November 10th, 2004

Arriving at Stanford in the fall of 2003, Joe McCannon took on a daunting challenge: devising a way to connect the care providers treating millions of HIV/AIDS patients in sub-Saharan Africa.

Undeterred by the region’s limited infrastructure, he started out with an ambitious idea driven by cutting-edge technology. When this proved impractical, however, he stepped back and realized that a relatively low-tech approach might actually address the problem more effectively after all.

Joe’s project was born out of his conviction that the systems through which treatment is delivered are every bit as important as drugs and doctors to an effective health care intervention. Unfortunately, however, just as a paucity of resources has limited the total amount of care available, poor communication channels have slowed the development of good models for providing that care. In addressing the latter problem, Joe set out to build a network that would allow workers to share data and ideas, thereby fostering cooperative learning and ongoing improvements to the health care system as a whole.

Joe’s original proposal called for supplying all practitioners with wireless-enabled PDAs. Each device would feature a custom-built application for medical data collection, and would link users to an online forum where ideas could be easily exchanged.

However, Joe soon realized that such a technology-heavy concept could end up being more cumbersome than beneficial, and he began to search for a more practical solution. The major turning point in his thinking came when he and the other fellows engaged in a User Needs Assessment, which encouraged them to adopt the perspectives of their constituents. “I put myself in the shoes of someone working in Africa,” he recalled. “All that stuff I was envisioning, it seemed unrealistic — you’d put such a burden on the providers.”

In its place, he developed the notion of enlisting local experts as mobile “knowledge agents” who could relay data and facilitate collaboration between practitioners. “While creating this vibrant network is important,” he said, “the way to do it isn’t always to bring in heavy-duty technology. An alternative solution is to put technology in the hands of mobile individuals, and they can supply the connectivity.”

Joe planned a diverse suite of communications equipment – PC’s, handhelds, cell phones, and so on — in support of these knowledge agents. However, recognizing the difficulty of using such devices in remote areas, he also worked out a simpler vision: using digital cameras and standardized paper forms, agents could record treatment data and periodically upload it via optical character recognition software to a central database. Other individuals could access the information in turn, spreading it quickly to even the most isolated outposts in the health care network.

Joe reported that he borrowed this idea from fellow Tino Tran, who was using similar technology for his work on microfinance in Vietnam. Echoing his vision for care providers in Africa, he said, “We all stole from each other pretty liberally, and that’s how the best learning takes place.”

—Mike Nowak

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