• mHealth
  • mHealth economics and finance are separate and integrated

    As mHealth continues to expand, especially from narrowly focused wearables to sophisticated clinical data and Artificial Intelligence (AI), robust economic and financial profiles are more important.

    Underlying sequences and profiles over time reveal information than can help to modify existing mHealth services and plan investments. A team from Acfee , the Johns Hopkins Bloomberg School of Public Health (JHU) and Johns Hopkins University Global mHealth Initiative has constructed a stage-based process for integrating economic and financial evaluations into business cases and M&E.

    Published this month in Cost Effectiveness and Resource Allocation (CERA), “Defining a staged-based process for economic and financial evaluations of mHealth programs” describes how eeconomic evaluations generate evidence about value for money achieved by a project. Financial evaluations provide evidence on the financing required to initiate, sustain and expand programmes and assess their affordability. Integrated economic and financial evaluation has several advantages. It:

    • Demonstrates how mHealth can be implemented concurrently across lifecycle
    • Helps to manage progressions across stages of maturity
    • Improves the rigour of evidence, optimise allocations of scarce and finite resources
    • Facilitates programme planning, implementation, efficiency, effectiveness and sustainability.

    Economic and financial data have some common features. It’s a theme important for Amnesty LeFevre from JHU, She says “There are so few high quality evaluations of digital health solutions, let alone ones that rigorously explore costs and consequences, particularly across sub-populations and geographic areas and consider the financial implications of sustaining and scaling up. Our article aims to promote evidence-based decision-making and encourage decision-makers to rely on a wider range of analyses to inform their decision on optimal resource uses.” It needs six stages:

    1.     Defining programme strategies and links with strategic outcomes

    2.     Effectiveness assessments

    3.     Full or partial economic evaluation

    4.     Sub-group analyses

    5.     Estimating resource requirements for expansion

    6.     Affordability assessment and identifying sustainable financing models.

    It recommends analysts:

    •  Prioritise activities within these stages based on programmes’ links with health outcomes
    • Align these with mHealth solutions’ broader stages of maturity and evaluation
    • Incorporate into M&E activities and match outputs to stakeholders’ evidence needs
    • Fit to time points of initiations and secure available evaluation resources for each stage.

    Acfee’s Sean Broomhead and a report author said “mHealth is a crucial and expanding part of Africa’s health systems. It’s vital we can show it’s worth it, affordable and sustainable. This rigorous methodology has an essential part to play in mHealth’s future.” Adopting the combined methodology will help to improve mHealth’s role in health systems.

  • Vodacom Siyakha launches mHealth for expecting mothers

    Siyakha means ‘we are building’ in isiZulu. It’s also a platform used by Vodacom South Africa, and offers prepaid customers free access to a range of zero-rated sites, including:

    • Vodacom insurance products
    • Free health content from the TV series Hello Doctor
    • Vodacom’s infotainment platform Video Play
    • Educational portals and careers and jobs websites.

    Vodacom Siyakha has an mHealth service for pregnant mothers too.  Mum and Baby builds on Siyakha’s health service to offer maternal support to pregnant mothers. It provides educational articles videos and health information containing stage-based pregnancy information and advice. An article in IT News Africa says Mum and Bay also provides free health information and videos for childhood development too, extending across children’s first five years. Expecting mothers receive three weekly SMS’s to keep them undated on the progress of their pregnancies. These videos and SMS’s cover a range of health topics including:

    • Sexual and reproductive health
    • Breastfeeding
    • Immunisation
    • Early childhood development
    • Mother and child bonding
    • Nutrition
    • HIV/AIDS.

    A publication at My News Room, says Mum and Baby’s available in several languages, making it more accessible. The solution targets expectant mothers who lack easy access to healthcare facilities, It can be used by family caregivers too, who’ll be empowered with information and tools to use in their daily work setting.

    Vodacom customers can access Mum and Baby by dialing *111*88#, a prepaid number, or visiting the Siyakha mobi site.

