[Bardram, Jakob E., Mihailidis Alex, Dadong Wan, eds. "Pervasive Computing in Healthcare" CRC: 2006. ISBN 978-0849336218.] ]
mHealth in Low and Middle Income Countries
There has been a growing interest within the health sector to capitalize on the rapid uptake of mobile communication technologies and the overall improvements in telecommunications within the general population throughout the world. Characterized as a ‘leapfrog technology,’ mobile phones have allowed developing countries, even those with relatively poor infrastructure, to bypass 20th century fixed-line technology and jump straight to 21st century mobile technology. [Economist. Leaders: The limits of leapfrogging; Technology and development. The Economist: 2008.] The number of global mobile phone subscribers in 2006 was estimated at 2.5 billion of an estimated global population of 6.6 billion (37.9%). These figures are expected to grow to 3.3 billion or approximately half of the world’s population by 2010 with the greatest growth 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 the case in developing countries. [ITU (2003). Mobile overtakes fixed: Implications for policy and regulation. Geneva: International Telecommunications Union.]
The cost of mobile technology deployment is increasingly going down, with vendors such as Nokia developing cheaper infrastructure technologies (CDMA) and cheaper phones (sub $50-100, such as Sun's Java phone). Cost may not be much of an issue in the near future, especially compared to PC-based solutions. The increasing functionality of phones enables SmartPhone-capability in relatively inexpensive phones. 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, which now enable web browsing, GPS navigation, and e-mail through what are being called, smart phones. In spite of these differentials, the basic SMS text functions and real-time communication capacity of devices available in low and middle income countries offer a broad range of potential benefits to the health sector. [Mechael, P. (2006). Exploring Health-related Uses of Mobile Phones: An Egyptian Case Study, Public Health & Policy (p. 264). London: London School of Hygiene and Tropical Medicine.] Increased availability and efficiency in both voice and data-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. [Istepanian, R. (2004). Introduction to the Special Section on M-Health: Beyond Seamless Mobility and Global Wireless Health-care Connectivity. IEEE Transactions on Information Technology in Biomedicine, 8(4), 405-413.]
The trends towards mHealth in developing countries are largely due to the overwhelming uptake of mobile phones within the health sector and by the general population as well as the increased uptake, however limited, of smart phones within the health sector for retrieval of web-based information and patient data in decentralized health management information systems (HMIS). In addition, wireless-enabled laptops and specialized health-related software applications are currently being developed, tested, and marketed throughout the world. This is happening primarily in high income countries; however, with broad advocacy campaigns for free and open source software (F/OSS), applications tailored to local contexts may soon become available in low and middle income countries. Efforts to provide resources and training for the localized development of applications and technologies ought to be encouraged in low and middle income countries. [Fontelo, P., Liu, F., Muin, M., Tolentino, H., & Ackerman, M. (2006). Txt2MEDLINE: Text-Messaging Access to MEDLINE/PubMed, AMIA Annual Symposium Proceedings pp. 259-263).]
Mobile technologies offer direct voice communication (of particular value due to literacy and language capacity in many countries) and information transfer capabilities. The appeal of mobile communication technologies is that they enable communication in motion, allowing individuals to contact each other irrespective of time and place. [Agar, J. (2003). Constant Touch: A Global History of the Mobile Phone Cambridge: Icon Books Ltd.] [Ling, R. (2004). The mobile connection: The cell phone's impact on society London: Morgan Kaufmann] This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people at a more rapid rate. As a result of such technological advances the capacity for improved access to information and two-way communication hence becomes available at the point of need.
mHealth to Improve Health Outcomes and Efficiencies
Technology integration within the health sector has great potential to promote healthy lifestyles, improve decisions by health professionals as well as patients, and enhance healthcare quality by improving access to medical and health information and facilitating instantaneous communication in places where this was not previously possible. [Shields, T., A. Chetley, and J. Davis, ICT in the health sector: Summary of the online consultation. 2005, infoDev.] [World Health Organization, eHealth Tools and Services: Needs of Member States. 2005, WHO: Geneva.] The increased use of technology can help reduce health care costs by improving efficiencies in the health care system and promoting prevention through behavior change communication (BCC). It also has the potential to advance clinical care and public health services by facilitating health professional practice and communication and reducing health disparities by applying new approaches to improve the health of isolated populations.
