Photo: A. de Ferron (ITU 990026)
Photo: A. de Ferron (ITU 990026)
As we prepare to hold the second World Telemedicine Congress in Buenos Aires from 7 to 11 June 1999, we must ponder new ways of fostering the application of telecommunications in health care.
Telemedicine is a multidisciplinary public service of great importance and value to all countries. We must therefore exploit to the full, its potential to meet the health care needs of the world's population anytime, anywhere, particularly in remote and rural areas where medical facilities are in short supply.
Much of the telemedicine experience has been accumulated in the developed countries,where a wide range of technologies and services of increasing sophistication and cost exist. There is nevertheless, a growing interest in telemedicine in developing countries which we, in BDT, have a duty to encourage and promote. We are doing so through pilot projects in line with Recommendation 9 of the second World Telecommunication Development Conference held in Valletta in March-April 1998. It was clear from this conference that we need to bridge the gap between the telecommunication and health care communities at all levels.
We expect pilot projects to serve as "test beds" or case studies for other developing countries interested in using telecommunications to extend health care to remote and rural areas where most of their population lives. We have completed five pilot projects and several others are in the pipeline. We have helped establish:
The link in Mozambique made it possible to carry out the first telemedicine trials in Africa. It was inaugurated on 30 January 1998 by that country's Prime Minister, Pascoal Manuel Mocumbi. He expressed the hope that telemedicine would end the isolation which had, until the establishment of the new link, existed between health professionals in the country.
In March this year, the Prime Minister sent us an encouraging message describing the project as "a very successful undertaking, resulting in clear benefits to both the medical community and the public". He also made two announcements. The first was the government's decision to extend the project to cover other medical disciplines and other parts of the country. The second was the government's intention to prepare a comprehensive telemedicine programme for Mozambique, a document which could be used to procure financial support from international institutions such as the World Bank and other development-oriented bodies.
"We strongly believe that applying proven best practices of telemedicine, through the widespread use of low-cost technologies, will make a decisive contribution to the well-being of our citizens and significantly improve our human development indices", said the Prime Minister.
For its part, the Empresa Nacional de Telecomunicações de Moçambique has agreed to contribute part of its 1999 investment budget to the second phase of the project. One of the main goals of this phase will be to extend the teleradiology link to Nampula, Mozambique's third largest city.
We are very encouraged by these announcements. Telemedicine services in developing countries must be made affordable, practical, profitable and self-sustaining. In our own programmes, we will continue to put special emphasis on low-cost solutions which have at heart, the realities of telecommunication networks in the developing world.
How do we select pilot projects? On the grounds that they use existing telecommunication networks. That they involve one or more countries in different parts of the world. That they involve a mix of players such as telecommunication operators and/or local service providers, local medical services, health care professionals, equipment suppliers, as well as international collaborators, including satellite operators and telemedicine institutes. It is important that pilot projects mirror the multidisciplinary approach required for the deployment of telemedicine. Besides, there must be someone from the local community where the pilot project is to be implemented. This person acts as the local project leader ensuring that all players remain committed and that they work together for the success of the project.
How are pilot projects funded? In the majority of cases, the budget comes from contributions made by project partners who include, as a rule, the local telecommunication operator. BDT's own contribution for each project is relatively small and comes from the TELECOM Surplus Programme. The funds from this Programme are mainly used to launch the activities and to attract other partners. Let us take the telemedicine project in Senegal which is in the pipeline. Fifty per cent of the budget is covered by the Société nationale des télécommunications du Sénégal (SONATEL), the local telecommunication operator, and the other half by the TELECOM Surplus Programme.
The results of these pilot projects will be produced in a report prepared by one of the study groups of the Telecommunication Development Sector (ITU-D). National administrations and private sector companies participating in the work of this group are expected to produce a global directory of suppliers of telecommunications and health care technologies appropriate for developing countries.
If telemedicine has become a matter of strategic importance in the work of the ITU-D, it is thanks to the first World Telecommunication Development Conference held in Buenos Aires in March 1994 (better known as WTDC-94) and to the Valletta Conference.
