Following a voice menu prompt on her cell phone,
Raquel goes through a list of questions, pressing one and two on the phone's
key pad for yes and no answers. She can also leave a voice message for a
doctor in Lima at the end of the interview.
"A cell phone makes my job easier," she said. She doesn't worry as much
about getting robbed because rather than sticking out, she appears like
anyone else making a phone call. She also doesn't have to carry folders full
of papers, or have to ship her reports every weekend to Lima. "I send the
reports in real-time," she said.
Doctors in Lima, meanwhile, monitor in real-time the reactions female sex
workers are having to medication and respond immediately if there is a
strong reaction such as vomiting. Each time the system detects a serious
adverse event, the system sends an alert to the cell phones of doctors in
Lima. Using the Internet, the doctors can also monitor the activities of the
health workers. After logging in, doctors can see the entire list of
participants registered by the mobile team, day-by-day, or on a weekly
basis. If Raquel leaves a voice message, the message is registered in the
database as an audio file. Doctors in Lima can hear her message by accessing
the database from the web. Doctors also have the capability to perform
searches, and they can download the database for further analysis.
By using the cell phone, Raquel can enter the code for a female sex worker
to get her past results from the lab. Because female sex workers do not stay
in one place all the time, being able to tap into a database makes accessing
records a world easier. "I don't have to wait weeks or months to share
results with patients who may have traveled to another city".
CELL PREVEN: A MOBILE TELEHEALTH PROJECT
PREVEN (Prevencion comunitaria de
enfermedades de transmision sexual; in English: Urban community randomized
trial of STD prevention) is a collaborative effort between the Universidad
Peruana Cayetano Heredia (Peru), Imperial College (London) and the
University of Washington (Seattle). This project is a national urban
community randomized trial in 20 Peruvian cities with populations more than
or equal to 50,000 inhabitants. The cities were randomized into two groups:
(1) 10 control sites with no intervention and (2) 10 intervention cities,
with syndromic management of sexually transmitted diseases (STD), delivered
primarily through pharmacies linked to referral networks of private
physicians and health centers, and outreach to marginalized female sex
workers (FSW). One of the primary scientific aims of the study is to
determine the impact of the interventions on prevalence of gonococcal,
chlamydial, trichomonal infection, syphilis and HIV seroreactivity in the
general population of young adults through a population-based survey and in
high-risk populations through sentinel surveillance of FSW and clients of
FSW (PREVEN, 2003).
Workers in rural health care, who serve most of the population, are usually
isolated from specialist support and up-to-date information because of poor
roads and scarce access to information technologies. Many developing
countries have a shortage of health care workers and most of the doctors,
specialists and services are concentrated in the main cities (Fraser &
Early detection and treatment of STDs represents one major strategy for
preventing transmission of STD, including infection with HIV (Sanchez et
al., 2003). Female sex workers (FSW), as other core groups, play a crucial
role in STD transmission (Campos, Chiappe, Carcamo, Garcia, Buendia, et al.,
2003). In a national survey conducted in 2002, the prevalence of STD and
bacterial vaginosis in FSW in Peru was 26% and 34% respectively (PREVEN,
2003). Early detection of STD in FSWs, as well as promoting and providing
condoms for commercial sex workers are needed to prevent HIV/STD in Peru, as
in much of the developing world (Sanchez et al., 2003). New technologies and
information systems can help programs and trials not only in STD/HIV, but in
other fields of public health involving prevention, surveillance, and
management of data.
Before the diffusion of new technologies among FSW in Peru, reports were
collected on paper. Weeks or months could pass before public health workers,
physicians, and team leaders learned of trends and patterns and were able to
Using cell phone and the Internet technology, the aim of this project was to
develop an interactive computer system for real-time collection and
transmission of adverse events (e.g., vomiting, diarrhea) related with
metronidazole administration as presumptive treatment for bacterial
vaginosis in female sex workers. We developed a system that combines the
phone and the Internet (Cell PREVEN). The idea was to design and implement a
real-time surveillance system of adverse events as a component of the PREVEN
Project. It also was a mean to optimize the data report efficiently, and
improve time in sending the reports in order to have realtime
We piloted the system in three cities of Peru: Chincha, Huanuco, and Piura.
