Disseminating healthcare resources and information in countries with a widesprea

d rural population and limited financial resources remains a public health issue
. Here, Temitope Folaranmi, MPP alumnus, looks at mHealth as an innovative and p
otentially effective solution to overcome these problems.
Over the past decade, Africa has experienced an incredible boom in mobile phone
use. In 1998, there were fewer than 4 million mobile subscriptions on the contin
ent, but today, there are more than 800 million subscriptions, and this is proje
cted to reach 1.12 billion subscriptions by 2017. (1) Various studies (2)(3) on
pilot projects implemented in Africa support the claim that mobile technologies
have the potential to transform the face of healthcare by serving as vehicles fo
r delivering specific health interventions. This form of health service delivery
, known as mHealth, is seen as a complementary strategy for strengthening health
systems and achieving the health-related Millennium Development Goals (MDGs) in
low-income countries.
Defining mHealth
The term mHealth was coined by Professor Robert Istepanian, who described it bro
adly as the use of emerging mobile communications and network technologies for he
althcare . (4) Essentially, mHealth is the use in medicine and public health of mo
bile communication devices such as mobile phones, patient monitoring devices, per
sonal digital assistants (PDAs), and other wireless devices, (5) to enhance access
to health information, improve distribution of routine and emergency health ser
vices, or provide diagnostic services . (6)
mHealth platforms operate on the premise that technology integration with the he
alth sector has the potential to improve health outcomes. (7) Today, countries s
uch as Ethiopia, Kenya, Nigeria and South Africa are leading the way in using mH
ealth solutions for health service delivery, (8) and this is driven by the conve
rgence of a myriad of factors
expanding penetration of mobile networks in rural
communities, reduced costs of mobile handsets, general increase in non-food expe
nditure and innovative technologies that integrate mobile applications with trad
itional health service delivery models. mHealth has found applications in treatm
ent compliance, data collection and disease surveillance, health information dis
semination, point-of-care support for health workers, health promotion, emergenc
y medical response, as well as drug supply-chain management.
Opportunities
mHealth implementation in Africa has the potential to improve health outcomes in
many ways. The portability and always on features of mobile phones, along with th
eir increasing capability to carry and transfer data, make them unique for relay
ing health information. (9) In addition, the functional and structural propertie
s, namely, low start cost, text messaging and flexible data plans make mobile ph
ones attractive for use in healthcare interventions. (10)
In pilot projects across the continent, the short messaging service (SMS) applic
ation has been successfully used to remind patients to take drugs and attend app
ointments. Studies on the use of SMS as a drug use reminder, conducted in Kenya
and Uganda, showed improved adherence to antiretroviral therapy (ART) without ad
ditional counselling among HIV positive clients. (2)(3) While most of these proj
ects have focused more on infectious disease treatment adherence, chronic diseas
e management applications will become more relevant as epidemiological shifts to
chronic disease accelerate on the continent. However, poor or inconsistent acce
ss to health services and drug supplies may frustrate mHealth implementation in
the context of treatment compliance in some areas; thus, strengthening health sy
stems is important for successful implementation. (10)
mHealth projects that focus on data collection and disease surveillance leverage

on mobile phones abilities to collect and transmit data in real time. While stud
ies have shown that mobile phones and PDAs are more effective in data collection
compared with traditional pen and paper data collection methods, there is very
little evidence that they improve health outcomes. (10-13) However, one primary
benefit of projects utilising mobile phones data gathering and storage capabiliti
es is that they could actually save government money. For instance, they could c
ut paper and data-entry costs, and cut travel costs for both doctors and patient
s. However, it must be noted that mHealth projects such as these are accompanied
by ethical dilemmas related to data ownership and sharing, especially if they i
nvolve individual patients data.
Health Management Information Systems (HMIS) and Point-of-Care support projects
for healthcare workers, utilising mobile technologies, have been piloted across
Africa with good results. A pilot project using an SMS and web-based data collec
tion tool that enables health workers at district health centres to submit weekl
y HMIS reports with a focus on disease outbreaks and essential medicines in Ugan
da proved successful and is currently being rolled out to the country s 5,000 heal
th facilities. (8) The success of these projects is hugely important, given the
acute shortage of healthcare workers in the continent s health sectors. However, u
ser-friendliness of mHealth applications is key to its successful implementation
, especially as clinicians tend to adapt relatively slowly to the use of informa
tion technology. When they need information, many clinicians would prefer to ask
colleagues, check their own personal library and search online for information,
in that order of preference. (14) Therefore, creating incentives for clinicians
to adopt HMIS applications may improve its acceptability among them.
The use of SMS to disseminate health information, and prevention messaging to ta
rget specific groups, has also been widely implemented across the continent. How
ever, an understanding of the context and culture of the target groups is import
ant in implementing effective mHealth prevention programmes. It should be noted
that certain groups, such as the elderly, may have some difficulties using mobil
e phones, highlighting the need for projects to be well tailored. Furthermore, a
ccuracy of the health information is vital to the success of such projects.
Challenges
Despite these successes, challenges remain. A major challenge to the implementat
ion of mHealth on the continent is the lack of standardisation and regulatory fr
ameworks to guide its scale-up. In addition, inadequate monitoring and evaluatio
n and use of meaningful, consistent indicators and rigorous evaluation methods f
or cost-effectiveness may make it difficult to scale up mHealth interventions. A
lthough there has been a proliferation of mHealth pilot projects across the cont
inent, a large proportion of these projects are unsustainable and often expire o
nce initial funding is exhausted. For example, in Uganda alone there were 23 mHe
alth initiatives in 2008 and 2009 that did not scale up after the pilot phase. (
8) Thus, business models and funding schemes for mHealth need to be reviewed to
support the scale-up of effective pilots. Conflicting health systems priorities
may also slow down the scale-up of successful mHealth interventions in resourcepoor countries.
Conclusion
The healthcare systems of many African countries are constrained by high populat
ion growth, high disease burden, inadequate health workforce, widespread rural p
opulations and limited financial resources. (15) mHealth is one innovative and p
otentially effective solution to overcome these constraints. With mHealth, patie
nts who ordinarily have limited access to healthcare may be able to experience c
ontinuity of care even after leaving the doctor s office, by getting connected wit
h providers through their mobile phones.
However, many successful mHealth pilot projects are never scaled up to regional
or national level programmes. This is largely due to a lack of funding and coord

