Assessment of SMS-based health applications in emerging countries

A recent study has been released by a team of scientists from the Swiss Tropical and Public Health Institute titled “Short message service (SMS) applications for disease prevention in developing countries.

The paper is of clear interest for mHealth Africa since several SMS-based applications have been presented in our posts “10 best tools to boost mHealth initiatives in AfricaPart 1 & Part 2.

Here are some of the points revealed in the paper written by Carole Déglise, L. Suzanne Suggs and Peter Odermatt.


Objective of the paper

The aim of this review was to describe the characteristics and outcomes of SMS interventions for disease prevention in developing countries and provide recommendations for future work.

The study is based on a systematic search of peer-reviewed and gray literature in English, French, and German before May 2011 that describe SMS applications for disease prevention in developing countries.

Applications for surveillance, disease management, or compliance with a treatment were excluded from the study.


Description of SMS-based applications

A total of 34 SMS applications were described.

The majority of SMS applications were pilot projects in various levels of sophistication. They were classified into 4 modes of intervention:

  • One-way communication
  • Two way communication
  • With or without incentives (some projects generated participation with a rewards system)
  • With educative games

In term of medical application, the paper revealed that HIV is the most covered disease while Malaria rank 3rd:

Disease FocusNumber of applications% of Sample
Sexual & reproductive health513%

Although projects extended across regions, SMS initiatives were concentrated in South Africa, Kenya, and India:

Assessment of applications

Among the 34 application studied only 5 had findings of an evaluation reported:

From those 5 evaluated projects the paper highlight some issues and potential barriers to usage:
  • Lack of timely responses
  • Language barriers
  • Mobile network connection fluctuations
  • Lack of financial incentives
  • Maintenance and SMS costs
  • Potential misuse or private use of SMS.


There are many SMS health initiatives for disease prevention in developing countries, yet few are being evaluated and reported.
Major opportunities are perceived, evident by the number and wide variety of projects, for instance the recent creation of the United Nations Foundation’s mHealth Alliance.
However, the need remains for evidence-based dissemination of information about behavioral, social, economic, and health outcomes in order to provide best practices and strategic directions.