  • mHealth good practices can reduce avoidable readmissions

    Many people don’t like the prospect of being admitted to hospital. It’s tolerable when it’s unavoidable. Being readmitted when it’s avoidable’s not a pleasant step, both for patients and their families and friends. A report from Mobile Smith, an app platform provider, says about 70% of the US’s hospital readmissions are avoidable. It’s hard to find equivalent numbers for Africa’s health systems.

    How Mobile Apps Can Reduce Preventable Readmissions sets out efficient app strategies that lead to quick impact on reducing avoidable readmissions. They’re:

    •  Effective discharge communication to minimise poor communication with patients and families members at discharge, a main reason for readmissions arising from confusion about follow-up care and prescribed medications
    •  Better discharge procedures that include education, communications with patients and families, support after discharge and fewer unresolved medical issues needing action after discharge, all of which result in lower readmission and improved patient outcomes
    • Use an app for post-discharge with interactive functions that includes promoting self-reliance, empowering patients to take charge of their health, connections to EHRs’ messages, managing appointments, access to educational articles and storing documents and notes
    •  Improving prescription adherence, including knowledge of the purposes of their medications and interactions, to improve health outcomes by tracking medication doses and intervals receiving medication reminders and recording reactions.

    There are six good practices:

    •  Research, know and understand target patient groups
    • Start simple and iterate often
    • Polish user interfaces and experiences
    • Keep apps fresh
    • Establish secure data exchanges
    • Embrace analytics to track utilisation and understand positives and negatives.

    These are valuable requirements for all mHealth initiatives. Africa’s developers and users can benefit by adopting them.

  • MapmyIndia and VISIT launch mHealth for Inida’s Swastha Bharat

    As mHealth moves towards more sophisticated services, collaboration between suppliers creates opportunities to move ahead. A report on India’s Outlook  news scroll says MapmyIndia, a digital map, GPS and tracking service, and VISIT Internet Services, provider of a range of getvisit apps are working together to support the government’s Swastha Bharat, a video and radio health magazine available through 30 regional kendras, types of charitable trusts. Doordarshan and All India Radio are the broadcasters. 

    It’s an mHealth service for people living in smart cities and, those with populations between 50,000 and 99.999, the tier-2 towns and villages. They’ll be able to access health services such as emergency ambulance services, finding nearby hospitals, clinics, labs and pharmacies, and a way to consult doctors and specialists by chatting, phoning and video.

    The new app’s powered by mapping technologies and AI-enabled telemedicine platform, respectively. VISIT developed the live chat service. It’s backed by India's top doctors who regularly review the information provided to users. It includes health recommendations about the most chatted issues, adjusted for users’ demographic data and past history. The aim’s to help them avoid health concerns. The chat assistant also provides updates on local epidemics and any preventive steps that users need to take. 

    It’s an mHealth initiative that Africa’s health systems could adopt for their towns and cities. From experiences in these locations, it may prove beneficial for some remote areas.

  • mHealth to test male fertility

    Infertility’s an important health challenge. Globally about 15%, 48.5 million, couples are affected by infertility. A study shows that underlying fertility issues are often associated with sperm abnormalities. A unique view on male infertility around the globe says that social stigma and lack of access to testing meant that many men never pursue diagnosis evaluation.

    Researchers at Harvard Medical School and Brigham and Women’s Hospital in Massachusetts  have developed an mHealth device that can accurately diagnose mens fertility by testing sperm counts. The innovative smartphone app and device pairing is fast, highly accurate and affordable.  It could become as prevalent for male fertility tests as the at-home pregnancy test is for women.

    A device for semen analysis and rapid infertility diagnostics attaches to a smartphone to count sperm numbers and measure motility, the markers for infertility. Fortune publications has reported that the combination can accurately measure sperm concentration and linear and curvilinear velocities using a small volume, less than 35 ?l, of unwashed, unprocessed semen samples. Using the solution requires drawing semen samples into disposable microchips plugged into the side of  phones’ attachments, similar to a USB. In less than five seconds, analysed results are displayed on the screen.

    Recently, the mHealth device was tested in comparison to lab equipment. Results in the journal Science Translational Medicine show 350 semen samples of both infertile and fertile men were analysed and found to be 98% accurate in identifying abnormal sperm samples. The device could also help to test sperm count of men who recently underwent a vasectomy to determine if the procedure was successful.

