Mobile Phones for Public Health | TechChange | The Institute for Technology and Social Change

According to a recent report by Grand View Research, Inc., the global market for the mHealth (mobile health) industry will reach $42.12 billion dollars by year 2020. That same year, GSMA estimates that smartphone connections will reach 6 billion, fuelled by growth in the developing world and mobile broadband expansion. The mobile phone market, the largest and most profitable segment of the global device market, is expected to total 1.9 billion units in 2015 alone.

With these high expectations for mHealth and smartphone adoption, what are the biggest opportunities for this $42.12 billion market?

We discussed this topic when we held a panel discussion in partnership with General Assembly DC at their office in Washington, DC in November 2014. In a rare opportunity to combine both “healthies” and “techies” in one room, we gathered a panel including Arthur Sabintsev, lead mobile architect at ID.me and instructor of General Assembly DC’s Mobile Development classes and workshops; Jessica Taaffe, global health and science consultant and writer at the World Bank; and our own Kendra Keith, mobile health specialist; and TechChange CEO Nick Martin – both of whom have facilitated our popular online course on mHealth. During this hour-long panel, we discussed a wide variety of topics on the mobile applications for public health.

Here are some of the highlights of “Mobile Development for Public Health” panel where the panelists shared insights that still ring true across the $42.12 billion dollar mHealth space.

1. mHealth can strengthen health systems

The need to strengthen health systems are the biggest challenges for public health, according to Jessica and Kendra, both of whom hold graduate degrees in microbiology and public health, respectively.

“The greatest opportunities for mHealth field and mobile developers focused on public health are in the public health sector, said Jessica. “The biggest public health issues are governance and figuring out the roles needed to fight infectious diseases and non-communicable diseases that are on the rise, especially as people are living longer.”

There are already several great examples of mHealth apps and programs that are strengthening health systems, including MAMA, MedAfrica, Dimagi, CommCare, and others.

2. mHealth can allow healthcare services to reach more people across the world

The ubiquity and diversity of mobile phones and their global usage will be a key driver of the mHealth industry reaching up to tens of billions of dollars, especially as GSMA estimates that there will be one billion unique mobile subscribers by 2020.

In their experience teaching the one of TechChange’s most popular online courses on mHealth, Nick and Kendra discussed the unique challenges of mHealth outside developed countries.

“Pay-as-you-go mobile phones are the most prominent form of mobiles in developing countries,” said Nick. “This model makes it more affordable for people to get internet access, and it will only get cheaper especially as players like Facebook and Google are ambitiously trying to get the entire world online.”

Clockwise from the top-left: TechChange CEO Nick Martin, mobile developer and General Assembly instructor Arthur Sabintsev, global health expert Jessica Taafe, and TechChange mobile specialist Kendra Keith.

3. Mobile development for health will become a hotter space for mobile developers through 2020

As a former nuclear scientist turned mobile developer himself, Arthur stressed how there are never enough mobile developers to meet demand in the current global market, much less the global mHealth market. Across the panel, everyone agreed that is it not easy to become a mobile developer, and to keep up with the quickly-evolving skill set demanded for building modern apps.

“Why aren’t there more developers building mHealth apps? Because it’s hard and time-consuming,” said Arthur. “There’s simply not enough time in a day to keep up with all the different standards for different operating systems, as well as all of their respective constant software updates. Although Android phones are used more in the developing world than iOS in western societies, there is a huge problem of Android fragmentation. What you tend to see more of now is that jobs in mobile development are mostly in the finance and advertising industries. If mHealth is truly going to grow to be worth $42.12 billion dollars, I’m excited to see more mobile dev jobs and incentives for this space to grow.”

So how do you incentivize mobile developers to build more mHealth apps for public health?

Nick mentioned that doing so will not be easy, given that mHealth/public health initiatives are often funded by governments or foundations that have procurement cycles. Though there are some initiatives such as the IBM Watson Venture Fund that has contributed to companies such as WellTok, funding long-term mHealth development has proven tough to sustain so far.

