Patricia Mechael, PhD, MHS, is a principal at HealthEnabled, senior mHealth advisor at the United Nations Foundation and a member of the faculty at the Earth Institute and School of International and Public Affairs at Columbia University. She has dedicated nearly 20 years to catalyzing global health movements - including 14 years unlocking the potential of mobile technology to drive ground-breaking innovation to solve global health challenges. She is recognized for her roles as thought leader, professor, researcher, writer and executive director of the mHealth Alliance. She is the recipient of the Knowledge for the World Distinguished Alumnus Award from the Johns Hopkins University, a member of the editorial board of the Journal of Medical Internet Research and co-editor of the book "mHealth in Practice: Mobile Technology for Health Promotion in the Developing World."
Q. What's the one promise of mHealth that will drive the most adoption over the coming year?
A. In low- and middle-income countries there are three main areas where mHealth will drive the most adoption: health systems, health workers and among the general population. Within each area there are one or two mHealth approaches that are rapidly gaining traction and advancing towards national scale. The first of these is health system performance monitoring and disease surveillance. Increasingly DHIS2 is being adopted as the national standard for facility, district and national level health reporting and first mile data capture at the facility level is being supported through mobile phones and tablets. The second area is in the standardization and delivery of health service protocols by health workers. Many national health plans and budgets are now including the procurement and distribution of mobile phones to all health workers within the public sector - in particular to doctors, nurses and community health workers. Decision support tools are being used to aid in the improvement of quality of care and health worker supervision for maternal and child health, HIV and AIDS and malaria, among other health issues, and they're moving from district-level coverage to national scale. Finally among the general population, health information services and the convergence of mHealth and mobile payments are helping to increase access to and coverage of health services in countries like Tanzania and Kenya, where the mobile money sector is rapidly maturing.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. In low and middle-income countries, smartphones and tablets are becoming more powerful, easier to program and cheaper to buy. Alongside this, more local content is becoming available and links between mHealth and mobile money are being more strategically leveraged. Biometrics as an extension of mHealth is also gaining momentum, especially as countries look to ensure that all citizens are registered and have a universal identification beginning with birth, and to track other civil registration and vital statistics as well as coverage of major health services, including immunization.
Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?
A. The increasing use of sensors, medical devices and wearables is making its way beyond the “worried well” and fitness-conscious of North America and Europe to Asia, Africa and Latin America, where they're being used for the care and treatment of non-communicable diseases and remote monitoring of aging populations. As the Internet of Things becomes reality, we will begin to see greater uptake and use of environmental sensors as well as augmented reality in low- and middle-income countries.
Q. What mHealth tool or trend will likely die out or fail?
A. While the uptake and advancement of mHealth will continue in many low- and middle-income countries, the use of the term “mHealth” is beginning to fade. Mobile technologies are increasingly being integrated with other technologies, and the inclusive term “digital health” has become a catch-all for this ever-evolving trend toward capitalizing on technological advancements within the health sector. We will also likely see more smartphone applications and less SMS as phones become more sophisticated.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. The rapid movement toward nationally integrated digital health systems has been surprising in a very positive way. One great example of this is MomConnect in South Africa, which is aiming to register and track every pregnant woman and newborn and provide age- and stage-based information for self and health system-based care. They are also providing a service-rating platform to improve quality of the health services. While the mHealth community has been mobilizing toward this for many years, it is amazing to see the action, strongly led by the Government of South Africa’s Department of Health in collaboration with NGO and private sector partners.
Q. What's your biggest fear about mHealth? Why?
A. I have always feared and continue to fear the inability of privacy and security policies to protect people’s rights without hindering innovation to keep up with the rapid advancement spread of technology. My concern is that with one or two damaging situations the potential and actual benefits of mHealth might be tossed aside. I believe a more proactive approach to these issues is needed - and countries are starting to become more sensible about how to regulate the use of mHealth without losing out on its benefits.
Q. Who's going to push mHealth "to the next level" – consumers, providers or some other party?
A. In global health, I believe that it’s the national governments along with supportive international agencies, NGOs and the private sector that are taking mHealth to the next level as they strive to provide more equitable and better access to and quality of health services and information to their people.
Q. What are you working on now?
A. I am currently a principal at HealthEnabled, is a non-profit organization based in South Africa that serves as a market facilitator enabling technology to strengthen health systems. The organization helps national digital health systems succeed by engaging national and global partners to refine policies, ensure programs are sustainable and support the effective use of technologies for health. The mHealth Alliance, for which I was the executive director, launched HealthEnabled – as the m- and eHealth Expert Learning Program (mHELP) – as a capacity building platform.
Today, HealthEnabled is an independent organization that strives to address the emerging misalignment between digital health policies, programs and user needs. The organization helps countries make informed policy decisions, design programs for scale and sustainability and adopt evidence-based public goods and practices that will lead to the effective use of digital health tools. Its vision is national integrated digital health systems in low- and middle-income countries that improve health and wellbeing for all people by 2020. And its mission is to improve health outcomes by aligning national policies, sustainable programs and user needs to activate the effective and widespread use of integrated digital health tools in low- and middle-income countries
Through a systematic assessment and prioritization approach, HealthEnabled helps identify country-specific needs and serve as “matchmaker” between top implementers and global experts to develop privacy and security policies, connect technology platforms and design systems for scale. HealthEnabled serves as a critical link between supply and demand for integrated digital health systems by acting as a broker, convener and advisor.
HealthEnabled also has established a vetted global network of 60 experts across 44 specialties who come from 24 countries and speak 23 languages. These experts provide thought leadership and help drive much of the work of the organization at the country and regional level. HealthEnabled is based in Cape Town, South Africa, to be close to projects and governments in Africa, and in Washington, D,C, at the Global Development Incubator to be close to large public health implementers and donors.
