IFGH 2012: Using technology to address health worker shortages

The ‘super convergence of technology’ has led to a new age. We are starting to shift our paradigm and think in new ways.

According to Tom O’Callaghan (CEO international health NGO iheed), a “creative distribution in technology” enables the public to contribute and benefit in ways they never could before. Mr O’Callaghan cited crowd sourcing, in which people contribute opinions, information or ideas to projects such as designing a health intervention, and the open source movement, which seeks to share free information such as the code for constructing a website, as examples of the way in which technology can empower ordinary people.

With one billion people worldwide having no access to a community health worker, resource poor countries may benefit greatly from such advances in technology. The second day of the Irish Forum for Global Health 2012 International Conference showcased a great deal of evidence to support this statement with presentations on topics ranging from human resource information databases to medical algorithms on android phones for patient diagnosis.

Human resource information databases guide decision makers by allowing them to identify understaffed areas and areas where skills are lacking. They are considered essential for quality healthcare information. Without such databases a manager’s ability to plan is limited. However, there are disadvantages as researcher Everd Maniple Bikaitwoha (Martyrs University) pointed out during his presentation on the use of human resources databases in Uganda. ‘Ghost workers’ reduce the quality of a database, and missing information can mislead database users. If the database is not updated regularly, high staff turnovers can deem the information old and useless. Clearly, knowing who’s who and who is where is extremely important.

However, success stories show it is possible to monitor and evaluate changes in trends of human resources when the quality of database information is improved through training, feedback and structure. Examples include the World Health Organization’s National HRH Observatory.

Marc Mitchell of Harvard, who was chairing the session, reminded us that combined sources of data can lead to interesting databases, and even suggested the construction of a master database showing where health workers are most needed. However, Bob Joliffe and Tom O’Callaghan were slightly sceptical. Risks and security issues would exist for such a database, and information technology companies would lose business.

During the session on mobile phone technologies and health workers, Mr Mitchell presented on a tool known as the ’D-tree’. Point of care health workers can use this tool, which is a mobile phone application, to access information about what to do in certain clinical situations. The approach has already been tested through randomised control trials, and is currently being used in the field.

D-tree uses symptom-based algorithms to guide health workers through a series of questions leading to a diagnosis and treatment for each patient. These protocols have been validated and considered a valuable ‘end-to-end solution’ for the shortage of doctors and nurses. It also reinforces health worker confidence by providing appropriate support leading to quality diagnosis and treatment. Research shows that D-tree is significantly better for treating children with severe disease as there is a need to probe deeper into the protocol, which many health workers forget to do.

Although these sessions on new technologies have mostly been positive, we should remember that to make a real difference it is essential for education, training, supervision and monitoring to accompany such interventions. It is also important to provide the appropriate content by taking the learning, literacy levels and languages spoken into consideration.

As stated by Tom O’Callaghan content development and open sourcing are also important for these advances.

Although the serious problem of health worker shortages are a long way from being resolved these advances in technology will no doubt serve to support progress in the years ahead.