MobileActive.org

For the first time the World Health Organization’s (WHO) Global Observatory for eHealth (GOe) has sought to determine the status of mHealth in Member States; its 2009 global survey contained a section specifically devoted to mHealth. Completed by 114 Member States, the survey documented for analysis four aspects of mHealth: adoption of initiatives, types of initiatives, status of evaluation, and barriers to implementation. Fourteen categories of mHealth services were surveyed: 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 there is a groundswell of activity.  The majority of Member States (83%) reported offering at least one type of mHealth service. However, many countries offered four to six programmes. The four most frequently reported mHealth initiatives were: health call centres (59%), emergency toll-free telephone services (55%), managing emergencies and disasters (54%), and mobile telemedicine (49%). With the exception of health call centres, emergency toll-free telephone services, and managing emergencies and disasters, approximately two thirds of mHealth programmes are in the pilot or informal stage.

The survey results highlight that the dominant form of mHealth today is characterized by small-scale pilot projects that address single issues in information sharing and access. There were only limited larger mHealth implementations (primarily supported by public-private partnerships). While it is anticipated that large-scale and complex programmes will become more common as mHealth matures, strategies and policies that integrate eHealth and mHealth interoperability into health services would be wise. mHealth is no different from other areas of eHealth in its need to adopt globally accepted standards and interoperable technologies, ideally using open architecture. The use of standardized information and communication technologies would enhance efficiency and reduce cost. To accomplish this, countries will need to collaborate in developing global best practices so that data can move more effectively between systems and applications. 

USAID‘s Strengthening Health Outcomes through the Private Sector (SHOPS) project seeks to increase the role of the private sector in the sustainable provision and use of quality family planning/reproductive health and other health products and services. One of the areas of technical focus of the SHOPS project is to identify, deploy, and scale up promising uses of mobile technologies to improve health outcomes. Many developing countries have a severe shortage of health providers, and many of the providers who are working have only limited access to up-to-date clinical protocols, or face-to-face trainings. Mobile phones offer an innovative channel through which to provide cost-effective approaches for clinical training and support for improving quality of care.

SHOPS‘ partners Abt Associates, Jhpiego, and Marie Stopes International (MSI), collaborated in a mobile learning and performance support pilot called Mobiles for Quality Improvement (m4QI) conducted in Uganda during the period September 2010–August 2011. The goal of m4QI was to demonstrate the potential for positive behavioral change in service delivery by reinforcing face-to-face induction training lessons provided to Marie Stopes staff. Research supports the theory that spaced reinforcement of training combined with testing can significantly improve long-term knowledge retention and facilitate behavioral change.

The objectives of m4QI were to develop and test a technology-supported approach to performance improvement including processes for identifying performance gaps in adherence to clinical protocols, a platform to manage and automate the delivery and receipt of text message reminders and quizzes to address the gaps, and production of actionable data to improve effectiveness of supportive supervision and follow-up. To support scalability and replicability, the pilot platform was designed for users of low-end phones, and those without Internet access.

The Vodafone Health Debate series is part of our continuing commitment to thought leadership in healthcare. It brings together senior pharma, public and private health stakeholders to learn, share and debate on issues and new thinking brought forward by renowned thought leaders and industry experts. Our aim is to provide some evidence- based stimulus that will encourage all those working in the different areas of healthcare to consider the innovation opportunities that are now available to them.

We believe that real progress can only be initiated when all stakeholders look beyond traditional horizons and share ideas that challenge the status quo so that together we can identify new ways of addressing current issues. Regulatory complexity, financial constraints, entrenched infrastructures and poor investment in technology combined with a lack of understanding by technology providers has meant that digital innovation in healthcare has been slow to take hold.

However, given changing healthcare needs of an increasingly aging population and the challenges presented by the current economic crisis, there is renewed interest in the potential of mHealth and Internet solutions to help reduce costs, increase efficiencies and effectiveness. This paper explores the practical reasons behind the slower than expected adoption of digital health technologies and discusses experiences from other sectors that could potentially help create wide scale adoption.

