Still no silver bullet

Tom Wheeler, Image Credit: GSMA

The conference ended last night on a positive note for developing countries. Tom Wheeler, chairman of the board of the mHealth Alliance, told the closing session that the developing world’s patchy healthcare systems make them extra suitable for mHealth applications, which will increasingly depend on services hosted in cyberspace, as opposed to facilities on the ground.

That said, mHealth solutions do not need to be sophisticated to deliver, he added. “It’s all about information, and the network that facilitates the transfer of information. And that information doesn’t have to be ‘zeros’ and ‘ones’. The ability to make a phone call to get someone to take a pregnant mother who is in distress, to a medical facility — there is nothing technologically revolutionary about that. But the impact of that is transformational.”

Personally, I got the feeling that many of the challenges and opportunities that have surfaced during the conference have done so before — and will do so again, at future mobile health meets. “It’s always the same talk,” said a woman I spoke to whose mHealth business had a stall at the exhibition part of the conference.

Another issue was the lack of doctors at a meeting dedicated to healthcare. One speaker on Tuesday commented that although this was a conference about healthcare, all the panelists on the stage at that moment were technology types.

So I leave heartened by what I’ve heard, and the enthusiasm I’ve seen, but wondering when we’ll see the promise of mHealth fulfilled in my own back yard in South Africa. It’s clear that what everybody is waiting and hoping for is a healthcare breakthrough like m-pesa, the mobile banking system that has become hugely successful in Kenya. Something so obviously useful that it can’t help but succeed.

There was no such silver bullet presented at this conference. But given the strong interest from techies and policymakers alike to get mHealth off the ground, this won’t be the last we hear on the subject.

Linda Nordling, SciDev.Net columnist

Health Unbound

David Haddad: Collaboration is part of the code of conduct

Most of the time, when people attend international conferences, they meet, chat and promise to network and that is the end of the story. They wait for the next conference and start the conversation all over again.

Health Unbound is seeking to change that.

“There is a gap in communication. After these conferences nothing happens,” David Haddad, Health Unbound’s director told me as he finished his lunch today.

“We link communities in an informative, educative and social way.”

Health Unbound, also referred to as the HUB and based in Washington DC,  United States, is an online forum that brings together health service providers, donors, development partners and researchers.

“The idea is to let people work and connect wherever they are. The people can speak about specific issues related to them,” he said.

Haddad said the website is a repository for data contributed by members and joining the community was free.

Apart from carrying mHealth related news, the website serves as a noticeboard for research networks and a database of technical programmes.

The first version of the website began in June 2010 but an improved, user-friendly website was launched during this week’s conference.

So far it has more than 500 members, including a vibrant community of African representatives from Ghana and South Africa.

The HUB has six principles, one of which is to enable connections and break down barriers between health implementers, developers and donors.

There is also a code of conduct for members, relating to their work. One that I noted with interest is collaboration.

“Collaboration reduces redundancy, and improves the quality of our work,” says Haddad.

There are plans  to have Arabic and Spanish versions of the site.

Munyaradzi Makoni, freelance science journalist and SciDev.Net contributor

A conference glossary

Know what a 'Moses phone' is? Credit: enter/flickr

Conferences like this always have their own language. Below is a short glossary of terms that I’ve come across so far:

Pilotitis The condition that affects many organsations like the WHO that are overrun with pilot programmes, few of which ever seem to make it to full-scale implementation.

mHealth ecosystem A prerequisite, some say, for functional mHealth services. This involves having the physical mobile infrastructure in place, as well as trained nurses and doctors, policies and guidelines to regulate the services, handset makers, technology companies etc etc. Quite a stretch for developing countries to achieve this…

Telemedicine Not to be confused with mHealth. TM is where you have a doctor at the end of a phone line making a diagnosis, more or less. mHealth includes this, but also applications for prevention and follow-up care, plus informing the public about health issues.

