The use of mobile phones in the field of Healthcare in developing countries

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Nov 12, 2013 (3 years and 11 months ago)

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The use of mobile phones in the field of Healthcare in developing
countries

Completed Research Paper

Sanket Jaju

sjaju@umd.edu


University of Maryland


The Power of Mobile Technology

Mobile phone usage in developing countries is increasing. 64% of
mobile phones are being used in the developing
world. There are more mobile than fixed lines. According to the International Telecommunications Union, the
continent of Africa has some 280 million total telephone subscribers, of which some 260 million (over

85%) are
mobile cellular subscribers.
[
1]

As such it represents the continent with the highest ratio of mobile to total telephone
subscribers of any region in the world.

The question is how to tap into this explosion of mobile phone usage to
support healt
h care programs in developing countries.
Despite limitations in Internet and electricity access, most
developing countries have some degree of mobile phone coverage. According to the U.N. Foundation, about 80% of
the world's population lives in a region wi
th mobile phone coverage and about 64% of all mobile phone use
rs live in
the developing world
[1]
.

Many people in developing countries already possess mobile phones and are familiar with
basic functions such as making phone calls and sending text messages. Therefore, he said, it doesn't take long to train
people to use new mobile phone applications suc
h as Internet browsers or information systems.

There are 2.2 billion mobile phones in the developing world, 305 million computers but only 11 million hospital beds,"
said Terry Kramer, strategy director at British operator Vodafone at the Mobile World Cong
r
ess held in Barcelona this
week

[46].
As a result there has been a need to

have

these

banded together to advance the use of mobile phones to
better aid those in need of healthcare in the developing world
.

This way a

new alliance wants to guide governments
,
NGOs, and mobile firms on how mobile technology can be used to help save lives.

Mobile

technology has the potential
to
revolutionize

health care in developing countries
, particularly in the area of heath awareness schemes and training
health care profess
ionals. Mobile phones are generally affordable and available to the population at large, making
them more accessible than computers and far more cost
-
effective than hospital beds.

Innovative mobile technologies
are helping to fundamentally transform health

care in many developing countries.
[47]

Mobile phones have made a recent and rapid entrance into many parts of the low
-

and middle
-
income world, with the
global Mobile phone penetration rate drastically increasing over the last decade. Improvements in
tele
communications technology infrastructure, reduced costs of mobile handsets, and a general increase in non
-
food
expenditure have influenced this trend. Low
-

and middle
-
income countries are utilizing mobile phones as “leapfrog
technology” (see leapfrogging).

That is, mobile phones have allowed many developing countries, even those with
relatively poor infrastructure, to bypass 20th century fixed
-
line technology and jump to modern mobile technology.
[16]

The number of global mobile phone subscribers in 2007 wa
s estimated at 3.1 billion of an estimated global population
of 6.6 billion (47%). [17] These figures are expected to grow to 4.5 billion by 2012, or a 64.7% mobile penetration rate.
The greatest growth is expected in Asia, the Middle East, and Africa. In
many countries, the number of mobile phone
subscribers has by
-
passed the number of fixed
-
line telephones, this is particularly true in developing countries. [18]
Globally, there were 4.1 billion mobile phones in use in December 2008.


While mobile phone p
enetration rates are on the rise, globally, the growth within countries is not generally evenly
distributed. In India, for example, while mobile penetration rates have increased markedly, by far the greatest growth
rates are found in urban areas. Mobile pe
netration, in September 2008, was 66% in urban areas, while only 9.4% in
rural areas. The all India average was 28.2% at the same time. [19] So, while mobile phones may have the potential to
provide greater healthcare access to a larger portion of a popula
tion, there are certainly within
-
country equity issues
to consider.

