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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. 

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.

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.

Mobile phone access in low and middle-income countries is rapidly expanding and offers an opportunity to leverage limited human resources for health. We conducted a mixed methods evaluation of a cluster-randomized trial exploratory substudy on the impact of a mHealth (mobile phone) support intervention used by community-based peer health workers (PHW) on AIDS care in rural Uganda. 29 PHWs at 10 clinics were randomized by clinic to receive the intervention or not. PHWs used phones to call and text higher level providers with patient-specific clinical information. 970 patients cared for by the PHWs were followed over a 26 month period. No significant differences were found in patients’ risk of virologic failure. Qualitative analyses found improvements in patient care and logistics and broad support for the mHealth intervention among patients, clinic staff, and PHWs. Key challenges identified included variable patient phone access, privacy concerns, and phone maintenance. 

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.

 We present a low-cost, energy-efficient system to remotely monitor the temperature and location of vaccines in a countrywide “cold-chain”. Our system is based on FoneAstra [11] – a low-cost, microcontroller-based, programmable device that extends capabilities of low-tier mobile phones that are commonly used in developing countries.

In the system discussed in this paper, FoneAstra is enhanced with a digital temperature sensor and integrated with a vaccine cold-box used to store vaccines in a temperature controlled environment. FoneAstra continuously monitors the temperature of the cold-box, aggregating readings over a period of time.

It uses the mobile phone to which it is coupled to send periodic SMS messages with routine temperature reports or immediate alerts if  it detects abnormal temperature conditions. Additionally, it enables location-tracking of vaccines in transit, based on the mobile phone’s cell tower-IDs.

We present results from an ongoing lab-deployment done at PATH [18], our Seattle-based partner NGO for this project. Over the next few months, we will deploy this temperature and location monitoring system for vaccine cold-chains in several countries in which PATH operates.

The client in this system, which includes a temperature sensor, FoneAstra and a mobile phone, costs $50; while the server, which includes a Netbook and a GSM modem, costs $500. We discuss how our system can scale up to enable large-scale monitoring while incurring low overhead costs.

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.

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.

Grameen Foundation’s experience of designing and implementing a mobile health program in Ghana can provide insights for the broader field and specific projects that are in early phases of planning and implementation. A fundamental tenet of Grameen Foundation’s work is to share information broadly, from program designs to management plans to source code to lessons learned - both successes andfailures. To that end, this document is intended to provide:

1) A comprehensive overview of the Mobile Technology for Community Health (MOTECH) project in Ghana and how it works.

2) An insight into strategic decisions and design approaches made by the project team throughout the course of the implementation.

3) Information on lessons learned during the project and implications of decisions on future scale.

Both mHealth and MFS (Mobile Financial Services) are nascent industries and fragmented along multiple dimensions. The aim of this paper is to help reduce some of these uncertainties and reinforce dialogue on how the mobile communications platform can be leveraged to strengthen mutually positive outcomes related to both financial inclusion and health. With user-centric solutions that leverage common technologies, new efficiencies and capabilities can be created that serve to accelerate global scale.

Unlocking this potential will require the following questions to be addressed: 1. What will be the best method to drive awareness and adoption of the self-reinforcing dynamics of “wealth and health”? Who will lead these efforts? 2. How will the integration and interoperability of disparate technologies across multiple industry and public sector domains occur? 3. Who will build and manage the common infrastructure and distribution networks? 4. How will the various points of policy coordination work across sector domains?

In the context of the rapid growth of mobile phone penetration in developing countries, mobile telephony is currently considered to be particularly important for development. Yet, until recently, very little systematic evidence was available that shed light on the developmental impacts of mobile telecommunication. The Information and Communication Technology for Development (ICT4D) program of the International Development Research Centre (IDRC), Canada, has played a critical role in filling some of the research gaps through its partnerships with several key actors in this area.

The objective of this paper is to evaluate the case of mobile phones as a tool in solving development problems drawing from the evidence of IDRC supported projects. IDRC has supported around 20 projects that cut across several themes such as livelihoods, poverty reduction, health, education, the environment and disasters. The projects will be analyzed by theme in order to provide a thematic overview as well as a comparative analysis of the development role of mobile phones. In exploring the evidence from completed projects as well as the foci of new projects, the paper summarizes and critically assesses the key findings and suggests possible avenues for future research.