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| Photo credit: S. Matter/NFSD |
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The potential of m-health for development
Mobile technologies and devices are increasingly
being used in innovative ways to support medical and
public health practice. This new field is loosely termed
m-health (mobile health). Mobile phones, patient monitoring
devices, personal digital assistants, and functionalities
such as voice and short messaging services,
general packet radio services, third and (soon) fourth
generation mobile telecommunications (3G and 4G),
global positioning systems and Bluetooth technology
all have the potential to improve the delivery of health
services in economically advanced countries. Can these
advances benefit developing countries too?
Opening the Geneva Dialogue, organized jointly
by ITU and the Novartis Foundation for Sustainable
Development at the Graduate Institute in Geneva in
Switzerland on 27 June 2011, ITU Secretary-General,
Hamadoun I. Touré, cited the following figures, which
give rise to hope. At the beginning of the millennium,
around half of the people in the world’s richest countries
had a mobile phone, compared with less than 2 per
cent in Africa. Today there are more than 5.3 billion
mobile phone subscriptions globally, and penetration in
Africa is more than 40 per cent. And more than half
of households in some developing countries — even in
rural and remote areas — have a mobile phone. At the
beginning of the millennium, around 280 million people
used the Internet worldwide. By the end of last year
that figure had grown to over 2 billion.
Mobile technologies have great potential for overcoming
health challenges in developing countries, says
Klaus M. Leisinger, President and Managing Director of
the Novartis Foundation, emphasizing the importance
of gathering all stakeholders together in order to avoid
duplication of efforts and to coordinate public-private
partnerships. Already, mobile phones are being used to
store medical records, and to give patients better access
to emergency services.
Both Dr Touré and Mr Leisinger believe that achieving
the Millennium Development Goals (including those
relating to health) is possible — but only if all the relevant
actors contribute their fair share. Novartis and
the Novartis Foundation for Sustainable Development
have contributed by investing in developing countries,
transferring technology, implementing numerous health
projects in these countries and employing and training
thousands of associates. Klaus Leisinger recalls that
“Novartis has established extensive access-to-medicine
programmes, thereby helping save millions of lives and
improving quality of life for hundreds of millions of
patients.”
Looking to the future, Dr Touré says there will be
a huge increase in the use of visualization technology,
for example enabling a surgeon to practise on a threedimensional
model of a patient’s heart before operating
in reality or to see exactly where a brain is malfunctioning,
without the need to open up the skull. Personal
and home-based sensor devices will play an increasing
role in the remote monitoring of patients. The machineto-
machine communication and the power demands of
m-health will be supported by the Internet of Things
and cloud computing.
Global perspectives
At present, m-health lacks a strong evidence base
to verify its impact on health outcomes and health systems,
so its cost-effectiveness needs to be evaluated to
support policy decisions, according to a recent survey by
the World Health Organization’s Global Observatory for
eHealth. The survey looked at 14 categories of m-health
services: health call centres; emergency toll-free telephone
services; managing emergencies and disasters;
mobile telemedicine; appointment reminders; community
mobilization and health promotion; treatment
compliance; mobile patient records; information access;
patient monitoring; health surveys and data collection;
surveillance; health awareness raising; and decision support
systems.
The survey shows that there is a groundswell of activity
in m-health, which is already being applied in lowincome
countries to improve maternal and child health.
Globally, 83 per cent of countries.have at least one m-health initiative in place.
Strategies and policies that integrate e-health and
m-health interoperability into health services would
be wise, and there is thus a need for globally accepted
standards and interoperable technologies, ideally using
open architecture. As Najeeb Al-Shorbaji, Director of Knowledge
Management and Sharing at the World Health
Organization, puts it: “If implemented strategically and
systematically, m-health can revolutionize health outcomes,
providing virtually anyone with a mobile
Examples of m-health projects in Africa
Telemedicine in Ghana
The Novartis Foundation is cooperating with the
Millennium Villages Project to use mobile and other
information and communication technologies (ICT) to
provide good quality primary health services that are
affordable, sustainable and meet the needs of patients
in Ghana. “The Millennium Villages Project involves
the systematic delivery of a package of proven health
and development interventions, with the aim of accelerating
progress towards the Millennium Development
Goals,” says Eric Akosah, Health Coordinator of Ghana’s
Millennium Villages Project.
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| Photo credit: Paroma Basu/NFSD |
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Remote areas of Ghana face a range of health challenges,
from inadequately qualified human resources
and limited health facilities, to a high disease burden,
with high levels of child and maternal mortality. Access
to health care is made even more difficult because road
networks and other infrastructure are underdeveloped,
adds Mr Akosah. The vision of the Ghana telemedicine
project is to use ICT to provide health for all, anytime
and anywhere. The project seeks to reduce unnecessary
transport and strengthen the referral system. This will
reduce congestion in bigger urban health facilities and
patients’ waiting time. The project also includes a monitoring
component to evaluate the effects of telemedicine
on the health system.
