Tag Archive for: mHealth

During the most recent mHealth Working Group, Kelly Keisling, Co-Chair, passed out a publication of mHealth cases studies developed by GBC Health. Entitled “Building Partnerships that Work: Practical Learning on Partnering in mHealth” and created in collaboration with Dalberg Global Development Advisors and the mHealth Working Group, its goal is to provide best practices for future mHealth partnerships. GBC Health sees partnerships as playing a key role in expanding mHealth into the mainstream of global health.

Hands together

Photo Credit: The University of Akron

The case studies focused on diverse set of organizations, ranging across multiple sectors – technology, NGOs, and multilateral institutions. Those included were the Carlos Slim Health Institute, Deloitte, HP, Intel, Nokia, Novartis, the Stop TB Partnership, UNICEF, USAID, and Vodafone. The research revealed overlapping topics and ideas that could be used to create sustainable partnerships for mHealth programs. Below is a list of best practices that the publication pulled from the case studies:

Partnership Selection

Shared Agenda and Vision: Look for partners whose vision is aligned with yours.

Organizational Capacity: Make sure that your prospective partner will be able to adequately support the initiative at all stages of relevant involvement – from development and implementation to scale-up.

Local Expertise: Work with partners who are already working in-country and possess relevant local expertise.

Complementary Assets: Identify partners who can bridge gaps in your organization’s expertise and knowledge.

Reputation and Integrity: Consider referrals from trusted partners to identify new partners with a good reputation in the market.

Structuring for Success

Clearly-Defined Problem and Solution: Solidify and remain transparent about objectives from the beginning of your conversations with potential partners.

Roles and Responsibilities: Ensure that each partner has unique core competencies to contribute.

Shared Value: Create shared value by ensuring a ‘win-win’ for all partners.

Leadership: Identify a “champion” in each of the partner organizations to lead the campaign within their organization.

National Priorities and Program: Align projects with government priorities at the outset to help with scale and rollout.

Community Involvement: Engage the end-users in the design and on-going feedback loop to continually refine the program.

Multi-stage Planning: Establish a clear and committed plan for funding, implementation and maintenance among partners, from the beginning.

Strict Project Management Process: Develop a structure project management plan with supporting documentation.

 

GBC Health is a worldwide coalition of over 200 companies and organizations focused on using their resources to improve global health. Dalberg Global Development Advisors is a strategic consulting firm that works to raise living standards in developing countries and address global challenges. mHealth Working Group is a collaborative forum composed of 150 global organizations  and more than 500 individual, for sharing and synthesizing knowledge on mHealth.

Mobile Phone and Cash

Photo Credit: OpenIDEO

According to article released this week by Uganda Online, hospitals in Uganda are now accepting mobile money to pay for health expenses. While there are eight mobile providers in Uganda, four are providing mobile money services to their customers – MTN’s MobileMoney, Airtel’s ZAP, UTL’s M-Sente and Warid Pesa – with Orange Uganda planning on releasing their version of the service soon. In the article, a picture clearly shows that the hospital (Case Clinic) allows for mobile payments from MTN and Airtel. Other companies in Uganda are allowing for mobile payments – DStv (satellite TV provider), NWSC (water and sewerage) and Umeme (energy provider).

Utilizing mobile money in the health sector is nothing new. M-PESA in Tanzania has been used by the CCBRT Hospital to pay for patients’ bus ticket from rural areas to the hospital’s location in Dar es Salaam (the capital city). In Kenya, Changamka allows individuals to save and pay for health services by combining a medial smart card with M-PESA. In the Philippines, Smart Communications has partner with PhilHealth, a national insurance provider, to allow customers to pay their premiums via mobile money. This list continues as money mobile is being further employed in the health sector which includes insurance, vouchers program, and conditional cash transfers. The ability to save and pay via mobile money for health issues creates insurance for individuals and families that do not have access to typical insurance products. Mobile money has also been leveraged to pay nurses and community health workers serving in rural areas which helps with worker retention and decreases tardiness.

