MobileActive.org

As part of our 'deconstructing mobile' series, we have been looking closely at the claims that have been made about mobile technology for a more realistic assessment of mobiles in social development that is based on data, rather than hype.  Unlike more recent reporting on the topic, the Financial Times has an interesting article that questions whether mobile tech can actually "fill the gap left by underdeveloped healthcare system,' particularly in Africa.

As has been reported, the challenges in delivering health care in many African countries are stark. As the Financial Times points, out, there is 'an acute shortage of resources and trained staff means that more than 50 percent of the region’s population is estimated to lack access to modern healthcare facilities."

At the time time, Africa's health challenges are formidable. According to a recent report by the International Finance Corporation, people in Sub-Saharan Africa have the worst health, on average, in the world. The region has 11 percent of the world's population, 24 percent of the global disease burden, and lacks the infrastructure to provide even basic health care to its people.

Lack of Scale

Given this, the Financial Times notes one of the major critiques in this field: The lack of scale in most m-health projects. The article notes also (without necessarily explaining what that means) that "fragmentation has put a brake on the expansion of mobile healthcare solutions. In addition, leapfrogging the infrastructure gap in the healthcare sector may prove more of a challenge, and a lack of quantifiable evidence to support the effectiveness of mHealth has led some to question the actual impact it can have." 

To quote:

Bright Simons, chief strategist of Mpedigree, an mHealth initiative that aims to tackle the major issue of counterfeit drugs, is critical of what he says is an inadequate approach by many mobile healthcare initiatives on the continent. “Most of the mobile health strategies we have seen so far assume that by taking away the physical infrastructure problem, they solve the constraints. The problem though is that more often than not they create additional social infrastructure problems. Issues of illiteracy, consumer behaviour and other factors are not properly dealt with,” he says. “The major problem that I see is that they try to introduce a technology in a social setting that is not prepared for it.” This, he argues, accounts for the lack of scale in mobile healthcare projects.

We tend to agree with this assessment, though other than the UN Foundation in its m-Health report, no one has actually adequately surveyed the field to understand what the scope and dimensions are currently of m-health, including data on how many patients are being served and how.

Claims by organizations are often misleading with number of patients in a catchment area noted as opposed to patients actually interacted with or served, and none of the data provided in anectdotal surveys and case studies is, in any way, audited or verified. 

Lack of Evidence

The Financial Times notes that "despite the intuitive appeal of the ability of mobile telecommunication to overcome traditional infrastructure barriers, the success of mHealth will ultimately depend on its ability to actually bring about a significant improvement in healthcare delivery capacity. While there are examples of situations where the application of mHealth ideas have had a beneficiary effect, demonstrable evidence that mHealth consistently leads to improved healthcare delivery is less forthcoming."

Mobile technology has indeed been piloted in a range of health-related areas, including improving dissemination of public health information (e.g., disease outbreak and prevention messages); facilitating remote consultation, diagnosis, and treatment; disseminating health information to doctors and nurses; managing patients; monitoring public health; and increasing the efficiency of administrative systems. In all these areas, evidence exists that mobile phones can play a significant role. Further work is underway to look at the actual impact of mobile phones on improving health outcomes.

For example, the PanAsian Collaboration for Evidence-based e-health Adoption and Application (PANACeA), a project underway at the International Development Research Centre (IDRC), is assessing the effect of mobile phones on improved health.  IDRC, in fact, is one of the leading supporters of research of the impact of mobile technology on health outcomes.

Laurent Elder, senior team leader at IDRC, in a recent paper, sums up the state of research in m-health:

On the basis of the research conducted by ICT4D, it is quite clear that mobile technology could be a very effective system for delivering health care services. Given the lack of other ICT infrastructure in poor countries, mobiles offer a great opportunity to provide information critical for heath care provision. Mobiles could be invaluable in tackling serious diseases as one study shows in the context of HIV/AIDS response in Southern and Eastern Africa.

Given the success of projects like UHIN, there is indeed a scope for cautious enthusiasm. However, it must be recognized that very few other projects were equally impressive. The efforts for integrating ICT in health have generally been sporadic. At the same time, most of the innovations in mobile technologies for health and medicine have yet to go beyond the pilot stage. This underscores the difficulties in e-health endeavours where successful implementation and scaling up depend on the interactions between technical aspects and the social-cultural and policy contexts. As a result, notwithstanding the regional and local variation in health sector needs and possible solutions, the optimal use and approach of mobiles in health are still being explored. 

In order to justify investing in the use of mobile technologies in the health sector in poor countries, much more attention needs to be paid to how such technologies effectively integrate and improve basic service delivery on the ground. Furthermore, the potential benefits in improved access, quality of care, and better clinical results need to be clearly demonstrated.

Elder notes that there are key issues that need to be addressed for mobile technology to deliver on the promise of improving health outcomes in developing countries.  These are, for example, illiteracy and localization, policy reforms related to funding, lack of research capacity, the presence of multiple stakeholders involved in e-health projects, and finally, the economic viability of mobile-based health services needs to be considered seriously. 

Elder notes also that "convincing evidence regarding the overall cost-effectiveness of mobile phone "telemedicine" is still limited and good-quality studies are weak and rare. There is a need to support research that demonstrate benefits within a framework of a cost-benefit analysis in order to justify significant up-front costs associated with implementing comprehensive, system wide telemedicine solutions."

Or, as our colleague and friend Peter Benjamin of the South African NGO Cell-Life notes in the Financial Times, "We have not proven that any of this stuff is worth the money… I am actually quite nervous that a lot of money will go into unproven, wide scale projects rather than literally life-saving drugs.”

Photo courtesy Cell-Life