• mHealth
  • SMS services work for some health conditions

    SMS services is increasingly used in Africa’s healthcare. The Annual Review of Public Health has a systematic review in Pub. Med of 15 reviews of 228 SMS services. It shows that it works for a set of conditions. It had three main findings. Successes are SMS services for:

    Diabetes self-management Weight loss Physical activity Smoking cessation Medication adherence for antiretroviral therapy (ART).

    The second is that there’s limited evidence inform features of successful SMS services. It seems that there are several ways to design and operate successful SMS services.

    The third is that the strong evidence supporting the value of SMS services into public health isn’t enough. More research is needed to establish longer-term effects, identify good practices and explore cost-effectiveness. There’s still more to do be sure about the value of SMS services.

    The priorities for SMS services in Africa extend to maternal and child health. Information on the SMS impact on these is essential. South Africa’s MomConnect project is currently undergoing a cost-effectiveness assessment. The results may add to the findings from the Annual Review and confirm an mHealth direction for Africa.

  • GSMA releases the importance of partnerships in mHealth report

    GSMA recently conducted an mHealth Tracker survey of 276 mHealth services across the ten African countries included in the mobile nutrition (mNutrition) initiative. The aim is to understand emerging best practices. One of best practice aspects identified was the importance of partnerships. The report highlights some of the evidence regarding partnerships within mHealth services.

    Three different types of partnerships are investigated in the report including:

    Partnership of mHealth services with Ministries of Health Cross-sector partnerships  Partnerships with mobile operators.

    The impact that each type of partnership is having on the delivery of mHealth services were analysed and discussed in the report. The report highlights the importance of these relationships and shows the positive impact they can have on the delivery of mHealth services. This impact is facilitated in three ways. Partnerships can:

    Strengthen the richness of offering of an mHealth service Improve the ability to achieve greater geographical coverage Improve the penetration of mHealth services to reach a larger audience.

    African countries looking at developing and successfully implementing mHealth services need to understand and invest in these key partnerships. These partnerships can increase the capacity of an mHealth service by leveraging the respective core knowledge, skills, resources and assets for the benefit of the service.

  • GSMA says mHealth feasibility's good in Zambia

    In September 2013, the Groupe Spéciale Mobile Association (GSMA) mHealth programme launched the mNutrition Initiative. UK Aid funds from the Department for International Development (DFID) and the Norwegian Agency for Development Cooperation (Norad) support the initiative. The project has completed and released Mobile for Development mHealth Country Feasibility Report: Zambia. It’s a comprehensive analysis of the current state of mHealth in the country.

    Zambia’s infant mortality rates of 56 per 1000 births and its under-five mortality rates of 89 per 1000 births are the second highest of GSMA’s ten  nutrition countries. Malnutrition is seen as the biggest cause. There’s a critical shortage of Community Health Workers (CHW), about 1.6 per 1000. Five mHealth services offer maternal health intervention.

    The Government has numerous initiatives to improve health. Expanded mHealth can help. At 57%, Zambia’s in the top half of a clutch of indicators, giving it moderate-to-strong potential for more mHealth, especially with 73% of the population have access to mobile phones, 70% more than the unique users. HIV/AIDS has the most mHealth initiatives, 2.5 times more than maternal conditions.

    GSMA found that the demand-side requirements for mHealth are in place. There’s an addressable market and audience. Work’s needed to improve the infrastructure for mHealth and popularise the concept. The core finding is that Zambia has the potential to develop into a strong mHealth market. Is next steps are to address common challenges and optimise the chances of success for partnerships between industry stakeholders.

    The evolving mHealth industry indicates that mHealth should use the simplest delivery formats in the initial stages. This gives a focus of literate women with children under-five, and using SMS to deliver nutrition and maternal health information to them. This mobile market segment is forecast to grow by 17% up to 2020, reinforcing the opportunity.

    Like all GMSA’s feasibility studies of its group of ten, it’s a good template for African countries to use in their mHealth decisions.