The GSM Association—the global trade association for mobile network operators—and its Development Fund believe that health hotlines can transform healthcare for poor people just as mobile phones are revolutionizing financial services (‘mobile money’). Health hotlines are simple to understand (“call a doctor”), provide immediate assistance, and are available to anyone with a mobile phone. The reach and branding of a mobile network operator (MNO), and the scalability of call center technology may mean that health hotlines serve vast numbers of people in the coming years.

As a first scan of the approach, this report tracks hotlines operating in developing countries, assesses their social and commercial success to date, and offers suggestions for governments, industry bodies and development agencies to advance this approach.

In the first section we define the health hotline model and present a brief landscape of health hotlines in operation today. Section 3 spotlights four of the most prominent health hotlines in developing countries, and compares their business approaches. In Section 4 we assess their commercial viability and potential for growth, and in Section 5 we evaluate their potential for social impact. Finally, Section 6 offers thoughts on how development agencies and governments can support the health hotline phenomenon.

This case study analyses the ways in which the Cell-Life initiative, a collaboration between UCT‘s (University of Cape Town) departments of Civil and Electrical Engineering and the Cape Peninsula University of Technology (CPUT), utilises technology-based solutions (in particular, cellphone technology) for the life management of patients living with HIV/AIDS.
 

Cell-Life is a model example of a socially responsive endeavor which utilizes technology to overcome limitations and constraints. The use of cellphones to save lives by aiding adherence to the ARV medication regime and gather data is a remarkable contribution to the fight against the HIV/AIDS pandemic and signifies an intersection between the academic endeavour, innovation and the lives of ordinary people on the ground. The open approach taken by the organisation in sharing its work also illustrates how research is able to contribute to the 'undead count' (i.e. the number of lives saved) of academic research, which must surely be considered the greatest achievement of any endeavor.

After extensive studies of BRAC’s health services for mothers, neonates and children in rural and urban areas (MNCH and Manoshi, respectively), ClickDiagnostics has developed a mobile phone-based solution for streamlining BRAC’s data collection procedures in Manoshi, enabling BRAC to take a more pro-active approach in strategizing and reaching the women most in need in the urban slums.

ClickDiagnostics is in the concluding stages of piloting thissolution jointly with BRAC, and after the completion of the project in January, will support BRAC in refining the model and scaling up for nationwide implementation in MNCH and Manoshi projects, and possibly also in BRAC Health’s other program.

One important reason why many pregnant mothers succumb to death or preventable miscarriages is that it is expensive for government or non-government health organizations to track pregnant mothers to assess their level of risk and prioritize its limited resources for targeted intervention. A model in which community health-workers use ICT to gather real-time information about pregnant women and send to a specialist can help to address this gap and help health organizations take precautionary measures about risky cases of pregnancies.

In this paper, we present D-tree International’s work with medical algorithms and mobile applications to improve the standards of care in clinical and community settings. In particular, we present a mobile phone-based application called CommCare which helps community health workers (CHWs) to provide home-based care and social support to HIV, tuberculosis and other chronic patients. The application guides the CHWs through a series of questions which they answer using the phone’s number pad. The data then can be submitted directly to a central database over a cellular GPRS network.

We report on our experience developing and testing the application in Tanzania, including the iterative development process with the CHWs and training them to use the program. We include an account of some of the hardware and software issues encountered and resolved during the process, and some initial reactions from the first CHWs and clients to use the program. While the formal evaluation of the program is still in progress, initial findings show that the phonebased system is generally viewed positively by the users and by the clients as more discreet and better for privacy than the paper-based system.

Because many infectious diseases are emerging in animals in low-income and middle-income countries, surveillance of animal health in these areas may be needed for forecasting disease risks to humans.

We present an overview of a mobile phone–based frontline surveillance system developed and implemented in Sri Lanka. Field veterinarians reported animal health information by using mobile phones. Submissions increased steadily over 9 months, with ≈4,000 interactions between field veterinarians and reports on the animal population received by the system.

Development of human resources and increased communication between local stakeholders (groups and persons whose actions are affected by emerging infectious diseases and animal health) were instrumental for successful implementation.

The primary lesson learned was that mobile phone–based surveillance of animal populations is acceptable and feasible in lower-resource settings. However, any system implementation plan must consider the time needed to garner support for novel surveillance methods among users and stakeholders.

