In this two-part series, MobileActive.org explores how mobile money services can support health care in developing countries. In part one, we described the key ways in which mobile money services can be adopted by the health sector.
At the primary level of care, subscription-based mobile payment services can create two-way links between patients and health care providers, as summarized here.
Patients can pay service providers directly for health care services delivered.
Service providers can use mobile transfer platforms to reward patients with monetary or airtime incentives for treatment compliance.
At the district, regional, and national levels, governments and organizations can improve management of funds and introduce better checks and balances by using mobile money platforms. Some uses include:
Mobile phones are being tried and tested in myriad ways in health care. They are used for data collection and disease surveillance, for ensuring treatment compliance, for managing health information systems and point-of-care support, for health promotion and disease prevention, and for delivering emergency medical services. Clearly, m-health, as this growing field is dubbed, is here to stay.
At the same time, achieving scale and sustainability in most m-health projects has been a challenge. One of the key aspects of beginning to think about ways to integrate m-health into health systems in a sustainable way is to establish financial systems to pay for health services and to ensure financial accountability within programs.
Jeffrey A. Hoffman, Janice R. Cunningham, Andrew J.Suleh, Aaron Sundsmo, Debra Dekker, Fred Vago, Kelly Munly, Emmy Kageha Igonya, Jonathan Hunt-Glassman
Publication Type:
Journal article
Publication Date:
1 Jul 2010
Abstract:
Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.
This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.
Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009
All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.
MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.
Mobile phones are currently used by millions of people around the world. In Africa, mobile phone ownership and use has dispersed at a surprisingly rapid rate across the continent. Recently, there have been multiple and diverse efforts to exploit mobile technologies for purposes of health communication, including collection of health data and provision of health information. Using mobile phones to provide family planning information, however, is a new area that has received almost no attention from health workers.
Recognizing this as a gap and an opportunity, the Mobile for Reproductive Health (m4RH) project was born. The m4RH project is conceptualized as an automated, text-based system that is compatible with any and every mobile phone to maximize reach and access to family planning information via mobile phone. Since this is a new project and mobile phones are a novel method of delivering family planning information, formative research to obtain feedback on the project was carried out in countries where the m4RH project will be piloted in 2010.
Karen G. Cheng, Francisco Ernesto and Khai N. Truong
Publication Type:
Journal article
Publication Date:
1 Apr 2008
Abstract:
Handheld computers have untapped potential to improve HIV/AIDS programs in sub-Saharan Africa, particularly in the collection of survey data. We conducted an experiment in three neighborhoods of Luanda, Angola to assess the impact of the technology on people’s comfort and willingness to disclose sensitive personal information, such as sexual behavior.
Participants were asked about their HIV/AIDSrelated knowledge, attitudes, and practices by local interviewers using either handheld computers or paper surveys. T-tests showed no differences between participants’ self-reported comfort across handheld and paper conditions. However, participants in the handheld condition were more likely to give socially desirable responses to the sexual behavior questions than participants in the paper condition. These results suggest that using handheld computers in data collection in sub-Saharan Africa may lead to biased reports of HIV/AIDS-related risk behaviors.
The overall goal of the PDAs for Malaria Monitoring in Maputo and Gaza Provinces, Centre was to improve the management of public health dat using handheld computers in order to provide the malaria program the Lubombo Spatial Development Initiative (LSDI) with appropriate assessment tools and the ability to make informed decisions.
The specific objectives of the project that would contribute to the achievement of the overall goal were
to enable personnel from District level of the health service to collect data and provide it to the Provincial level in a timely fashion;
to develop training courses and appropriate collection tools designed for use with handheld computers; and
to evaluate the utility of handheld computers for the malaria control program to provide data rapidly and accurately to allow better targeting of interventions and resources.
AED-SATELLIFE developed and successfully deployed electronic data collection tools which catalog drug and rapid diagnostic test stocks; spray operators daily work performance; weekly health facility data; localization of individual households with GPS, including demographic data on household members, house structure and divisions; and health facility surveys linked to GPS positioning. Training materials were developed inPortuguese.
Independent evaluation confirmed that the electronic data collection/transmission tools proved to be a useful, adoptable, and result in higher user satisfaction compared to paper based approaches. Some challenges need to be addressed before there can be widespread adoption of the technology, such as limited infrastructure, especially cellular coverage.
Catholic Relief Services' maternal and neo-natal health monitoring program in Uttar Pradesh, India is incorporating mobiles into its work. The pilot project, which launched in June 2009, uses mobiles to increase volunteers' ability to share and gather health information.
The program uses SMSs to allow ASHAs (Accredited Social Health Activists who are local volunteers) to report statistics on maternal and neo-natal health metrics. According to O.P. Singh, who gave a presentation on the program as part of the SHOPS/mHealh Alliance online conference, several problems in the current system led to the adoption of mobiles: the existing paper system was difficult to use, workers at village and block levels had limited access to information from headquarters, and the paper system was slow. The organization hoped that incorporating mobile phones would give the volunteers a better sense of the health landscape, since they would have access to real time information and be able to instantly share their results. During the presentation, Singh illustrated the system with the following graph:
To increase communication flow and collect data via community health workers
To teach local health workers to incorporate technology into their work
To more accurately track births and deaths
Brief description of the project:
Catholic Relief Service's "Texting with a Purpose" gave mobile phones to community health workers (ASHAs) in the Uttar Pradesh region of India in order to track live births and deaths. The ASHAs filled out mobile forms and submitted them via SMS to a central database in order to better monitor maternal and neonatal health in the region.