In the mHealth sector, this is a clear sign that innovative solutions can be shaped around current mobile products and services. Once mobile money has been established in countries, this opens doors for new businesses to be developed around the mobile money platform. The examples above show the need and desire for products that create the ability to both save and pay for health service. While the Ugandan example is not a revolutionary app (or killer app), it provides a necessary product so individuals and families can receive curial medical services. In this case, the ‘killerness’ of the service to using mobile money in the health care system is that it fits both the needs and infrastructure of Uganda, include accepting payments from multiple mobile providers.

A white paper release by the Advanced Development for Africa (ADA) last month laid out the necessary steps to scale mHealth projects in the developing world. Its goal was to provide governments, donors, and the private sector with the essential knowledge to push mHealth from pilot projects to scalable and sustainable solutions.

The report, entitled “Scaling Up Mobile Health: Elements Necessary for the Successful Scale Up of mHealth in Developing Countries” and authored by Jeannine Lemaire, preformed an extensive review of the sector. It focused on multiple case studies and pulled best practices and recommendations from organizations and thought leaders in the sector. With the current mHealth in a transition stage from proof of concept to widespread scale and adoption, there is a need to show key stakeholders that scale and sustainability is possible and necessary to improve health outcomes in the developing world. The ability to be sustainable and scale will push the sector forward and make the case for greater investment by governments, donors, and the private sector.

The author provided nine case studies including TulaSalud, TXTAlert, mPedigree, and ChildCount+. She also included the insights from thought learners in mHealth (David Aylward – Ashoka,  Patricia Mechael – mHealth Alliance, Brooke Partridge – Vital Wave Consulting, Anne Roos-Weil – Pesinet, and Getachew Sahlu – WHO).

Doctor with a mobile phone

Photo Credit: IICD

 

Through the interviews and case studies, multiple best practices were established in order to properly implement a pilot with the ability to scale and be sustainable in the future. These best practices included the idea that sustainability and scale must be planed from the program’s inception, the necessity to perform a needs assessment for the local region, facilitating collaboration in order to avoid duplication, the inclusion of targeted users and beneficiaries during the development phase, getting buy-in from multiple stakeholders (governments, communities and local healthcare providers), collaborating with local implementation partners, creating partnerships with a focus on scale up, and including M&E to assess the impact off the interventions.

The research also provided recommendations at multiple levels of mHealth policy and development – programmatic, operational, policy, and global strategy. The recommendations were:

Programmatic:

  • Integrate the program within existing healthcare structures.
  • Employ an integrated solution and/or holistic approach rather than a silo single-solution approach. Identify innovative ways to incorporate other mobile services using cross-sectoral approaches.
  • Identify a sustainable and scalable business model that is applicable for large-scale implementations and can bring in valuable strategic partnerships to support scale up.
  • Build partnerships with the private sector after a successful pilot phase.

Operational:

  • Seek out and invest in building local capacity to minimize costs and support local ownership of the project.
  • The software and mHealth application should be geared towards the objectives of the program, suitable for local conditions and designed with the end-user in mind.
  • Identify what motivates the end-users, not just what the objectives of the program are. Use incentives to promote the consistent and effective use of the mHealth tool.
  • Perform social marketing.
  • Empower users through the mobile phone technology, particularly women.
  • If an area of the project is failing, fail quickly and publicly; adjust the program accordingly.

Policy:

  • Mainstream mHealth in the MOH and relevant government bodies.
  • Establish an e/mHealth structure to support the multi-sectoral mainstreaming of mHealth and advise the decision-makers on creating an enabling policy and regulatory environment for mHealth scale up.
  • Create an inter-ministerial working group and collective agreement involving stakeholders from the various ministries to support the scale up of mHealth programs.
  • Identify and promote the use of specific data, technology and interoperability standards.
  • Advocate for the integration of mHealth within local public and private healthcare initiatives; prioritize mHealth training for healthcare workers.

Global Strategy:

  • Establish a global network of key institutional players to inform an overall global approach to support the scale up of mHealth in developing countries.
  • Establish a global repository of mHealth applications, tools, best practices, recommendations and evaluation data. Institutional players must be willing to share and connect their existing repositories.
  • Create frameworks for success targeted towards informing policymakers, project designers and implementers, and donors.
  • Advocacy by institutional players to both internal and external stakeholders, particularly to donors, to utilize and integrate mHealth into programs in developing countries.
  • Donors and institutional players need to support the evaluation of initiatives in developing countries and the creation of common metrics, indicators and methodologies to evaluate impact on health outcomes.

