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Why Mobiles and Health?
Mobile phones have shown to be a promising tool in the field of health. In areas with lack of Internet and computer access, mobile phones are used to connect health workers, provide access to and collection of data, and monitor patients. Mobiles have served as a source of health information through SMS infolines, which connect people to just-in-time information on topics like sexual health. The report Wireless Technology for Social Change: Trends in NGO Mobile Use lists many of the ways that mobiles have been used in health:
Mobile technology has 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.
Strategy Considerations
A report by InfoDev, Improving Health, Connecting People: The Role of ICT in the Health Sector in Developing Countries, drew seven broad conclusions/recommendations about the use of mobile phones in the health sector. These conclusions were:
- Keep the technology simple, relevant, and local.
- Build on what is there (and being used).
- Involve users in the design (by demonstrating benefit).
- Strengthen capacity to use, work with, and develop effective ICTs.
- Introduce greater monitoring and evaluation, particularly participatory approaches.
- Include communication strategies in the design of ICT projects.
- Continue to research and share learning about what works, and what fails.
Mobile phones fit well within these conclusions. They are, in many ways, an ideal ICT in the developing world because they are already fairly ubiquitous -- there are currently 3.5 billion mobiles in the world -- and are widely used even in the poorest countries. Successful initiatives in the field of mobiles and health have built on the phones that people already use and the applications -- like SMS -- that are already widely accepted.
Case Studies
Health Data Collection and Transmission
Mobile phones have been used most widely for data collection and transmission in areas where Internet penetration is low and health workers lack other means of communication and the ability to easily transmit data. Much of the software developed for collecting health data via mobile phones is open source, making it accessible and affordable for health workers in developing countries.
Bloodbank SMS
An application called BloodbankSMS allows health workers to communicate blood type levels via text message. From the BloodbankSMS website:
Medical workers from each district hospital can simply send a free text message to the service detailing the amounts of each blood type remaining. Real-time blood levels for each local hospital are graphically displayed on a web-based interface designed for administrators at the central blood repositories. Additionally, should the blood levels at a local hospital get below a critical threshold, the system automatically sends SMS alerts to the appropriate individuals at the centralized blood bank.
Cell-life
Cell-life uses mobile phones to transmit data about patients who have HIV/AIDS. From the MobileActive blog:
Cell-Life is a Cape Town based NGO that develops applications used by home-care workers to transit HIV/AIDS data. Home-care workers in the Vodacom-sponsored Cell-Life Aftercare program are each assigned 15-20 patients who are monitored in their homes. The health worker transmits necessary data -- such as medication, socio-economic factors affecting treatment, or symptoms -- via mobile to a central server, where the data is recorded and necessary responses are sent.
A case study of Cell-Life is also available in the report Wireless Technology for Social Change: Trends in NGO Mobile Use.
EpiSurveyor
EpiSurveyor is an open-source software tool for mobile phones. It has been used for data collection in Zambia and Kenya, including in a pilot project as part of the measles initiative.
From a case study in the report Wireless Technology for Social Change: Trends in NGO Mobile Use:
In 2002, Selanikio teamed up with computer scientist Rose Donna to form the DataDyne Group, a non-profit dedicated to increasing access to public health data through mobile software solutions. Inspired by an earlier CDC product called Epi Info, Selanikio created EpiSurveyor, a free, open-source, mobile data collection software tool. EpiSurveyor offers health data collection forms that can be downloaded at no cost and modified by anyone with basic computer skills. Selanikio and Donna believed that this technological innovation could empower developing country health officials with the tools needed to gather time-sensitive health data quickly, and without outside assistance.
Mobile Demographic Surveillance System
The Mobile Demographic Surveillance System (MDSS) is a project of MIT's EPROM project. It allows medical workers in Kenya to transmit data via SMS. According to the EPROM website:
The Mobile Demographic Surveillance System (MDSS) is an attempt to enable these medical field workers to conduct these surveys on mobile phones that can remotely interface with local hospital’s database. Shifting the system from paper-based surveys to mobile phones has the potential to allow the field workers to remain in the field for longer periods of time while bypassing the time consuming and potentially error-prone data transcription process.
mPedigree
mPedigree is an initiative in Ghana that uses SMS to identify whether drugs are legitimate or counterfeit.
