Health workers at Tivaouane district hospital, Senegal PHOTO: AFP/GETTY IMAGES/mHEALTH ALLIANCE
Healthcare at the touch of a button
Published: 01 October, 2009
The use of mobile telecommunications technology to tackle sub-Saharan Africa’s healthcare challenges has attracted much interest. But can mobile technology actually fill the gap left by underdeveloped healthcare systems? Lanre Akinola reports
One of the most striking developments to take place on the African continent in recent years has been the mobile telecommunications revolution. From a virtual standing start, the continent now has 300 million mobile phone subscribers, with the penetration rate fast approaching 30 percent.
This growth is opening new possibilities to address the developmental challenges of the region, including the nascent mobile healthcare industry. Various “mHealth” initiatives seek to apply mobile technology to what is arguably one of the continent’s biggest challenges; the widespread underdevelopment of healthcare systems. 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.
However, most mHealth projects are currently small in scale, and fragmentation has put a brake on the expansion of mobile healthcare solutions. In addition, leapfrogging the infrastructure gap in the healthcare sector may prove more of a challenge, and a lack of quantifiable evidence to support the effectiveness of mHealth has led some to question the actual impact it can have.
One of the organisations at the forefront of the mobile healthcare debate is the partnership between the Vodafone Foundation and the UN Foundation, formed in 2004. In 2009 it published one of the first major reports on the field of mHealth, detailing the areas in which mobile technology can address deficiencies in developing world healthcare markets, such as sub-Saharan Africa. The report lists six main areas in which mobile telecommunications can address healthcare challenges, focusing on remote data collection and patient monitoring, as well as disease tracking, education and awareness and healthcare worker training. The emphasis on all points is the ability of mobile telecommunications to overcome geographical and infrastructural obstacles.
“There is still so much paper-based health data collection,” says Claire Thwaites, head of the partnership. “That paper takes so long to get to the national ministry, be analysed, and then you are months away from responding to an epidemic on the ground. For the first time you are seeing data being collected on mobile phones and wireless devices, and that data being analysed virtually in real-time.”
The report goes on to profile 51 different projects. There are mostly small-scale and fragmented pilot initiatives and Ms Thwaites argues that “the key to success here is scaling up and sustainability for these projects and programmes.”
In order to do this, Vodafone and the UN officially launched the mHealth Alliance, together with the Rockefeller Foundation, at the Mobile World Congress in Barcelona in February 2009. The objective of the alliance is to reduce the level of fragmentation in the mHealth field through more extensive research, as well as building partnerships between different stakeholders to scale-up selected programmes.
Major technology firms such as Google are also interested in the field of mHealth and e-health. Last year, the firm launched Google Health in the US market, an online tool that enables individuals to store their medical records in a digital database, and in June 2009 the company launched a mobile information service in Uganda. While it provides subscribers with information on health-related issues, it is not specifically an mHealth solution: it also provides information on weather patterns and agriculture.Explaining the reasons for this, Joe Mucheru, the head of Google’s sub-Saharan African operations, highlights the difficulties of mobile technology in overcoming physical infrastructure constraints. “There are infrastructure issues of roads, how to get to hospitals or clinics. There are so many issues right now that need to be sorted out in the healthcare space. In terms of priorities we need to make sure that people have basic connectivity to be able to start accessing this data, or uploading this data.”
Bright Simons, chief strategist of Mpedigree, an mHealth initiative that aims to tackle the major issue of counterfeit drugs, is critical of what he says is an inadequate approach by many mobile healthcare initiatives on the continent. “Most of the mobile health strategies we have seen so far assume that by taking away the physical infrastructure problem, they solve the constraints. The problem though is that more often than not they create additional social infrastructure problems. Issues of illiteracy, consumer behaviour and other factors are not properly dealt with,” he says.
“The major problem that I see is that they try to introduce a technology in a social setting that is not prepared for it.” This, he argues, accounts for the lack of scale in mobile healthcare projects.
MHealth models must be compatible with the way in which people use mobile technology in a given country or region, thus creating an instant familiarity with the consumer, he adds.
The idea of Mpedigree is to replicate the top-up card model, whereby subscribers send a text message to their operator, which then sends one in return informing the subscriber of their balance. Applied to pharmaceuticals, the idea is to label drugs with an identification code contained under a scratch panel on the packaging. This code is validated by a central database, with the consumer recieving a text message confirming the product’s authenticity.Mpedigree is currently piloting this initiative in Ghana, Nigeria and Rwanda, where it is awaiting government legislation to make it a mandatory requirement for all pharmaceuticals deemed to be at risk of counterfeiting to carry a verification code. The project has caught the attention of CIPI, a large pharmaceutical trade association in India, explains Mr Simons, which has agreed a partnership with Mpedigree.
Despite the intuitive appeal of the ability of mobile telecommunication to overcome traditional infrastructure barriers, the success of mHealth will ultimately depend on its ability to actually bring about a significant improvement in healthcare delivery capacity. While there are examples of situations where the application of mHealth ideas have had a beneficiary effect, demonstrable evidence that mHealth consistently leads to improved healthcare delivery is less forthcoming.
Dr Peter Benjamin of Cell-Life, a South Africa based mHealth initiative focused on providing support to HIV infected people, argues that a cautious approach should be taken towards mHealth until such evidence is available. He does acknowledge that mHealth has the potential to fundamentally change the dynamics of the healthcare market, in the same way the internet has revolutionised the retail and business-to-business markets. However, he adds that “it is also currently much more hype than reality.”
“The people who are getting excited about mHealth aren’t the medical profession. It is overwhelmingly NGOs, researchers, or donors around health, and the mobile companies,” he says. The reason for this, he argues, is a lack of clear evidence that demonstrates the practical and monetary benefits of mobile healthcare. “At the different mobile conferences I have been to, there is lots of hype, but almost no relevant evidence that proves it is useful, let alone does a cost benefit analysis.”
Mobile technology can complement healthcare systems by facilitating better internal communications, or through the digitisation of records, he suggests, but until pilot projects – run by the medical profession and not donor agencies or NGOs – can demonstrate an impact, the case for the expansion of mHealth services remains weak, he says. “While the project is being led by the consultants’ papers and conferences, be wary of it. There are no mHealth applications that I would genuinely advise any department of health to put to scale,” he says.
“We have not proven that any of this stuff is worth the money… I am actually quite nervous that a lot of money will go into unproven, wide scale projects rather than literally life-saving drugs.”
