MobileActive.org

In November 2009, the USAID | DELIVER PROJECT office in Zambia, with technical assistance from the home office, conducted the End-Use Verification activity to assess the performance of the logistics management and supply chain systems for selected essential drugs, malaria and family planning commodities.

The survey was used in conjunction with the ongoing Essential Drugs Logistics System Pilot in Zambia, and overall objective was to assess how the logistics systems managed selected commodities at public health institutions, as well as provide a snapshot of how malaria was being diagnosed and treated at lower level facilities. This report presents the findings of the assessment as well as the short- and long-term recommendations to successfully implement the End-Use process, as well as the use of EpiSurveyor for regular data collection purposes.

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.

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.

The Health Impact Fund (HIF) is a proposal designed to incentivize pharmaceutical innovation by rewarding the development of new medicines in proportion to their health impact. The health care sector is plagued by wastage and poor governance, especially in developing countries. The MHIF system is a mobile payment and data collection system designed to enhance transparency and accountability, whilst improving the quality of data available for impact assessment. It also provides a platform for reporting misuse and abuse. The system is designed to mitigate some of the deployment challenges of the HIF and to act as a springboard for further expansion into broader mobile health (MHealth) solutions.

Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations. 

We read with interest the modeling study by Bärnighausen et al. which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA). The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients.

The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points. In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda.

This paper presents a case study of the efficiency gains resulting from the introduction of electronic technologies to monitor and support adherence to highly active antiretroviral therapy (HAART) in Guguletu, South Africa. It suggests that the rollout of HAART to such resource-poor communities can be assisted significantly by the introduction of modified cellphones (to provide home based support to people on HAART and improve the management of adherence data) and simple barcoding and scanning equipment (to manage drug supplies). The cellphones have improved the management of information, and simplified the working lives of therapeutic counsellors, thereby enabling them to spend less time on administration and to devote a constant amount of time per
patient even though their case loads have risen threefold. It has helped integrate the local-level
primary health service provision of HAART with the kind of centralised data capture and analysis
that could potentially support a national HAART rollout.

This White Paper, written by a team of researchers at the Center for Global Health and Economic Development at the Earth Institute, Columbia University, examines and synthesizes the existing mHealth literature to assess the current state of mHealth knowledge, evaluate the impact of mHealth implementations in LMICs and to examine programming, policy and research-related barriers to and gaps in mHealth scale and sustainability.

The paper is divided into two main sections. The first section reviews and summarizes the peer-reviewed literature on mHealth initiatives (focus on LMICS) to highlight trends and challenges. The second section examines the existing mHealth policy environment, barriers and gaps, and key drivers needed for an enabling policy environment.

The major thematic areas include:

• Treatment Compliance
• Data Collection and Disease Surveillance
• Health Information Systems and Point of Care Support
• Health Promotion and Disease Prevention
• Emergency Medical Response

The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.

Over four and a half billion people live in the developing world and require access to services in the financial, agricultural, business, government and healthcare sectors. Due to constraints of the existing infrastructure (power, communications, etc), it is often difficult to deliver these services to remote areas in a timely and efficient manner.

The CAM framework has found success as a flexible platform for quickly developing and deploying high-impact applications for these environments. Many of the applications built with CAM have relied on a model where a field worker with a mobile phone regularly returns from a disconnected environment to one with connectivity. In this connected state, the phone and a centralized server can exchange information and get the collected data backed up on reliable media.

We propose extending CAM’s networking model to enable continual operation in disconnected environments. Using a set of heterogeneous paths made available through social and geographic relationships naturally present among workers, we describe a system for asynchronously routing data in a best-effort manner.

Results of proof-of-concept testing for an mHealth solution for reproductive health in Uttar Pradesh, India. The text messaging tool based on FrontlineSMS, is a family planning service that relies on the Standard Day Method system of birth control. This method of birth control depends on the woman's fertility cycles to avoid pregnancy. Women can text the date of their menses and user receives their fertility status. Additionally, women can receive information about other family planning options, and support. Presented are observations on the appropriatenss of the technology from focus group discussions. The authors share the input given by target users in the product and service design. Women tested the solution to give insight on feasibility and design.

