The role of information and communication technologies in health system resilience after the 2015 Nepal earthquake

Olivia Crane graduated from the Master of Public Health (MPH) programme at ScHARR in 2016. She applied for the programme after deciding on a career change away from Communications in the private sector, towards Public Health. The Masters programme built on her background in anthropology and gave huge new insight into the links between health systems and the ways people live and organise themselves socially.
Since graduating from the MPH programme, Olivia has started working with the Public Health Guidelines department at the National Institute of Health and Care Excellence (NICE) as an Assistant Technical Analyst. The skills she learnt during the programme were invaluable in opening up this opportunity!

The title of Olivia's dissertation project was 'The Role of Information and Communication Technologies in Health System Resilience after the 2015 Nepal Earthquake' 
The project was offered through a research attachment to staff from ScHARR and the Department of Politics,  Dr. Julie Balen and Dr. Simon Ruston respectively. The time Olivia spent living in Nepal as a child for 6 years gave her both a passionate interest in the country, and some useful background understanding of language and culture.


Background: Information and Communication Technologies (ICTs) are increasingly recognised for their important role, and even greater potential in mitigating, preparing for, responding to, and recovering from natural disasters. However, to date, the vast majority of research into their use in disasters has been conducted in high-income country settings. This research should be expanded into low- and middle-income countries, particularly as vulnerability to natural disasters increases with poverty. Here the role of ICTs during a series of earthquakes that occurred in Nepal in April 2015 is explored.
Methods: In depth semi-structured interviews (n=24) and focus groups (n=4) were conducted in March and April 2016, almost one year post-earthquake. Data collection took place in three settings, namely (i) at village level in Barpak, the epicentre of the earthquake; (ii) at district level in Gorkha, the capital of the district in which Barpak is situated; and (iii) at central level in Kathmandu, the capital city of Nepal. Participants were individuals affected by the earthquake, and those in formal health system roles as well as informal grassroots responders. Data was recorded, professionally translated and transcribed, and underwent thematic analysis using NVIVO 11.
Results: Perceptions of the role of ICTs and their value varied greatly between groups. While access and capability were found to be key barriers to use rurally, ICTs formed a greater part of the response in urban settings. This was particularly true for the informal response, which relied on ICTs for networking and coordination. The response of the formal health system lagged behind in terms of ICTs, generally relying more upon traditional methods of disaster management. Preparation was severely lacking in all areas, including communication planning.
Conclusions: The findings of this study indicate that the complex problems of access and capability remain key barriers to ICT use in Nepal, as seen in other low-income country literature. It demonstrates the potential of ICTs for giving people voice, and in developing community intelligence for the benefit of affected groups as well as for the information of decision makers within the formal system. It also reveals the scope for increased connectedness between the formal health system and the informal health system response, which currently operate separately but with many of the same aims.