Health – Integra LLC

Where to Turn When Researching: A Database for Innovative Global Health Initiatives

Photo Credit: Results for Development Institute

While working on a mhealth project that expanded across three countries, I was tasked with researching both the public health and mobile sectors in each country. Having worked on a number of strategic plans to implement mhealth, I knew what technology was being used in the field and the challenges that mobile technology can solve. But I had less knowledge about the public health challenges and the innovative, non-mobile health projects in these nations. In need to fully understand these two areas, I came upon the Center for Health Market Innovations (CHMI) website. CHMI has an extensive and straightforward database to research the numerous innovations going on in developing countries. I was able to customize my search and focus on the three nations as well as the health focus (ie maternal and child health, HIV/AIDS, chronic diseases, etc) and its technology (ie mobiles, GPS, radio, etc). It gave me knowledge of the specific health challenges in those nations as well as how mobile technology could be leveraged in existing programs and policies.

About CHMI

The origins of CHMI were born out of a study in 2008-2009 entitled “The Role of the Private Sector in Health Systems.” It focused on further understanding how the private sector participated in the health care sector in the developing world. CHMI was created as a continuation of the initial research through funding from the Gates Foundation and the Rockefeller Foundation. The goal was to expand on the research in order to support the advancement of health markets. CHMI’s role is to identify and analyze programs and policies that improve private sector health care delivery and financing for the poor. These include mHealth programs, health franchises, health savings programs, consumer education programs, and many more. By developing this database, governments, NGOs, and social entrepreneurs can include their own innovative health programs as well as search for others. To date, there have been 978 completed programs with 117 still in the pipeline, all across 104 countries. As mentioned above, the database allows users to customize their search based on the categories below:

Profile Status (completed or not)
Program Type (type of innovation)
Health Focus
Country
Target Population
Legal Status (private, nonprofit, government, etc)
Target Geography
Reported Results
Source of Funding
Technology Used

Along with researching innovative programs, the database allows users to connect directly with organizations running these programs and provides content about new programs and update others already in it. It is also downloadable so users can play with the data for their research. The ability to discover and develop profiles of the programs has been primarily done by both partner organizations and CHMI staff. But recently third parties with no CHMI affiliation, such as researchers or program managers, have also submitted profiles. By having a community approach, the database has the most up-to-date information and data. CHMI also takes responsibility to verify information with the organizations on the ground when possible. If this is not possible, the CHMI staff tries to be as transparent with this knowledge. This includes rating the quality of the information source. Here is how they break it down:

High: Interview with high-level employee of the organization and/or a site visit.
Medium: High-quality website or contact with a high level employee of the organization, trusted secondary source (e.g., a report published by a collaborating organization)
Low: Secondary online sources or other publicly available resources

In the end, CHMI wants to increase the information available about recent health innovations, assist donors/investors in identifying new models to fund, give policymakers greater knowledge about designing health policies, connect implementers in order to share lessons and knowledge, and provide data and impact evaluations submitted by partners or third parties.

With information about innovations in development (mostly around mobile technology) spread throughout the internet, CHMI has taken the reigns to promote and show the ground-breaking health market innovations. The partnership approach and focus on gathering the most accurate information gives the CHMI an extensive and trustworthy database of knowledge for practitioners, policy makers, and donors to learn the most innovative approaches.

If you have any questions or would like to include an innovative health program in the database, please contact CHMI at chmi@resultsfordevelopment.org.

April 23, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Alerta MINSA: The First mHealth Project in Latin America

Photo Credit: rcrwireless.com

In the news and blogosphere on ICT4D, there is a heavy focus on Sub-Saharan Africa, mostly because mobile phones have exploded across the continent. But we have missed many of the innovations that are going on in Latin American and the Caribbean. In an effort to reach back to the history of mHealth, I was able to connect with one of the first individuals to work in mhealth, even before the term mhealth had been coined – Ernesto Gozzer, currently working as a Researcher and STC with the World Health Organization and is an Associate Professor at Universidad Peruana Cayetano Heredia.

