The Impact of Cell Phones in the Provision of Health Services

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1 1 The Impact of Cell Phones in the Provision of Health Services Liliana Ruiz de Alonso Martha García Murillo Instituto del Perú, Universidad San Martin Convergence Center, School of de Porres, Lima Perú Information Studies, Syracuse University Fátima Ponce Regalado ALTERNA Perú S.A.C. Objective The purpose of this study is to determine the effect of cellular phones on individuals health and community health in the Province of Canas in Perú. Background It is well known that information and communication technologies (ICTs), such as the Internet, personal computers and personal digital assistants, have a positive impact on societies (Ayres & Williams, 2004). However, in less developed countries these technologies benefit a minority of the population. In Peru, for example, only 10% of the population has access to a computer, and only 27% can access the Internet (WB, 2007). Because of the importance of ICTs, in Perú there have been regulatory efforts, through the Telecommunications Investment Fund (FITEL), to enhance connectivity through public phones and access to the Internet. The government, however, does not include cellular as a technology that can be supported to provide voice connections to rural communities. However, it has been shown that cellular access brings important benefits to rural communities, and in a much faster fashion. (Alterna Peru S.A.C., 2008; Indepen and Ovum, 2005). This study will look at the province of Canas in the Cusco Department. This community was selected because it was part of a program called Intégrame (sponsored by Telefónica Móviles) that allowed cellular coverage beginning in In addition, an initial qualitative exploratory study has already been conducted, and we have preliminary evidence of the impact that cell phones have on community members health, as well as other intangible benefits such as privacy. In the initial exploratory study, we interviewed individuals who worked in health institutions in Yanaoca, the capital of Canas. The table below presents the results of this qualitative study.

2 2 Finding Awareness about medical problems Saving of lives Professional medical assistance Reduced treatment costs Reduction in the costs of medical supplies Protection of the patient s privacy Delivery of prompt medical diagnoses and treatment even before patients come to see a health professional. Representative quote Not to long ago there was a motorcycle accident. The victim had a cell phone and he called. If he didn t have one, we wouldn t have known. A girl had a fight with her mother and because of that she poisoned herself. A man found her displaying cramps and unable to walk. He phoned us, and saved time saved the life. Before, most pregnancies where attended by family members. Today 95% of deliveries are done by health personnel. This is because family members can call each other to find a car that can take the women to the hospital. A poisoned patient that comes for treatment within 4 to 7 hours will require 40 treatment capsules. If he comes within an hour, we don t need as many. we have an accountant who lives in Cusco. I can call him to find the prices and characteristics of products; in the past we had to send somebody to Cusco and it took a lot of time, in addition to the time wasted by having a person traveling. if I had to tell person X the cost because he has been diagnosed with tuberculosis, I had to do it through the radio and the entire community found out. To this patient, the disease will not kill him but, rather, the community which is going to isolate him. Because there is a lack of doctors, there are some members of the community that promote health education and help to collect and monitor health statistics. They also receive health education and can provide initial diagnosis in conjunction with the pharmacist. I will give them [referring to patients] my phone number so they can call me and I can provide some advice. If the problem appears more serious, they are then advised to come to the clinic where I can make a more thorough check and provide the prescription. Originality and Policy Relevance There are several factors that make this study original and relevant for policy decisions. First, while it is well established in developed countries that ICTs can support the provision of health services, there is not the same recognition in less developed countries. In Europe, for example, there are Community wide initiatives focused exclusively on ICT or health (European Commission, 2009). In Latin America, there are not yet these types of regional efforts; but we do see increasing use of ICT health related projects that are, for example, supported by the Inter American Development Bank (IBD, 2007) Second, although it is understood that ICTs can bring benefits to the population, we do not know how specific technologies are being used at a more granular level. It is thus difficult to design a program if we do not have a clear understanding of what technologies are being used for what purposes and by whom.

