Public eHealth in the Caribbean

1. Public eHealth in the Caribbean Nancy Muturi Kansas State University Public eHealth Innovation and Equity in Latin America and the Caribbean eSACCaribbean Webinar Series Public eHealth and Equity: Media Focused

2. Outline • Defining eHealth • Concept of mHealth • eHealth in the Caribbean • Gender and health • Gender and ICTs • Considerations for women in eHealth

3. 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)

4. 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.

5. 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

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

7. 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

8. 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

9. eHealth Applications • Websites • (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 records • Health decision support systems • Tailored health education programs • Health care system web portals • Mobile health communication devices • Advanced telehealth applications • Online gaming for health promotion

10. If used correctly HITs can: • Increase patient and provider access to relevant health information • Enhance the quality of care • Reduce health care errors • Increase collaboration among providers • Enhance doctor/patient interactions • Improve patients’ knowledge and confidence • Empower patients in health decision-making • Encourage the adoption of healthy behaviors

11. mHealthDefined • 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

12. mHealth in the Caribbean • Mobile 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.

13. 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

14. Technological Divide • Based on: • Age • Gender • Income • Disability access • Literacy/illiteracy levels • Computer/digital literacy • Geographical location

15. 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

16. Challenges for eHealth • Cost Concerns • For organizations to operate inexpensively • Lack of adequate funding for healthcare • For consumers/women to participate affordably • Standardization • To enable different systems to communicate • Security and Privacy • Data security and privacy of personal health data • Quality of Publicly Available Information • Timeliness, accuracy, depth, and diversity

17. eHealth Imperative • eHealth 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

18. 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

19. 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

20. Women’s Access to ICTs • More likely to have access to internet at work • More 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

21. Gender Considerations • Gender component in the IT policy • Ownership – hardware/software • Training and capacity building • Access points – public/private • Cost and capability • Literacy/computer skills/technophobia • Participation • Confidentiality/privacy issues especially in dealing with stigmatized diseases • Ethical issues in health care • Security issues in regard to ICT access and use

22. 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?

23. 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 MinkeValk, (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