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New mHealth service gives Iraq options for monitoring health

Iraq’s largest private telecommunications company, Asiacell, announced this week the launch of its mobile health content download and SMS service which is now available to its prepaid and postpaid subscribers. Asiacell is the only mobile telecom company providing coverage for all of Iraq.

An Iraqi man holds a cell phone. Photo Credit: Mario Tama, Getty Images

The new service offers information on various health practices which can be discriminately selected by the user. Asiacell offers a weekly and a daily health update service. The daily health updates include information on women’s health, men’s health, children’s health, dieting, mental health, and diabetes. Albeit a little more limited, the weekly updates is a downloadable service which only cover topics such as sports and fitness, mental health, and emergency medicine.

Customers can subscribe to the daily SMS service, by sending a blank SMS message to the toll-free short code “2330”, and then send their preferred health topic, which they can choose from a list that will be automatically sent via SMS, to short code “2331”.  This service costs IQD 2,500 ($2.14) per month.

Subscribers can also download content on a weekly basis by sending the number “1” to short code “2332” for sports and fitness information, or to “2333” for mental health information, or to “2334” for emergency medicine information. This service costs IQD 2,000 ($1.71) per month.

A similar service operates in India called mDhil which uses SMS to send health messages on various topics. The service overcame social stigmas regarding certain topics of health such as reproductive health, and became one of the most successful mHealth programs in India. Asiacell’s new service faces identical hurdles in Iraq and hopes to prevail like mDhil did.

Photo Credit: Asiacell

Asiacell is the only telecom provider to cover all of Iraq. They provide services to nearly 8 million of the estimated 31 million living in Iraq. This is remarkable given that just 5 years ago under the reign of Saddam Hussein, less than one million Iraqis had access to land lines and the average civilian did not have access to a mobile phone. Despite that and the war which ruined telecommunication infrastructure, Iraqis now have steady access to telecom services, especially mobile phones.

It is probably due to the increased access to information that has led Iraqis to become more health conscious claims Asiacell. Dr. Mustafa Adil, an Iraqi physician, said that maintaining a healthy lifestyle has become a major concern for communities, as people are more aware of the importance of following the latest health advancements and practices. He explained that Asiacell’s Mobile Health service supports the healthcare sector’s goal to promote sound health habits.

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Unlimited medical consultation offered in India

A telehealth service was launched in India in early May called MeraDoctor. Created by the managing director of mHealth Venture India Pvt Ltd. Dr. Ajay Nair, MeraDoctor is the first service in India to offer unlimited medical consultations with a licensed doctor over the phone.

The service is highly convenient and highly accessible, since Indians can call the service from any part of India that has phone connectivity. It sounds like a customer service hotline, but unlike customer service systems which usually provide 24 hour coverage, MeraDoctor only operates from 8am to 10pm. However they are now advertising that 24 hour coverage will be coming soon.

Photo Credit: MeraDoctor

The MeraDoctor system is quite simple. They offer two plans, one for 300 Rs and a second for 500 Rs, for 3 months and 6 months of coverage respectively. The customer has the freedom to make unlimited consultations during hours of operation from any where in India and medical help can be offered for up to 6 family members.

Customers call the number, explain the symptoms and receive a diagnosis along with a drug prescription. The drug prescription is designed to be sent via SMS to the customer. If the condition is complex or enigmatic, the doctor sends information via SMS to the customer on the location of the nearest health facilities and the medical tests to take.

Nair says the doctors are fully licensed and are not to exit the phone conversation until the customer is completely satisfied and has all questions answered. “We encourage them to call us if they don’t understand their test results or what the doctor told them. Our aim is to answer all queries until the caller is satisfied,” explains Nair.

According to Nair, calls sometimes last up to 45 minutes long. MeraDoctors train their doctors not to use medical jargon in order to make the customer comfortable. Says Nair, “all the doctors at MeraDoctor besides being trained in internationally accepted phone triage protocol, are also taught to offer a friendly ear to each caller.”

