Mobile Health: How Far We’ve Come

When I first started in the field of technology for development back in around 2010, I was working specifically in global health tech, and there weren’t too many of us around. The idea of using technology in places besides the developed world was just starting to gain traction, and even then, it was limited to mostly technologists and a few health experts. Pilotitis was infecting everyone, and every project I worked on for the first few years was a pilot of some sort, with no solid plan to move beyond that stage. The focus was on finding tools and concepts that showed evidence of working, although that ended up being a more difficult task than everyone expected!

Recognizing this, the mHealth Alliance (formerly part of the United Nations Foundation) created programs to incentivize all the many organizations out there to move past the pilot stage and begin exploring how to scale their projects, and eventually other organizations followed suit. Even then, though, the health field at large was still a bit unsure about how to treat digital interventions, especially in terms of evaluation. Do you measure the success of an SMS stock monitoring tool by just counting how many times it was used, or do you count the many patients who were treated using those very drugs kept in stock? Is there even one right way to measure it?

Additionally, nobody could really agree on what terms like “scale” and “sustainability” meant for mobile health tools. It wasn’t until more recent years that the space has truly started to embrace that the definition of “scale” and “success” varies for each project, and that planning for sustainability is paramount for a mobile health product to truly make an impact.

These days, among many lessons learned, it’s widely recognized that like any technology, mobile health tools are great for targeted usages, but at the end of the day, they are just tools that cannot solve problems on their own. Even the sleekest vaccination reminder system, for instance, must be accompanied by an equally well-run vaccination program for it to really benefit a community.

The mobile health community, additionally, has expanded significantly to include a wide variety of experts and crossover roles, from doctors to designers and software developers to supply chain experts. This has contributed to an increasingly holistic view of mobile health, rather than the siloed space that it once was – which is a good thing! The more perspectives you incorporate into projects, the more likely you are to come up with a truly innovative and engaging product.

Looking Forward in Mobile Health

It’s hard to say what the next big breakthrough in mobile health will be, but we’re already starting to see a rise in the number of projects that incorporate more advanced technologies like sensors and wearables alongside mobile phones. These types of additions have the potential to reduce the amount of time and resources needed to activities that currently serve as barriers to access and utilization of health services. We’re still figuring out how these sorts of tools can be best incorporated into healthcare, even in the western world, but we’re making progress. The UNICEF Innovation team even just began testing the usage of drones to speed up the process of testing infants for HIV, which brings a whole new meaning to the concept of “mobile” health tools!

Personally, I think that the biggest changes coming ahead in the near future will not be so much in the tools themselves, but rather in how we use existing tools. With the rise of patient records and other consolidated data sources around the world, I think we’ll soon be seeing a bit more of personalized medicine in the developing world, which will help bring customized care to places where it otherwise would have been difficult to provide. Similarly, better data analytics will lead to smarter interventions – for instance, we’ll have a much better sense of exactly what types of diagnoses are prevalent in specific areas, and thus be able to better support clinicians with their precise needs. And it may sound crazy, but if you want to really look ahead, I do think we’re much closer than you’d imagine to our futuristic vision of robots supporting clinics in hard-to-reach areas. The technology for that exists; it’ll just be a matter of finding ways to make it affordable, accepted, and safe enough to use! That would open up all kinds of new doors to allowing patients with mobile phones to directly connect to their healthcare.

Regardless of what the future holds, one way that you can be prepared to participate in it is by learning more about the space at large, which is why the TechChange Mobile Phones for Public Health course is such an exciting resource! I look forward to meeting the students taking it and seeing the kind of impact they’re able to create.

About the Author
Priyanka Pathak is a technologist and digital designer whose work focuses on co-designing and co-creating technologies for social impact, especially in global health and STEM education for women. Currently, she is a Senior Designer at the Design Impact Group at Dalberg. Previously, Priyanka worked as an ICT and Innovation Specialist at the World Bank, in addition to having taught courses around design, technology, and social good at Parsons the New School and the Copenhagen Institute of Interaction Design. Priyanka holds a masters degree in informatics from Columbia University and bachelors degrees in information systems and business from the University of Texas at Austin, and is currently based in Washington, DC.

pathak_profile B&W

By Katie Kelly, Medic Mobile

Maeghan Orton and Dianna Kane, guest speakers at TechChange

Dianna Kane, Senior Designer, and Maeghan Orton, Africa Regional Director, are frontwomen for the Skoll Award Winning nonprofit, Medic Mobile. The groundbreaking technology company is now helping 9,000 health workers in 20 countries reach more people using mobile tools. They’ll be sharing their experience on April 3rd as part of the TechChange course, “Mobile Phones for Public Health”, this Friday.

