Healthcare and Digital Divide

My first few posts have included information on digital divides within and between countries. Also, it has discussed ways in which countries and organizations can try to bridge the divide. From this point onwards, I would like to focus more on individual industries/sectors and the digital divide surrounding them. In this post, I would like to concentrate on digital divide faced by the healthcare sector.


I want to start this post by mentioning an important difference that I have personally felt between the healthcare systems of India and the USA. When my daughter was born in Princeton, most of the bills were paid online. In the first year of her birth, I had visited the doctor’s website many times. I had used the website to fill various forms, view symptoms and cures, and even view her vaccination records. On the contrary, in India, most payments are still made in person or through a bank. While consumers in big cities (metropolitan) may surf the web for information, small towns/villages do not have such facilities. This delineates the digital divide that exists in healthcare between two countries. To bridge this gap, many countries are adopting digital diagnostic services for its rural areas.


In rural India, there is a scarcity of doctors. Very few people with an MBBS degree like to stay in villages. Many non-profit organizations seek to help this situation by conducting free clinics in villages. Rotary and Inner Wheel clubs in India are very active on this front. Their aim is to irradiate polio and TB infections in India.

http://bangalore.citizenmatters.in/articles/view/1715-rotary-polio-eradication-drive


Also, doctors from all around the world volunteer to spend a few months in developing countries to run free clinics and educational classes. Their aim is to help patients suffering from diseases like HIV, Cancer etc.
http://www.unv.org/en/news-resources/news/doc/un-volunteer-doctors-mobilized.html
However, it is not always possible to have doctors volunteer and visit such remote places. In such cases, villagers are looking to adopt digital diagnostic services. These services are available throughout the world.


http://www.healthcareitnews.com/news/diagnostic-software-aids-rural-providers

This technology allows doctors and non-doctors to diagnose and treat patients by viewing information (images and text) on the software. However, the scope of such information is limited. The database can include only a limited amount of information on a specific disease or problem. Also, non-doctors may assess the symptoms wrongly and this can be fatal. A better system can incorporate online video chats with the doctors who can be more efficient in providing a diagnosis. However, it is again difficult to establish such technologies (Internet, computer and camera usage etc.) in rural area of developing countries (as these places may not have the infrastructure to support such technologies). Also, people in such places are not accustomed to these technologies.


Digital Divide in healthcare is also prevalent within countries. In the United States, minorities and low-income groups face various technological issues. They are unable to afford technology. Even if they have access to technology in some form, they do not use it on a regular basis. For improving the condition of minorities in healthcare, President Obama has asked to deploy the Electronic Health Records. The aim is to reduce cost, aid in record keeping, and help the overall quality of care. However, this plan may backfire.


According to an article in the National Journal, EHR may be creating a bigger digital divide than helping the minorities. They mention that the providers for uninsured minorities may not have adopted EHR as it is very expensive.

http://techdailydose.nationaljournal.com/2010/10/health-it-official-to-vendors.php


There are various unsolved issues surrounding the digital divide between and within countries. One way of solving this may be by public-private collaboration (the public gives the expertise/knowledge about the culture and the private puts in the fund and assess the result). However, this is a simplistic way of looking at a very complex problem. More study is required in this area to come up with a working solution.

Public- Private Collaboration

Many countries are using a new model of alleviating the digital divide. They believe that involving the private sector in this process will help remove discrepancies faced earlier. One example of this can be found in Taiwan. The Asia-Pacific Economic Cooperation in Taiwan has started the ADOC project. This project seeks to collaborate with the private sector in order to achieve focused goals. They are working with companies like ACER (second largest PC maker) by making ‘digital cars’. These units will help as mobile classrooms and serve more people. The project is already gaining success in eastern Taiwan.
http://english.rti.org.tw/Content/GetSingleNews.aspx?ContentID=111056

Government officials of many developing countries believe that the public-private partnership can result in more sustainable programs. Such programs will not only offer an in-built structure for accountability but will also help with transparency. According to Dr. Krishna (Additional Secretary for the Ministry of Panchayati Raj, Government of India), “This transparency brings about improved accountability of the [government] agency and gives satisfaction to the people.”
http://www.futuregov.asia/articles/2010/oct/20/public-private-coalitions-key-digital-divide/

