THROUGHOUT THE QUARTER in CS 181, our class has observed ethics and policy in relation to technology. Studies have ranged from copywright laws, hacktivism, and life in the Silicon Valley. What many of these ideas and concepts have in common stems from the discussions held in class regarding ethical frameworks and current day situations. For our final project we have chosen to approach the topic of ICT in Bangladesh through the lens of Education and Healthcare.
WHAT IS ICT?
ICT, also known as information, communication and technologies, is a broad term, spanning a variety of communication devices or applications. This involves radio, televisions, cell phones, computer network hardware and software. Often with these features, ICT becomes associated with education, health care as well as Ebanking, and in many of these areas, ICT allows for greater access to information and communication, leading to sustainable development. Thus, in developing nations, ICT has the potential to “close the gap between the economic gap between technological “have” and “have not” areas, so much so, the United Nations actively promotes ICTs for development (searchcio). ICT often promotes cooperation, communication, problem solving and lifelong learning, with the potential to improve performance, teaching, and administration, positively impact education (Barriers to the Introduction of ICT)
Located just east of India, Bangladesh is a developing country home to 152.4 million people. Its residents primarily speak Bengali, practice Hinduism or Islam, and taka as currency. The country is about 56,00 square miles large, roughly the size of Iowa and less than a third the size of California (Bangladesh Country Profile). Its current GDP is $150 billion, compared with $16.77 trillion for the U.S. It is the country with the 16th greatest GDP growth percentage (World GDP Ranking 2015).
ICT IN BANGLADESH
As a developing nation Bangladesh relies heavily on imported technology, and within the context of education, economy and technology, lags behind other nations. (academic journals ICT) The sustainable development of Bangladesh will depend upon the employment of science and technology, which will lead to the investment in ICT to promote economic and political sustainability. To date, ICT is entering into Bangladesh but is still in its primary stages of integration and adoption into the existing technology infrastructure, and although ICT could potentially improve the educational systems that already exist in Bangladesh, due to certain barriers Bangladesh is having difficulty reaping the benefits (Barriers to the Introduction of ICT).
According to the Technology Achievement Index (TAI) mandated by the UNDP Human Development Report in 2001, for Bangladesh, "the achievement value for creation of technology and diffusion of recent innovations is negligible in comparison to 72 countries included for TAI computation.” The other two dimensions involving diffusion of old innovations and human skills the values are very low as well. (The role of science and technology education) Additionally, an ICT policy has been formulated for Human Resource Development (HRD) stating that Bangladesh must “prepare itself to compete effectively in the global ICT market” (ICT in vocational teaching/learning).
EDUCATION IN BANGLADESH
Education in Bangladesh, though improving, lags far behind developed countries. Unicef estimates that though most Bengali children are enrolled in school, there are still 3.3 million children who are not enrolled. Only about half of children living in urban slums attend school, and 24% of girls living in urban slums never attend school. The “contact hours,” or hours children spend with instructors, of most students amount to half the international standard, as most schools offer half day instruction for students (certain grades in the morning, others in the afternoon). This lack of instruction time, combined with the fact that 24% of primary school teachers are untrained, contributes to the inability of half of primary school students to complete minimum national competencies. The average Bengali student takes 8.6 years to complete a 5-year primary school program. (Quality Primary Education In Bangladesh).
ICT & EDUCATION IN BANGLADESH
ICT has the ability to increase access to education, fortify the positive relationship between the workplace and education as well as ameliorate the quality of education offered at institutions- ultimately encouraging students to actively learn and connect content with real life situations and examples. (ICT in vocational teaching/learning). It also has the ability to increase the creativity and innovativeness of teachers and students, as it is often viewed as a tool for pedagogical practices and hands on practice. Additionally, with ICT, students become increasingly aware of their own learning as well as achievements. Studies conducted in Bangladesh at Polytechnic Universities have shown that ICT has a positive impact on student’s learning, and their ability to attain and retain information. This is because the use of ICT promotes engagement with material being taught, but only “where the use of ICT is planned, structured and integrated effectively.” (ICT in vocational teaching/learning)
The introduction of ICT training in public and private educational institutions has been endorsed by policy statements so that the nation is able to increase the production of adept ICT manpower, and become competitive in global markets. Increased involvement on the part of educational institutions, and integration of ICT into curriculums has been listed as a criterion that must be fulfilled if this nation is to meet the demand for skilled manpower in ICT worldwide. Unfortunately, the Bangladeshi government does not have the capacity, to change the curricula fast enough in order to move in stride with global technological changes- nor do the institutions have the resources to implement ICT into their environment for that matter (ICT in vocational teaching/learning). The use of ICT in Polytechnic universities is not satisfactory due to several factors including: the lack of ICT facilities and a shortage of ICT experts. Several other shortfalls include: "poor administrative support; lack of appropriate staff training and quality training for teachers and school principles; lack of qualified ICT coordinators who will assist teachers to integrate ICT in classroom and lab and favorable school culture." (Barriers to the Introduction of ICT) All of these factors must be observed, and policies implemented to improve the current ICT climate in Bangladesh.
