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Analysis: Sending the right message on mHealth
lead photo
NAIROBI, 8 May 2013 (IRIN) - We've read the stories: From bedridden
patients sending text messages to their health workers, to young people
receiving HIV prevention messages via SMS, the mobile phone seems to
have morphed from communications device to essential life-saver. But is
the evidence there yet that mHealth is an effective and suitable health
delivery intervention in the developing world?
IRIN, like others, has been reporting for years on mHealth's potential:
This communication technology could provide the answer to distant and
under-resourced health services, in particular for Africa's poor.
Kenyan health workers
es-off> have recounted how mobile phones have made it easier to track
their patients' progress; there have been anecdotal reports of lower
maternal mortality rates as a result of Ghanaian mothers
ths> being able to call for ambulances during labour.
In Africa, with some 63 mobile phones per 100 inhabitants (compared to
Asia and the Pacific's 89 per 100 inhabitants), the cell in your pocket
can become a direct channel
for receiving public health messages, improving communication between
patients and health providers, boosting data collection and,
increasingly, assisting in diagnosis.
But a systematic review - published in January in PLOS Medicine
1001363> - into the effectiveness of mHealth technology in improving
health delivery found mixed results from 42 trials of mHealth
interventions. SMS appointment reminders, for example, were found to
have modest programmatic benefits, while using phones to send digital
images for diagnosis actually led to a drop in the correct analysis in
two trials examined.
A 2012 study by the mHealth Alliance
3.pdf> , which advocates the use of mobile technologies in health care,
found that sub-Saharan Africa had a higher number of mHealth projects
compared to Asia and Latin America, with more than half of all mHealth
projects related to communicable diseases such as HIV and malaria.
Insufficient evidence
Despite the rapid growth, "there is currently a gap in terms of
evidence linking mHealth to improved health and operational benefits,
and this is particularly true when it comes to studies in low- and
middle-income countries," Patricia Mechael, executive director of the
mHealth Alliance, told IRIN.
The PLOS review found that "none of the trials were of high quality -
many had methodological problems likely to affect the accuracy of their
findings - and nearly all were undertaken in high-income countries."
Rajesh Vedanthan, an assistant professor at New York's Mount Sinai
Medical Centre who is currently working with AMPATH
, an academic health programme involved
in research and health care in Kenya, told IRIN via email that some of
the practical challenges with the use of mHealth technology included
"optimizing the user interface, ensuring that users have an easy and
error-free working experience with the mHealth device, not impeding the
workflow of clinicians, issues related to network connectivity, access
to a central server, coordination of individual devices with a central
coordinating office, systems integration, etc.
geID=20090407&width=490>
Photo: Edgar Mwakaba/IRIN
Smarter communication can boost community health work (file photo)
"mHealth has the potential to assist with several aspects of the 'supply
chain' of care for non-communicable diseases - including
screening/diagnosis, linkage to care, treatment/decision support,
retention and follow-up, systems coordination, etc.," he added. "Whether
mHealth will be effective in all of those arenas is still not robustly
known, and rigorous research is still required."
A need for standards
The mushrooming of mHealth pilot projects has caused concern around
monitoring. Uganda has declared a moratorium on pilot mHealth
initiatives as it seeks to bring them in line with national health
policies.
"We first needed to study them [mHealth and mHealth initiatives]. Some
of these people are duplicating what is already there," Asuman Lukwago,
the permanent secretary in Uganda's Ministry of Health, told IRIN. "As
a ministry, we only implement innovations that have been tested and
approved. At the moment, we are suggesting reforms to put into practice
for these new innovations."
The mHealth Alliance recently released a review
_2013.pdf> of standards in the use of mHealth among low- and
middle-income countries, which found that as mobile health systems "move
towards scale, existing guidelines and strategies will need to be
revised to reflect new demands on executive sponsorship; national
leadership of eHealth programmes; eHealth standards adoption and
implementation; development of eHealth capability and capacity; eHealth
financing and performance management and eHealth planning and
architecture maintenance".
Scaling up mHealth
Mechael noted that mHealth could only meet its potential if it was
fully integrated into general health programmes, becoming "so much a
part of health systems that we no longer need to use 'm' as a
designation", something that cannot happen unless mHealth projects move
beyond the pilot phase and really reach scale at a national or regional
level.
Importantly, experts say, the use of mHealth and other humanitarian
technology should be allowed to be driven by the communities who
benefit from it.
"There has been a recognition - belatedly, in some cases - of the ways
beneficiaries are using technology, voting with their wallets and their
feet... We can see that the most innovative models of humanitarian
technology are driven by communities themselves," Imogen Wall, the
coordinator of communications with affected communities for the UN
Office for the Coordination of Humanitarian Affairs, told IRIN.
She noted that humanitarian agencies would increasingly need to
increase their engagement with the private sector as partners in
preparedness and response, recognizing that the private sector is no
longer merely a support system, but a humanitarian service provider as
well.
OCHA recently released a report, Humanitarianism in the Network Age
%20Network%20Age%20vF%20single.pdf> , which stresses the importance of
information and communication in humanitarian work and urges new ways
of thinking that adapt to the changing realities of communities around
the world.
"In order for humanitarian technology to meet its full potential, there
must be a willingness - an openness - to innovate, to think outside the
box, to test new ideas and to risk failure and success in both the
processes and the deliverables - essentially, a willingness to accept
change," Wall said.
kr/so/oa/cb
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_____
[This report does not necessarily reflect the views of the United
Nations]
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