SIM app A mobile application that uses the simplest and cheapest way that mobile phones can communicate: The same mechanism that you use to find out your airtime, say, or phone number, by sending a code to a particular number. Very useful for developing countries where few people have smartphones.

Moses phone Cheap mobile phones made in China that cost US$15-20 each and which even the poorest can afford. Like Moses, these phones are delivering all Africans to the ‘promised land’ of mobile phone ownership.

Freemium A business model where a service is offered for free in a basic version to the majority of users, and the revenue is garnered from a minority of users who can pay for unlimited use of the service.

WHO publishes mHealth survey

Today the summit proper is in full force. There are supposed to be 400 delegates here in total.

This morning, the big news is that the WHO launched what it claims to be the first comprehensive review of mHealth in 114 of its member countries.

The report is quite a tome, stretching for 112 pages, but here are some of the findings:

• The vast majority of countries (86 per cent) reported some kind of mHealth activity.
• The most frequently reported mHealth technologies were health call centres (59 per cent), emergency toll-free telephone services (55 per cent) and managing emergencies and disasters (54 per cent).
• Many mHealth initiatives are at pilot stage.
• Africa reported the least mHealth activity and Europe the highest.
• Results-based evaluation of mHealth implementations is not routinely conducted. Only 12 per cent of member states reported evaluating mHealth services.

The WHO has set itself the task of spreading best practice on mHealth implementation and is in the process of developing a National eHealth Roadmap Development Toolkit for member states. The full report can be downloaded here.

Going forward, collaboration between nations will be vital, it concludes:

“While it is anticipated that large-scale and complex programmes will become more common as mHealth matures, strategies and policies that integrate eHealth and mHealth interoperability into health services would be wise. mHealth is no different from other areas of eHealth in its need to adopt globally accepted standards and interoperable technologies, ideally using open architecture. The use of standardized information and communication technologies would enhance efficiency and reduce cost. To accomplish this, countries will need to collaborate in developing global best practices so that data can move more effectively between systems and applications.”

Linda Nordling, SciDev.Net columnist

‘Please call me’

A free lunch? Image Credit: Amy C Lam/Flickr

mHealth in the developing country context is all about getting healthcare to poor people in remote regions. But how do you provide a service through a paid-for technology — i.e. cell phones — to people with zero incomes? This is where the real innovation happens, we heard today. Sexy iPhone apps with videos and images won’t change the world — it’s the programmes that you can run even if you haven’t got any prepaid airtime left on your phone that will really make a difference to the poorest of the poor.

In South Africa, even the poorest can be reached using a service called ‘Please call me’. This allows people without credit to text a ‘please call me’ SMS message with their telephone numbers to the people they need to get hold of. A way of richer South Africans subsidising their poorer friends, perhaps; but also a potent way of reaching people through advertising and awareness campaigns. A billboard can read “If you are looking for advice on staying HIV free, send a ‘Please call me’ to so-and-so”. The individual will then receive advice on their mobile — free of charge.

Of course, there is rarely such a thing as a free lunch. Many so-called ‘free’ services offered by cellphone networks are only available to customers with some money on their account. Another model that is being used in some mHealth initiatives is the concept of ‘freemium’. That is, the service is free for the majority of users, but is funded by the small number of wealthier users that want more and better access. I have a feeling that business models will be at least as much a focus as technological solutions at this summit.

Linda Nordling, SciDev.Net columnist

Of money and failure

The MAMA alliance will use mobiles to reach pregnant mothers. Image Credit: hdptar, Flickr

Just before lunch we heard from Sandhya Rao, senior advisor for private sector partnerships at USAID, about a pilot project they are going to be rolling out in Bangladesh, South Africa and India. The Mobile Alliance for Maternal Action (MAMA) will develop a programme to improve health of pregnant women before and after the delivery of their child.