While he could not confirm that the project was the first in the world, Alerta MINSA was the first in Latin America. Originally launched on February 6^th, 2001 in the Cañete Town Hall Auditorium (in the southern part of Lima), Ernesto admitted they had no idea they were pioneering mhealth. “We thought we were helping to improve the health information systems for critical health issues. The aim was using available technology to connect the unconnected, to help to reduce the digital divide.”

Alerta MINSA stands for Alert Ministry of Health and was initially funded by InfoDev. The tool allowed for disease surveillance to send via text messages and through the internet. The information is then consolidated in a database. Alerts can then be sent when thresholds have been surpassed as well as automated reports and compiling data in tables, graphs, and maps in dashboards. Currently Alerta is the “official disease surveillance system” of the Peruvian Air Force, Navy, and Army. It also has been used in other countries including Ecuador, Panama, Tanzania, Rwanda, Colombia, and Paraguay.

My favorite idea that Ernesto talked about was the following: “So, this was not a pilot but what I call a local innovation that expanded beyond borders.” I love this quote because an innovative solution was created to solve a specific problem using mobile phones. Instead of it being the sexy thing to do, it was done out of necessity. The developers use the power of mobile phones to provide a solution to a problem. This is an important lesson that has been mentioned before in the mhealth space. Start with the problem first and then develop a solution around it. This is as true today as it was 11 years ago.

April 14, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

More Randomized Controlled Trials in mHealth Please!

mHealth is by no means the magic bullet (I believe there is no magic in international development; every situation is so different and complex for one solution). But it could help to improve the public health workforce or women’s health in developing countries. In order to determine this, there needs to be further field research. And it needs to focus around the true impact of the intervention. While the social sciences are imperfect and it is very difficult to know an intervention’s true impact (meaning if the mobile device is removed, how different would the outcome be), there is a best practice to assess the true impact – Randomized Controlled Trails.

There are multiple examples of projects providing “evidence,” but they tend to only show who has been reached (reproductive health information was received by 20,000 mothers). We need further evidence to show that mobile phones and/or their content are creating the sought behavior change. mHealth could be like microfinance where there has been a lack of evidence showing the impact of it on families. But, knowing this, microfinance is still essential for the bottom of the pyramid to access necessary formal financial services (savings/insurance/credit). In the same light, mhealth tools help fill in gaps (ie sending information via text message instead of walking it in paper form). But does it really make a community health worker (CHW) more effective and efficient at their jobs? It will give women and families reproductive health information. But does it improve ART intake or change a women’s behavior? These are the questions that must be answered in order to know the true impact of mhealth applications.

To the benefit of the sector, RCTs have and are being conducted. At the ICTD 2012 Conference in Atlanta a few weeks ago, Brian DeRenzi, who completed his Ph D at University of Washington in the department of Computer Science and Engineering, presented his paper entitled “Improving Community Health Worker Performance Through Automated SMS.” As the title indicates, the focus of his research was testing the impact of reminders via SMS to CHW’s follow up visits to their patients. The study was conducted in Tanzania and in collaboration with D-Tree International, Pathfinder International, and Dimagi. It included one pilot project and two larger studies. In the end, the reminders reduced the average number of days between follow up visits to patients by CHWs. This is a clear benefit to helping improve the care provided to patients. But the study also provided further knowledge into issues with patient reminders to CHWs. This included the benefit of having the supervisor of the CHWs receive a SMS reminder if their employee did not conduct a follow up visit. When the supervisor was taken out of the equation, the performance of CHWs decreased considerably. This is an important design aspect to the program that could have been missed without a RCT. By testing the removal of the supervisor, it showed that the mobile phones helped but combining it with the supervisor’s real time knowledge of their work provided greater incentive to the CHWs to follow up with greater regularity with their patients.

Another example of an RCT currently in progress is in Ethiopia. In a very similar study, Kate Otto, from the World Bank, is working in collaboration with Addis Ababa University to test the impact of mhealth interventions on the care provided by Health Extension Workers (HEWs) in rural areas to women and child (In Ethiopia, the HEWs are equivalent to CHWs in Tanzania). The research question is “does the use of a mobile phone-based tool enabling patient registration, appointment reminders, and inventory management – in the hands of Health Extension Workers – result in improved maternal and child health outcomes in a rural Ethiopian setting?” The goal is to find evidence supporting the use of mhealth interventions with HEWs.