This report tackles ICT4D under three key headings: information, communication and participation. While not ignoring negatives, the report primarily explores, through the lens of Cambridge activities in ICT4D, the positive impacts and ongoing challenges of ICT4D: its ability to provide access to valuable information, to create meaningful two-way dialogues, to reach remote and excluded communities, and to empower the excluded to participate in their own development and societies.

There are still significant barriers preventing people in the Global South from accessing ICTs. But with the ongoing, rapid growth in mobile phone use and network connectivity across the world, the parameters are changing. We need to keep adapting to this environment in order to succeed. We must also ensure that the poorest and most disadvantaged are not left behind.

We have also seen challenges and progress that still need to be made in harnessing ICTs to achieve positive and lasting development outcomes. Technology can only ever be one ingredient in this process, but it can be a potent one. A key strength of ICT4D lies in the potential for participation, especially as technologies become more and more interactive.

The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel.

Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised.

We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information. The paper discusses modes of encryption, database security, the transformation from eHealth to mHealth, and the theoretical background for privacy and data protection. 

Stock-outs of malaria treatments at the health facility level in many sub-Saharan African countries have been a persistent problem for many years. A stock-out is the unavailability of medicine at the health facility. In Tanzania, 93 % of the population are at risk for malaria infection. The number of malaria cases is estimated to be 11 million resulting into 60-80 thousand deaths per year or 220 deaths per day in Tanzania alone. The goal of the SMS for Life pilot project was to develop a flexible and scalable solution to bring up-to-date visibility of anti-malarials within the Tanzanian Public Health Sector with a potential to reduce or eliminate stock-outs of five drugs (four dosage forms of ACTs and Quinine Injectable) in all health facilities in a pilot sample of three districts.

Initiated and led by Novartis, a public-private partnership was established with the Roll Back Malaria Partnership, IBM, Vodafone and the Ministry of Health in Tanzania. This unique partnership developed a solution using mobile phones, SMS messages, internet and mapping technology to visualize weekly stock inventory of Artemisinin Combination Therapy (ACTs) and Quinine Injectable at 129 health facilities and 226 villages. Over the course of one year, the Project Team designed the system, created a data repository, trained key staff and implemented the solution for a 21-week pilot in three districts of Tanzania: Ulanga, Kigoma Rural and Lindi Rural. These districts are located in three different regions and supplied from different Zonal Stores with a catchment population of 1.2 million people.

The application of mobile computing and communication technology is rapidly expanding in the fields of health care and public health. This systematic review will summarise the evidence for the effectiveness of mobile technology interventions for improving health and health service outcomes (M-Health) around the world.

To be included in the review interventions must aim to improve or promote health or health service use and quality, employing any mobile computing and communication technology. This includes:

(1) interventions designed to improve diagnosis, investigation, treatment, monitoring and management of disease;

(2) interventions to deliver treatment or disease management programmes to patients, health promotion interventions, andinterventions designed to improve treatment compliance; and

(3) interventions to improve health care processes e.g. appointment attendance, result notification, vaccination reminders.

A comprehensive, electronic search strategy will be used to identify controlled studies, published since 1990, and indexed in MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, the Cochrane Library, or the UK NHSHealth Technology Assessment database. The search strategy will include terms (and synonyms) for the following mobile electronic devices (MEDs) and a range of compatible media: mobile phone; personal digital assistant (PDA); handheld computer (e.g. tablet PC); PDA phone (e.g. BlackBerry, Palm Pilot); Smartphone; enterprise digital assistant; portable media player (i.e. MP3 or MP4 player); handheld video game console. No terms for health or health service outcomes will be included, to ensure that all applications of mobile technology in public health and healthservices are identified.

Bibliographies of primary studies and review articles meeting the inclusion criteria will besearched manually to identify further eligible studies. Data on objective and self-reported outcomes and study quality will be independently extracted by two review authors. Where there are sufficient numbers of similar interventions, we will calculate and report pooled risk ratios or standardised mean differences using meta-analysis.

This systematic review will provide recommendations on the use of mobile computing and communication technology in health care and public health and will guide future work on intervention development and primary research in this field.

