Mobile technology has the potential to
revolutionise health care in developing countries,
particularly in the area of heath awareness schemes and training
health care professionals. Mobile phones are generally affordable
and available to the population at large, making them more
accessible than computers and far more cost-effective than hospital
beds.
Widespread mobile
resource
mHealth for
Development
SMS to
encourage medication
Case study:
Text to Change
Case study:
EpiSurveyor
Widespread mobile resource
Mobile phone usage in developing countries is increasing. 64% of
mobile phones are being used in the developing world. There are
more mobile than fixed lines. According to the International
Telecommunications Union, the continent of Africahas some 280
million total telephone subscribers, of which some 260 million
(over 85%) are mobile cellular subscribers. As such it represents
the continent with the highest ratio of mobile to total telephone
subscribers of any region in the world.
The question is how to tap into this explosion ofmobile phone
usage to support health care programmes in developing
countries.
Patricia Mechael, a researcher at the
Millenium
Village project at the Earth Institute in Columbia, has been
looking at mHealth since 2001, as part of a research project at the
London School of Hygiene. "People are using mobile health whenever
they call their mothers for advice or use Google to find health
related information." She says the biggest benefit of the mobile
revolutionhas been that it enables emergency response teams to
co-ordinate their efforts using mobile phones. Over the last few
years, mobile technology has allowed health professionals to gather
large amounts of information from the public in real time,
replacing paperwork that would have previously been passed up from
local, district, regional up to national health organisations.
mHealth for Development
This is a growing area of research for the health sector and
non-government organisations like the United Nations Foundation,
which is collaborating with Vodafone Foundation and Rockefeller
Foundation. In July 2008 the UN Foundation and Vodafone technology
partnership held a week-long workshop during a Rockefeller
Foundation eHealth event, which brought together 25 experts in the
use of mobile technology for health care. The three organisations
have now combined forces to create the mHealth for Development
programme, which was unveiled at
GSM MobileWorld Congress.
The group has been set up to help promote best practices in
using mobile technology to support healthcare programmes in
developing nations.
Claire Thwaites,
head of Vodafone Foundation and United Nations Foundation
Partnership, says: "The partnership has been focusing on mHeath for
three years. Mobile is so ubiquitous in emerging markets.
Infrastructure can more easily be deployed than fixed line
infrastructure. We are looking at how mobile communications can
improve health care." She says some of the areas mobiles are being
used include SMS text alerts to enable patients adhere to their
prescriptions, education programmes to improve health awareness,
data collection and training of health care workers.
According to Claire Thwaites, educational awareness can be
improved by using SMS messages to disseminate information. "SMS is
a relatively simple application. A group called Text to Change
operating in Uganda sends SMS text to the population to improve
awareness of HIV Aids treatment and prevention. We have seen that
encouraging the population to participate in a quiz is raising
awareness of the disease and how to prevent it. We are actually
seeing a 40% increase in those going in for HIV tests."
She says the scheme has been a huge success with uptake of over
40%. People are being encouragedthrough free air time from the
mobile provider involved in the project.
SMS to encourage medication
SIMpill is another example of SMS, being used to help combat
diseases. This time it is about making sure people take their
medication. It was used during a 2007 trial in South Africa to
ensure people took their medication for TB. In the pilot, 90% of
patients complied with their TB medication compared to 22% to 60%
take-up without it.
Developed by David Green, a South African GP,SIMpill uses a
prescription bottle with an embedded mobile phone chip. Basically,
it is a pill bottle that uses mobile phone technology to remind
people on medication to take their pills on time. Italso warns the
patient if they are about to take too much.
The system works in two parts. The patient's pill-taking
schedule is programmed into a tamper-proof pill bottle which
communicate with the patient's mobile phone. The SIMpill server is
alsoprogrammed with the patient's medication schedule and
communicates with the patient's SIMpill dispenser in which their
medication is kept. The server monitors the patient medication
schedule against the times when the patient opens the dispenser and
initiates, in real time, the programmed responses as detailed
below.
If the patient takes their medication as prescribed, no
communication is made and the "medication event" is stored in the
database. If the patient does not take their medication as
prescribed, then, after a set deviation period, the patient is sent
a reminder to take their medication.
It looks like mHealth will revolutionise healthcare in
developing counties by allowing medical staff to survey the
population, train staff in the field and use SMS marketing to
change the population's attitudetowards health issues. Furthermore,
Mechael from the Millenium Village project believes mobile health
is moving from informal to more formal use.Thanks to the huge
amount of interest from the mobile telecommunications industry, it
seems that mHealth is now being deployed far wider than was
possible previously.
Case study:Text to Change
Text to Change, the Dutch non-profit organisation, is an example
of how a simple application can make a big difference. It runs a
series of four-week education programmes using SMS messaging. Each
programme starts with an announcement SMS message to target a group
of mobile users in a given region, which encourages them to opt
into a questionnaire. Participants are then sent multiple choice
quiz questions as SMS messages. They receive airtime as an
incentive. Hajo van Beijma at Text to Change, says, "We increase
their knowledge, gather data about their current knowledge on
HIV/AIDS and stimulate them to go for HIV testing."
Text to Change ran a pilot in Mbarara, Uganda to test this
initiative in February 2008. From February 14th 2008 until April
8th 2008 there were 15,000 Celtel (now ZAIN) mobile phone users
targeted in the Greater Mbarara region. The duration of the
programme was 8 weeks. During this time 2,610 (17.4%) people
responded to one or more SMS question.
The current Ugandan programmes have to be scaled up to a
nationwide programme. Expansion to other EastAfrican countries is
expected to start from mid-2009. Text to Change is part of the Open
Mobile Consortium. The group pans to redevelop its SMS software to
make in open source this year.
Case study EpiSurveyor
EpiSurveyor is an open source field survey tool made by
DataDyne, designed to help healthcare professionals gather
information from the population to curb the spread of epidemics.
With backing from the United Nations Foundation, Vodafone
Foundation and the World Health Organisation, EpiSurveyor has been
deployed in 20 countries in sub-Sarharan Africa and Kenya, Uganda
and Zambia. It is regarded as a shining example of mHealth in
action.
Health workers need to run surveys and collect health data to
run immunisation programmes, such as the programme to provide
immunisation against measles. The software, which runs on Palm
handheld computers, allows healthcare workers to gather information
from the population. This information is uploaded onto a central
database.
According to a
report by the World Bank, The DataDyne EpiSurveyor project is
lowering the barriers to collecting high-quality data by creating
inexpensive, easy-to-use software for data collection on handhelds.
"If the cost and difficulty of collecting data are drastically
reduced, data is more likely to be collected."
The World Bank also believes the creation of a public domain,
common-data collection platform will have other, far-reaching
effects. For instance it believes the digitally collecting data
will allow more and faster analysis. "Because the data collected
with EpiSurveyor will be digital from the moment of collection and
because digital data is much easier to analyse, we believe that
analysis is much more likely to be done, and done promptly, without
having to wait months for data entry."