Data collection and transmission of AE information in the field began in
early September, 2004. The system was incorporated in the mobile team
activity of the PREVEN Project. The mobile team is composed mainly of nurses
or obstetricians and a peer educator. They periodically screen female sex
workers for STDs (gonococcal, chlamydial, trichomonal infection, and
syphilis) and provide presumptive treatment of bacterial vaginosis. One week
after they provide treatment, they return to the participants and ask for
any adverse events. Six public health workers were trained to use the mobile
phones and keep track of study participants. The report in the cell phone
contained the same questions as on the paper form.
We developed an interactive voice response application for cell phones in
Spanish, based on the infrastructure of Voxiva, a telecommunications company
based in Peru (Voxiva, 2005). The architecture of the system has five
elements: a central database and web server; remote access to the database
from any Internet-connected computer; telephone audio computer- assisted
personal interviewing; voice messages and short-message service (SMS)-based
communications to and from the server via cell phones (Figure 1).
Public health workers received an account number, personal identification
number (PIN) and a plastic card with simple instructions and codes for all
the symptoms they need to report (Figure 2). By calling into a number in
Lima using cell phones they could access the system and report adverse
events from FSW systematically and in real time in urban and rural areas.
Authorized users logged on and followed instructions on a wallet-sized card
or a simple prompted menu and entered digital information about participants
with adverse events. They could attach additional information in voice
Information was stored in an online database and could be immediately
accessed worldwide and exported over a secure Internet connection.
Safeguarding the privacy, confidentiality, and security of any public health
informatics or e-health project is an important undertaking (O'Carroll,
Yasnoff, Ward, Ripp, & Martin, 2002; see also Wallis & Rice, chap. 14, this
volume). Our project does not collect the names on the database. The project
works only with numbers. Each time that the health worker wants to make a
report they have to enter a login, a password and the code number of the
participant. If someone steals the cell phone, it could be easy to get
access to the number that gets access to the system, but it is difficult to
guess the login and the password and even more difficult to guess the code
of the participants.
Team leaders (doctors) could receive the information immediately via the
Internet, analyze the data, and use the system's communication and
|Figure 1 Architecture
of the system.
|Figure 2 Example of
the instruction card.
messaging tools to respond. Team leaders could monitor incoming reports
through a Web interface (Figure 3). Individual adverse event reports arrived
in real time with full-case details. Authorized users could also listen to
voice files recorded by the remote health workers. Data were available
immediately and team leaders could export it to various programs for
analysis and presentation.
Designated users received automatic notification of selected symptoms via
e-mail and SMS messages. Health officials could communicate with remote
health professionals using voice mails as well as e-mails. For example, Dr.
Pablo Campos, one of the team leaders in Peru received e-mail messages and
text messages on his cell phone. He accessed the database for the project at
his work at University Cayetano Heredia. I was consulting on the project
through e-mail, chat and telephone from Seattle before heading to Peru. In
Seattle, I could access the database from my computer. The system was
operational 24 hours a day, 7 days a week. Because data was entered
directly, data errors were reduced.
During September through December 2004, the system collected 800 reports of
adverse events. A formal evaluation is currently under development. For
updates please refer to the Web site of the cell phone project:
|Figure 3 Basic text
and elements of the Web page (https://www.preven.alertaperu.net/).
CONTEXTUAL BARRIERS AND OPPORTUNITIES IN DEVELOPING COUNTRIES
Socioeconomic and Technology
There are many factors that limit the dissemination of e-health applications
in developing countries. Technology distribution and access deficiencies are
two factors (Rodrigues & Risk, 2003). For example, there is a huge variation
in terms of access to computer-based information technologies, usually
measured in terms of teleaccessibility, personal computer ownership, and
Internet connectivity available to people (Rodrigues, 2003).
Other factors that contribute to the digital divide include insufficient
telecommunications infrastructure, limited markets for information
technologies (IT), high telecommunication tariffs, inappropriate or weak
policies, organizational inefficiency and lack of locally created content.
Inequalities in the utilization of information technologies by the general
population are also found in developed countries determined by income and
level of education. In the health sector, the divide between developed and
developing countries in technology access is wider than the gap observed in
social and commercial sectors (Rodrigues & Risk, 2003).
Poor telecommunications infrastructure, limited number of Internet service
providers, lack of access to international bandwidth, limited wireless
networks and affordable Internet access costs continue to be major
impediments to the diffusion of Internet applications to the point-of-care
in developing countries.