WTDC-94 instructed our Sector to study the "impact of telecommunications in health care and other social services". I am confident that Buenos Aires with its unparalleled opportunities will make the second World Telemedicine Congress as exciting as it will be memorable. Let me take this opportunity to thank very warmly, the Government of Argentina for their generous offer to host this world event.
The Telecommunication Development Advisory Group (TDAG) met for the first time under this new name on 8 and 9 April 1999. Known previously as the Telecommunication Development Advisory Board (TDAB), the group acquired its new name and status at the 1998 Minneapolis Plenipotentiary Conference. Although this change in name was to officially enter into force on 1 January 2000, as will all other amendments to the Union's Minneapolis Convention, TDAG is already in use for practical reasons.
The difference between the two acronyms lies in their last letters: the "B" and the "G". TDAB was composed of "persons with a wide and equitable cross-section of interests and expertise in telecommunication development". Such persons were appointed by the Director of the Telecommunication Development Bureau (BDT). TDAG is intended to be a much wider body "open to representatives of administrations of Member States and Sector Members and to chairpersons and vice-chairpersons of all ITU study groups".
The Director may also invite representatives of bilateral cooperation and development aid agencies and multilateral development institutions to participate in the advisory group's meetings.
TDAG's main role is to "review priorities, programmes, operations, financial matters and strategies for activities in the Telecommunication Development Sector" (ITU-D) and recommend any necessary actions to the Director.
Jong-Soon Lee, Executive Director of the Asia-Pacific Telecommunity (APT), was appointed Chairperson of TDAG. Consultations are under way to appoint vice-chairpersons, based on competence and the principles of equitable geographical distribution and gender balance. They will represent each of the Valletta Action Plan (VAP) programmes:
ITU Secretary-General, Yoshio Utsumi, opened the two-day meeting which was also addressed by BDT's Director, Hamadoun Touré. The event attracted some 250 participants including heads of all ITU's regional offices, marking a good start in the implementation of the Minneapolis resolution to strengthen the Union's regional presence.
TDAG discussed the conclusions of the Minneapolis Conference relevant to ITU-D, a progress report from the focus group on the "promotion of infrastructure and use of the Internet in developing countries", promoting rural telephony, Centres of Excellence, regional telecommunication development conferences, a report of its subgroup on private sector issues, and the gender perspective in telecentres (including three presentations, two of which are summarized here). TDAG commended BDT for its first-ever operational plan which constitutes a transparent management tool. This article summarizes the main highlights of the meeting.
TDAG has endorsed guidelines for a new focus group to begin work on promoting the development of new telecommunication technologies for rural applications. The guidelines were proposed by Japan, which has also offered to provide funding and a rapporteur for the focus group.
Japan's gesture comes in the wake of growing concern that the efforts of private manufacturers to develop suitable technology for markets of the developing countries are likely to be limited, without specific and active encouragement and support from the public sector.
The guidelines will allow the focus group to establish an Internet homepage to gather and exchange information on the development of telecommunication technologies that truly meet the needs of developing countries. In addition to Japan's assistance, the homepage would be funded through voluntary contributions from ITU Members.
The homepage is expected to attract input not only from the Union's membership, but also from other organizations and individuals concerned with developing rural areas through telecommunications. Such input would be entered into a database and made available to ITU Members and the public. In addition, a "virtual conference room" would be provided to allow direct contact with the authors of the input. Information for the database will be of three kinds:
The focus group will start collecting data in June and is expected to submit an interim report in September 1999 to ITU-D Study Group 2 (Development, harmonization, management and maintenance of telecommunication networks and services). It will report to TDAG during February-March 2000.
Jong-Soon Lee
Photo: J.-M. Fesselet (ITU 990027)
TDAG has endorsed a number of training initiatives from a Special Group on Human Resources Development, chaired by David Mellor (United Kingdom). One of the initiatives seeks to promote twinning arrangements between developing Centres of Excellence such as the African Regional Advanced Level Telecommunication Training Institute (AFRALTI) in Nairobi or the Ecole supérieure multinationale des télécommunications (ESMT) in Dakar and established ones like TEMIC (Canada) and Cable & Wireless College (United Kingdom).
