TELECOMMUNICATION, HEALTH AND DEVELOPMENT
Mahbub-ul-Haque (1948- 2000)
The Human Development Index (HDI), developed by UNDP in order to measure the level of development of a nation is based on three principal variables. These are longevity, knowledge and decent living standards. Lilt expectancy at birth, has been taken as a proxy for longevity and adult literacy for knowledge. Improved standard of living, however, depends on command over resources like land, credit, income and other variables. Although, per capita income is easily available information in this regard, but. the presence of non-tradable goods and services, distortions due to exchange rate anomalies, tariffs and taxes made straight forward per capita income unsuitable for international comparison. Therefore, The UNDP report adopted purchasing power adjusted real GDP per capita as better approximation of the relative power to buy commodities and to gain command over resources for a decent. living standard.
However, it is evident from the above, that health care has direct contribution on HDI i.e. the level of development of a nation. Life expectancy at birth directly depends on The health care system of a nation; healthier people maintain a better life and live longer for obvious reasons and in fine, healthier people have increased opportunities for having command over resources. Therefore, health care system of a nation plays a vital role in national development.. And, telecommunications have positive role in developing health care system of a nation.
This paper attempts to highlight the role of telecommunication in promoting health care system of a nation and thus its development. Efforts shall also be made to project a few examples in respect of the same. These may he found useful by the development Thinkers, policy makers and practitioners in general and those of Bangladesh in particular while assigning priorities to the different sectors of the economy for development.
TELECOMMUNICATIONS AND THE HEALTH CARE SERVICES
To begin with, let us have a close look at telecommunication, International Telecommunication, union (ITU) defines telecommunication as "any process that enables a correspondent to pass to one or more given correspondents (telegraphy or telephony), or possible correspondents (broadcasting) information of any nature delivered in any usable form (written or printed matter, fixed or moving pictures, words music, visible or
audible signals, signals controlling the functioning of mechanism etc) by means of any Electro-magnetic (electrical transmission by wire, radio transmission, optical transfusion etc. or a combination, of such system) system." Therefore, telegraphy, telephony, broadcasting, television, telex, data communication, fax etc are included in telecommunication.
Primary health care facilities in developing countries is provided mainly by the para professionals. They are the people with a few weeks or months raining as medical workers or about one year training as assistants. They generally provide for preventive, promotional and curative health care services. These include early diagnosis and treatment of common illness including maternal and child health care, midwifery, family planning, treatment of injury and referral of patents to higher facilities. Primary healthcare workers may also organize immunization and mass treatment program; provide guidance and education on nutrition, family planning anti hygiene; monitor epidemics, water quality and sanitation and collect. demographic and health information, The second level health care service, however, include those which are a little hit complex These services ate normally provided at larger health centres, district or regional hospitals. Nurses and general practitioners normally treat this type of cases. The next and most sophisticated services in the health care system is provided by the medical specialist based in major hospitals in large urban centres may he identified as the Third tier, The fourth tier in the system is highly specialized hospitals treating specific health problems.
Therefore, the health care system of developing countries is associated with many variables. The system need services of many dimensions. These require services of practitioners with widely varying level of expertise. The physicians should he specialists, general practitioners, registered nurses, other nursing personnel and various kinds of health workers or health aides But, in developing countries there are shortage of trained manpower of all the above types. As a result, the individuals having requisite training iced to serve in different areas. Besides, individuals living in towns, villages and rural areas have limited access to organized health care system. This is also true for the poor people of urban centres, In addition to the above, the health workers in the developing countries have less trainin2 than Their counter-parts in the developed countries. In developing countries, there are short<age of trained managers for managing a complicated health care system. Because of the above, the health sector in the developing countries face administrative, qualitative and logistical problems.
‘Telecommunications services call solve the aforementioned administrative, qualitative and logistical problems to a considerable extent. The relatively less large number of lesser-trained health workers has a critical need to communicate up the hierarchy of expertise. Therefore, rapid and reliable communication is necessary for the system to function efficiently. The scarcity of the trained personnel may considerably he mitigated if reliable telecommunication facilities are available. The expert managers sitting in the urban centres may help the management of the rural centres over telephone. The rapid and reliable telecommunication can he of use to focus more effectively on the highest priority problems thus increasing the scope and quality of health services available per trained doctor or nurse. By adding the speaker phone to an individual telephone immense benefit.
for the patients can he derived. Using The speaker phone the patients particularly those who are expecting can participate in a dialogue with the health workers. In addition to the above, Using a modem only, be same individual telephone line can also he used for transmitting information from the local health centres to regional hospital fixing a facsimile with it. Computerized record keeping of systems are also used to store and update patient data. These systems allow patient records to he accessed and updated at different places. These records, make it possible to monitor bean patients with a history of rheumatic ever and to provide up to date This that health workers can use to treat children requiring vaccination. Using slow scan video over a telephone line still pictures can he transmitted. Thus x-ray and picture of pathological tests can he transmitted to a long distance. Telephone line can also he used to transmit Electro-cardiograms, heart sound and ultrasound. This type of communication is very useful when communication between the small health centres and large regional centres become necessary. Videos are being used for consultation too.
It is necessary that a health worker to visit a patient regularly. But, rough tern n, i naval ability of road communication, vehicle and fuels may create hindrances in such visits, But, reliable telecommunication may help overcome this problem. The doctor or the patient may keep close contact using telephone, fax and other forms of communication It has been reported on many occasions that patients in the rural areas accepts the advice of rural health workers if The advice is supported by the senior doctors of the district or regional hospitals. The rural health workers may make the consultation smoothly if reliable telecommunication facilities are available.