Another opportunity for mHealth will be in protecting the data collected in mHealth apps and programs. mHealth is fraught with mobile data security concerns in places where privacy policies are both well-established or barely existent.

What opportunities do you see for the growing mHealth global market? Let us know in the comments below, or tweet us @TechChange.

If you’re interested in learning more about the opportunities for mHealth, sign up now for our mHealth online course! The next round begins this Monday, 30 March 2015.

Treating HIV with antriretroviral treatment (ARV) medication can be very challenging, given how complicated it can be to dispense these pills correctly. Especially in remote clinics throughout the world, it can be difficult for clinicians to distribute ARVs because they require customized mixes of medication based on the specific symptoms of individual patients in order to be effective.

To help clinicians to correctly prescribe antiretrovirals, Dr. Musaed Abrahams, an alumnus of our mHealth – Mobile Phones for Public Health online course, has launched a mobile app for managing antriretroviral treatment (ARV) medication in South Africa.

The Aviro HIV mobile app acts as a virtual mentor for clinicians to easily consult for proper ARV (Anti-retroviral) initiation and treatment during the patient consult. Designed for Android and based on the current South African guidelines, it provides real-time, immediate feedback and guidance for the clinician, so that excellent and reliable care can be delivered to every patient. Following a care checklist, it gives clinical prompts aiming to educate and raise the standard of patient care.

Aviro featured on a national news broadcaster in South Africa

We asked Musaed to tell us more about his new mHealth Android app below.

1. What personal experiences of yours inspired this app?

I have worked for Medicines Sans Frontiers (MSF) for over 6 years, training clinicians throughout Southern Africa on the best practices on HIV Care. Through my experience I quickly recognized some of the challenges nurses and clinicians face day to day with changing guidelines and lack of training resources. I also recognized that many nurses were using technology informally, and were conversant with their mobile technology.

My aim was to create an app that can bridge the training and information gap with the already existing technology – particularly with mobile phones.The Aviro HIV app was created with this goal at the forefront. Providing a mobile tool for doctors and nurses, using technology to simplify the initiation and management of patients on anti-retroviral therapy (ART), with connectivity providing further referral support for complex patients.

2. What impact did the TechChange mHealth online course you took have on designing and launching this app?

This mHealth online course gave me an overview of different components of mhealth and how they interlink – specifically monitoring and evaluation, communication and decision tree support tools which were my interest. I valued most the practical examples/case studies and insights from the developing world and their implementations of mHealth projects, and challenges that they needed to overcome. Although I was already conversant in human-centered design, the HCD-focused workshop in the course rounded out my knowledge in this area while being engaging and informative.

Aviro

3. What exactly went into creating this Aviro mHealth app?

It was a team effort involving those with both HIV technical expertise as well as mobile development. We collaborated with the best medical expertise on HIV including James Nutall, Graeme Meintjes, and Ashraf Coovadia to design treatment algorithms. We incorporated human design thinking principles when working with African digital artist, Jepchumba to do the user experience (UX) design in collaboration with nurses on the ground in South Africa. Funding was provided with a partnership with MTN Foundation, Aviro’s technology partner. In addition, we partnered with nurse and clinician organizations, the Anova Health Institute and Southern African Clinician Society, for testing implementation of the app.

4. How successful has it been so far? (Any metrics you can share?)

We just launched the app at Social Media Week and Southern African Clinicians Society last week and have had over 300 downloads by South African nurses and doctors. we have interest from the SA National Dept of Health in adopting the app nationwide. Currently, we are working on an iPhone/iOS version of the app and will keep updating the app with new versions as we get more downloads and feedback.

Clinicians test Aviro

Download the app here on the Google Play store

About Musaed Abrahams

Musaed has worked and trained in Southern Africa as a HIV Training coordinator of MSF (doctors without borders). With over 5 years experience of coordinating HIV courses for nurses and doctors, with trainings in South Africa, Mozambique, Malawi and Zimbabwe he has developed innovative educational approaches to medical training.

