Notes from the eDevelopment Thematic Group event World Bank Day @ mHealth Summit – mHealth from policy to implementation.

.

Session 2: Global Overview, Country Cases and Perspectives

According to a recent UNF-Vodafone Foundation study, the use of mHealth is being implemented in several developing countries with using a number of applications such as data collection and analysis; education and awareness; and monitoring and surveillance. The panelists in this session will provide an overview of the mHealth movement and describe actual project implementations in the field followed by an interactive comment and Q&A video conference session from several country representatives.

• Panel Discussion

Chair: Deepak Bhatia, Lead eGovernment Specialist, Global ICT, World Bank

Global Overview: Mitul Shah, Senior Director, the UN Foundation

What’s being done currently around the world concerning mHealth?

We need a cross cutting tool which can address different challenges

• This tool is the mobile phone

mHealth: delivery of health care services via mobile

communication devices

how does it fit in the whole eHealth sector?

We don’t need train the individuals to use their mobile, it’s also becoming ubiquitous

What can be done specifically to leverage the potential of this tool which is already in the peoples’ hands?

Two client sets:

• patients
• ministry of health

key application

• education and awareness – campaigns
• data collection – health data which is critical
• monitoring and medication compliance
• disease emergency tracking
• health administration systems
• diagnostic tool – most interesting application, maybe in a few more years we’ll see

where is it currently being used?

• Africa is on the forefront

What has the impact been?

• mobile health reaches out to very different audiences
• health care providers, mobile providers, individuals, …

Where do we go from here?

• there is a growing momentum
• we need to focus on solid research, proving the impact

.

Mexico Case: Rodrigo Saucedo, mHealth Lead Researcher, Carso Institute

What are the things crucial to mHealth projects?

empowering individuals, focusing on the patient

Technologies are increasingly becoming a part of people’s daily lives

Four solutions

• CardioNet – assessing health indicators and giving advice to change the lifestyle
• Diabediario – reminders on medications and dates, monitoring it on the website to see how users react to various measures
• VidaNet for people with HIV/AIDS – they receive medication, appointments; monitoring, also the ministry of health
• A solution on H1N1 flu

Standardized methodology

• Strategic Planning
• Operation
• Scaling

None of the projects have been scaled so far

Field workers have to be trained

How to take the most of technologies – even without too much knowledge about technologies

• partners

Governments are open to initiatives but they are very risk-averse

Technology is seen as an expensive intervention

Conclusion and outlook – what’ important:

• Training
• Social marketing
• integration into national health system
• funding in the long term

Need for evidence of success

• Networking
• Evaluation
• Best practices

.

Kenya Case: Yusuf Ibrahim, Training and Support Manager, DataDyne and Kenyan Ministry of Health

mHealth as a solution to fight polio

EpiSurveyor is used in the ministry

traditional life cycle

• data collection
• data entry
• data analysis
• data reporting
• action

mHealth can drastically decrease the time from data collection to action

February 2009:

• polio outbreaks
• vaccination campaigns
• mHealth was used to support this campaign – making paper work more efficient
• daily information review with EpiSurveyor

.

Cambodia/Mekong Region Case: Romdoul Kim, Director of Government Affairs, Mekong Region, InSTEDD iLab (via VC from Phnom Penh) and Eric Rassmussen, CEO, InSTEDD

InSTEDD is an NGO from California

Provides health related tools to actors in the public health sector

Cambodia facts

• 30% mobile phone
• health situation not too good
• but all public health workers have access to mobile phones

Tool: GeoChat

• Open Source
• Vertical Communication
• Used for disease surveillance
• Also horizontal communication – server-independent

Mekong Basin Disease Surveillance

• Six countries
• Instedd helping the countries in ICT adoption
• Keeping whole team updated by using GeoChat

HIV Clinical Management

• mHealth system connecting to current patient database
• using SMS
• purpose: HIV healthcare delivery, not losing the HIV patients

One health – animal health

• working with ministry of agriculture
• telephone hotline to report sick animals
• veterinary in the village receives advice via SMS

GeoChat is also conncted with other tools to maximise impace

In Cambodia there is no reliable way of communication except mobile phones

What we are learning:

• even though almost 100% of health workers for the health centre staff have mobile phones, using English mobile phone technology has proven difficult
• we are working on other ways – e.g. machine-driven way to deliver the correct information

Innovation Lab

• live and work in the field
• training local staff & partner staff
• it’s an open source technology, can be expanded also when Instedd leaves

Instedd does also web synchronisation of data in various countries

.

