The introduction of beneficial IT into rural areas via handheld computers and low-cost solutions is gaining ground. Frederick Noronha takes a look at the Ca:sh project and discovers that the researchers working on this project in India have since expanded their horizons to encompass the rest of the world

Young researchers from the US, including Indian expats, have been stirred by India’s problems to create a useful health software solution that works in rural areas using low-cost, handheld computers.

Ca:sh by Tarjei Mikkelsen and his team was launched as a data collection package for health care-workers in rural India. It has already been used in a pilot study at Ballabhgarh, outside Delhi, by the Mumbai-based Media Lab Asia.

Now, this is inspiring solutions for South Africa and Latin America too, Mikkelsen told this correspondent.

Mikkelsen, a Norwegian currently in Cambridge, Massachusetts, said: “Ca:sh came about sometime in the fall of 2001 as a joint Media Lab Asia project between a number of MIT students. The original focus was on exploring ways to introduce beneficial IT into rural areas via low-cost, handheld computers. We reasoned that the best way to introduce such technology was through existing infrastructure, such as the rural healthcare system.”

Ca:sh (Community Access and Sustainable Health-tools) was inspired by a similar project developed on the Apple Newton handheld in Rajasthan around 1995.

“We ran a successful pilot project where we showed that this kind of technology could significantly increase the quality of the population databases used to make healthcare management decisions, and Media Lab Asia hired a full-time technical staffer to support the project after we left,” said Mikkelsen.

Innovative solutions
In recent years, India is gaining a reputation for attempts at harnessing innovative IT solutions to help the rural dweller and poor. But health-based solutions have not been as many, or as noticed, as compared to those in fields like education, information, micro-credit or even low-cost access to computing.

In January, two groups explored different aspects of this idea in “the field”. One group, led by Nathan Eagle and a few Sloan MBA students, visited rural Internet cafes in the Delhi area and introduced them to handheld computers.

“They were able to show that using store-and-forward techniques, they could increase the effective geographic reach of a single Internet cafe. Some members of that group went on to found the DakNet initiative for bringing wireless store-and-forward Internet access to rural areas,” according to Mikkelsen.

The other group worked with a community healthcare centre in Ballabhgarh outside Delhi to replicate the paperwork and registers of local healthcare workers in a Qt/Embedded application that ran on ipaqs (hand-held computers) with Familiar Linux and a MySQL server.

Company formed
Since leaving MIT, some of the members of the Ca:sh team have founded a healthcare IT company called Dimagi (www.dimagi.com) to develop similar projects along with other technologies invented by the team. They have recently completed an exciting project in South Africa, where a population health study centre is now using (Palm-based) handhelds to securely store and report HIV test results. Other countries such as China and Brazil have expressed interest in implementing similar solutions. The company intends to develop mobile medical registers and point-of-care systems across the world.

“Even the US homecare and visiting nurses could benefit greatly from these kinds of systems. But currently rural healthcare workers in Ballabhgarh have a more advanced system than any US-based nurse,” argues Mikkelsen.

Users, meaning healthcare workers, appreciate the system because it puts useful information about the patients they’re visiting at their fingertips, and it saves them from retyping a whole lot of notes back into a computer system after work. Before this project, the nurses would spend a whole day each month re-entering data into central computers.

In addition, policy makers find the tool intriguing because it ensures higher quality in the information collected and the possibility for near real-time monitoring of population health (potentially useful for disease surveillance and outbreak prediction), according to Mikkelsen.

“It works great on many levels,” he adds.