As mobile technology advances and expands, it could change the way health care is delivered around the globe. Six billion people, or 87 percent of the world, had mobile subscriptions by the end of last year, up from 5.4 billion in 2010, according to the International Telecommunication Union. In India alone, the market for mobile health interventions will be worth $557 million by 2017, PricewaterhouseCoopers forecasts.
This development has had investors and aid groups pouring money into mHealth, the practice of using mobile devices for medicine and public health practices. Earlier this year, for instance, the Norwegian Agency for Development Cooperation committed $9.9 million to the mHealth Alliance, founded in 2009 by the Rockefeller Foundation, Vodafone Foundation and United Nations Foundation. Related networks include the Mobile Alliance for Maternal Action and TechChange, which offers an online mHealth certificate course. Research institutions like Johns Hopkins University’s Bloomberg School of Public Health are adding mHealth courses to their curriculum.
As the mHealth field grows, it has now become a common belief that technology will play a growing role in building health capacity in the developing world. Technology is getting cheaper, which means that even the poorest citizens are able to access mobile phones. In addition, the development of low-cost or free open-source software is spreading. mHealth proponents highlight these factors when explaining why mobile devices are ideal for improving health care consultations, data delivery and outcomes.
The Bangladeshi organization mPower Health is one example of this vision. In February, mPower Health was awarded a Grand Challenges Canada grant for a mobile phone application aimed at promoting breast cancer screening among rural women in Bangladesh. The application works in combination with a two-day training course to help community health workers educate women about breast health and refer them to a clinic if an issue needs to be addressed. Findings from a recent study show the technology can be used to obtain data more accurately than when it is recorded on paper, reports Mridul Chowdhury, CEO of mPower Health, who has worked with the United Nations Development Program and the Bangladeshi government.
Another example is Mobile Baby, a service for pregnant women that is available in Tanzania, Nigeria, the United Arab Emirates and Saudi Arabia. It was recognized as the best mobile health innovation and the best service for women in emerging markets at mobile operators’ organization GSMA’s Global Mobile Awards this year.
USAID funds more than 40 mHealth projects in a variety of countries, according to Sandhya Rao, a senior adviser for private sector partnerships at the U.S. Agency for International Development’s Bureau for Global Health. But although she says USAID’s investments in mHealth have increased in the past five years, the organization’s mHealth activities tend to be embedded within larger projects. That means it’s difficult to pin down how much USAID actually spends on mHealth. The agency hired its first overall lead for eHealth, Dr. Adam Slote, a few months ago.
USAID and other organizations that aspire to succeed in the mobile health space face two major challenges. For one, mHealth is a fundamentally interdisciplinary field, and public health professionals and computer science specialists traditionally don’t communicate very well with each other. Both areas require technical expertise, and the two fields don’t always share the same terminology and mode of operations.
“From my standpoint, you’ve basically got the technologists and the implementers. And they’re not always having the most open-minded conversations,” says Bill Philbrick, a consultant for the mHealth Alliance and a former director of the HIV/AIDS, Emerging and Infectious Diseases Unit at CARE.
Engineers and health professionals also tend to mingle like oil and water at industry conferences, according to Philbrick.
“A lot of technology folks will attend sessions about how people use source code, but that is over the heads of the implementers,” he says.
Another challenge that faces mHealth professionals is that, because it is still in infancy, mHealth does not have a particularly rich history for researchers to mine for best practices. Also, unlike many other fields, mHealth — since it is so tied to new and emerging technologies — is moving and developing so rapidly that it can be tough to pin it down to conduct any kind of evidence-based studies or gauge how effective it is.
However, this issue is less pressing for projects in the developing world than it is in the West, USAID’s Rao notes.
“It’s true that things are changing very quickly,” she says. “But for the audiences we work with it’s not that quick… There is still a lot we can do that will still be relevant in a five-year time span.”
Complications can even arise in the research phase on mHealth projects. The timetable for a typical computer science study can be as short as a few months, while a typical health research project will be significantly longer.
“Part of the reason why computer science programs move quickly is because tech[nology] moves so quickly,” says Brian DeRenzi, a computer science and engineering doctoral student at the University of Washington in Seattle.
While public health researchers are more accustomed to publishing their new findings in peer-reviewed journals, computer scientists use conferences as their primary platform for presenting new research findings, adds DeRenzi, who has conducted research on CommCare and other health software used in the developing world.
Computer scientists are also accustomed to measuring project performance through different performance indicators than those preferred by public health researchers, DeRenzi adds. Computer scientists may look at how an application can improve patients’ chances of interacting with health workers, while public health specialists would want to ensure that those interactions actually yielded successful health outcomes.
The deeper issue has to do with separating mHealth into its own unique area, according to Jody Ranck, an mHealth specialist and analyst for GigaOM Pro. That distinction “feels foolhardy and delusional,” but it’s a broader problem that has affected global health since donors decided to go with the disease-specific approach in the 1990s, says Ranck, who spent 18 months working with the mHealth Alliance.
“Data should not be in silos, it should be liquid,” he says. “But donors have yet to embrace that and reward that perspective.”
Even with the growing number of opportunities available to improve mHealth, a number of health practitioners think it’s necessary to draw attention to the limitations. Though some “old guard” leaders have argued that mobile phones and other technologies “take the humanity out of humanitarian work,” most mHealth critics take a more measured position. In a thorough examination of the limits of mHealth, Dr. Sanjay Basu of the Department of Medicine at the University of California San Francisco notes that mHealth technologies are “generally concentrated in the hands of those who already have resources, organized electronic health initiatives, and motivated and skilled staff.” Basu does not believe mHealth will “generate mass mortality benefits in the near future.” More likely, he says, “[o]ur joy of experiencing and creating new technologies may just outpace our need for them, or direct us towards the most-fun-to-use technologies rather than the most necessary ones.”
These challenges, however, shouldn’t dissuade implementers from jumping on the mHealth bandwagon. Donors are increasingly interested in projects with a mobile component – even if proposal requests don’t explicitly ask for mHealth to be included.
For implementers, there’s also a big thirst for projects that add to the mHealth evidence base. From USAID’s perspective, the big question of the moment is around evidence related to cost effectiveness. But over the next few years, the focus could shift to interoperability or creating a set of standards to ensure new technologies are able to work together.
“If you’re really going to try to create scale, you have to have systems that talk to each other,” Rao says.
CORRECTION: An earlier version of this story mischaracterized Sandhya Rao current role within USAID, and failed to note the appointment of Dr. Adam Slote as eHealth coordinator with USAID’s Bureau for Global Health.