Women for Change Executive Director Emily Sikazwe says she was saddened by the high number of maternal mortality rates in the country. World health Organisation Country Representative Stella Anyangwe said it was sad that the just launched Vision 2030 does not address maternal health and primary health care like it does on HIV/AIDS. In 2001-2002, 77.2 per cent of the women who had a non-institutional delivery did not receive postnatal check-up.

More such women in rural areas (81 percent) were discharged before receiving the postnatal check-up compared with those in urban (53 percent) who did not receive the postnatal care. Other reasons for increasing Maternal Mortality Ratio (MMR) include limited access to facilities due to few health facilities; long distance to facilities; non availability or costly transportation facilities; shortage of trained staff; attitude of some health staff; and poor quality of care (untrained staff and lack of surgical and medical supplies). Low postnatal care, prenatal complications, complicated deliveries, postpartum deaths from hemorrhage and infections and post abortion complications also contribute to increased Maternal Mortality Rates (MMR). Maternal mortality increased from 649 deaths per 100,000 in 1996 to 729 deaths per 100,000 births during the period 2001 to 2002 (Zambia Demographic and Health Survey) according to the UNDP 2003 MDG report,. The target for maternal mortality ratio in 2015 is 162. The critical indicators in maternal health include access to antenatal, delivery and postnatal care. A total of 95.7 per cent of the women during the 2001-2002 ZDHS received antenatal care; 93.4 per cent from a health professional and 2.3 per cent from a Traditional Birth Attendants (TBAs).

The percentage of women receiving antenatal care from a health professional slightly decreased from 96 per cent in 1996 to the 93.4 per cent in 2001-2002 period. One contributing factor to high maternal ratio could be the increase in the number of women delivering at home. During the 2001-2002 ZDHS, 56 per cent of the women delivered at home and fewer of them, 44 percent, at a health facility.

Medical persons are also attending slightly fewer deliveries, while the proportion of births attended by traditional birth attendants (TBAs) increased to the highest record in 2001-2002 since 1992. The proportion of women delivered by a medical person declined, from 51 per cent of births in 1992 to 47 per cent in 1996 and 44 per cent in 2001-2002. The proportion of women delivered by a relative or friend consequently, increased from 33 percent in 1992 to 41 per cent in 1996, though slightly declined to 38 per cent in 2001-2002. Postnatal care is important in detecting complications related to delivery. Meanwhile, the use of information communication technologies (ICTs) in delivering care to pregnant women and newborns in Lusaka is on the verge of becoming easier and more efficient, thanks to the advent of Tele-health , which is simply the use of information technology to deliver health services and information from one location to another.

Collins Chinyama, former information technologist at the Central Board of Health, describes the concept of tele-medicine as a multimedia system using voice, video and data to deliver medical services remotely. “People may phone their doctors and prescriptions are done either by telephone or fax,” he says.

But the new technology overcomes the limitations of the telephone and fax to ensure that patients are diagnosed from remote locations. Tele-medicine has its advantage and negative sides: though it meets government needs for bringing health care as close to the family as possible, the need for medical workers will also diminish. But it has the potential to bridge the gaps created by Africa’s brain drain as health professionals seek greener pastures in developed nations. “There is need for tele-health in Africa because it has very few doctors and there are increasing health needs and staff constraints in most hospitals,” says Chinyama.

Tele-health works by installing information technology such as digital cameras, camcorders, digital senders and other medical equipment in all health centres. Lusaka women and their babies are the first beneficiaries of new technology in health, with the establishment of an electronic prenatal record system.

It is fitting that this new technological adventure should start at the source of life: many of the basic needs in the care of pregnant women and newborns have largely been unmet in Zambia. This is despite the fact that inadequate resources can literally be a matter of life and death in the maternity situation. Zambia’s maternal and infant mortality indicators are unacceptably high. United Nations statistics show a one in 14 lifetime risk of death in pregnancy for women. The just released demographic and health survey show that these statistics have not improved over the past five years, making this a high priority concern.

Customised software designed by doctors from Lusaka district, the University of Zambia Teaching Hospital and the Central Board of Health will eventually replace the paper records currently in use. Computers in all Lusaka clinics that provide antenatal care will be linked with several wards at the teaching hospital through a high speed wireless network. Patient data will, therefore, be entered just once and not a dozen times. Whether or not a woman goes to the same clinic, the nurse attending her will be able to see all the relevant information about her without having to ask for it and re-entering it again.

Healthcare for pregnant women in Lusaka is a large and complex system. Nearly 50,000 deliveries take place in Lusaka district clinics and the teaching hospital. Most mothers make multiple antenatal and postnatal visits, and many of them go to several sites for health care. Benefiting groups will receive better care because clinicians will have more information and more time to focus on giving care.

Maureen Chitalu, a mother of three, says she hopes the use of information technology will also manage complicated cases. She explains: “I live in Mutendere, where I also go for my antenatal care. During my previous pregnancies, nurses kept on referring me to the University Teaching Hospital (UTH), where there are specialists, because I delivered by caesarean section. It was not easy. I had to spend a lot of money on transport and, in the process, wasted a lot of time. With the new system in place this should now be a thing of the past.”

At one time, clinic staff at the teaching hospital could not find her records as they were never kept in an organised manner. But the tele-health project now means clinicians will be able to monitor and track patients, see their entire history at a glance and analyse the outcomes. Health care officials will be able to generate better information about the population.

