MobileActive.org

The number of mobile phone subscriptions has increased by approximately one billion between the end of 2007 and the end of 2008 (ITU, 2009).  At the beginning of 2009, the number has surpassed four billion.  With this, the use of mobile phones and networks in the mobile health has become increasingly popular in low- and middle-income countries, including Ghana where a broad range of mHealth initiatives are now being implemented. 

This offers many opportunities to translate information and communications technology into gains, particularly for fighting disease and improving population health.  This mHealth Ethnography serves as a critical entry point to both assess the initial state of information, communication, and mobile phone use for maternal and newborn health both within the health sector and the general population in the Dangme West District in the Greater Accra Region of Ghana. 

Key study findings illustrate that there is a strong foundation upon which the MoTECH Project can build to advance the use of mobile telephony to support the achievement of the Millennium Development Goals for health.  These can be divided into two broad categories – those within the health sector and those that extend services to target beneficiaries in the general population. 

With the continued expansion of mobile technology around the globe, and the persistent lack of universal Internet connectivity, the use of mobile phones in public health presents a new opportunity to improve health services delivery. This intersection of mobile technology and public health, known as m-health, offers four distinct applications for international development, including drug adherence and remote monitoring, remote dissemination of information, data collection and disease outbreak surveillance, and diagnostic treatment and support.

Several programs have addressed these m-health applications, but those that are most effective utilize open-source coding, are not reliant upon the Internet, and have great potential for scalability.

This report explores the ways in which non-
governmental organizations (NGOs) and
other groups deploy and use mobile
technology in their work to help solve some
of the world’s greatest problems. This study
is not meant to be exhaustive or definitive,
but rather to provide a view into how a
number of organizations are using mobile
technology to achieve social impact. The authors
selected case studies that enabled an
exploration of significant innovations,
opportunities, and emerging trends, as well
as the obstacles, in the use of mobile
technology to advance social goals.

Mounting interest in the field of mHealth—the provision of health-related services via mobile communications—can be traced to the evolution of several interrelated trends. In many parts of the world, epidemics and a shortage of healthcare workers continue to present grave challenges for governments and health providers. Yet in these same places, the explosive growth of mobile communications over the past decade offers a new hope for the promotion of quality healthcare. Among those who had previously been left behind by the ‘digital divide,’ billions now have access to reliable technology. There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services—even in some of the most remote and resource-poor environments.

This report examines issues at the heart of the rapidly evolving intersection of mobile phones and healthcare. It helps the reader to understand mHealth’s scope and implementation across developing regions, the health needs to which mHealth can be applied, and the mHealth applications that promise the greatest impact on heath care initiatives. It also examines building blocks required to make mHealth more widely available through sustainable implementations. Finally, it calls for concerted action to help realize mHealth’s full potential. The report is organized into the following sections:

• 1. Identifying the potential of mobile phones to improve health in the developing world 
• 2. Defining mHealth within the context of eHealth 
• 3. Meeting health needs through a broad array of mHealth applications 
• 4. Examining the impacts of mHealth projects 
• 5 Assessing mHealth and future health needs in developing countries 
• 6. Identifying the building blocks for sustainable and scalable mHealth programs 
• 7. Understanding the incentives for multiple players: mHealth value chains 
• 8. A call for action 
• 9. Looking forward 
• 10. Compendium of mHealth projects

Every year almost 10 million children die before reaching
the age of five despite the fact that two-thirds of these
deaths could be prevented by effective low-cost
interventions. To combat this, the World Health
Organization (WHO) and UNICEF developed the
Integrated Management of Childhood Illness (IMCI)
treatment algorithms.
In Tanzania, IMCI is the national policy for the treatment
of childhood illness. This paper describes e-IMCI, a system
for administering the IMCI protocol using a PDA. Our
preliminary investigation in rural Tanzania suggests that e-
IMCI is almost as fast as the common practice and
potentially improves care by increasing adherence to the
IMCI protocols. Additionally, we found clinicians could
quickly be trained to use e-IMCI and were very enthusiastic
about using it in the future.

Efficient electronic medical record (EMR) storage and retrieval
systems for treating the millions of HIV/AIDS and tuberculosis
(TB) patients in the developing world is largely an unsolved
problem. One attempt at addressing this need is the Open Medical
Record System (OpenMRS) – a framework that provides a free
and flexible EMR system for resource-constrained environments.
Although OpenMRS is a step in the right direction, implementers
of such systems face a question that is largely unanswered by
previous work. Where in the existing paper-based workflow can
such plastic technology be injected and how does one evaluate the
efficacy of this intervention?

In this paper, the authors describe the role manual processes have played
in a rural hospital in Rwanda and how they determined where to
implement appropriate technology solutions of these challenges through an open source framework that provides a free and flexible electronic medical record system
(EMR) for resource-constrained environments. In this
paper, the authors describe the role manual, paper-based processes have
played in a rural hospital and how they determined where to
implement appropriate technologies.