Good connectivity is needed for reliable transactions. In developing
countries, fast connectivity is still limited and usually only dial-up
access is available. As an example, a study by Harte Hanks in 2001 across
different industries showed that only about one-third of the connected
organizations in selected lower and upper middle income Latin American
countries had access to connection speeds higher than 56 Kilobits per second
However, the reform of telecommunications in many sectors of developing
countries has been bringing considerable improvements in services. As a
result of greater competition, expanding markets, and rapid trade
liberalization, telecommunications prices are dropping and the
infrastructure has been improving worldwide. One-fourth or 22 of the 89
major public telephone operators that were privatized throughout the world
by the end of 1999 were in Latin America and the Caribbean (Rodrigues &
New Technologies in Developing Countries
By 2002, telephones had reached more than 6,000 communities in Peru, with
Internet access reaching 900 (Prahalad, 2005). A high demand for cell phones
is occurring in many developing countries, a demand that was lagging
|Note: *Kilobits per
second. Source: Harte-Hanks CI Technology Database (Harte-Hanks Market
Intelligence, 2001), cited by Rodrigues and Risk (2003).
behind with the installation of conventional land-based communications
equipment. Approximately 50% of refurbished cell phones are sold in Latin
America, Africa, Russia, India, China and Pakistan (Bhuie, Ogunseitan,
Saphores, & Shapiro, 2004). In Peru, the market for cell phones has been
increasing since 1993, with major growth from about 200,000 in 1996 to 2.5
million cell phones by mid-2003 (ONGEI, 2003).
In some countries, one user may access the Internet in numerous ways
including wireless, Internet cafes, kiosks, home, work and/or school
accounts. Other single accounts may be shared by many users. Some users are
heavy and others light; some started long ago while others started recently.
Internet cafes are popular access points in many developing countries, such
as Peru. By the year 2003 more than 3,600 "cabinas publicas" or Internet
cafes were operating in Peru, up from 417 in 1999 (Yachay, 2003). Recent
estimates reported that, by February 2005, there were 10,000 "cabinas
publicas" in Peru and at least 6,000 were in Lima (Villalobos, 2005).
In Peru, doctors have limited access to the Internet in their workplace.
They access mainly from home and Internet cafes. Meanwhile, 54 countries and
territories in Africa have Internet access - at least in the capital cities
(Jensen, 2002) - and many acquired the connection in recent years,
indicating the rapid pace of change. The dramatic falling costs of computers
suitable for Internet use should go some way to closing the gap between rich
and poor. This price drop and accessibility to computers brings a unique
opportunity for health care research.
Lack of Proficiency in Using Computers, and the Internet
Several other factors have been identified as contributing to the digital
divide in developing countries, chief among them a lack of proficiency in
using computers (Chandrasekhar & Ghosh, 2001). Other factors that have
contributed to the digital divide include a gap in the actual use, measured
as the amount of time spent utilizing information technologies; and a gap in
the impact of use, measured by financial, economic and clinical returns. In
other words, equipment alone is useless unless people are able to use it
effectively and informed of the potential benefits of its use (Samuel et
Inadequate education in informatics skills is a constraint among medical
students, doctors, nurses and many other health care professionals who have
different levels of computer competence. In our study (1999), 40% of the
sample composed by medical students in Peru' reported lack of proficiency on
the use of Internet. We also found that the proficiency on the use of the
Internet was not related with the year of medical school nor with age (Horna,
Curioso, Guillen, Torres, & Kawano, 2002).
Similarly, in 2003, Samuel et al. reported that only 52% of medical students
in Tanzania felt that they understood the basic terminology and concepts of
computing. Only 23% of their sample had ever consulted an electronic
journal, and 70% did not use any electronic resource. The authors concluded
that the sample had a low level of ability (very basic) to use information
technology facilities (Samuel et al., 2004). In Nigeria, Ajuwon reported
that only 42.6% of the sample studied could use a computer. Another study
conducted in Nigeria reported that 79% of students had little or no computer
skills (Odusanya & Bamgbala, 2002).
Absent or Costly Committed Human Resources
People are central for the success of any application of e-health products
and services. Employees' skills are the most expensive and least elastic
resource, and an obstacle to technological development in developing
countries. Systems professionals, technology products, services providers,
and project team must have superior skill levels and experience in the
particularities of the area being automated (Curioso, Saldias, & Zambrano,
Managing IT personnel and projects in both developing and developed
countries is a challenging undertaking (O'Carroll et al., 2002). Successful
IT projects depend greatly on a project head's ability to identify and
select the right people to work on the project, to communicate with
technical people, to hire consultants appropriately, and to organize
technical teams. Selecting the most appropriate technology is important when
developing an e-health project, but also important are good managing skills.
