mHealth – Integra LLC

Tag Archive for: mHealth

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

Qualcomm’s Wireless Reach mHealth Project to Improve Cardiovascular Disease in Resource Scarce China

Qualcomm’s Wireless Reach™ initiative, the strategic initiative of the wireless chipset manufacturer, has partnered with Life Care Networks and the Community Health Association of China to start a mHealth project focused on improving prevention and care of cardiovascular diseases (CVD) in rural China. The project, Wireless Heart Health, was launched back in September in community health clinics in three provinces (Shandong, Anhui, and Sichuan) and one municipality (Chongqing).

Photo Credit: Qualcomm

In the past, most mHealth projects in rural areas have focused on acute diseases. These diseases are easier to handle via treatment and/or prevention, which allows for numerous mHealth interventions including appointment and pill reminders as well as data collection and information dissemination. But chronic diseases are becoming a larger public health issue in rapidly developing countries. Within China, CVD is the leading cause of death. By leveraging mobile technology to reach the rural community clinics, patients and health workers in rural areas can be connected directly with trained medical personnel in an urban area. While this type of connection is common in many countries (see MTN CareConnect in South Africa), the level of technology sophistication in this project allows for more in-depth data to be gathered and transferred to trained doctors.

Project Details

Life Care Networks developed a cardiovascular monitoring system that uses China Telecom’s 3G network to send heart data to cardiac specialists, who can provide rapid patient feedback. The system includes an electrocardiogram (ECG) senor on a smartphone, electronic medical record software, and workstations at the community clinics. The ECG-enabled smartphone has a gold rim around the outside part of it which is the senor. The patient simply holds the top and bottom of the phone in order for it to read their heart data. The medical records software is web-based and includes all past data collected in the clinic. This allows for both the community health workers and the doctors in the call center to have access to historical data in order to provide better care to the patients.

Within the project, the community health clinics are connected via the 3G network directly to cardiac specialists in the Beijing Life Care Networks Call Center. Using the ECG sensor along with the software and workstations, the patient data is sent to the call center and allows for real-time feedback either by SMS or voice. The call center is open 24-hours a day, and their services range from monitoring and diagnosis to treatment and referral. Referrals are especially important in these clinics as the clinic staff often do not have the knowledge and expertise to treat complicated cardiovascular issues. Because the smartphone sends the patient information directly to a trained doctor, it allows for referrals to happen swiftly, cutting down the time it usually takes. Also the smartphones are available for patients to rent in order to monitor their cardiovascular information.

Partnership Model

By leveraging a partnership model, Wireless Reach has been able to expand many services into rural or resource scarce areas by working with both for-profit and nonprofit organizations. With the Wireless Heart Health project, Life Care Networks is a for-profit company that has a commercially available ECG monitoring service as well as products and services for personal care. They offer different levels of service, depending on the needs and desires of their clients. The other project partner, the Community Health Association of China, is a nonprofit organization that supports the efforts of the Ministry of Health in helping to strengthen the Community Health Clinics throughout China.

Wireless Reach’s partnership model does not only include bringing together for-profits and nonprofits to strategically work together. An important aspect of all Qualcomm’s Wireless Reach projects is that they tie directly to government policies and initiatives. For example, this project addresses one of the specific issues outlined in the recent 2009 Chinese Health Care Reform, which focuses on strengthening the country’s grassroots medical institutions to provide equitable health care for all citizens.By partnering with Community Health Association of China, Qualcomm is able to engage in a project that supports the Chinese government’s efforts to develop a primary health care system.

Sustainability and Scale

Another important aspect of Wireless Reach projects is the goal for them to sustain as well as reach scale. In some cases, the project and its products/services become commercialized. In other cases, they have been sustained by the relevant country’s government. Since this project is only months old, the long-term model has not been decided yet. But there is a plan to create sustainability in the short-term and answers the age old question of “who pays?” In the model, patients are charged a small fee to its patients to rent the specialized phone. This allows the clinics to generate revenue and creates incentives to actively use the products and services.