Uganda Case Study: Fiona Lee, Project Lead, Google Africa & Grameen Foundation

Vision for Applab initiative

• Bring accurate, relevant, localized information to the poor
• Partner: Google

Process

• working with users – look at the demand, where are the gaps, how is information consumed
• partnering with local organizations
• piloting and testing lots of applications
• iterate & fail fast
• building sustainable models
• you have to have incentives for all involved

information that is timely, trusted, and specific is important, there are also local customs which have to be

People want specific answers

SMS works on any phones

We tried ten pilots, reaching a lot of peopl

Google SMS service in Uganda was launched

• Google Trader – supporting traders
• Google Seach – for news, sport results, …
• Google SMS tips – agriculture tips, health tips

Providing information to the most vulnerable in a community

• women
• youth
• farmers

SMS Tips has gotten 1.5 million queries in the first months

There is a huge demand – even at the bottom of the pyramid, if there’s value in the services

We want to extend Google Tips to other regions

• We need more content
• there were a lot of queries on health which we didn’t cover
• We need a lot more health information

Google will build a platform for everybody to add relevant health information

.

Questions & Remarks by Participating countries: Armenia, Russia, Moldova, Ghana, Rwanda, Tanzania, and Kenya

Moldova:

There is a need for a participatory approach in creating mHealth technologies including public health sector, patients, …;

mHealth seem to rely on a quite sophisticated marketing

What about data protection?

It must be made sure the data is not monopolized by any of the service providers

Services should be designed before thinking about technology

Russia:

Mobile systems should be based on a developed informatio infrastructure;

We try to gather data on every citizen with all disease data – database which is open to the entire country

Mobile technology is important means to support other services

Ghana:

Ghana has an ICT policy, but it needs to be reviewed in the light of developments in the health sector

Different stakeholders which emerged on the screen need to be included

Currently developing an eHealth strategic plan

We need to reach the targets of the MDGs, we need to strategically deploy mHealth for that purpose

Kenya:

We tend to prescribe solutions to the poor – is there any suprising innovation the poor have come up with using the mHealth systems?

Rwanda:

Whatever program you have, you need to have a national plan to introduce it

Instedd in Cambodia – what is the cost of ownership? What is the cost of scalability?

Google Uganda – did you assess the willingness of poor people to pay? Is the SMS cost a barrier for people to access the service?

Tanzania:

We have an initiative of eGovernment & eHealth – mHealth is a subdivision of that and is currently being coordinated – there is a recent project on that

New project using mobile phones tackling the transport costs to the hospitals

Ethiopia:

Ethiopia is going through a business process reengineering process currently

One achievement – free broadband for health institutions

D.C audience:

Are there any policies that were already in place in the countries the organizations the presenters worked in?

Language: is anyone looking at none text-based mHealth solutions?

Twitter:

What is the strategy for Goggle sms health tips beyond the ‘free’ period? Still plans for charging premium SMS rates?

Google/grameen sms health mentioned 1.5 million queries. How are they promoting the service to public?

Instead of prescribing ICT for the poor, what are the local “killer apps” that we should note?

what are the poor actually using these mhealth apps for? and do they think that this is useful for their lives?

Answers:

Language? Software used for end-users: French, Spanisch, Swaheli

Google

• Killer-app? Facebook; there’s no magic killer app, we are continuing to experiment
• Google tips Costs? We offer the service for free for a while, since the launch we started charging for some services – still very cheaply
• How were Google SMS services promoted to the public? Our carriers – e.g. short message by checking their balance
• Language? Uganda: very difficult to provide Google service in other languages
• When you make a service free you devalue it in the eyes of the user

Grameen

• Always looking for sustainability – that’s why we don’t provide them for free
• Langauge? Often it comes down to the kids – they tend to speak English and often translate for their parents

Instedd

• everything we do is free, open standards
• Language: Instedd – we are translating everything in various languages, but we also do
• we try to work with the ministries