Since these RCTs seem very similar, it would be easy to say that the World Bank and Addis Ababa University should have simply copied the intervention and implementation of the best practices learned in Tanzania. But this is the power of RCTs. Since each region is different with varying degrees of complexity, solutions that work in one area will not produce the same outcomes in another. Just because a program and intervention worked one place does not mean the same model or theory will work in another setting (see m-Pesa). The benefit of RCTs is that it will assist in finding interventions that will provide a solution for the region/country. This is especially necessary in the mhealth sector as the complexity of each situation dictates the need for specific program requires. But we are not sure what those are. The benefit of RCTs is that it can remove these variables and focus directly on the how and why interventions work or not, especially in behavior change. And as shown in Tanzania, it helps us understand what is and provides insight into areas of improvements.

Funding is always going to be an issue with RCTs. But the knowledge gained makes up for the investment by further understanding the true impact (if any) of the device. In the end, we need to find answers to what changes behavior, especially the role of mhealth in the change. There has been a greater increase in RCTs in mHealth projects to test how mobile phones and their applications are improving health. But there needs to be more done.

For those interested in learning more about M+E in global health programs, there will be a panel through GHDonline.org at the beginning of April. Please find further information about the panel here.

April 3, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Opening the Discussion of Data Privacy in mHealth

Photo Credit: Technorati.com

During New America’s Mobile Disconnect talk on February 9th, Katrin Verclas, Co-Founder and Editor of MobileActive.org, brought up an interesting question about data privacy in mhealth – what is being done to protect patient data in mhealth projects in developing countries?

“If you are gathering sensitive health data over completely clear text and insecure SMS, somebody’s HIV status, sensitive information protected by HIPAA standards in this country, completely unregulated by development organizations, they don’t self-regulate. Countries certainly don’t have any privacy or data protection stipulations…If we are talking about mobile telephony and mobile phones in development, we need to talk about how we protect the data that we are gathering, the information that we are distributing…”

Data privacy is an important, yet undiscussed topic. As Katrin mentioned, an individual’s health information is extremely personal, especially because it can be used against the person to make them a social outcast. But there is little talked about how patient information is being protected, especially the structure and framework of data protection on a large scale. As mentioned in the white paper “Barrier and Gaps Affecting mHealth in Low and Middle Income Countries” by the Earth Institute at Columbia University, many mhealth studies expressed the need for data protection and some measures were taken. But further security steps need to be taken as projects scale into national programs.

First, security is a tough question to answer in any setting. In the U.S., there are strict laws that require health information to be protected (HIPAA). Corporations holding patient health information must internally regulate how this information is being stored and transmitted in order to avoid penalties (both monetary and brand loss) if data is lost or there is a security breach. Along with setting user policies to further protect this sensitive data, corporations also leverage security software to protect against internal and external data lost. This includes protection against network attacks or unprotected lost/stolen devices. In these cases, the companies not only spend money on security measures but also employ a team solely focused on security. Chief Information Security Officer is vastly becoming an important and necessary role with large enterprises.

But the reason for all these security measures is the value individuals and families put on the privacy of their health information. Similarly to people protecting information about their finances, people want to keep their personal and family health information private. With the stigma of specific diseases or the unknown of the future as testing, diagnosis, and treatment is occurring, individuals and families want to have the power to inform others when they are ready. Do individuals and families in other countries place the same value on their health information? My guess is very much so.

But, as Katrin mentioned, many of the countries using mobile phones for data transmission do not have strict data privacy laws to regulate how patient data is protected. This leads to a lack for incentive for development organizations to create their own data protection policies which includes user policies and technology solutions to protect the storage and transmission of patient information. The GSMA recently began a movement to support data privacy on mobile devices. This includes providing principles, guidelines and resources in order to tackle the new challenges of data protection on global mobile networks. The International Telecommunication Union (ITU) and infoDev have created the ICT Regulation Toolkit to provide insight and best practices for policy-makers, government regulators and the telecommunication sector to implement telecom policies. There is a section directly focused on Data Protection and Privacy Laws. While these are steps forward, they are more generally focused on the over telecom industry. There needs to be a greater focus on the mhealth sector as it continues to grow.