Since the start of the project in September 2010, the
project team has established a teleconsultation centre
and provided mobile phones to all health workers in
Bonsaaso village in the Amansie west district of the
Ashanti region of Ghana. A mobile phone application
called “Childcount+” allows project staff to record and
manage patient data, and to send health reports to a
central database. Health workers can access the medical
records of patients. The powerful messaging features
of ChildCount+ facilitate communication between
health workers, and an automated alert system helps
reduce gaps in treatment. Five communication masts
have been built and mobile operator Airtel has extended
its services. Computers have been installed in all seven
health clinics to store electronic medical records.
The results of the project so far seem promising. The
next steps will be to train health workers in telemedicine.
An assessment of the impact of telemedicine on
child mortality rates, together with a cost-benefit analysis,
will inform future telemedicine activities in Ghana.
Access to malaria treatment in rural Tanzania
An innovative mobile phone-based tool is being developed
within the scope of a project called ACCESS,
which aims to improve access to effective malaria
treatment and care in four rural districts in Tanzania,
in particular for pregnant women and children under
five years of age. ACCESS is being implemented by the
Ifakara Health Institute, with scientific support from the
Swiss Tropical Institute, as well as technical and financial
support from the Novartis Foundation.
The Foundation is working with Vodafone on the
development of a mobile phone-based tool to assess
the quality of services in health facilities. Before the
project, local health authorities carried out these assessments
using paper based questionnaires. Assessments
were therefore costly in terms of the amount of paper
copies needed and human resources required to enter
and to analyse data. The mobile phone-based tool will
allow for a more viable and efficient performance assessment
approach, requiring less financial and human
resources to be scalable for the rest of Tanzania. With
this tool, data are stored in a secure environment and
can be accessed easily.
Presenting the m-health tool, Alexander Schulze of
Novartis Foundation for Sustainable Development, and
Niklas Bergvall of Vodafone explained that there are
two categories of users: assessors, who collect data by
visiting individual health facilities and who give immediate
feedback to health workers; and health authority
managers, who use the data and statistical reports
to identify quality gaps in health facilities, and who
make informed decisions about how to allocate scarce
resources.
Diagnosing and treating childhood illnesses through a mobile phonebased tool in Tanzania
The correct use of simple standards of care such as
the Integrated Management of Childhood Illness (IMCI)
protocols for classifying and treating common causes
of death, for example, pneumonia, diarrhoea, malaria,
measles and malnutrition could save many lives.
However, despite a worldwide effort, the use of IMCI
protocols remains limited because of the expense of
training health workers and the tendency to follow protocols
less rigorously over time.
D-Tree International has been working in the area of
child health to improve the flexibility and use of these
protocols through the development of an electronic version
of IMCI (eIMCI) for use on mobile phones and other
mobile devices. Initial results from a pilot e-IMCI project
in rural Tanzania indicate that clinicians more closely adhere
to the IMCI protocol when using e-IMCI than without
it, and were enthusiastic about its use with patients.
“The personal digital assistant makes its own decision,
and will tell you if medicine is necessary and what the
dosage is, so you can’t make a mistake in treating a
child”, says one health worker.
The software guides health workers step-by-step
through the full IMCI assessment, classification and
treatment plan. It is easy to use and the training of clinicians
to use the tool takes less than one hour. A largescale
study is under way to validate the initial finding
that e-IMCI leads to improved adherence to the IMCI
protocols compared to the conventional use of IMCI,
and that e-IMCI can be used to improve the communication
between health worker and child caretaker about
how to treat the child and watch for danger signs. “In
the past, the doctor used to write prescriptions on a
piece of paper without asking us questions, but today
we were asked questions. That is what was different”,
says one mother.
Lucy Fulgence Silas of D-Tree International observes
that the “estimated shortage of almost 4.3 million doctors,
midwives, nurses and support workers worldwide… is most severe in the poorest countries, especially
in sub-Saharan Africa, where health workers are
most needed.” In addition to its work on IMCI protocols,
D-Tree International is using mobile technology to store
information about each child, including immunization
records and growth history, and will prompt the health
worker to offer preventative care.
How to scale up m-health in the future?
Some basic approaches are needed to spread the
benefits of m-health. These include anchoring e-heath
and m-health in government priorities and strategies
and standardization. Most health systems are severely
overburdened, and have to make difficult decisions
about competing priorities. Countries will need to collaborate
in developing global best practices so that data
can move more effectively between systems and applications.
Data security is a particularly important concern.
Message transmission and data storage must be
secure in order to protect personal information.
The greatest incentive to invest in m-health is to
see the health dividend that m-health projects achieve.
Building a publicly available repository of registered projects
would showcase the projects that have already
strengthened healthcare delivery. Such evidence would
provide an incentive for ministries of health and other
stakeholders to invest in m-health.
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| Photo credit: Nokia |
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The summary of the presentations and discussion on “M-health:
Using mobile technology to advance public health in the
developing world.” are available at the Novartis Foundation
website:
www.novartisfoundation.org.
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