By Tanvir Ahmed, Doctoral Researcher (Institute of Development Studies, UK), Assistant Scientist (International Centre for Diarrhoeal Disease Research, Bangladesh) and member of Future Health Systems and the Health Systems Global Private Sector in Health Thematic Working Group
There are about 7 billion mobile users globally, and no less than 95% of people are covered by at least 2G network. Via smartphones, people have access to over 40,000 health apps. As a result, globally there is much interest in eHealth, especially in addressing various barriers related to access to healthcare. However, from the health equity standpoint, we have to ask, who has access to quality health information through electronic platforms (eHealth)? At the Institute of Development Studies (IDS) and International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) we are digging deeper into this question, specifically in the context of low and middle income country with a particular focus on Bangladesh*.
Bangladesh: eHealth fertility and health inequity
Bangladesh has the right combination to capitalize on the growth of ICTs for the improvement of healthcare:
- Large mobile subscriber base of over 108 million and rising (pdf)
- Extensive household ownership (up to 81%);
- Political mandate of digital Bangladesh (pdf): current policies have adopted eHealth to: improve management; ensure quality healthcare; improve awareness of and access to and enhance the capacity of the healthcare delivery system;
- Rapid growth of government, NGO and private-for-profit eHealth and mHealth initiatives (pdf): examples include awareness and services related to pregnancy, drug and alcohol abuse, smoking cessation, HIV/AIDS, immunization etc.
In spite of substantial progress in demographic and health indicators, there is growing concern around ongoing disparities in access to and utilization of quality healthcare. In this, understanding who has access to quality eHealth, owns an electronic device and uses it to access health information is crucial to challenging the persistent inequities. IDS and icddr,b analysed data for exactly this purpose, looking closely at the age, gender, education, socioeconomic status and geographic location of the Bangladeshi population.
What did we find out?
Findings from a cross sectional survey of 2,556 respondents from rural, peri-urban and urban slums of Bangladesh revealed:
- 87% of rural, 90% of peri-urban and 88% of urban respondents owned electronic devices;
- Ownership was positively related to age, education and household socioeconomic status;
- Male respondents are more likely to own devices than female;
- Among those who owned devices, about 9% (rural 15%, urban and peri-urban 6% each) had used their devices to access health information;
- No significant association was observed between the use of electronic devices for health information seeking and socio demographic variables probably due to such low use of electronic devices for seeking health information.
Based on the fact that proportionally younger educated adults were found to be using or are aware more of electronic access to health information compared to the rest of the population we ran another survey of 439 college (10+ years of education) students in a peri-urban setting and the findings indicated that about 98% had access to electronic platform (predominantly mobile phones). Among this group, about 54% sought health information through electronic means and 30% were aware of using devices to access health information.
Results from these two surveys show that:
- Rapid growth and high household ownership of mobile-cellular technologies may not be enough to ensure its use to access health information.
- The young educated adults have specific capacities or skills to use devices and, in turn, have more access to health information electronically compared to the rest of the population.
Is eHealth literacy essential for equitable eHealth?
While eHealth holds enormous potential for access to healthcare, it also contributes further to existing inequities, as evidently, those who have the means and capacity to access and understand information will automatically be a step ahead of the rest. This has recently generated lot of interest around eHealth literacy/skill. Having the ability and access to read texts, use electronic platforms and make decisions based on information sounds simple, but it is incredibly complex.
So, the question remains: can eHealth literacy define who has access to healthcare electronically and who doesn’t? Can this be a potential dimension to understand the impact of eHealth? If yes, then efforts will be needed to build certain aspects of health and technology literacy to enable people to truly benefit from the eHealth revolution.
A number of researchers from both IDS and icddr,b were involved in the analysis of the data. They are: Syed Jafar Raza Rizvi, Susmita Das, Abbas Bhuiya, Sabrina Rasheed (from icddr,b) and Hilary Standing, Gerry Bloom, Linda Waldman (from IDS). This work is supported by the Canadian International Development Research Centre (IDRC)
Image credit: Dr. Mahabubur Rahman, public health physician, icddr,b