Nearly 40 million people in Africa suffer from HIV/AIDS. African governments and international aid agencies have been working to combat this epidemic by vigorously promot- ing Highly Active Anti-Retroviral Therapy (HAART) programs. Despite the enormous subsidies offered by governments along with free Anti-RetroViral (ARV) drugs supplied by agencies, the introduction and implementation of HAART programs on a large scale has been limited by two fundamental problems: (a) lack of adherence to the ARV therapy regimen; (b) lack of accountability in drug distribution due to theft, corruption and counterfeit medication. In this paper, we motivate the case for SmartTrack, a telehealth project which aims to address these two problems facing HAART programs. The goal of SmartTrack is to create a highly reliable, secure and ultra low-cost cellphone-based distributed drug in- formation system that can be used for tracking the flow and consumption of ARV drugs in HAART programs. In this paper, we assess the potential benefit of SmartTrack using a detailed needs-assessment study performed in Ghana, using interviews with 516 HIV-positive rural patients in a number of locations across the country. We find that a system like SmartTrack would immensely benefit both patients and healthcare providers, and can ultimately lead to improved patient outcomes and better accountability.

Starts page 458.

This assessment, commissioned by the United Nations Children's Fund (UNICEF) in South Africa and implemented by Women's Net, aims to provide baseline data that will inform a a strategy to launch a new generation of cell phone technologies to address underdevelopment and in particular, HIV/AIDS as a development issue. The rapid assessment consists of an assessment that will be used by UNICEF as a baseline to inform and kick start further discussions and strategy development with key stakeholders for the potential scaling up of cell phone technology usage in projects with a development agenda. The long term objective of this activity is to support the government and civil society programs to leverage partnerships with companies developing cell technologies and other related service providers to develop a comprehensive strategy and plan for monitoring treatment adherence, providing information on sexual health including help lines and services and prevention messages by the use of technology.

This presentation provides insight into current mobile health initiatives and the current global health landscape. The presentation outlines the Thai system as an example of health informatics in resource poor setting, and introduces areas of global health and SMS application. Rwanda's implementation of TRACnet and public health for monitoring of the national HIV/AIDS program is used as an example. The presentation focuses on developing a framework for mobile computing in global health, including: standardizing Health Metrics (HMN), standardizing approaches, and integrating SSM into broader public health information systems and enterprise health information architecture. The report concludes with a look into SMS applications in emergency response, program monitoring and reporting, and patient monitoring. Key challenges are listed.

This presentation provides an overview of the InSTEDD Global Platform for Early Disease Detection, Reponse, and Evaluation. The summary includes reviews the proportion of infections detected and proposes addressing these challenges by adopting a social network and cognitive model approach. The approach facilitates: Early identification of potential health threats and verification, assessment, and investigation of threats in order to recommend measures (public health and other) to control them. The presentation describes the indicator and event-based hybrid surveillance approach and gives two examples of collaborative testing in the field.

This paper takes a look at the potential evolution of mobile technology and services over the next ten years and discusses an mServices framework for building and deploying diverse mobile services. The paper also looks at the challenges of such an endeavor and the steps needed to achieve the vision.

The report suggests how mobile devices will be used for much more than voice communications in the coming years in mHealth, mGovernance, mEnterprise, and mPublic Safety. Supporting the projections are: a mapping of mobile penetration, mobile ecosystem dynamics and deployment and adoption of mobile technology in the developing world. The report summarizes the building blocks of a mobile services platform and concludes with an emphasis on public-private partnership and the innovative business models that will accompany these changes.

The “mHealth in the Global South: Landscape Analysis” report by Vital Wave Consulting examines in detail the current mHealth landscape and provides an in depth overview of mHealth's scope, it's impact on healthcare, and existing opportunities across developing regions. The report also analyzes critical success factors for making mHealth more widely availab;e through sustainable implementations.

This presentation was given by Janice Nall at the Center for Disease Control (Division of eHealth Marketing (eHealth)) at the Texting4Health conference in Palo Alto in February of 2008. The Stanford Persuasive Technology Lab hosted “Texting4Health,” the premiere conference on how mobile text messaging can promote better health. In February and March of 2008. The event was co-sponsored by the CDC and Stanford University and others. Janice Nall about using SMS to improve health behavior, with the imperative:

“Text messaging is the only viable interactive means of reaching people on a massive scale around the world. This event will highlight the significant, untapped potential for changing health behavior through this channel.”

This report is based on interviews with more than two dozen researchers, clinicians, and application developers, and on a review of a broad range of published papers and articles, web resources, and other materials.The report begins with an overview of the global wireless revolution in term of who is using the technology and how the technology is evolving. It then describes a variety of wireless health care applications that are currently available or under development: considers the impact these advances could have on potential providers, pateints and payers; and discusses key unresolved issues. The report concludes with a brief look at some likely future developments and their implications for healthcare.

