"We really see such a huge opportunity here," said Claire Thwaites, head of the Vodafone Foundation and United Nations Foundation partnership. "There are 2.2 billion mobile phones in emerging markets and such a low number of PCs [only 305 million]. The number of healthcare workers and hospital beds are very, very low too. Mobile networks, of course, can be deployed much more easily than can fixed networks. The use of mHealth programs can really have a bigger impact on the ground when up against such barriers like not having hospital expertise for maybe hundreds of miles."
The potential opportunity for mHealth in emerging markets has been no secret to the tech industry, but a sweeping report just released by the Vodafone Foundation and U.N. Foundation partnership, which details some 50 mHealth pilots and programs going on around the world, makes the case clear: the time is now. mobihealthnews caught up with Thwaites, who is currently in Barcelona, Spain for the Mobile World Congress event, to discuss the formation of the mHealth Alliance, a group pulled together by the Vodafone and U.N. partnership as well as the Rockefeller Foundation.
The Vodafone and U.N. Partnership has been running mHealth programs for at least the past three years while working in conjunction with groups like the World Health Organization and other NGOs on the ground in Africa. Last July the Rockefeller Foundation hosted an event on eHealth that included a summit that drew 25 experts from both public groups and private industry who were stakeholders in the mHealth sector. The group included representatives from government agencies, international institutions, NGOs as well as executives from Microsoft, Qualcomm, Nokia, Vodafone and others.
"We wanted to get together because we felt that mHealth was really on the tipping point" Thwaites said. "There is a huge amount of programs going on around the world in pilot phases. We wanted to be able to share what we were doing and see what synergies there were. We made a commitment then to form a global mHealth Alliance."
Thwaites said the mHealth Alliance aims to bring together the major mHealth stakeholders in order to maximize the potential opportunity of mobile health in the developing world. She also noted there will be some movement by the end of the year to incorporate the mHealth Alliance into an independent body.
Why is there a need for the mHealth Alliance?
1) To foster collaboration between public and private interests and between the mobile sector and the health sector. There are different organizations and groups out there that are overseeing various facets of mHealth, but there is no one body that is bringing broad stakeholders together, which is what the mHealth Alliance hopes to do.
2) This body will enable the scale of mHealth programs. While there are a lot of pilot programs that are having some impact on the ground, the real key is scaling up some of these programs and fostering collaboration between the public and private forces in conjunction with what's already taking place on the ground will help scale these programs' activities.
What will the Alliance's key activities be?
"We want the mHealth Alliance to be a thought-leader, which is why we are commissioning rigorous research into why different stakeholders would want to get involved--governments, businesses, NGOs, etc.," Thwaites said. "There is not a lot of research out there yet. We also need to determine what the best regulatory environment for a lot of these programs would be and with that how to address privacy and security. There is a lot of research to be undertaken."
"There is also a lot of activity needed for standardization and sharing of best practices. While we don't see the mHealth Alliance being a standards body or anything like that, what it can be is an advocate to drive this whole field forward."
"Finally, a third role is facilitating better implementation of these programs. We are looking at having annual challenge grants that we will give to public-private collaborations for people who have put together innovative mHealth projects. This way we can invest money and funding in the program and really help drive that project to scale."
What do you see as the general use cases for mHealth in emerging markets?
Thwaites said there are six key use cases for mobiles in healthcare for emerging markets:
1) Using mobiles to improve education and awareness amongst population through text messaging
2) Using mobiles to gather data collection
3) Using mobiles for remote monitoring, especially for medicine adherence
4) Using mobiles to track disease and epidemics
5) Using mobiles for training and communication of health workers
6) Using mobiles for diagnosis and consultation
Describe a few programs that have been successful so far.
DataDayne: "One program that we've supported over the past three years run by an NGO called DataDyne, which developed a software downloadable to wireless devices that lets health workers collect health data in the field. They collect data such as nutritional statistics, medical supply change, immunization and vaccination programs. So they are using PDAs and more and more mobiles to collect data. For the first time you are seeing real-time responses to health challenges from national health ministries and district health offices on the ground, because for the first time instead of collecting patient data by pen and paper (or maybe even not at all) they are getting the information they need and are able to respond to an epidemic outbreak. In Kenya last year they were able to divert medication to the south of Kenya thanks to this program because they could track a polio outbreak as it started."
"The health data collection is having a great impact on the health system itself as it brings greater efficiencies there. We have worked with the WHO to scale that program after having two pilots in Kenya and Zambia two years ago. By the end of this year that program will be deployed across 22 countries in sub-Saharan Africa, which is great because a lot of these pilots are happening in just one village at a time. We have actually seen the Kenyan government invest some money into this program and to start training even more health workers to use this mobile tool."
Text2Change: "The other use case we're seeing is using text messaging to spread awareness and education about particular communicative diseases amongst large populations. There are a few examples of this in the publication, but one great one is Text2Change in Uganda. Information is being relayed to the population about HIV. It's a quiz-based awareness system so recipients of text messages have to text back answers and they are incentivized by getting free [calling minutes] for participating. As a result, there has been a 40 increase in the population getting HIV tests."
Project Masilulekeis: "This NGO is working with a South African carrier MTN who is providing free SMS texting for the program. About 1 million texts were sent every day to distribute HIV information, including info on a HIV hotline people could call with questions. They saw a 350 percent increase in calls to the hotline, which helped people become more aware of preventative measures. About 25 percent of the population in South Africa is suffering from HIV. It has a real stigma there so this program is really opening up private channels for communicating about the disease."
SIMpill: "There is a lot of growth in the information gathering and we are also seeing more interest in remote monitoring where you are tracking patient adherence to taking their drugs. Another application in the report is called SIMpill, which is actually a pill box full of drugs used to combat tuberculosis. That actual pillbox is fitted with a SIM card so a healthcare worker is alerted when the pillbox is opened so they know that the patient is hopefully taking the medicine. They are also alerted if the pillbox is not opened so they contact the patient and ask why. We have seen an adherence rate increase from 22 percent to 90 percent in that program by keeping track of patient drug-taking and texting to remind them to take it has been a great use of the mobile phone."
Most of the programs only make use of SMS or text messaging. Do you think that's set to change or will text messaging remain the key enabling technology for these programs given its simplicity and ubiquity?
"Those are some of the key areas where you have the simplistic health awareness tools that use SMS and then you have much more sophisticated areas like remote diagnosis and consultation through mobile, but we're seeing the bulk of the examples in the SMS area. I think at the moment a lot of foundation and NGOs are pushing the existing programs right now, but you are also seeing that the applications are becoming more sophisticated, especially as you are getting more and better collaboration with both the healthcare and technology industry. We're seeing more sophisticated remote monitoring campaigns and data collection campaigns as well. Also training of health workers is becoming more sophisticated as trainers send copious amounts of data to the trainees. More examples in the simplistic area at the moment but the technology does exist so it's just a matter of collaboration with industry to bring it to the market."