This paper provides an overview of the implications of this trend for the delivery of healthcare services and population health. In addition to addressing how mobile phones are changing the way health professionals communicate with their patients, a summary is provided of current and projected technologic capabilities of mobile phones that have the potential to render them an increasingly indispensable personal health device. Finally, the health risks of mobile phone use are addressed, as are several unresolved technical and policy-related issues unique to mobile phones. Because these issues may influence how well and how quickly mobile phones are integrated into health care, and how well they serve the needs of the entire population, they deserve the attention of both the healthcare and public health community.

A how-to guide on using and implementing RapidSMS for mobile data collection and communication.

The aim of this paper is to encourage reflection and discussion around the
potential of mHealth in developing countries and to consider how early experiences
can inform the way forward. Toward this aim, I synthesize many reviews and
presentations from the eight years I have been studying the evolution of mobile
phones and health in developing countries. I include observations and discussions
that are now shaping the creation of mHealth as a field, to highlight the ingredients
we need to move from a series of pilot projects and isolated business opportunities
to a full-scale maximization of health-related benefits.

I begin by reviewing the strategic priorities within global health, where mobile
telephony can have the greatest impact, along with organic health-related uses of
mobile phones, and examples of formal mHealth interventions. I then demonstrate
the potential for mobile phones to become an extension and an integral
component of eHealth, describing how information and communication technology
(ICT) can be used in health care, as well as mHealth, as a subset of mServices:
using mobile devices to deliver services such as banking and health. I also show
how trends and interests are converging among key stakeholders within the
mHealth ecosystem, thus forming a foundation on which we can scale up and sustain
more and better mHealth activities. Finally, I present some tactical guidance
for a way forward that will further the objectives of both public health and business,
particularly in outreach efforts to emerging markets, the bottom of the pyramid,
and the next billion mobile phone subscribers.

Baseline under five child mortality in Sauri, Kenya as of 2005 was estimated to be 148 deaths per 1000 live births. By 2008, the rate had dropped to 81 deaths per 1000 live births due to Millennium Village Project (MVP) interventions. A review of child deaths revealed that among other causes, such as malaria, acute febrile illnesses, diarrheal illnesses and HIV, malnutrition contributed to more than 50% of all child deaths. Community health workers (CHWs) led several interventions, namely community-based management of acute malnutrition, home-based testing for malaria and diarrheal illnesses and immediate dispersal of appropriate treatments.

To support these interventions, MVP ran a pilot project where CHWs were equipped with mobile phones to use SMS text messages to register patients and send in their data with the goal of improving child health and empowering community health workers. This report seeks to detail the methods used, illustrate early results and initial findings of the ChildCount mHealth platform that CHWs have now been using since early July of 2009.

Presented here is an overview of the operational needs of NGOs and CBOs and the role information systems can play to increase their accountability and efficiency. Information systems need to fit the diverse operational needs of NGOs and CBOs, which include coordinating activities, training and monitoring staff, documenting results, accounting, reporting, decision making and learning, acquiring external information and encouraging community participation.

Unfortunately, there are gaps in information systems that impede the ability of NGOs to embrace ICT. To name a few, the lack of open, accessible, cross-platform mobile development tools, limited opportunities and resources provided to local small software companies to engage with NGOs, and the lack of long distance networking technologies to reach remote locations.

Two examples of technologies that were applied successfully are shared: Self Help MIS, an application to monitor activities of small microfinance organizations and credit groups and DigitalICS, an application for data collection used by agricultural cooperatives.  The author stresses that ICTs should be viewed as a tool to allow local change agents to be more effective and accountable and shows how computing is able to support local organizations by inspiring innovation, implementation and dissemination of projects, and measuring impact.