MeraDoctor has reached 900 families so far in India and looks to keep growing. Similar programs have been implemented in Bangladesh, Australia and Kenya with mixed success. However, if MeraDoctor stays true to its claims of customer friendly service, reliability and unlimited consultations, the service may become a popular fixture.

According to Nair, the patient-doctor dynamic in India is one where a patient refrains from medical consultation until the condition worsens. And when a patient sees a doctor, he/she waits at the doctor’s office for hours for only 5-10 minutes and then pays for the visit out of pocket. Nair wants MeraDoctor to serve as an avenue for thorough and convenient consulting.

Ideologically, the MeraDoctor system is precious for many Indians who have inadequate and substandard medical care. However, immediate issues surface when talking about quality of medical advice and providing accurate diagnoses. Also, if patients are referred to visit a clinic, are they still asked to pay full price for the clinic services despite paying for MeraDoctor services? That wouldn’t seem opportunistic at all. Especially when Indians spend up to an eight of their income paying for medical services. In any case, MeraDoctor seems to be gaining ground, and any success will be significant for Indians.

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Mobile health quizzes get a 2.7 million Euro boost

Text to Change (TTC), an mHealth non-profit organization based in the Netherlands, announced earlier this month that they will receive a €2.7 million grant to expand its services. TTC provides an SMS-based educational service to improve the health of citizens in eight countries in Africa and one in South America.

Already a big contributor in mHealth development, TTC hopes to become a leader in the field with the reception of its multi-million Euro grant from the Dutch Ministry of Foreign Affairs via Connect4Change (C4C), a consortium funded by the Dutch Ministry of Foreign Affairs that develops mobile based solutions on issues of poverty in Africa and Latin America. TTC will partner with C4C to expand its services to 11 more countries in Africa and South America by the end of this year.

Implementing ICT in the 11 countries is a top priority for both TTC and C4C. They are hoping the mutual partnership will make establishing ICT services an easier task as the expansion continues. According to TTC, the game plan calls for TTC to provide “low” technologies like SMS and mobile voice services while C4C provides “high” technologies such as mobile internet and video transfer. Therefore, TTC and C4C will play different roles.

C4C will also invest its time reaching out to local entities on the ground to strengthen ICT networks. TTC will focus on improving health outcomes through their established mobile phone initiatives.

TTC sets up their mobile platform through the recipient country’s mobile service infrastructure already in place. They then subscribe mobile phone users to their programs which use SMS communication to inform people of HIV testing, treatment clinics, and other health related services at no cost to the recipients.

TTC SMS system Photo Credit: TTC

TTC programs offer the information through a free educational quizzing service where participants are quizzed about a specific health topic. As participants answer the questions correctly, they are sent more rounds of questions, again at no cost. If the participant can answer enough questions correctly, he/she receives incentives such as phone credit, t-shirts and health products.

Thus far, TTC has reached thousands of individuals with their programs on HIV/AIDS, malaria, and reproductive health. Furthermore, to assess the impact of ICT in the countries they are currently working in, TTC will even conduct large scale ICT evaluations over the next few years in those countries.

TTC is poised to make an impact in ICT through their mobile services. Their work is just another example of how mobile phones are being used as a medium to educate, inform and save lives. The tag-team partnership with C4C will be expanded to all 11 target countries by the end of this year. However, we will have to wait some time before confirming the outcome of this joint strategic approach.

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How mobile banking and financial incentives can fight TB

Photo Credit: Stop TB Partnership

Earlier this month, the Indus Hospital in Karachi, Pakistan reported a substantial increase in Tuberculosis (TB) detection rates after the start of a program that uses mobile technology and financial incentives to get people to test for the disease.

Since the implementation of the program in January 2011, reported TB cases more than doubled at the hospital. Doctors reported a total of 420 cases in the first quarter of 2011, up from 200 in the last quarter of 2010, before the program was in place.

The program is anchored by a financial incentive scheme and use of mobile technology. In the program, doctors and community health workers who screen for TB are rewarded with a financial incentive through their mobile banking account. Health professionals are rewarded based on both the number of sputum samples that they collect and the number of patients that test positive for active TB following sputum test results.

