Appropriate information-communications technologies for developing countries.

Many of the solutions to global health problems exist, but are not applied. This is called the “know–do” gap: the gap between what is known and what is done in practice.1 However, it is not enough that “someone, somewhere” knows about best practices; it is also essential that the very people who are dealing with health problems know what to do. Ironically, regions of the world with the least resources for solving health problems often have the least access to needed health information. For many in the well-connected world, the first response to a need for information is to search the Internet. We expect that the world’s health information is just a few keystrokes away. Many health-related organizations work to disseminate information to the world through comprehensive and attractive websites where information can be easily and quickly accessed. Regrettably, this “come and get it” approach to the dissemination of health information often fails to serve the needs of the “information-poor” in developing countries. Only one-sixth of the world’s population uses the Internet.2 A recent World Bank report provides estimated numbers of Internet users per 1000 inhabitants, along with average costs of Internet connections, in the countries in sub-Saharan Africa.3 The costs of Internet connectivity in Africa can be hundreds of times higher than those in Europe or the United States of America. For “free” information on the Internet, institutions in developing countries must often buy larger-capacity connections than they can realistically afford. For example, some universities in Africa are spending as much as the equivalent of 20 full-time faculty salaries for a 2-megabit Internet connection that is then distributed to 500 to 600 computers, resulting in a costly and painfully slow connection for everyone.