Socializing accountability for improving primary healthcare: an action research program in rural Karnataka

The Alma Ata Declaration of 1978 invoked a socialising form of accountability through which communities and health workers participated in and were jointly accountable for primary healthcare. Aside from a few experiments, by the 1990s these ideals were quickly replaced by policy prescriptions based on increasing efficiency in data quality and reporting through the introduction of health information systems. More recently, there has been a revival of interest in community participation as a mechanism for improving the poor status of primary healthcare in developing countries through the constitution of village health committees. This paper documents and reflects on nine years of research on interventions aimed at improving primary healthcare accountability in rural Karnataka. Over this period, our focus has shifted from studying how computerised health information systems can strengthen conventional accountability systems to a period of extended participatory action research aimed at socialising accountability practices at village level. The findings from this study constitute vital knowledge for reforming the primary healthcare sector through different policy measures including the design of appropriate technology-based solutions

Data and Image Transfer Using Mobile Phones to Strengthen Microscopy-Based Diagnostic Services in Low and Middle Income Country Laboratories

Background: The emerging market of mobile phone technology and its use in the health sector is rapidly expanding and connecting even the most remote areas of world. Distributing diagnostic images over the mobile network for knowledge sharing, feedback or quality control is a logical innovation. Objective: To determine the feasibility of using mobile phones for capturing microscopy images and transferring these to a central database for assessment, feedback and educational purposes. Methods: A feasibility study was carried out in Uganda. Images of microscopy samples were taken using a prototype connector that could fix a variety of mobile phones to a microscope. An Information Technology (IT) platform was set up for data transfer from a mobile phone to a website, including feedback by text messaging to the end user. Results: Clear images were captured using mobile phone cameras of 2 megapixels (MP) up to 5MP. Images were sent by mobile Internet to a website where they were visualized and feedback could be provided to the sender by means of text message. Conclusion: The process of capturing microscopy images on mobile phones, relaying them to a central review website and feeding back to the sender is feasible and of potential benefit in resource poor settings. Even though the system needs furthe