The first pilot project, in this context, will be a joint workshop which will be run at the ESMT under the ITU and Cable & Wireless Training Scheme. Some of the topics at the workshop will include: commercialization and its financial implications, the role of regulation, and identifying what attracts investment. In principle, Cable & Wireless will provide the workshop content, lecturers and fellowships for participants from English-speaking countries to travel to Dakar. The workshop is planned for June 1999 and the results will be reported to ITU-D Study Group 2 in September 1999.
Another pilot project offering doctoral studies will allow a French-speaking participant from Niger to undertake a doctoral course under the ITU and Cable & Wireless Training Scheme. In this way, a developing Centre of Excellence can call upon the services of experts studying at this high level to present papers on topical issues. This pilot activity will commence in the autumn of 1999 and should strengthen the link between developed and developing Centres of Excellence.
A question mark now hangs over the future of regional telecommunication development conferences (RTDC). A proposal from the BDT Director to replace RTDCs by a series of preparatory meetings in each of the regions has been seen as a bold political move which goes beyond the mandate of TDAG. The proposal argues that preparatory meetings would offer a better tool to prepare adequately for the third World Telecommunication Development Conference to be held in 2002. It goes on to say that the budget allocated in 1999 to hold an RTDC either this year or in 2000 would be used to strengthen ITU's regional presence. After an interesting exchange of views, TDAG encouraged the Director to refer the matter to the Council (Geneva, 14-25 June 1999) for further debate and decision.
One of the strategic priorities of the Telecommunication Development Sector is "to promote partnership arrangements in and between the public and private sector in both developed and developing countries, and to collaborate with the private sector in implementing the Valletta Action Plan, including partnerships with related entities in developing countries".
At its first meeting as TDAG Subgroup dealing with private sector issues (Geneva, 7 April 1999), participants engaged in a real debate on how to increase cooperation and partnership between the private sector and non-private sector entities in developed and developing countries.
"Having had the opportunity myself to experience life in the private sector and coming from not only a developing country, but from a least developed one, I feel blessed to be able to contribute in bringing the two worlds together. This is a real challenge. The private sector is often branded as having "deep pockets"; we know that in the prevailing new environment, the private sector culture has changed and is looking more and more often for real partnership opportunities rather than short term profit. This is the reality of globalization, the evolution of our sector in the world", said Mr Touré.
After a day of brainstorming, the meeting came up with a number of recommendations that should serve the needs and expectations of the private and public sectors and, hopefully, the users. The recommendations highlighted below were made looking at factors specifically relevant to the five geographical regions: Asia-Pacific, Americas, Arab countries, Africa and Europe.
lBDT should help bring developing and developed countries together on a one-to-one basis so that they can understand each other's needs and seek ways of fulfilling them. The Global Telecommunications Action Committee (GTAC), made up of some 30 trade associations from around the world, could offer its website for reaching out to the private sector and informing them of BDT's activities. GTAC is chaired by the United States Telecommunication Industry Association (TIA).
The BDT Task Force on Gender Issues has mounted an effective awareness-raising campaign and is becoming more and more visible at international and national gatherings. Gillian Marcelle of Global Information Infrastructure Commission (GIIC, Africa), who is Vice-Chairperson, and Walda Roseman (United States), who heads two of the Task Force's working groups took part in the 43rd Commission on the Status of Women (New York, 1-19 March 1999). At this meeting, the Task Force expressed interest in taking part in the preparations for the Special Session of the United Nations General Assembly entitled "Women 2000", which is planned for June 2000.
BDT is organizing a series of regional seminars on the role of community telecentres in fostering universal access and rural development in line with VAP Programme 3. Seminars have been, so far, conducted for Central European countries, Africa and the Arab States.
In addition, BDT's Human Resources Development Unit, which is responsible for VAP Programme 6, plans to include a gender perspective in its Eighth Interregional Human Resources Management and Development meeting to be held in Coventry (United Kingdom) from 18 to 24 August 1999. Among the topics up for debate are: new opportunities for women and minority groups as a result of restructuring and re-engineering, the impact of the corporate use of Internet on the management culture and human resources and changes to management information systems and the new jobs, skills and competencies required to manage these new systems.
In-service training will be offered to BDT programme managers and support staff during 1999 to assist them in integrating a gender perspective into work plans, projects and programmes.
