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Talking Technology: It Matters to Health Systems

I recently traveled to visit three of IntraHealth’s offices in Ethiopia to work with them on how to best use the technological access they have. Building better health systems requires offering health workers—and those who support them—access to the latest technology.  This includes stable computer networks, which allows health workers to do everything from report on important clinical data to process key financial information.

Ethiopia uses a lot of hydroelectricity, and there are frequent power outages and rolling blackouts, particularly during the dry season. No electricity means no Internet. Often in rural areas having a working Internet connection on any given day is the exception. Although things are getting better in East Africa with the SEACOM fiber that provides some African countries with broadband, Ethiopia is not yet connected to it.

In Ethiopia, and even in countries that are connected to the SEACOM fiber, Internet service providers often oversell their actual bandwidth, which means they are selling to more users than the system can handle simultaneously. Even with a 1 MB Internet connection, you may only be able to transmit and receive 256KB because you are sharing it with everybody else in that area. This is also a common practice in the United States, but it is less of a problem here because people are more transitory in their working habits. In Ethiopia, and in many parts of Africa, people don’t have that luxury because their main access to the Internet is at work. By and large, people are using the Internet during business hours; this is when connectivity is most difficult. The Internet is more available in the early morning or late evening when most people aren’t actually at work.

In Ethiopia, we have come up with some creative options to get work done even within the limitations of the national infrastructure.  There is still, however, a tremendous divide between urban and more rural areas. In the capital city of Addis Abba, we were able to automate some of the work of transferring data files so the system runs at night when the Internet is most available and is capable of pausing and resuming in the case of a blackout. Bahir Dar, on the other hand, is a rural tourist destination and has a fair amount of technology available but also regular power outages. (At the hotel I stayed in, every room has its own candle.)

At IntraHealth’s Bahir Dar office, we did not have the same tools available as in Addis so when the electricity goes out there a file transfer has to be restarted. This office also has the added challenge of supporting clinics that treat obstetric fistula in even more remote locations. These clinics are often managed by just one staff person.  They are currently using dial-up, which is incredibly slow but the only option in that area. During my visit, I worked with the staff in various offices to make a plan for improving their connection speed.

I was also able to fix the dial-up connection in one of the fistula clinics that had been without Internet for some time. In this remote area, being connected to the Internet allows health workers to connect back to the organization and to send data on numbers of patients, how many patients return for follow-up, and the success rate of the surgeries.

We often think of supporting health workers as a matter of offering education and training or providing clinic supplies. However, connecting health workers to the wealth of knowledge available on the Internet and offering regular contact with their colleagues, peers, and organizations is also a crucial component to supporting health workers to save lives.