Although there is a lack of computers at institutions, studies have shown that the larger issue at hand is the overall lack of internet access in Bangladesh, both in major cities and in the countryside. More than 80% of teachers in Dhaka, Chittagong, Rangpur and Khulna Polytechnics have easy access to computers, but don’t have access to facilities where they can use these computers. These include the appropriate learning spaces as well as resources necessary to maintain the ICT (ICT in vocational teaching/learning). Studies have shown that teachers do not feel as though their teaching needs are satisfied by the current ICT offerings at their institutions. When this occurs, the overall attitudes of teachers change, and they become less motivated to use these materials to improve the learning environment and increase their students’ rate of learning (Barriers to the Introduction of ICT). So while institutions may have enough computers, even though they often don't, the resources necessary to optimize on the benefits presented by ICT are lacking. Without the necessary ICT infrastructure in place, or even the availability of multimedia projectors, scanners, printers, effective teaching will not take place, nor will students be able to learn the necessary skills to result in a competitive country in the global market. (ICT in vocational teaching/learning).
As many institutions Bangladesh are still “far away from implementing ICT into teaching and learning situations”, plans must be implemented and realized at the educational institutions to solidify a reasonable vision and plan (Barriers to the Introduction of ICT). It is crucial for a multitude of parties to be committed to ICT in Bangladesh, including the government, teachers, administrators, parents, students and the community.
Below are a few more details on how the government can get involved, granted educational institutions comply.
WE CAN CALL ON THE FOLLOWING ORGANIZATIONS TO EXECUTE OUR PLANNED PROPOSAL
MINISTRY OF EDUCATION:
- Promote computer integration by provide schools with resources (hardware and software), and other ICT supported tools
- Continue to make resources available, and update all necessary resources
- Provide in-depth education for teachers and principal at educational institutions on the instructional value of ICT and how to use the resources and other computers provided
- Provide evidence for teachers and staff that ICT is in fact beneficial
- Promote a positive outlook on ICT for teachers and staff
- Encourage collaborative staff development that are consistent and over time
- Include staff and student input for ICT policies and feedback
- Connect teachers with local software companies in order to produce appropriate Bangla software programs
- Strive for strong internet access across the country
- Promote and financially support efforts executed by other sectors of the government
(Barriers to the Introduction of ICT)
However, prior to implementing many of these strategies it is also important to consider the ethical implications that could potentially arise. It is obvious that the current system set in place is widening the knowledge gap between social classes. Those who live in rural areas of Bangladesh with less resources and electricity do not have the same access to education, and those that can afford to, or have the opportunity to live in larger cities. The general poor standard of education, with minimal contact hours decreases the chances of students being prepared for the workforce, and this could potentially cause them to lose jobs to more qualified individuals. Ultimately, on a national level these insufficiencies and ethical implication could decrease Bangladesh's ability to compete in global science and technology markets.
In an attempt to remedy these issues at hand, the suggestions listed above there may also be other problems that arise. For example, even with the implementation of ICT tools, there is still a possibility that the distribution may be unequal, sustaining the wealth and education gap in Bangladesh. Along with the implementation of ICT comes the responsibility for teachers and students to use the resources they are provided responsibly. If this technology is new to the students and teachers, there is a risk that internet usage may result in complications with intellectual property and copywright issues. Even if cases are not as severe, the lack of prior exposure, may also lead to issues with "net etiquette"- a term describing the "proper behaviour of the internet." Additionally, as the introduction of ICT is related to globalization, the acceptance of other cultures and values may also become an issue in the future (Ethical, psychological and societal problems).
ICT in Healthcare
Healthcare availability in Bangladesh is greatly disparate. “All significant public and private institutions, including most medical colleges, hospitals, clinics, laboratories, drug stores, are established in the capital city or at the division level and thus the rural population are inherently deprived of specialist services in general” (Bangladesh Health System Review). There is one doctor for every 3000 people and a consistent 20% vacancy rate for certified healthcare professionals, reflecting the dire lack of qualified personnel in the healthcare field (Bangladesh Healthy System Review). Furthermore, only about 5% of doctors are licensed; the remaining 95% are informal doctors who use modern medicine, but, since they are untrained, often misprescribe medication and end up harming patients (Role of Village Doctors'). In rural areas, one community clinic for every 6,000 people provides no-cost treatment. Clearly, the health system has room for improvement. ICT can help.