Another example of this collaboration can be seen in Vietnam. Cisco has collaborated with educational institutions to create a highly skilled workforce by supporting the demands for information and communication technology. According to Sandy Walsh (Regional manager of Cisco in Asia Pacific), " Students learn both ICT and other 21st century skills which give students an edge in their career as networking professionals of the future.”
http://www.marketwatch.com/story/cisco-helps-transform-education-in-vietnam-by-investing-in-next-generation-2010-10-19?reflink=MW_news_stmp
This collaboration will help the students in achieving competitive advantage. They can be considered for employment all over the world.

The public-private collaboration is indeed a better way of dealing with the situation. This will allow the companies to focus on a particular issue and diligently manage it. Because the company’s reputation is at stake, they will handle it better than the public organizations. They will try to cut through the corruption or will have financial tools to face them. To acquire a better understanding of the situation, I conducted a telephonic interview with the chairman of a railroad ties company in India.

According to my interviewee, private sectors can indeed put in more money and effort in the process. He believed that the public sector had the potential to get the work done but due to too much intrinsic politics and lack of proper resources, they start well but eventually get stuck. He said that the private sectors could help change this.

The private sector is more interested in sustainability and stakeholder relations. By taking over a project, they can help the local community while keeping their employees and other stakeholders happy. Also, many industrialists who have done well for themselves like to give back to their community as they have strong ties with them. This is more on the lines of pure philanthropy.

The involvement of private sector will help establish checks and balances that will help in improving accountability and transparency of a particular project. Also, these companies like to assess their impact and that such assessment is possible if there is better funding. So, it is definitely better to involve the private sector. The only problem associated with such collaborations is that the public and the private sector may not have the same goals. So, it is imperative that such goals are decided upon at the nascent stage.

Do programs really work?

Do bridging programs help or do they increase the divide?

Many researchers believe that bridging the digital divide will help in the development of a country. They conduct programs that may help to bridge the digital divide and then measure the changes in the development of the country.
http://mcs.sagepub.com/content/29/6/869.abstract

One such example is the Passenger Reservation system in India.
The Passenger Reservation system for Railways in India was one of the first successful projects in India that aimed at bridging the digital divide. It made travel and its bookkeeping easier. According to an article by SS Rao, this system made life easier for the common man.
www.emeraldinsight.com/journals.htm?articleid=1718896&show=pdf

Lately, the computerization of the reservation system has extended itself to online reservation of tickets. Prior to this, the ticket could only be reserved at the counters. However, with the advent of the World Wide Web and the Internet, the existing system has tried to improve itself. It has incorporated the new technologies in order to make life easier for the consumers. This post will discuss whether this advancement is helping bridge the digital divide or expanding it.

I want to point out that people in villages are not technically educated to reserve/book their tickets through the Internet. Also, most villages do not have Internet connections or even electricity to run the technologies (Rao, 365). While people in towns and cities can easily avail this service, people in villages have great difficulty in achieving the desired result. This in itself defeats the whole purpose of using technology to lessen the divide.


A few weeks ago, some relatives of mine were traveling from Patna (the capital of a state in India) to a small town in West Bengal. After waiting for a while at the railway station, they realized that there was no information for their designated train. They went to the railway administrator who informed them that the train had been canceled a few weeks earlier and that no such train was on the timetable anymore. The information on the website was not only incorrect, it also made a vital mistake of accepting reservations for a train that did not exist. The refund process took about 3 months. This process is known for its delayed response.
http://hubpages.com/hub/Now-you-can-plan-your-railway-travel-in-India-from-your-home-How-to-book-your-e-ticket


So, any person who is economically unable to afford another ticket would have to wait until the refund from the prior cancellation was received. On the contrary, people who are affluent can reserve their tickets again, without waiting for the refund. They can also ask agents, who take a higher premium, to reserve or cancel by making a phone call. In my opinion, this is reestablishing a bigger digital divide based on financial status rather than helping the issue.