Some organizations have included data privacy in mhealth projects. eMOCHA, developed by Johns Hopkins Center for Clinical Global Health Education, is a program for Android smartphones that stores and transmits data. Included in the program is security on both the endpoint device (the smartphone) and the servers. The servers that store the data are encrypted to protect against internal leaks. The smartphones also utilized encryption to send messages. They also are password protected in order to prevent data access if the phone is lost or stolen. Dimagi has also used technology to protect both internal and external leaks. This includes individual logon passwords and full data encryption on handsets and full server database encryption and auditing of who has logged into the database. It would be great to hear from other mhealth developers to see what they are doing to protect data. As is the case with the open dialogue of discussing best practices implementing and scaling programs in the mhealth community, it would be beneficial to the sector to share advice on data privacy.

MobileActive has been focusing on data security lately with the release of their SaferMobile website. It has helped to open the discussion and provides knowledge and advice to activists, human rights defenders and journalists to better protect their mobile privacy in their jobs. Those in the mhealth community should piggyback on their work. The discussion of data protection has been brought up before, but it is time to have it on the forefront of developers and implementers minds working on mhealth projects in developing countries. The goal is to understand all issues of data privacy (from the regulatory, technological and social aspects) and how we can make sure to always be aware of the patient’s right to privacy. It will be interesting area to continue to follow, and I hope this at least opens the door to a more in depth discussion on the topic.

March 28, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Two Guides You Must Read Before Using Mobile Technology for Behavior Change

Photo Credit: Larissa Frei

As the desire to utilize mobile phones in international health projects has increased in the last few years, organizations continually ask a similar question, “We want to use mobile phones. Now what?” But the decision to introduce or start a mhealth project needs to come after answering many questions before “now what?” especially when dealing with behavior change communication projects. Enter Abt Associates, FrontlineSMS, and Text to Change. Two guides have recently been released to help organizations assess whether or not mobiles are the right tool, and if they are, the process moving forward. One is from Abt Associates and is entitled mBCC Field Guide: A Resource for Developing Mobile Behavior Change Communication Programs. The other one was created in collaboration between FrontlineSMS and Text to Change and is entitled Communications for change: How to use text messaging as an effective behavior change campaigning tool.

mHealth is a sexy term these days but it is not always the best approach to creating behavior change. Simply using mobile devices will not instantly make your project/program better. But when designed and implemented with the end user in mind, they can be a cheaper and more direct tool to pass information along in order to change behaviors.

Reason for the Guides

Abt and FrontlineSMS/Text to Change saw the need to have a guide that can lead practitioners through the necessary steps in order to see if and how a mobile solution could be used in the field. Each guide clearly shows the need to analyze on how a mobile intervention would fit into a program. They both do a great job pointing out that every situation is different and that a mhealth intervention must fit into the context and infrastructure of the region. But they are structured in very different ways and have noticeably different lengths (50 pages vs 7 pages). The Frontline/Text to Change guide is structured more like a checklist and mostly focused on text message interventions. The mBCC guide is longer and walks the reader thoroughly through the assessment process. But the guides show how to strategically think about behavior change communication projects.

The mBCC Field Guide

Abt Associates broke down the guide into 6 chapters with each chapter focusing on a specific topic. Each chapter lays out the necessary research and design that must be conducted in order to successfully utilize mobiles for behavior change. The chapters are in order of how one should follow the process (even though you can pick and choose chapters if you have already completed a chapter before reading). The chapters include Situation Analysis, Audience Segmentation, Behavior Change Objectives, Message Development, Tools & Technologies, and Monitoring and Evaluation. Each chapter also includes tools in the form of Excel templates that can be utilized to complete the assessment discussed in the chapter. With a high level of detail along with the structured worksheets, this guide is designed for those who are new to mhealth and are seeking a step-by-step walk through from the start.