Target audience:
The target audiences are:
36 volunteer accredited social health activists
Pregnant women and newborns in Uttar Pradesh, India
Length of Project (in months) :
10
Status:
Ongoing
Anticipated launch date:
What worked well? :
The project has raised the level of reported births to almost 100%. Because the data is compiled instantly, less children are missed than under the old system. The Catholic Relief Service has also seen that the ASHAs view the SMS system as a viable plan for the future or reporting on maternal/neonatal health and that they are working hard to master the system.
What did not work? What were the challenges?:
So far, 65% of the ASHAs still need support from family members or the Catholic Relief Services staff in order to manage the SMS texting; reasons for this include a lack of familiarity with mobile technology and low literacy. Another challenge is the coded SMS system; it has to be filled out very precisely, which can lead to errors.
Mobile phones are becoming prolific in society, both in industrialized and non-industrialized countries. Of all of the developments in new media, mobile is the only one that seems to be narrowing the digital divide rather than widening it, making it a crucial tool in improving the health of poor and hard-to-reach populations. Organizations around the world are beginning to implement mobile technology into their health behavior interventions and are seeing rising success. In diabetes and other chronic disease management, mobile phones are being used for medication alerts and health reporting. The technology is being used to send sexual health and HIV/AIDS information in places like downtown San Francisco and rural Africa, as part of ongoing testing, counseling and prevention services. In the US, applications involving GPS technology, video games, and persuasive technology are all being tested for their effectiveness in influencing health behavior and applicability on mobile phones.
Through published research and interviews with key leaders in the mobile health field, this paper outlines the benefits of mobile technology and the barriers to integrating mobile fully into public health campaigns. Despite the enormous work already being done and a host of new technologies on the rise, most experts will agree that mobile phones on their own will not serve as primary tools for influencing health behavior. A comprehensive and integrated campaign that incorporates mobile will be most effective, but mobile alone faces too many barriers to fostering social norms on the wide-scale. In fact, many argue that the ways in which public health advocates are able to place health messages in broadcast media cannot be applied on cell phones because of society’s growing resistance to mobile marketing.
The paper asks: What are some examples of how organizations around the world have harnessed mobile technology to improve the health behavior of disease-specific and target populations? What lies in the future for mobile technology and health? Is mobile the answer we have been looking for?
The number of mobile subscribers globally is estimated to have reached four billion in 2008 (ITU, 2008), with mobile penetration reaching 61%. Around 58% of subscribers are in developing countries, and subscriber growth in Africa – more than 50% per year – is the highest in the world. Studies have shown that this rapid increase in mobile penetration has contributed significantly to economic growth. Fuss, Meschi and Waverman (2005) looked at 92 countries, both developed and developing, to estimate the impact of mobile phones on economic growth for the period 1980 to 2003. They found that a 10% difference in mobile penetration levels over the entire sample period implies a 0.6% difference in growth rates between otherwise identical developing nations. The effect of mobiles was twice as large in developing countries as in developed ones (Waverman, 2005).
Mobile phones have brought three kinds of benefits (id21, 2007). First, incremental benefits, improving what people already do – offering them faster and cheaper communication, often substituting for costly and risky journeys. Fishermen in India, for example, can earn more money and waste less fish by phoning coastal markets to see which market has a shortage of supply. Second, transformational benefits that offer something new. Innovative applications, such as m-banking and m-commerce, are bringing banking services to millions for the first time, and enabling people to use mobile phones to pay for goods and services. Third, production benefits that result from the creation of new livelihoods, not only through professional telecommunications jobs but also through activities like re-selling air-time or phone cards. Since the liberalisation of Nigeria’s telecommunications sector in 2000, the industry has become a key source of new jobs in the economy, employing about 5,500 professionals, and responsible, indirectly, for another 450,000 jobs.
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."
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.
Although nonprofits in the United States has been slower to embrace mobile phones for health purposes than the rest of the world, mobiles are catching on as a way to reach diverse populations across the U.S.
“Mobile provides a fantastic channel for communication,” said Erin Edgerton, senior social media strategist at the Center for Disease Control and Prevention (CDC). “It’s always on, always with you and provides personal access to information.”
Nonprofits and government agencies are using this ubiquitous device for health purposes including monitoring, education and instant alerts and communication.
Mobile monitoring
For diabetes patients in Georgia, mobile phones have facilitated an instant connection to help and education.In several different pilot studies, participants used cell phones to document aspects of diabetes treatment ranging from glucose readings to snapping photos of the meals that they ate. Participants then sent the photos, readings, or other questions to a diabetes education center, where a diabetes educator could instantly respond to questions.
Wired has finally picked up the story that has been circulating for a while -- the phenomenal medical diagnostic hack using a mobile and beginning to turn it into a lab for developing countries.
Aydogan Ozcan, assistant professor of electrical engineering at the UCLA School of Engineering and Applied Science and a member of the California NanoSystems Institute (CNSI), and his team of graduate and udergraduate students developed a medical diagnostic application from a mobile phone, in effect bringing the hospital to the patient.
In our series of interviews from the Bellagio conference on mobile health, here is David Sasaki's last interview with Patricia Mechael who is coordinating the mobile strategy for the Millennium Village Project. She talks about mobile adoption, user-centric design, women and mobiles, how Millennium Villages is using mobiles to improve health outcomes, and what she sees as the next big projects in mobile health.
David Oso: You have worked in a number of countries -- Egypt, Sudan, the UK, Bangladesh, Cambodia, Mozambique, Russia, Rwanda, the list keeps going on and on. How are cell phones used differently in these different countries where you've worked?