Women, even in the developed world, are generally lower paid than men and often do not have control over their income. For example, in the United Kingdom, women employees working full-time earn on average only 80 per cent of the average hourly earnings of men full-time employees. Women's family responsibilities, such as health and education of children, are the primary priorities for the income they earn, so that often there is little left for other less immediate needs. Women also do not have as much professional access to information technology (IT) and telecommunications as men.
Telecentres can provide free or low cost IT training for women and free or low cost access to the technology. Any IT training should be offered in software that women can easily afford to buy. Telecentres should also consider investing in low cost and low maintenance networking technologies. For example, a telecentre could set up low cost network computers which can be used as word processing and data input terminals and as a means of gaining Internet access.
Because of their domestic and child care responsibilities women have less time to improve their skills or carry out paid employment. For example, the telling quote: "I wanted to go out and save the world but I could not find a babysitter!" In the United Kingdom, 51 per cent of mothers with children aged five are in work compared with 89 per cent of fathers.
Any IT and telecommunications training for women has to be in their communities so that they do not spend too much time travelling to the training venue rather than learning. This means that when a telecentre is set up and is trying to train local women, it may need to consider some type of mobile training equipment.
Some of the barriers faced by women and how telecentre projects and teleworking initiatives can help overcome these
For example, our colleagues Ryan & Vause Associates have a bus which is set up with IT and telecommunications equipment which travels into the ethnic minority communities of Oldham. This was to overcome the cultural and religious concerns faced by Muslim women for whom attending courses outside their own communities could make them feel uncomfortable. When our company, Small World, recently provided telework training for a group of women we had a mobile training suite of ten laptops which could fit in the boot of a car. As a result we were able to offer training in an old abbey; and even in a local restaurant.
In the United Kingdom, nursery fees are around GBP 400 per month so they are only practical for middle class women who earn in excess of GBP 12 000 per year. Also, for every eight children under eight, there was only one place in a day nursery or family centre with a registered child-minder or on an out-of-school scheme.
Any telecentre which is providing training for women has to provide child care. This can be done either through an in-house crèche or by providing money to cover child care. For women with school age children the training has to be at a time which suits women ¾ a time that fits in with school hours. Also, if the training is over a long period of time, it has to reflect the school holidays. For example, there is no point in arranging a training day during the school half-term or trying to run a training programme in the month of August.
If women have spent the previous five years looking after children they often feel they have no useful skills other than child care and domestic work. This can lead to a lack of confidence and cause women to apply for jobs well beneath their capabilities and earning potential. Therefore they tend to carry out part-time menial jobs with little skill or income.
Women can often feel uncomfortable with using computers and telecommunications. They can be afraid that they will make a mistake and the "machine" will break. This can be as a result of social conditioning where "girls do not play with machines".
Any IT and telecommunications training programme for women has to have a holistic approach and have a strong measure of confidence building. This can be through improving women's assertiveness skills and goal setting. During the training the women decide what are their aims, how and when they will achieve them.
It is also important to help the women realize that through bringing up children they have learned many new skills. For example many women find that running a household has given them excellent project management and budgeting skills as well as how to balance conflicting priorities.
To overcome lack of confidence with using technology, any training course has to acknowledge the problem and start with the basics of IT. Any course should be free of jargon and should explain how computers work and that they cannot explode! Also I have found that if people can see inside a computer — this can de-mystify it. Any course should allow as much hands on as possible. Dealing with faults, problems and basic information technology maintenance are also crucial elements so that women have the confidence to deal with any basic faults when they occur. This has the knock on effect of making them feel more comfortable with computers.
For many women who may already have a job, the telecentre can provide improved access to information, especially for those in rural areas. In the case of women farmers in rural Africa, access to the Internet through a local telecentre will enable them to learn new methods of farming, and how to market their products.
According to an article on telecentres in Uganda from the "Panos" website, lack of information has hampered women's ability to maximize their income generating potential. They have plenty of projects but many remote villages cannot get information on where they can take their handicrafts. Here, there could also be a role for development agencies, non-governmental organizations and community organizations to repackage the available information to make it appropriate for the needs of rural women.
I welcome the consistent attention that the International Telecommunication Union pays to gender issues in its activities.