Starting in Bangladesh, the pilot will recruit 2000 women who will then receive carefully timed SMSes with medical advice. For instance: ‘if you are bleeding during this month, you should seek medical advice’ or ‘this month, vaccinate your child to protect it from getting sick’.

The initiative will be funded by a mixture of USAID funding, host country government budgets and private funding, for instance through letting companies advertise their products in the SMSes. It also has the support of Johnson & Johnson, a company that manufactures healthcare products.

In the long term, however, the aim is to phase out the USAID funding, and make these systems sustainable on their own — drawing on government funding and private sector income predominantly.

Many mHealth projects seem to be in a financial limbo, where initial funding has been granted by somebody with deep pockets, but the future financial viability of it depends on finding a sustainable business model. I’d say that none of the ideas that we’ve heard here today — from the MAMA alliance to a South African online community for youth to discuss HIV, love and sexuality — are bad. However, it is the way of these things that several of them will fail when the initial funding runs out.

How can such failures help others succeed? By “failing quickly and failing publicly,” said Sean Blaschke, technology development specialist for UNICEF. mHealth is still in its infancy, the people at this pre-summit workshop seem to agree. But will any of tomorrow’s speeches focus on failures? Saying that you’ll report on failures is one thing, doing it in front of an audience of your competitors is another… I guess we’ll see.

Linda Nordling, SciDev.Net columnist

The technology is there — but politics can get in the way

Today is a ‘mHealth 101’ workshop for journalists and others who want to quickly catch-up on the issues involved in this large and diverse field of technological application before the summit kicks off tomorrow.

The first speaker of the day was Joel Selanikio, MD, CEO and co-founder of DataDyne — a company that among other things have developed EpiSurveyor, a neat way for health workers to collect data on things like vaccinations and disease outbreaks in rural areas. The technology is helping the ministry of health in Kenya to act much more quickly on medicine shortages and disease outbreaks, he said.

Cholera outbreak in Zimbabwe. Credit:Sokwanele Zimbabwe

Selanikio explained how the technology applications are playing catch-up with the explosion of mobile phones across poor areas of the world. Even basic phones are many times more powerful than desktop computers were 15 or 20 years ago, he said.

But the session also heard from Lucy, a radio journalist based in Zimbabwe, about the problems that limit access to health data in her country. In Zimbabwe, she said, the government is reluctant to release information on health to journalists. When there was an outbreak of cholera, the information came first from international news sources, and even then the government denied it for a long time.

Lucy’s story illustrates some of the challenges facing the roll-out of mHealth and other mobile technology applications in countries where information is restricted. While this summit will show us all the wonderful things mHealth could do, it’s important to remember that information is power — and a power that some governments, not just in Africa, are reluctant to share.

Linda Nordling, SciDev.Net columnist

Health going mobile: Mobile Health Summit 2011, Cape Town

There are five billion mobile phone subscribers in the world. For many in the developing world it represents the most efficient and reliable way of accessing information and communicating with each other. This provides an opportunity for healthcare providers to improve healthcare for people living in hard-to-reach areas.

The emerging field of ‘m-health’ technology applications will be the focus of the Mobile Health Summit that will be held in Cape Town next week (6-9 June). I will be on site, reporting on the latest innovations and the challenges in rolling them out in developing countries.

On this blog, you will read about the first comprehensive global survey looking at how 112 countries use mobiles to achieve health goals. This report, prepared by the UN Foundation, as part of a partnership with the Vodafone Foundation, and the World Health Organisation will be launched on Tuesday (7 June).

I will also attend an invite-only roundtable where ministers, mobile companies and international development organisations. And of course there will also be a bunch of m-health success stories (and some not so successful ones) to light the road ahead.

Meanwhile, you can check out some of SciDev.Net‘s coverage of mHealth issues on our homepage. Most recently, Jody Ranck argued that using mobile to collect and share health data can make healthcare cheaper, faster and more equitable and we reported from a similar mHealth Summit in Washington DC in November.

Linda Nordling, SciDev.Net columnist