It is important to recognize that the latest technology does not necessarily
solve all the problems (O'Carroll et al., 2002).
Lack of Vision of Public Health Authorities Regarding IT
In developing countries, most public health organizations have a very
limited use of IT applications in day-to-day practice. Some public health
authorities believe that using IT is limited to creating a chart of the
epidemiological weekly report or to produce statistical reports. Collecting
and presenting data in a chart is not necessarily of interest to health care
professionals and managers when it comes to surveillance systems.
Most of the information systems in developing countries are inadequate to
the current models of health care, and many public health authorities are
not aware of the potential of IT to support public health. Moreover, the
public health sector is behind business, banks and other sectors in terms of
effectively using information technologies. There can be many reasons for
resistance to chance in developing countries. These can be classified as
resistance to a particular change or resistance to the changer, for example,
the individual initiating the change. There are several strategies that can
be used to address these factors. One strategy, the five-stage model,
includes assessment, feedback and options, strategy development,
implementation and reassessment (O'Carroll et al., 2002).
On the other hand, private providers and managed care groups have been
recognizing that a different type of information system and data elements
are required to run their organizations and to survive in a competitive
environment driven by increasing consumer demands and expectations for the
delivery of personalized evidence-based services (Curioso, Montori, &
CAN INEXPENSIVE TECHNOLOGIES BE USED EFFECTIVELY IN PUBLIC HEALTH IN
New technology offers much better ways to
collect data; for example, it can be collected more easily over much shorter
periods of time (McCoy, 2002). Although the use of computers or PDAs are
limited in developing countries because of their expense and requirement for
additional equipment such relatively complex network connections, cell
phones are proving a simple solution. Cell phones are ubiquitous and cheaper
than most computers and PDAs. Cell phones are showing how easy it is to
collect data electronically in developing countries even in remote settings.
Currently, one of the simplest solutions to collect data is to call a
telephone number that links to the investigator's computer via the Internet.
In our project, subjects accessed the system, and provided data using the
push buttons on the telephone. Data was automatically inserted into the
subjects' data files. The Internet provided the team leaders the possibility
to access to all reports made by the field workers so doctors can monitor
what is going in the field on a daily or weekly basis. The team leaders
could perform searches of participants, and hear the voice files that the
health workers recorded. Use of such technology depends on various factors -
cost and availability, the socioeconomic status and education level of the
subjects, and/or the amount of money available for the research. However,
the cost of new technology tends to decrease over time, and it offers much
improved methods for collecting more accurate data while involving less time
and inconvenience for subjects and researchers alike (McCoy, 2002).
APPLICATIONS OF THE SYSTEM IN OTHER CONTEXTS
There are other applications of the system in
both developing and developed countries. Alerta is a system that involves
phone and the Internet for communications and disease surveillance in
real-time in Peru. Health professionals, using available telephones and the
Internet (whichever was available), submitted real-time, electronic reports
of mandated diseases and disasters. Alerta required a substantially lower
allocation of resources, lower operating costs, and resulted in a threefold
increase in reporting coverage (Prahalad, 2005). Overall, the system
required 40% lower costs of operations than the traditional paper system.
The application was incorporated in health clinics and health centers of the
Ministry of Health (Prahalad, 2005). The study also concluded that the use
of voice mail for communication was 7.8 times less expensive than written
Lescano et al. (2003) reported that the introduction of the application has
led to early outbreak identification/response, timely case management, and
increased review of clinical procedures within reporting units. The
investment required by the system was small compared to alternative
approaches to building disease surveillance capabilities, particularly in
terms of infrastructure and maintenance expenses. The combination of
scalable technology, accurate and close monitoring of performance,
controlled growth, and effective mechanisms for information sharing,
feedback and data-driven decision making has turned the application into a
highly innovative, cost-effective, and replicable surveillance model (Lescano
et al., 2003).
Applications Outside Peru
The U.S. Food and Drug Administration developed a Web-based system using
Voxiva's platform for monitoring blood shortages in the United States. After
discovering that 40 % of the nation's blood centers did not have ready
access to the Internet, they used a system based on the use of the phone as
well as the Internet to track blood shortages. The U.S. Department of
Defense developed a disease surveillance system for Washington D.C., and San
Diego County regarding a smallpox vaccination monitoring system (Voxiva,
In the developing world, similar systems have deployed health solutions in
Latin America, Africa, Iraq, and India. For example, in Africa, they created
a national HIV/AIDS information system for eight countries that among other
things, monitors current data for national and global reporting requirement
and manages the use of antiretrovirals to reduce the spread of viral
resistance. In India, a surveillance system for Japanese encephalitis was
created in a month (Prahalad, 2005).
