Impact of Information Computer Technology on Primary Health Care Services to Rural

Communities in Niger Delta Region of Nigeria

Readers Services Librarian
Delta State Polytechnic
Ozoro, Delta State, Nigeria
Introduction
Primary health care service became a dream come true for the first time in Nigeria in 19!, "hen
#a$ubu %o"on, the former &ilitary 'ead of State announced the (asic 'ealth Service Scheme
)('SS* as +art of the ,hird National Develo+ment Plan )19!-./*0 ,he ob1ectives of the scheme
"ere to increase the +ro+ortion of the +o+ulation receiving health care from 2! to 33 +ercent,
establish a health care system best ada+ted to the local conditions and to the level of health
technology in this information age )Sorungbe, 19.9*0
&ost of the rural d"ellers are not highly educated and most of them understand and s+ea$ their
dialects only0 45+erience sho"s that the ability to ac6uire and use information is fundamental to
the successful im+lementation of +rimary health care service scheme es+ecially "ith the
ado+tion of ne" technologies0 Poor access to information is a ma1or constraint to the +rimary
health care service scheme in rural communities in Niger Delta Region of Nigeria, and the
situation is aggravated by the high level of illiteracy among the rural d"ellers0 7t8s clear evidence
that the ability to ac6uire and use information is a sine 6ua non for the a++lication of 79, and
im+rovement of +rimary health care services scheme in all the rural communities in Niger Delta0
(enson )2//1* o+ined that com+uter literacy by both educated and uneducated have become the
most im+ortant factor for im+roved standard of living0 ,here is no effective health education
any"here in the "orld "ithout the a++lication of 7nformation and 9om+uter ,echnology )79,*0
'ealth education is the +assing of health information to +eo+le on matters affecting their health
for the +ur+ose of change in behaviour0 'um+hrey )2///* +erceived 79, as an unavoidable
technology for the im+rovement of organisation, team and +eo+le in the information age0
9om+uter com+liance by +eo+le according to 'um+hrey )2///* has become the accelerator for
+roductivity and +ros+erity0 79,s include electronic net"or$s "ith com+le5 hard"are and
soft"are lin$ed by a vast array of technological +rotocols0 :ccording to the ;nited Nations
4conomic 9ommission for :frica )1999*, 79,s cover internet service +rovision, information
technology e6ui+ment, library and documentation centres, net"or$ based information services
and other related communication activities, ):nie and :chugbue, 2//9*0
Rural d"ellers need a "ide range of health information access, es+ecially in all areas of +rimary
health care services "hich include the services of s+ecial centres0 ,hese s+ecial centres are
designed to handle s+ecial health +roblems such as tuberculosis, le+rosy, disabled, mental illness,
mobile clinic, diagnostic services and referral services0 ,he information received hel+s to
enlighten the rural d"ellers on the activities of the above mentioned health services centres0 7n
Nigeria, rather than accelerating single ste+s in the +roduction +rocess, ne" "hole +rocess
chains are being targeted for elimination or s+eeding u+0 ,he use of database in +rocessing
information enhances effective management of information in manufacturing, agricultural,
educational and health sector )Oyeban1o, 199!*0
,he significance of this study lies in the fact that the findings "ill enable the rural d"ellers in
Niger Delta to be ac6uainted "ith ne" ideas and the activities of the Primary 'ealth 9are
Services Scheme through the a++lication of 7nformation and 9om+uter ,echnology )79,*0
Literature Review
indings and Discussion
,his section +resents the analysis of the collected and discussion of the findings of the study0
,here "ere 19/ res+ondents from the four communities under survey and their distribution is as
follo"s< 4"hu !2, Oginibo =9, %baregolor =2 and O$"agbe =0
Ta!le "# $ducational %ualification of the Respondents
4ducational >ualification ?re6uency @
?irst School Leaving 9ertificate A A.0=2
SS94B%94 92 =.0=2
N94 A 10!.
(:B(0Sc0B(04d 2 10/!
No 9ertificate 2/ 1/0!A
,otal 19/ 1//0//
,able 1 reveals that A of the res+ondents had formal education u+ to National 9ertificate in
4ducation )N94*, "hile 2 out of the res+ondents made it to the degree certificate level0 Chen
they "ere intervie"ed, it "as discovered that they had s+ent years in the city searching for 1ob
a++ointment but could find none, so they decided to settle do"n for farming0
Ta!le &# 'ender actor on how Li!rary (aterials are located
Information Needs $whu
No) of
Res)
*gini!o No)
of Res)
'!aregolor No)
of Res)
*+wag!e No)
of Res)
Total ,
P'9 services !2
20A3@
=9
2!0.@
=2
2201/@
=
2=0A@
19/ 1//0//
'ealth 4ducation !2
20A3@
=9
2!0.@
=2
2201/@
=
2=0A@
19/ 1//0//
Promotion of food su++ly
and nutrition
1A
30.=@
=3
2=021@
19 2.
1=0A@
1/A !=021
Su++ly of safe "ater and
basic sanitation
2A
1201/@
A3
1.09=@
2.
1=0A@
A1
130A1@
11. 32011
&aternal and child health
and family +lanning
!2
20A3@
=9
2!0.@
=2
2201/@
=
2=0A@
19/ 1//0//
7mmunization against ma1or
infectious diseases
2
1=012@
A2
130.=@
29
1!023@
A.
2/0//@
123 330A2
Prevention and control of
locally endemic diseases
!2
20A3@
=9
2!0.@
=2
2201/@
=
2=0A@
19/ 1//0//
,able 2 reveals the information needs of the rural d"ellers on health education in Niger Delta0
&ost of the rural d"ellers are not "ell educated and are ignorant of the activities of the P'9
services0 :ll the res+ondents )1//@* indicated that they need information on health education<
P'9 services< +revention and control of locally endemic diseases0 :ll the res+ondents also
o+ined that they need information on family +lanning, maternal and child health care0 1/A
)!=021@* of the res+ondents o+ined that they need information on +romotion of food su++ly and
nutrition0 11. )32011@* of the res+ondents declared that information need is on the su++ly of safe
"ater and basic sanitation0 Chile 123 )330A2@* revealed the area of their information need to be
+revention and control of locally endemic diseases0
Ta!le -# Rural Dwellers contact with PHC agents
Rural Dwellers Contact re.uency ,
#es 9A =.09!
No 9 !10/!
,otal 19/ 1//0//
,he result from the above table sho"s that rural d"ellers have contact "ith the P'9 agents0
?rom the 19/ that filled their 6uestionnaire, 9A )=.09!@* of the res+ondents agreed that they
have come in contact "ith P'9 agents "hile the remaining 9 )!10/!@* declared that they have
not come in contact "ith the P'9 agents0
Ta!le /# re.uency distri!ution of respondents in relation to the Source of ac.uiring
information on Primary Health Care Services
Sources of Information re.uency ,
Primary 'ealth 9are :gents !/ 230A1
,hrough &edia 13 .0=2
,hrough ,o"n 9rier 3 A!023
,hrough 79, materials e0g0 9D-RO&, Dis$ettes, ?ilms0 ! A/0//
?rom the analysis in table = above, 3 )A!023@* of the res+ondents declared that ,o"n 9riers
"ere their ma1or source of information on the +rimary health care services es+ecially in times of
immunization against +olio and other endemic sic$nesses and diseases0 !/ )230A1@* of the
res+ondents o+ined that Primary 'ealth 9are :gents "ere their ma1or sources of information
through consultation0 ! )A/0//@* of the res+ondents declared that they receive information on
Primary 'ealth 9are activities through 79, materials such as films, radio, television, D9D< and
9D-Rom0
Ta!le 0# The effect of communication on rural dwellers in Niger Delta
The $ffect of communication on rural dwellers re.uency ,
Positive 11. 32011
No effect 2 A0.9
,able ! reveals 11. )32011@* of the res+ondents admitted that the information they receive have
+ositive effects on their health education, "hile 2 )A0.9@* of the res+ondents are of the vie"
that the information they receive has no effect on their health education0 ,he researcher "as
rightly informed that a good number of the rural d"ellers have no confidence in medical care and
drugs but solely de+end on herbs and leaves "hich are actually "or$ing for them0
Ta!le 1# Rural dwellers constraints in information access
Constraints re.uency ,
Lac$ of a"areness of sources of information 1=9 .0=2
Lac$ of ade6uate information system 13/ .=021
Lac$ of contact "ith Primary 'ealth 9are :gents 11/ !0.9
7lliteracy 1.! 90A
Poverty 19/ 1//0//
Su+erstitious belief 2 A0.9
,able reveals +overty as the ma1or constraints facing rural d"ellers in information access "ith
19/ )1//@* of the res+ondents0 ,his revie" is in agreement "ith the findings of &etiboba
)2//9*, Sorungbe )19.9*, and ?ederal &inistry of 'ealth )?&', 19..*0 Other factors that made
the constraints include lac$ of a"areness of source of information "ith 1=9 ).0=2@* of the
res+ondents, lac$ of ade6uate information system "ith 13/ ).=021@* of the res+ondents, "hile
illiteracy "ith 1.! )90A@* of the res+ondents "as also declared as one of the ma1or constraints0
Ta!le 2# 3ssessment of the Primary Health Care 4or+ers5 Performance in the ield
3ssessment of the Primary Health Care 4or+ers5 Performance re.uency ,
Dery good 2/ 1/0!A
%ood 1!3 .2011
?air 1/ !023
Dery good = 2011
,able above indicates that 1!3 ).211@* of the res+ondents scored the Primary 'ealth 9are
"or$ers8 +erformance in the field EgoodE es+ecially in this +resent +olitical reign0 ,his reveals
that the im+act of information and communication in Primary 'ealth 9are Services is +ositive0
,hese services couldn8t have been recognized at the grassroots "ithout ade6uate information, and
information couldn8t have been "ell disseminated "ithout 7nformation and 9ommunication
,echnology )79,*0
Summary and Conclusion