ination among relevant bodies. Creating sustainable, large-scale mHealth interve

ntions requires collaboration among different stakeholders. National governments
, for example, may need to align the regulatory and pricing policy of the teleco
mmunications sector with health policy goals to achieve their mHealth goals. (16
) However, it should be noted that mHealth is only an enabler of healthcare deli
very and cannot entirely replace the role of healthcare providers. Despite its c
hallenges, mHealth has a role to play in reducing the burden of disease and impr
oving health outcomes, and therefore, it should be given priority by governments
and health-focused non-governmental organisations (NGOs) working on the contine
nt.
References
1. ABI Research. Mobile Subscriber Forecast 2012. Available online at: https://w
ww.abiresearch.com.
2. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects o
f a mobile phone message service on anti-retroviral treatment adherence in Kenya
(WelTel Kenya1): A randomised trial. The Lancet 2010; 376(9755): 1838 45.
3. Zurovac D, Sudoi RK, Akhwale WS, Ndiritu M, Hamer DH, Rowe AK, et al. The eff
ect of mobile phone text-message reminders on Kenyan health workers adherence to
malaria treatment guidelines: A cluster randomised trial. The Lancet 2011; 378(9
793): 795 803.
4. Istepanian R, Laxminarayan S, Pattichis C (eds) M-Health: Emerging Mobile Hea
lth Systems. New York: Springer, 2005.
5. World Health Organization. mHealth: New Horizons for Health through Mobile Te
chnologies . Global Observatory for eHealth series, Adobe digital edition version,
vol. 3. 2003. Available online at: http://www.who.int/goe/publications/goe_mhea
lth_web.pdf.
6. Labrique A. Opportunities and Challenges for mHealth Strategies in Resource-L
imited Settings. Health Informatics Grand Rounds Series, Johns Hopkins Universit
y Global mHealth Initiative, 2012. Available online at: http://www.jhumhealth.or
g.
7. Shields T, Chetley A, Davis J. Improving health, connecting people: The role
of ICT in the health sector in developing countries: Summary of online consultat
ions. InfoDev working paper series, 2005. Available online at: http://www.infode
v.org/en/Document.486.pdf.
8. Lemaire J. Scaling up mobile health: Elements necessary for the successful sc
ale up of mHealth in developing countries. White paper, 2011. Available online a
t: http://www.adaorganization.org.
9. Mitchel KJ, Bull S, Kiwanuka J, Ybarra ML. Cell phone usage among adolescents
in Uganda: Acceptability for relaying health information. Health Education Rese
arch 2011; 26(5): 770 81. Abstract Full text.
10. Earth Institute Center of Global Health and Economic Development Columbia Un
iversity. Barriers and gaps affecting mHealth in low and middle income countries
. Policy white paper, 2010. Available online at: http://cgsd.columbia.edu/files/
2012/11/mHealthBarriersWhitePaperFINAL.pdf.
11. Krishnamurthy R, Frolov A, Wolkon A, Vanden Eng J, Hightower A. Application
of pre-programmed PDA devices equipped with global GPS to conduct paperless hous
ehold surveys in rural Mozambique. America Medical Informatics Association Annua
l Symposium Proceedings 2006; 991. Available online at: http://www.ncbi.nlm.nih.

gov/pmc/articles/PMC1839572/.
12. Parikh TS, Javid P, Ghosh SKK, Toyama K. Mobile phones and paper documents:
Evaluating a new approach for capturing microfinance data in rural India. In Pro
ceedings of the SIGCHI conference on human factors in computing systems, 2006, p
p. 551 560. Available online at: http://classes.soe.ucsc.edu/.
13. Patnaik S, Brunskill E, Thies W. Evaluating the Accuracy of Data Collection
on Mobile Phones: A Study of Forms, SMS, and Voice. ICTD, 2009. Available online
at: http://research.microsoft.com.
14. Research2guidance. Global mHealth developer survey: White paper summary of r
esult. 2011. Available online at: http://www.research2guidance.com.
15. World Health Organization. Global burden of disease: 2004 update. 2008. Avai
lable online at: http://www.who.int/healthinfo/global_burden_disease.
16. Kaplan WA. Can the ubiquitous power of mobile phones be used to improve heal
th outcomes in developing countries? Globalization and Health 2006; 2(9). Availa
ble online at: http://www.globalizationandhealth.com/content/2/1/9.
This article originally appeared on Perspectives in Public Health.
Image source: morguefile.com
Tags: Africa Healthcare mhealth mobile phone public health
Previous
Next
Share
Related Posts
Future financing of health in Africa
14 December 2015
To end malaria in Nigeria, focus on health systems
20 April 2015
A New Tax-and-Spend Strategy to Fight Obesity
14 January 2014
Do governments have a role to play in healthcare?
16 December 2015
2 Comments
Pingback: mHealth in Africa: challenges and opportunities...
Pingback: mHealth in Africa: Challenges and Opportunities | Health Technolog
y Africa