Tele-health will also ensure security and confidentiality of patient information because it will be more difficult to gain access to patient data. Nurses and doctors will have to enter a password to see individual records. Although officials of the Central Board of Health and the district health management board will be able to see statistical information but only authorised clinicians will have access to personal patient information.

For now, an automated referral system is being written for Lusaka and it will be the first programme that will be used in the computers. It is hoped to be introduced soon.

Chinyama explains that each clinician will receive an individual e-mail address. Telephones will be connected to the computers, allowing phone calls throughout the network and training manuals will be available on the computers. Free computer training is expected to take place through the end of 2003. It will include general computer knowledge, e-mail, filling out web-based forms, refereeing patients using the automated referral system and using Acrobat reader to access training manuals.

The benefits to clinical care will be that training materials will be easily available and there will be better communication between sites and automated checks on care quality. Voice Over Internet Protocol (VOIP) telephone will allow district health management board midwives to speak to teaching hospital midwives or doctors at any time. The health management board midwives will also be able to track their referred patients as the system will allow more accurate monitoring. It is of great relevancy that Zambia applies emerging technologies to empower rural communities towards the attainment of the MDGs goals as this is the theme of the Africa Telecommunications Day which is observed on December 7 every year.

DataDyne.org, the non-profit organization founded by Joel Selanikio and technologist Rose Donna, is helping to forge this promising new path. Through the course of Joel’s work as a Wall Street IT consultant, a pediatrician, and a medical officer at the U.S. Centers for Disease Control and Prevention, he developed an interest in applying computer science to the public health domain. The result is EpiSurveyor a free, easy to use, open source software solution.

So far, year-old pilot projects in Zambia and Kenya are showing that data received from the field has streamlined the inoculation of children against measles, collected information on HIV, and has even helped to contain a polio outbreak.

Reality

Journalists in Africa have not specialised in reporting on ICTs and therefore find e-health, ICT stories to be difficult to follow and cover. Political stories still overtake ICT stories in the media. Editors feel ICT stories do not make news. At the end of the day we have Journalists and editors both being gatekeepers for not allowing e-health stories to be reported in the media.

Journalists need to get ICT training and specialise in the subject area of e-health reporting. This will enable them to wear e-lens which will make them be able to analyse ICT issues and share knowledge, amplifying marginalised voices, organise political action, empower participation and sustainability and celebrate cultural and intellectual diversity.

Challenges to media

These include the following: E-health is a new thing in Africa and this also has resulted in a few e-health professionals most of them being men. It is therefore difficult to have a woman’s voice on e-health unless when e-health benefits the women e.g. in the area of reproductive health. The media also lacks active ICT Media networks, specialised ICT publications and lack of e-conferences where stories stand a chance of being reported in the media after a presentation which is usually in written form.

Challenges in e-health delivery

These include, Inadequate human resource, Lack of expertise on health information system Technology, Resistance (Community), Infrastructure-lack of Telecom facilities and power. Also lack ofcoordination and intersectoral collaboration caused by lack of awareness and sensitisation by decision makers, Journalists and health officials.

E-health publicity

There is need to popularise this new initiative especially among Journalists and also demystify e-health issues as it is the answer to Africa a rural continent. This is a fact in that Africa has suffered brain drain especially in the field of health. There is need for a media campaign on e-health issues which would include production of visual printed materials in comprehensible languages that share information on issues that affect man and even women’s daily lives.

Constraints

Many rural areas and towns in Africa do not have electricity. Electricity supply is not stable because of frequent power cuts. The equipment for Tele health is expensive Health official always need to get clearance from their bosses before talking to Journalists._E-health initiative in Africa are mainly at project level and ICT policies are still in draft form.

The consumer’s involvement

Journalists reporting an e-health story should include the voices of the consumers (women and men). Gender issues also need to be incorporated in e-health reporting e.g. Reproductive health. In many cases new technologies should not be imposed on a community because many times there is resistance. For this we need to make the consumer aware of e-health which is new.

Global e-conferences

There is need for Journalists to be invited so that they apart from covering the event they also learn about e-health issues. They need to be involved from the beginning so that they understand the issues as they evolve and you all know technology keeps on changing. There is also need to identify Journalists who are interested in reporting on ICTs and let them cover such events. E-conferences such as this one should also have a platformwhere Media people should exchange ideas and also learn about reporting e-health issues. More importantly after such a fora there is need to also form a d-group even a blog or wiki where Journalists in collaboration with Health personnel in e-health can exchange questions and share knowledge and information about e-health.

Limitations in the information Society

These include:

• Access to the Internet
• Infrastructure
• Language
• Lack of ICT tools and equipment
• Politics rule at the end of the day
• Lack of knowledge especially on e-health

Conclusion

The media has a role to play in e-health reporting by educating and informing the public on e-health issues. Health personnel need to partner with media and educate and informthem on e-health issues and developments at national, regional and global levels. Journalists need to be trained in order to demystify e-health issues in their writing so that the ordinary person can understand what e-health means as these technological terms simply put off readers who are consumers of e-health. There is need to develop an e-health tool kit for both print and electronic media which can be given to media houses for production stories, radio programmes and Television programmes. Media also needs to develop a resource on the internet where they can get info on e-health reporting as currently we have very few materials.