    The team’s currently performing additional tests to gain approval by the US Food and Drug Administration (FDA). An article on ehealth news says the device will cost about US$50 when it’s ready to go to market.

  • There’s an mHealth generation gap

    Technology adoption’s becoming shorter. Larry D Rosen said technologies that used to take dozens of years to become mainstream now achieve it in three to five years. Radio took 38 years to reach an audience of 50 million. Television took 13 years. Personal computers took 16 years. The Internet took a mere five years. Within these changes, different generations use technologies in different ways. Their questions, choices and web navigations aren’t the same. 

    Research in the Journal of Medical Internet Research (JMIR) aimed to learn more in the context of chronic conditions, an increasing challenge for people and healthcare systems. Smartphones and health apps are promising tools to change health-related behaviours and manage chronic conditions, but they may have different roles across generations. The study explored:

    •  The extent of smartphone and health app use
    • Socio-demographic, medical and behavioural correlations of smartphone and health app use
    • Associations of app uses and characteristics with actual health behaviours.

    A survey of 4,144 Germans aged 35 and older identified socio-demographics, presence of chronic conditions, health behaviours, quality of life, health literacy and the use of the Internet, smartphones and health apps.

    About 61% of the sample were smartphone users. Younger users undertook more Internet research net, were more likely to work full-time, have a university degree, engage more in physical activity, ate low fat diets and have a higher health-related quality of life and literacy.

    Almost 21% of smartphone users also used health apps. They were younger, less likely to be native German speakers, undertook more research on the Internet, more likely to report chronic conditions, engaged more in physical activity, ate low fat diets and were more health literate than people who used only smartphones.

    The profile of their health apps was:

    ·       Planning                            51%

    ·       Smoking cessation           44%

    ·       Healthy diets                     39%

    ·       Weight loss                        23%

    ·       Reminders                         36%

    ·       Prompting motivation        34%

    ·       Providing information         34%.

    There were significant associations between planning, health behaviour and physical activity. Equivalent links were found between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctors’ advice.

    Two overall findings emerged. One’s that there were many smartphone and health app users. The other’s that a substantial proportion of the population was not engaged. The difference is attributed to age, socio-economics, health literacy and health disparities in mHealth use. A recommendation’s that health app developers and researchers should include the needs of older people, people with low health literacy and chronic conditions in their innovative endeavours. As Africa’s population increases and the demographics slowly change, this will be important to maximise the benefits.

  • AskNuma’s Nigeria’s latest eHealth service

    Personal health’s a big step forward from one size fits all. It’s also challenging to achieve and sustain, which is where eHealth, and especially its mHealth component fits.

    Nigerian digital health company Numa Health has launch AskNuma, an mHealth personal health assistant. It provides patients with high quality health information and creates a network for healthcare vendors.

    An article in BIZTECH AFRICA says the platform has revolutionised healthcare delivery in the country. Its Artificial Intelligence (AI) healthcare system hosts a wide database of health information which users can access in real-time. The services also serve as a personal health record, allowing users to manage their health wherever they go.

    AskNuma provides users with diagnoses based on the results of their interactions with the platform and connects them with nearby health facilities using  the diagnoses to find them. To access AskNuma, users can visit www.asknuma.com.

    Co-founder, Dr. Obisanya identified the lack of information and poor supporting healthcare infrastructure as leading to poor health in Nigeria. “In maternal health, over 2,300 children under five and 145 women of childbearing age die daily in Nigeria and according to UN figures, Nigeria contributes to over 10% of the maternal mortality figures globally. These figures highlight the wider issues and challenges in the Nigerian healthcare system and exist due to fragmentation in the healthcare system, a lack of information regarding healthcare options and a lack of basic medical records.”

    Co-founder, Anthony Ajose added, “Numa directly addresses these gaps in healthcare provision by leveraging existing healthcare resources with novel technology, increasing access to healthcare for patients and caregivers. Our personal automated health assistant is accessible via AskNuma.com, patients can manage minor conditions while securely and confidentially connecting to verified healthcare professionals and services when needed for further treatment locally.”