The ADA is African-based nonprofit which focuses on scaling development in Africa through innovative solutions. This includes building capacity, transferring technology, hosting forums, and establishing cross sector partnerships. Jeannine Lemaire is the Director of eHealth and New Media at Actevis Consulting Group.

The 4th Afrihealth Conference, held in Nairobi, Kenya on Nov. 30 and Dec. 1, broadened the debate on the adoption of Telemedicine, mHealth and eHealth in Africa, and brought attention to the need to integrate and mainstream eHealth into the continent’s health system.

Afrihealth conference logo

The theme of the conference was “consolidating the gains of technological innovation in healthcare through effective management,” and some debate sparked on what direction to take eHealth in Africa.

According to Science and Development Network reporter Maina Waruru, experts attending the conference argued that “a focus on high-tech healthcare solutions could come at the expense of basic prevention such as access to clean water and sanitation, good nutrition and hygiene, and health education.” Since 80 percent of illnesses in Africa stem from preventable infectious diseases, this focus on high-tech is a move in the “wrong direction.”

But the potential for using ICTs to continue to improve basic healthcare in Africa is great, and a focus should be on ensuring that appropriate technology is utilized and effectively delivered.

One concern attendees brought up was the lack of a legal framework to determine what qualifies a person to work as an “e-health” professional. E-health is often practiced by non-professionals such as ICT technicians and nurses, and many countries have not established what qualifications are needed to be certified as a professional.

In addition, physicians in many countries are of an older generation and received their degrees before the ICT explosion. Many are not comfortable with situations where they consult with patients remotely, without actually being in the room with them.

Image from Dr. Kwankam's powerpoint presentation at Afrihealth conference

From Dr. Kwankam's presentation at Afrihealth 2011 conference

To address some of these issues, Shariq Khoja, the coordinator of the e-health program at Aga Khan University, has suggested that laws should be put into place to “accommodate and mainstream [e-health].” According to Dr. Yunkap Kwankam of the International Society for Telemedicine and eHealth, “for eHealth to take root and thrive…it must itself be transformed…we must weave eHealth into the fabric of the health system.”

Dr. Kwankam claims that Africans can benefit from technology changes by effectively managing it and charting a course for ICT in health through an organized eHealth profession, national eHealth policies and strategies, and addressing large eHealth challenges, such as scaling up eHealth interventions.

Dr. Kwankam and other experts’ presentations from the conference are now available.

 

MedAfrica, the Nairobi-launched mobile health app that makes basic health information more readily available through phones, is generating buzz in mHealth for Africa.

Med Africa Logo

The app was developed by the start-up tech firm, Shimba Technologies, and boasts a sustainable, innovative business model.  Shimba CEO Steve Mutinda says the tech company “aims to achieve by creating platforms that facilitate dissemination of information and build communities around the different issues and conditions [in health] while at the same time converging all stakeholders and amplifying their efforts.”

The platform provides information such as doctor and hospital listings, drug authenticators, and lists of symptoms with suggestions for self-diagnosis. This sort of symptom checking could be very useful in countries like Kenya, where as little as 14 physicians exist for every 100,000 people. Members of MedAfrica explain that because the app is providing such valuable information to clients, as well as recommending good doctors and dependable, lab-tested drugs, users are willing to pay for the service.

Originally meant to provide health information solely in Kenya, MedKenya was the overall winner for the East African mobile tech event Pivot25 competition. Changing the name to broaden the app’s potential scope, MedAfrica presented at Demo Fall 2011; in video below, VentureBeat interviews Mutinda and a colleague.

The best news about the launch of the app is its potential scalability. The organization wants to use its launch in Kenya as a road map to scale the product to other African countries. MedAfrica’s mission is to reach every household in Africa.

The content for the app will come from partners such as the Nairobi Hospital and open data from the Kenyan government. During the launch, Kenya’s ICT Board Chairwoman Catherine Ngahu called on other medical institutions, physicians, and health providers to supply content for the app as well.

Given Kenya’s track record in developing some of the most innovative apps in Africa, if not the world, it’s no surprise that MedAfrica has garnered so much attention and holds so much hope for expansion.