At the UN Millennium Summit in September 2000, world leaders adopted the Millennium Declaration, committing nations to a new global partnership to reduce extreme poverty and address pressing challenges of hunger, gender inequality, illiteracy, and disease. The year 2015 has been affirmed as the deadline for reaching these Millennium Development Goal (MDG) targets.

The goal is to show how an integrated approach to community-level development can translate the international MDG agreements into ground-level breakthroughs throughout rural sub-Saharan Africa. Villages are located in deeply impoverished rural areas that were considered hunger hotspots—with at least 20% of children malnourished. Sites were selected to reflect a diversity of agro-ecological zones, representing a range of challenges to income, food production, disease ecology, infrastructure, and health system development.

The Millennium Villages Project is a ten-year initiative spanning two five-year phases. The first phase focuses on achieving quick wins, especially in staple crop production and disease control, and on establishing basic systems for integrated rural development that help communities escape the poverty trap and achieve the MDGs. The Project involves the coordinated community-led delivery of a locally tailored package of scientifically proven interventions for agriculture, education, health, and infrastructure. Over the first five-year phase, interventions are delivered at a modest cost, totaling approximately $120 per capita per year, of which MVP brings about half to complement funds from the host government, the local community, and other partners. The second five-year phase will focus more intensively on commercializing the gains in agriculture and continuing to improve local service delivery systems in a manner that best supports local scale-up.

This report for mHealthEd 2011 at the Mobile Health Summit focuses on the effectiveness of mHealth Education applications, analyzing at length the first wave of projects and the steps to be taken into consideration for further initiatives.

The first wave of mHealthEd applications for health workers – most introduced within the last 4 years and some of which are 7 presented in this report – include ones which enable workers to learn new treatment procedures, test their knowledge after training courses, take certification exams remotely, look up information in medical reference publications, and trade ideas on crucial diagnostic and treatment decisions. It is too early to test for impacts on health outcomes, but projects suggest that mHealthEd applications are improving the provision of care and levels of knowledge. Improved training can also increase job satisfaction and reduce attrition rates for healthcare workers.

While researchers are often depicted as either ‘social scientists’ or ‘technologists’ often their educational and ideological backgrounds are much richer than the two simple terms might imply.

This paper describes the methodology and approach of a qualitative researcher with a computer science background in investigating how information technology changes communications and information management practices within the health ecosystem constitutued by a health subsidy program in southwest Uganda.

The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe. A powerful combination of factors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services, and the continued growth in coverage of mobile cellular networks.

According to the International Telecommunication Union (ITU), there are now over 5 billion wireless subscribers; over 70% of them reside in low- and middleincome countries. The GSM Association reports commercial wireless signals cover over 85% of the world’s population, extending far beyond the reach of the electrical grid.

For the first time the World Health Organization’s (WHO) Global Observatory for eHealth (GOe) has sought to determine the status of mHealth in Member States; its 2009 global survey contained a section specifically devoted to mHealth. Completed by 114 Member States, the survey documented for analysis four aspects of mHealth: adoption of initiatives, types of initiatives, status of evaluation, and barriers to implementation. Fourteen categories of mHealth services were surveyed: 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 opportunities in South Africa for using mobile technologies to support initiatives in the HIV/AIDS sector are enormous. A huge number of people have cellphone access, and there are a range of innovative ways in which cellphones can be used to support treatment, disseminate information, provide anonymous counselling, gather data and link patients to services. Cell-Life is an NGO based in Cape Town, South Africa, that seeks to improve the lives of people infected and affected by HIV through the appropriate use of technology. This paper describes three pilot interventions that use cellphones for behaviour change communication, ie that are experimenting with different cellphone technologies to disseminate information, undertaken as part of Cell-Life’s Cellphones4HIV project: ARV adherence SMSs, USSD content delivery and content delivery via MXit. Challenges around measuring impact in behaviour change communications are briefly discussed, and some of Cell-Life’s upcoming initiatives are outlined.

According to industry estimates, there are more than 500 million mobile phone subscribers in Africa now, up from 246 million in 2008. In 2000, the number of mobile phones first exceeded that of fixed telephones. Africans can accelerate development by skipping less efficient technologies and moving directly to more advanced ones.

The telecommunications sector continues to attract a flurry of public and private investment from foreign sources and local banks, but the investment should be in software and services, not just cabling infrastructure.