If Ethiopia is to achieve two of the United Nations' Millennium Development Goals, mobile technologies will need to play a central role, according to a proposed strategic plan now being circulated in global development spheres. The document is intended to serve as a model for other countries considering national mobile health strategies.
The UN wants developing countries such as Ethiopia to reduce child mortality by two-thirds and deaths of new mothers by three-quarters between 1990 and 2015. Greater availability of community-based health services are key to achieving these goals, and mobile technologies can make community health workers more efficient and effective, suggests a detailed report from Vital Wave Consulting, a Mountain View, Calif.-based firm that specializes in finding ways technology can help accelerate growth in emerging markets.
"If managed successfully, mHealth can be an effective tool for advancing the government's key health initiatives, particularly community-based interventions that have women at their center," the report says.
But that will not be an easy task.
Ethiopia has nearly 85 million people, but only 8 percent have mobile phones, according to the report. A state-owned telecommunications company has a monopoly on mobile phone service, and service tends to be spotty. Plus, many rural outposts lack reliable electricity, so it's difficult to recharge phones.
Vital Wave, in a report "intended to serve as an early step that can guide the planning and implementation of projects that will benefit communities throughout Ethiopia," is counting on a class of government employees known as health extension workers (HEWs), who get a year of training before being assigned to a rural health center.
"As the front-line workers in the country’s health system, HEWs interact with communities and families as well as other actors in the health system, and as such they have a variety of information and communication needs, many of which could be addressed by mobile or electronic health tools. Their key information and communication needs are referrals, data exchange, supply chain management, training and education and consultation," says the report (emphasis in the original).
The East African nation has placed more than 34,000 community health workers at 14,000 sites since 2003. Unlike the general population, nearly 90 percent of these health workers have mobile phones.
In the report, funded by the Bill and Melinda Gates Foundation, Vital Wave also notes that most mobile phones cannot display text in the native Amharic language and alphabet, but trained health workers are more likely than others to know a language that uses the Latin alphabet. The plan is to roll out mobile health first to these trained health extension workers, then to volunteer "team leaders" in various communities, and finally to the general population.
Importantly, Vital Wave acknowledges that mobile health does not exist in isolation, but rather as part of a larger "digital ecosystem," so programs must be designed to support and work in concert with other technologies. "The ideal digital ecosystem should be simple enough to manage yet complex enough to grow," the report says.
"Wisely, the Ministry of Health is discouraging multiple pilots, each funded by a different company or NGO. Instead, they want partners to get behind a coherent mHealth program that is sustainable and scalable across the whole country. They are doing their homework, assessing various technologies, and considering how new ICT platforms could be partnered with development initiatives in other sectors," reads a Vital Wave e-mail newsletter.
"Many companies in a range of industries (computing, telecoms, networking, pharmaceuticals, and others) should be getting familiar with the nascent Ethiopian national mHealth strategy. Despite restrictive policies in telecoms and financial services policies, authorities are building a foundation for a more prosperous society. Ethiopia is a learning lab for the implementation of a national mHealth strategy. The roll out will illuminate the challenges and opportunities in achieving scale and sustainability for both the private sector as well as the government," the newsletter adds.
However, Vital Wave has designed a "cafeteria" strategy, in which local authorities and health professionals can choose whichever interventions work best in their communities, without worrying about how their decisions will affect the national health system, the report says.