Attendees of the course will be introduced to the pieces that make up a successful Medic Mobile mHealth partnership. These must be present for a project to be successful, sustainable, and lead to scale.

  1. Tools – Choosing the right tool is not as intuitive as it sounds. You need to employ empathy, human-centered design, and a lot of logic to know what to build for a specific community.
  2. Strategy – Invite the Ministry of Health and other government bodies to get involved early; they can be your greatest advocate and help support your project into the future.
  3. Funding – Your project needs to be secure in its funding in order to continue. You may need to employ creative ways to ensure a projects can sustain itself.
  4. Continuous Design – Your mHealth program needs to keep evolving as the project and user needs change.

Participants will also learn from Medic Mobile’s vast experience employing human-centered design. “Users are at the center of everything we do,” says Dianna, “Our process begins when we sit down with community health workers, nurses, patients, and community members.”

Interested in learning more? Join students from more than 20 countries around the world in the Spring 2015 session of Mobile Phones for Public Health. It is still not too late to sign up! Can’t make it this round? Be sure to mark your calendar for the Fall 2015 session!

About Katie

katie_kelly_medic_mobile_profile_web

Katie loves creative storytelling and is excited to shine a spotlight on Medic Mobile’s incredible mission. She comes to Medic Mobile with a background in marketing and advertising, telling stories for big brands like Hershey and Proctor & Gamble and young startups like Rdio and Dot & Bo. Katie has also volunteered her writing for Watsi and DailyGood. She is unabashedly in love with travel, yoga, capture the flag and writing young adult fiction.

 

By Samita Thapa and Kendra Keith

When we interviewed Nobel Peace Prize winner, Muhammad Yunus, at the 2013 mHealth Summit, he said that mobile phones are the “Aladdin’s lamp for healthcare”, a statement that still rings true today. Two years after that interview, we take a look at how digital health is beginning to expand beyond mobile phones. Mobile phones – especially smartphones – have been revolutionary in health care, especially in developing countries. With budding industries like add-ons to smartphones and wearable tech, the mHealth landscape is evolving.

Here are 5 digital health tools that extend beyond the mobile phone:

1. Pre cancer screening phone attachment

OscanPhoto source: Cellphone Beat

In areas of the world with high amounts of tobacco consumption and limited access to affordable dental care, oral cancer is a major concern. Oral cancer can be prevented with early detection and to equip rural health workers, the OScan team at Stanford university has developed a screening tool that mounts on a camera phone and conducts screenings for oral lesions. The data can then be transmitted to dentists and oral surgeons for assessment. OScan is in the process of conducting field tests with grants from Stanford, Vodafone Americas Foundation, and previously received funding from the mHealth Alliance.

2. STD testing smartphone attachment

Columbia University researchers have created a dongle (an attachment with a specific software) that can plug into Androids or iPhones and conduct tests for HIV and syphilis in about 15 minutes. The attachment costs $34 to manufacture, unlike the current method of conducting these tests in labs which can cost nearly $18,000. The dongle was recently tested in Rwanda on 96 patients and is still under development to improve its accuracy before doing a bigger trial run.

3. Ultrasound attachment for smartphones

Photo source: MobiSante

Seeing how an infant is developing during pregnancy allows any dangers to mother and baby to be addressed at an early stage, and is important to reducing mortalities related to pregnancy and birth. Urban hospitals may be equipped to provide ultrasound services to pregnant women, but it is difficult to extend these services to rural communities. To make ultrasound imaging accessible to everyone, MobiSante, Inc, an imaging technology company has developed a “smartphone based ultrasound device that allows health workers to perform ultrasounds anywhere and share the images via secure Wi-Fi, cellular networks, or USB.” With this attachment, the benefits of ultrasound services can be put in the hands of community health workers in even the most remote clinics.