Technology

Mobile phones are spreading because the cost of mobile technology deployment is dropping and people are, on
average, getting wealthier in low
-

and middle
-
income nations.[20] Ven
dors, such as Nokia, are developing cheaper
infrastructure technologies (CDMA) and cheaper phones (sub $50

100, such as Sun's Java phone). Non
-
food
consumption expenditure is increasing in many parts of the developing world, as disposable income rises, cau
sing a
rapid increase spending on new technology, such as mobile phones. In India, for example, consumers have become
and continue to become wealthier. Consumers are shifting their expenditure from necessity to discretionary. For
example, on average, 56% o
f Indian consumers’ consumption went towards food in 1995, compared to 42% in 2005.
The number is expected to drop to 34% by 2015.Indian consumers are getting wealthier and they are spending more
and more, with a greater ability to spend on new technologie
s. [21]

Basic SMS functions and real
-
time voice communication serve as the backbone and the current most common use of
mobile phone technology. The broad range of potential benefits to the health sector that the simple functions of
mobile phones can provid
e should not be understated. [22]

The appeal of mobile communication technologies is that they enable communication in motion, allowing individuals
to contact each other irrespective of time and place.[23][24] This is particularly beneficial for work in re
mote areas
where the mobile phone

is

increasingly wireless infrastructure

and as a result

able to reach more people, faster. As a
result of such technological advances, the capacity for improved access to information and two
-
way communication
becomes more
available at the point of need.

More advanced mobile phone technologies are enabling
chances for having a better future

for further healthcare
delivery. Smartphone technologies are now in the hands of a large number of physicians and other healthcare worke
rs
in low
-

and middle
-
income countries.
[48]

Smartphone technologies opens up doors for projects such as technology
-
based diagnosis support, remote diagnostics and telemedicine, web browsing, GPS navigation, access to web
-
based
patient information, and decentralized health management information sys
tems (HMIS).

While uptake of Smartphone technology by the medical field has grown in low
-

and middle
-
income countries, it is
worth noting that the capabilities of mobile phones in low
-

and middle
-
income countries has not reached the
sophistication of those

in high
-
income countries. The infrastructure that enables web browsing, GPS navigation, and
email through Smartphone’s is not as well developed in much of the low
-

and middle
-
income countries.[25] Increased
availability and efficiency in both voice and da
ta
-
transfer systems in addition to rapid deployment of wireless
infrastructure will likely accelerate the deployment of mobile
-
enabled health systems and services throughout the
world.[26].

Technologies relates to the Operating Systems which orchestrate mo
bile device hardware while maintaining
confidentiality, integrity and availability are required to build trust. Devices in this class may include Apple's iPad 1&2
and Motorola's Xoom. Operating systems which control these emerging classes of devices includ
e Google’s Android,
Apple’s iPhone OS, Microsoft's Windows Mobile, Nokia Symbian OS and RIM's BlackBerry OS.

Operating Systems must be agile and evolve to effectively balance and deliver the desired level of service to an
application and end user, while ma
naging display real estate, power consumption and security posture. As advances
in capabilities such as integrating voice, video and Web 2.0 collaboration tools into mobile devices, significant
benefits can be achieved in the delivery of health care servic
es. New sensor technologies such as HD video and audio
capabilities, accelerometers, GPS, ambient light detectors, barometers and gyroscopes [27] can enhance the methods
of describing and studying cases, close to the patient or consumer of the health care
service. This could include
diagnosis, education, treatment and monitoring.

As par
t of

health IT strategy, the foundation intends to leverage
mobile phone
-
based technologies to improve health care access, quality and efficiency.

Technologists believe

that
the foundation sees mobile health technologies "as sort

of the front lines of e
-
health[23].

A
strong foundation of

servers, databases and Web sites will be necessary to support the mobile phone
applications;

health

workers can use the devices to extend their reach to regions that lack adequate health care infrastructure.

Such

mobile health tools are particularly suited to meet the needs of developing countries. The thing that is very
compelling about the mobile phon
e is that it's an infrastructure,

and it exists for the most part in a lot of these
countries
.
The mobile phone is mu
ch more suited to

environments in some cases than a computer or a laptop or an
Internet connection because

it doesn't use a lot of power.

A

lot of

staff members work with local and international
nongovernmental organizations to develop mobile data collection and dissemination tools
.

Turning Mobile Phones Into Health Solutions

Therefore an

effective health system management requires active communication about regional health trends and
medical needs. For example, mobile health tools could improve clinic management, facilitate disease surveillance, and
enable clinical research
.

For example,
system
s

convert large clinical documents into formats that are easily readable on the small screens of
mobile devices.
Such a
system allows physicians and nurses in developing countries to access current medical
research and literature.
[36].
Meanwhile,
so
me

system
s

an open
-
source mobile phone application that allows health
care workers to electronically submit reports to district health centers or health ministries. Officials then can use the
data to monitor health trends or
diseases in a particular region

[36].