Interested in mHealth to use mobile phones to improve healthcare delivery? Enroll now in the same course that Musaed took, mHealth – Mobile Phones for Public Health which runs from November 17 – December 12, 2014.

According to GSMA’s Digital Entrepreneurship in Kenya 2014 report, 99% of internet subscribers in Kenya access the internet through mobile devices. Kenya has been the leader in mobile banking, with apps like M-PESA, Zoona, and others. When taking TechChange’s Mobile Phones for Public Health online course with a group of 10 colleagues at PATH, I was curious to learn what mHealth looked like in Kenya and learn what lessons I can apply to my mHealth programs in Bihar, India. As part of my final project for the course, I asked Debjeet Sen, one of my colleagues at PATH based in Kisumu, Kenya, to share his views on the state of mHealth interventions in Kenya.

Like other developing countries, mHealth in Kenya primarily focuses on two core areas:

1. Data collection, where mobile devices replace and/or complement traditional paper-based tools;

2. Behaviour change, where mobile devices are used to disseminate key messages and good practices among communities.

And like any low-resource setting, there are inherent challenges in rolling out mHealth interventions, so it is important to be cognizant of them and develop appropriate counter-strategies.

Community health workers (CHWs) during a mHealth training in Kenya

Here are a few challenges that Debjeet sees mHealth interventions face in Kenya:

Multiple mHealth interventions have remained at the pilot stage

Many mHealth interventions in Kenya have not yet been integrated into larger health and information technology systems due to the absence of a clear scale-up strategy in the pilot project design and a lack of consensus on common software and hardware requirements. Different projects use different handsets with different operating systems for different mobile platforms. Aligning individual mHealth projects with regional and national management information systems (MIS) is necessary, but may not necessarily happen, as mHealth projects often function autonomously. Wherever possible, it is important to integrate mHealth data streams with existing MIS platforms in order to prevent duplication and mixing of data.

Many mHealth projects rely on the use of smartphones

Smartphones can be expensive and beyond the purchasing power of Kenyan government institutions and individuals. Most people continue to rely on low-end phones, which are cheap and widely available.

Scarcity of a reliable power source

Electricity supply in Kenya is unreliable and regular electricity is mostly available only in semi-urban and urban areas. Since graphics-enabled smartphones are highly power-intensive, any mHealth project that relies on smartphones may face challenges if users struggle to keep their phones regularly charged.

However, there are opportunities that can help tackle these mHealth challenges:

Almost universal penetration of cell phones

Kenya has a very strong base for implementing mHealth projects, partly because Kenyans are familiar with the use of mobile phones for functions other than just making and receiving calls. Mobile banking app like M-PESA is used by tens of millions of Kenyans. In fact, many financial transactions in the social sector, such as paying for trainings and workshops, issuing stipends to community health workers (CHWs), and transferring conditional cash transfers are all done through M-PESA. In a way, this extensive use of M-PESA for the social sector is already (indirectly) helping improve mHealth outcomes.

Incentivizing end-users such as CHWs to buy the phones

A common mistake of many mHealth projects is to provide the cell phones for the project as “giveaways.” In turn, this results in less accountability and a lack of ownership among the phone users. Asking CHWs to partially cover the cost of the phones or buy them is a good strategy to create ownership and accountability. This also has ramifications for scale-up and sustainability, as governments in low-resource countries may be unable to cover the entire cost of purchasing cell phones.

Work is underway to develop a plan to coordinate mHealth activities in Kenya

There are plans to align multiple platforms, hardware, and software with a common national strategy and to ensure that data collected from these activities are facilitated to feed into national and regional MIS.

