The paramount role of Local Governments in ICT4D projects

Carlos Rey-Moreno (crey@ ehas.org)

 Researcher at EHAS Foundation (www.ehas.org)

 Madrid, July 2010

Many studies have corroborated that Information and Communications Technologies (ICT) are one of the most important tools for boosting the development of a region. However, a third of the inhabited world cannot benefit from them. Most of these regions are rural areas located in low and medium income countries which cannot afford providing infrastructure of any kind in this areas. The lack of roads and energy infrastructure, together with a population sparse and based on a subsistence economy, make them less attractive for telecom operators which do not see return on investment deploying networks in these areas. 

In these contexts, several development agents are using donors' aid by building communications infrastructure in special sites of these areas such as schools, health centres, municipal facilities, and kiosks. Most of them consist of individual satellite connections with associated high fixed costs. To reduce these costs, some stakeholders are using alternative radio technologies, like VHF or WiFI over long distances, to share these connections. Although these solutions may ease the economic problem, since the higher initial costs due to additional infrastructure are paid by donors, they have to face other problems. Once the donors' aid is gone, technicians from nearby cities cannot be paid to come and maintain the network: the lack of trained peopled in these areas threatens the sustainability of the networks.

One institution which is looking for solutions to these problems is the EHAS Foundation (Enlace Hispano Americano de Salud - Hispano American Health Link). It is a non-profit organization whose purpose is to promote the appropriate use of ICT to improve health care processes in remote rural areas of developing countries. It has more than ten years of experience connecting healthcare facilities with their reference hospitals in the Amazonian Jungle.  To date, it has deployed several networks, mainly in the Loreto department, Peru, connecting more than 100 health care centres and benefiting indirectly around 20,000 people in this region. These centres can benefit from second opinion diagnosis and better coordination when referring patients both in urgent and non-urgent cases. Furthermore, infirmary technicians in charge of some rural health care facilities, who before the deployment of the networks had to travel around 3 days to their reference centre for training, coordination or  management issues, leaving the centre unattended, can now carry great part of these tasks through ICTs. However, due to the lack of funding for repairing network failures, it has been impossible to provide these services regularly.

Donors' funds only allow the start up the networks, and although local governments pay for the satellite connection, the EHAS Foundation and its local partner GTR-PUCP (Grupo de Telecomunicaciones Rurales – Rural Telecommunications Group) have had to work out all these years on how to find funds to keep the network running. In areas where lightning storms are frequent and the humidity level is very high, communication devices, though adapted for such conditions, suffer and often become useless. When these devices need to be replaced, technicians, who, as said, are not local, have to travel for several days into the jungle incurring several costs. An attempt to solve this problem is by training local people, both users and technicians in order to do preventive maintenance and solve minor problems which can extend largely the connectivity of the network. This also generates local human capital and empowers them since they are considered to be in charge of the network. However, it takes a lot of time, and money, to train people to do so, and still some budget is needed for technicians to travel to other communities. Furthermore, trained people and healthcare staff tend to emigrate to bigger cities where they can earn more, so training needs to be repeated to keep new staff maximizing the opportunities provided by connectivity.

Having demonstrated the big impact telemedicine has in healthcare process in the region, the EHAS Foundation started last year to negotiate with the regional authorities about the ways of making the networks sustainable and increase connection availability. Along this year several meetings have been held, leading to  the transference of all the networks to the regional health authorities. It has also been agreed to include ICT specific training into the course that infirmary technicians have to follow before working in an isolated healthcare centre.

In ICT driven projects carried out in rural and isolated areas of developing countries – areas where direct beneficiaries cannot pay for the technology who are using- the role of authorities is key for the maintenance of the projects. However, building itrust is a long run process that many projects do not achieve, ending up in a so called white elephant. Luckily, the EHAS Foundation projects in Peru have avoided becoming one, and  more than 20,000 have assured benefiting from telemedicine in the coming years.