Current Results

As mentioned before, each of Qualcomm’s Wireless Reach projects are focused on reaching sustainability and increasing scale. For this project, Wireless Reach is focused on gathering information and creating best practices in order to keep the project sustainable and eventually scale up. New impact data has recently been received and ranges from September 2011 to the end of January.

46 community health clinic doctors have been trained on how to use the system.
A total of 1033 patients have participated in the project.
These patients have sent 2172 pieces ECG data.
Out of that data, 513 pieces were identified as abnormal.
Out of all of the patient participants, 208 were screened for serious cardiovascular conditions and referred to higher-level clinics for further evaluation and testing.

Wireless Heart Health is an interesting example of how creating strategic partnerships, utilizing current technology and infrastructure (both telecommunications and health), and tying the project goals to current government policies can create a sustainable and scalable mobile health model.

Please also find below a video of the project:

View More Qualcomm Videos

February 17, 2012/by actualize

Health, Originally posted on the GBI Portal

Made in Cameroon: Touch Screen for mHealth

Arthur Zang - Photo Credit: http://www.rnw.nl/africa

A 24 year-old Cameroonian has invented a touch screen medical tablet that enables heart examinations such as the electrocardiogram (ECG) to be performed at remote, rural locations while the results of the test are transferred remotely to specialists for interpretation.

The touch screen tablet – Cardiopad was invented by Arthur Zang, a young computer engineer born and trained in Cameroon at the Ecole Nationale Supérieure Polytechnique (ENSP) in Yaounde.

According to Zang, the Cardiopad is “the first fully touch screen medical tablet made in Cameroon and in Africa.” He believes it is an invention that could save numerous human lives, and says the reliability of the pad device is as high as 97.5%. Zang says he invented the device in order to facilitate the treatment of patients with heart disease across Cameroon and the rest of Africa. So far, several medical tests have been carried out with the Cardiopad which have been validated by the Cameroonian scientific community.

“The tablet is used as a classical electrocardiograph device: electrodes are placed on the patient and connected to a module that, in turn, connects to the tablet. When a medical examination is performed on a patient in a remote village, for example, the results are transmitted from the nurse’s tablet to that of the doctor who then interprets them, says Radio Netherlands.”

While doing his academic internship at the General Hospital of Yaounde, in 2010, Arthur Zang became aware of the difficulties faced by Cameroonians in accessing care related to the heart. The Central African country has an approximately 40 cardiologists for about 20 million population with almost all these cardiologists located in the two large cities of Yaounde and Douala.

Access to cardiologist by patients especially those living in remote cities is therefore a huge challenge. This severe deficit of medical personnel means that patients with heart ailments usually have to travel long distances to undergo heart examinations and consult with doctors. Even at that, it is still not easy. On some occasions, patients must make appointments months in advance, and some even die in the process of waiting for their appointment.

Photo Credit: Cardiopad

This is how the technology works. Both the cardiologist (in the city) and the nurse (in the remote community) need to have the Cardiopad. A patient in the remote community is connected to electrodes placed on his heart. These electrodes are connected to a module called Cardiopad Acquisition Mobile (CAM) via a Bluetooth interface, which transmits the heart signal to the Cardiopad after the signal has been digitized. The nurse can then read the heart beats, heart rate, and the intervals between each beat displayed on the Cardiopad, etc. All these data are then stored in a file and sent to the cardiologist’s Cardiopad via a mobile telecommunication network.

The Cardiopad is already generating a lot of interest in African tech and medical circles. Zang believes his invention will cut down the cost of heart examinations and he is currently looking for venture capital to commercially produce the device. Visit here for detailed information on the Cardiopad and its inventor.

February 14, 2012/by actualize

Agriculture, Health, Originally posted on the GBI Portal

How Design and Collaboration Can Improve mHealth

We have all seen or heard of an organization developing and implementing an innovative solution and then one or two months later the product is in the corner of the health clinic. It has not been used since the organization finished its initial training. While the outsiders who came in saw it as innovative, it clearly did not resonant as a solution to the users. But why? It seemed so obvious to the developers that this product would solve a glaring problem. Why wouldn’t these health workers want to use this application?

