barriers concerning standards and interoperability

mHealth in Nepal (part II of IV)

This is part two (of four) of mobile health series, which I am sharing after completing an online education on mHealth. For those who would like to read the Part One – its here.
The following are some of the concept we discussed in online class, and google group. I think this is very reasonable to developing countries like Nepal. Most of the barriers are specifically from mHealth Africa, but I have here tried to include my nepali perspective as well. Here are few of the barriers that I think I see in Nepal concerning standards and interoperability on mHealth.
  1. Language – Nepal despite being a small country, has a huge demographic variability. The mountains and hill terrain has made number of spoken language (culture) variation. “Nepali” is the official language, and English (UK) is taught from primary and secondary school. There are about 123 spoken languages (in 125 different community) and many who still do not speak or understand English at all.
  2. (limited) Mobile Technology – Most of the mobile handsets used in Nepal are under NRS.4000 (rough estimate USD=50  Euro=40). These are not Google Android OS phones, but Java based technology with proprietary OS from local market (mostly – China and India). There are about 5-6 different mobile company that have stronghold in budget feature phone in Nepal. The only technology similar (standard) in these feature phones is Java. However, almost all have Facebook (Java Application) installed in them. Facebook being number one Social Network in Nepal (at the moment).
  3. Lack of Government Initiatives – There is no standard Government based protocols regarding mHealth in Nepal. Although, Nepal Government has recently begun a trial phase of mHealth program in few districts; there is no details about this in government websites (This is something I  am considering to write for my first assignment also).
  4. Internet (Availability and Cost) – Internet access through mobile handheld is expensive; and this hasn’t reached throughout Nepal. As with mobile network, the mountainous terrain in most of the country is hampering the WiFi (WiDi, or WiMax, or LTE) rollout from Government and Private Initiatives. There is considerable progress, but more need to be done.
  5. mHealth education – is very new to Nepal. Health providers have very little knowledge about mHealth. Data Mining and Research are at its infancy in Nepali Health Community, very few if any are interested in mHealth (for this purpose) at present. Medical School (Doctors, Nurse, Health Assistant, Health Volunteers) do not have curricula to teach mHealth. Courses that offers technology (mobile or any) teaching is in Public Health related education. This education is concentrated in Data Entry, Evaluation and Analysis, but not in Health Education. I am a recent medical graduate and I had no proper formal education on Medical Technology. Most of the course work was limited to using MS Excel (2003) and SPSS (v11)
  6. Lack of (active) Open Source Community – There is a huge gap in programming education in Nepal, that most are financed/taught by proprietary holdings like Oracle and/or Microsoft. Most of the health initiatives related to technology are in the form of Outsourced Code writing by multinationals.
  7. Technical Infrastructures – present today in various Public and Private Health institute are scattered, rudimentary and closed source. Many hospitals and health care institution have both handwritten documents and e-records. Most of the time, its the physical documents that gets used, and the electronic records are forgotten. Most of the times doctors, nurses (or any other health worker) does not know how to use the electronic record. There is no inter portability between any two health care givers (both e-records or physical records).
  8. Lack of Adherence – Health providers do not seem to adhere to e-health technologies. Partly due to the lack of electricity or lack of proper motivation, or knowledge, electronic recording is seldom done in Nepal.
what can i explore for my next part?
well there are Ncell and NTC. and there network. There is Ministry of Health and its working, plus community members who love mobile. keep watch.