OTHER TELEMEDICINE APPLICATIONS IN PERU
There is a great potential to improve health
through the use of telecommunications and information technologies in
developing countries. Installing more computers or connecting a computer to
the Internet is not necessarily the answer to public health problems. One
answer could be using cell phones, public phones or "cabinas publicas".
Other telemedicine projects have been developed in Peru. One of the most
relevant is The Enlace Hispano Americano de Salud (EHAS; Hispanic American
Health Link) (Martinez, Villarroel, Seoane, & del Pozo, 2004). EHAS has
developed a system that facilitates the exchange of information between
health centers and health workers in a rural area. The EHAS system uses
radio (VHF, HF and WiFi) for voice and data communication. Information
exchange is by e-mail, and is focused on distance training, the exchange of
epidemiological reports and patient transfer. The system was installed in
the province of Alto Amazonas in Peru. EHAS demonstrated that: (1) voice and
e-mail communication via VHF radio is technically and economically
sustainable for rural telemedicine; (2) rural health workers, in many cases
nursing technicians with no university education, are capable of learning to
use computers for basic office tasks and email, by attending training
sessions of no more than 10 days' duration; (3) only through a scheme
involving the active participation of all users can a sustainable service be
achieved. Currently, EHAS is working in four Latin American countries as
well as Spain (EHAS, 2002).
TeleMedMail (Fraser, Jazayeri, Bannach, Szolovits, & McGrath, 2001) is a
software application to facilitate store-and-forward telemedicine by secure
e-mail of images from digital cameras. TeleMedMail is written in Java and
allows structured text entry, image processing, image and data compression,
and data encryption. This web-based telemedicine system is currently under
evaluation in South Africa and Peru and is available for free at
Lastly, but not least, training in telemedicine is a key aspect. In Peru,
for example, a collaboration between the University of Washington (UW) and
the Universidad Peruana Cayetano Heredia, allows better training. The
training includes a combination of short-term training for resource
personnel in Peru, and bringing many of the information integration and
organizational tools from ongoing information technology projects at the UW
(Karras et al., 2001).
LESSONS LEARNED WITH CELL PREVEN IN A DEVELOPING COUNTRY
1. Even in a challenging social setting with
limited infrastructure it is possible to develop an effective surveillance
system. It is not necessary to have the latest Palm Pilot or Tablet PC to
create a sophisticated public health surveillance system (Chin, 2005). It is
possible to deploy a health information system much more quickly and
cost-effectively than systems that require a lot of logistics and expensive
network requirements and devices.
2. The system described in this chapter is applicable to a range of health
problems - from reporting and monitoring adverse events during clinical
trials or vaccination campaigns to reporting disease outbreaks. We can even
apply the system to nonhealth settings like reporting crime or potentially
tracking commercial orders and distribution.
3. Systems implementers need a clear idea of the problem. Many technologies
failed because of lack of careful planning and evaluation of the
necessities. Factors to consider include: scan assessment of barriers,
technology, training, cost and sustainability. Even in 20 years this example
could be still used by health professionals for different purposes. This
system addresses three key ingredients of an effective surveillance system:
(a) Real-time data collection, from health workers reporting an adverse
event or a doctor reporting a disease outbreak, for example; (b) Rapid
analyses of data to make opportune decisions and allocation of resources;
and (c) Communications back to the field to coordinate response.
4. Two-way information systems are more than just collecting data. They
provide feedback and support to health care workers in the field. Many
times, only managers have information that allows them to monitor and
evaluate data but these systems do not prove any aggregate value to health
care workers in the field. A well-designed information system has to support
and enhance the performance of all user levels in a secure environment.
5. Information systems should be carefully planned and integrated across
different programs. Prahalad (2005) has reported that health workers in some
developing countries spend as much as 40% of their time filling out forms,
compiling and copying data from different programs (e.g.,
tuberculosis, malaria, HIV/AIDS, etc.). By choosing the most appropriate
information technology, we can avoid duplication and deploy different
devices - i.e., cell phones, Internet - to report from each public health
6. Partnership is key to overcome technology barriers. We can attract
top-tier industry partners if we have a comprehensive public health
initiative. Public private partnerships can increase developing country
access to improved health technologies.