From the MobileActive blog:
Although mPedigree has plans to integrate more complex technology -- including responses explaining how to read the holograms on some Ghanaian drugs -- the trial tests one of the simpler options of the proposed technologies. In the trial, a consumer will be able to text a serial number that is written on the drug to a short code. A short code is a 5-digit number that functions as the mobile equivalent of a URL or website. The short codes that mPedigree uses for common drugs mimic the codes that are used to recharge pay-as-you-go mobile accounts in Ghana, so the codes are easy for people to remember. The consumer will then receive an SMS response about the drug's authenticity.
OpenMRS
OpenMRS is an open source medical record system.
From a case study in the report Wireless Technology for Social Change: Trends in NGO Mobile Use:
The Open Medical Records System (OpenMRS) is a free and open source electronic medical record application for developing countries (www.openmrs.org). The application has been used to manage patient and treatment information associated with HIV/AIDS and tuberculosis care in several countries in sub-Saharan Africa.
An interface called OpenROSA would port OpenMRS to mobile phones. The code is available here.
Health Education and Peer Support Groups
SMS has proven to be an effective tool for health education. In the case of the Zumbido Project, SMS allowed for conversation about difficult and often sensitive topics.
Text to Change
A nonprofit called Text to Change uses mobile phones to educate people about HIV/AIDS. One component of their education initiative is an SMS quiz. From the Text to Change website:
With the Text to Change concept we offer an interactive Mobile SMS Quiz with (general) knowledge questions regarding HIV/AIDS linked with a rewarding system (incentive). By means of this edutainment and this interactive way of communicating, we tend to reach out to millions of people in Africa and around the world in order to spread the message of HIV/AIDS and make it a subject of discussion. The SMS Quiz is designed to raise and help resolve key issues around HIV transmission and prevention.
Zumbido Project
The Zumbido project in Mexico was a type of peer-education and support group initiative, connecting a network of diverse people who had from HIV/AIDS via mobile phone. From the MobileActive blog:
A recently completed pilot project called Zumbido allowed its 40 test users of diverse backgrounds to communicate about the daily challenges they face in a meaningful and lasting support network. Unlike other hotlines or support mobile phone services, where a user calls one person for help, Zumbido functioned as a network, with each text message sent to every member of the support group.
Health SMS Infolines
A variety of infolines offer health information via text messages. Infolines can be particularly useful for sexual health information because they provide anonymous, just-in-time information about sensitive subjects, and don't require the user to go in person to a clinic or doctor.
Ask Brook
Ask Brook is a sexual health infoline in the U.K. From a case study in the report Wireless Technology for Social Change: Trends in NGO Mobile Use:
In 2002, The Brook Advisory Centre, a UK charity, launched an enhanced “Ask Brook” information service providing young people with sexual health knowledge and support via telephone, the Internet, and text message. To access the service via mobile phone, young people text BRK, followed by their postcode, to 81222. Subsequently, they receive information regarding sexual health services in their area. They can also select standardized responses to questions relating to contraception, pregnancy, sexually transmitted disease, and other sexual health issues. In 2006 and 2007, the service received an average of 100 text message queries per month.
Healthy Toys
A United States based nonprofit called MomsRising sponsors an infoline that tells users whether toys contains high levels of toxic chemicals.
From MomsRising.org:
Send a SMS/text message to 41411 with the text, "healthytoys [search term/toy name]" -- where [search term] is the name of a toy, type of toy, manufacturer, or retailer. This will let you know if a toy contains toxic chemicals or not. Example: Text "healthytoys alphabet pal" to 41411 to find out the toxics rating for the Alphabet Pal by Leap Frog, sold at Walmart. You can also search by retailer (text "healthytoys walmart" to 41411) or manufacturer (text "healthytoys leap frog" to 41411). We'll respond instantly with the results, based on recent comprehensive tests by HealthyToys.com. The results will indicate whether the toy or product had a low, medium, or high detection of toxic chemicals.
HIV Texting Locations via SMS
An infoline in South Africa gives users the locations of HIV testing centers.
From the MobileActive blog
A mobile phone service launched in South Africa this past Saturday provides HIV testing station locations through the use of SMS. South Africans can send an SMS to the short code "31771" with the word "HIV" followed by the name of their town or postal code. The service then responds with the location of the two nearest traveling testing units.
