Visiting Rural Health Posts

I have spent the past 4 days visiting rural Health Posts with my colleague Araya. His phd is looking at the gaps of the Health Extension Workers (HEWs), specifically related to maternal health. Once the gaps are known, the next stage will be to design a programme to fill the hole in knowledge/skills, possibly using technology to help deliver the training.

Altogether he’ll interview 150 HEWs at over 100 Health Posts in 3 districts in Tigray. Over the 4 days I’ve been out with him, he managed to interview 18 HEWs at 14 health posts. Each day has been long – leaving Wukro around 7 am and not returning until after 7pm, so 12 hours to conduct about 5 interviews, each interview lasting about an hour or more.

I’ve been helping with the technology support and will be helping look at what could be appropriate to use in this context. Not all the concerns I mentioned in my earlier post have been realised.

The GPRS coverage has been far better than I’d expected, out of the 13 posts we visited, only one had no mobile or GPRS coverage. A couple had patchy coverage – but it was working for some of the time during our approx 2 hour visits. This is really positive from the point of view of the technology we might like to use in the future.

However, none of the posts had an electricity supply. A couple had electricity poles running very close to the building, but they weren’t connected up. In most cases there wasn’t any electricity supply to the village at all.

My phone battery got to be a real problem for me, despite having wireless and bluetooth turned off, I found that battery was only lasting for about 8-9 hours. I was using the GPS quite a lot, but even on the first couple of days when I was only briefly turning the GPS on (to get the coordinates for the posts), this only gave me a couple of extra hours battery life.

All except one of the HEWs we met had a mobile phone. The reason for the one exception was that she worked at the post with no mobile coverage, so she’d given her phone to a relative. Which for me than raised the question of how they charge the phones given there’s limited power supply. The answer to this was that they must travel to the town to charge their phones (this could be a 2-3 hour walk), or they send the phones with someone else going to town.

The HEWs have very limited English (although much better than my Tigrinya), so delivery of any training materials must be in either Amharic or Tigrinya to have any chance of being effective. One of Araya’s questions is about their use of text messaging, many don’t use text messaging simply because they don’t know the latin alphabet well enough.


What I’ve seen over the past few days is only a small proportion of all the posts that Araya will eventually be covering, but it’s likely that the further interviews will reinforce what we’ve already found out – rather than raising any new issues or significantly altering the results to date.

Over the coming months (after some more of the interview have been conducted), we’d like to get the results from the technology aspects written up into a paper.

Using smart phones for health research in rural areas

I recently became the owner of an unlocked HTC Dream smartphone (running Android 1.6). Smart phones are still quite a rarity in Mekelle (and I’d guess in much of the rest of Ethiopia), so despite this not being the most recent model, everyone who sees me using it asks me to have a look & play around. I have seen a few people with Nokia E71 phones, but when you look closer they’re actually Nokla E71′s (yes, that’s Nokia with an L instead of an i).

In a couple of days I will be heading out to some rural areas with a colleague doing his doctorate in public health. He’s testing different smartphones and applications for data collection whilst he’s interviewing Health Extension Workers (HEWs). I’m joining him to see what some of the issues are with using these types of phones and applications in this context, with a view to spending some time over the coming months seeing how these devices may be used to deliver training.

I’ve only really been using the phone for the past week or so and there are a couple of areas where I can already see we may run into problems.

Firstly, the battery life. With my usage, not particularly heavy, the battery usually only lasts just over a day. Given that we’ll be using these devices for data collection, then they’re likely to be having heavy use in areas with little or no mains power. We are testing out some small solar power chargers.

Secondly, the GPRS coverage. GPRS is not used widely here and coverage in extremely patchy (even in large city like Mekelle) and it’s not yet been rolled out to other more rural areas (or even large towns). Sim cards need to be specifically enabled to use GPRS – it’s not turned on by default. The applications we’re testing out (EpiSurveyor and Sana) will both allow data to stored until an area with coverage is reached, but unless the user visits Mekelle on a regular basis then the data will never get uploaded.

I’m sure that improvements in the phones and the phone network infrastructure will eventually make both of my concerns invalid – it’s just a question of when they will be addressed.

The other questions and areas I’d like to look at include:

1) How easy is inputting the data on such a small screen? Might a tablet or netbook PC be more appropriate? Perhaps they’ll work well for short, relatively simple surveys, but not for others?
2) Do any of the HEW’s already have java enabled phones? If so, this would enable them to use the EpiSurveyor application without any new phones.
3) Do any of the phones support input using ge’ez (the alphabet used for Amharic and Tigrinian)? I can’t see how to input these characters on my phone (if anyone knows how I’d be pleased to hear from you), but I can display the characters.
4) How long do the phones take to get a GPS signal? For each record input we can automatically attach the location coordinates – but I’ve noticed that sometimes the phones can take a long time getting a GPS fix. With the power issues it’s unlikely they’d want to leave the GPS on all the time.
5) Would they really be used? Getting reliable data in these areas (even just for the number of births/deaths) is extremely difficult – reporting processes are often unreliable or just not used. Using these phones could help with gathering this info – but obviously only if they are used.
5) What are the other uses for the phones? E.g. providing remote diagnostic support, clinical support, training content/activities or reference, or perhaps for fun/social activities.

Plus I’m sure many other questions and possibilities will arise over the coming days.

An interesting index of OER Resources

This list shows examples of OER, which, as explained: “The Open Educational Resources come in many shapes and sizes”.

This listing is part of the Free to Learn Guide (look in the Table of Contents: Index of OER Resources)

This guide describe Open Educational Resources (OER) as a cost-efficient method of improving the quality of teaching and learning while at the same time reducing costs imposed on students related to the purchase of expensive commercial textbooks and learning materials.

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