4. Sensory patch for remote patient monitoring

Wendy Taylor with Smart band-aidPhoto source: Mashable

USAID recently launched the ‘Grand Challenge’ calling for innovative approaches in the fight against the ongoing Ebola crisis. One of the two innovations unveiled at SXSW ‘15 is the multisense memory patch or Smart Band-Aid. It’s a flexible patch that takes a patient’s baseline vitals and measures the changes from the baseline remotely. The vitals can be measured from outside the hot zone, or area containing active ebola cases, as the patch uses a USB cable to transmit data (the final version will use Bluetooth). With 7 – 10 hours of battery life, it costs $100 and is disposable. Wendy Taylor, Director of the USAID Center for Accelerating Innovation (pictured above), calls the smart band-aid a game changer!

5. Data Collection Necklace for Infant Vaccinations

Khushi BabyPhoto source: Khushi Baby

Developed to address the challenge rural clinicians and parents face in documenting children’s vaccination records, Khushi Baby stores children’s medical history in a digital necklace. After winning the Thorne Prize for Social Innovation in Health in 2014, this Yale University classroom project has become an organization and has conducted a successful field test in the village of Mada Daag, India. When vaccinations are administered, the healthcare worker can scan the necklace with their Khushi Baby app on their smartphone to transfer vaccination data to the necklace. The data is also automatically uploaded to the cloud once the healthcare worker returns to the clinic. Parents then receive automatic voice calls reminding them about vaccination clinics and during their next visit, the healthcare worker simply scans the necklace of the baby to see which vaccines are due.

As amazing as mobile phones and these new attachments and wearables are in global health, these new technologies also raise important issues. For example, when it comes to wearables, battery life can be an issue. Erica Kochi, a senior advisor at UNICEF noted that internet connectivity has beat electricity to many rural parts of the world, so access to electricity may still be minimal or non-existent in parts of the world where wearable tech can help. While finding better ways to collect more data is vital in healthcare, data privacy and security is increasingly becoming an important concern as we are realizing that there is too much data to manage.

The overall issue of practicality is another concern. Are these innovative solutions practical, cost-effective, and cost-saving? These are the conversations we will be having in our upcoming mHealth online course. We will be discussing new mHealth approaches like the ones mentioned in this post among others. We have a great group enrolled already and will be hearing from guest experts from organizations like Medic Mobile, National Institutes of Health (NIH), D-Tree International, PATH, and more!

GIZ Nepal participants Pushpa Pandey, Valerie Alvarez, and top TechChange student Bikesh Bajracharya with TechChange Communications Associate Samita Thapa, (and TechChange cubebots).

In our most recent mHealth online course, twelve participants from GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit) Nepal enrolled in the course to support its mHealth pilot for adolescent sexual and reproductive health. This holiday season, I was fortunate enough to return to my native home of Nepal to meet these TechChange alumni in person at the Nepali-German Health Sector Support Programme (HSSP) at their new office in Sanepa, Nepal. Since the September 2014 mHealth pilot launch, more than 150,000 adolescents have used their interactive service.

Nepal’s National Health Education, Information and Communication Center (NHEICC) developed a National Adolescent Sexual and Reproductive Health Communication Strategy (2011 – 2015) that stressed strongly the use of modern methods of communication in its implementation. GIZ, Health for Life (H4L), and the UN Population Fund partnered under NHEICC’s leadership to initiate this SMS based mHealth project – the first in Nepal. The SMS messages and interactive package focus on delaying marriage and pregnancy, healthy timing and spacing of babies, health and hygiene, and addressing gender based violence. The local mobile services provider, Nepal Telecom and NCELL, distributed the interactive SMS package that includes an encyclopedia, role model stories, quizzes, and a hotline for further questions.

Mr Khaga Raj Adhikari, Minister, Ministry of Health and Population launching ‘m4ASRH’ (Mobile for Adolescent Sexual & Reproductive Health) on 18 September 2014.

