NEVER SEE 
A DOCTOR. Their healthcare is provided by community health workers, 
nurses, dresser-dispensers, medical assistants, clinical officers and 
so on. Much of this care is given at health centres, dispensaries etc. 
where there is often no electricity or telephone and certainly no com-
puter! Patients who reach the secondary (district hospital) level, will 
be find themselves in a facility where electricity and telephone serv-
ices are nowadays generally in place but unreliable. The situation of 
course varies considerably between and within countries.

How can the front-line health workers who provide care to the great ma-
jority of those who are in need of it gain access to up-to-date and ap-
propriate information to help them in their work? In particular they 
require CLINICAL information on the diagnosis and treatment of the most 
common conditions. Their need for health information (HI) is growing 
and indeed medical research is generating more and more important re-
sults that should be urgently communicated to them. Yet the sources of 
HI available on the front line are in decline.

In the North the Internet has not only facilitated the communication of 
HI it has managed to overload practitioners with data; sorting through 
what is available and digesting it is the problem! But how can the new 
technology help Africa's front-line providers when most of them do not 
have access to that technology?

The Internet is allegedly reaching a growing number of centres in Af-
rica and perhaps, before too long, a significant minority of health 
workers will be able to receive and send email messages, either di-
rectly or via a colleague with a functioning computer within a few 
miles of them. Technical problems would mean that such a service would 
not be very reliable; electricity and telephone services cannot be de-
pended upon and it is not easy to fix a computer that has crashed in 
Africa. Reasonable access to email would, nevertheless, be a useful 
step forward.

Sending HI via email messages would, however, be a cumbersome process 
and we all know how difficult it can be to translate email attachments. 
(I can open less than half of those that get sent to me here in the 
UK!) The Web would appear to offer greater potential for the transmis-
sion of HI but accessing information on the Web is harder than using 
email. More computing power and more know-how are required. It will be 
a VERY long time before front-line workers can themselves either look 
up specific information on the Web or browse, for example, something 
like the British Medical Journal site.

STAGING POSTS

A staging post would be an office in an Africa country, probably in the 
capital city, where a knowledgeable health professional with a reliable 
electricity supply, computer and Internet connection would be able to 
extract information from the Web which he/she considered appropriate to 
healthcare providers in that country.

The staging post officer would then arrange for this information to be 
printed out in a fairly basic fashion (perhaps as a monthly digest) and 
put in place arrangements to ensure that it reached care providers. 
Particular care would be taken to get it to those in far-flung corners 
of the country with no electricity or telephone! Local printers / pub-
lishers could be involved in the process. There would be many logisti-
cal problems to overcome but, for example, it would surely be a more 
cost-effective process than we use for the distribution of our journal 
'Africa Health', which is printed in the UK and then posted (at great 
cost) to individual readers in countries across Africa.

It would be asking too much of the staging-post officer to browse all 
the myriad medical sites available on the Web. Hand in hand with the 
launch of staging posts there would have to be one or more customised 
Web sites, probably at this stage run from countries in the North, 
which would contain HI specifically compiled to be appropriate to the 
needs of health workers in developing countries.

My own interest in the staging post concept began when Erik Nordberg, 
AMREF's Medical Director, suggested that Africa Health and Medicine Di-
gest would make the basis of an excellent Web site and that, if we put 
these journals on the Web, he and his colleagues in Nairobi could act 
as a staging post for Kenya/East Africa. However, healthcare providers 
need more than just the latest editions of appropriate journals; they 
also need access to basic information on common conditions - the sort 
of thing one would expect to find in a reliable, up-to-date textbook.

A WIDER ROLE

The term 'staging post' suggests perhaps a rather passive operation. 
However, in addition to selection and onward transmission of informa-
tion the staging-post officer could for example:
 
1. add comments on how research findings reported from elsewhere in the
   world should be interpreted in the national/local context; 

2. send comments back to the customised Web site(s) from which informa-
   tion was taken, so that these comments could be seen by those ac-
   cessing the site from other African countries (South-to-South HI
   exchange).

MONEY!

Before trying to develop the staging post idea beyond this rather 
sketchy outline, we would have to find a potential source of finance. 
Who would fund the staging posts? Who would fund the customised Web 
site(s) on which they would largely depend?

I must stress that our company, FSG MediMedia, is in no position to 
fund such a venture; I am approaching the idea on a theoretical basis 
only! We have generally funded our (print) journals through the sale of 
advertising space. We would have two problems in trying to do the same 
for an Africa Health/Medicine Digest Web site. 

1. Most of our advertisers would realise that the site would be seen by
   a vanishingly small number of people and that staging-post officers
   would not be 'purchasing decision makers', whom advertisers wish to
   reach through advertising.

2. Our advertising clients have limited budgets. Every GBP 1 spent on
   advertising on the Web site would be a GBP 1 that was not available
   for advertising on the print version of our journals.

Probably some revenue could be obtained by making it possible for bet-
ter-off doctors and institutions to access the customised site for a 
fee. Increasing the number of site visitors might also impress poten-
tial advertisers. My guess is, however, that only a small proportion of 
the funds needed could be raised in this way.

It seems to me that funding from aid agencies would be required. Ob-
taining such funding is something that I know little about. There are 
other AFRO-NETS subscribers who have much greater experience here.

I therefore close my position paper at this point. What do other AFRO-
NETTERS think? And in particular how do they think the money could be 
found to get such an idea off the ground? Or is someone (HealthNet per-
haps) working on such a scheme already and am I just re-inventing a 
wheel?

The Internet affords us great opportunities to provide a useful HI 
service to those on the front-line but it will be necessary to go about 
this systematically and also to bear in mind the realities of the low-
tech environment in which those we seek to serve must operate.

Paul Chinnock
FSG MediMedia 
Editor of publications including 'Africa Health' and 'Medicine Digest'
mailto:paul@fsg.co.uk



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