This article summarizes how the Kenyan Research Institute (KEMRI) in collaboration with the University of Nairobi (UON) abd the Massachusetts Institute of Technology (MIT) are applying mobile technology to help gather field data crucial to understanding and fighting Malaria. The project featured forms a part of MIT's Entrepreneurial Programming and Research on Mobiles (EPROM) Program. The goal of the project is to improve the efficiency and accuracy of dta collection and input to better comprehend the spread of disease and develop responses.

This study is the result of a collaboration between Columbia University’s School of International and Public Affairs, UNICEF Malawi, and UNICEF’s Division of Communications Innovations Team in an attempt to use mobile communication devices to facilitate the surveillance of child nutrition in Malawi. As part of the pilot study, health workers at three district growth monitoring clinics were trained to submit child nutrition data via mobile phone SMS (text messages). Using an open-source software platform (RapidSMS), this data was received by a central server and automatically analyzed for indicators of child malnutrition. Health workers received instant feedback messages confirming the information sent and provided additional directions if malnutrition was indicated by the data received. Finally, a website was created to provide the Malawian government and other stakeholders real-time access to this data and its analysis. The report details the pilot study’s findings and outline recommendations for the future use of RapidSMS in Malawi.

This pilot study yielded a number of findings that may be applicable to other development projects using similar mobile phone technology. The results of this particular program included: Significant reduction in data transmission delay compared to Malawi’s current paper-based system. increase in data quality reported by health workers, elimination of the need for time-consuming manual data-entry, increased two-way flow of information between stakeholders at the national government level and health workers in the field, increased system and personnel monitoring capabilities, and elimination of costs related to transporting paper forms and manually entering data.

However, technology can only aid development within a limited scope. The true value of this innovation will be dependent on several other factors, including the integration of RapidSMS into the larger context of health activities and policy making in Malawi; the willingness of the Government of Malawi to take ownership of the platform; the ability to build and develop local technical capacity; and the maintenance of training and monitoring at all levels of participation.

This report maps out what is known about a broad range of mobile and wireless technologies and the contributions that they are making towards achieving health care objectives in low and middle income countries.

The report is divided into six sections: overview of mHealth as a critical domain within eHealth, review of health-related applications associated with mobile technologies, exploration of how various technologies are being used to achieve health objectives, documentation of key leaders and partnerships that have emerged to test and expand mHealth in low and middle income countries, critical considerations based on early initiatives and research, and key recommendations for next steps in the area of mHealth.

The report is based on an intensive study of peer-reviewed literature, program evaluation and industry reports, grey literature, and communication with a broad range of stakeholders. Recommendations include that key mHealth stakeholders focus their energies on the testing and scale-up of interventions. These interventions should show promise in achieving the key health outcomes as laid out by the Millenium Development Goals (MDG's) for health. Further, the report recommends that the World Health Organization (WHO) serves as a convener of key partners and a broker of mHealth strategies, information, and frameworks.

The potential of mobile communication technologies to reduce professional isolation, facilitate the work of overstretched human resources, and yield cost savings and efficiency is recognized. However, the report concludes that technological solutions should be designed according to local realities and meet local needs in away that practically and measurably contributes to the MDG's or health.

The Vodaphone Policy Paper Series No. 4 is a compilation of reports that look specifically at the contribution of Mobile phones in healthcare. The reports focus on the basic voice and text potential of mobile phones and identify opportunities for improved efficiency and effectiveness in service delivery where service provider-customer communication is important.

Moving the debate forward are reports made by experts who provide an analysis of the healthcare situation and their view on the contribution of Mobile phones in healthcare. Their analysis highlights three areas where mobile applications offer potential value to healthcare providers: Tracking inefficiencies in service provision by improving communication between service providers and users, improving the effectiveness of healthcare (and the risk of serious complications) through improved self-management and monitoring of patients with chronic conditions, and increasing the ability of hard-to-reach groups to access healthcare services by reducing the barriers of inconvenience, confidentiality, and privacy.

The Office of Health Economics (OHE) Consulting, contribute an overall analysis of healthcare costs in Western Europe and an assessment of potential applications of mobile phones in that context. Health Economists at the Tanaka Business School of Imperial College in London, NHS Direct, the University of Dundee and other institutions provide a series of case studies.

Reports included:

Upward Trend in Healthcare Spending
Analysis of Calls to NIH Direct
Review of Characteristics and Benefits of SMS in Delivering Helthcare
Potential Uses of SMS Applications for the Control of Tuberculosis
Use of Mobile Technologies to Enhance Control of Type 1 Diabetes in young People: Economic Evaluation