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This paper examines the current use of ICTs to advance family planning, reproductive health, and other health programs, and identifies the enabling conditions for further scale-up. The examples of ICTs at work are structured around specific elements of success that were captured in the 2008 USAID-funded report, Elements of Success in Family Planning Programming: (1) building a high-performing, welltrained staff; (2) providing strong leadership; (3) communicating effectively; (4) basing decisions on evidence; and (5) assuring contraceptive security with a strong logistics system.

Examples of ICT are being applied to support or advance family planning and reproductive health programs in many African countries. Examples from Ethiopia, Kenya, Rwanda, Senegal, Tanzania, Malawi and Uganda are examined here, complemented by a review of efforts in Bangladesh and India as well as several virtual global programs. The paper also takes a look at how digital platforms and mobile technology are being integrated into the overall health systems strengthening approach. The collective review of these programs illustrates the myriad ways in which technology is adapted to respond to local needs as well as to support national health programs and global health initiatives.

Despite the strong promise demonstrated by mHealth tools and applications, the current landscape of mHealth development in developing country contexts is characterized by a proliferation of unsustainable pilot projects that often expire once initial funding is exhausted. For example, in Uganda alone there were 23 mHealth initiatives in 2008 and 2009 that did not scale up after the pilot phase. In India, there were over 30 mHealth initiatives in 2009 that did not go beyond the pilot phase.

Current policy environments, business models and funding schemes around mHealth have fueled the proliferation of pilot projects without enabling them to scale up in a meaningful, replicable way. An additional, and perhaps most significant, obstacle to improving and scaling the implementation of mHealth initiatives is the lack of monitoring and evaluation (M&E) and use of meaningful, consistent indicators and rigorous evaluation methods.

Given the obstacles within the current landscape, this white paper was commissioned by Advanced Development for Africa (ADA) to assess current implementations of successful mHealth programs in developing country contexts. The objective is to identify elements necessary for successfully scaling up, with the aim of highlighting best practices and specific programmatic, operational, policy and global strategy recommendations that can promote scale up of mHealth.

Profiled in this report are several select mHealth programs that have been piloted and are currently in the scale up phase, and have proven enough success that they should be considered as models for other initiatives to follow. As the following case studies will demonstrate, through more accurate and timely data, disease surveillance, decision support and health information management, mHealth can effectively inform policy-making and planning within healthcare systems and improve the health of local communities, particularly remote populations. The scale up of mHealth within national health agendas should be supported by all departments within the Ministry of Health and across other relevant ministries and agencies including Telecommunications. Both internal stakeholders, such as end-users and beneficiaries, and external stakeholders, such as mobile network operators and donors, should be engaged in the planning and business model design and scalability assessments. The primary goal of this white paper is to provide evidence and recommendations that will allow mHealth initiatives to better plan their own scale up beyond successful pilot phases.

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. 

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.

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. 

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.

‘Aarogyam’ is a Sanskrit word which means "complete freedom from illness”. Aarogyam is an ICT based responsive system which ensures and involves active participation of all key stakeholders viz. local administration, health facilities and doctors, frontline health workers (ASHA (Accredited Social Health Activists), ANM (Auxiliary Nurse Midwife), and AWW (Angan Wadi Workers)), village heads and beneficiaries, to ensure that a pregnant woman is provided with ANC, PNC and complete immunization throughout the continuum of care.   Aarogyam maintains a village wise database of all the beneficiaries (pregnant/lactating women, children up to 5 years) of an area, which gets continually updated with new data generating on the field with the help of front line health workers. The database thus generated is the backbone of the software system used by Aarogyam. This system generates automated alerts in the form of vernacular voice calls/SMS to the beneficiary thus enabling the beneficiary with vital information at their door step.   The system not only provides beneficiary with the information to be acted upon but also ensures that the services are delivered to the beneficiary by generating automated alerts (vernacular voice calls/SMS) for the ANM and Block level health officials, informing them of due services in their area.  

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.

Access to basic health  service is limited in rural areas of Bangladesh, where 80% of the total population lives. For instance, 35% of doctors and 30% of nurses are located in four metropolitan districts where only 14.5% of the population lives. Most of the rural people are physically remote from the qualified health care providers. Two major mobile phone service providers in Bangladesh have initiated mobile health care help line service s nationwide as a remedy in this case. Since there is much hope of mobile phones to be used for basic health care services for populations living in rural areas, this research aims to evaluate how far such interventions reached  for the improvement of health care in those communities. Through an interpretive case-based research strategy, our field studies uncover enthusiasm from the rural people towards availing health help line services and the intervention's contribution to improved health-seeking behavior.

Claim Mobile is a platform designed to support a project that subsidizes healthcare by reimbursing health service providers in Uganda for treatment of patients with sexually transmitted infections. As with many development projects, the Uganda Output-Based Aid (OBA) project involves a number of stakeholders: the service providers, the project implementers,the financiers, and the Ugandan government. Design of an appropriate solution requires meeting the various and conflicting requirements of all of these stakeholders. In this paper we detail the rapid design and testing of a pilot implementation of a mobile and web-based system for processing claims forms, based on two prior field visits to Uganda. Based on a comparative device study, semi-structured interviews, health clinic surveys, and a brief deployment, we affirm the selection of the mobile phone as a platform from the health clinic perspective, and further suggest that effective design for development requires more than addressing requirements of the the “users” of the mobile phones but also all the other stakeholders involved, who may have conflicting requirements.

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 Freedom from Fistula Foundation (FFF) in Kenya and Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) have taken great strides in reducing these barriers. Using a combination of mobile banking, public information, and free treatment, they have helped make fistula repair a reality for women who were previously excluded from care.

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.

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?

Still in its infancy, mHealth, the use of mobile technologies for health, runs the risk of not realizing its full potential due to small-scale implementations and pilot projects with limited reach. To help shed light on these issues, the mHealth Alliance commissioned an in-depth exploration of the policy barriers and research gaps facing mHealth. 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.

As illustrated throughout the literature, the current single-solution focus of mHealth needs to be replaced by using mHealth as an extension and integrator of underlying health information systems along the continuum of care. Creating a strong collaborative foundation will be instrumental in driving and positioning public and private investment in mHealth in a way that contributes to achieving improved access to health information and services, health outcomes, and efficiencies.

Within such structured paradigms, planning for infrastructure investment and human resources capacity strengthening and identifying public and private stakeholders within the ecosystem to take leadership for the development, testing, implementation, and evaluation of mHealth activities can be appropriately mapped and planned and mHealth services more effectively extended to support the health of citizens and the work of health professionals and administrators.

The Millennium Villages Project (MVP) is a community-based comprehensive multi-sectoral approach to achieving the Millennium Development Goals (MDGs) in Africa over a five-year period. MVP and Ericsson’s Consumer Lab collaborated to investigate the baseline conditions for enhanced connectivity and integrating mobile telephony in MVP sites. It is hypothesized that this will accelerate the achievement of the MDGs through improved communication and availability of information. Using quantitative and qualitative methods, the research team aimed to assess the effects of network strengthening and strategic integration in the context of a rural village in a low-income African country.

Four Millennium Village sites were examined for this study on connectivity: Bonsaaso, Ghana; Dertu, Kenya; Ikaram, Nigeria; and Mbola, Tanzania. The survey results from the sites showed common attributes for mobile phone owners but usage trends differed across study sites. Given the results, in three of the four sites, there is a significant market to be explored for voice services to be strengthened and made more easily available in terms of infrastructure and costs. Lessons drawn from these sites can provide us with useful insights into the potential for development and use of mobile phones in the rest of the continent, in addition to providing useful policy implications.