Frontline/Text to Change

As mentioned before, the FrontlineSMS and Text to Change guide is more of a checklist of things to research and discuss before designing and implementing a mobile-based behavior change project. With a DOs and DON’Ts list, it covers context, content, developing campaigns, and monitoring and evaluation. This skeleton format is a quick read and is probably better suited for an organization that either has worked with mobile devices before or is somewhat knowledgeable about mhealth.

Both are very useful guides for the intended audiences. With mhealth still only mostly being used in pilot projects, we need to find answers to what changes behavior. The greater number of projects that use mobile devices for behavior change communication (when they are deemed most appropriate) means more data and evidence will be produced in order to show the true impact of mobile devices. These guides give the necessary direction to organizations to start leveraging mobile devices in health projects and discover what does and does not work along with why, which is the most important question of all.

As an ending note, the mBCC Field Guide was presented by Gael O’Sullivan, Stephen Rahaim, and Shalu Umapathy from Abt Associates during the latest mHealth Working Group meeting. They explained that the guide needed to be a “living document,” and they requested feedback about it from mhealth practitioners, especially those in the field. Please visit their website (http://www.mbccfieldguide.com/) in order to provide any feedback. To provide feedback to FrontlineSMS and Text to Change, please find used the contact information here and here.

March 21, 2012/by actualize

Agriculture, Health, Mobile Money, Originally posted on the GBI Portal

The Intersection of mHealth and mFinance: A mHealth Alliance Report

Photo Credit: mHealth Alliance

The mHealth Alliance recently released their second white paper on the interconnection between mobile health and mobile finance services. Entitled “Advancing the Dialogue on Mobile Finance and Mobile Health: Country Case Studies” and co-authored by Menekse Gencer, Founder of mPay Connect, and Jody Ranck, the report focused on four separate countries with varying degrees of intersection between mHealth and mFinance – Ghana, Haiti, Kenya, and the Philippines.

The report was commissioned in order to further explore how business models in the mHealth sector have leveraged mobile financial services (MFS) to improve the access and reach of health care in developing countries. The objectives included identifying new use cases that have shown promise at strengthening health systems, showing the characteristics in markets that have allowed MFS to improve the health care system, and recognizing the trends and challenges in how MFS can be implemented into mHealth projects. The goal is to continue to open the eyes of health providers, NGOs, MNOs, and government health agencies in developing countries to the ways that MFS can increase the care provided to the poor.

Benefits of Using MFS in Health Care

The authors make the argument in the report that mHealth can be assisted by MFS along the entire continuum of care (pre-pregnancy, pregnancy, birth, and postnatal) at multiple levels – patient, provider and administrative. Its uses at the patient level include all aspects of formal financial services (savings, insurance, and credit) to help smooth consumption as well as mobile money transfers to pay for medical services or transportation via cash. For providers, MFS allows for quicker remote payments to occur for health services and products along the supply chain and settlement of patient vouchers. Finally, at the administrative level, mobile payments allow remote and unbanked health workers to receive their salaries and reimbursements as well as for families to receive conditional cash transfers.

Countries

The countries selected have a diverse infrastructure in the MFS market and drivers from the private or public sectors, but the authors discovered three trends in each country:

1. A significant health concern that needed to be met

2. MFS had already launched in the markets

3. Either the business model, the quality of the services, or the accessibility of critical healthcare services was suboptimal without the use of MFS.

In Ghana, insurance has been pushed by the government. In a partnership with two MNOs (MTN and Tigo), Microensure has provided customers on the networks with life insurance. The drivers for this service included the need for assistance in covering funeral costs, the lack of a public option for life insurance, and consumer demand of insurance products which was caused by the government’s push to educate its citizens on health.

In Haiti, the driver of MFS in mHealth was the effect of the earthquake in 2010. After grants were provided to MNOs to develop mobile money services after the earthquake, the MNOs saw an opportunity to expand their services into mHealth with the cholera outbreak. This includes utilizing MFS to dispense medical supplies to stop the spread of the disease across the country.

The Philippines is the first country to heavily adopt MFS, and now they are leveraging the large adoption rate to provide health services. The government is now supporting the use of mHealth to reduce maternal and neonatal mortality rates through the well-developed MFS infrastructure. This includes payment for health products and vouchers for health services.