Another problem with the online system is that the website does not provide comprehensive information. Users do not have enough information about various seat options etc. They may pay a higher premium for a seat that they may have to share with 4-5 other people (RAC). Also, these tickets are non-refundable. Purchasing the tickets at the counter have more advantages than purchasing them over the internet. Even though the users have to wait in long ques to buy their tickets, they still possess the opportunity to ask questions about the type of ticket/seat.

http://www.indiamike.com/india-articles/indian-railways-rac-and-indian-railways-waitlists/


Also, many travel agents buy the tickets before hand in order to sell them at a higher commission, making it difficult to find tickets. The affluent can again afford the tickets. However, it is tough for the lower class to buy such highly priced tickets from the agents.

The system faces other technical difficulties. It has a very slow interface and hangs frequently. Many users believe that this is purposefully done. According to these users, the incompetence of the system renders the users to buy the tickets from travel agents at higher commissions. However, this accusation has not been proven.

http://www.inewsindia.com/2010/06/02/is-tatkal-railway-reservation-system-working-for-common-people/

These programs are genuinely trying to make a differences but they face problems due to restricted resources (making good interface or spreading the programs to other parts of the country) and corruption (agents, politicians, and bureaucrats reserve a large number of seats beforehand and make it difficult for common people to find vacant seats). My next post will discuss new ways by which such discrepancy can be countered.

Digital Divide within countries

This week I want to discuss the prevalence of digital divide within different countries. After reading various articles, I realized that this divide exists within both developing and developed countries. This post seeks to elaborate the former point by stating examples from different countries.


While researching on this topic, I came across an interview I had conducted a couple of years ago for some undergraduate class. This interview was based on the idea that women in developing countries, and especially in rural areas, are also being introduced to new technologies. However, after interviewing a technical assistant for an IT development center in a village in Bihar, India, I gathered that most of the people who used the technologies from this IT center were men. Very few women visited the IT center (some by choice and others due to societal expectations).


Context plays a very important role in the creation of digital divide. For example, the caste system in India is a very influential part of the society. Women from certain castes are not allowed to perform certain tasks. Also, associating with different castes is considered to be profane or wrong. While some women are not allowed to attend emancipation programs, others do not join them voluntarily. I came across an article that describes this phenomenon really well. It depicts the important role of context in shaping the society. Also, it outlines how participation of women and other underprivileged groups are shaped by the societal structure and results in minimal participation from these groups.
http://mcs.sagepub.com/content/29/6/869.abstract


This furthers our discussion about the digital divide between men and women in South Asia. The article below describes how there is a considerable difference in phone usage between men and women in the South Asian countries. This study was conducted in 2006 and showed that phone usage in women (BOP) were limited in comparison to men. Also, in the higher classes, the male members were considered to be the primary decision-makers in the family and had an advantage over the women while using technology.
http://nms.sagepub.com/content/12/4/549.abstract


Gender difference is not the only reason for this digital divide. Economic instability is another big deciding factor. Countries like Pakistan, Bangladesh, India etc., all have a huge disparity between the rich and the poor. According to a U.N. report, 30% of the South Asian population still lives on a dollar a day.
http://www.mdgasiapacific.org/node/126


However, in truth, this percentage could be much higher. This is due to the fact that many people in these countries are still illiterate and uneducated. They may not participate in the surveys/census conducted by various governmental and non-governmental parties. On the other hand, there is an upper class that is becoming technologically savvy. They are sending their children to Britain and USA to have a better education. The middle class is also trying its best to catch up with the current trends. This difference within the various subsections of the society causes the digital divide.


So far, this post has discussed the Digital Divide in developing countries. Now, it aims to emphasize that such differences also exist in developed countries. Brussels is a good example to consider.


A study in Brussels delineates that youths who belong to immigrant families do not use computers and the Internet as much as other average young people. So, ethnicity is very important in deciding the digital divide. It also outlines that religion plays an equally important role in establishing the divide.
http://www.reference-global.com/doi/abs/10.1515/COMM.2010.010