The recently issued report by the World Bank, Information and Communications for Development 2012: Maximizing Mobile, present a large section about mHealth challenges and opportunities in developing countries.
The mHealth Africa team decide to sum up the report in order to give you some takeaways.
In emerging countries, SMS-based solution are the most frequent among mHealth initiatives.
More than 500 mHealth projects have been deployed around the world and Africa in still the region with the most mHealth deployments, while the developed world and other developing regions have seen stronger adoption growth in recent years.
7 kind of mHealth initiatives
The report classified mHealth initiatives into the 7 distinct categories:
|mHealth category||Fields of application||Description / Practical Use|
|Improving management and decision-making by health care professionals||• Treatment of medical conditions|
• Targeted provision of information and marketing about health care products
|• Remote patient tracking
• Updating and verification of digital medical records, accessible to health care providers and pharmacists
• Delivery of health insurance and savings products
|Real-time and location-based data gathering||• Health care delivery and logistics|
• Crisis mapping
• Resource allocation
|• Monitoring and surveillance of disease outbreaks for more timely reporting of symptoms and containment of epidemics
• Crisis mapping after natural disasters
• Reporting of urgent health needs
• Real-time provision with information on available health facilities and resources
• Supply chain management
• Access to health emergency services and rapid response systems
|Provision of health care to remote and difficult-to-serve locations||• Remote provision of health care |
• Extending the reach of health care
• Complementing traditional face-to-face
health care services
|• Medical advice, reminders counseling, monitoring, simple diagnoses
• Focusing on areas where only limited physical infrastructure is available, such as remote and rural areas, including telenursing, teleradiology, telepsychiatry, and tele-education.
|Fostering learning and knowledge exchange among health professionals||• Medical knowledge repositories|
• Virtual communities
• Event and conference organization
|• Retrieving best practices, international standards, and patient histories from other health care professionals
• Local communities
• Expert crowdsourcing for health information wikis
• Virtual classrooms, webinars, and the like
|Promoting public health||• Delivery of health information|
• Awareness building and campaigning
• (Mass-oriented) tele-education
|• Games, quizzes, and other nontraditional mechanisms
• Conventional mHealth prevention and education campaigns
• Medication reminders
|Improving accountability||• Transparency for usage of funds|
• Feedback systems
|• Public health fund flow tracking
• Interactive portals for comments and complaints
|Self-management of patient health||• Enabling better self-help and limiting transactions|
• Lowering health care costs (shifting tasks to the patient)
• Patient empowerment
|• Patients obtain accurate information
• Patients can better understand their diagnoses, for example, by checking medical records
• Mainly focused on noncommunicable diseases and may deal with health indicators such as weight and blood pressure
What are the 4 challenges?
• Insufficient financial resources. It’s a common obstacle fo mHealth solutions, especially if no monetization models have been established. It’s not still clear who should cover the costs between patients, governments or insurance companies. Yet the most expensive part is not the development of mHealth services/product but the integration within the traditional healthcare environement.
For example several project in low-income countries has been stopped once initial funding of pilot projects ended because there were no money to replicate effective models in large-scale implementations.
• Lack of sustainable business models. Sustainable business models need human resources and purchasing power on the demand side, sometimes missing in developing nation. However it seems that patients from there are willing to pay out of their pocket if solutions are adapted to their needs (i.e; not copied on western solutions).
• Difficult coordination of stakeholders. Managing diverse private, public, and non-profit actors can be challenging. Precise roles have yet to be determined and included into clear models. All the players often diverge by their own goal and strategies leading to predictable conflict and inefficiencies.
• Interoperability issues Multiple choice of platform and device create a myriad of different application and standards. Finding and developing interoperable norms would be crucial to allow mHealth service widespread throughout emerging area.
8 advices to implement successful project
While assessing early pilot mHealth projects with dramatically varying levels of success it’s possible to highlight some of basic and simple principle to follow when implementing mHealth initiatives:
- Avoid a one-size-fits-all approach. Respond to people’s needs and suited to their local context.
- Maintain flexibility. Be aware to not overregulate. Create bridge with other industries than healthcare
- Take standards and interoperability into account. Within mHealth sector but also with others (consumer electronic, mMoney,…)
- Track key success indicators for monitoring and evaluation. Seek for evidence from the beginning.
- Ensure quality and content of health information. Lack of trust is a major resistance factor for healthcare profesionals.
- Enable public-private partnerships. Because money and incentive are needed.
- Offer training and take literacy into account. mHealth services will have a greater impact where users have high levels of literacy.
- Ensure the commitment of leaders. Long-term leadership is needed from government and from the health, technology, and financial sectors
The World Bank report is illustrated by several example of mHealth projects in Africa:
- Botswana: Kgonafalo allows for remote diagnosis of health ailments. A pilot project served 6 areas but is ready to expand to 25. Handsets have been replaced with Android tablets.
- Kenya: MEDAfrica, launched in November 2011, integrates a pioneering a viable business model into a single platform, which has attracted worldwide media and investor attention.
- Senegal: RapidSMS saves costs by using SMS aggregation to send text messages to multiple recipients for a single cost.
- South Africa: Cell-Life works with over 50 organizations to notify patients to take medication.