Finally, Kenya has utilized M-Pesa to pay for medical services and transportation at the patient level, payments for remote diagnostics at the provider level, and dispensing of conditional cash transfers and salary payments at the administrative level. M-Pesa was the driver along with Universal Health Care (UHC) in Kenya.

Key Challenges and Future Trends

The authors noted that there were multiple challenges discovered in their research and included brief look into the future of MFS and mHealth. The challenges included the MNOs desire for exclusive partnerships, scaling of services that need greater customer information, risks of cross-sector initiatives in markets with low mobile money adoption rates, shared phones which make it difficult to implement ID management systems, and exorbitant setup costs because of lack of interoperability between mobile money providers. As for the future, the authors see that these challenges will decrease with increased adoption rates of MFS and the decrease of the costs of utilizing MFS in the mHealth sector. Finally, the authors see a greater need for quality data to be accessible by both healthcare and financial service providers. The idea is that more quality data about a patient’s health and finances will allow for micro-insurance to be provided. It would allow for re-insurance to be provided to private or public insurance schemes to provide greater protection to those providing the insurance. The authors see a lack of movement in this space because of this lack of data. They see technology as a tool that would provide this information and expand the reach of insurance to the poor.

March 16, 2012/by actualize

Agriculture, Family Planning, Health, Health, Maternal & Child Health, Originally posted on the GBI Portal, Women in Development

mHealth for Women: A Diverse Set of Applications

Photo Credit: Anupam Nath / AP

In an ode to International Women’s Day, we wanted to review a few of the mobile health projects and programs directly focused on women’s health issues. mHealth has a great variance in the type of applications used to promote and assist in women’s health. This ranges from sending health information about pregnancy via basic text messaging to more advanced tools that allow community health workers to collect data, diagnosis diseases, and refer patients. As the need and ability to extend health information to women in developing countries increases, here is a diverse set of examples that have been used or are in current use.

MOTECH

Launched in Ghana, the Grameen Foundation’s Mobile Technology for Community Health (MoTECH) initiative has a duel focus – providing health information to pregnant women and arming community health workers with applications to track the services provide to women and children. This project was funded by the Gates Foundation and has worked in partnership with Columbia University’s Mailman School of Public Health and the Ghana Health Service. The “Mobile Midwife” application provides pregnant women with time-specific information about their pregnancy via text or voice messages. This includes reminders about seeking care, advice on how to deal with specific challenges during pregnancy, and knowledge about best practices and child development. The Nurses’ Application allows community health workers to register and track the care provided to patients in the region. By recording patient data in the MOTECH Java application and sending it to the MOTECH database, the system captures the data and can send automatic reminders to nurses for when and what type of follow up care to provide. For more information about the MOTECH as well as the lessons learned, read the report from March 2011, “Mobile Technology for Community Health in Ghana: What It Is and What Grameen Foundation Has Learned So Far.”

MAMA

Launch in May 2011, MAMA (Mobile Alliance for Maternal Action) is a public-private partnership focused leveraging mobile connectivity to improve information and access to health care for pregnant and new mothers in developing countries. USAID and Johnson & Johnson are the founding partners, and the United Nations Foundation, the mHealth Alliance, and BabyCenter are supporting partners. This initial 3-year, $10 million investment from USAID and J&J is being used to build and expand global capacity of new and current mHelath programs in three countries – Bangladesh, South Africa, and India. The beauty of the MAMA Partnership is the focus on country ownership through these partners. And each country has a separate focus based on the specific needs and problems of the maternal health. In Bangladesh, the focus is to decrease maternal morbidity and mortality through stage-based health messages via mobile phones to low-income and at-risk mothers. The public-private partnership network in Bangladesh has already been established. Lead by D.Net, it includes technology developers (InSTEDD, SSD-Tech), corporate sponsors (BEXIMCO), outreach NGOs (Save the Children, BRAC), mobile operators (Airtel, Grameenphone, Banglalink), content providers (MCC Ltd), media (Unitrend Limited, Brand Forum), researchers (ICDDR, B), and government agencies (Ministry of Health and Family Welfare). In India, MAMA is completing a landscape analysis to understand the complex cultural environment and see in what areas mobile phones can be utilized to improve maternal health throughout the country. Finally, in South Africa, MAMA has partnered with the Praekelt Foundation (lead partner), Wits Reproductive Health and HIV Institute, and Cell-life to provide messages to pregnant and new mothers about receiving earlier antenatal care, prevention mother-to-child HIV transmission, and exclusively breastfeeding.