Mobile banking centers that have emerged in Karachi make this program possible. Health professionals use SMS to send their TB data to the Indus Hospital TB Reach mobile data collection system and in return receive a text message which tells them how many cases they have helped to detect. The incentives are then tabulated and distributed at the mobile banking centers on a monthly basis by the data collection system, called OpenMRS Mobile.

Tackling TB is a big deal in Pakistan and the South Asian region as a whole. According to estimates by the World Health Organization, Pakistan developed nearly 300,000 new cases of TB in 2009, making them 8th on the list of countries most burdened by TB. Case detection is imperative in treating TB because according to TB Reach, for every 10 additional cases detected, an estimated 5 lives are saved and 100 infections are prevented.

The Indus Hospital received a grant from the Stop TB partnership’s TB Reach program. The TB Reach program focuses on promoting increased case detection of TB cases, ensuring their timely treatment, all while maintaining high cure rates within the national TB programs. Working in two “waves,” the first wave targeted 19 countries with $18.4 million worth of funding. The project at the Indus Hospital in Karachi is a product of the first wave. Under its Wave-2 funding, TB Reach has approved US$ 31 million for 45 projects in 29 countries.

The Indus Hospital program’s success has caught local attention as the Indus Hospital health workers are now training local private general practitioners on TB screening and detection. Furthermore Indus Hospital has launched a communications campaign complete with billboards, posters and local cable television ads that encourage people to get tested for TB. The Indus Hospital, also Pakistan’s first hospital to go paperless, hopes to expand the program nationally and even beyond.

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New telemedicine center in Nigeria aims to keep patients at home

A new telemedicine center opened last month in Lagos, Nigeria with the purpose of providing healthcare to local Nigerians. Designated as the Glo-Telemedicine Center, located on Victoria Island in Lagos, this center is a product of the collaboration between Nigeria’s Global Resources and Projects and healthcare providers in India, U.S., Egypt and other countries.

Photo Credit: Onche Odeh

The center is designed to minimize transportation concerns for Nigerians, especially those in isolated areas, to bring them expert healthcare from abroad. According to the executive officer of Global Resources Dr. Wale Alabi, “the Glo-Telemedicine Centre would bridge the gap between the poor and good health services by creating a simless [sic: seamless] communication between them and those with the expertise and facilities to help them.”

Dr. Alabi cited the high prevalence of Nigerians using life savings, and even taking out crippling loans to travel to foreign countries seeking expert healthcare. Dr. Alabi also claimed that over 60% of those who go abroad for services can get those same services in Nigeria, but often go abroad due to incorrect diagnoses.

The center will be used as a medical tool to reduce medical costs and substantially increase range of access to patients. The center is designed to offer specialty treatments to Nigerians at a low cost. It will also offer Continuing Medical Education to health professionals as a means to keep them informed of latest trends in health services.

The center’s capabilities are dependent on broadband fiber optics supplied by a Nigerian Telecommunication firm called Globacom. Their services take advantage of advances in ICT to transmit text, sound, video, image and other information from one location to another location.

Telemedicine is an application of medicine that takes advantage of electronic communications to transfer information from one location to another, often between health provider and patient, or between two health providers. Dr. Alabi noted that the success of telemedicine in African countries such as Kenya and Ghana is “transforming those countries.”

Similarly, Dr Alabi hopes the center will ultimately transform the way Nigerians think about accessing healthcare. However, this is not the first telemedicine project in Nigeria. Several years ago, the Nigerian government through the ministries of science and technology and health, commissioned a pilot telemedicine project that used satellite-based technologies. That project, called the NigComSat-1 Telemedicine pilot, was labeled impractical due to high costs and inapplicability. The Glo-Telemedicine center however, took note and addressed those issues, which is why it is now fully operational to Nigerians.