4. Simple smartphone apps.

The simpler smartphone apps have been demonstrated to assist frontline workers such as CHWs in data collection and as job aids to assist them in household visits and group and/or individual counselling. In an environment that faces challenges in literacy rates as well as financial and network connectivity, we cannot simply develop and run any iPhone or Android app. Sometimes, it is important to develop ways to access mHealth tools offline.

Community health workers explore Information for Action app during the field test

In particular, Debjeet discussed his work on the Information for Action app, an innovative app running on the Android platform designed by the Human Sciences Research Council of South Africa. The app collects information from CHW home visits and immediately turns the collected information into actionable information in the form of a key message or suggested actions that can be shared by CHWs with caregivers. It is a dynamic app because it collects information and provides contextualized key messages and suggested actions on areas of children’s development, health, nutrition, and water and sanitation. The Information for Action app also stores records of individual home visits, which can be used by CHWs to plan for future home visits, as well as uploaded into a central data server/cloud, where supervisors can monitor for quality of home visits.

Currently, a field test of the app is being carried out in Kenya and South Africa to determine its operational feasibility and acceptability among CHWs, their supervisors, and community members receiving home visits from CHWs. Debjeet would be happy to share the app after the field tests are completed.

Debjeet asserted that the TechChange mHealth course has provided him with a structured overview of mHealth, which is a contrast to the way he has generally learned about mHealth through on-the-job experiences. The TechChange course has exposed him to interesting resources, people, and mHealth projects and he wishes to use the learnings from the course in his current projects at PATH

Why learning about mHealth in Kenya is useful for India

Since working in Bihar is quite similar to working in other countries of low resource settings like Kenya, it is helpful to learn about the challenges and strategies of different countries as we develop mHealth programs in Bihar. The PATH team in Bihar provides knowledge management support to a behavior change community mobilization project called Parivartan, which means “transformation”. The knowledge management team is in the process of conceptualizing a mobile based data collection and analysis system for village health sanitation nutrition committee (VHSNC). The committee members would develop effective social mobilization strategies to influence people to attend village health sanitation nutrition day (VHSND) at local primary health centers for health and nutrition related services. We have already started collecting a lot quality assurance sampling (LQAS) data through tablets and Kenya’s mHealth lessons definitely help as the fuel to work at per PATH’s technology and healthcare innovation in low and middle income group setting.

The knowledge on mHealth in Kenya which Debjeet has shared will help my team develop its own mHealth strategy in a low-resource setting such as Bihar, India.

If you are interested in learning more about the current state of mHealth, enroll in our upcoming mHealth course, TC309: Mobile Phones for Public Health today.

Alumni bios

Debjeet Sen is a Senior Associate with PATH. He has managed and supported a range of early childhood development (ECD), infant and young child nutrition, prevention of mother-to-child transmission (PMTCT) of HIV, and maternal and child health projects — primarily in Kenya and Mozambique, but also in DRC, Ethiopia, India, Malawi, Namibia, Nigeria, Pakistan, Rwanda, and South Africa. His core skills include technical design and management of complex projects, monitoring and evaluation (M&E), behavior change communication (BCC), curriculum development, capacity building and training, organizational development, documentation, and technical research and writing. He is currently based in Kisumu, Kenya. You can connect with Debjeet on LinkedIn.

Pratyaya Mitra is a communication professional with more than 12 years of experience in corporate and social sector. Currently working as communication and documentation officer in PATH Knowledge Management team in Bihar, India. Previously, worked with UNICEF as communication consultant for C4D, advocacy-partnership. Pratyaya worked in corporate communication and as copywriter with Ogilvy and Mather. He works with wide range of communication channels such as, written, audio visual, online, social media and mobile. He plays pivotal role in advocacy, PR and social and mHealth communication strategy to meet the project goal and business development. He did his masters in communication. You can connect with Pratyaya on Linkedin, Twitter, and Facebook.

Hamlet (community) health workers in Vietnam learn to interact with mCare (Photo credit: FHI360)

With international development program cycles often having a “project design phase”, how can online learning as a team improve project design?