  • mHealth to encourage treatment adherence in Tanzania

    The Vodacom Foundation has donated mobile phones to the Sickle Cell Foundation of Tanzania to support treatment adherence among patients. About 150 sickle cell patients are set to receive mobile phones that will simplify monitoring of their health condition says an article in BIZTECH Africa. 

    Sickle cell disease rate in Tanzania keeps rising, as 11,000 babies are born with the disease each year. The Sickle Cell Foundation is committed to supporting prevention, care and effective management of disease in Tanzania. It’s working with Muhimbili University on the Mighty Dots (MDOTS) project that uses graphic screen designs for mobile phones to improve adherence to medication.

    The pilot will see 150 patients on long-term medication receive mobile phones. These patients will be monitored daily by recording themselves ingesting the medication and sending the video to the clinic using the new phones.

    MDOTS Programme Coordinator, Dr. Robert Mongi said, “We prescribe medication for different strains of sickle cell. Patients with severe sickle cell disease are prescribed medication that must be taken daily however, not all patients observe these instructions. This project will help us determine whether monitoring intake of medication is effective in ensuring adherence to medication on a daily basis.” Many long term patients tend to skip taking their medication based on lack of symptoms. The accountability aspects of the initiative should help improve adherence.

    Tanzania ranks fourth in the world for the highest number of sickle cell disease births a year, after Nigeria, India and DRC. Sickle cell disease is manageable with comprehensive care, but needs diligent treatment adherence. This basic mHealth initiative could help patients manage their disease better.

  • mHealth experiences from USAID

    The mHealth compendium from USAID is now in its fourth series. mHealth Compendium Volume Four is packed with information, links and case studies for Africa.

    Examples of proven mHealth are:

    Supporting Ebola:

    mSOS disease notification system CommCare’s case management and reporting system The Interactive Voice Response (IVR) mLearning platform for health workers.

    Other initiatives with hard evidence are:

    Mobile money vouchers for the MYpatient scheme in Tanzania used M-PESA mobile money system to buy bus tickets for fistula patients contributed to 200% more annual restorative surgeries Text messaging health workers in Kenya increased care quality for malaria case management and 25% more children treated correctly SMS reminders in Kenya for adherence to treatment in the WelTel randomized trial found that HIV patients receiving SMS support and active client follow were 24% more likely to comply with antiretroviral therapy (ART) and 19% more likely to have suppressed viral loads RapidSMS alerts to monitor pregnancy and reduce maternal and child deaths in Rwanda resulted in 25% more prenatal care visits, 54% fewer home deliveries, 26% more deliveries at health facilities and 48% fewer deaths of under fives In Zanzibar, Tanzania, SMS reminders improved pregnant women’s maternal and neonatal health in the Wired Mothers intervention group who received text messages and an airtime credit voucher when 4% had four or more antenatal care visits, lower perinatal mortality and other health gains In Zambia, Project Mwana used RapidSMS helped 50% faster HIV turnaround times

    The case studies are grouped by Behaviour Change Communication (BCC), data collection, finance, logistics and service delivery. Alongside these are nine principles, with more detail online, for digital development:

    Design with the user Understand the existing ecosystem Design for scale Build for sustainability Be driven by data Use open standards, open data, open source and open innovation Reuse and Improve Address privacy and security Be collaborative.

    USAID’s comprehensive compendium is valuable material for African countries developing mHealth strategies and plans. It offers a sound step forward.

  • GSMA releases Mozambique's mHealth Report

    In September 2013, the Groupe Spéciale Mobile Association (GSMA) mHealth programme launched the mNutrition (mobile nutrition) Initiative. UK Aid funds mNutrition from the Department for International Development (DFID) and the Norwegian Agency for Development Cooperation (Norad). As part of this initiative, GSMA is completing mHealth Country Feasibility Reports for ten African countries. Mozambique is one of the latest. It’s a comprehensive analysis of the current state of mHealth in the country, focussing on nutrition.

    The report tracked 18 live mHealth services deployed with partnerships from over 45 different organizations representing multiple stakeholder groups. It found that 48% of districts across the country have at least one active mHealth service. While mHealth is uniquely positioned to improve healthcare in Mozambique, there are several challenges.

