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Geneva Dialogue on m-health
Using mobile technology to advance public health in the developing world
Photo credit: S. Matter/NFSD

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.

Photo credit: Paroma Basu/NFSD

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 paperbased 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.

Photo credit: Nokia

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:


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