mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World

This 70-page report is a response to mounting interest in the field of mHealth - the provision of health-related services via mobile technologies. It is part of a series of publications from the United Nations Foundation and Vodafone Foundation Technology Partnership, a public-private alliance using strategic technology programmes to strengthen humanitarian efforts worldwide. The Partnership is inspired by a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services - even in some of the most remote and resource-poor environments.

To that end, this report examines issues at the heart of the rapidly evolving intersection of mobile phones and healthcare, surveying the current mHealth landscape. It begins by helping the reader understand: mHealth's scope and implementation across developing regions, the health needs to which mHealth can be applied, and the mHealth applications that promise the greatest impact on heath care initiatives. It also examines building blocks required to make mHealth more widely available through sustainable implementations that can meet the future health needs of those in developing countries. Chapter 7 focuses on understanding the incentives for multiple players: mHealth value chains. Calls for concerted action to help realise mHealth's full potential are followed by a compendium of over 50 specific examples of mHealth projects in developing countries.

An excerpt from the Introduction follows:

"Though the mHealth field is still in its early stages, it has already begun to transform health delivery. Projects throughout the developing world are demonstrating concrete benefits, 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
• Expanded access to ongoing medical education and training for health workers

Due in large part to the successes of pioneering mHealth programs, activity in the field is rapidly gaining momentum. In 2008 alone, over a dozen new mHealth applications have been implemented or are in the trial stage. These include:

• InSTEDD, a US-based non-governmental organization (NGO) that provides technology solutions for humanitarian and disease support, opened a development center in Cambodia where mHealth-based disease and surveillance solutions are being designed for the Southeast Asian region.
• The Canadian development agency, IRDC, expanded support for a project providing nurses in the Caribbean with portable digital assistants (PDAs) to empower improved diagnosis and decision making.
• The United Nations Foundation and Vodafone Foundation Technology Partnership, together with the World Health Organization (WHO), a specialized agency of the United Nations (UN), announced plans to expand their mobile data-gathering program, powered by DataDyne’s EpiSurveyor software,  to more than 20 countries in sub-Saharan Africa.

This report profiles more than 50 mHealth projects taking place in the developing world. The long-term goal is that such programs will make healthcare more effective, and have a demonstrable and significant positive impact on clinical outcomes such as reduced infant mortality, longer life spans, and decreased contraction of disease.

Experts across the field, and interviewed as part of this report, assert that there is an unprecedented opportunity at hand to fulfill mHealth's promise. To accelerate this momentum and fully unleash the potential of mHealth applications, dynamic multi-sector collaboration between groups as diverse as governments, multilateral organizations, and the private sector is needed. To facilitate this new direction, the United Nations Foundation and Vodafone Foundation Technology Partnership joined together with the Rockefeller Foundation at the time of this report's launch to create the mHealth Alliance. As stated in the report: “Joint action should be directed toward the creation of a global mHealth infrastructure that lays out common standards and guidelines, and serves as a repository for shared resources and best practices..."

An excerpt from the Call for Action follows:

"The mHealth field offers opportunities for players across multiple sectors, from governments to businesses to NGOs. By taking a strategic approach, each of these players can advance their organizational objectives while contributing to improved health outcomes on a massive scale.

Operators

• Combine mHealth with delivery of other mServices - Operators can capitalize on the popularity of mServices in developing countries to build support for mHealth initiatives. Rapidly growing mServices such as mBanking and mCommerce are proving the viability of mobile technology as a service model. Packaging such services with mHealth solutions creates economies for operators and takes advantage of shared resources and best practices. It also presents a more compelling proposition to end users by serving as a 'one-stop shop' for all their needs.
• Leverage handset maker relationships - Mobile operators have tremendous influence and strong relationships with handset manufacturers, and they should leverage this position to bring to market phones and other devices that can provide the mHealth and other mobile services consumers in developing countries need. Affordability is critical, yet not sufficient to significantly increase the usage of mServices across the developing world. Low-cost phones that incorporate simple, innovative features are key to increasing access to mServices and helping to create the scale and market needed to sustain them over the long run.
• Enhance mHealth infrastructure -...[O]perator services geared toward mHealth can enhance their networks to facilitated increased mHealth activity. As Eduardo Jezierski, Vice President of Engineering at InsteDD notes, 'From a technical perspective you need to think not just about use of your network as a way for humans to communicate with humans but also as a way for humans to communicate with systems and information. The challenge is to build better application gateways that allow for different organizations involved in mHealth to build the applications themselves.'