Learning About Living
Learning About Living is a program of One World UK that operates in Nigeria. They have developed an "experiential learning" curriculum that uses mobile phones to help educate youth about sexual education. Read this article on OneWorld.net for more info.
From the MobileActive blog:
Learning About Living is a project by One World UK, Nigerian NGOs, the MTN Foundation, and the Nigerian Department of Education using computers and mobile phones to teach Nigerian teenagers about sexuality and HIV/AIDS prevention. The program includes an interactive e-learning tool with cartoons and sexual health tips based on the national Family Life HIV/AIDS Education (FLHE) curriculum. It is aimed to teach sexual health and prevent HIV/AIDS and gender-based violence and now has an innovative mobile component. The MyQuestion service, launched in late 2007, is a free question and answer service that teenagers can contact by free 3-in-1 text message, by email, and a toll free voice number.
SexInfo
SexInfo is a sexual health SMS info line in San Fransisco, CA in the United States.
From the MobileActive blog:
ISIS, an NGO in San Francisco, USA, set up SexInfo, a sexual health info line for teens, in conjunction with the Public Health Department. For example, if the condom breaks, teens can turn to their cell phone for help: "if u hve sex, u can get an STD + not know it. Chlamydia, gonorrhea=no symptoms most of the time Dropin get chcked FREE," reads a text message tip, followed by a health clinic number and hours. Send the message "sexinfo" to (917) 957-4280 on MetroPCS phones or 36617 on all other cell phones to try it. SexInfo is the only mobile sexual health service available in the United States so far.
Sextxt
Sextxt is an SMS info line in Australia, and according to their website, is the first sexual health SMS infoline in Australia. It is sponsored by Marie Stopes International.
From the sextxt website:
Got a question about sex? sextxt™ gives you accurate answers when you need them... all in the time it takes to send and receive a text message. sextxt™ SMS messages give you quick answers to those emergency questions such as what to do when a condom breaks or when you've missed a pill.
Medication Reminders
SMS messages have been used to remind patients to take their medication. These messages have been most commonly used with tuberculosis (TB) and HIV/AIDS patients.
On Cue Compliance
A service called On-Cue Compliance (a project of SIMpill) functions similarly. From a BBC article:
The service, called On-Cue Compliance, was set up in January 2002 by Doctor David Green, a Cape Town family doctor. He bought a second-hand computer for around US $200, downloaded free software from the internet and rented cheap space on a server. Altogether the set-up costs were less than US$3,000. He told BBC News Online that the service is an answer to a problem which can affect all patients who have to take medication on a consistent basis.
SIMPill
SIMpill is an SMS-based system that reminds patients to take TB or HIV medication. From the MobileActive blog:
Simpill is a special pill bottle that, when opened, delivers an SMS to a central server. If the server doesn't receive the SMS, it can then be programmed to send a message to the patient or to various support services, like family, friends or community health organizations. Simpill has been shown to be effective in reminding patients with tuberculosis to take their medicine.
Women's Health
A report by UNICEF and Women'sNet includes many ways that mobile phones have been used in women's health.
From the MobileActive blog
The document, written and compiled by Sally-Jean Shackleton of Women'sNet with contributions by Toni Eliasz of Ungana-Afrika, is an overview and analysis of mobile usage in development projects, mainly in South Africa. Most of the projects profiled in the report deal with health issues, especially regarding HIV/AIDS. In addition to summaries of 17 projects currently addressing health issues in South Africa and neighboring areas, the report contains four case studies of current health initiatives with mobile phones. These case studies, written by Toni Eliasz, profile Simpill, Cell-Life, the Fahamu-UmNyango Project (which we wrote about here on the MobileActive blog), and the UWC project, and provide a deeper analysis into the methodologies, successes, and results of these projects.
The report is available here on the UNICEF website.
Other Resources
- UNICEF/Women'sNet Report on mobiles used for health in South Africa
- What to Expect When Texting
- Health and Medicine category in the MobileActive directory
- Articles on health and mobile phones in MobileActive's del.icio.us account
- Wireless Technology for Social Change: Trends in NGO Mobile Use. The first four case studies involve mobiles and health.
- Improving Health, Connecting People: The Role of ICT in the Health Sector in Developing Countries InfoDev report on ICTs and health.
- Mobile Applications on Health (download PDF)