The Millennium Development Goals (MDGs) that specifically address health as set forth by the United Nations Millennium Declaration in 2000 include reducing child mortality; improving maternal health; combating HIV and AIDS, malaria, and other diseases; and increasing access to safe drinking water. [United Nations, United Nations Millennium Declaration (General Assembly Resolution 55/2). 2000, United Nations: New York.] A progress report published in 2006 indicates that childhood immunization and deliveries by skilled birth attendants are on the rise, while many regions continue to struggle to achieve reductions in the prevalence of the diseases of poverty including malaria, HIV and AIDS and tuberculosis (TB). [United Nations, The Millennium Development Goals Report. 2006, United Nations: New York.] Increasing attention has also been drawn to the critical shortages in trained healthcare personnel throughout the world whereby there are now 57 countries with critical shortages in health work force density with a global deficit of 2.4 million doctors, nurses, and midwives. [World Health Organization, The World Health Report 2006: Working Together for Health. 2006, WHO: Geneva.] Investing in the training and ongoing development of the healthcare work force is considered among the most effective means of improving health. [World Health Organization, The World Health Report 2006: Working Together for Health. 2006, WHO: Geneva.] Three key areas in which early and rapid gains can be achieved through technology design and integration are in the areas of Safe Motherhood, routine immunization and integrated management of childhood illness, and in addressing the diseases of poverty, namely HIV and AIDS, malaria, and TB- where significant resources have been mobilized to reduce the disease burden in low and middle income countries.
Efforts are ongoing to explore how a broad range of technologies, and most recently mHealth technologies, can improve such health outcomes as well as generate cost savings within the health systems of middle and low income countries. The specific potential of mHealth lies in its ability to offer opportunities for direct voice communication (of particular value due to literacy and language capacity in many countries) and information transfer capabilities that previous technologies did not. This is particularly beneficial for work in remote areas where the mobile phone, and now increasingly wireless infrastructure, is able to reach more people at a more rapid rate. As a result of such technological advances the capacity for improved access to information and two-way communication hence becomes available at the point-of-need and for healthcare workers at the point-of-care. 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. [Malhotra K, Gardner S, Rees D. (2005). Evaluation of GPRS Enabled Secure Remote Patient Monitoring System. ASMTA 2005, Riga, Latvia, 41-48.]
Applications
Mobile devices have been used in a number of different settings, but most applications can be classified as follows:
* Telemedicine
* Data collection (for public health or clinical domains)
* Decision support
* Access to information
Emerging trends of interest in mHealth include the use of technologies in the following capacities:
* Emergency response systems (e.g., road traffic accidents, emergency obstetric care)
* Disease surveillance and control (Malaria, HIV/AIDS, TB, Avian Flu, chronic diseases- esp. diabetes)
* Human resources coordination, management, and supervision
* Mobile synchronous (voice) and asynchronous (SMS) telemedicine diagnostic and decision support to remote clinicians [Mechael, P. "WHO mHealth Review: Towards the Development of an mHealth Strategy." August 2007.]
* Clinician-focused, evidence-based formulary, database and decision support information available at the point-of-care [Mechael, P. "WHO mHealth Review: Towards the Development of an mHealth Strategy." August 2007.]
* Clinical care and remote patient monitoring
* Health extension services
* Health services monitoring and reporting
* Health-related m-learning for the general public
* Training and continuing professional development for health care workers
* Health promotion and community mobilization
mHealth Technology
Key mobile communication technologies relevant to mHealth include:
* Mobile phones
* PDAs and smart phones
* Patient monitoring devices
* Mobile telemedicine/telecare devices
* MP3 players for mLearning
* Microcomputers
mHealth Technology capabilities:
"Voice"
Voice is usually personal two-way communication although automated systems may provide voice recorded information as well.
"Data"
Data access is primarily focused on visualizing static text but can also extend to interactive decision support algorithms, other visual image information, and also communication capabilities through the integration of e-mail and SMS features. Integrating use of GIS and GPS with mobile technologies adds a geographical mapping component that is able to “tag” voice and data communication to a particular location or series of locations. These combined capabilities have been used for emergency health services as well as for disease surveillance, health facilities and services mapping, and other health-related data collection.
ee also
*eHealth
*Health Informatics
*Health 2.0
*Telehealth
*Telemedicine
References
Further Reading
*"Technology plays crucial role in vaccination distribution" Computer Weekly: April 2008. [http://www.computerweekly.com/Articles/2008/04/03/230128/technology-plays-crucial-role-in-vaccination-distribution.htm] . Discusses use of handheld electronic data collection in managing public health data and activities.