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HP plans to provide mobile technology to tackle malaria

Nurse using app on Palm Pre 2 smartphone in Botswana. Photo Credit: HP

On June 6th, Hewlett Packard (HP) announced it will collaborate with a non-profit organization in Botswana to provide technology to monitor and treat malaria outbreaks. HP announced it will begin a yearlong clinical trial that will equip medical professionals in Botswana with Palm Pre 2 smartphones designed to collect information on malaria outbreaks.

HP will supply the technology to the non-profit group Positive Innovation for the Next Generation (PING) who will train health workers to collect the data on malaria outbreaks. The data will be collected and stored through an application on the smartphones provided. The application can store photos, videos, audio files as well as GPS information which can be used to generate a geographic map of the areas affected by outbreaks, which has never before been done in Botswana.

The program hopes to increase the rates of mosquito net distribution and provide advanced warnings to regions at risk of an outbreak. Within a day, health workers can achieve results that would normally takes weeks to produce.

Malaria is one of the most widespread infectious diseases, and according to the World Health Organization (WHO), takes nearly one million lives every year, mostly in Africa. WHO has predicted as much as 10% of the African population is under the threat of malaria. Therefore, controlling outbreaks and being able to predict devastating malaria epidemics is crucial to alleviating its burden.

What’s also noteworthy here is that HP is plunging into the mobile health monitoring market, one example of HP’s plans to contribute to global healthcare. Instead of putting money into pockets, HP is aiming to contribute technology and other innovative solutions to tackle challenges that are hindering healthcare around the world. This shouldn’t surprise anyone however, since HP was one of the founding members of the mHealth alliance.

This program indicates the rising importance of mobile health technology as a key player in tackling health burdens in developing countries. Using mobile technologies, whether to collect data from isolated populations or to monitor disease prevalence presents an avenue for NGO’s and governments to reduce health service costs and increase accessibility. HP hopes to scale up this program to all of Africa, contingent upon success in Botswana.

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Medic Mobile introduces first mobile SIM application for healthcare use

Medic Mobile, a mobile health non-profit based in Washington D.C., announced the development of the first mobile SIM application for healthcare on June 6th. SIM apps can operate on 80% of the world’s phones ranging from $15 handsets to Android smart phones, so their potential use means reaching unimagined levels in data collection.

The SIM applications are menu based applications on mobile phones that reduce costs and increase accessibility for patients. Says CEO Josh Nesbit on his blog, “I can imagine all eight million global community health workers utilizing SIM applications to support their work and improve the lives of their patients.” Through these applications, patients don’t need to see a doctor, they can simply register their health data through the app and the data gets sent to health professionals who send feedback.

Medic Mobile is a pioneer in developing SMS based communication solutions. The organization started out with a project in Malawi where their SMS services saved clinical staffers 1,200 hours of patient follow-up time, thousands of dollars in costs and doubled the number of patients who were treated for Tuberculosis. Perhaps their most well known project came after the earthquakes that devastated Haiti. Mobile Medic created an SMS database where people could text the number “4636” to be tagged, mapped and subsequently assisted. Thousands of victims were rescued with this service.

SMS and SIM application based healthcare services can serve as a blueprint in the developing world to alleviate health burdens. Over half of all Africans use mobile technology, and according to an ITU report, over 70% of low and middle-income countries utilize mobile technology. Mobile technologies dominate any other technology in the developing world. They are cheap and conveniently accessible.

Photo Credit: Medic Mobile

Nesbit sees great potential and envisions applications that help patients schedule appointments, access remote consultations and connect with health care professionals during a medical emergency. Nesbit’s products are proof that mobile phones can be a game changer in providing healthcare. They can essentially serve as health professionals at any place and any time. Not even the developed world can claim that.

Medic Mobile, a mobile health company started in college by Josh Nesbit, is a trailblazer in the field.
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UN calls for increased sustainability of mobile health clinics in Pakistan


Mobile maternal health clinic on the road. Photo Credit: UNFPA

Nearly a year after the devastating floods in Pakistan, calls are being made by UNICEF health officials to expand capacities of mobile health clinics in the country. The clinics were first developed in response to the 2005 earthquakes in the northern region of Pakistan. Although the mobile clinics have touched hundreds of thousands of lives, more will be needed with expanded capabilities to ensure their long term impact.