7. Installing programs and PCs in public health organizations does not mean
that we are creating an integrated system. It is necessary to have a robust,
scalable, integrated information system that connects health care
professionals from the local to the national level and provide them with the
most appropriate information and support they each need. To accomplish this,
it may be necessary to have a different technology architecture and
different approach for each demand.
8. Any new technology will fail if there is not support for management
change by leaders or chief information officers. Many public health
authorities in developing countries are not accustomed to real-time
information. They have to understand that helping decision-making and
response with information technologies is critical to the success of their
mission. This change requires considerable teamwork, leadership with solid
strategic planning, training, and capacity-building efforts that go together
with the deployment of a robust information system.
9. We need to understand the culture and to select the most appropriate
technology for a determined necessity.
Telecommunications and information technology
breakthroughs hold great potential if properly harnessed. We must understand
the rich array of information-based technologies that support public health
goals, and which communications technologies are the most appropriate for a
specific cause (intervention, prevention, etc.). We must also understand who
needs to know about these new public health solutions and how to educate and
Telemedicine holds the promise of improving access to health care,
especially in areas where there are geographical barriers, and of reducing
costs (Wootton, 2001). Telehealth in developing countries is a reality and
offers tremendous opportunities that need to be explored more in the future.
One of the problems with telehealth is that telecommunications companies
often try to force a technical "solution" in public health services without
understanding the problems in the field. Some new technologies may become
more important in the future, as wireless access improves (for example,
Wireless Application Protocol -WAP- phones) (Hung & Zhang, 2001, 2003).
Karras et al. reported that a Java-enabled wireless phone could be
potentially used in disaster response and public health informatics. They
emphasized that the technology was inherently deployable, portable and that
minimal orientation to new hardware was needed since everyone was
comfortable with entering numbers on a phone keypad and pushing the send
button (Karras, Huq, Bliss, & Lober, 2002). Any application that can run on
a PC can potentially run on a portable phone using Java applets.
In teleconsultation, cell phones has been proven that is feasible to capture
and transmit images using e-mail for care of chronic wounds (Braun et al.,
2005). However, the main problem in telemedicine is not the lack of
technology; rather, it is the organizational problem of knowing how to take
advantage of the technology. For example, how communities may benefit from
the right information technology application. In some countries, cell phones
may be a better application than using Tablets PCs, smart cards, or
satellite communications (Wootton, 2001).
A Web-based electronic medical record system has shown that effective
information management is also possible in a poor community with no modern
infrastructure. In Peru, Fraser et al. (2004) described a webbased medical
record system to support the management of multidrug resistant tuberculosis.
Web-based analyses have been developed to track drug sensitivity test
results, patterns of sputum smear and culture results and time to conversion
from positive to negative cultures (Fraser, Jazayeri, Mitnick, Mukherjee, &
Bayona, 2002). Jazayeri et al. (2003) described a prototype Electronic
Medical Record system the "HIV-EMR" to support treatment of HIV and
tuberculosis in remote and impoverished areas in Haiti. The EMR allows
physicians to order medicines and laboratory tests, and provides alerts
based on clinical status and test results (see also Wallis & Rice, chap. 14,
Recently, we developed a web-based electronic report system for STD for the
PREVEN project. Interviewers entered their data directly into a single
database as they progress through the reports, thereby saving time and costs
over having the data entry done after data is collected. The system collects
new participants and generates alert reports defined by the number of missed
treatment that must be provided by the health care interviewers. The system
has the capability of searching so the interviewers can check past
laboratory results and medications. The system allows real-time access of
the database (only available for the team leaders) via the web. We believed
that web-based data collection may provide better access to
difficult-to-reach populations and cities considering the great 390 CURIOSO
popularity and cheap cost of Internet cafes or "cabinas publicas" in
Peru (Curioso, Campos, Buendia, Butron, & Kimball, 2005). The unique
popularity and low-cost of Internet cafes in some countries open new
possibilities to developing future web-based systems to show that effective
information management can be possible in poor communities with no modern
infrastructure but widespread use of "cabinas publicas".
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"New Technologies and Public Health in
Developing Countries: The Cell PREVEN Project, " was written by Walter
Curioso, in The Internet and Health Care: Theory, Research, and Practice, by
Monica Murero (ed.) and Ronald E. Rice (ed.). 1st Edition,
Copyright © 2006 Lawrence Erlbaum Associates, Inc.
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