 

A recent report compiled at the United Arab Emirates’ Mobile Show illustrates that citizens overwhelmingly believe that the mobile industry in the Middle East can have a positive effect on the health sector, emphasizing the great potential for mHealth in the region.

Mhealth – or mobile health – is a consistently reported topic in the ICT4D field, with projects popping up in developing countries on a daily basis. While many of these projects are being undertaken in sub-Saharan Africa and Southeast Asia, there is less news on mHealth initiatives in the Middle East.

Mobile user in Afghanistan

Photo credit: mHealth Insight

Take Health Unbound (HUB), for example, the mHealth Alliance’s open source database of mHealth projects around the world. Of the 217 projects in the database, only about 8 are located in the Middle East, as opposed to 37 in Southeast Asia and a whopping 109 in sub-Saharan Africa.

But recent reports indicate that more attention is being given to mHealth in the Middle East. One article states that the Middle East has been a “hotbed for mHealth development,” reporting on various mHealth initiatives in the region. Qatar’s Supreme Council of Health announced that it will launch an app that locates clinicians, physicians and other health resources in the country, and two mobile companies in Qatar have partnered up to offer health and wellness education using mobile phones. In addition, the first mplushealth conference will take place at the Arab Health Exhibition and Congress in Dubai in January. The conference will bring together healthcare professionals, insurance providers, government regulators and telecommunications decision-makers to explore mHealth opportunities in the Middle East and hopefully pave the way for the sector to thrive.

The UAE Mobile Show report also revealed challenges that need to be overcome before mHealth can take off in the region. 73 percent of respondents indicated that patient-physician confidentiality was a major concern in implementing a mobile health system, as well as privacy, security, high costs, network infrastructure and technology.

Mobile conference

Photo credit: AMEinfo.com

These obstacles may be part of the reason that mHealth initiatives in the region have remained primarily in the hands of independent mobile app developers, without much governmental support. But as attention on mobile health in the Middle East continues to grow, the region could be one to watch for future mHealth innovations.

A recent study undertaken in Haiti found that mobile phones can deliver critical information on population movement rapidly and accurately following disasters.

Richard Garfield presented the findings from the research he conducted with several other public health specialists and social scientists at a recent mHealth working group meeting using data from mobile phone networks before and after the 2010 earthquake that rocked Haiti. The publication explains how the research team used position data of SIM cards from Haiti’s largest mobile phone company, Digicel, to estimate population movement trends following the earthquake and the subsequent cholera outbreak.

Girls with phone in Haiti after earthquake- from USAID

Photo credit: USAID

The researchers originally set out to find this data in order to respond to the disaster in Haiti. Knowing that 1 in every 3.8 people in Haiti owned a cell phone, they collaborated with Digicel to track the number of calls and the location of those calls over the course of a year, before and after the earthquake. Most mobile users were based in Port-au-Prince where the earthquake was centered. While cell reception was down for a few days immediately following the quake, the network capacity was rapidly re-established, making the phones easy to trace.

A 22 % decline in phone usage in Port-au-Prince after the quake correlated with the massive outflow of population from the capital, which was widely known. In the aftermath of the disaster, the UN and Haitian government had created maps based on eyewitness observation to track population movements. But because these were reliant on eyewitnesses, there was no way to tell how accurate the data was.

In fact, the mobile phone usage analysis showed different results from these official maps, showing movement that was more spontaneous and seemingly more accurate. Many of those who evacuated Port-au-Prince originally returned back within 7 days, and this was something the official numbers did not catch right away. Months after the earthquake when the UNFPA carried out a survey in Haiti to retrieve more accurate numbers of where people were and when, the mobile phone data was much more closely associated with these results. The mobile phone data also helped to estimate where the cholera outbreaks were happening and to get people out of the danger zones.

Graph from Richard Garfield mobile data in Haiti article

Estimated net changes of the Port-au-Prince population compared to the capital's population on the earthquake day

 

Garfield emphasized that while these results do not indicate that mobile data should be used as final, official counts on death tolls, it can provide initial estimates while waiting for more accurate counts. The key point is to mine the data rapidly and assist in a quick response.

Will this research lead to improved quick responses for future disasters? It certainly could be combined with current disaster relief efforts following the recent earthquake in Turkey, such as Google’s Person Finder app or social media response.