:n attem+t has been made in this study through a case study research to investigate the im+act of
7nformation and 9ommunication ,echnology )79,* in Primary 'ealth 9are Services in Niger
Delta0 ?our rural communities "ere selected from Delta State, (ayelsa State, Rivers State and
:$"a 7bom State0 ,he main +ur+ose of this research "or$ is to find out if there is any
remar$able changes in the P'9 "or$ers8 model of o+eration since the advent and a++lication of
79, to Primary 'ealth 9are Services< and to identify the sources of information and ho"
efficiency are the sources0 ,he result of the findings sho"s that 79, has a +ositive im+act on
rural d"ellers in res+ect of Primary 'ealth 9are Services0 &ore so, information and
communication technology should be seen as an indis+ensable tool for effective P'9 services in
Niger Delta0 79, "ould be encouraged to serve as a ma1or "ea+on to brea$ing the yo$e of
su+erstitious belief among the rural d"ellers "hich is discovered to be a barrier that inhibits the
+rogress of Primary 'ealth 9are Services to rural communities0 ,o this end, 79, is seen as a
bridge to hel+ the rural d"ellers to cross from the dar$ ages to an era of enlightenment in order
to enhance their a"areness on +revention and control of endemic diseases, maternal and child
health including family +lanning, the im+ortance of safe "ater and basic sanitation< +rovision of
essential drugs, a++ro+riate treatment of common diseases, in1uries and immunization against
ma1or infectious diseases0
Recommendations
,he research "as carried out to ascertain the im+act of information and communication
technology on +rimary 'ealth 9are Services to rural d"ellers in Niger Delta0 :nd it "as
discovered that the Primary 'ealth 9are "or$ers have +ositively touched the lives of rural
d"ellers through the distribution of 79, materials to rural communities and these materials
include D9D, dis$ettes, films, film +ro1ectors, 9D-RO&, e0t0c0 yet urgent attention of the
government is therefore needed to im+rove the social life and the health education of the rural
d"ellers0
10 :dult education and com+uter literacy should be em+hasized among the rural farmers0
20 4stablishment of cyber cafF or bro"sing centres at rural areas should be the +riority of the
State and ?ederal %overnment0
A0 ,he P'9 "or$ers should be motivated and "ell-e6ui++ed by the governments to enhance
regular visit to the rural d"ellers0
=0 Drugs should be made available and easy for rural d"ellers to obtain0
References
:nie, S0 O0 G :chugbue, 40 70 )2//9*0 Library 7nformation and 9ommunication ,echnology in
Nigerian ;niversities0 Library Hi Tech News 26, No0 0 ++ .-1/0
(en, ;0 N0 )2//3*0 Public Relations 9ommunications and 9onflict Resolution in NigeriaH the
Niger Delta >uestion Conflict Management and Peace Building in Africa !)1*H !1-330
(enson, :090 )2//1*0 Neal"#chumann Com$lete %nternet Com$anion for Librarians0 Ne" #or$H
Neal-Schumann Publishers0 ++ 2=0
(roadbent, I0 P0 )19.*0 &obilizing local ca+abilities for more effective e5change of information
in develo+ing countriesH agriculture as an e5am+le0 &uarterly Bulletin of %AAL'( )2)2*H .=-9A0
?ederal &inistry of 'ealth )?&', 19..*0 The National Health Policy and #trategy to Achie*e
Health for all Nigerians+ Lagos ): ?ederal &inistry of 'ealth Publication*0
'um+hrey, C0 S0 )2///*0 The Team #oftware Process ,MM-#.-"2///"T0"/2)10 Soft"are
4ngineering 7nstitute, Pittburgh0 P+ A3-!=0
&etiboba, S0 )2//!*0 Social factors, community +artici+ation and 'ealth Develo+ment among
the O$on #oruba of Nigeria0 P+ 19-A30
&etiboba, S0 )2//9*0 Primary 'ealth 9are Services for effective 'ealth 9are Develo+ment in
NigeriaH a study of selected rural communities0 2ournal of 0esearch in National 'e*elo$ment+
3 )2*H !.-3=0
O1edo$un, :0 :0 )2///*0 Pros+ects of Digital Libraries in :frica0 African 2ournal of Library
Archi*es and %nformation #cience !/)1*H 10
O$ere$e, P0 )2//2*0 Princi$les of Primary Health Care0 OnitshaH Noble Publishers, ++ 1!-230
Oyeban1o, O0 ,0 )199!*0 Trade $olicy and the $erformance of the manufacturing sector0 NigeriaH
Nigeria 7nstitute of Social and 4conomic Research )N7S4R* Publication0 P+ 13-220
Oyegbite, S0 )19.9*0 Strengthening Primary 'ealth 9are at Local %overnment :rea Level0
Lagos, :cademy Press Ltd0, ++ -110
Par$, R0 D0 )199*0 :nimal Production and 'ealth0 4nuguH &oris Publishers0 ++ A.-=90
Sorungbe, O0 O0 )19.9*0 Strengthening Primary 'ealth 9are at Local %overnment :rea Level,
Lagos, :cademy, Press Ltd0 P+ 1-210
'ender Digital $.uality In ICT Interventions In Health# $vidence
rom IDRC Supported Pro6ects In Developing Countries
Kathleen Flynn-Dapaah
Senior Program Officer, Pan :sia Net"or$ing, 7DR9, 9anada
$flynn-da+aahJidrc0ca
Ahmed Tareq Rashid

Research Officer, Pan :sia Net"or$ing, 7DR9, 9anada
arashidJidrc0ca
3!stract
Ne" information and communication technologies )79,s* such as mobile +hones and the
7nternet are considered im+ortant instruments for advancing social and economic
develo+ment throughout the "orld0 ,he benefits of 79,s, ho"ever, have not been evenly
distributed among individuals "ith different socio-economic status0 ?or e5am+le, fe" studies
consider ho" 79,s affect men and "omen differently0 ,he dearth of studies that integrate
gender analysis is +articularly true in the case of 79, interventions in the health sector,
broadly $no"n as e-'ealth0 e-'ealth refers to the use of 79,s in different as+ects of
healthcare including healthcare delivery, administration, education and communication0
Chile there is a gro"ing focus on the +otential im+act of e-'ealth a++lications and +ractices
in develo+ing countries, little attention is given to ho" the technologies can address
"omenKs health concerns or ho" +articular interventions affect men and "omen differently0
,he ob1ective of this +a+er is to e5+lore the gender dimensions of e-'ealth interventions in
develo+ing countries0 : select number of +ro1ects funded by 9anadaKs 7nternational
Develo+ment Research 9entre )7DR9* are systematically analyzed to dra" out good
+ractices in integrating gender analysis in e-'ealth research +ro1ects0 Ce conclude by
summarizing the good +ractices and a++lying them to analyze ne" +ro1ects to ensure gender
is integrated ade6uately0 ,he +a+er underscores that e-'ealth interventions in develo+ing
countries need to better articulate the social +rocesses of ine6uality that affect access and use
by men and "omen0
Introduction
:ccess to and use of information and communication technologies )79,s* are considered
im+ortant for im+roving health outcomes for different socio-economic grou+s in the
develo+ing "orld0 79,s are increasingly being used in different as+ects of healthcare
including healthcare delivery, administration, education and communication, broadly $no"n
as e-'ealth0 Over the +ast ten years, many international develo+ment organizations such as
the Roc$efeller ?oundation, Corld (an$BinfoDev, and 9anadaKs 7nternational Develo+ment
Research 9entre )7DR9* have sought to introduce effective and innovative e-'ealth
solutions0 7n 2//!, the Corld 'ealth Organization )C'O* ado+ted a resolution for an e-
'ealth strategy and established the %lobal e-'ealth Observatory "hich "ill monitor e-
'ealth systems and service +articularly in lo" and middle-income countries0
Chile there is a gro"ing focus on the +otential and im+act of e-'ealth in the develo+ing
"orld, fe" studies give attention to ho" 79,s can address "omenKs health concerns or ho"
+articular interventions affect men and "omen differently0 Chile ne" 79,s li$e mobile
+hones and the 7nternet are increasingly more available "orld"ide )Orbicom 2//*, benefits
of 79, have not been evenly distributed "ithin and bet"een countries and certain socio-
economic grou+s and individuals, such as +eo+le "ho are illiterate, the disabled, and
indigenous +eo+les< have fe"er +ros+ects of benefiting from 79,s )D:C 2//!*0 Comen
constitute a ma1ority across these grou+s )'af$in G 'uyer 2//2*0 %iven the uneven
distribution of the benefits of 79,s, there is a need to ta$e stoc$ of the e5+eriences and
understanding of gender analysis in e-'ealth +ro1ectsB+rograms and ho" +o"er relations,
s+ecifically social and gender relations, mediate e-'ealth interventions0 7n this +a+er,
"e e5+lore the gender dimensions of e-'ealth interventions to dra" out good +ractices in
gender integration in 7DR9 su++orted +ro1ects in develo+ing countries0
7DR9, a 9anadian agency founded in 19/, "or$s in close collaboration "ith researchers
from the develo+ing "orld in their search for the means to build healthier, more e6uitable,
and more +ros+erous societies0 ,hrough its 7nformation and 9ommunication ,echnologies
for Develo+ment )79,=D* +rograms, 7DR9 has been +roviding grants for research in the
area of e-'ealth in :sia, :frica and Latin :merica0 45+loring ho" 79,s can solve health
+roblems "as +art of 7DR9Ks early "or$ in 79,=D0 &ore s+ecifically, 7DR9 "as interested
in ans"ering 6uestions such as the follo"ing )4lder G 9lar$e 2//9, 3.*H
'o" can 79,s +lay a role in +roviding health care services to rural and remote
regions of develo+ing countriesL
Chich a++lications afford the most +otential "ith res+ect to effectiveness,
ada+tability and sustainabilityL
Chat are the challenges to setting u+ e-'ealth +rogrammes in develo+ing countriesL
'o" do different user grou+s access and use these +rogrammesL
Several studies have +rovided systematic overvie"s of the 7DR9 e-'ealth interventions
)&olin 2//3< 4lder G 9lar$e 2//9< 4lder G 9lar$e 2//< Rashid G 4lder 2//9< Scott G
Sayeed 2//*0 &any of the e-'ealth innovations and a++roaches are still at a relatively ne"
stage of im+lementation, "ith insufficient studies to establish their relevance, a++licability or
