Putting the mobile phone on health duty

Tom Jones

New ways of using mobile technology in health delivery and management have been evolving rapidly, and developing countries can now exploit them for health service improvements Tom Jones

Can we live without mobile phones? A study in Australia found that half the mobile users said their lives could not proceed as normal without them. Every day, reports arrive about mobile-health (m-health) projects and initiatives that strengthen the bond. Many offer new opportunities to communicate with patients, for healthcare professionals to access clinical data and for suppliers to nibble at some e-health initiatives.

There are plenty of examples where it is happening in developing countries too. The mHealth Alliance estimates that there are more than 5 billion mobiles among the world’s 6.9 billion people. About two-thirds of them are in emerging economies. These simple numbers reveal a difference between rich and developing countries. Rich countries have about 1.35 mobiles for each person. This is more than twice the rate than in developing countries, where there are fewer than 0.6 mobiles for each person. But if m-health is to have the potential to improve health, developing countries must catch up. This is not impossible as, from a low base in the early 2000s, Africa’s mobile phone usage has been growing at almost three times the global average.

Since the 1980s, the use of communications technology for healthcare, or e-health, has offered lots of potential but has so far under-achieved. Many practitioners ignored the risks until they materialised.

Projects excluded the long time-scales needed to change the clinical and working practices that realise the benefits. Telemedicine is full of promise, but projects have struggled to scale up from their pilot stages. In many developing countries affordability constraints hamper e-health initiatives. Skills shortages exacerbate these challenges in most, if not all countries.

It is still not clear if m-health will suffer the same difficulties as e-health, although it has some clear advantages. Developing mhealth projects can catch the wave of expanding mobile use. Many users already possess the skills needed, as it builds on the mobile technology that has become familiar. More usable than e-health, m-health supports people directly.

There are large numbers of m-health initiatives. An interesting example is Washington DC’s inner-city diabetic project that monitors diabetics’ blood sugar levels. If they move outside preset limits, an automated message advises these patients on the actions they need to take. Such a project offers good potential for developing countries too.

Rapid response is different. It began with UNICEF’s support in the Millennium Villages Project and uses simple SMS text messages to send information to and from health workers – usually lay people providing care in communities. Staff can register patients and submit reports about malnutrition and clinical diagnoses to a central web dashboard for a team to monitor the communities’ health. Messaging supports communication between the health team and an automated alert system helps reduce treatment gaps.

Scale-ups are coming. In July this year, in partnership with the US Center for Disease Control and Prevention, the Tanzanian government announced a project that will convene groups from several sectors, and combine skills, expertise and resources to strengthen its healthcare system and explore m-health opportunities. The aim is to form a team greater than the sum of its individual partners.

It will bridge communication gaps between remote healthcare facilities, community health workers and government headquarters, and extend m-health to direct patient care, rapid results reporting, health worker training and drug supply management.

The Tanzanian project is a scale-up, not a start-up. It builds on Phones for Health, a pilot launched in 2007 that provided the concepts for the countrywide project. It has a national perspective and several large international companies behind it. It aims to leverage mobile phones, PCs, smart phones, the web, and fixed-line phones and integrate them with Tanzania’s current initiatives for its national enterprise architecture and district health information system.

For all m-health applications, however, the risks need assessing and mitigating. Realistic timescales to achieve change and realize net benefits need increasing, not shortening. A project known as FailFaire assembles information about m-health schemes that did not work, and uses this to learn lessons for subsequent projects (Royal Tropical Institute Amsterdam, www.kit. nl/smartsite.shtml?id=36955). Such knowledge can compensate for the absence of cost-benefit evaluations of live projects.

A success factor for good economic performance will be the inter-operability of m-health with electronic health records and public health information. However, one of the big challenges for developing countries will be improving patient access and expanding sparse health workforces. While m-health can play a role, it cannot overcome the massive need for more healthcare resources. As long as expectations do not exceed reality, m-health does offer opportunities within developing countries’ healthcare strategies.

About the author:

Director of TanJent Consultancy


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