Ulrike Rivett

The use of a spatial information system in the management of HIV/AIDS in South Africa

BackgroundSouth Africa is experiencing an HIV/AIDS pandemic of shattering dimensions. The availability and provision of antiretroviral (ARV) drugs could bring relief to the situation, but the treatment is unfortunately complex with each patient being assigned a different antiretroviral therapy varying in diet-medication regiment. The context of South Africa, its variety of urban and rural settings adds to the challenge of administering and monitoring the HIV+ person throughout the treatment, which will last for the rest of their lives. The lack of physical infrastructure, reliable statistics and adequate resources hinder the efficient management of HIV/AIDS.ResultsThe collection of reliable data will be a first step to assess the status of HIV/AIDS in communities. A number of hospitals have started this process using the conventional approach to collect information about their patients using a paper-based system. Since time is of essence in the fight against the pandemic, data exchange between various hospitals, municipalities and decision-making bodies is becoming more and more important. The logical response to such a need is a computerised system, which will collect and administer HIV/AIDS related information within the local context and allow a monitored access to the data from a number of stakeholders.ConclusionsThe purpose of this study was to design and develop an HIV/AIDS database, which is embedded in a Spatial Information Management System. The pilot study area is the Gugulethu township in Cape Town where more than 27% of the 325 000 residents are HIV+. It is shown that the implementation of the HIV/AIDS database and the Spatial Information Management System can play a critical role in determining where and when to intervene, improving the quality of care for HIV+ patients, increasing accessibility of service and delivering a cost-effective mode of information.

Open source GIS for HIV/AIDS management

BackgroundReliable access to basic services can improve a communitys resilience to HIV/AIDS. Accordingly, work is being done to upgrade the physical infrastructure in affected areas, often employing a strategy of decentralised service provision. Spatial characteristics are one of the major determinants in implementing services, even in the smaller municipal areas, and good quality spatial information is needed to inform decision making processes. However, limited funds, technical infrastructure and human resource capacity result in little or no access to spatial information for crucial infrastructure development decisions at local level.This research investigated whether it would be possible to develop a GIS for basic infrastructure planning and management at local level. Given the resource constraints of the local government context, particularly in small municipalities, it was decided that open source software should be used for the prototype system.ResultsThe design and development of a prototype system illustrated that it is possible to develop an open source GIS system that can be used within the context of local information management. Usability tests show a high degree of usability for the system, which is important considering the heavy workload and high staff turnover that characterises local government in South Africa. Local infrastructure management stakeholders interviewed in a case study of a South African municipality see the potential for the use of GIS as a communication tool and are generally positive about the use of GIS for these purposes. They note security issues that may arise through the sharing of information, lack of skills and resource constraints as the major barriers to adoption.ConclusionThe case study shows that spatial information is an identified need at local level. Open source GIS software can be used to develop a system to provide local-level stakeholders with spatial information. However, the suitability of the technology is only a part of the system – there are wider information and management issues which need to be addressed before the implementation of a local-level GIS for infrastructure management can be successful.

Public perception of drinking water safety in South Africa 2002–2009: a repeated cross-sectional study

BackgroundIn low and middle income countries, public perceptions of drinking water safety are relevant to promotion of household water treatment and to household choices over drinking water sources. However, most studies of this topic have been cross-sectional and not considered temporal variation in drinking water safety perceptions. The objective of this study is to explore trends in perceived drinking water safety in South Africa and its association with disease outbreaks, water supply and household characteristics.MethodsThis repeated cross-sectional study draws on General Household Surveys from 2002–2009, a series of annual nationally representative surveys of South African households, which include a question about perceived drinking water safety. Trends in responses to this question were examined from 2002–2009 in relation to reported cholera cases. The relationship between perceived drinking water safety and organoleptic qualities of drinking water, supply characteristics, and socio-economic and demographic household characteristics was explored in 2002 and 2008 using hierarchical stepwise logistic regression.ResultsThe results suggest that perceived drinking water safety has remained relatively stable over time in South Africa, once the expansion of improved supplies is controlled for. A large cholera outbreak in 2000–02 had no apparent effect on public perception of drinking water safety in 2002. Perceived drinking water safety is primarily related to water taste, odour, and clarity rather than socio-economic or demographic characteristics.ConclusionThis suggests that household perceptions of drinking water safety in South Africa follow similar patterns to those observed in studies in developed countries. The stability over time in public perception of drinking water safety is particularly surprising, given the large cholera outbreak that took place at the start of this period.

The management of greywater in the non-sewered areas of South Africa

The management of greywater in the non-sewered areas of South Africa has been identified as a key area of research owing to the fact that very little, if any, provision has been made for it. Without water-borne sanitation, the disposal of greywater becomes a problem that has the potential to create a host of environmental and health problems, and this is particularly evident in the high density informal settlements that surround the major South African cities. The main aim of this study was to understand the use and disposal of greywater in the non-sewered areas in South Africa, determine typical quantities and qualities, and develop a preliminary guide for its management, both in terms of reducing health and environmental risks as well as possibly providing benefits through controlled reuse.