3 Third, most initiatives and studies regarding ICT and health have been focused on the Internet. However, in remote communities like those in the province of Canas, the Internet is not yet available, and the means through which ICT can support the provision of health services is a cellular phone. We should thus understand in greater detail how technology is being used informally in the provision of these services, because this can then help to formulate health programs that work. 4 3 Fourth, rural communities have economic, social, educational and political circumstances that differ from those in a city (where there can be greater access to the Internet,) for example. The use of ICT for health needs to be understood in these contexts, and we must realize they can be tools that can complement other community practices regarding health. ICTs should thus be understood as being part of a web of entities, technologies and practices that have to be respected and reported. Data issues Given that we already have a preliminary qualitative study of the impact of cellular phone use in a rural community, the purpose of this project is to determine how generalized these benefits are. We will thus conduct face to face and phone surveys in the province of Canas. In order to do this we will use the phone list for that Province and interview a random sample of individuals who live in that community. The data will then be analyzed using Stata, a statistical software package that will allow us to conduct multivariate logit analysis on the data collected from the surveys. Policy Potential There are significant policy implications that may be drawn from this study. The results of the survey can become the basis of both health and ICT policy. For example, in the case of health services, knowing that the phone is being used to contact health professionals, a health policy program can include the implementation of hot lines that provide basic information about a particular disease that has been commonly found in the community. Health professionals can also use the hot lines to disseminate health education materials. This use of the phone can be particularly beneficial if, in addition to lack of connectivity, the population also experiences illiteracy. Understanding trends in the use of cell phones in these isolated communities can help policy makers design programs that support both prevention through education and treatment through phone consultation with specialists in the larger cities. The identification of trends of cell phone use can also help in the development of ICT policies, because the population can then be alerted about the benefits that these technologies can have on their health. An education campaign can be then launched in these and other similar communities that use another communications technology, the radio, to deliver public announcements about the benefits and uses of the cell phone for the provision of health information and services.

4 This is particularly important because in Peru, FITEL s projects do not consider cellular among the technologies that can be provided through this universal service fund. This, in the opinion of these researchers, can be a mistake. The preliminary evidence collected in the qualitative study indicates that the deployment of cell phone services can have a more immediate and widespread beneficial impact on these populations compared to public phones and Internet telecenters, which reach far fewer people and require greater technical sophistication than the use of a phone. Team members This project benefits from the collaboration of two institutions, one in the U.S. and one in Peru. Mrs. Liliana Ruiz de Alonso is an affiliated researcher of the Instituto del Peru Universidad San Martin de Porres. She conducts reports on telecommunications regulatory issues and the impact of telephony and internet in rural towns of Latin America. She recently worked for the telecommunications regulatory authority of Ecuador, SENATEL, and of Bolivia, SITTEL. She also worked for local Peruvian telecommunications operators and the Ministry of Transport and Communications of Peru. She managed FITEL while she was the general manager of OSIPTEL, the telecom regulatory authority of Peru. Prof. Martha Garcia Murillo is a researcher at The Convergence Center at Syracuse University s School of Information Studies. She has extensive experience as a researcher of ICT policy and in conducting quantitiative research. She was also regulatory officer at the International Telecommunications Union and has written about universal service and convergence and harmonization of regulations for Latin America. Ms. Fatima Ponce Regalado worked more than twelve years in OSIPTEL. She was an active member of the Information Society Commission (CODESI) in Peru, representing OSIPTEL for the years This Multi institutional Commission was formed by the Executive Power of the Peruvian Government for promoting e government and ICT projects in Peru. In OSIPTEL, she worked as Vice Manager in Research, Strategic Planning Coordinator, and Regulation of Services and International Agreements Coordinator on the Regulatory Policy Division. She also worked as FITEL s economist, where she was a member of the Supervisor Committee for the Project Consulting for the design and development of the International Bidding for operating telecommunications services with rural obligations in Perú, awarded to Coopers&Lybrand y O Melveny & Myers.

5 References Alterna Peru S.A.C. (2008). Impacto en el Desarrollo Económico y Social de la Telefonía Celular en la Provincia de Canas. Lima. Ayres, R. U., & Williams, E. (2004). The digital economy: Where do we stand? Technological Forecasting and Social Change, 71(4), European Commission. (2009). e Health. Retrieved February 15, 2009, from IBD. (2007). ICT in Social Development and Poverty Reduction (TeleCenters, Education and Health). Retrieved February 15, 2009, from Indepen and Ovum. (2005). El Impacto Económico de los Servicios Móviles en América Latina. : AHCIETo. Document Number) WB. (2007). World Development Indicators. Retrieved February 2, 2009, from D/ict/publications/world/world.html

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