*"A world of witnesses" "The Economist": January 2008. [http://www.economist.com/surveys/displaystory.cfm?story_id=10950499] Discusses use of EpiSurveyor open source software in public health monitoring in Africa.
*"Globally, deaths from measles drop sharply" The Washington Post: November 2007. [http://www.washingtonpost.com/wp-dyn/content/article/2007/11/29/AR2007112902021.html] Describes role of EpiSurveyor mobile data collection software in contributing to the highly successful fight against measles mortality.
*Kaplan, Warren. "Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?" "Globalization and Health" 2 (2006): 9. [http://www.globalizationandhealth.com/content/2/1/9]
* Olmeda, Christopher J. (2000). Information Technology in Systems of Care. Delfin Press. ISBN 978-0-9821442-0-6
*United Nations. "Compendium of ICT Applications on Electronic Government, Volume 1: Mobile Applications on Health and Learning." United Nations: 2006. [http://unpan1.un.org/intradoc/groups/public/documents/UN/UNPAN030003.pdf]
*Economist "The doctor in your pocket [Medical technology: Nearly everyone in the developed world carries a mobile phone- so why not use it to deliver health care?] " The Economist: 2005. [http://www.wirelesslifesciences.org/pdfs/MONITOR_doctorinyourpocket_Economist.pdf]
*Mechael, P. "Exploring Health-related Uses of Mobile Phones: An Egyptian Case Study." "Public Health & Policy" (p. 264). London: London School of Hygiene and Tropical Medicine 2006. [http://open.intrahealth.org/wiki/upload/PatriciaMechaelThesisFinalDecember2006.pdf]
*Mechael, P. "WHO mHealth Review: Towards the Development of an mHealth Strategy." August 2007.
*Istepanian, R. "Introduction to the Special Section on M-Health: Beyond Seamless Mobility and Global Wireless Health-care Connectivity." IEEE Transactions on Information Technology in Biomedicine: 2004. 8(4), 405-413.
* Istepanian, Robert "et al.", eds. (2006) "M-Health: Emerging Mobile Health Systems." Springer Verlag. ISBN 0-387-26558-9
*UNICEF and Women's Net (2007). Rapid Assessment of Cell Phones for Development. Written and compiled by Sally-Jean Shackleton.
*UN Foundation and Vodafone (2008). mHealth in the Global South: Landscape Analysis. [report by Vital Wave Consulting]
External links
Non-profit Sector
* [http://www.econsult.mobi Telemedicine Consultation and Healthcare on Mobile]
* [http://www.healthnet.org/ictinhealth.php AED-Satellife (USA)]
* [http://www.cell-life.org/ Cell-Life (South Africa)]
* [http://www.datadyne.org/ DataDyne.org (USA, Kenya)]
* [http://www.d-tree.org/ D-Tree (USA)]
* [http://www.epihandy.com/ EpiHandy (Norway)]
* [http://www.freedomhivaids.in/FreedomHivAids.htm Freedom HIV/AIDS (India)]
* [http://www.instedd.org/ InSTEDD (USA)]
* [http://www.mpedigree.org/ MPedigree (Ghana) ]
* [http://www.pepfar.gov/press/80384.htm Phones for Health (USA)]
* [http://www.freewebs.com/sexedtext/ SexEdText (Philippines)]
* [http://www.sextextsf.org/ SexInfoSF (USA)]
* [http://www.unfoundation.org/vodafone/index.asp UN Foundation/Vodaphone partnership (USA)]
* [http://www.mobileactive.org MobileActive]
Private Sector
* [http://www.3gdoctor.com 3G Doctor (Worldwide)]
* [http://www.voxiva.net Voxiva (USA/Worldwide)]
* [http://www-03.ibm.com/technology/designconsulting/port_mhealth.html IBM mHealth wireless solution (USA)]
* [http://www.iqmax.com IQMax Mobile Healthcare Solutions]
* [http://www.mygluco.com/glucomonhowitworks GlucoMON-ADMS by Diabetech (Worldwide-GSM/GPRS)]