cost effectiveness )4lder G 9lar$e 2//*0 Nevertheless, there is sufficient evidence generated
from "or$ carried out by 7DR9 +artners and others to sho" that e-'ealth a++lications can
have many benefits including direct benefit to +atients0
One area "here more evidence is re6uired is ho" different user grou+s such as men and
"omen +artici+ate in and benefit from e-'ealth initiatives as +atients and +ractitioners0 7n
the current +rogramming cycle, all three of 7DR98s regional 79,=D +rograms have devoted
increasing attention to gender and "omen8s em+o"erment in the 7nformation Society and to
ensuring that gender analysis is integrated in all research +ro1ects )P:N 2//3< :cacia 2//3,
94: 2//3*0 Ce ran $ey"ord searches )gender, "omen, men* through 1 e-'ealth +ro1ects
a++roved by 7DR9 since 2//! )see anne5 1*0 ,he results "ere uneven at best0 %ender
analysis "as integrated into fe" of the +ro1ects0 7n some cases, se5 disaggregated data and
issues of gender ine6uality relevant to the +roblem "ere raised in the 8bac$ground and
1ustification8 section of the +ro+osal only to be left unaddressed in the articulation of
ob1ectives, research 6uestions and the methodology section0 Often gender is relegated to
discrete +aragra+hs on 8gender considerations08 7n many cases the discussion of gender is
limited to as+ects of "omen8s +artici+ation< rarely is it discussed in terms of gender
e6uality0 7t is against this bac$dro+ that "e investigate the gender dimensions of 7DR9-
su++orted e-'ealth +ro1ects by e5amining a fe" case studies to dra" out good +ractice in
gender integration0
,he argument of the +a+er is structured as follo"s0 7n the first section, "e e5+lore 6uestions
of gender ine6uality as discussed from the +ers+ectives of sociology of health< 79,=D, "ith
s+ecific reference to e-'ealth +ro1ects to establish the need for gender analysis in e-'ealth
initiatives0 ,his allo"s us to situate our analysis "ithin broader theoretical discussions of
gender ine6uality0 ,he 7DR9 +ro1ects are then evaluated to determine "hether they integrate
gender analysis into the design and im+lementation of the +ro1ect including considerations of
gender and social ine6uality and the constraints to "omen and men benefiting from e-'ealth0
On the basis of our analysis, "e a++ly the lessons learned to a discussion of a recent +ro1ect
to suggest ho" ne" +ro+osals might be e5amined to ensure gender analysis is integrated
a++ro+riately0
'ender7 health and ICTs
4ender and health ine5ualities
,he literature from the field of sociology of health ma$es several assertions relevant to the
design and im+lementation of health interventions "hich "e discuss belo"0 1* ,he literature
strongly argues for the integration of social and gender analysis in all health +rograms and
interventions< 2* ,he social and economic vulnerabilities related to gender ine6ualities are
evident in the health system through ine6ualities in accessing health care and in the
differential +osition of "omen and men as both users and +roducers of healthcare< and A*
,he causes of gender ine6ualities in health are com+le5 M related to both larger socio-cultural
+o"er relations and the different health needs of "omen and men0
Literature from the field of sociology of health strongly asserts the need for gender and
social integration in all health +rograms and interventions for a "ide variety of reasons0
Standing )199* highlights the fact that globally, "omen are found dis+ro+ortionately among
the most vulnerable grou+sH "omen tend to have lo"er incomes com+ared to men0
45+enditure on health for "omen is less than that for men in both urban and rural areas
),imyan et al 199A*0 Other social factors that mediate health outcomes include level of
education, "omenKs gendered roles such as caregiving res+onsibilities, division of labour at
home, nature of "omenKs labour force +artici+ation, etc0 ?or instance, the greater burden of
being the +rimary care giver and the resultant division of labour means that "omen have
higher o++ortunity costs in see$ing health treatment )Leslie 1992< O$o1ie 199=*0 4ducation
has an affect on "omenKs health not only because it influences em+loyment and income but
also as it facilitates better access, understanding and use of health-related information
)9olman 2//A*0
%ender is a significant mar$er of social and economic vulnerability "hich is manifest in
ine6ualities of access to health care and in "omenKs and menKs different +ositioning as users
and +roducers of health care )Standing 199*0 ,he social mechanisms of health ine6uality are
accentuated in the conte5t of develo+ing countries )O$o1ie 199=< Dlassoff 199=*0 7n many
+atriarchal societies, definitions of health status and traditional medical +ractices reflect the
subordinate social status of "omen0 4vidence sho"s that in many instances, "omen cannot
decide to see$ healthcare on their o"n )O$o1ie 199=*0 Some reasons for health ine6ualities
include em+hasis on "omenKs childbearing role resulting in early and e5cessive
childbearing, se5 +reference manifested in discrimination against female children in health
and general care, "omenKs "or$loads "hich result in being e5+osed to health hazards and
having less time to see$ healthcare and lac$ of decision-ma$ing +o"er )O$o1ie 199=*0
Dlassoff )199=* highlights the lac$ of gender-sensitivity in the +rovision of health services
including health information and communication bet"een +atient-client +rivacy and
confidentiality, among other areas0 :ccess and utilization of health services are influenced by
cultural and ideological factors such as embargoes on consulting male +ractitioners, lac$ of
freedom to act "ithout +ermission of husbands or senior $in )Standing 199*0 :s such, from
a gender +ers+ective, allocation of household resources and +o"er is critical0 ,i++ing G
Segall )199!* argue that often the health needs of "omen and girls are given less im+ortance
and value com+ared to men and boys0
,he root causes of gender differences )or ine6ualities* in health are com+le50 (roadly, an
e5amination of gender ine6ualities in health has +rom+ted the develo+ment of t"o
understandings of the root causes of this ine6uality )Standing 199< Doyal 2///*0 ,he first
one em+hasizes the similarities and differences in the health needs of men and "omen0 ?or
e5am+le, many health ine6ualities are lin$ed to biological and se5-s+ecific conditions such
as re+roductive health, breast cancer or male infertility0 ,he second a++roach focuses more
on gender )in*e6uality "hich considers the social obstacles that differentially affect men and
"omen from realizing their +otential for health0 ,he social determinants of health
ine6ualities bet"een men and "omen em+hasize the +rocesses through "hich different
social roles of men and "omen in society influence health outcomes )Denton et al 2//=<
Standing 199< Doyal 2///*0 Such gender based analyses ta$e into account the issues of men
and "omenKs social location, relations of +o"er and access to resources )Donner G Pederson
2//=*0
4ender and %CT' " .6$loring the 'imensions of 'igital %ne5uality
79,s can have +rofound im+lications for "omen in terms of a number of socio-economic
domains including health, education, and livelihoods )%urumurthy 2//=< Odame 2//!*0
Des+ite the +otential, a significant gender ine6uality +ersists in established and emerging
7nformation Societies0 ,he literature on gender in 79,D suggests that it is necessary to
un+ac$ the field by e5amining the nature and causes of gender ine6uality in 79,D +ro1ects0
Our understanding of this ine6uality and our ability to address it are ham+ered by the lac$ of
se5 disaggregated data in develo+ing countries and reinforced by gender biases in +rogram
design0 ,he gender ine6uality in 79,=D is com+le5 in that it both sha+es and is sha+ed by
+o"er relations "ithin households and society at large0 ,he literature therefore0 asserts the
need to focus on the nature and effects of ine6uality in 79,D0
:s indicated above, one of the main +roblems in understanding the gender digital divide is
the dearth of se5-disaggregated data in develo+ing countries0 Des+ite the lac$ of gender
s+ecific 6uantitative data, +ro1ect level 6ualitative data have established that 79,s are not
gender neutral )'af$in G 'uyer 2//*0 4stimates in :frica indicate that "omen com+rise
2!@ or less of 7nternet users )'af$in G 'uyer 2//, 2*0 7n terms of +ractical
im+lementation of 79, interventions the literature suggests that there is an overall gender
bias in 79, +ro1ects0 'af$in and ,aggart )2//1* highlight three reasons for this bias, 1*
"omen are rarely involved in the needs assessment of 79,s for develo+ment< 2* attitudes that
high-end information technology Nis not for "omenK "ho are still being treated as +assive
reci+ients of information and not as active information users and communicators< and A*
there is considerable delay in addressing the limitations faced by "omen in accessing
su++osedly N+ublicK information s+aces0
Chile the gender dimension of the digital divide +rovides us "ith some idea about the
une6ual access to different forms of 79,s, it does not e5+lain the underlying mechanisms of
these ine6ualities0 :s one author argued, Ogender statistics on access to 7nternet are only the
ti+ of the iceberg that hides much dee+er social +sychological and social structural
mechanisms reinforcing a gender ty+ing in almost all as+ects of technologyP )9uneo 2//2,
23*0 %ender ine6uality in access to, use of and benefit from 79,s is higher in countries that
have dee+er social divisions based not only on gender discrimination, but also on other