CycleTel

Developed by the Institute for Reproductive Health (IRH) at Georgetown University, CycleTel is an innovative solution, combining a previously used family planning technique with mobile phones. In 2001, IRH created the Standard Days Method (SDM) as a low-cost alternative to family planning based on a women’s menstrual cycle. By avoiding intercourse on a woman’s most fertile days during her menstrual cycle, days 8 to 19, there is only a 5% chance of becoming pregnant. Having developed the system, IRH saw a natural fit with mobile phones. In the original set up, women would use Cyclebeads (multiple colored beads used to represent specific days of a menstrual cycle) to keep track of when they are more likely to become pregnant. Using the same idea, the CycleTel replaced the beads with a mobile phone. Each month on the first day of menses, a women text messages the system. Utilizing FrontlineSMS, it then responds by sending a message showing which days she could get pregnant. In 2009, IRH conducted a research study in the region of Uttar Pradesh, India. The pilot showed the need to tweak the system to fit the region context including the local languages and women’s past experience using mobile phones. But it also showed the willingness of women and men to pay for the service in order to avoid unwanted pregnancies. This program is being operated under to the Fertility Awareness-Based Methods (FAM) Project which is funded by USAID.

Dunia Wanita

Dunia Wanita, which means World of Women, was launched in February 2010 by Telkomsel, a MNO in Indonesia. It is a part of the MNO’s value-added services applications and is specifically for women to receive information on a number of different topics, including health. The subscription costs $0.12 per day. By dialing *468#, women have access to a “one stop info service.” By selecting “Cantik Sehat” (Health and Beautiful), women can receive health information and advice from famous Indonesian doctors. The voice messages include information about sexual health, pregnancy, and healthy living.

These are just a few examples of mobile health applications that are available to women in the developing world. The applications vary in information provided, media used, and business models utilized. This is a great illustration of how diverse mobile health can be in order to reach a targeted group within a country, based on infrastructure, location, health knowledge, and mobile usage/connectivity.

March 8, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

What Big Aid Can Learn from the Ugandan Ministry of Health

“If you want to do M4D in Uganda, you have to be willing to coordinate.” This is the underlying message of UNICEF Technology Specialist David McCann’s blog, “A Ugandan mHealth Moratorium Is a Good Thing.” According to McCann, proliferation of Big Aid-supported mobile interventions, coupled with a severe lack of integration and collaboration, has hindered Uganda’s ability to take ownership of its development.

The Ugandan Ministry of Health, on the other hand, is quickly becoming a leader in mobile integration. By migrating its databases to free open source District Health Information software (DHIS2), the Ministry is encouraging community collaboration and reducing dependency on the tracking of aid-biased health indicators. According to McCann, the Ministry’s adoption of DIHS2 is now forcing Big Aid to “do M4D in a more coherent way.”

To learn more about this pioneering initiative, read McCann’s blog here.

Initiative:

mHealth Systems Integration

March 1, 2012/by actualize

Agriculture, Family Planning, Health, Health, Maternal & Child Health, Originally posted on the GBI Portal, Women in Development

50 Ideas and Solutions that Deliver for Girls and Women

As you may have heard Women Deliver is celebrating the progress made on behalf of girls and women worldwide. Building on its 2011 competition, which featured inspiring people who have delivered for girls and women, this year they have chosen to spotlight top ideas and solutions in the following five categories:

•   Technologies and Innovations
•   Educational Initiatives
•   Health Modernization
•   Advocacy and Awareness Campaigns
•   Leadership and Empowerment Programs

Out of hundreds of submissions, a selection committee has chosen 25 per category. The top 125 have been posted here, where viewers can choose and vote on ten favorites per category. Several of the chosen innovations and solutions incorporate the use of mobile technologies for health, showing the increasing inclusion of this type of innovation for the advancement of women’s health. Finalists include the Mobile Alliance for Maternal Action (MAMA), Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) by M-PESA, and many, many others.