Already, mobile technology is providing and augmenting healthcare initiatives throughout the world. In a recent
study released by the UN and Vodafone titled, "mHealth for Development: The Opportunity of Mobile Technology for
Healthcare in the Develo
ping World," over 50 of these types of initiatives throughout 26 countries were discussed.
The biggest adopters of mobile technology were India with 11 projects and South Africa and Uganda with 6 each.

[46]

In
future
, doctors will be replaced by robots and

patients will have advanced cell phones capable of screening for
cancer

and

monitoring wound healing. When sites offering medical advice first appeared on the World Wide Web few
GPs believed that, within a decade, they would encounter patients who used th
e Internet to become specialists in a
particular ailment. Before the arrival of the 'informed patient' the GP was expected to provide a diagnosis,
and then

recommend a course of treatment. Mobile and wireless
e
-
health

will enhance and broaden the scope of
this type of
self diagnosis.

Companies
that are run by clinicians with firsthand experience of clinical processes

will accelerate the take up of
wireless
e
-
health
. They will

giv
e

credibility to
e
-
health

and providing reference sites with
in the healthcare s
ector itself

[47]

Motivation of mHealth

MHealth is
option
of
e
-
health

which is
helping people

how to acquire, transport, store, process, and secure the raw
and processed data to deliver meaningful results

[1]
. mHealth

offers the ability of remote individuals to participate in
the health care value matrix. Participation does not imply just consumption of health care services. In many cases
remote users are valuable contributors to gather data regarding disease and publi
c health concerns such as outdoor
pollution, drugs and violence

[2]
.

The motivation behind the development of the mHealth field arises from two factors. The first factor concerns the
constraints felt by healthcare systems of developing nations. These const
raints include high population growth, a high
burden of disease prevalence

[
5]
,

low health care workforce, large numbers of rural inhabitants, and limited financial
resources to support healthcare infrastructure and health information systems. The second f
actor is the recent rapid
rise in mobile phone penetration in developing countries to large segments of the healthcare workforce, as well as the
population of a country as a whole.[6] With greater access to mobile phones to all segments of a country, inclu
ding
rural areas, the potential of lowering information and transaction costs in order to deliver healthcare improves.

The
combination of these two factors has

motivated much discussion of how greater access to mobile phone
technology can be leveraged to mitigate the numerous pressures faced by developing countries’ healthcare systems.
It
looks like mHealth will revolutionize healthcare in developing counties by

allowing medical staff to survey the
population, train staff in the field and use SMS marketing to change the population's attitude towards health issues.
Middle income and especially low
-
income countries face a plethora of constraints in their healthcare

systems. These
countries face a severe lack of human and physical resources, as well as some of the largest burdens of disease,
extreme poverty, and large population growth rates. Additionally, healthcare access to all reaches of society is
generally low
in these countries.

Examples of the mHealth projects included:



Sending mobile phone owners updates on diseases via SMS.
[
50
]



Letting health workers in Uganda log data on mobile devices from the field.
[
50
]



In South Africa, the SIMpill is a sensor
-
equipped
pill bottle with a SIM card that informs doctors whether
patients are taking their tuberculosis medicine.
[
50
]



In Uganda, a multiple
-
choice quiz about HIV/AIDS was sent to 15,000 subscribers inviting them to answer
questions and seek tests. Those who comple
ted the quiz were given free airtime minutes. At the end of the
quiz, a final SMS encouraged participants to go for voluntary testing. The number of people who did so
increased from 1000 to 1400 over a 6
-
week period.
[
50
]



In the Amazonas state of Brazil, he
alth workers filled in surveys on their phones about the incidences of
mosquito
-
borne dengue fever.
[
50
]



In Mexico, a medical hotline called MedicallHome lets patients send medical questions via SMS.
[
50
]

mHealth for Development

mHealth is a term used for th
e practice of medical and public health, supported by mobile devices. The term is most
commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health
services and information. The mHealth field has emerged as a

sub
-
segment of
e
-
health
, the use of information and
communication technology such as computers, mobile phones, communications satellite, patient monitors, etc., for
health services and information.[1] mHealth applications include the use of mobile devices

in collecting community
and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real
-
time
monitoring of patient vital signs, and direct provision of

care
.