variables associated "ith gender li$e education, income, socio-economic status, and
occu+ational stratification )'af$in 2//2*0 ?or e5am+le, rural "omen are more disadvantaged
as com+ared to younger, literate or "ealthier urban "omen )Odame 2//!, 1!*0 7n countries
"ith entrenched +atriarchal structures, the nature of 79,s access and use is influenced by
discriminatory +ractices that e5clude "omen0 ?or e5am+le, in the study conducted by the
%ender and 79, Net"or$ )2//3* in "estern :frica, it "as found that some men feel
threatened "hen "omen used cell +hones or accessed the 7nternet and they tried to control
79, use by "omen0 ,his suggests that cultural norms are im+ortant determinants in gender
differences in the use of technology0
,he conce+t of the digital divide needs to be re-oriented to a different stand+oint, one of
digital e6uality, "here em+hasis is +laced on analyzing technology access in terms of social
inclusion to encom+ass the "ide range of +hysical, digital, human, and social resources that
meaningful 79,s entail )Carschauer 2//A*0 ?or e5am+le, the ca+ability to effectively
information obtained through 79,s is de+endent on literacy and education and "omen in
develo+ing countries are less li$ely than men to have the re6uisite literacy, language,
com+uter s$ills and information literacy )'af$in 2//2*0 :t the same time, "omenKs relative
+overty +laces them at a disadvantage in terms of accessing 79,s-- "omen are less li$ely to
o"n communication assets such as radios, mobile +hones, and com+uters )D:C 2//!*0
4ender considerations for e"Health inter*entions( some insights
,he gender dimensions of e-'ealth interventions reflect the com+le5ity of gender relations
in both health and 79, interventions0 ?or e5am+le, an infoDev +ro1ect using Personal Digital
:ssistants )PD:s* for health data collection in Nalgonda district of :ndhra Pradesh, 7ndia
+rovided tools that allo"ed au5iliary nurse mid"ives ):N&* to reduce time s+ent doing
+a+er"or$ and increase the accuracy of data )'af$in G 'uyer 2//2*0 :N&s "ere given
PD:s and training on ho" to use them for data entry and lin$age "ith +rimary health
centres0 :n analysis of the gender dimensions of the +ro1ect by 'af$in G 'uyer )2//2*
revealed that gender "as not included in the +ro1ect ob1ectives0 ,he em+hasis of the +ro1ect
"as on the convenience of the technology, and the +ossible resulting im+rovement in service0
Several gender issues became a++arent in the +ro1ect im+lementation and outcome0 One of
the most notable issues that emerged from the +ro1ect "as that no target grou+s "ere
involved at the +lanning and design stage0 ,he conse6uence "as that the collected +ro1ect
data designated by the health officials to be im+ortant for "omen actually did not reflect the
health concerns of the "omen in the area0 ?or instance, "hile national and district level
medical officers "ere intent on data collection on family +lanning and immunization,
"omenKs health +riorities in Nalgonda included 1oint +ains, re+roductive-tract ailments,
anemia, childbirth and infant health issues0 ?urthermore, although the content of
re+roduction issues has significant gender im+lications, the data collection +rogram of the
+ro1ect treated re+roduction as +urely a "omenKs issue0
:t the same time, the intervention narro"ly focused on "omen "hich led to +erce+tions of
gender ine6uality amongst +ractitioners0 Chen PD:s "ere distributed to :N&s, their male
counter+arts )&'Cs-- male health "or$ers* +rotested that they had not been given PD:s0 to
the e5tent that PD:s "ere later distributed to &'Cs as "ell0 One of the lessons emerging
from the +ro1ect "as that :N&s should "or$ "ith &'Cs on the issues of re+roduction as
"omenKs re+roductive health is highly influenced by the attitudes and behaviours of men0
,his case underscores the need to understand gender ine6uality in health +lanning and
+riority-setting )i0e0 by understanding better the different health demands of "omen and men
"ithout com+artmentalizing them as N"omenKsK issues or NmenKsK issues* and the need to
understand the "ay that the introduction of technologies are +oliticized through local gender
+o"er relations0
,he &id"ives to &obile-Phone +ro1ect in :ceh (esar, 7ndonesia )9hib et al0 2//.* tested a
model for understanding the value of 79,s for healthcare develo+ment0 ,he model builds on
the *alue"of"%CTs"to educationframe"or$ by incor+orating an analysis of four inter-related
barriers to 79, usage including technological, infrastructural, economic and socio-cultural0
Notably they highlight the need to e5amine cultural barriers and gender ine6ualities "hich
may hinder the ado+tion of 79,s0 ,heir research did not uncover negative attitudes or
behaviors related to mid"ives use of mobile +hones in the villages< to the contrary, in some
cases it enhanced their credibility "ith +atients and their families0 ,he research did ho"ever
uncover other socio-cultural barriers related to the hierarchy of the healthcare system "hich
+osed greater challenges "hereby mid"ives +referred to consult their +eers rather than
mid"ife coordinators or doctors even "hen they $ne" it "ould be better to contact a doctor
for advice0 )9hib et al0 2//., A!9*0 7t should be noted that gender relations in the health
system related to 8occu+ational stratification8 )'af$in 2//2* may also +ay a role in the latter
finding, +articularly as mid"ives, "ho are +redominantly, if not e5clusively "omen, have to
deal "ith doctors "ho tend to be over"helmingly men0 ,his model underscores the
im+ortance of loo$ing at the range of barriers to 79, use including socio-cultural and gender
barriers "hen assessing an e-'ealth intervention0
,his literature revie" suggested that "e should be loo$ing for the follo"ing evidence in e-
'ealth +ro1ectsH
analysis of gender and social ine6ualities and ho" these may influence +eo+le trying
to use or benefit from%CTs and B or are see$ing or +roviding healthcare )including
differentiation among various socio-economic categories - i0e0 among "omen
differentiated by age, education, location, marital status etc0*
identification and discussion of both the +ossibilities of e-'ealth for various socio-
economic grou+s as "ell as the barriers, constraints and even threats resulting from
the intervention
collection and analysis of se5 disaggregated data
use of +artici+atory methods, +articularly for needs assessments and +rogram design
and evaluation0
(ethodology
7n this +a+er, "e analyze three 7DR9 su++orted +ro1ects )see table 1*, to loo$ at "hether and
ho" they have integrated gender analysis into the +ro1ects0 : number of e-'ealth +ro1ects
funded by 7DR9 +rovide e5am+les of good +ractice for integrating gender considerations in
e-'ealth0 :ll three +ro1ects received overall +ositive e5ternal evaluations0 Ce chose these
+ro1ects for in-de+th analysis to see if "e could find evidence of gender analysis in the final
technical re+orts and ho" this lin$ed bac$ to the integration of gender analysis in the +ro1ect
design0 Our intention "as to dra" out e5am+les of good +ractice that could be a++lied at the
+ro+osal revie" stage to facilitate better gender integration in future research0
?or each +ro1ect "e loo$ed for evidence of gender considerations in $ey sections of the
+ro+osal including 8bac$ground8< 8+roblem and 1ustification8< 8ob1ectives8< 8research 6uestions8<
and 8methodology80 Ce also loo$ed at the technical and evaluation re+orts for discussions of
gender findings and recommendations0 S+ecifically "e loo$ed to see "hether +ro1ects dre"
on any of the relevant literature "e have discussed in the first +art of this +a+er< "hether they
included s+ecific ob1ectives or research 6uestions concerning gender< "hether they collected
se5 disaggregated data and analyzed factors of ine6uality that "ould affect the success or
sustainability of the +ro1ect< and "hether they included a situation analysis of gender and
social ine6ualities either in the +ro+osal or in the technical re+ort0
Ta!le "# 8asic information of the evaluated IDRC e9Health pro6ects
Pro1ect name Organization Duration RegionsB9ountries
,echnology su++orted
distance non-formal training
and education in "ater,
sanitation, and hygiene
&olave
Develo+ment
?oundation
2//=-2//3
Smo$ey &ountains G
&aguinda, Phili++ines
7,-mediated rural "omenKs
education and
dissemination of health
information
9entre for Comen8s
Develo+ment and
Research
2//A-2//= ,amil Nadu, 7ndia
;ganda 'ealth 7nformation
Net"or$ );'7N* )Phases 7,
77, and 777 and 7D*
Satellife 2//A-2//9
&bale, Ra$ai G
&anaf"a,
;ganda
SourceH Darious 7DR9 documents and the 7DR9 "ebsiteH htt+HBB"""0idrc0ca
?rom our analysis, "e dra" +articular attention to good +ractices in these +ro1ects0 7n the
discussion section "e then analyze a relatively ne" 7DR9-funded research +ro1ect to address
some of its "ea$nesses by suggesting ho" our analysis might be a++lied to ne" +ro1ects0
3nalysis of selected IDRC pro6ects
10 Technology #u$$orted 'istance Non"formal Training and .ducation in 7ater+ #anitation+
and Hygiene in the Phili++ines )C:S' Pro1ect*
)CebsiteH htt+HBB"""0idrc0caBenBev-!!!.-2/1-1-DOQ,OP790html and
htt+HBB"""0molave0orgB*
,he C:S' +ro1ect determined the effectiveness of using 79,s as a tool for teachers and
students to teach and learn about "ater, sanitation and hygiene )C:S'* issues0 ,he rationale
of this study "as to e5+lore the +ossibilities of using 79,s and distance non-formal education
to reach more +eo+le to be educated and em+o"ered on issues of health, hygiene, and
sanitation0 ,he C:S' module included sub-to+ics on +ersonal hygiene, dengue fever,
diarrhea, scabies, ty+hoid fever and environmental hygiene0 7t also assessed the changes in