    The Numa platform aims to give patients control of their health, and provide a space where healthcare professionals can offer high quality services to their patients. It can be a catalyst for Africa’s health systems by encouraging healthcare organisations to be more responsive to their population’s needs.

  • Are mobiles part of Africa’s eHealth last mile?

    Connecting all Africa’s communities and citizens to communication networks has been a longstanding and challenging objective. It seems that the ambition remains unfulfilled. In an interview with Health Enabled, Dr Dustin Gibson, Assistant Scientist at the Johns Hopkins Bloomberg School of Public Health, described his research activities in Kenya. He said it’s “been very difficult to reach the last mile populations – that last 15-20% – with public health interventions.” Scaled up to all Africa, that’s between about 190,000 and a quarter of a million people.

    A solution included leveraging the widespread access to mobile phones combined with financial incentives through a widely used mobile-money system, like m-pesa. The result was an increase in full immunisation coverage in Kenya’s children from about 82% to 90%. The project took some four years to complete.

    Does this show that the mobile phone network’s an essential part of the solution to eHealth’s last mile? It seems that it can be.

  • Samsung's launching new telemedicine features

    At the launch of Samsung Galaxy S8 and S8+ phones, the company announced the re-invention of its S Health app as "Samsung Health". An article in mobihealthnews says the upgrade includes tracking and social features already in S Health and  adds new features and a new user interface.

    Ask an Expert’s Samsung's most-popular feature. Users can connect via video to a doctor for US$59 without insurance. It includes real time insurance verification. 

    The app taps into American Well's system so users can see several doctors. The company says its network contains more than 1,200 certified, licensed doctors with an average of 10 to 15 years of clinical experience.

    "This isn’t telemedicine, this is a connected healthcare ecosystem,” American Well CEO and President Dr. Roy Schoenberg told MobiHealthNews. “And we’ve been building up so that it is bigger than anything we have done, and what Samsung is saying is, ‘I’m not going to build healthcare on my product, I’m going to tap into that ecosystem and open the door through technology that touches a lot of people.'”

    In addition to the telemedicine features, Samsung Health includes:

    • Access to lifestyle, food, and fitness trackers
    • A step leaderboard to compete with friends
    • A Discover feature for health content
    • Integration with connected health devices
    • Rewards for signing up with Ask an Expert or Health Insights, a feature that adds analytics and coaching to Samsung's health trackers. 

    The app will be available on all devices that run Android 4.4 and higher. Some older devices and devices in certain countries may not have access to all features. It highlights an important component of Africa’s drive towards Universal Healthcare (UHC).

  • mHealth gives South African women access to legal abortions

    Illegal abortions are unsafe. WHO has a global survey showing there’s a death every eight minutes from preventable, unsafe abortions. Of the 21.6 million unsafe abortions globally, 18.5 million, more than 85%, are in developing countries like South Africa.

    Abortion in South Africa’s a reproductive right. Even after introducing the Choice on Termination of Pregnancy Act, 50% to 60% of abortions are illegal and unsafe. Research by Ipas says that 30% of South African women are unaware that abortion is legal.

    To give all South Africans access to immediate and locally relevant sexual health services, Safe2Choose has launched a new mHealth initiative. It includes evidence-based information and counselling to encourage having safe abortions. Safe2Choose's innovation arm, Fem, will run the campaign.

    The first will refer women to legal, safe abortion providers in their area privately and quickly. To use the services, users will have to:

    • SMS FEM to 30816
    • Answer standard questions on the platform, after which they will receive a referral SMS to a nearby legal and safe healthcare facility providing abortions
    • Authorise the system to map their geographic locations
    • If unable or unwilling to authorize geo-location, users will have access to a manual look-up option so they can select their preferred location and receive referrals.

    The pilot phase is currently underway in Gauteng. The campaign will gradually roll out to other provinces. In the first month, Fem referred some 300 pregnant women to safe and legal abortion facilities. The campaign was promoted on radio stations, flyers at local clinics and social media.