Last week’s mHealth working group meeting laid out the opportunities, challenges, and potential of monitoring and evaluation (M&E) within the mHealth sector.

JhPiego circumcision promotion through texting service

Poster in Swahili promoting male circumcision through SMS service, part of Jhpiego program

 

Several experts in the field presented their experiences of monitoring and evaluating mHealth projects, emphasizing the considerable potential that mobile projects offer in generating robust and accurate data. Kelly L’Engle, a behavior scientist at FHI 360, discussed the need for M&E in order to gauge the impact of mHealth. She claimed that mHealth technology is not being fully leveraged and that the current mHealth research “doesn’t provide evidence on actual impacts…or answers to critical research questions…”

James BonTempo from Jhpiego presented on evaluating behavior change evidence from a text message project that promotes male circumcision (MC) for HIV prevention in Tanzania. He referred to this evidence extraction as “mining the data exhaust” – that is, the data generated as a byproduct of ICTs, the “trail of clicks” that ICT users leave behind.

The MC program offered a toll-free text-messaging/SMS service. With the service, individuals could request to receive information on the benefits of MC (using key word: TOHARA), where to find MC services (WAPI), as well as receive follow-up care information after undergoing the circumcision (BAADA). While the SMS platform was intended to capture requests to the three keywords and generate access logs for system performance monitoring, Jhpiego has analyzed this data in order to see if there was a relationship between requests for the MC data and actual utilization of MC services.

Jhpiego male circumcision project in Tanzania- behavior change evaluation

Potential link to behavior change in Jhpiego male circumcision project

The data set included 12,056 keyword requests sent by 4,954 users. After performing a Chi Square analysis on the data, the project team found that requests for information on the benefits of MC (TOHARA) was not strongly associated with going to receive the circumcision. However, it was found that those who requested where to find the data (WAPI) did have a statistically significant association with undergoing the circumcision. These results are consistent with pathway models of behavior change, indicating that those who simply wanted to know more about MC were not quite prepared to undergo the procedure, but those looking for service availability were ready to use the services.

The associations found in this particular project imply that providing text or voice messages that tell people where to get a particular service could be more effective in encouraging clients to utilize that service. M&E that finds results such as these could help project leaders design SMS services that generate more useful data.

Like most forms of M&E, there are limitations on findings that use mobile data. There is a lot of information that mobile devices do not provide, such as which phones belong to whom and who actually sends the text messages; this makes it difficult to link messages to specific individuals. In the MC case, data analysts found an association, but did not necessarily know the nature of the association. It can also be challenging to find the time or manpower to rake through the massive amount of data that is produced by mobile devices.

While M&E in mHealth has its limitations, it is difficult to find data that can be collected and analyzed as quickly, cheaply, or easily using other means. Paper, radio, and television simply do not offer the same kind of easily-mined data exhaust that mobile does.

 

 

The mHealth Alliance is building on the monumental success of last year’s mHealth Summit, which saw more than 2,600 attendees from nearly 50 countries. This year, the mHealth Alliance joins HIMSS and NIH as organizing partners for the FNIH-presented mHealth Summit. The Summitwill bring together leaders in government, the private sector, industry, academia, providers, and not-for-profit organizations from across the mHealth ecosystem and around the world.  It will take place December 5th-7th at the Gaylord National Resort & Convention Center located just outside Washington, DC at the National Harbor.

As everyone gears up for the 2011 mHealth Summit, I have received a lot of questions.  Some have been logistical, while others have been about the content of the Summit.  I thought it might be helpful for those thinking about attending or planning to attend if I post questions as I get them along with answers.  Here are a few I have gotten so far:

Q: What is the best airport to fly into and how do I get from the airport to the Gaylord?

A: There are three major airports that serve the Washington, DC metropolitan area, including Washington Dulles International Airport (IAD), Baltimore/Washington International Airport (BWI), and Ronald Reagan Washington National Airport (DCA)Super Shuttles can be taken from all of these locations, and the Gaylord offers hourly shuttle service from Reagan National Airport (DCA).  Please visit Shuttle & Metro page of the mHealth Summit site for more information.

Q: Unfortunately, I missed the early registration period.  Is there a discount code available?