the $no"ledge, attitudes, and behavior of +eo+le "ith regards to +ro+er hygiene and
sanitation0 ,he study "as underta$en in t"o areasH one in an urban area using a 6uasi-
e5+erimental method "ith 6ualitative and 6uantitative methods0 7n the urban site )Smo$ey
&ountain*, +re- and +ost-intervention 6uizzes "ithin the 79, intervention grou+ and the
traditional module com+arison grou+ "ere underta$en0 7n the rural site )&aguinda*, an
evaluative design "as em+loyed, "ith a focus on 6ualitative measures0 7n both the sites, the
interventionMthe C:S' moduleR"as tested and delivered in a digital, multimedia format in
distance education mode0 7n the urban site, the module "as delivered using an intranet server
connected to a local area net"or$ of com+uters0 7n the rural site, the same distance education
module "as used by adult, non-formal education students using a &ulti-Pur+ose 9ommunity
,elecentre )&9,* facility "ith com+uters lin$ed to a server "ith a broadband satellite
7nternet connection0
,he study had a gender ob1ective and a +artici+atory research methodology that laid the
ground"or$ for strong gender integration0 ,he develo+ment and im+rovement of the 79,
+latform involved the "hole community and the +artici+atory nature of the +ro1ect facilitated
localization and ada+tation of the technology )&olin 2//3*0 ,he +ro1ect, due to its focus on
sanitation and hygiene, understood the need for incor+orating local gender roles and
circumstances0 7t e5+licitly had the ob1ective of de+loying distance education technologies to
em+o"er different socio-economic grou+s, including "omen )&olave ?oundation 2//A*0 7n
fact, the +ro1ect considered gender at different levels, including, ensuring gender balance in
recruiting staff, consultants, and volunteers, and develo+ing materials and tools "ith a focus
on gender mainstreaming0 Notably the methodology included the collection of se5
disaggregated data0
,he study e5+lored the level of $no"ledge and attitude to"ards C:S' issues in the +ost-
intervention stage0 ,he findings reveal that more "omen increased their $no"ledge and
attitude levels using the 79, method0 7n terms of $no"ledge and attitude levels, those
"omen "ho used 79,s for health information +erformed better than their male counter+arts0
,he data is +resented in the table0
Ta!le &# Percentage of students with increased post9intervention .ui: scores
,raditional 79,
&en Comen &en Comen
Ino"ledge 3@ 3=@ !A@ !9@
:ttitude 2!@ =!@ ==@ !!@
SourceH 9om+iled from Ramos )2//3*0
,he findings +articularly underscore some notable gendered dimensions of education and
health +romotion )Ramos 2//3*0 ,raditionally, hygiene and sanitation are considered the
domain of "omen0 No clear +atterns, ho"ever, emerged out of the +ro1ect that reflected
these +rocesses0 ,he study revealed that gender roles affected the learning +rocess0 Comen
seemed more interested in the content "hile men "ere more concerned "ith mode of
delivery0 On the other hand, men are more inclined to be interested in the 79, tools0 ,his is
consistent "ith evidence that "omen are more li$ely to e5+lore health information through
79,s than men )Lorence G Par$ 2//*0 ,he study underscored the basic differences in the
value attached to com+uters by men and "omen0 &ale +artici+ants see com+uters and the
7nternet as tools for them to +otentially become more em+loyable, "hile female +artici+ants
see these as tools for communication, as a "ay that voices and o+inions could be heard0 7t
"as also revealed that "omenKs res+onsibilities affect their healthRfor mothers, +ersonal
health is sacrificed for household chores0
,he C:S' +ro1ect demonstrates a number of good +ractices for integrating gender into e-
'ealth +ro1ects0 Princi+al among these is the inclusion of a research ob1ective or research
6uestion focused on understanding gender issues "ithin the +ro1ect0 ,his "as reinforced by
their understanding of the +roblem as a human B social issue and the +artici+atory
methodologies em+loyed in the +ro1ect0 ,he collection and analysis of se5-disaggregated
data allo"ed them to uncover and address different needs for "omen and men "ithin the
+ro1ect and surfaced the factors of gender and social ine6uality that influence the +ro1ect
)such as gender roles and res+onsibilities*0
2 %T"mediated rural women education and dissemination of health information in Tamil
Nadu
)CebsiteH htt+HBB"""0idrc0caBenBev-31=.3-2/1-1-DOQ,OP790html*
,he ob1ective of this +ro1ect "as to design and evaluate an 79,-based +latform to address the
lac$ of a"areness of health issues among young and middle-aged rural "omen in ,amil
Nadu, 7ndia0 &ore s+ecifically, the +ro1ect aimed at e5amining the level of a"areness of
s+ecific health issues among rural "omen and +iloting an 79,-based solution that im+roves
the dissemination of information0 ,he +ro1ect "as carried out in +hases0 7n the first +hase, a
survey "as carried out in 1= villages and five schools to assess the level of health a"areness
"ith s+ecial reference to +renatal care, +ostnatal care, and '7D :7DS0 79, tools "ere
develo+ed on the basis of the information gathered0 ,he tools included 9D-based training
materials and a training and information dissemination soft"are +ac$age )&olin 2//3, 1*0
,hese tools "ere fine tuned in the second +hase before the information "as disseminated in
the target areas0 ,he research identified +re- and +ost-natal care and :7DS as im+ortant
health issues faced by rural "omen0 ,he t"o 79,-based information modules on health
a"areness that "ere develo+ed during the +ro1ect received significant +ositive feedbac$ from
+artici+ants and the findings indicate that the level of a"areness increased )Den$atesan G
(ai 2//=*0
Cithout s+ecifically articulating a gender ob1ective the researchers demonstrated a rich
understanding of gender issues in the 8+roblem and 1ustification8 section of the +ro+osal0
Rather than treating "omen as an undifferentiated category, they note differences among
"omen related to class and caste that led to some girls receiving little or no education0 ,he
researchers underscore the im+ortance of +o"er relations in determining "omen8s health
stating for e5am+le, ESe5uality and +o"er are at the root of most se5ual and re+roductive
health +roblems0 %ood health therefore de+ends in +art on having the +ersonal +o"er to
negotiate effectively "ith others not only "ithin intimate relationshi+s but "ithin the
institutions of society as a "holeE )Renu$a 2//=*0
:lthough the +ro1ect focused s+ecifically on "omen, the findings reveal some interesting
gender dimensions0 :n im+ortant issue "as the lac$ of education among "omen in general0
,here are severe constraints faced by young girls in accessing education0 :s all the schools
"ere co-educational, many girls "ere not allo"ed to continue "ith their schooling0 ,his
"ider social +roblem "as not ta$en for granted by the researchers "ho noted in the research
+ro+osal E"e $no" that it is the socio-economic and cultural reasons "hich create the
+roblems for girl children and 1ust using 79, "ill not solve these issues0 (ut 79, as an
information tool as a catalyst has lot of +otential to educate and motivate these girls come
together to solve their issues and gro" as an em+o"ered "omenE)Renu$a 2//=*0 Chile this
+ro1ect "as modest in sco+e, 79, clearly can +lay a significant role in distilling "orld"ide
information and disseminating it to a rural audience at a reasonable cost )Dougherty 2//3,
32*0
,he researchers in this +ro1ect uncovered many of the challenges faced by "omen in
attem+ting to use and benefit from 79,s "hich result from gender ine6uality0 ComenKs
res+onsibilities for contributing to the household income +ool affected their o++ortunities to
access 79,s0 &any "omen in the sam+le actually "ere reluctant to +artici+ate in the
dissemination +rogram because they are involved in agricultural "or$ and +artici+ating in
the dissemination meant that they "ould lose a dayKs income )Den$atesan G (ai 2//=, 3<
also see ,imyan et al 199A*0 Due to the conservative nature of the "omen in the villages,
attracting "omen to come out in the +ublic "as also a challenge0 (oth these challenges
during the +ilot stage suggest long-term sustainability of the +rogram "ill be challenging0
:nother outcome of the +ro1ect "as that "omen e5+ressed the need for raising a"areness on
re+roductive health issues among men as "ell )&olin 2//3< Dougherty 2//3< Den$atesan G
(ai 2//=*0
7n terms of 79,s, it is a++arent that visual learning hel+ed "omen to better understand the
re+roductive health issues )Den$atesan G (ai 2//=, 3*0 ;sing 79,s effectively de+ends on
understanding the strengths and limitations of the technology in a changing information
environment )&a5field 2//=*0 7n the case of the ,amil Nadu +ro1ect, it is seen that t"o-"ay
communication is highly significant M an interactive +rocess +rovides better outcomes in
terms of content and targeting0 7ncreasing the level of interaction and engagement is really
im+ortant for marginalized grou+s li$e "omen )Neuhauser G Ire+s 2//A*0 7t +resents ne"
o++ortunities for "omen "ho are ty+ically more affected by health +roblems but are less
li$ely to be included in the e5isting channels of communication0 &oreover, it "as seen that
some face-to-face interactions may be a suitable "ay to introduce 79,s0 Chile more analysis
is needed to assess "hether health information dissemination through 79,s is effective, 79,s
clearly e5+and the mechanisms of the distribution of health information0
,he richness of the discussion of gender ine6uality in the +ro+osal demonstrated that the
researchers had a thorough gras+ of gender analysis0 :lthough the +ro1ect did not include a