Mr Khaga Raj Adhikari, Minister, Ministry of Health and Population launching ‘m4ASRH’ (Mobile for Adolescent Sexual & Reproductive Health) on 18 September 2014.

Since Pushpa had shared the status of the GIZ mHealth pilot in Nepal as her final project for the mHealth online course the day before we met, it was especially great to catch up with her in person! She expressed that this mHealth course was much more engaging and fun to complete than other online courses she has tried out. Bikesh, the top user in our course with over 400 tech points, is new to the GIZ team and very excited to apply what he has learned in the mHealth course to his work in Nepal. Valerie recently arrived in Nepal and very new to the GIZ-team, was also excited to learn how much the other participants were engaging and that she can still access all course material for four more months.

All three GIZ Nepal participants shared their astonishment on how many tech points Bikesh was able to stack up in the course and also the fantastic course facilitation by Kendra. They also admitted that hearing Pushpa present in the mHealth course gave them insights that they weren’t aware of even though they work at the same office. While taking a technological approach to development projects in a country like Nepal can be challenging, it is an even bigger challenge to get the government’s buy in. It was exciting to learn that despite some hurdles, this mHealth pilot was an initiative supported by the government of Nepal.

We are excited for the future of mHealth in Nepal and wish GIZ all the best in their continued success! We are also excited to welcome six more participants from GIZ Nepal in our upcoming Technology for Monitoring and Evaluation course in January to better measure the impact of this mHealth pilot! It is wonderful to see how GIZ is committed to mHealth and M&E through their investment in technology capacity building in Nepal.

Kendra first connected with us almost a year ago while taking our mHealth online course. She was interning with the USAID Bureau of Global Health, mentored by the eHealth Coordinator of the Office of Health Systems. Having recently returned from Zambia, where she collaborated with ZCHARD and the Zambian Ministry of Health to scale Programme Mwana, an SMS test result delivery system to support early infant diagnosis, Kendra was interested in exploring how integration of mobile devices with public health programs could increase impact.

As a TechChange Alumna now team member, she has led facilitation of TC105: Mobiles for International Development and TC309: Mobile Phones for Public Health, coordinating live events, developing content, case studies and activities, and moderating discussion forum. With a background in global public health and project coordination, she provides content support and management for a variety of TechChange projects, while also supporting overall TechChange operations. Passionate about user centered design, she studies development and design in her free time, aspiring to ultimately improving mobile health and online learning user experience.

Prior to joining the team, Kendra completed an MPH with Boston University, as well as a Bachelor of Science from the University of Florida. She also worked in the non-profit sector, supporting the mPowering Frontline Healthworker and mHealth Working Group initiatives with Jhpiego.

Welcome, Kendra!

This feedback on mhealth concerns a field mission I undertook in July 2014. I visited one of Handicap International Federation’s HIV and disability projects being implemented in the region of Ziguinchor in the South of Senegal. Like many other organisations represented by colleagues in TechChange’s mHealth course, Handicap International is strongly exploring how mHealth can best fit in and with what we can offer not only to our primary focus on people with different impairments (our main targets), but also to various communities confronted with different issues, be they related to development, relief or emergency settings..

I realised that our project was provided with two android phones from CommCare to collect data as a “pilot activity” (not initially designed in our project, but rather as an add-on to our M&E system and tools). The project M&E officer in charge was supposed to learn about how it works and two project community mobilizers were supposed to collect specific information to feed into the beneficiary and activities database.

What happened with this pilot was quite interesting. Given that there was no specific planning or budget assigned to this seemingly exciting additional activity, and after discussions with CommCare, they graciously provided the project with two phones and basic training to the staff. Project staffs started the process of collecting data, but it didn’t work because there was the phones had no credit. So, they added credit and restarted the process of collecting data. Data were entered and things seemed to be on the right track. Knowing this, the M&E specialist in charge wanted to synchronise the system to see how data looked like. It didn’t work. After another brainstorming, the team learned that they had to set other aspects on the phones so that data can reach to the other end. Furthermore, given that this was an “extra activity”, problem-solving was not that fluid with CommCare as it was not the priority of neither party. And barriers continued, to the point that no one really bothered with whether the phones were useful to the project, to the beneficiaries, to the staff, nor to the system.