[2]

Mobile
e
-
health

or mHealth broadly encompasses

the use of mobile telecommunication and multimedia technologies
as they are integrated within increasingly mobile and wireless health care delivery systems. The field broadly
encompasses the use of mobile telecommunication and multimedia technologies in h
ealth care delivery.
[2]

While there are some projects that are considered solely within the field of mHealth, the linkage between mHealth
and
e
-
health

is unquestionable. For example, an mHealth project that uses mobile phones to access data on
HIV/AIDS rat
es would required an
e
-
health

system in order to manage, store, and assess the data. Thus,
e
-
health

projects many times operate as t
he backbone of mHealth projects
[1]
.

It
can largely be viewed as technology that supports the functions and delivery of heal
thcare, while mHealth rests
largely

on providing healthcare access
[4]
.

Because mHealth is by definition based on mobile technology such as
IPhones, healthcare, through information and delivery, can better reach areas, people, and/or healthcare
practitione
rs with previously limited exposure to certain aspects of healthcare

[4].

While mHealth certainly has application for industrialized nations, the field has emerged in recent years as largely an
application for developing countries, stemming from the rapid
rise of mobile phone penetration in low
-
income
nations. The field, then, largely emerges as a means of providing greater access to larger segments of a population in
developing countries, as well as improving the capacity of health systems in such countrie
s to provide quality
healthcare.

Within the mHealth space, projects operate with a variety of objectives, including increased access to healthcare and
health
-
related information (particularly for hard
-
to
-
reach populations); improved ability to diagnose and

track
diseases; timelier, more actionable public health information; and expanded access to ongoing medical education and
training for health workers.[1]
.
T
he biggest benefit of the mobile revolution

has been that it enables emergency
response teams to co
-
ordinate their efforts using mobile phones. Over the last few years, mobile technology has
allowed health professionals to gather large amounts of information from the public in real time, replacing p
aperwork
that would have previously been passed up from local, district, regional up to national health
organizations
.

SMS to encourage medication

SIMpill is another example of SMS, being used to help combat diseases. This time it is about making sure
people take
their medication. It was used during a 2007 trial in South Africa to ensure people took their medication for TB. In the
pilot, 90% of patients complied with their TB medication compared to 22% to 60% take
-
up without it.
[48]

SIMpill

uses a presc
ription bottle with an embedded mobile phone chip. Basically, it is a pill bottle that uses mobile
phone technology to remind people on medication to take their pills on time.
It also

warns the patient if they are
about to take too much.
[48]

The system wor
ks in two parts. The patient's pill
-
taking schedule is programmed into a tamper
-
proof pill bottle which
communicates with the patient's mobile phone. The SIMpill server is also

programmed with the patient's medication
schedule and communicates with the pat
ient's SIMpill dispenser in which their medication is kept. The server
monitors the patient medication schedule against the times when the patient opens the dispenser and initiates, in real
time, the programmed responses as detailed below.
[48]

If the patie
nt takes their medication as prescribed, no communication is made and the "medication event" is stored in
the database. If the patient does not take their medication as prescribed, then, after a set deviation period, the patient
is sent a reminder to take
their medication.
[48]



Air Quality Sensing Technologies

Environmental conditions have a significant impact to public health. Per the World Health Organization, outdoor air
pollution accounts for about 1.4% of total mortality
. [
28] Utilizing Participatory
sensing technologies in mobile
telephone, public health research can exploit the wide penetration of mobile devices to collect air measurements
, [
27]
which can be utilize to assess the impact of pollution. By aggregating this data, public health policy sha
ll be able to
craft initiatives to
lessen

risk associated with outdoor air pollution.
[28]

mHealth

and Health Outcomes

The mHealth field also houses the idea that there exists a powerful potential to advance clinical care and public health
services by facil
itating health professional practice and communication and reducing health disparities through the
use of mobile technology
[1]
.

Efforts are ongoing to explore how a broad range of technologies, and most recently
mHealth technologies, can improve such healt
h outcomes as well as generate cost savings within the health systems
of low
-

and middle
-
income countries. In some ways, the potential of mHealth lies in its ability to offer opportunities
for direct voice communication and information transfer capabilitie
s that previous technologies did not have. Overall,
mobile communication technologies are tools that can be leveraged to support existing workflows within the health
sector and between the health sector and the general public
. [
31]

Within the mHealth space
, projects operate with a variety of obje
ctives:

1.

