Mobile health or “mHealth” applications featuring targeted text or video messages to frontline health workers and patients in resource-poor countries have had mixed success so far owing mostly to the limitations of the technology and economics in scaling up pilot projects. The mHIFA Working Group recently updated a review of existing projects, highlighting some of the more successful ones.
Foremost among them is the Safe Pregnancy and Birth app from Hesperian Health Guides. As judged by the Working Group’s criteria of “Significance of the Health Problem,” “Appropriateness of the Targeting,” “Value of the Information,” “Ease of Assimilation of the Information,” “Availability of the Application,” and “Technological Accessibility of the Application,” the Safe Pregnancy and Birth app provides short, easy to follow, step by step instructions (illustrated by simple drawings) of pregnancy and birth health issues.
For example a lay birth attendant in a remote location can get simple instructions on how to check the baby’s position in the womb or non-medical techniques for strengthening labor.
The app is freely downloadable to iPhones (or iPads and other Apple products) as well as Android devices. For now, the information is available only in English or Spanish, but the producers welcome offers to translate the information into other languages. The Working Group noted the app’s focus on action-oriented instructions and ease of navigation.
Mobile health applications are still proving their worth, but apps such as this one definitely help to make the case for continuing the effort.
In an earlier post, I described a few text messaging public health initiatives under way in the United States. These efforts are part of a global trend in the practice of “mHealth,” involving mobile and wireless technology as a means of promoting health objectives. The “explosive growth” of mHealth programs, particularly in developing countries were described in a recent draft brief on Emerging High-Impact Practices for Family Planning, produced by USAID, FHI 360, Progress in Family Planning and the Johns Hopkins School of Public Health Knowledge 4 Health project. This document notes the driving forces behind the popularization of mHealth projects, including the mobile phone market penetration worldwide (especially in developing countries – from 2005 to 2010 mobile technology subscriptions grew in developing countries 221%), the shortage of health workers, and technological improvements. Together these forces provide a perfect breeding ground for innovative, mHealth solutions to health challenges in resource poor countries. The main difficulty at this point is in moving these projects beyond the pilot phase and sustaining them for the long run. The document authors also observe that, as far as reproductive health mHealth projects are concerned, there isn’t even substantial evidence available documenting the effectiveness of mobile technology in promoting family planning in developing countries at this point.
Perhaps the most important part of the draft brief is its “How To Do It” tips to guide developers of new mHealth programs in limited resource areas. The tips are divided into five sections, including Planning & Design, Technological Considerations, Scale-Up, Sustainability, and Evaluation. Some key points include:
• Involving end-users and other stakeholders in the design and testing of the program will increase buy-in and promote sustainability. In particular, the target population’s technological understanding and common usage should be accounted for in order to avoid a steep learning curve and/or expensive outlays for new equipment.
• Likewise, it is important to involve government officials early in the process so that projects aren’t derailed by unexpected regulatory challenges. Government buy-in also helps in scaling up and sustaining projects for the long-term.
• Long-term costs should be considered from the outset, as well as the possibility of private sector support for the project. Open mHealth systems encourage sharing data standards and modifiable system functionality, which may also promote scalability and sustainability.
Of course, it’s important to review existing mHealth projects and those under development before striking a new – and perhaps redundant – path. Check out these resources for global mHealth projects: