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Tag Archive for: mHealth

Agriculture, Health, Health, Maternal & Child Health, Originally posted on the GBI Portal

USAID MAMA initiative leading the way in mobile for maternal health projects

The USAID-initiated MAMA (Mobile Alliance for Maternal Action) project that utilizes cell phones to improve maternal health in developing countries gave an in-depth update at the latest mHealth Working Group meeting.

The pilot initiative, announced in May by Secretary of State Hillary Clinton and co-sponsored by Johnson & Johnson, has begun work in Bangladesh. MAMA seeks to achieve “scale, sustainability and impact” by creating a replicable model of reaching low-income mothers and household decision-makers (husbands, mothers-in-law) through increasing the impact of current mHealth programs, providing technical assistance to new mHealth models, and improving methods of applying mobile technology to improving maternal health.

At the working group meeting, Sandhya Rao of USAID and Pamela Riley of USAID’s SHOPS (Strengthening Health Outcomes through the Private Sector) program discussed the status of Aponjon, the MAMA project in Bangladesh. Aponjon provides vital health information through mobile phones two times a week to expecting and new mothers, reminding them of when to receive checkups and how to stay healthy during the pregnancy. Bangladesh was chosen to pilot the project because the country’s government has been a leader in promoting and expanding access to ICTs and is very active in mHealth.

Photo credit: Council on Foreign Relations

In order to bring it to a national scale, the burgeoning MAMA initiative has established private, public, and NGO partnerships to help implement its activities, and is carefully monitoring its methods and practices to ensure that the project is reaching its target goals. For example, Aponjon is constantly tweaking the content of its phone messages so that mothers and decision-makers understand, retain and relate to the information given.

Photo credit: Highmark Medicare Services

Another aspect of the project that MAMA will be monitoring is its business models to determine which are the most sustainable and effective. Currently, customers pay service providers to retrieve the phone messages. Text messaging is the cheapest method for remitting information in most developing countries, but many of the poorest clients are unable to read the texts. The alternative is interactive voice response (IVR) through which customers can hear recorded messages at a much lower cost than call centers but more than texting. MAMA and its partners are experimenting with different pay schemes, such as subsidizing rates, working with service providers to offer low rates or donate funds to the project, and charging fees based on usage.

It will take the new initiative years before sustainable, reliable, and replicable models are in place. What is clear is that the potential for improving maternal and newborn health through the use of mobile phones is being tapped.

September 29, 2011/by actualize

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

Mobile Operators as Clinical Service Providers?

Mobile Health Live recently held a live broadcast webinar from Kuala Lumpur to examine the role of mobile operators in the delivery of mobile health services.

The webinar was moderated by Richard Cockle of the GSMA and featured contributions from Claire Margaret Featherstone of Maxis, Irfan Goandal from Qtel, Dr Mubbashir Iftikhar from KPJ Healthcare and Craig Friedrichs from the GSMA.

The panel discussed the opportunities open to operators working within the mobile health sector, and highlighted a number of specific areas of interest where operators can provide tangible benefits to healthcare partners and their patients. According to the panel, support for a stretched public sector and the remote monitoring of patients with lifestyle diseases, such as diabetes and hypertension, are two key services that mobile operators can provide for the mobile health sector

The panel recognised the complex nature of the healthcare industry with multiple stakeholders and country specific regulation affecting local markets and discussed some of the work being undertaken to help facilitate the integration of mobile services into existing value chains.

If you weren’t able to tune in live to the webinar, you can now watch it on demand.

September 21, 2011/by actualize

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

India to use mobile phones to track millions of immunizations

Child being given vaccination. Photo Credit: getty images

India’s health minister announced earlier this month a new initiative designed to boost the country’s rate of immunizing newborns by collecting mobile phone numbers of all pregnant mothers to monitor their babies’ vaccinations over time.

Ghulam Nabi Azad, the health minister, told a World Health Organization meeting in New Delhi that his ministry has been supervising the collection of about 26 million mobile numbers of pregnant women in India since January and plans to finish the job by December.

The women whose numbers are collected will be tracked via the mobile phones in the future by the Indian government to ensure the women’s babies receive the proper immunizations at the proper times. Babies in India are supposed to be immunized against tuberculosis, polio, diphtheria, tetanus, whopping cough and measles, health experts say.

According to Mr. Azad, the campaign will “enable us to monitor our immunization service at a national level. In addition, the central government will be able to check on the accuracy of data collected locally, which is often in doubt.”

The impetus for this program manifested due to a decentralized and deficient public health system, poor monitoring methods and sub standard vaccination coverage.

Photo Credit: wisdomblog.com

In 2010, only 72% of Indian babies received the three doses of the DPT vaccine against diphtheria, tetanus and whooping cough, an accepted indicator of a successful vaccination program, according to a joint estimate United Nations Children’s Fund and the WHO. That compares poorly with Bangladesh at 95% and Indonesia at 83%, according to the same joint estimate.

An inherent problem with the monitoring of vaccinations in India is that once babies are vaccinated, there tends to be no physical record of that baby being vaccinated. It is up to the guardians of the child to remember which vaccination was administered at which time. Also, the district levels governments may report erroneous numbers when reporting on the number of children vaccinated.

This initiative will give the central government the ability to contact the new mothers to confirm their babies’ immunization. “We’ll know the capacity of each state so they can’t fool us,” said Mr. Azad, reflecting widespread frustration.

Such an encompassing initiative is bound to face obstacles. Mr. Azad already encountered problems when he tried calling ten numbers from a list gathered back in February. “In front of all of the ministers, I picked up the phone and dialed the first 10 numbers. Only six of them were accurate numbers. Knowing we were going to be checking these numbers, our health workers still collected 40% faulty numbers—that is very bad” he said.

Mr. Azad declined to detail the cost of the program or how many numbers have been entered into the government’s system so far. But he said that tracking 26 million babies “is not an easy job.”

This is an ambitious project to say the least. Mobile phones after all aren’t permanent tools. A family could potentially report one number and procure a new phone with a new number. Also keep in mind, the Indian government is talking about a series of vaccinations that will span over a number of years for families living in rural areas. There could be a high turnover issue of mobile numbers. Families could also report a false phone number for fear of government intrusion – there is no way of double checking for that. Don’t forget, not all mothers will have a mobile phone to begin with.

The list of possible impediments could go on, but the bottom line is that attaining 26 million accurate and functional mobile numbers is idealistic at best. Nonetheless, this is a good start for the central government – it shows they are paying attention to the issue.

August 29, 2011/by actualize

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

Tanzania tracks malaria prevention with mobile phones

Photo Credit: medatanzania.org

In Tanzania, a new voucher program started in late July that provides discounted insecticide treated bed nets for pregnant women and children. This program also takes advantage of mobile technology as retailers can inform local clinics when their shops are getting low on life saving supplies by text messaging.

The program which is being overseen by MEDA, a Canadian organization, integrates health clinics, wholesalers, retailers and bed net manufacturers. Pregnant women and families with children in rural areas are eligible to receive a voucher from health clinics to get discounted insecticide treated bed nets from health supply retailers at 500 Tanzania shillings (about $0.35).

Once a woman takes a voucher to a retailer and pays a discounted price, she receives a bed net in return. The retailer then uses his or her cell to send a text message back to MEDA, which helps run the program. That SMS provides crucial monitoring data that includes the number of bed nets provided to the community and how many are needed in their next shipment.

The use of mobile technology to monitor bed net stocks and shipments is the feature that set this bed net initiative apart from others.

Each shipment contains a predetermined number of bed nets for a specific region based on their unique needs. Once the bed nets are delivered and the vouchers are collected, the retailers receive monetary compensation.

Long lasting insecticide treated bed nets. Photo Credit: medatanzania.org

In the “fight” against malaria, insecticide treated bed nets are a cost effective and proven weapon, especially for families in rural communities. According to the Global Fund, more than 300 million bed nets have been distributed in Sub-Saharan Africa since 2008. Moreover, Tanzania is a hard hit country as 2 million out of the 44 million people are affected by malaria.

Distributing vouchers for discounted bed nets is not a new method of tackling malaria. However, this approach produces a different sentiment amongst bed net owners than simply passing out bed nets to families for free.

Health workers have found that when a family makes a small investment in the net, it becomes a more valued commodity. Initiatives that pass out bed nets for free sometimes fail because families adopt the mentality that bed nets are valueless and easily replaceable.

This program distributes paper vouchers to the women that visit health clinics. Paper vouchers can easily be lost or ruined altogether. Therefore, keeping track of paper vouchers is often an obstacle. The next step is eliminating paper vouchers and developing text message based vouchers to make the process more efficient.

August 17, 2011/by actualize

Agriculture, Health, Infectious Diseases, Mobile, Originally posted on the GBI Portal

Study shows importance of evaluating mHealth programs

One the biggest issues in mHealth and mobile campaigning in the developing world is the lack of evaluation. Well, the Lancet published an article last week that measured the effectiveness of mobile phone text message reminders on Kenyan health workers’ adherence to malaria treatment guidelines.

What the study found was that text messages can be a cost effective way to improve the care for malaria treatment in African children. Even though the study focused on malaria treatment, the results of the study suggest that using text messages can be an effective weapon to fight many different health burdens with.

According to the study, half of children received the correct treatment at the end of the study, more than double the starting figure. At the beginning of the study, 20.5% of children were correctly managed, this increased to 49.6% after the six month study.

The effect appeared to persist after the texts stopped. Six months after the trial ended, 51.4% of children were receiving the correct treatment due to the text messaging.

Professor Bob Snow, who headed the research group, said, “The role of the mobile phone in improving health providers’ performance, health service management and patient adherence to new medicines across much of Africa has a huge potential.”

Despite the positive numbers, the authors acknowledge that “we do not fully understand why the intervention was successful”. They speculate that the presence of the texts themselves serve as a reminder and reinforce the importance of the message itself.

One of the conclusions in the study is that “text-message reminders should be used to complement existing interventions—which themselves should be qualitatively improved—to target weak points” in health management practices.

The study however, sheds light on the importance of evaluating an mHealth campaign. Through evaluations, stakeholders can figure out whether a program is meeting its goals and how much of an impact it is making on the health issue it was designed for.

Currently in the developing world, numerous mHealth programs are being implemented on a small scale basis without monitoring and evaluation components. This not only leaves the project unfinished, but it is irresponsible as well. If a given program is appropriate to scale up to a wider population, we would never have the statistics to prove it. Then again, that hasn’t stopped NGO’s and governments before.

Evaluating mHealth programs is not a complicated task. Perhaps stakeholders are afraid to discover that their programs are not actually producing the impact they envisioned in the board room. This study has shown that positive results can indeed manifest from text messaging campaigns, and it is worthwhile to evaluate such campaigns.

The world needs to know what works and what doesn’t for the sake of the populations that are supposed to be the beneficiaries of the programs they are involuntarily thrown into. Otherwise, stakeholders are shooting in the dark with the well-being of innocent people.

August 11, 2011/by actualize

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

New app gives Thailand’s healthcare chance to go paperless

A doctor using the Family Folder Collector app on an Android pad, collecting information on a member patient. Photo Credit: bangkokpost.com

Thailand’s public health system has developed a mobile app for Android enabled tablet PC’s to monitor and collect household information on patients. The app, called Family Folder Collector (FFC), was developed by a research team at the National Electronics and Computer Technology Centre (Nectec).

Nectec researcher Watcharakon Noothong said the application comprises three major programs, including a walking map, genogram (a pictorial display of a patient’s health and family relationships) and Java Health Center Information System (JHCIS) synchronization.

FFC is designed to make life easier for public health workers who collect data on patients and for patients who are on time sensitive treatment schedules and cannot travel to health stations at any given moment for treatment.

The app is free. The only cost to utilize the service is paying for the tablet PC’s which is being covered by the province’s public health office.

Here are some of the features and capabilities of the FFC app:

Google maps shows the exact location and number of households in a given area
Genograms can be displayed
Chronic disease frequency can be color coded on a house-to-house basis
The program can collect and store other vital data, such as a patient’s weight, height, blood pressure and pulse rate, and even calculate a patient’s body mass index (BMI) automatically.
The program provides forms for treatment results, initial symptoms, health recommendations, and health behaviors
Doctors can schedule future appointments with patients
In the near future, the program will also be able to send an SMS to alert patients to get treatment at the health station.

All the collected data is updated and stored on the Android device then synchronized to the JHCIS database server. Public health workers were trained on how to properly input data into the tablet PC’s before pilot testing started. Of a total of 25 districts in the province of Ubon Ratchathani, eight are running the pilot trial of the FFC program, which, in its first phase, covers 123 health stations.

Ubon Ratchathani was chosen as the province since its existing IT infrastructure can accommodate sophisticated ICT’s for healthcare. There are over 1.8 million people in the province, all of whom will be accounted for by health workers using the FFC app.

This do-it-all app is a valuable tool for public health officials and physicians in Thailand. FFC can potentially replace the paper based system of collecting data and monitoring patients in Thailand.

The FFC application can display a genogram, monitor chronic diseases with Google Maps, and locate the house coordinates using a GPS system. Photo Credit: bangkokpost.com

The potential benefits of using this service are bountiful. Patient data will be gathered much easier and will be much harder to lose over time. Doctors can schedule appointments and prescribe treatments without physically seeing patients. Also, analysis of patient data will be faster, more efficient and more accurate.

Thailand may experience a revolution in healthcare if this service lives up to its potential. Currently, each health station has one tablet PC equipped with the program. The FFC application is expected to run throughout the province covering all 346 health stations by 2012.

Furthermore, according to Sinchai Tawwuttanakidgul, director of ICT Centre, Office of the Permanent Secretary, Ministry of Public Health, today there are some 45 provinces that are ready to switch from their paper-based system to the FFC mobile application. It sounds like Thailand is ready to experience that revolution soon.

August 11, 2011/by actualize

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

Gamification: The future of mHealth?

Photo Credit: mashable.com

A report that was released at the end of July highlighted the emergence of gamification in mobile services, especially in mHealth. In the report, the term gamification is defined as “the use of gameplay mechanics for non-game applications. The term also suggests the process of using game thinking to solve problems and engage audiences.”

Therefore, in the realm of healthcare, gamification refers to the use of game mechanics or game principles in mHealth applications. In some mHealth circles, a sub field has emerged call health games, which are games that are intended to improve the health of the users. The report suggests that gamification is the future of mobile, web and social media technology.

These gaming apps are designed to alleviate health burdens by promoting healthy behaviors and actions, and educating users on the nature of the burden itself.

For instance, there could be a gaming app on the importance of having an insecticide treated bed net for malaria prevention. The app could educate the user on how malaria is contracted and how to treat it by presenting a series of questions to answer for a prize.

At its most basic level, these apps can reward the user with virtual or actual incentives as they complete certain actions that attenuate a health burden. The incentive encourages the user to perform the action.

A recent Gartner report predicts that by 2015, more than 50% of organizations will gamify their innovation processes. “By 2014, a gamified service for consumer goods marketing and customer retention will become as important as Facebook, eBay or Amazon, and more than 70% of Global 2000 organizations will have at least one gamified application,” says the report.

SCVNGR founder Seth Priebatsch agrees. “It feels like the next natural evolution of human-technological interaction to me,” he says. As we complete the social layer, we’ll begin construction in earnest on the game layer.”

In the realm of health, gaming apps can be used as tools to encourage a diet plan, educate about a disease, promote drug adherence, and present treatment options. According to experts, one indirect result is that along with promoting certain actions towards improving health, the games may also generate positive attitudes and improve emotional states towards achieving better health.

Photo Credit: texttochange.org

In the developing world, one such app exists called Freedom HIV/AIDS that was implemented in India and Africa. Designed to promote HIV/AIDS awareness, the app offers games themed for its location. For instance, in India, safety cricket, and Quiz with Babu were just some of the games through which HIV/AIDS awareness was promoted.

Text to Change(TTC) is another mobile service that offers gaming apps to its participants. Implemented in Africa, TTC offers quiz games that educate participants about different health burdens. In the end of the quizzes, incentives are provided to the participants. TTC’s services have been popular with UNICEF, WHO, UN and USAID initiatives.

The games are a great way to engage people with health campaigns that may otherwise be neglected due to lack of social interaction. Another report says that gaming apps can help overcome the guilt associating with failing to complete a health program. The report says, “ Games help patients manage that guilt. The game navigates patients through their story of successes and failures until they ultimately become victorious.”

If this is one of the roads that will be embarked by mHealth apps, and mobile apps as a whole, at least it will be a fun one. After all, when was the last time anyone had fun learning about HIV/AIDS or vaccinations?

August 9, 2011/by actualize

Agriculture, Environment, Originally posted on the GBI Portal

Sachs says Millennium Villages are a model to avoid famine

Photo credit: Millenium Villages

Last week, renowned development economist and special advisor to the UN secretary for the millennium development goals, Jeffrey Sachs, wrote a series of public articles advocating for use of “cutting-edge technologies” to fight the current epidemic and to create sustainable solutions to avoid famine in the first place. He said that the Millennium Villages are a good example of ways to use technology in order to anticipate and prevent drought and famine from spreading.
What technologies are the Millennium Villages using? How do these technologies inform and assist villagers to mitigate potential food insecurity and the affects of climate change?
As listed on the Millennium Villages website, the main goals that for ICTs include:

Establish and improve mobile telephone and internet connection

Greater access to energy, improved transport and information and communication technologies (ICT)

In addition, each village has individualized goals and projects, depending on their circumstances and resources. Many of the villages have implemented mHealth initiatives, computer laboratories, other ICT-related projects. Just a few have organized ICT projects to ensure energy and environmental sustainability. Those few include:

Dertu, Kenya – In 2008, in partnership with Ericsson, Dertu received a cell tower and Internet connectivity; Sony-donated laptops provide Internet access at the school

Ruhiira, Uganda – Schools and clinics now have access to electricity through low-cost solar technologies

Ruhiira, Uganda – Partnership with Zain and Ericsson has increased cell phone coverage through the construction of cell towers

Perhaps additional ICT-based projects are underway to ensure environmental sustainability and avoid the long-term effects of drought, but they are not listed on the Millennium Villages website. Sachs’ claim that ICTs have decreased famine and anticipated drought in the Millennium Villages, then, is possibly true, but is not verified by documented evidence available on their website. A more detailed evaluation of the villages is needed, or a report synthesizing the lessons learned from the ICT projects completed.
As many have pointed out over the past few months during the famine and drought in the horn of Africa, famine is preventable when the circulation of goods is active and well-planned. Stable distribution of goods, and monitoring of climate change and weather patterns is key to ensuring food security, environmental sustainability, and consistent agricultural production. ICTs can aid in all of these practices, but their effectiveness is in need of additional documentation and review.

August 9, 2011/by actualize

Agriculture, Health, Infectious Diseases, Mobile, Originally posted on the GBI Portal

Grad students build novel tool in fight against malaria

Photo Credit: geardiary.com

A new faction has joined in the war against malaria: graduate students. A group of students developed a malaria diagnostic tool that will be rolled out in India and Ethiopia this summer. Called, the Lifelens project, the tool uses a micro lens on the camera of mobile phones that can ultimately test for and diagnose malaria.

Created by Harvard Business School student Cy Khormaee and UC Davis doctoral student Wilson To, the lifelens product attaches a $50 micro lens to the camera of a Windows 7 enabled smartphone.

With the camera in place, the phone can then capture high-resolution images of the cells in a drop of blood that is placed on the micro lens. Windows 7 software quickly analyzes the images, confirming the presence or absence of malaria. Once the images are analyzed, the results can be sent to public health workers and other health professionals via SMS for further assessment and data collection.

Current standard practices in malaria diagnosis involve administering a rapid diagnostic test (RDT). This method takes a blood sample, usually off of the finger of the patient, and then exposed to a cotton swab containing a solution that reacts with malaria antigens that may be in the blood. However, this method is inefficient and produces many false positives, with only a 40% accuracy rate.

Photo Credit: springwise.com

The lifelens tool acts as a powerful microscope and can easily be sterilized for further immediate usage. It is also more accurate than RDT since it detects malaria cells directly. To and Khormaee say that in the long run, the lifelens tool will be more cost effective than current RDT detection methods.

However, there are some obstacles. The lifelens tool only operates on a Windows 7 enabled smartphone. These phones cost hundreds of dollars and may be affordable in resource poor areas. Also, the lifelens tool is not the only novel technological tool in the malaria detection space. Disposable tests are already in wide use, and others are developing diagnosis technologies, including a DNA-based one that could, like Lifelens, test for malaria and other illnesses.

The lifelens project received an award in the Microsoft sponsored Imagine Cup competition that featured innovative technological tools that use Microsoft software. With this award in hand, To and Khormaee plan to roll out a testing phase for their tool in India and Ethiopia.

Virtually all deaths from malaria occur in the developing world with 90% occurring in Africa. Any advancement in malaria diagnosis is highly valued. The lifelens project is aiming to change the way infectious disease diagnosis is handled. “Malaria is just the beginning,” says To. “We’re building a platform.”

August 3, 2011/by actualize

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

Fight against HIV/AIDS in India gets helping hand

Argusoft, a Fremont, CA start-up that’s combines video, instant messaging and Internet telephony in a platform for “e-health” programs in the developing world, is ready to implement a mobile phone application that will enable field workers to register HIV-positive mothers and provide regular updates on their care.

The application, called mAID, runs on any java-enabled phone and utilizes the SMS interface. It is designed primarily for health workers that go out into rural communities to inform citizens on different health issues.

Using the application in the field is simple. Cell phones are given to health workers who communicate through the phone to a central database. The health workers are sent daily instructions in the morning via SMS on where to go and which houses to visit. The health workers collect relevant data on HIV/AIDS prevalence and awareness and report the data back to the central database via SMS.

The new program is overseen by the Indian government with financing from the Global Fund, a nonprofit in Geneva that targets AIDS in developing countries. IL&FS, an infrastructure development conglomerate based in Mumbai, is handling logistics.

mAID underwent a pilot test where 35 health workers reached over 2500 patients using the application. The pilot phase ended last month, and based off its results, the Indian government wants to inject 3600 more health workers into the field with the mobile app for a nationwide scale up. There are even talks about using the application in Africa.

Argusoft's Ram Gopalan. Photo Credit: mercurynews.com

The CEO of Argusoft, Ram Gopalan has cited the difficulties of preventing HIV/AIDS as the impetus of his application. “It’s fully preventable, but one of the highest killers of children in the Third World,” Gopalan said.

Gopalan echoes the same sentiments of the Indian Government who have been working to prevent prenatal HIV transmission since 2002, using counseling and testing centers around the country. The Indian Government also cited issues with health worker capacity. Regarding that Gopalan said, “There was a lot of inefficiency, workers misinterpreting instructions, and paperwork getting lost.”

Argusoft is no stranger to implementing eHealth initiatives. In the eastern Indian state of Tripura, Gopalan linked isolated villages with a hospital in the state capital where doctors can remotely diagnose simple but life-altering problems such as cataracts. This telemedicine project has provided eye care for more than 100,000 patients over the past five years.

In the future, Gopalan wishes to introduce a network of accredited family-care doctors from India who could be available 24/7 for live video chats with patients. This is similar to the meradoctor project which already exists in India. In the meantime, the HIV/AIDS burden in India needs some attention as it is the third highest burden in the world in terms of sheer numbers living with HIV.

July 28, 2011/by actualize

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