Mobile technology has the potential to revolutionise health care in developing countries, particularly in the area of heath awareness schemes and training healthcare 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.
Mobile phone usage in developing countries is increasing, with 64% of mobile phones worldwide being used in the developing world. There are also more mobile than fixed lines.
According to the International Telecommunications Union, the continent of Africa has some 280 million total telephone subscribers, of which some 260 million (more than 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 of mobile phone usage to support health care programmes in developing countries.
Patricia Mechael, a researcher at the Millennium Village project at the Earth Institute in Columbia, has been looking at mobile health (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,” said Mechael.
She added that the biggest benefit of the mobile revolution is that it enables emergency response teams to coordinate their efforts using mobile phones.
Over the past 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 and regional, all the way up to national health organisations.
Mhealth for Development
This is a growing area of research for the health sector and non-government organisations such as 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 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, said: “The partnership has been focusing on mHeath for three years. Mobile is so ubiquitous in emerging markets, and infrastructure can more easily be deployed than fixed line infrastructure, so we are looking at how mobile communications can improve healthcare.”
She said some of the areas mobiles are being used include SMS text alerts to enable patients to adhere to their prescriptions, education programmes to improve health awareness, data collection and the training of healthcare workers.
According to 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,” she said.
“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 added that the scheme has been a huge success with uptake of over 40%. People are being encouraged through 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 with 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. It also 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 communicates with the patient’s mobile phone.
The SIMpill server is also programmed 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 in the case study 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 ’s attitude towards health issues.
Furthermore, Mechael from the Millennium 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, and 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, receiving airtime as an incentive.
Hajo van Beijma, at Text to Change, said: “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 14 February 2008 to 8 April 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, and 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 East African 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 hand-held devices. “If the cost and difficulty of collecting data are drastically reduced, data is more likely to be collected,” said the report.
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 for 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,” the report said.