"Too narrow a definition of appropriate technology ignores the profound social implications of technology and risks consigning the world's poor to a life of third-rate capacity and opportunity. Information technology, when designed for the right job, can be deployed even in regions that lack adequate water, food, and power. This technology can be effective for many tasks, not least human and economic development. In fact, this technology is often indispensable in meeting basic needs."

--From "Harnessing Information for Development: A Proposal for a World Bank Group Strategy" by Eduardo Talero and Philip Gaudette, March 1996

During an outbreak of a deadly virus in Africa, doctors and researchers use the Internet to check details about similar cases. Using a laptop, a dockworker in the Philippines takes a self-assessment quiz to privately find out his risk of exposure to sexually transmitted infections. Using e-mail, doctors in a rural hospital get prompt treatment advice from a specialist at the nearest medical school.

Science fiction? Hardly. All of these are examples of how information technology is being used right now to change the way health providers around the world do their jobs.

Technology Is More than a Luxury

There are a host of possible uses for computer and Internet technology in the developing world, particularly in the area of health education. For example, through CD-ROM, highly visual training information could be used to train low-literate clients and staff in basic health education and infection control. Using the Internet, doctors in the developing world could have access not only to an enormous range of medical information, but to dialogue with a worldwide community of health professionals.

But information technology is more than a luxury for the developing world; it is fast becoming a necessity. In a world where information is becoming yet another form of currency, countries without access to information technology risk facing "information poverty" in addition to economic hardship. For example, as international science networks and updates in medical technology become increasingly electronic, research and development could slow or halt in countries without access.

Governments around the world are making a commitment to developing a communications infrastructure in their countries, and organizations like the World Bank and the United Nations have begun initiatives to take full advantage of these technological developments. Some nongovernmental organizations (NGOs) are finding innovative ways to help "wire the world," while others are beginning to add computer-assisted education to their training and development programs.

Is the World Really Wired?

Recent reports from the Internet Society, the nonprofit NGO that oversees Internet standards and connectivity, indicate that nearly every country in the world now has some form of Internet access. But while it can be said that the Internet is now truly global, local conditions vary widely.

Connectivity and hardware resources range from state-of-the-art to archaic. While some countries have full access to the Internet, others are limited to e-mail only. In some locales, the Internet can be reached through a simple telephone; in others, Internet users must rely on satellite or radio technology, bypassing unreliable or nonexistent telephone services.

In many cases, access is limited to the "technological elite" of businesses, government, and universities; if the average person has any access at all, it is frequently very limited access to computer terminals centered in a public place.

However, ingenuity and resourcefulness have rendered the Internet a useful tool to many professionals, especially in the health care field. This was made clear in the spring of 1995, when e-mail played an important role in research and discussion of an outbreak of Ebola fever. An e-mail-based discussion group called ProMED (www.healthnet.org/programs/promed.html) continues to make it possible for researchers, physicians, and others to study, monitor, and share information about emerging diseases in the developing world.

Distance Learning

In the developing world, there is a strong need for training that reaches more people, maximizes the impact of limited training resources, cuts down on classroom time that may interfere with services, and decreases the travel costs associated with centralized training. There is also a clear need for training opportunities that arise as needed ("just-in-time") instead of centralized training that is attended "just in case" it will be needed.

Computer-based instruction has enormous implications for the future reach of health education and can go a long way toward addressing the concerns about logistics and effectiveness that may arise regarding conventional approaches.

In fact, some experts have found that interactive multimedia training can increase learning speed and retention by as much as 50%, and computer-assisted instruction has the potential to vastly expand training capacity that is both on-site and interactive.

Such computer-based "distance learning" has become a mainstay of medical training in the developed world. However, organizations have only recently begun to fully investigate the possibilities of using this method in the developing world.

Looking Ahead

The "Information Age" presents both challenges and possibilities for public health in the developing world. While the enormous growth in information technology threatens to further deepen inequality, it also holds out the promise of improved access to education, health care, and information, even in settings that lack basic necessities. But perhaps most important is the promise the Internet holds for real communication--for networks to arise in which health providers throughout both the developed and developing world can really talk to one another.

Joanne Tzanis, managing editor, develops Internet and multimedia applications for AVSC.