gender ob1ective, the rich integration of gender analysis into the understanding of the
+roblem "as reinforced in the methodology such that it "as integrated into the +ro1ect and
reflected in the research findings0
) 8ganda Health %nformation Networ9 ,8H%N1
)CebsiteH htt+HBB"""0idrc0caBenBev-11//3-2/1-1-DOQ,OP790html and
htt+HBB"""0healthnet0orgB*
,his +ro1ect entitled 8ganda Health %nformation Networ9 );'7N* "as underta$en in the
&bale, Ra$ai and &anaf"a regions of ;ganda0 ;'7N used handheld com+uters to deliver
medical information at the +oint of care0 ,he medical information includes disease treatment
guidelines, continuing education materials, ne"sletters, essential drug lists, and databases0
9ustomized soft"are "as used for data collection on handhelds so that the medical "or$ers
are able to trac$ +atients and $ee+ records electronically0 ;'7N also used PD:s to +rovide
early "arning information about the s+read of communicable diseases such as measles or
cholera0 ,he information "as revie"ed by the district health authority and if medicines or
su++ort "or$ers are needed they are sent 6uic$ly0,hree +hases of ;'7N have been
com+leted so far "hile a fourth +hase is currently ongoing0
:n evaluation of the overall +ro1ect revealed that handheld com+uters result in more ra+id,
accurate and cost-effective data collection and re+orting )Satellife 2//!*0 Previously it too$
si5 months or more to get a res+onse before this system "as introduced0 ,he +rocess of data
collection, even "ith the cost of hard"are and soft"are "as 2!@ more cost-effective than
the +revious manual system0 ;'7N demonstrates that PD:s are a technologically viable,
cost-effective tool to im+rove communication, information access and data e5change in a
lo"-resource environment0
7t seemed, ho"ever, that there is a technology bias in the "ay the PD: "as introduced and
used in the first three +hases0 : revie" of the +ro+osals in all the first three +hases indicates
that gender issues "ere not integrated at the design level revealing several missed
o++ortunities to ta$e into consideration gender and socio-cultural factors0 ;sing the
frame"or$ +ro+osed by Long"e )1991*
1
, Litho )2//* argues that the ;'7N +ro1ect can be
considered to be gender neutral0 :lthough the +ro1ect did not s+ecifically target "omen,
"omen are $no"n to have +artici+ated0 :t the +ro1ect team level, at least t"o "omen doctors
"ere involved0 &ore im+ortantly, the level of decision-ma$ing that these female doctors had
in the +ro1ect has not been documented0 7n terms of ca+acity building for the +ro1ect staff,
training "as offered in some occasions but the documentation indicates that only male staff
"ent for the training )Satellife 2//=*0
Lac$ of data on "omen8s +artici+ation in the +ro1ect at the technical and beneficiary levels
made gender-based analysis difficult )Litho 2//*0 Se5 disaggregated date "ould have
allo"ed analysis of the +oints of access according to gender, attitudes to"ards 79,s "ithin
the health sector, differences in fre6uency of use by men and "omen, and im+ortantly, the
relationshi+ bet"een gender, access and attitude0 ;nfortunately, this $ind of information is
absent in the +ro1ect out+uts of the first three +hases0
7n the third +hase of ;'7N, there "as recognition in the conclusion of the final technical
re+ort of the need for assessing the +otential of ;'N for em+o"erment of "omen0 One of
the recommendations s+ecifically em+hasized in6uiring and documenting ho" diffusion and
ado+tion of ;'7N has contributed to overcoming gender-based barriers to 79, access and
use and to changes in gender relations and "omen8s em+o"erment )Satellife 2//, =9*0
?or the current )fourth* +hase of the +ro1ect from 2//-2//9, the +ro+osal is designed to
ensure that a gender +ers+ective is integrated into the im+lementation and research +rocesses
and that the resulting interventions contribute to the +romotion of gender e6uality0 ,he
+ro+osal +resents a clear research strategy and references relevant literature on gender issues
in health, develo+ment and 79,=D0 ,he +ro+osal outlines t"o s+ecific activities to e5+lore
the gender issues for the im+lementation of ;'7N in this +hase ):4D 2//, A2-AA*0 ?irst,
given that "omen and men have different re+roductive health needs that are affected by both
biological distinctions and societal roles, the +ro1ect see$s to ensure that the health content
disseminated to frontline health "or$ers is relevant to the diagnosis and treatment of both
female and male re+roductive health illnesses0 Second, the +ro1ect see$s to ensure that the
intervention "ill not result in gender ine6uities and ine6ualities in terms of "omenKs access
to the use of PD:s0 :n e6ual number of female and male health "or$ers "ill be trained in
the use of PD:s to ensure that female health "or$ers continue to use ;'7N tools to im+rove
their +ractice0 &ore im+ortantly, the +ro1ect +ro+oses to use a 6ualitative study a++roach
using in-de+th case studies on ado+ters of PD:s and other related technologies in the ;'7N
+rogram, including analysis of gender ine6uality for both users and +roducers of health
services in relation to the +rogram0
Chile earlier +ro+osals had little discussion of gender, this fourth +hase +ro1ect suggests that
gender integration re6uires intentional design M s+ecifically an ob1ective or research 6uestion
and a++ro+riate methodology before gender analysis can ha++en0 ,he +ro1ect e5+licitly
+ro+oses to integrate gender analysis and to e5+lore ho" the +ro1ect contributes to changes
in gender relations and "omenKs em+o"erment0 Chile "e "ould suggest that these
considerations should be e5+lored more in earlier +hases, the commitment of the donor to
long-term funding allo"ed for incremental increases in gender and social analysis as the
+ro1ect develo+ed0 ,his case demonstrates clearly that "hen +ro1ects +ut a +riority on this
issue it is reflected in the e5tent to "hich it is integrated into $ey as+ects of the +ro1ect
design )i0e0 8+roblem and 1ustification< ob1ectives< research 6uestions and methodology*0
#ummary
(y systematically revie"ing +ro+osals and technical re+orts for three 7DR9 +ro1ects, "e
noted a number of good +ractices related to the design of the +ro1ects "hich are reflected in
the 6uality of gender analysis "e sa" in the final technical re+orts0 :bove all "e assert that
the most critical factor for addressing gender ine6uality in e-'ealth +rograms is ensuring that
gender analysis is integrated into the design e-'ealth initiatives "hich is characterized by
dra"ing from most )if not all* of the good +ractices "e identified includingH
10 Situating the +ro1ect "ithin the larger conte5t of +o"er relations and genderBsocial
ine6ualities
20 7ncluding s+ecific gender ob1ectives or research 6uestions
A0 ;sing +artici+atory research methods )that ta$e gender and social differentiation into
account*
=0 4nsuring the collection of se5-disaggregated data
!0 :nalyzing data from a gender +ers+ective by connecting +ro1ect findings "ith the
larger conte5t of gender and social relations0
30 Discussing barriers, challenges and une5+ected outcomes in research re+orts0
Cith the e5ce+tion of the ,amil Nadu +ro1ect, "hich clearly established gender ine6uality as
a critical influence on the develo+ment +roblem and em+loyed gender analysis as the overall
analytical frame"or$, "e "ould suggest, +articularly based on the ;'7N e5+erience, that for
most e-'ealth +ro1ects including s+ecific gender ob1ectives or research 6uestions is an
essential ste+ that is su++orted by the other good +ractices to yield a rich gender analysis of
the intervention0
3pplying the Lessons# Community based e"health $romotion for safe motherhood( lin9ing
community maternal health needs with health ser*ices system in Phili$$ines+ Pa9istan and
%ndonesia )S&P Pro1ect*0
)CebsiteH htt+HBB"""0idrc0caBenBev-1199-2/1-1-DOQ,OP790html and htt+HBB+anacea-
ehealth0netB*
7n this section, "e a++ly these lessons to a more recently a++roved S&P +ro1ect by loo$ing
for e5am+les of each and discussing the im+lications of their inclusion B e5clusion0 ,his is
an ongoing research +ro1ect in three :sian countries testing the use of lo"-cost 79,s to
im+rove the effectiveness of safe motherhood +rograms )S&P*0 ,he S&P +ro1ect is a +art of
a larger net"or$ of e-'ealth +ro1ects called the P:N :sian 9ollaboration for 4vidence-based
e-'ealth :do+tion and :++lication - one of . sub-+ro1ects in P:N:9e: and one of t"o
dealing "ith maternal health0 Our $ey"ord search of the P:N:9e: +ro+osals reflected our
$ey"ord search of the 1 7DR9-su++orted e-'ealth +ro1ects, suggesting that gender
integration "as uneven for the P:N:9e: +ro1ects0 Ce chose the S&P +ro1ect for several
reasons0 ?irst "e noted from the literature that maternal health +ro1ects can fall short in
gender analysis, +articularly if it is seen as a 8"omen8s issue8 only )'en"ood G 'art 2//A*0
Secondly gender sho"ed u+ in our $ey"ord search for this +ro1ect but "e noted that the
discussion "as limited to only one or t"o discrete sections of the +ro+osal0 ,his latter +oint
suggested to us that the +ro1ect "ould have +roblems but sho"s some +otential for
im+roving gender integration "ithout building from the ground u+0
,he S&P Pro1ect is ongoing0 ?ollo"ing the submission and a++roval of the net"or$
+ro+osal )"hich included draft versions of sub-+ro1ect +ro+osals* the researchers have
com+leted the first +hase of research - a si5 month needs assessment e5ercise0 ?inal +ro1ect
+ro+osals "ere revised on the basis of the needs assessment and the full research +ro1ects