Increased

access to healthcare and health
-
related information (particularly for hard
-
to
-
reach populations)

2.

Improved

ability to diagnose and track diseases

3.

Timelier
, more actionable public health information

4.

Expanded

access to ongoing medical education and training for health workers

Applications in the mHealth Field

While others exist,
some applications of mhealth are to:
-


1.

Education and awareness

2.

Helpline

3.

Diagnostic and treatment support

4.

Communication and t
raining for healthcare workers

5.

Disease and epidemic outbreak tracking

6.

Remote monitoring

7.

Remote data collection



Education and awareness

Education and awareness programs within the mHealth field are largely about the spreading of mass information
from
source to recipient through short message services (SMS). In education and awareness applications, SMS
messages are sent directly to users’ phones to offer information about various subjects, including testing and
treatment methods, availability of health
services, and disease management. SMSs provide an advantage of being
relatively unobtrusive, offering patients confidentiality in environments where disease (especially HIV/AIDS) is often
taboo. Additionally, SMSs provide an avenue to reach far
-
reaching ar
eas

such as rural areas

which may have
limited access to public health information and education, health clinics, and a deficit of healthcare workers [1]

Below is a list of mHealth Education and Awareness projects:

Country

Name

Man

or services

Sponsors

Telkom
partner
role

Mexico

Vida net
[22]

Vida net gives People Living
With HIV (PLWHIV) the
ability to register to receive
messages to help improve their
adherence to their specific
treatment.

Votive has partnered with the
Institute Carson de la Salad
(ICS)


Mexico

Cardio net
[22]

Votive, along with ICS, has
developed CardioNet, a
solution in self
-
health care,
health risk prevention, and
adherence to prescribed
treatments.

Voxiva has partnered with the
Instituto Carso de la Salud
(ICS)


Rwanda/Uganda

ResultsSMS.org

ResultsSMS is an open
-
source
platform compatible with
OpenMRS designed to
disseminate test results,
patient education, follow
-
up
appointments and adherence
reminders to patients via SMS.

ResultsSMS is a partnership
between

GPAS,

and

Support
for International Change

with
seed funding from
the

Harvard Initiative for
Global Health


India

Freedom
HIV/AIDS


Freedom HIV/AIDS comprises
four mobile games targeting
different mindsets and
psychology of mobile users.
The games are deployed on
low
-
end
black/white to
sophisticated high
-
end colored
devices.

Freedom HIV/AIDS

is a social
initiative of

ZMQ Software
Systems (A Technology for
Development Social
Enterprise). The initiative is
supported by Delhi State
AIDS Control Society and was
launched by Chi
ef Minister of
Delhi Shrimati Sheila Dikshit.


Uganda

Text
to
Change

[34]

HIV/AIDS awareness via an
SMS
-
based multiple choice
quiz in exchange for free
airtime
.

Celtel, AIDs Information
Centre (AIC), Merck, and the
Dutch Ministry of Foreign
Affairs


Uganda, Tanzania and
Kenya in Eastern
Africa, and Malawi,
Mozambique and
Namibia in Southern
Africa


Africa Reach
Program

[34]

Freedom HIV/AIDS
introduced two HIV/AIDS
awareness games to countries
in Africa.

Freedom HIV/AIDS is a social
initiative

by

Afri
ca Reach
Program supported by Hivos,
a leading Dutch development
organization, and KPN, the
largest Dutch telecom
company, under the "Star
Programme"


Many countries

Frontlines

[34]

Free open source software that
turns a laptop and a mobile
phone into a central
communications hub that
enables users to send and
receive text messages with


large groups of people through
mobile phones, without
requiring an internet
connection


UNICEF/G
eorgia





Mobile4Good





(table retrieved from
http://en.wikipedia.org/wiki/Mhealth
)

Helpline

Helpline typically consists of a specific phone number which any individual is able to call to gain
access to a range of
medical services. These include phone consultations, counseling, service complaints, and information on facilities,
drugs, equipment, and/or available mobile health clinics
.