A few lessons learned from this minuscule pilot trying to use mobile technologies for data collection (and arguably for other aspects of project management and global development):

  1. If rationales are well thought through at project inception, it would be important to include planning, budget and dedicated human resources for the utilisation of mHealth within a project.

  2. Having “free phones” may not be the best incentive to projects when it is not tied to any specific performance indicators associated to bigger project goals.

  3. Excitement about mHealth is insufficient; there needs to also be interest combined with strong planning and field testing, coupled with systematic follow-up from the mHealth provider. This aligns with what mHealth guest speaker Ray Brunsting told us in the course about the importance of a project preparation phase that regularly iterates and progressively constructs what is needed so that the mobile mechanism works smoothly thereafter.

  4. Careful, regular, and frequent feedback is needed especially when getting an mHealth program is in its initial phases.

But this experiment didn’t deter us to pursue our desire to use mHealth and mainstream disability. We decided to partner with AMREF (France) which has tremendous experience in using mHealth. This project will start shortly and is going to use mHealth in the context of maternal and child health in Senegal. It will bring the expertise of two different organisations for the benefit of mothers and children, through a specific project, planning and budget, and through disability lens.

All this to say that using mobile phones to promote public health is not that straightforward. However, when we attempt to consider lessons learned and good practices from others, it tends to work better. So thanks so much to TechChange, all participants in the mHealth online course, as well as from our great speakers and facilitators for sharing all the mHealth wisdom

Interested in learning more about mHealth pilot programs and successfully scaled projects across the world? Register now for our mHealth online course which runs from November 17 – December 12, 2014.

About Muriel Mac-Seing

Muriel Mac-Seing

Muriel Mac-Seing is an alumna of TechChange’s Spring 2014 mHealth: Mobile Phones for Public Health online course. For the past 12 years, Muriel Mac-Seing has dedicated her work to community health development in Sub-Sahara Africa and South and South-East Asia, in the areas of HIV and AIDS, sexual and reproductive health, gender-based violence and disability. Currently, she is the HIV and AIDS/Protection Technical Advisor to Handicap International Federation supporting country missions and national programmes to include disability for universal access to HIV and AIDS and protection services for all. She co-chaired the HIV and Disability Task Group of the International Disability and Development Consortium (IDDC) from 2010 to 2012. Since May 2014, she is also a member of the Human Rights Reference Group at the Global Fund to Fight AIDS, Tuberculosis and Malaria. Trained as a nurse, she served an underprivileged and multiethnic clientele in the regions of Montréal, Canada.

 

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

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 testing Aviro

Clinicians test Aviro

Download the app here on the Google Play store

About Musaed Abrahams

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.

mHealth training for CHWs in Kenya photo 1Community health workers (CHWs) during a mHealth training in Kenya

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

  1. 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.

  1. 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.

  1. 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:

  1. 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.

  1. 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.

  1. 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.

CHWs learning about mHealth in KenyaCommunity 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

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

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.

 

Before the recent Ebola outbreak, the terms “contact tracing” and “Ebola” were spoken by only a small community of public health specialists consisting of infectious disease physicians and epidemiologists. As total cases of Ebola Virus Disease reported by the Centers for Disease Control and Prevention (CDC) exceed 10,000 across Guinea, Liberia, and Sierra Leone – almost 5000 of those fatal – these terms are increasingly entering general conversation.

What is Ebola contact tracing?

Rapid contact tracing is essential to the identification and isolation of symptomatic cases of Ebola disease, interrupting secondary transmission, and slowing exponential spread of the virus. It involves identification, documentation, and monitoring of all individuals who have come in contact with a single symptomatic case. In many cases, this is an analogue process of recording data on paper case notification, contact follow-up and field report forms, transporting those to a data entry center, and entering them into an electronic database. In other cases, mobile device can be used in the field for direct data entry into an electronic database.

Contacts have been exposed and are at risk for developing Ebola disease, but have yet to show symptoms. This is where understanding a few basics about Ebola virus and disease is helpful.