commenced in ?ebruary, 2//90 Our analysis is based on a revie" of the original +ro+osal<
the needs assessment re+ort and the revised +ro+osal0
,he multi-country design of the +ro1ect ta$es into consideration the "ays in "hich Safe
&otherhood +rogrammes are ada+ted in different countries "hile testing a common e-'ealth
intervention and evaluating it "ith a shared methodology0 ,he enhanced S&Ps in the
Phili++ines )ComenKs 'ealth and Safe &otherhood Program 2* 7ndonesia )&a$ing
Pregnancy Safer Program* and Pa$istan )Lady 'ealth Cor$ers Program* share common
goals "hich include i* im+roved 6uality of services< ii* im+roved referral< iii* behavioral
change intervention< and iv* establishment of sustainable su++ort systems0 ,he e-'ealth
intervention focused on behavioural change interventions0 ,he researchers +ro+ose to design
and test an S&S-based e(99 )(ehavioral 9hange 9ommunication* initiative "ith one
community in each country receiving information via S&S and control communities in each
country receiving the same information using current communication channels )Saligumba et
al0 2//.b*0
:ccording to the revised +ro+osal,
Sbeha*ioral change inter*ention ,BC%1 $lays a crucial role in $romoting safe motherhood
$rograms BCC aims to $romote 9nowledge+ attitude+ and beha*ior to its $rimary
beneficiaries to increase demand for and use of safe motherhood ser*ices %t also aims to
increase $o$ular understanding of the barriers and ris9s to safe motherhood and
communicate desired beha*ior+ and to reduce stigma and e6clusion of disad*antage and ris9
grou$s BCC is a sta9eholder:dri*en communication using a$$ro$riate media mi6 consists
;sic< of inter$ersonal and grou$ communication+ community $artici$ation and radio and
$rint su$$ort ,%bid+ =1
,his descri+tion of behavioural change intervention suggests that understanding gender
relations at the household and "ithin the community "ould be im+ortant for a successful and
sustainable intervention and "ould be integrated into the research design0
,he available +ro1ect documents suggest that the S&P +ro1ect sho"s +otential for some
gender analysis but there are ris$s for missed o++ortunities and gender fade0 Notably the
+ro+osal does not include a s+ecific gender ob1ective0 (oth versions of the +ro+osal include a
section on gender and social considerations "hich could offer a richly integrated gender
analysis0 ,hough it discusses a number of activities and methodological considerations it is
a discrete section of the +ro+osal and these ideas are not reflected in other sections of the
+ro+osal, +articularly in the +ro1ect ob1ectives and methodology0 ;nfortunately, the original
version suggests that much of the "or$ in this area "ould be done in the needs assessment
+hase and it "as not addressed in the needs assessment re+ort0 Chile the bac$ground section
of the needs assessment re+ort em+hasizes socio-cultural factors including the role of other
family members in decision-ma$ing, the needs assessment research does not include much
analysis or discussion of socio-cultural influences in the three study areas0 ,he situation
analysis does not include a discussion of the literature )from the health or 79,D fields* or
+rimary research that +rovides details of gender and socio-cultural factors that may influence
the +ro1ect in each of the three sites0 ,his section is unchanged in the second version of the
+ro+osal, suggesting it "ill continue to receive inade6uate attention0
,he ob1ectives and even the methodology )in both the original version of the +ro+osal and
the revised +ost-needs assessment +ro+osal* suggest that there are o++ortunities to consider
socio-cultural and gender issues but they are not e5+licitly stated0 Presently for e5am+le, the
em+hasis +laced on family acce+tance and assistance in the +ro+osal and needs assessment
bac$ground is not reflected in the methodology "hich uses 8Ino"ledge :ttitude and Practice
)I:P* studies involving mid"ivesB,(:s and clients )s+ecified as +regnant "omen*0 ,he
o++ortunity to e5tend the study to include family members "ho may +lay critical roles in
decision-ma$ing< trans+ortation etc0 )including husbands, in-la"s etc0* is missed here0
%iven that the current ob1ectives allo" for a more integrated gender analysis and the
methodologies dra" from +rinci+les and +ractices of +artici+atory research, the o++ortunity
still e5ists to modify the data collection and analysis to include more se5 disaggregated data
and to +robe the gender and socio-cultural considerations ade6uately0 :t the net"or$ level
more attention is being given to su++orting gender integration in all the +ro1ects including
mid-course ad1ustments to +ro1ect im+lementation0
:lready in the case of Pa$istan the researchers have noted a socio-cultural and gender
e6uality factor that could influence the success of the +ro1ect - namely lo" literacy of "omen
in the study community0 ,he +roblem is being addressed by sending the S&S reminders and
messages to both Lady 'ealth Cor$ers and husbands of +regnant "omen )Shari6
Iho1a, +ro1ect mentor, +ersonal communication*0 :t +resent the research does not engage
"ith this issue beyond this 8technical fi58 of sending messages to husbands as "ell0 ,he
study "ould be enriched by using this modification to involve husbands more in the study by
including them in the I:P assessments and tracing the lines of communication to see
"hether "omen received vital information from both husbands and lady health "or$ers0 :
discrete section on user +artici+ation in the +ro+osal notes that target clientele may include
husbands but only "here cultural factors related to the definition of household decision-
ma$ers "ould result in husbands being registered in the system )Saligumba et al0 2//.b*0
,his a++roach fails to consider that intra-household relations al"ays mediate decision-
ma$ing "hich may affect +rioritization of health concerns< trans+ortation and treatment0
;ncovering the socio-cultural outcomes )+ositive and negative* of including husbands in this
+ro1ect "ould +rovide stronger evidence for designing effective and sustainable interventions
modeled on this +rogram0
,he S&P +ro1ect falls short or fails to address most of the si5 good +ractices "e have
identified0 ,he research teamKs understanding of the +roblem, +articularly their discussion of
family roles and decision-ma$ing, im+licitly +oints to the influence of gender relations on
the develo+ment issue "ithout e5+licitly discussing gender and social ine6uality0 ,he lac$ of
a gender s+ecific ob1ective allo"ed for the gender considerations to remain isolated and
therefore they did little to influence the situation analysis or the methodology0 %ender
ine6uality could be e5+lored in greater de+th if the +artici+atory methods they +ro+osed "ere
modified to ta$e gender and social considerations into account and to ensure that se5-
disaggregated data are collected0 7n combination, these changes "ould +rovide the
researchers "ith the theoretical and em+irical data re6uired to incor+orate a gender analysis0
Conclusion
One of the central issues, "hich is evident in the literature revie" and "hich reverberated
throughout the +ro1ects findings, is "omenKs ca+ability, or lac$ thereof, of benefiting from e-
'ealth +ro1ects0 :s suggested in the ,amil Nadu +ro1ect in 7ndia, this results from broader
societal ine6ualities "hich influence "omen8s level of education, 79, and literacy s$ills<
their decision-ma$ing +o"ers< and their allocation of time, labour and resources0 ,hese
issues highlight the im+ortance of giving ade6uate attention to +o"er relations0 ,hese +o"er
relations "or$ at different levels including intra-household as "ell as "or$ conte5ts0 Chile
in some cases, it is difficult to address the +o"er relations in the households and
communities, at a minimum +ro1ects should see$ to understand these influences and give
s+ecial attention to ensure that +ro1ects do not e5acerbate them0
On a substantive level the 7DR9 +ro1ects "e discussed here +rovide evidence of the
influence of gender ine6uality on e-'ealth interventions0 %iven their intent to e5+lore these
issues the +ro1ects uncovered ho" gender relations "ithin the household and the community
affected "omen8s abilities to access and benefit from the +ro1ects0 Ce note the im+ortance of
establishing this intent in several sections of the +ro1ect +ro+osal, +rinci+ally, the 8+roblem
and 1ustification8< 8ob1ectives8 andBor 8research 6uestions8 and the methodology0 Pro1ects
should ensure that se5-disaggregated data is systematically collected0 Ce also em+hasize that
rich gender analysis emerges from +artici+atory and 6ualitative research methods "hich can
also uncover unintended outcomes or une5+ected findings0 Ce also suggest that this
crossBmulti-disci+linary a++roach and systemic gender analysis should be a++lied to other
79,=D domains such as agriculture and rural livelihoods, education and governance0
References#
:cacia )2//3*0 :cacia Pros+ectus 2//3-2/110 Otta"aH 7DR90 :vailable at
htt+HBB"""0idrc0caBenBev-11A=A1-2/1-1-DOQ,OP790html0
:4D ):cademy for 4ducational Develo+ment*0 )2//*0 Pro+osalH ;ganda 'ealth
7nformation Net"or$ Phase-7 );'7N Phase-7D*0 October 2// M :ugust 2//90 Otta"aH
7DR90
94: )2//3*0 79,=D :mericas Program 7nitiative Descri+tion of the +rogram for 2//1-2//30
:vailable athtt+HBB"""0idrc0caBenBev-1//..2-2/1-1-DOQ,OP790html0
9hib, :0, L"in, &0, ' Lin, T :ng, and Santoso, ?0 )2//.*0 &id"ives and mobilesH using 79,s
to im+rove healthcare in :ceh (esar, 7ndonesia0 :sian Tournal of 9ommunication, 1. )=*H
A=.-A3=0
9olman R0 )2//A*0 : +rofile of "omen8s health in 9anada0 Otta"aH (ureau of Comen8s
'ealth and %ender :nalysis, 'ealth 9anada0 Tuly 2//A0