How do you design a technology program intervention to improve health outcomes?

HIV Challenges and Keeping Up with mHealth

According to the WHO, HIV has claimed 39 million lives so far globally with 1.5 million lives in 2013 alone. At the end of 2013, there were 35 million people living with HIV, with 2.1 million becoming newly infected. With 24.7 million people living with HIV in 2013, Sub-Saharan Africa is the most affected region in the world accounting for almost 70% of the global HIV infections.

HIV often gets highlighted as a major problem in Sub-Saharan Africa, but it is also a major public health concern in Southeast Asia, particularly in Vietnam where the use of needles to inject drugs drives the epidemic. As of 2012, 260,000 (of the 89 million) people in Vietnam are living with HIV, according to UNAIDS Vietnam. As a result, FHI 360 is working with the Government of Vietnam to address the country’s HIV challenges with “effective programs that cost less, are implemented locally, and decrease donor dependence”.

Technology developments in public health change very quickly, especially with the emergence of mHealth – there’s more mHealth programming, new applications, and emerging research.

MHealth is a key strategy for us as these applications can be used to incentivize health-seeking actions, increase the timeliness of data collection, improve patient communications, and document system-client interactions. MHealth can also facilitate workforce development through task shifting, performance support, and human resources management.

According the blog Tech in Asia, “For every 100 Vietnamese people, there’s 145 mobile phones. For a country whose population is just over 90 million, that amounts to more than 130 million mobile phones.” RefWorld.org reported that, as of January 2012, census data indicated there were 119 million mobile users in Vietnam when the population was at 88 million. Given the emergence of the mHealth industry and the large percentage of the Vietnamese population with cell phones, we at FHI 360 need to effectively mobilize this ubiquitous technology for impactful programming that helps individuals in all areas of the country protect their health and well-being.

A Social Online Learning Solution

In 2012, I first participated in TechChange’s 4-week online certificate course called “Mobile Phones for Public Health.” I decided to take the course again in 2013 – this time with numerous colleagues — to share our mHealth programming experiences and to continue to learn from renowned mHealth practitioners around the world.

Like all busy development professionals, it is difficult to find time to cultivate learning during our day-to-day work. The TechChange course was structured and delivered to meet our needs.

Here’s a social graph from Mobile Phones for Public Health showing participant interaction

Cutting-edge, timely, and relevant information

TechChange updated its courses at least once every 3-6 months, based on direct feedback (through crowdsourcing and surveys) from its broad learning community to deliver the most up to date and relevant course content.

Great format for busy working professionals in Vietnam and beyond

Keeping our busy schedules in mind, the course content was designed to be mobile and tablet-friendly, allowing us to learn wherever and whenever fit our schedules. All live events were recorded so that learners could access materials according to their schedules.
For those of us who had difficulty finishing the course in the one-month period, access (and technical support) is available for four months after the end of the course so that we can complete our final project and receive the formal certificate.
The online interface was the most intuitive learner platform we have ever used: An online course map visually illustrated all components of the program, while a calendar highlighted a variety of live discussion events with renowned experts from around the world.
The main facilitator actively participated in all discussion boards; introduced weekly themes (through video, email and platform) and summarized (through print and video) the highlights of each week. He and a facilitation team also provided “office hours” for those who needed extra support (and this support was provided in various time zones).

Interactive learning experience

There was great communication between facilitator and learners. The course required 7-9 hours of effort per week and the 50 or so participants were motivated to actively participate. Learner outcomes were clearly defined and each week’s themes were well-articulated so that we knew what to expect and what was expected from us.
Instead of relying primarily on print materials, sharing video, audio and weekly live events/”chats” allowed learners from various cultural backgrounds to gain knowledge and skills through a variety of channels through interactive learning.
Practical exercises and interactive simulations ensured knowledge application and exchange.
Individuals got to know each other through a variety of “get to know you” activities and collaborative exercises.
TechChange added some fun by integrating game dynamics into the course, awarding points each time a person participated in a discussion or attended an event, with a minimum participation threshold established in order to earn a certificate.