When applied to healthcare, ICT takes the form of telemedicine. Telemedicine, according to the WHO, is the “delivery of health care services at a distance aimed at the diagnosis, treatment, and prevention of disease and injury by using information and communication technologies” (Telemedicine: Opportunities in Development). This definition is very broad because telemedicine can be found in several different forms: video conferencing, “store and send” (take a photo of a patient and send via email), or remote monitoring of vitals or other signs, for example. 4 principles are common among all applications of telemedicine:
1. Its purpose is to provide clinical support.
2. It is intended to overcome geographical barriers, connecting users who are not in the same physical location.
3. It involves the use of various types of ICT.
4. Its goal is to improve health outcomes.
The practice is only about 15 years old: the first studies concerning the implementation of telemedicine date back no earlier than the late 1990’s, and the practice is still in its infant stages (Telemedicine and Developing Countries). Some of the first studies that signaled the potential of telemedicine in developing countries were conducted in Nepal and Bangladesh (Telemedicine -- the way ahead). These studies showed a high rate of diagnosis or partial diagnosis through telemedicine. Almost all patients were able to receive comments from specialists remotely (An Evaluation). In Bangladesh, referral to specialists through telemedicine was deemed helpful for 89% of patients, and 50% of patients in the Nepal study received advice through telemedicine that would shorten their hospital stays. These studies established both the effectiveness of telemedicine and its feasibility: the savings of just four patients from the study in Bangladesh (no need to travel to a specialist, shortened hospital stays) were enough to make up for the startup costs of the telemedicine system.
Since 2000, telemedicine has begun to integrate into the Bengali health system. Several projects are underway as we speak, and the lack of access to healthcare in rural areas makes Bangladesh an appropriate location to pilot this technology (http://arxiv.org/pdf/0911.1520.pdf). The main barriers to wide implementation of telemedicine include poor internet connection, startup costs, and infrastructure. Though telemedicine can enhance the health system in Bangladesh, it cannot replace the classic infrastructure of hospitals and clinics. Patients need roads to travel to a clinic, equipment to take scans and video conference, and hospitals and pharmacies to support treatment after diagnosis. Telemedicine will not function without this key infrastructure in place (Telemedicine in Developing Countries).
When approaching the topic of telemedicine in developing countries like Bangladesh, there are certain ethical concerns to consider. FIrst, if local doctors and patients work with doctors from another country, it’s possible that the local doctors could feel disrespected or be patronized by outside doctors. Second, during consultations with doctors outside Bangladesh, language and cultural barriers could hinder the exchange. Next, liability isn’t clear with this setup. For instance, if a hurt patient incurs a health problem caused by her treatment, is it the fault of the nurse who took the picture of her wound or the doctor who diagnosed it virtually? Furthermore, doctor-patient confidentiality and patient privacy aren’t necessarily guaranteed with unencrypted video conferencing and email. And finally, grainy images due to poor equipment or internet connection could lead to a costly misdiagnosis. For example, a physician outside of Bangladesh could view an x-ray, identify what she believes is a telling spot the scan, and prescribe specific treatment. However, if her diagnosis based on the scan is incorrect (if the spot is really just an error on the scan), the prescribed medication could actually cause harm to the patient. (Telemedicine in Developing Countries).
On the flip side, we have clear benefits to telemedicine in Bangladesh. Telemedicine would provide more thorough and comprehensive access to healthcare to the Bengali population, particularly those in rural areas. Telemedicine would be especially effective in Bangladesh in connecting rural patients with specialists in Dhaka. In addition, telemedicine consultations with specialists would be more affordable for patients, as there is no need to travel to the capital city or pay the high premium charged by the specialist. Telemedicine can also provide education for local doctors, especially given that most have not received formal training. With the help of trained doctors via telemedicine, village doctors can become more adept at making diagnoses and prescribing appropriate treatment to patients (Telemedicine in Developing Countries: Challenges).
We can call on the following organizations to execute our planned proposal
Ministry of Health and Family Welfare:
Continue to make telemedicine available, especially in rural areas. We believe this technology has far-reaching potential to make an impact in Bengali healthcare.
Establish secure email and video conference pathways. This is critical to insure doctor-patient confidentiality and patient privacy, neither of which should need to be sacrificed in order to receive proper health care.
Leverage availability of Bengali specialists in Dhaka and require cultural awareness training for all doctors outside of Bangladesh. We hope many consultations can occur within the country, largely eliminating language and cultural barriers. Training for outside doctors will hopefully accomplish the same result while decreasing probability of disrespect of local doctors.
Create fail-safes in cases of subpar internet service. Developing and standardizing these systems will decrease the chance of an incorrect diagnosis caused by an unclear image or scan. Currently, when internet access is poor, some local doctors and nurses burn scans and images to CDs and send them to specialists via ground transportation. This is a good solution as long as the internet access is far from perfect country-wide.
Report diagnosis rates and track long-term patient health to gauge impact. Because telemedicine is so new, modifications will need to be made along the way. We need to know whether the system is accomplishing what we hope it will.
Eventually, draft policies to address liability concerns. This will be more possible once lawmakers have more experience with this technology and how it works in Bengali communities.
- Continue to improve health infrastructure. This is critical and should not be abandoned in favor of telemedicine. Telemedicine doesn’t replace traditional health infrastructure but requires it.
Strive for strong internet access across the country. Without the internet, telemedicine is not possible.
Improve education system to generate more Bengali doctors. We may be able to utilize ICT in this pursuit (see ICT in education section).
In analyzing our proposal, we believe that many of the concerns raised earlier are mitigated and benefits are maximized. This proposal will, above all, lead to better healthcare and healthier Bengali people. We believe that the happiness generated by this proposal will far surpass any unhappiness, and the proposal is therefore sound under a utilitarian interpretation.
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