Henry Lucas
Publication Date
March 1, 2009

Institute of Development Studies

This article examines the nature of technological impact on health systems and the shifting balances of power resulting from advances in mobile telephony and internet services which convey medical information. Several examples convey the claim that technological advances are impacting the health sector:

  • "Patients and informal providers in Bangladesh routinely seek advice from doctors supporting HealthLine, a subscriber service implemented by the Grameen mobile telephone company.
  • Health information systems for HIV and AIDS services in Rwanda – including TRACNet, a mobile phone-based system that allows tracking the use of anti-AIDS drugs through text messaging – are widely regarded to have been improved by the introduction of data transfer via mobile phones and personal data assistants.
  • Medical staff world-wide have many opportunities to update their skills through internet-based advice and training initiatives. For example, Moorfields Eye Hospital in London provides an internet-based consultancy service for ophthalmology patients in a number of African countries."

According to the author, shifting the power balance of the provider-patient paradigm is the possibility offered by "expert-systems" software, which offer "best practice" clinical protocol information to the public to guide health diagnosis, recommend treatment, and monitor implementation. As stated here, "It could transform existing power relations within the health sector by circumscribing the behaviour of professional staff."

The services of connecting patients and families and informing the public are already information and communication technology (ICT) functions: "ICTs could also transform informal regulation by providing people with the knowledge they require to challenge existing practices and make more rational health care choices. Communications networks that allow those facing health problems to share information, identify trustworthy providers, seek advice or campaign for improved treatment are central to such forms of empowerment."

However, the article cautions that there may be an attraction to the potential power stemming from being a 'trusted intermediary’ in an unregulated health advisory network that could attract those looking for financial advantage, prestige, or support for religious or other convictions. Also, there is a risk that the most high profile health conditions and advocates may receive the most resource allocations.

The author concludes with the warning that: "Those working on health systems have traditionally encouraged 'evidence-based planning and priority setting' in order to address both equity and efficiency concerns. A world in which multiple disease-specific networks, possibly funded by international drug companies, use ICTs to compete for the attention of governments, donor agencies and private enterprises, may undermine that approach."


id21 insights website, Issue 76, March 2009, on accessed on March 11 2009. Image courtesy of Piers Benatar, Panos Pictures 2002.