The value of telecommunication in health care can better he imagined than he described. Example include telephone access to all medical personnel, computerized patient records that are accessible to on line mobile telecommunications links with ambulance and other emergency vehicles, and applications for training and consultation for developing countries, where resource constraint are more binding. Telecommunication are also used to support health care, although at a less capital intensive level In particular, application of telecommunications to primary health care services offers a key to maintaining the system; building moral and maintaining confidence, providing emergency assistance allowing consultation, facilitating administration and logistics, maintaining supervision and quality assurance and supplying education and training.
TELECOMMUNICATIONS BASED HEALTH CARE IN THE WORLD.
From the previous section we have seen the role of telecommunication in health services. In this section, a few specific example to that context shall he projected.
The government of Bangladesh in 1970 employed cyclone early warning telephone system consisting of single telephone installations in several coastal areas previously without access to telecommunications.
Several Alaskan villages are connected with earth stations that are used for the medical communication service. The medical network is a shared audio conferencing system that includes health aids and sometimes provides in service training. Each day during a scheduled "doctor call’, a physician at the regional hospital contacts each health aide o discuss current cases, to provide advice on diagnosis and treatment of patients and to authorize
evacuations. The Alaskan satellite network is also used for twenty tour hour emergency monitoring by pressing a button. A health aide in village can activate an alarm at the nearest regional hospital, if necessary.
In Guyana, "medix", a health team use a two way radio network to communicate with headquarters to check the drugs delivery position and receive advice on health problems. They may also follow up patients conditions referred to the hospital. The medix members, with one year of training, use their radios for advice on difficult or complicated cases. In Guyana, he dedicated radio telephone network was used most frequently, for health administration problems that took longer time to resolve by mail or in person, were resolved within hours by radio telephone. The scope to contact the health workers of other villages and sectors reduces the feelings of isolation and improves the sense of security and the morale of health workers. In Guyana, the aforesaid contact by radio telephone themselves improved their morale. In some countries, the moral of health workers demonstrated to have reliable communication facilities.
Medical services in some countries use small planes to take physicians to field sites rather than bring patients to central hospitals. This approach known as flying Doctor’ begging in Australia in 1928. People living in remote stations used two-way high frequency radios to contact regional flying doctor bases. The flying doctor service now a days uses telephone service instead of high frequency radio. Similar network are also working in the developing nations. Plying doctor services use two way radio networks to link nurses at. rural clinics with headquarters in East African countries. The operation of aircraft used to transport doctors to he clinics and to evacuate seriously ill patients are co-ordinated by radio network. Two-way radio is a vital support for the service with radio telephone communications linking the headquarters with all field hospitals and clinics and with the airplanes Themselves through a common frequency installed in the planes radios.
For health services, the help of new technologies are being taken in place of basic telecommunications services. One of these is the teleconferencing service. There are at present live dedicated audio channels in Alaska. Four are identified for regional service units in a way so that two hospitals and the associated villages can share a channel. The fifth channel is dedicated for communication between hospitals. This ensures privacy too. This system is also used to train the health workers involved in complicated health service.
‘Health Net’ a organized telecommunication network for health services have been organized in recent days in Cambridge, Massachusetts The objective of this networks to arrange flow of information about medical vesicle from the developed countries to the developing countries. The network also provide a Electronic mail service which maybe used by the developing countries to collect information and data from the developed countries. It may he mentioned that the developing countries can not communicate otherwise due to want of good telecommunication facilities in those countries.
The World Health Organization used the weather forecast satellite network to summon medical teams during epidemic in south pacific. Cellular Phones were used for disaster relief activities in Sanfransisco during the earthquake of 1989.Studies show that about 5 percent of total calls are being made for medical reasons in a few developing counties. These calls saved lives and help improve the conditions of the patients.
It needs no mention that health care facilities is a basic issue for development of a nation. It is the birth right of human being. No country in the world shall be identified as developed country unless it can ensure basic health care facilities for the people. This is necessary not only from the social point of view hut from the economic considerations as well. But the health care facilities in Bangladesh is inadequate both in quantity and quality. The country needs to undertake major programs in order to extend primary health care facilities to all its population.
The above pages have projected in brief, the role of telecommunications in health care management. Besides, the practices of using telecommunications for health care facilities in the developed and developing nations of the world have also been presented in the paper, But the use of telecommunication facilities in Bangladesh for health is still at a minimum level. The reason behind may he many. But the major ones are her inadequate telecommunication infrastructure on the one hand and inappropriate planning to use telecommunications or health care facilities on the other. But these barriers are required to he over in the greater interest, of the national development.
In view of the above, the first requirement is to conceptualize in reality by the authorities concerned, the role of telecommunications in helping the management of health care facilities. And, then to attach appropriate priority to the telecommunication sector. At a later stage, the Tele-network need to he planned and developed keeping also this particular aspects into consideration, in addition to the existing ones. As a matter of fact, in order to implement the proposals there should he fundamental research at the aggregate level covering particularly the health and telecommunication sectors for obvious reasons.
I. Robert J. Saunders. Jereny J. Warlord. Bjorn Wellenius, ‘Telecommunication and Economic Development.’ The Johns Hopkins University press, Baltimore, USA, 1994.
2. The Human Development Report UNDP, 1994.
Dr. Mahbubul-Haque (13 Oct 1948- 05 Sept 2000), Joined BTTB on 6 Dec 1972. He was a Director of Bangladesh Telegraph &Telephone Board and was the Chairman of Electrical Engineering Division of the Institution of Engineer, Bangladesh at time of Death. He is a prolific writer. He had many writing on Human Resource Development and Education. A few translation was made by him from Somerset Maugham