Joining a professional network and community

All learners also became TechChange alumni upon finishing the course. We are now connected through social media with others in mHealth (and offered substantial discounts on upcoming courses).
It’s been great to see other mHealth alumni like Lauren Bailey making strides in the field after joining this course.

Here are some additional comments from two of my colleagues:

“I really enjoyed reading the forums at my own pace. I liked that other participants put so much thought into them.” – Deen Gu

“I like the discussion parts most as they offer me many interesting thoughts and experiences of TechChange’s members on different topics.” -Nguyen Thi Van Anh

As a recent graduate of TechChange’s courses, I can speak to the benefits of participation.

USAID/SMART TA team provides hands-on training to hamlet health worker in Nghe An (Photo credit: FHI360)

Results of mHealth Training with TechChange

Through this mHealth course, my team learned best practices as a group to explore ways to implement mHealth projects. My colleagues learned how mobile technologies are being used in other countries and sectors and thought about ways it could be applied in Vietnam. The individuals who have participated in the TechChange course are now our office mHealth champions and are actively identifying areas of work where mHealth solutions can be applied.

Here are two current mHealth pilots we have launched in Vietnam through the USAID/SMART TA program to address HIV challenges:

1. Fansipan Challenge – uses the metaphor of Fansipan mountain (Vietnam’s highest peak), gamification, and mobile technologies to support people who inject drugs and their intimate partners to test for HIV and be linked to care if they are positive.

Fansipan was created by USAID funded SMART TA project in Vietnam. Learn more about SMART TA here.

Here is a Prezi presentation explaining the Fansipan project in Vietnam called How Mobile Technologies and Gaming are Improving HIV Program

2. mCare – is the first case management application in Vietnam that utilizes mobile technologies to support and track clients across the cascade of HIV outreach, testing, care and treatment services. It also manages performance-based incentives for hamlet health workers who identify potential clients, encourage them to test for HIV, and support them to enroll and be re-engaged in HIV care and treatment and methadone maintenance treatment.

A confirmation message sent from mCare (Photo credit: FHI360)

The Results of the mHealth Pilots So Far

While mCare is in its early stages of deployment and refinement, the Fansipan Challenge has shown a dramatic reduction in programmatic unit costs, combined with significant increases in testing uptake and HIV yield among underserved key populations. Between June – November 2013, 62% of 656 injecting drug users and their intimate partners tested for HIV after a single contact. Approximately 71% of these individuals were first time testers; 17.8% were diagnosed as HIV positive. Comparative expenditure analyses of USAID/SMART TA-supported outreach services show a 50% reduction in costs associated with identifying an HIV positive person. And preliminary data further suggest that HIV positive people identified through Fansipan have higher CD4 levels (average 287.5 cells/mm3) and will thereby have better treatment outcomes than those who initiate treatment when they are severely immuno-compromised.

These new initiatives rely on mobile technologies and we, like other technical assistance providers in the development sector, need to be constantly learning about mHealth innovations, and emerging knowledge and applications. The TechChange mHealth class was a great investment in having my team become more familiar with mHealth as we introduced our mHealth initiatives.

About Caroline Francis

Caroline Francis is FHI360’s Deputy Country Director in Vietnam and completed TechChange’s Mobile Phones for Public Health course in 2012 and in 2013 when she took the course again with her team in Hanoi and Ho Chi Minh City. She is currently involved in FHI360’s Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance (SMART TA) project in Vietnam and her areas of expertise include HIV and AIDS prevention and care and Social and behavior change communications. Caroline has previously worked as the Associate Director (HIV Prevention, Mitigation, Strategic Behavioral Communications and M&E) and Deputy Director for FHI 360 Cambodia. She received her M.A. in Anthropology from University of Victoria.