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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, Health, Health Systems, HIV/AIDS, Mobile, Originally posted on the GBI Portal

HIV/AIDS: A window of opportunity for South Sudan

Photo Credit: antiimperialism.com

As South Sudan prepares for independence, the celebrations will be tempered by the grim reality that awaits them. The nation is plagued by numerous health burdens due to decades of civil war resulting in a lack of trained health workers and poor infrastructure, and inadequate health and education systems. One such burden is HIV/AIDS. Dr. Wichgoah Piny, the state’s HIV/AIDS commissioner said that about 116,000 people are known to be infected by the virus in South Sudan, 46,000 of which are being treated at hospitals within the region. This number lies in the middle ground when looking at the rest of Africa. East Africa generally has a higher prevalence whereas West Africa exhibits a lower prevalence of the disease. Some estimates say up to 4.7 million in South Sudan are at risk of acquiring the disease.

But those numbers could grow exponentially in the coming years. The World Health Organization (WHO) has described HIV/AIDS prevalence in South Sudan as “a ticking time bomb” and a threat which needs a cooperative and collective effort to fight in the new nation. Dr. Olivia Lomoro, the GoSS Undersecretary in the Ministry of Health who spoke at a South Sudan AIDS conference warned, “HIV/AIDS is a real issue in Southern Sudan despite the efforts we have put to fight it. It remains a threat and a time bomb we are expecting.”

UNAIDS officials in South Sudan

Dr. Mohamed Abdi, the WHO Director in South Sudan said that, “AIDS is a big problem in South Sudan and we need to fight it together.” He said that in more than two years he had worked in the region, very few people were getting treatment.

The consequences of a surge in HIV/AIDS could be catastrophic. The health infrastructure is already poor as it stands. An HIV/AIDS epidemic would paralyze the health sector for years and impair growth in other sectors. This could result in a crisis that no new government would be prepared to handle.

So in a sense, this is a defining moment for the future of health in South Sudan. As the new government establishes itself and its policies, it has the opportunity to be forward looking in the development of its health infrastructure. If HIV/AIDS is afforded a chance to “blow up” as WHO fears, the country will immediately be sunk further into a health crisis.

This presents an opportunistic entry point for the implementation of ICTs into the health sector in South Sudan.

Opportunities

A survey completed in 2006 by WHO revealed that over 910 health facilities existed in South Sudan. At the time, a majority of those facilities were claimed to be in a “deplorable state”. However, Dr. Lomoro recently pledged that Lakes state now has a new hospital which is going to be used as a teaching hospital to help in delivering quality health. She also mentioned investments through the Chinese government will be used to build new health centers and rehabilitate old ones. Incorporating ICTs in the rehabilitation process will pay dividends for the health sector in the future.

South Sudan is being held captive by a number of health issues such as measles, yellow fever and tuberculosis to name a few. Furthermore, South Sudan has up to 80% illiteracy rates in some parts, which make communicating through ICTs invaluable. The most basic forms of ICTs like radio, television and mobile phones can build a communication bridge for the illiterate to keep them connected and informed.

Dr. Lomoro also pointed out that the first target for the Ministry of Health in the Government of South Sudan is the training of health personnel in all the ten states of South Sudan in order to deliver quality health services to the population in a professional standard. One way to go about this would be to include ICT training in that workforce development. Taking this route would build workforce capacity and bolster the development of ICTs in the country.

The population returning from Sudan proper and surrounding African countries are also coming back with health work force skills. So there is a hope that as people return, their skills will be used in improving service delivery.

Several factors exist that support the idea of integrating ICT into the health infrastructure of South Sudan

Present ICT Usage

The market for ICTs is ripe and growing in South Sudan. The initiatives that would make a big impact in fighting HIV/AIDS using ICTs utilize mobile phones and radios as the media for communication. These media platforms are the largest in South Sudan.