In addition, the mHealth Alliance’s Catalytic Grant Mechanism for Maternal, Newborn, and Child Health (MNCH) and mHealth has been chosen as one of the top 25 ideas and solutions in the health intervention category. The Innovation Working Group, part of the Every Woman Every Child initiative, Norad, and the mHealth Alliance have partnered in the creation of a competitive and catalytic grant mechanism with a special focus on growing programs with sustainable financing models and early indications of impact. The projects supported through this grant mechanism harness the reach and popularity of mobile phones to help women, their families, and their health care providers in low-income settings combat inequitable access to quality health services. Funding is awarded through annual competitions managed by the mHealth Alliance and allows winners to take mHealth pilot programs to scale. You can find out information on this year’s grantees here.

Please show your support for mobile innovations and vote. The top 50 winners will be announced on March 8th, International Women’s Day. Vote now!

Initiative:

Maternal Newborn mHealth

February 27, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

mHealth in the News This Week

From conference and summit features to global health technology innovations: here’s what the news had to report on mHealth this week.

mHealth Alliance

“Barcelona’s GSMA to spotlight mHealth technologies,” Yahoo Philippines, February 24.
The Mobile World Congress will feature a mobile health conference to discuss the emergence of remote monitoring, wellness, and assisted living technologies, and their role in transforming the healthcare industry around the globe. To learn more about the mobile health sessions, click here.

“HIMSS takes over the mHealth Summit,” Government Health IT, February 21.
Last year, HIMSS became an organizing partner of the mHealth Summit, and they now own the event. This year’s summit will take place Dec. 3-5 at the Gaylord, located just outside of Washington, DC. The theme will be “Connecting the Mobile Health Ecosystem.”

“Kenya’s Startup Boom,” Technology Review, March/April.
Local programmers and homegrown business models are helping to realize the vast promise of using phones to improve health care and save lives.

e/mHealth

“eHealth Africa Conference – Integrating mHealth into eHealth Strategy Implementation,” All Africa, February 23, 2012.
This multi-stakeholder conference will take place in Nairobi, Kenya on the 18th and 19th of April 2012. The conference will identify best practices and lessons learned from previous experiences of developing national eHealth strategies and will also focus on integrating mHealth into eHealth strategy implementation. Click hereto learn more about the conference.

“Mobile technology boost health care,” Gant Daily, February 23.
Recent mobile phone initiatives in Bangladesh are allowing patients to reach a health worker for advice at no cost 24 hours a day, receive prenatal care reminders and even send complaints about patient care.

“Monitoring Your Health With Mobile Devices,” New York Times, February 22.
Dr. Eric Topol says that the smartphone will be a sensor that will help people take better control of their health by tracking it with increasing precision. He is already seeing signs of this as companies find ways to hook medical devices to the computing power of smartphones. Devices to measure blood pressure, monitor blood sugar, hear heartbeats and chart heart activity are already in the hands of patients.

“Africa to generate $1.2b revenue from mHealth by 2017 – GSMA Report,” Ghana Business News, February 20.
The mobile health market’s worth is predicted to reach $23 billion in terms of revenue by 2017, according to a new report. In terms of the market opportunity, the research found that the provision of pervasive mHealth services and applications worldwide could provide mobile operators with revenues worth approximately $11.5 billion by 2017 while “device vendors could benefit from a revenue opportunity of $6.6 billion, content and application providers $2.6 billion, and healthcare providers $2.4 billion by 2017.”

“mHealth Innovation and Developers Challenges,” Department of Health and Human Services, February 17.
Last July, HHS CTO Todd Park announced the availability of the HHS Challenge Toolkitand highlighted the department’s use of Developer Challenges as a tool to engage technology innovators to build creative and useful health solutions. The toolkit itself provides guidance, examples, and best practices for creating and running a challenge. Having participated in the design and judging of mHealth challenges/competitions, the author of this article, Audie Atienza, offers some reflections on his experiences.

February 27, 2012/by actualize

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