NGOs

• For best results, think big and join forces -...As Jesse Moore of the GSMA states, 'Scale is of utmost importance to mobile operators. Operators evaluate value-added services, such as mHealth applications, by volume and volume is measured in millions of users, not hundreds or thousands. Scale is evaluated on three dimensions: how easy is the service to use by the end users? How easy is it to install and maintain on the operator's network and how many handsets can use the service (many handsets in Africa are very basic and hence the service must be designed for simple handsets). Without scale, the mHealth application will be evaluated as a corporate social responsibility initiative and its sustainability will be in question.'
• Partner - The most effective approach to achieving scale is to join forces with companies that are already offering mServices (mobile money, mobile government services, mobile education), and propose a joint effort on mHealth. NGOs bring valuable assets to the table - they understand the local environment and how to design services with cultural and behavioral patterns in mind. NGOs also have feet on the ground and can assist with training and education around the mServices. In return, they can use the existing technology platform to launch mHealth initiatives.
• Provide proof of concept by using the simplest available technology - Many operational mHealth programs build on the broad use of standard cell phones. Early applications provide data access and exchange in the form of one-way or basic two-way services. The infrastructure for these applications is already in place through standard telecommunications networks, and, unlike more complicated devices such as PDAs, users have widely embraced the functionality. These simple applications thus have the distinct advantages of lower start-up and operating costs and broader reach, pointing to a clearer path toward financial sustainability.

Policymakers

• Define an mHealth policy and provide incentives - ...mHealth applications can be designed as an integral part of the overall health information system, and policymakers are in a unique position to shape these efforts. One of the most important roles to play in this regard is in driving innovation through incentives. Incentives can include tax rebates to telecom providers for provision of mHealth services, and funding for universities and research institutes studying mHealth solutions.

Funders

• Provide resources for impact assessment - Help grantees help themselves. Non-profit and international development funding sources are placing a growing emphasis on 'demonstrable impact.'...To mitigate this problem, funders can set aside funds to enable independent researchers to conduct rigorous evaluations of mHealth programs.
• Ensure project sustainability - ...By ensuring that mHealth projects are integrated into government health programs, funders gain long-term sustainability and greater health impacts for their projects. Academic researchers affirm the central role of long-term financial planning..."

An excerpt from Conclusion: Looking Forward follows:

"...As this paper has shown, mHealth projects are operating in a wide variety of developing countries and providing demonstrable impacts. Documented results - in both the developed and developing world - reveal that mobile technology improves the efficiency of healthcare delivery. The next stage in the evolution of the mHealth field is to increase the scope and scale of operations. By learning from examples of similar projects, mHealth organizations will enhance their opportunity to scale and increase their health impact.

Case studies detailed in this paper reveal some of the key benefits of mHealth and provide examples of how to structure successful mHealth initiatives. These studies also reveal key building blocks of success for mHealth projects, such as forging strong partnerships and designing with the end user in mind....To move forward, leading players in the field of mHealth agree that multi-stakeholder collaboration on a global level is needed.

Due to its nascent stage, mHealth presents a tremendous opportunity to create a global facilitation body, enabling maximum innovation and impact on global health. There is an agreement among participants in this arena on the need for a body to address the many informational and logistical gaps in the mHealth ecosystems; from basic market research to best practices; from policy engagement and standards advocacy; to support scalable implementations of mHealth pilot programs through public-private partnerships.

An alliance cultivating the cross-sectoral and pan regional partnerships and projects necessary to expand the existing embryonic mHealth ecosystem would be a significant step in enabling closer collaboration on mHealth initiatives by multi-sectoral organizations..."