Recently, Advanced Development for Africa released a report, “Scaling Up Mobile Health: Elements Necessary for the Successful Scale Up of mHealth in Developing Countries,” which details the work of nine projects that are deploying mobile technology to achieve specific global health goals.

The report crossed my desk at the same time as another study, “Cell Phone Use among Homeless Youth: Potential for New Health Interventions and Research” from the Journal of Urban Health. I was also finishing an article profiling some of IntraHealth’s work in India, including a pilot project called mSakhi (meaning mobile friend in Hindi), which uses mobile phones to guide community health workers in offering basic care and health education.

From these studies, there were several take-away messages. First, and perhaps most commonly repeated, cellphones are everywhere, and nearly everyone has one.

• There are “5.3 billion mobile subscribers across the globe,”¹ which may include more than 60% of homeless youth in Los Angeles,² I was surprised to learn.
• In developing countries, 3.8 billion people have mobile subscriptions, which accounts for 73% of subscriptions globally.1
• Wireless signals are available to 90% of the world’s population, and even in rural areas, about 80% of rural com­munities can tap into a mobile network.¹

Beyond the pervasiveness of these tools, it is apparent that cellphones have achieved a certain democratic reach globally even among marginalized or isolated groups. Cellphones are more than just useful, accessible, and affordable; they are also desirable or even ‘cool.’

Cool and personal, as my colleague Dykki Settle, blogged some time ago. Cellphones are “uniquely personal communication tools. Their portability makes it possible to talk to colleagues, friends, and family from nearly anywhere and at anytime….we’ve managed to extend our social circles from the immediate to the global. It’s a convenience that people are willing to invest in.”³

But even as more and more people buy their personal cellphones, another message coming out of the Scaling Up Mobile Health report is that although we see the promise of the popularity of this technology, many global health groups have yet to figure out how to harness and direct this promise into larger-scale programs.

The report refers to Getachew Sahlu of the World Health Organization’s assessment that mHeath programs in developing countries are being driven by:

• “Record growth of mobile phone users
• Rapid expansion of mobile networks
• The decline in mobile phone costs
• The innovation in mobile technology.”¹

It also suggests that the “the current landscape of mHealth development in developing country contexts is characterized by a proliferation of unsustainable pilot projects that often expire once initial funding is exhausted.” Recognizing this reality, the report offers nine brief case studies of mHealth projects:

• ChildCount+ by the Millennium Villages Project
• mPedigree by HP and mPedigree
• mTrac by UNICEF Uganda
• Pesinet by an organization of the same name
• Project Mwana by UNICEF, and the Zambia and Malawi ministries of health
• SMS for Health by Text to Change
• SMS for Life by Novartis, Vodafone Health-Solutions, and the Roll Back Malaria Partnership
• Tele Salud byTulaSalud
• Txt Alert by Right to Care, Praekett Foundation.

The case studies are quick summaries, and from this work the author, Jeannine Lemaire, offers an overview of best practices as well as recommendations related to mHealth programs, operations, and global strategy. The entire report is well worth the read, and some of the recommendations apply to public health programs, generally, such as the importance of monitoring and evaluation. Other recommendations are more specific to mHealth, such as the operational recommendations, quoted below, and worth publicizing:

• “Seek out and invest in building local capacity to minimize costs and support local ownership of the project.
• The software and mHealth application should be geared towards the objectives of the program, suitable for local conditions and designed with the end-user in mind.
• Identify what motivates the end-users, not just what the objectives of the program are. Use incentives to promote the consistent and effective use of the mHealth tool.
• Perform social marketing.
• Empower users through the mobile phone technology, particularly women.
• If an area of the project is failing, fail quickly and publicly; adjust the program accordingly.“

In many cases, sustainable and scalable mHealth programs will also require a tech savvy health workforce; helping to develop this workforce is one IntraHealth’s goals.

References

1. Lemaire, J. December 2011. Scaling up mobile health: elements necessary for the successful scale up of mhealth in developing countries. Advanced Development for Africa. Geneva, Switzerland.  

2. Rice E., Lee A., Taitt S. December 2011. Cell phone use among homeless youth: potential for new health interventions and research. J Urban Health. 88(6):1175-82.

3. Settle, D. Nov 29, 2010. mHealth: the possibilities of the personal. Global Health blog. IntraHealth International. Chapel Hill, NC.