9uneo, 90 )2//2*0 %lobalized and localized digital divides along the information high"ayH :
fragile synthesis across bridges, ram+s, cloverleaves, and ladders0 ,he AArd :nnual Soro$in
Lecture, ;niversity of Sas$atche"an0
D:C )Division for the :dvancement of Comen* )2//!*0 %ender e6uality and em+o"erment
of "omen through 79,0 ;nited Nations0 :ccessed ?ebruary 21, 2//9 from
htt+HBB"""0un0orgB"omen"atchBda"B+ublicB"2///-/90/!-ict-e0+df0
Denton, &0, Calters, D0 G Prus, S0 )2//=* %ender differences in healthH : 9anadian study of
the +sychosocial, structural and behavioural determinants of health0 Social Sciences and
&edicine, !.H 2!.!-23//0
Donner, L0 G Pederson, :0 )2//=*0 (eyond vectors and vesselsH Comen and +rimary
healthcare in 9anada0 National Cor$sho+ on Primary 9are and Comen, ?ebruary 3-, 2//=,
Cinni+eg0
Dougherty, &0 )2//3* Pan-:sia 79, RGD %rants Programme Revie" and :nalysis0
(ang$o$H :sia-Pacific Develo+ment 7nformation Programme0 Otta"aH 7DR90
Doyal, L0 )2///*0 %ender e6uity in healthH Debates and dilemmas0 Social Science and
&edicine, !1)3*H 9A1-9A90
4lder, L, G 9lar$e, &0 )2//* Past, +resent and futureH 45+eriences and lessons from tele-
health Pro1ects, O+en &edicine, 1)A*0 :ccessed &ay 1., 2//9
from htt+HBB"""0o+enmedicine0caBarticleBvie":rticleB191B9.0
4lder, L0 G 9lar$e, &0 )2//9*0 45+eriences and lessons learnt from telemedicine +ro1ects
su++orted by the 7DR9 in ,elehealth in the Develo+ing Corld0 4ds Cootton, R0 et al0 3.-.0
Otta"aH 7DR9BRoyal Society of &edicine Press0 :vailable at htt+HBB"""0idrc0caBenBev-
1A3A=-2/1-1-DOQ,OP790html0
%ender and 79, Net"or$ )2//!*0 ,he gender digital divide in ?ranco+hone :fricaH : harsh
reality0 Otta"aH 7DR90
%urumurthy, :0 )2//=*0 %ender and 79,sH Overvie" re+ort0 De+artment for 7nternational
Develo+ment )D?7D*0
'af$in, N0 )2//2*0 %ender issues in 79, +olicies in develo+ing countriesH :n
overvie"0;ND:C0 :ccessed ?ebruary 1., 2//9 from
htt+HBB"""0un0orgB"omen"atchBda"BegmBict2//2Bre+ortsBPa+er-N'af$in0PD?0
'af$in, N0 G 'uyer, S0 )2//*0 Comen and gender in 79, statistics and indicators for
develo+ment0 7nformation ,echnologies and 7nternational Develo+ment, =)2*H 2!-=10
'af$in, N0 G 'uyer, S0 )2//2*0 Lessons on gender in 79, a++licationsH 9ase studies of
7nfoDev +ro1ects0 Cor$ing Pa+er No0 1., infoDev0
'af$in, N0 G ,aggart, N0 )2//1*0 %ender, information technology, and develo+ing countriesH
:n analytical study0 Cashington D9H :cademy for 4ducational Develo+ment0
'en"ood, ? G 'art, :0 )2//A*0 :rticulating gender in the conte5t of 79,s and health careH
the case of electronic +atient records in the maternity services 9ritical Social Policy,0 2A)2*H
2=9M23
Leslie, T0 )1992*0 ComenKs time and the use of health services0 7DS (ulletin, 2A)1*H =-0
Litho, P0I0 )2//*0 79,s and health in ;gandaH benefits, challenges and contradictions0
:ccessed ?ebruary 19, 2//9 from htt+HBB"""0genderit0orgBenBinde50shtmlLa+cUa--e--
1G5U9!=A0
Lorence, D0 G Par$, '0 )2//*0 %ender and online health informationH : +artitioned
technology assessment0 'ealth 7nformation and Libraries Tournal, 2=H 2/=M2/90
&a5field, :0 )2//=*0 'ealth 9ommunication 7nsights0 (altimoreH 'ealth 9ommunication
Partnershi+ based at Tohns 'o+$ins (loomberg School of Public 'ealthB9enter for
9ommunication Programs0
&olave ?oundation0 )2//A*0 Pro+osal- ,echnology-su++orted distance non-formal training
and education in "ater, sanitation and hygiene ),he Phili++ines*0 Otta"aH 7DR90
&olin, T0D0 )2//3*0 Pro1ect +lanning for a P:N regional health and 79, research net"or$H
Revie" and evaluation of e5isting +ro1ect out+uts, technology scan, and e-coloy conce+tual
frame"or$0 Otta"aH 7DR90
&urray, S0?0 G Pearson, S090 )2//3*0 &aternity referral system in develo+ing countriesH
9urrent $no"ledge and future research needs0 Social Sciences G &edicine, 32H 22/!-221!0
Neuhauser, L0 G Ire+s, %0 )2//A*0 Rethin$ing communication in the 4-health era0 Tournal of
'ealth Psychology, .)1*H -2A0
Odame, '0'0 )2//!* 7ntroductionH %ender and 79,s for develo+mentH Setting the conte5t0
P+0 1A-2A0 %ender and 79,s for Develo+ment : global sourceboo$0 I7, )Royal ,ro+ical
7nstitute*, the Netherlands, G O5fam %(0
O$o1ie, 904040 )199=*0 %ender ine6ualities of health in the ,hird Corld0 Social Science and
&edicine, A9)9*H 12A-12=0
Orbicom0 )2//* 4merging Develo+ment O++ortunitiesH ,he &a$ing of 7nformation
Societies and 79, &ar$ets0 Otta"aH 7DR90
P:N )Pan :sia Net"or$ing* )2//3*0 Pan :sia Net"or$ing Pros+ectus 2//3-2/110 Otta"aH
7DR90 :vailable athtt+HBB"""0idrc0caBenBev-1A3A/3-2/1-1-DOQ,OP790html0
Ramos, :0 )2//3*0 ,echnology su++orted distance non-formal training and education in
"ater, sanitation, and hygiene )Phili++ines*H ?inal ,echnical Re+ort0 &a$ati 9ity,
Phili++ines0 &olave Develo+ment ?oundation0
Rashid, :0 G 4lder, L0 )2//9*0 &obile +hones and develo+ment0 :n analysis of 7DR9
su++orted +ro1ects0 4lectronic Tournal of 7nformation Systems in Develo+ing 9ountries,
A3)2*H 1-130 :ccessed &ay 1., 2//9 from
htt+HBB"""0e1isdc0orgBo1s2Binde50+h+Be1isdcBissueBvie"B930
Renu$a )2//=*0 7, mediated rural "omen education and dissemination of health information
- : +ilot +ro+osal0 :ccessed &ay 1., 2//9 from htt+HBB"""0idrc0caB+anasiaBev-!1A/-2/1-1-
DOQ,OP790html0
Saligumba, 70?0 and Raza, S0 G Soegi1o$o, S0 )2//* P:N:9e: Research Pro+osal MDraftH
9ommunity-based e-'ealth Promotion for Safe &otherhoodH Lin$ing 9ommunity &aternal
'ealth Needs "ith 'ealth Services System in :ga Ihan ;niversity and ;niversity of
9algaryH Pro1ect Pro+osal P:N :sian 9ollaboration for 4vidence-based e-'ealth :do+tion
and :++lication )P:N:9e:*0 Otta"aH 7DR90
Saligumba, 70?0 and Raza, S0 G Soegi1o$o, S0 )2//.a* 9ommunity-based e-'ealth
Promotion for Safe &otherhoodH Lin$ing 9ommunity &aternal 'ealth Needs "ith 'ealth
Services System- Needs :ssessment Re+ort in :ga Ihan ;niversity and ;niversity of
9algaryH P:N :sian 9ollaboration for 4vidence-based e'ealth :do+tion and :++lication
)P:N:9e:* 7nterim ,echnical Re+ort0 Otta"aH 7DR90
Saligumba, 70?0 and Raza, S0 G Soegi1o$o, S0 )2//.b*0 P:N:9e: Research Pro+osal M
9ommunity-based e-'ealth Promotion for Safe &otherhoodH Lin$ing 9ommunity &aternal
'ealth Needs "ith 'ealth Services System in :ga Ihan ;niversity and ;niversity of
9algaryH P:N :sian 9ollaboration for 4vidence-based e'ealth :do+tion and :++lication
)P:N:9e:* 7nterim ,echnical Re+ort0 Otta"aH7DR90
Satellife )2//=*0 ;ganda 'ealth 7nformation Net"or$0 ,echnical Re+ortH Caterdo"n, &:0
Satellife )2//!*0 'andhelds for 'ealthH SatellifeKs 45+eriences in :frica and :sia0
Caterdo"n, &:0
Satellife0 )2//3* : +ro+osal for ;ganada 'ealth 7nformation Net"or$, Phase 7770 Otta"aH
7DR90
Sattelife )2//*0 ;ganda 'ealth 7nformation Net"or$, Phase 7770 ,echnical re+ort0 Otta"aH
7DR90
Sciadas, %0 )2//!*0 ?rom the digital divide to digital o++ortunityH &easuring infostates for
develo+ment0 &ontrealH Orbicom0
Scott, R G Sayeed, :0 )2//*0 Pro1ect Planning for Regional 'ealth and 79, Research
Net"or$ P:N-:sia M 9onsultantKs Re+ort0 Otta"aH 7DR90
Standing, '0 )199*0 %ender and e6uity in health sector reform +rogrammesH : revie",
'ealth Policy and Planning, 12)1*H 1-1.0
,imyan, T0 et al )199A*0 :ccess to careH &ore than a +roblem of distance0 7n ,he health of
"omenH : global +ers+ective0 4ds0 Ioblins$y, &0, ,imyan, T, G %ay, S0 Cestvie" Press0
,i++ing, %0, Segall, &0 )199!*0 'ealth care see$ing behaviour in develo+ing countriesH :n
annotated bibliogra+hy0 120 (rightonH 7nstitute of Develo+ment Studies0
Den$atesan, D0S0 G (ai, T0 )2//=*0 7,-mediated rural "omen education and dissemination of
health information- : +ilot0 ?inal Pro1ect Re+ort0
Dlassoff, 90 )199=*0 %ender ine6ualities in health in the ,hird CorldH ;nchartered ground0
Social Science and &edicine, A9)9*H 12=9-12!90
Carschauer, &0 )2//A*0 ,echnology and social inclusionH Rethin$ing the digital divide0
9ambridge, &:H &7, Press0
Corld 'ealth Organization0 )2//*0 &aternal mortality in 2//!H 4stimates develo+ed by
C'O, ;N794?, ;N?P: and the Corld (an$0 %enevaH Corld 'ealth Organization0
3nne; "# IDRC e9Health Research Pro6ects approved since &<<0
10 R"anda 'ealth and 4ducation 7nformation Net"or$ )O:S7S-R'47N*
20 4valuating a Real-,ime (io Surveillance Program H Pilot Pro1ect
A0 4nhancing Nurses :ccess for 9are >uality and Ino"ledge through ,echnology
)4N:9>I,*
=0 9a+acity (uilding in O+en &edical Record System )O+en&RS* in R"anda
!0 Pilot Pro1ect ;sing 79,s to &onitor 9hagas8 Disease in :rgentina, (olivia and (razil
30 Punto T H a Portal for #outh-to-#outh 4ducation on 'ealth and '7DB:7DS - Phase 77
0 ;ganda 'ealth 7nformation Net"or$ );'7N* - Phase 7D
.0 O+en :rchitecture, Standards and 7nformation Systems )O:S7S* for 'ealthcare in
:frica
90 P:N :sian 9ollaboration for 4vidence-based e-'ealth :do+tion and :++lication
)P:N:9e:*
1/0 4lectronic 'ealth Delivery using O+en Source Soft"are and Personal Digital
:ssistants ):rgentina and 9olombia*
110 &ozambi6ue 'ealth 7nformation Net"or$
120 &other and 9hild 'ealth 7nternational Research Net"or$
1A0 'andheld 9om+uters for &alaria &onitoring )&ozambi6ue*
1=0 Develo+er Net"or$ H O+en Source Personal Digital :ssistant Soft"are for 'ealth
Data 9ollection
1!0 Lin$age for 4ducation and Research in Nursing )L4:RN* H a 9aribbean 7nitiative
130 ,elemedicine in Remote :reas of :lgeria
10 ;ganda 'ealth 7nformation Net"or$ - Phase 77
1

:ccording to Long"e )1991*, a +ro1ect may be considered gender negative, neutral or
+ositive de+ending on ho" many "omen +artici+ate in itH a +ro1ect is considered be negative
if it does not involve "omen at all< it is neutral if it recognizes "omen< and +ositive if it
considers "omenKs issues in its design and im+lementation )6uoted in Litho 2//*0