MOBILE HEALTH: A solution to Health bottlenecks

The World has become fast paced and technology is quickly advancing especially regarding mobile phones.'

At the end of 2011 about 6 billion mobile subscriptions existed, 87% of the world population owned mobile phones, a figure which has been steadily rising from 5.4 billion in 2010 and 4.7 billion in 2009.

Over 7.8 trillion SMS’ were sent in 2011.

Now these statistics are two years old so imagine how high the numbers have risen especially in Africa where studies have shown that mobile phones are now the major source of communication.

The World Health Organisation (WHO) says that for every Doctor in Zambia there are 17,000 patients which is dismal to say the least.

WHO also says that only 50% of rural households are within 5 Kilometres of a health facility.

Thus imagine if the population had increased access to health as they do to Mobile phones and if they could access basic medical information and intervention through mobile ?

That is the whole essence of Mobile health or mhealth as it is commonly called.

According to Sam Musariri who is the mhealth Specialist in training at the Ministry of  Community Development, Mother and Child Health (MCDMCH) and the Chief Operations Officer of TeleDoctor ;

“it is medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.”

According to a WHO study of its 114 member states, 83% offer mHealth service.

There is a higher uptake in Europe and Asia which comprise 60% of the global mHealth market whilst Africa by 2017 mHealth market will be 5% at $1.2bn of the market.

Dr Musariri reveals that there are many diverse things driving mhealth such as; ‘local disease patterns, regulation and legal issues as well as funding’.

He also says that there are two contrasts in approach to mhealth between developing countries and developed nations.

“Developing countries deal more with interventions that are based on shortage of Health personnel unlike in the West where it is more chronic diseases driven.” He says

He adds that most mhealth programmes are NGO or Government driven with a few been run through enterprise and entrepreneurship.

Examples of mhealth initiatives regionally are; Med Africa which is a resounding success in Kenya as well as M-Pedigree from Ghana and MAMA in South Africa.

Med Africa works by increasing interactions and purposeful engagements between health practitioners and consumers of their services.

 Whilst M-pedigree helps people authenticate drugs that the buy by them simply punching in the bar code imagine what a tremendous initiative this is in preventing sale of expired or fake drugs.

MAMA helps due mothers monitor their progress and overall health, so they submit their details and they get tips and information on their phones.

Interventions in mhealth can be either through Health Care Practitioner to Health Care Practitioner (HCP), or HCP to Patients.

‘Regarding the HCP to HCP, Tele-Doctor has a facebook page where Doctors across HCP can interact and solicit for information from each other.

In HCP to Patient intervention, a website was built with a live chat platform where patients can ask questions with immediate response as well as information on where to find medical assistance.

The website is currently on hold as regulation procedures are yet to be cleared according to Dr Musariri.

Mhealth would help decongest medical facilities as well as ease the burden on the health system, because its advantages are many;

Dr Musariri lists the benefits of mhealth; Geographic distance no longer a hindrance, consultation would be fast, easy and cheap thereby increasing, demand access, and advice.

He also says that apart from online appointments and referrals as well as E-prescription would offer a great convenience.

“It should be about packaging medical information in your pocket, for example if someone has a condition such as Hypertension and 

Diabetes, there is no need for them to line up consistently for the same prescriptions. That is where electronic prescriptions (e-prescriptions) come in.” He says

The goals therefore are to reduce maternal and infant mortality rates, to follow up on chronic diseases as well as increase the rate of immunization, drug adherence, and generally health awareness.

Another organisation that is making strides in the field of mhealth is Zambia Center for Applied Health Research and Development (ZCAHRD ).

The Organisation has two mhealth programmes namely Programme Mwana: which focuses on Early Infant Diagnosis (EID) results delivery system.

As well as mUbumi: Maternal and Child health, which has Emergency Obstetric and Neonatal Care (EmONC) services.

Both systems were developed using RapidSMS which is a free and open-source framework for dynamic data collection, logistics coordination, and communication and leveraging basic short message service (SMS) mobile phone technology.

According to Kaluba Mataka who is mhealth Project Manager at ZCAHRD:

“Programme Mwana  addresses EID by helping to reduce Dry Blood Spot (DBS) results turnaround times and helps to increase post natal coverage through patient tracing. “

She says this is done through three features:

Results 160: an EID results delivery system used primarily by trained health centre staff.

RemindMi: which is used by community based agents (volunteers) for patient tracing and birth registration.

In addition, Web Tool: This is real time program monitoring and management by Ministry of Health (MOH) as well as Provincial, District and implementing partners.

Ms Mataka says that programme has recorded success in that it was first piloted in 10 sites, with the scale up system currently running in 197 sites in 9 districts in Southern Province.

“It is now a countrywide program in 10 provinces, 66 districts and 581 sites with 556 Health Workers 319 Community Based Agents (RemindMi Agents) trained Users in Southern Province “she reveals

Ms Mataka also says that there has been a tremendous improvement in communication between District offices and their respective facilities.

The major victory has to be the reduction in turnaround time in infant HIV result delivery to health care providers and care givers.

“The results used to take about 4 to 6 months to arrive back to the health facilities and now it has reduced to 54 days whilst retrieval of the results takes about 5 days, when health personnel are notified via mobile.”

She says that the delay in retrieval is due to a number of factors such as low network coverage in some parts of Zambia as well as the issue of a Health Care provider manning a health facility alone.

Their other project mUbumi  is a sub-project of Saving Mothers Giving Lives (SMGL).

Ms Mataka says that it is a Global partnership initiated by the US Government (USG) in 2011 to reduce maternal mortality by 50% in 4 pilot districts in Zambia.

It focuses on:  Increasing demand for maternal and newborn health services through community outreach by community-based volunteers called Safe Motherhood Action Groups (SMAGs) as well as improving health facility quality of care, with emphasis on Emergency Obstetric and Newborn Care (EmONC).

What mUbumi does is use automated and timely SMS reminders to SMAG  who are paired with individual pregnant woman to enhance Ante Natal and Pre Natal attendance.

This is to increase proportion of facility deliveries and to improve emergency referral linkages between communities, health facilities, and hospitals to support EmONC.

This seems to be working because as Ms Mataka says there is an 88% increase in 3rd antenatal care visit attendance among pregnant women that were reminded via SMS.

Reminders improved visit punctuality and also caused a 5-fold increase in 4th antenatal care visit attendance among pregnant women.

The Ministry of Health in Zambia has also been recently using mHealth as a tool to compile health information in Districts.

Through its use of Community Health Assistants (CHAs) a system of Community Data Reporting is implemented using a District Health Information Software (DHIS2).

The software is installed on the phone and the CHA has to configure the mobile phone and enter the information that they collect from the communities.

The process runs from the time data is collected from Communities, households and patients after which it is tallied and summarised onto the mobile phone and sent to the District Health Information Officer (DHIO) and then to MOH.

Principal Monitoring and Evaluation (M&E) Officer at  MOH, Trust Mufune said that there are some challenges faced such as loss of configuration, non fuctional batteries and lost and stolen phones.

These problems are not so fatal because the phones can be reconfigured as they are not expensive and information can be entered in offline until a CHA finds internet.

 mHealth can be an opportunity to address some of the bottlenecks that contribute to poor health outcomes in general.