In October 2005, the UNFPA joined hands with the Pakistani government and created mobile health clinics, whose main focus was on maternal health needs. By 2008, these clinics had treated over 850,000 patients, mostly for maternal and child health related issues. The clinics, still running, are staffed by women and are stocked with equipment and supplies for quality maternal health care. Since 2005, UNICEF has also become a key funder for mobile health clinics in Pakistan.

The UNICEF funded mobile health clinics tackle a variety of health issues, with an emphasis on maternal and child health. These clinics are staffed by three health workers, and treat up to 300 patients on a daily basis. After the emergence of the floods that affected 20 million people in Pakistan in July 2010, these health clinics became pivotal in reaching isolated populations.

Healthcare for women and children is better now than it was before the floods and the earthquake. However, despite the welcomed success of these mobile health clinics, there has been a call to expand the capacities for the mobile health clinics in order to make them more sustainable. This is where the world of ICT can step in and lend a helping hand.

The potential for impact is highest is rural and isolated areas where resources are poor and hardest to reach. According to a UNDP report, “ICT is yet to be widely mainstreamed to assist developing countries in addressing traditional development problems with innovative solutions and approaches that are both effective and more easily scalable and replicable.”

ICT services can complement existing initiatives such as the mobile health clinics in Pakistan to attenuate health burdens such as maternal mortality, which is what the UNFPA funded clinics focused on. This would be crucial in rural areas where ICT services would be invaluable. ICT services can potentially offer live video or audio feeds to health professionals when examining patients as well as educational classes to women from urban based instructors using the mobile clinics already in use.

Once ICT services are in place, NGO’s and government agencies can directly improve citizen access to information and at the same time, immediately strengthen their own capacities to help the citizens. Pakistan and other developing nations will only continue to reap the benefits for years to come.

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Cell Phone Attachment Helps/Manages Malaria

Today is World Health Day 2011 and theme this year is on antimicrobial resistance. In developing countries, one of the most pressing health issues is malaria, with a high morbidity and mortality rate. Rapid diagnosis and prompt treatment are most basic managerial elements on how to circumvent this vicious disease. The attachment of a microscope onto a cell phone, known as Cellscope, can help with these diagnoses.

View the Prezi below to see how the innovative mHealth tool can help rural health workers.


 

Copy of CellScope Story on Prezi

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2011 mHealth Trends- Webinar

MobiHealthNews held their first webinar, last Thursday, February 11,to discuss mobile health news and trends that will likely emerge during the Healthcare Information and Management Systems Society (HIMSS) 2011 annual gathering this year in Orlando. The webinar, which was attended by health professionals and practioners around the world was the first of its kind to predict future innovations and trends in mobile health.

Brian Dolan, MobiHealthNews editor, discussed the increasing expansion of peripheral health devices. Most of these were manufactured to assist medical practitioners in the developed world, but a few stood out as contenders for development context:

iHealth blood pressure dock

  • iPhone ECG case developed by AliveCor called the iPhonECG is a great new device. This gadget turns your Apple iPhone 4 into Electrocardiogram (ECG) by putting it into a special $100 case, however it has not been approved for sale in the U.S. yet. This would possess the capability to help healthcare works in the field monitor electrical activity of the heart and detect any heart disease, allowing them to assess the patient’s level of risk more accurately.
  • Cellscope which turns a cell phone into a high-magnification microscope.is a revolutionary approach to curing infectious disease are a huge upcoming trend that will launch throughout the year and gain FDA approval.

    The CellScope

The HIMSS will hold its annual conference on February 20-24, where hundreds of corporate and non-for-profit members come together to collaborate on their mission to transform healthcare through effective use of IT and management systems.. Each year a few innovations stand out among the crowd. Two years ago, one of the big themes that emerged was that an electronic medical records (EMR) vendor developed a smartphone application. Last year, tablets such as the iPad, emerged as catalysts for mHealth devices to grow in usage.

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