Below is a list of mHealth Helpline projects:

Country

Name

Program
size

Major services

Insights and
Outcomes

Sponsors

Bangladesh

Healthline

[36]

10000
Calls per
day

Phone consults,
information on facilities,
drugs, test result
interpretation, discounts
on hospital visits

Top health complaints:
Chronic diseases
(40%),
ENT, early pregnancy,
malaria, pneumonia (each
8%), diarrhea (7%)

MNO
-
sponsored:
Telemedicine
firm and MNO

Colombia

Telemedic

[36]




Independent

Dominican
Republic

Telemed

[36]




Independent

India

HMRI

[36]

50000
Calls per
day

Phone consults,

counseling and
complaints, information
on facilities, drugs,
mobile health clinics
(vans).

Top health complaints:
Recurring abdominal pain
(13%), back pain (9%),
knee pain (8%)

Government
-
sponsored:
Government and
a private charity

Mexico

Telemedic

[36]




Independent

Mexico

MedicallHome
[36]

10000
Calls per
day

Phone consults,
information on facilities,
drugs, discounts at
clinics, pharmacies.
Mission: be the first
choice in private health
services.


Independent:
Call center
entrepreneurs

Pakistan

Teledoctor

[36]

1000 Calls
per day

Phone consults,
information on facilities,
Top health complaints:
Diarrhea and vomiting
MNO
-
sponsored:
Telemedicine
drugs.

(gastro
-
enteritis),
Gynecological ailments
and obstetrics, Fever
(usually associated with
respiratory tract
infections)

firm and MNO

Philippines

Fonemed Asia
-
Pacific
[36]




Independent

Trinidad
and Tobago

MedStar Health
Information
[36]




Independent

(Table retrieved from
http://en.wikipedia.org/wiki/Mhealth
)

Diagnostic support, treatment support, communication and training for healthcare workers
.
mHealth

projects within
the communication and training for healthcare workers subset involve connecting healthcare workers to sources of
information through their mobile phone
[2]
. This involves connecting healthcare workers to other healthcare workers,
medical in
stitutions, ministries of health, or other houses of medical information. Such projects additionally involve
using mobile phones to better organize and target in
-
person training. Improved communication projects attempt to
increase knowledge transfer amongs
t healthcare workers and improve patient outcomes through such programs as
patient referral processes

[1]











Below is a list of mHealth projects for both diagnostic and treatment support, and communication and training for
healthcare workers

Country

Name

Program
size

Major services

Insights
and
Outcomes

Sponsors

India

Tele
-
Doc
[33][37]

Launched as
a pilot
project in 15
villages in
Haryana in
April 2003

TeleDoc

provided handheld
mobile phone devices to village
health workers in India,
permitting them to
communicate with doctors who
use a web application to help
diagnose and prescribe for
patients.


TeleDoc was a project
of Jiva Institute, an
India
-
based non
-
prof
it.
Supported by the Soros
Foundation.

India

mQure
[38]

Services
operational
across India

mQure provides innovative
solutions to make healthcare
more accessible, convenient
and at the lowest possible cost.
Patients can get medical help
on their mobile phon
e 24x7 or
second opinions, information
on latest hospital bed
availability.

Over 10,000
active
clients
across India

Independent
entrepreneurs

Peru

Nacer
[33][39]


Nacer

is a phone
-

and web
-

based information and
communication system for
maternal and child health that
allows health professionals in
remote locations to
communicate and exchange
critical health information
between themselves, medical
experts, and regional ho
spitals.
All reported data is recorded in
a central database, and is
available to health officials in
real
-
time for analysis and
decision
-
making. Health
workers in locations without
Internet connectivity can access
the system using any phone
(satellite, fi
xed
-
line, mobile, or
community pay phone).


The USAID
-
funded
Pathfinder
International program
and
Voxiva

worked with
the Regional Health
Directorate of Ucayali
and the Peru Ministry
of Health

Rwanda

TRACn
et
[33][40]


TRACnet is Rwanda’s dynamic
Information Technology
solution designed to collect,
store, retrieve, and disseminate
critical program, drug, and
patient information related to
HIV/AIDS care and treatment.


Voxiva and The
Rwanda Ministry of
Health

Uganda,
Mozambique

AED
Satellife
[33][41]


Information and
communications technologies
(ICT) initiatives through the
USA
-
based not
-
for
-
profit


Academy for Educational
Development providing support
for HIV/AIDS, malaria, child
and maternal health, and
health

systems management
programs.

