mHealth is often promoted as a big part of the eHealth contribution for stronger healthcare in Africa. The potential is good, but not all mHealth is good mHealth. While this is obvious for all eHealth, the challenge is to know the difference before it’s implemented. A study in Medscape, Systematic Review on What Works, What Does Not Work and Why of Implementation of Mobile Health (mHealth) Projects in Africa, can help.
It uses SWOT analyses, the widely known strengths, weaknesses, opportunities, and threats, to review 44 peer-reviewed publications on mHealth over the ten years 2003 and 2013. It focused on sustainability, medium and long-term results, integration to health systems, management process, scale-up, replication, legal issues, regulations and standards.
It’s mHealth groups were:
- 19 for patient follow-up and medication adherence
- 10 for data collection and transfer and reporting
- 4 for staff evaluation, monitoring and guidelines compliance
- 4 for disease surveillance and intervention monitoring
- 2 for staff training, support and motivation
- 2 for drug supply-chain and stock management
- 2 for overview of mHealth projects
- 1 for patient education and awareness.
A common theme was that mHealth projects succeeded if they had accessibility, acceptance, low technology costs, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement.
There were several significant threats. Funding dependency, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness are challenges to successful implementation.
The main features of an effective mHealth project in Africa are seen as:
- Good project design adapted to local contexts, promotion, education and awareness of the project
- Technology and resources that use local resources, capacity building, availability and maintenance
- Stakeholder involvement across public-private partnerships, multidisciplinary teams, ministries of health, political leaders and local champions
- Government eHealth and mHealth departments engaged in programme monitoring, evaluation and research.
A conclusion is that mHealth projects are not a solution to the challenges that health systems face in many African countries. Evidence remains poor, and results are still specific and constrained to projects or setting. Questions regarding impact, scalability and increased coverage remain, such as transferability to different diseases, different settings and different target populations. Questions over cost-effectiveness and sustainability of projects in Africa still remain. While mobile phone technology continues to improve, more research on these areas is essential to understand mHealth’s potential and help to reach the hard isolated and marginalised communities.
The study provides a strong and constructive challenge to all mHealth decision takers in Africa. Responding to it isn’t too difficult.