    Like most African countries, Mozambique has a shortage of health workers. There’s approximately 0.46 maternal and child nurses per 1000. While there has been an increase in healthcare worker numbers, they’re not keeping up with population growth. Mozambique has seen 38% more health workers over a five-year period, but
the number of doctors comparative with population remains grossly imbalanced.

    One of the most pressing needs is to utilise its limited health workers better by using efficiency tools, time saving processes and human resource planning and management. About 43% of mHealth services tracked by GSMA are directly involved in this process. This presents an opportunity for mHealth to develop its role in providing a combination of pushed and pulled information and decision support services to address the gap in the Mozambican health sector. Services can incorporate retention strategies and training features to maximise the benefit.

    In order to succeed, mHealth needs partnerships with numerous stakeholders. This is a particular issue in Mozambique which faces challenges of ICT coverage, particularly in rural areas, infrastructure and relatively low levels of mobile access. Most of its initiatives are also proofs of concept and pilots.

    The Mozambican mobile operator market is highly competitive. While it can drive down prices, enforced competition between the three mobile operators might create problems for the type of multi-partnering arrangements that are required to ensure mHealth success. The lack of partnerships between operators and mHealth initiatives tracked by the GSMA provide some evidence of this.

    Despite the challenges, Mozambique shows strong potential to scale its mHealth initiatives. The most addressed health condition within mHealth in Mozambique is HIV/AIDS followed by Malaria, diarrhea and nutritional deficiencies. These health conditions are amongst the top ten causes of death in all ages in the country.

    mHealth services reviewed by GSMA and that target health workers reached 1,183 facilities. Ones that target women and children reached 593 facilities. Scaling up and integrating mHealth services with health workers could help national strategies to improve the countries overall health indicators. There’s good potential for mHealth.

  • Sanofi joins WHO-backed diabetes mHealth programme

    The diabetes section of the WHO and ITU initiative Be Healthy, Be Mobiles, set up in 2012, has a new partner. Sanofi, a global leader in pharmaceuticals, vaccines and medical supplies, has joined.

    PMLive has a review of the new links and its benefit to using mobile technology to help prevent and treat non-communicable diseases like diabetes, cancer, cardiovascular conditions and chronic respiratory diseases, in low- and middle-income countries (LMIC). The first set of Be Healthy, Be Mobile's phases for its mDiabetes programme are in Senegal.

    In 2014, a pilot during Ramadan delivered about 80,000 SMSs to about 3,500 participants, an average of about 23 each, to help patients with diabetes manage their disease. Sanofi aims to step it up to two-way SMSs, including reminders to patients on topics such as blood glucose levels and food consumption.

    Lots of partners already engaged in Be Healthy, Be Mobile. They include Bupa, Verizon, the World Lung Foundation, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the Non-Communicable Disease (NCD) Alliance, Novartis and GSK. The ITU, WHO and Sanofi are all delighted with the expanded contributions and way ahead. It’ll be good when mDiabetes is available across all Africa.

  • There are still many challenges for mHealth apps

    Winston Churchill said lots of things. One was that “Continuous effort - not strength or intelligence - is the key to unlocking our potential.” It seems that the mHealth apps industry needs more of it.

    A post by Dr David Lee Scher in Medscape says that in the USA, there’s about 26,000 mHealth apps. Of these, some 7,400, nearly 30%, are for doctors and aren’t regulated by the Food and Drugs Agency (FDA). A consequence is that doctors are right to have concerns about app quality, especially when surveys show that 90% of physicians use smartphones or tablets in their daily professional activities, a third of doctors have recommended apps to their patients.

    There’s an app ambivalence. They’re seen as helpful, but they need regulating too. First, people can expect that apps should do what they say the can, but they’re not always accurate, Dr Scher found an example of $3.99 app giving inaccurate blood pressure readings, and the doctor using it discovered it was still at the beta-testing stage, so not ready for use, but was for entertainment only. How can blood pressure readings be entertaining?