(table retrieved from
http://en.wikipedia.org/wiki/Mhealth
)

Disease surveillance, remote data collection, and epidemic outbreak tracking

Projects within this area operate

to utilize mobile phones’ ability to collect and transmit data quickly, cheaply, and
relatively efficiently. Data concerning the location and levels of specific diseases can help medical systems or
ministries of health or other organizations identify outb
reaks and better target medical resources to areas of greatest
need
.

[36]
Policymakers and health providers at the national, district, and community level need accurate data in
order to gauge the effectiveness of existing policies and programs and shape
new ones. In the developing world,
collecting field information is particularly difficult since many segments of the population are rarely able to visit a
hospital, even in the case of severe illness
.

[38]

Below is a list of mHealth disease and epidemic ou
tbreak tracking projects, and data collection software

Country

Name

Program size

Major services

Insights and
Outcomes

Sponsors

Brazil


400 test results
gathered by 20
field
professionals in
two days, all with
GPS information

Containing the spread of

the
Dengue virus. Customized
questionnaires distributed
to field health agents’
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es
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⡰E灥p
-
扡獥搠 s祳瑥t
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浯n瑨s for lesser
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-
畳er 慣捥灴an捥 very
h楧栮

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[33][43]


AESSIMS is designed to
build health capacity at the
field level by enabling front
-
line health workers to report
disease incidence through
an innovative combination
of telephone and web based
technology that leverages
available infrastructure.
AESSIMS enabl
es health
officials to better
understand the scope of
disease impact and
strategically allocate
resources to areas with the

PATH, Voxiva,
and the
Government of
Andhra
Pradesh
(GoAP)

highest prevalence and
need.

Kenya and
worldwide

EpiSurveyor.org

Since
moving
from older, PDA
-
based version to
online version,
more than 3500
users from
hundreds of
organizations in
more than 170
countries
.

EpiSurveyor is an online
system developed
by

DataDyne.org

that

allows
rapid development of forms
which can then be
downl
oaded to mobile
phones for data collection
:
user can go from concept to
fully functional mobile data
collection system in hours.
Used in more than 170
countries worldwide for
outbreak investigation,
disease surveillance, drug
stock tracking .

Major insight
: if you
make an easy
-
to
-
use
tool available to
anyone online, many
people will find and
use it. EpiSurveyor is
not a "project" or a
"pilot": it is a fully,
functional system for
creating mobile data
collection systems,
and it is available to
anyone, for fr
ee, right
now. "Like Gmail for
data collection"

:
-
)

Developed with
funding from
the

United
Nations
Foundation,
the Vodafone
Foundation,
and the World
Bank



Treatment support and medication compliance for patients, including chronic disease management

Rem
ote monitoring and treatment support allows for greater involvement in the continued care of patients. Within
environments of limited resources and beds

and subsequently a ‘outpatient’ culture

remote monitoring allows
healthcare workers to better track pat
ient conditions, medication regimen adherence, and follow
-
up scheduling. Such
projects can operate through either one
-

or two
-
way communications systems.

Below is a list of mHealth treatment support and remote monitoring projects:

Country

Name

Program
size

Major services

Insights and
Outcomes

Sponsors

Kenya

Weltel
[45]

1 year clinical
trial. ~500
participants.

HIV
-
positive
patients

were
sent weekly text messages
inquiring about their well
-
being. Patients responded to
these message by saying
everything was OK, or they
had a problem. If there was a
problem, a Health Worker
would call back to assist them.

Positive results
showing that
mobile phones
can be a useful
tool in
supporting HIV
-
positive patients.

The US Centers for Disease
Control and Prevention
(CDC)
-

PEPFAR Public
Health Evaluation (PHE)
and the International
Development Research
Centre's Africa Health
Systems Initiative Sup
port
to African Research
Partnerships (AHSI
-
RES)

Mexico

Diabediario


Voxiva, along with ICS, has
developed Diabediario, a
solution for changing
diabetics’ lifestyles and for
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their adherence to their
diabetic treatment. This
syste
m empowers the patient
to take control of their health
by taking all the necessary
steps to control their diabetes.

Peru

Cell
-
Preven
[1]


Cell
-
Preven

health workers
use mobile phones to send
SMS messages with real
-
time
data on symptoms
experienced by clinical trial
participants. This enables
immediate response to
adverse symptoms


Powered by Voxiva

Thailand

Name?