  • Transmission: direct contact with the body fluids of someone, ill or deceased, with symptoms of Ebola disease; or contact with objects contaminated by their body fluids

  • Symptoms: fever, headache, diarrhea, vomiting, stomach pain, unexplained bleeding or bruising, and muscle pain developing up to 21 days after exposure to the virus

If a contact develops symptoms within the 21 days of monitoring, they are immediately isolated and contact tracing begins for this new symptomatic case.

Ebola and Contact Tracing 

Contact tracing can get complicated, so much so that the CDC has a dedicated program, the Epidemic Intelligence Service, to build US health professional capacity and expertise to do so. A single Ebola case can result in the need to trace numerous contacts. In the early outbreak stages, rapid response is most critical as contact tracing efforts are somewhat manageable. If not contained, exponential transmission can make contact tracing efforts unwieldy, as is the case in the current West Africa Ebola outbreak.

Why is it so difficult to integrate mobile phones for contact tracing?

Several challenges in contact tracing could potentially be addressed with mobile solutions. Given wide geographic spread, remote locations and limited resources, real-time data collection and monitoring with mobile phones could facilitate rapid alert of new cases and contact follow-up. These tools could reduce time lag between data collected in the field and response, and serve as a more relevant basis for assessment and prioritization of control interventions. Given that solutions are developed with the Principles for Digital Development in mind, particularly open standards, open data, and open source software, the use of mobiles could address asynchronous data collection and reporting while lowering barriers to stakeholder collaboration.

Irrespective of the integration of mobile devices, contact tracing in Guinea, Sierra Leone and Liberia presents challenges unique from those in which the methods were developed. How do you identify and quarantine an affected patient effectively in a culture where many objects – from mattresses, toilets and food, to the burden of caring for the ill– are shared? How can reliable data be collected if interviewees intentionally misdirect or misinform surveillance officers in fear of response efforts? Social behavioral change communication could address these challenges, with mobiles playing a role.

Several groups are currently working to address data related issues in the West Africa Ebola outbreak. Notably, the World Health Organization’s Harmonized Ebola Response built on the Ona platform, the Ebola Open Data Jam, and mHero, a collaborative effort partnering IntraHealth International’s iHRIS software and UNICEF’s mobile messaging platform RapidPro. Three initiatives running in parallel leave one questioning if any single effort is actually impacting harmonization?

The challenges hindering rapid integration of mobile solutions are not necessarily unique from larger challenges in implementing mobile solutions, nor aid for that matter. Do you understand the user and ecosystem, did you design for sustainability and scale, and did you leverage opportunities for collaboration? There are suggestions that the WHO and mechanisms for responding to global health challenges are outdated, positioning the West Africa Ebola outbreak as a defining moment in their reevaluation. Perhaps it will also bring new perspective to effective leverage of mobile solutions.

Are you a “healthie”, “techie” or someone in-between interested in the use of technology in global health? Then don’t miss your chance to join course facilitator Kendra Keith and the next cohort of TC309: Mobiles for Public Health starting November 17th, 2014!

The field of digital data collection is constantly and rapidly changing, and as we’ve seen in the many iterations of our online courses on Mobiles for International Development and mHealth, Magpi has been a leading innovator in mobile data collection.

That’s why we were not surprised to learn that Magpi has been ranked “Top Digital Data Collection App” by Kopernik, a Rockefeller Foundation and Asia Community Ventures non-profit that ranks technology for development tools in their “Impact Tracker Technology” program.

Rankings for this category were based on scoring for criteria including affordability, usability, rapidity – the “ability to send and receive large volumes of data on a real-time basis”, scalability, and transferability – “flexibility in using the services for different purposes, sectors, and contexts”. This is first time Magpi has appeared on this Kopernik list where the judges tested the tools in the field.

For those who might not yet be familiar with Magpi, it is a user-friendly mobile data collection application that works on various mobile devices. Magpi uses SMS and audio messaging, and is built specifically for organizations with limited IT and financial resources. The company formally known as DataDyne is now Magpi and they have retired the DataDyne name as well as updated their website here, which lists some of the new comprehensive features they’ve recently added. Magpi is led by Joel Selanikio, who is also an Assistant Professor at Georgetown University’s Department of Pediatrics

Congratulations to the Magpi team! We look forward to having you guys join us again in our upcoming online courses!