The ideas I have developed on how telecentres could be better adapted to the needs of rural women in the context of sustainable development spring implicitly from the situation I know best, that of the West African countries and African women.
The principal message I wish to convey is to some extent a statement of the obvious: if the local women are to benefit from them, rural telecentres must respond to their needs and contribute to removing the constraints to which they are subject, such as:
Telecentres are meant to serve as a key tool for development by providing an opportunity for communal access to information and communication, particularly in disadvantaged communities, where women are nearly always in the majority but are left on the sidelines. In the present context of unequal development in our societies, however, that will not happen on its own; specific policies will have to be developed for the purpose.
Without policies to ensure that they are properly run and used, telecentres will only accentuate the economic, social and cultural disparities between those who enjoy access to them and their benefits and those for whom they will serve only as an additional factor of exclusion.
The rural world is disadvantaged in terms of "conventional" infrastructure, hence the importance of finding appropriate solutions, in particular for power supply and access, equipment and maintenance.
The dilemma of the rural world is its isolation in an era of globalization: the riches of its communities (in terms of information, culture, knowledge and skills) are not exploited and are in danger of disappearing.
For women, the major contribution of telecentres will be to help them to assume their new roles, especially in the economy and public life.
Because of these factors rural women, whom all studies show to be the prime movers of sustainable development, are among the last to benefit from the services of telecentres
Women are no longer confined to domestic work: they take economic initiatives and build up structures, in many cases starting in the so-called informal or "popular" sector but going on to forge links with the formal economy (particularly the public and banking sectors), thus extending the scope of their economic activity from the street corner to the export trade.
Women also participate more actively in public life, negotiating and decision-making, fields in which information and communication technologies play a major role. Both this year and in the year 2000 the international community will be assessing the progress of the Beijing Platform for Action for the advancement of women. Using information and communication technologies on a large scale, machinery is being set up to enable women all over the world to take part in this evaluation exercise. Unfortunately, there is every possibility that rural women will be left out, even though they are virtually the main beneficiaries.
Telecentres will only benefit rural women if they form part and parcel of a broad range of information and communication resources, and if other steps are taken to improve quality of life in the rural world, particularly for women.
State policies need to be developed in the area of telecommunications and civic involvement (including participation by women's organizations) in order to respond to women's needs.
It is also necessary to involve women from rural and peri-urban areas in the development of activities designed to meet their needs in terms of awareness-raising, training and experience in the use of information and communication technologies, and to plan how training can be geared to their requirements.
Pretto J. (Argentina)
National consultant
(15.4.99-14.10.99)
Campos I. (Brazil)
National consultant in Internet site —Technical structuring
(5.4.99-4.10.99)
Desauziers W. (France)
Senior expert in telecommunication equipment maintenance
(22.4.99-21.5.99)
Stanev I. (Bulgaria)
Senior expert in network planning (PLANITU)
(22.4.99-9.5.99)
Nasser A. (Jordan)
Consultant in telecommunications
(25.4.99-15.5.99)
Chaudhuri A. (India)
Consultant on frequency management
(8.4.99-28.4.99)
Bhatnagar P. (India)
Senior expert in Signalling System No. 7
(2.4.99-17.4.99)
Skowronski W. (South Africa)
Senior expert in Year 2000 compliance
(22.4.99-8.5.99)
Diakite D. (Mali)
Senior expert in management information systems
(17.4.99-31.5.99)
Paalu P. (Finland)
Consultant/Lecturer on rural telecommunication
(14.4.99-17.4.99)
Widl W. (Sweden)
Consultant/Lecturer on rural telecommunications
(14.4.99-17.4.99)
Chhabra J. (India)
Senior expert in telecommunication industry
(18.4.99-14.8.99)
Nasser A. (Jordan)
Consultant in telecommunications
(4.4.99-9.4.99)
Ward K. (United Kingdom)
Senior expert (technical, economics and policies) for telecommunication business course
(17.4.99-25.4.99)
Erlevent A. (Turkey)
Consultant in telecommunications
(25.4.99-30.4.99)
Serafimovska M. (Macedonia)
Senior expert in transmission
(12.4.99-11.4.2000)
Satagopan S. (India)
Senior expert in switching
(24.4.99-23.4.2000)