Photo Credit: Tecca

But not to worry. This is something that all organizations and companies deal with. Do you remember Windows Vista, Nokia’s N-Gage, and HP’s TouchPad? Well, each company would hope that you do not. There is an endless list of failed technology products and services. With the movement of leveraging high tech products in international development, especially in global health, failure has become a part of the dialogue in the sector. So much so that MobileActive began hosting FailFaire, where organizations utilizing technology in their projects can come and speak about their “failures.” The idea is to learn from mistakes that others have made. In the most recent FailFaire in New York, many of the stories were focused around design and collaboration issues. Not simply physical design issues (like there were too many buttons on the device), but multiple issues that the designers and implementers did not take into account.

While design has been on the forefront minds in the corporate world for many years (see iPhone and IDEO), design in the social sector is a relatively new idea. In order to decrease the number of failures, organizations have created partnerships with design firms. They are bringing user-centered design to the social sector. Below are some examples:

Reboot has worked with United Bank Limited (UBL) in Pakistan and the Gates Foundation to expand branchless banking via mobile phones.

IDEO.org is assisting Evotech in the further development of their low-cost endoscopy device. It is used during obstetric fistula procedures in developing countries.

Frog Design teamed with the Aricent Group, PopTech, iTeach, the Praekelt Foundation, and Nokia Siemens to design programs to support HIV/AIDS patients as well as expand awareness and knowledge about the disease.

Design Strategy

By focusing on the human-centered design, the product/service takes into account the culture and needs of the targeted consumer. As the pioneer in human-centered design, IDEO wrote a paper in 2010 for the Stanford Social Innovation Review entitled “Design Thinking for Social Innovation.” In the paper, they discuss some of the issues with design in social projects. Along with looking into the culture and needs of the end-users, they mentioned that the project failed because the intervention had not been properly prototyped with the users and receive direct feedback from them. Human-centered design also sees a need to have the intervention fit into the infrastructure of the communities. The overall idea is to have the product/service that solves a problem that the user or community has. In order for this to occur, IDEO sees the solutions coming from focusing on those on the ground instead of the design process occur from outside the targeted community. Along with the design, they also believe that there must be a well thought out distribution and implementation strategy because that can kill a project too. Their most important strategy to the human-centered design process is observing people in their experiences and behaviors. This will tell the designers more than any survey because it can be difficult for people to explain what they need, especially if they do not know what that really is.

Collaboration

In order for the human-centered design to occur, there is a need for greater collaboration in mHealth. mHealth is a complex web of networks as it includes individuals from all areas affected in the sector – mobile operators, ministries of health, telecommunications regulators, community health workers, doctors, technology developers, global health NGOs, etc. As mentioned before, by understanding the problem and how a solution would be used in the field, the technology is more likely to be adopted. The creation process needs to understand all the aspects involved in the usage of the product/service. By creating a collaborating environment, no matter who the end user is (a mother, family, community health workers), the team has the experience and knowledge to look deeply into all the internal and external issues that are causing the problem. Once those are understood, then the group can start to see how the intervention can be both designed and implemented in the field with the end-user in mind. With this focus, there will be a clear incentive for the end-user to utilize the technology. Without understanding how a technology will improve their lives, there will be a low adoption rate. And then the technology becomes useless and another wasted investment.

The process of creating greater collaboration and utilizing a design strategy is easier said than done. Clearly money is an issue when including a design firm in the development of a mHealth product. It would be beneficial to include extra funds in budgets for the design process. The funds should be used to design the look, functionality, and business plan of the mHealth intervention as well as allow for greater collaboration. The end goal of developing a design strategy and increasing collaboration is to create products/services that will solve a problem but also that will be used by the indented users.

February 10, 2012/by actualize

Tag Archive for: mHealth

Case Studies

Contact Details

Quick Links

About

Expertise

Impact

Join

Sign up for Updates