Designing for sustainability: Involving communities in developing ICT interventions to support water resource management

Rural Africans have poor access to clean and safe water compared to other developing areas. Many Information and Communication Technology (ICT) interventions have been implemented to address the information gaps that hinder improved service delivery but have subsequently failed. The inability to provide suitable content, failure to address priority needs of communities and foster local buy-in are seen as the main causes. The transition from developing technologies for users to developing with users has created the need to harness collective ideation. Developing community-based ICT interventions collaboratively with the user communities provides a better understanding of the cultural nuances that can easily affect the use and adoption of an intervention. In this paper, we present a landscape analysis of rural water supply management in Uganda and an ICT intervention implemented to support the community management model. We present findings and a justification for a more user-centred approach to developing sustainable ICT interventions through co-design.

Leveraging Intermediated Interactions to Support Utilization of Persuasive Personal Health Informatics

Behavior change support systems (BCSS) and persuasive technologies for healthcare often entail users interacting with mobile devices. However, especially in developing countries, the target community is unfamiliar with and often intimidated by new technologies. In this paper we propose the use of intermediaries to facilitate interaction with a mobile phone-based application and to motivate ongoing use by the target beneficiaries. The application incentivizes utilization through gamification techniques, using badges, scoreboards, and other rewards. For example, a young girl might help her father keep track of his walking and diet, maintaining participation as much for her fathers health as for the social awards given by the app. We explain how intermediaries can be leveraged to improve utilization and engagement of the beneficiaries, and describe factors affecting interaction between the participating pairs and interaction with the application. This study highlights the importance of social rapport - typically through a familial relationship - as a key component of the intervention. Finally, we discuss the implications of designing for the motivation of two different users: gamification, personalization and utility play different roles for the intermediary and the beneficiary but ultimately combine to make a more effective application for the beneficiary than one targeting the beneficiary alone.

The clinic-level perspective on mHealth implementation: a South African case study

ABSTRACT This exploratory investigation presents a case study of the deployment of an mHealth service in established public clinics, and assesses the findings using Activity Theory. We contribute to the limited empirical research on mHealth implementation in established public facilities, and build on work on the use of Activity Theory to frame investigations of ICT4D interventions. The study investigates the perspective of clinic staff responsible for registering women for a free maternal health messaging service. Open-ended interviews and observation sessions were used to reveal staff experiences of the implementation, and their work practices. Activity Theory analysis was adopted to help interpret the data, and identify likely dynamics leading to these specific practices. Some themes that emerged were the hierarchical nature of the medical profession and implications for task shifting, the influence of technical design choices on use patterns and issues arising from the developing-country context.

Using Activity Theory to Understand Technology Use and Perception among Rural Users in Uganda

Implementing technologies in developing communities often involves working with people that have a very different context from the researcher in terms of lower literacy and less experience with technology. Having worked with three rural communities in Uganda and introduced an Information and Communication Technology (ICT) intervention for water management, we use activity theory to analyse peoples activities in relation to the use and uptake of the community-based ICT tool. To understand the contextual factors that influence the use of the tool, we proceed from our activity theory analysis and we unpack the perceptions and attitudes that rural technology users have towards technology. Our findings provide insights into what motivates and demotivates people in rural communities to use ICTs. We use our findings to substantiate the relevance of the intangible impacts of ICTs such as empowerment, social cohesion and improved self-worth for rural technology users. We recommend that technology designers be open to the unintended uses of the technologies they introduce in rural communities.

Codesigning with communities to support rural water management in Uganda

Abstract The use of information and communication technologies (ICTs) in developing regions has gained momentum due to their increasing affordability, particularly in rural areas where other ICT infrastructures for information management are often non-existent. Giving potential technology users, the opportunity to actively engage and contribute to the design of an artefact increases adoption and sustainable use. In this paper, we illustrate our application of community-based codesign (CBCD) that led to the development of an ICT intervention to support water management in three rural communities in Uganda. The community-based system helps water managers to track water users, payments and expenditures in a bid to improve transparency, accountability and trust. We present research learnings of the method and how engagement with rural communities can be improved through the use of intermediaries and paying more attention to community values as well as exercising ethics of reciprocity in community-based ICT initiatives.

Supporting community needs for rural water management through community-based co-design

We set out to support three rural communities in Uganda to manage their water supplies using a locally relevant and fit-for-use technological intervention developed with the Community-Based Co-design (CBCD) method. This participatory and inclusive approach allowed us to introduce Information and Communication Technologies (ICT) to communities that are untrained and inexperienced in technology design. We describe the intervention and identify research learnings for CBCD. Our design experience with the communities highlights the barriers and enablers of using the CBCD method with rural users. We conclude with reflections on the use of intermediaries and the issue of reciprocity in community-based ICT for development research.