[1]


TB patients were given mobile
phones and called daily with a
reminder to take their TB
medication

90% of patients
took their
medication.



SIMpill



SMS appliance that monitors
medicine compliance by
sending a text message when
the patient takes medicine.




Cell
-
Life



SMS data
gathering
applications





Emerging trends and areas of interest in mHealth

1.

Emergency response systems (e.g., road traffic accidents, emergency obstetric care)

2.

Human resources coordination, management, and supervision

3.

Mobile synchronous (voice) and
asynchronous (SMS) telemedicine diagnostic and decision support to
remote clinicians[46]

4.

Clinician
-
focused, evidence
-
based formulary, database and decision support information [46]

5.

Pharmaceutical Supply Chain Integrity & Patient Safety Systems (e.g. Sproxi
l and mPedigree) [47]

6.

Clinical care and remote patient monitoring

7.

Health extension services

8.

Health services monitoring and reporting

9.

Health
-
related mLearning for the general public

10.

Training and continuing professional development for health care workers

11.

Health promotion and community mobilization

Being connected by mobile health services, different novel networking among various entities, (which were previously
isolated) directly or indirectly related to health care delivery mechanism, are on the verge of

development.


Case:

Text to Change

Text to Change, the Dutch non
-
profit
organization
, is an example of how a simple application can make a big
difference. It runs a series of four
-
week education programmes using SMS messaging. Each programme starts with a
n
announcement SMS message to target a group of mobile users in a given region, which encourages them to opt into a
questionnaire. Participants are then sent multiple choice quiz questions as SMS messages. They receive airtime as an
incentive.
[51]

The cur
rent Ugandan programmes have to be scaled up to a nationwide programme. Expansion to other East

African
countries is expected to start from mid
-
2009. Text to Change is part of the Open Mobile Consortium. The group p
l
ans
to redevelop its SMS software to mak
e in open source this year.
[51]

Case
:

EpiSurveyor

It

is an open source field survey tool made by DataDyne, designed to help healthcare professionals gather information
from the population to curb the spread of epidemics
.

EpiSurveyor has been deployed in 20

countries in sub
-
Sarharan
Africa and Kenya, Uganda and Zambia. It is regarded as a shining example of mHealth in action.

[51]

Health workers need to run surveys and collect health data to run
immunization

programmes, such as the programme
to provide
immunization

against measles. The software, which runs on Palm handheld computers, allows healthcare
workers to gather information from the population. This information is uploaded onto a central
database
.

[51]

The World Bank also believes the creation of
a public domain, common
-
data collection platform will have other, far
-
reaching effects. For instance it believes the digitally collecting data will allow more and faster analysis.
[51]














What's Next for Mobile Health Technology?

Mobile

phone technology is advancing so rapidly that the cost of using these devices in the developing world is falling
every year
.
Five years ago, we started by using PDAs
and
now, because of changes in technology, we've been doing
similar kinds of things on ce
ll phones that cost less than half of wh
at we used to pay for the PDAs.

Its believed that

developing countries will see dramatic advances in mobile technology over the next several years as bandwidth access
expands, connection speeds increase and costs go
down.

Also

the next step will be to use mobile technology to
promote patient
-
centered health. If you can put the patient at the center of the health care system and empower them
to make better decisions, their portal and the way that they interact with the

health system is going to be their mobile
device.

This is happening as a new generation of e
-
health products and services, based on wireless and mobile
technology, is putting diagnosis and treatment management into the hands of the patient. Companies such

are
offering suites of wireless e
-
health applications
-

which include blood pressure, heart rate and blood glucose
monitoring
-

to patients, with or without the support of a conventional healthcare provider.

Some Drawbacks

Using mobile technology is not a

panacea for the world's health issues, though. Says Forrester analyst Elizabeth
Boehm, one of the biggest issues with mobile healthcare is that "the people who are most in need of healthcare are
usually more aged, so they don't use the mobile or they're n
ot comfortable with it." This limits the use of mobile
phones in public health information campaigns.

However, as the technology continues to spread throughout the world, it's easy to see how, over the course of time,
phones could become a "doctor in your
pocket" for the less fortunate citizens of our world.


References

and Citations
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