    Data overload is another challenge. Apps collect lots of data, but doctors don’t want a data deluge where most of it’s not needed.

    Medical apps about which false claims are made may be useless at best and harmful at worst. For many years, app developers and clinicians anticipated that the US FDA would serve as the guarantor of the accuracy and safety of mobile medical apps. Finally, in 2013, the FDA published its ruling on what it will regulate.[6] The document stated that only apps that function as medical devices, transform a device into a medical device, or perform patient-specific analysis and then provide a diagnosis or treatment on the basis of it will be regulated.

    He proposes options for better regulation as:

    Specialty societies and hospitals to evaluate apps designed for their members and their members' patients and develop their own branded apps aimed at physicians and patients Set up third parties in academia or the private sector to develop a certification system for medical apps.

    As Africa’s healthcare relies increasingly on mHealth, it’s essential that these themes are built into their routine use. It’s a role for the health ministries to set them in train with rigorous certification and badging.

  • Is IoT more important than mHealth for Africa?

    The Internet of Things (IoT) is a catchy phrase compared to Machine to Machine (M2M). Whatever it’s called, its impact in Africa seems as though its rising.

    A report by Reuters says that Africa is “fast of blocks (sic)” for IoT. It said that by the end of 2014, developing countries would have 52% of M2M connections, and it’s set to increase to nearly 60% by 2020.

    Africa had some 7 million mobile connections in June 2014. There could be 57 million by 2020. This is the most used route for people in Africa to access the Internet. Most IoT initiatives in Africa are vehicle tracking, mobile payments and smart cities. Other growth services include smart meters and

    using SIM cards to electronic point of sale (ePOS) terminals in remote areas so merchants can accept credit and debit card payments.

    With this surge in devices, Africa’s healthcare has a growing opportunity to expand its IoT projects. It could include initiatives like monitoring patients vital signs remotely, managing supply chains for drug and medical suppliers, managing vaccination supplies as part of vaccination and immunisation information systems, more SMS reminders for patients and carers, and collecting data from medical devices for analysis and action.

    Stepping up IoT in Africa’s healthcare needs a structure to decide on priorities and investment. A white paper by Freescale Semiconductor is one place to start. It’s important that healthcare isn’t left behind in what looks like a bit of an IoT rush into the future.

  • Botswana's Black Oak wins mHealth Innovation Competition

    The winner of this year’s Youth mHealth Innovation event in Gaborone was Black Oak. Its team was Hortantia Tebogo, Kelly Sorinyane and Florence Chilisa. The Tswana Times says they developed a system to enable access to accurate, up to date and complete information about patients from EHRs. It allows access to patient records from any location either from the cloud or QR code, an array of black and white squares used to store wed addresses as URLs or other information that smartphone cameras can read.

    The event was again supported by Orange Botswana. All Africa has a report on the event too, and says that Dr Kabelo Mokgacha from the Botswana Ministry of Health encouraged innovators to adopt a set of standards for their mHealth projects:

    Easy to use Effective Medically accurate Valid Sound.

    These should lead to increasing collaboration between physicians and their communities that are essential for successful mHealth product development. Despite these, the lack of a common language for mHealth will continue to limit efforts to identify, catalogue and synthesise evidence needed for extensive mHealth adoption. Botswana is developing an eHealth Strategy and mHealth Enterprise Framework to help with these. It’s seen as advancing mHealth along initiatives in other African countries such as Rwanda and Kenya. Alongside these, Dr Mokgacha urged Botswana’s youth to use global mHealth developments as a source of inspiration.

    Ms Lepata Mafa, Director of Corporate Affairs at Orange Botswana was clear that technology is a vital part of social development.  In Botswana, there are plenty of opportunities to develop mobile technologies for a wide range of economic and social benefits.

    Congratulations to Black Oak. It will now have access to the Orange technical platform API gateway to host its mHealth service and complete tests on its applications before its launched. eHNA’s looking forward to hearing more about its mHealth initiatives.