Photo Credit: biztechafrica.com

A 2007 survey entitled “Media Access and Use in Southern Sudan,” showed that radio was the main source of information for the population as a whole with 59% of respondents citing the radio as a source of information, the highest out of all forms of media. Additionally, HIV/AIDS awareness radio programs make up 17% of the most popular radio programs. This indicates that HIV/AIDS discussions already have a base in South Sudan media.

Mobile phones on the other hand don’t enjoy such high rates of usage as radio due to 30% coverage rates. However, the mobile phone network has expanded considerably since 2005 and is predicted to keep expanding in the near future. Also noteworthy is that only 14% of South Sudanese get their information from newspapers and 13% from television according to a report. It’s clear that radio and mobile phones are the most widely used avenues of communication in South Sudan.

Plans to expand broadband cables

As recently reported, South Sudan is on the shortlist to receive fiber optic broadband cables. Broadband services make it possible to interconnect affiliated healthcare facilities around the country so that they can utilize and share scarce human and technical equipment resources to deliver quality and affordable healthcare services. These cables can establish a foundation for ICTs not just in health, but for all sectors in South Sudan.

Past Successful HIV/AIDS Programs

South Sudan won’t be the guinea pig for using ICTs for HIV/AIDS either. There have been quite a few successful HIV/AIDS programs in the past that succeeded in similar environments:

Targeting Nomadic Populations – USAID and other external NGO’s worked together in Nepal in 2005 to introduce a radio program on HIV/AIDS awareness by integrating entertainment into its programming

Capitalizing on existing media penetration:

o Radio – Tanzania also introduced the Tunajali HIV/AIDS Care and Treatment Radio Program in 2010 with the help of PEPFAR.

o Mobile – Two mobile phone programs, Text to Change(TTC) and Freedom HIV/AIDS used mobile phones to reach thousands of people to educate them on HIV/AIDS

Photo Credit: freedom HIV/AIDS

South Sudan should approach some of the major NGO’s on the ground to help implement these initiatives that use ICTs. Organizations like USAID, WHO, UNICEF and the UN have spearheaded many initiatives like the ones described above in the developing world. They should at the very least try to do the same in South Sudan. They need to realize the opportunity at hand.

Possible ICT Policy

So the framework to set South Sudan off on the right foot is present just as they kick off their sovereignty. However, an HIV/AIDS epidemic is a threat. The markets for intervention exist, proven initiatives exist and they can be adopted using the aforementioned plans to establish new broadband cables. All of the stars have aligned. The tricky part is getting officials to the table and churning out an action plan. This will involve NGO officials talking with South Sudanese Government officials and making this opportunity a priority.

South Sudan has already seen its darkest days. They want to move now from being a hub for relief efforts to a hub for development. The health sector can benefit tremendously from using ICTs to prevent an HIV/AIDS disaster. Once HIV/AIDS is under control, the ICTs can be utilized strategically to tackle other health issues, as they are being done all over Africa and the developing world. If not, it may not be long before South Sudan encounters its darkest days once again.

July 8, 2011/by actualize

Agriculture, Health, Health, Health Systems, HIV/AIDS, Infectious Diseases, Maternal & Child Health, Mobile, Originally posted on the GBI Portal

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.

June 27, 2011/by actualize

Agriculture, Health, Health Systems, Humanitarian Assistance, Infectious Diseases, Maternal & Child Health, Mobile, Originally posted on the GBI Portal

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.

June 9, 2011/by actualize

Agriculture, Health, Originally posted on the GBI Portal

Global Observatory for eHealth series – Volume 1

This publication presents data on the 114 World Health Organization (WHO) Member States that participated in the 2009 global survey on eHealth. Intended as a reference to the state of eHealth development in Member States, the publication highlights selected indicators in the form of country profiles.

The objectives of the country profiles are to:

describe the current status of the use of ICT for health in Member States; and
provide information concerning the progress of eHealth applications in these countries.

January 13, 2011/by actualize

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