More mobile phones than toilets?

A version of this post originally appeared on K4Health’s Blog. Reposted with permission.

Are there more mobile phones than toilets in some places? Yes, in some developing countries, that’s true. This was one of the take-aways from the mHealth Summit that took place last week in Washington, DC, where over 3,800 people gathered to hear about the fast-growing health-related mobile phone industry. The Summit featured for the first time this year a Global Health Track that focused solely on mobile health interventions and lessons learned from developing countries– lack of access to care, providers without the necessary knowledge or information to do their job properly, and stockouts of supplies and medicines.

Patty Mechael, Executive Director of the mHealth Alliance, said in her introductory remarks on the first day of the conference that “more people in developing countries have access to mobile phones than clean water or bank accounts,” things we take for granted. What a possible game changer for health in developing countries if mobile phones can be used to leverage access to health care.

The number of doctors in Africa is woefully low, and there exists a game-changing opportunity to use mobile phones with front line health workers to improve patient care. According Sandya Rao, Senior Advisor of Private Sector Partnerships in the Office of Health, Infectious Diseases and Nutrition at USAID, working with frontline health workers is the “most immediate and cost-effective way to save lives and improve health”, quoting the Frontline Health Workers Coalition. The challenges of frontline health workers include inadequate training, inadequate performance incentives and weak health systems. Many different approaches to using mobile phones with health workers exist and are working. The successful ones have benefited from stakeholder inclusion in design and taking a holistic systems approach. According to Alain Labrique, Director of the Johns Hopkins University Global mHealth Initiative, countries can “recognize the individual, support disconnected frontline health workers, engage the community, and make the invisible visible.”

Sustainability of mobile phone initiatives was one focus of the Summit, and an extremely important one given the ubiquity of “pilotitis” – the mass of pilot programs that are not scaled up due to mainly financial reasons. Eric Woods of Switchboard explained one innovative model in Tanzania that utilizes an innovative business and financing model with governments, donors, and the private sector to ensure sustainability of a successful program using cell phones to improve patient care. Working with the Ministry of Health (MOH) of Tanzania, the 9,000 health practitioners in the country across all health facilities – 6,500 rural health workers and 2,500 urban doctors – are being connected with free calling. This connectively feature will enable them to find knowledge locally, communicate in real time, and allows the MOH to collect data from them or send targeted or bulk SMS messages with information regarding client care or disease outbreaks in their area. The program incentivizes health workers while at the same time is a gain for the telecommunications operator Vodafone, which has seen an increase in revenue from calls health workers are making outside the network. Pretty clever. And just one of many innovative solutions.

Another tool for frontline health workers is the Knowledge for Health (K4Health) project’s Application for Contraceptive Eligibility (ACE) mobile app. It gives family planning providers an easy and effective way to check whether clients are medically eligible to start using certain contraceptive methods. Based on the popular and trusted Family Planning: A Global Handbook for Providers (2011 edition), ACE reflects the latest family planning guidance from the World Health Organization’s Medical Eligibility Criteria for Contraceptive Use.

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