A: Yes! The mHealth Alliance has a discount codefor the mHealth Summit.  If you enter the code mHA11 during the registration process, you will receive $50 off a Full Access Pass.  The Full Access Pass will get you into all of the Super Sessions, the Concurrent Sessions, the Exhibit Floor, the Monday Evening Reception, and the Keynote Luncheon on Tuesday.  For more information about the different levels of passes available, please visit the registration page.

Q: How much of a focus will there be on maternal health projects?

A:  The Maternal-newborn mHealth Initiative (MMI) is an important initiative of the mHealth Alliance.  By focusing on maternal-newborn health as a lens to the application of ICTs to health systems, the mHealth Alliance is working toward health systems transformation to improve health outcomes for all populations.  As such, maternal health is a very important topic for us, and it can be found throughout the summit program.  A few panels and events that may have maternal content include, but are not limited to: mHealth Business Models in Maternal Health, The Intersection of Mobile Health and Public Health – Towards Greater Understanding and CollaborationDeployment Case Studies for the mHealth Field Worker, and several sessions of the mFinance track.  There will also be a Mobile Alliance for Maternal Action (MAMA): An Exchange with Partners side event, which will feature active discussions with its in-country and global partners.  Visit the Mobile Alliance for Maternal Action (MAMA) site to learn more about their activities around the world.

Q: How much of a focus will there be on mHealth in the developing world?

A:  Making sure that the experiences of people in the developing world are represented at the mHealth Summit is a priority of the mHealth Alliance.  Panels and events that focus on this include, but are not limited to: Global Policy and Regulatory Perspectives of mHealth, Global Regulatory Frameworks: Understanding Regulatory Concerns Across Different MarketsGovernment Role in Scaling mHealth: Collaborations to Launch National mHealth Strategies, Successful mHealth Business Models in Emerging Markets, A New Model for National-level mHealth Planning, and the above mentioned MAMA event.  The mHealth Alliance will also host a side event featuring mHealth national stakeholders from around the globe.  At the National Stakeholders: Learning from the Global South event, panelists will share the successes and challenges they have faced in bringing a diverse group of stakeholders together to tackle issues like policy and regulation, interoperability, data security, and intersections with other mServices.

If you have any other questions, please feel free to comment below, and I will try to answer you as soon as possible. 

Thank you so much for your interest in the mHealth Summit.  If you would like to register, please click here.  We hope to see you there!

Nigeria may be joining a number of African countries in prioritizing mHealth as a way to improve the country’s troubled healthcare system. At a recent mobile Health workshop in Nigeria that was put together by the African telecommunications company MTN, stakeholders voted for the nation to adopt a mobile healthcare system.

Omobola Johnson, Nigerian ICT Minister

Omobola Johnson, Nigeria's Minister of Technology and Communications

According to some, Nigeria is among the countries leading the way in using mobile health services. Several mobile companies operate there, with MTN serving the largest population percentage followed by Globacom, Zain and Etisalat. The Nigerian Communications Commission estimates that around 105 million of the country’s 155 million people were subscribed to a mobile service provider in August 2011.

Nigeria faces many challenges in expanding its healthcare system, such as a lack of infrastructure, a shortage of trained healthcare professionals, high illiteracy rates and unreliable power sources. The nation’s government has made some efforts to address these challenges in order to meet the Millennium Development Goals. The National Primary Healthcare Development Agency operates under the Health Ministry to promote and support the development of a high quality primary healthcare system.

mHealth in Nigeria

Photo credit: eHealth Nigeria

But is the Nigerian government prioritizing mHealth as a means to improve healthcare delivery? Omobola Johnson, Nigeria’s recently appointed Technology and Communications Minister, has been pushing toward nationwide mobile coverage as well as the implementation of emergency call centers and phone lines. However, when Johnson revealed the Ministry’s mandate at the end of August, the use of mobile devices for improved healthcare was not mentioned specifically.

Many individuals, private companies, civil society organizations, and aid agencies feel that Nigeria should embrace mHealth as a mechanism for repositioning the country’s healthcare system. Through fuller adoption of mHealth into the healthcare delivery system, many more people could be reached. But the government will need to place mHealth at the top of the agenda and support mHealth initiatives should the emerging field succeed in improving Nigeria’s healthcare.

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