Vital Wave Consulting
Field Offices
Latin America
Rio de Janeiro,
Brazil
San Jose,
Costa Rica
Mexico City,
Mexico
Asia
Bhopal,
India
Beijing,
China
Phnom Penh,
Cambodia
Eastern Europe
mHealth for Development
Mobile communications for Health
Tallinn,
Estonia
World Bank Group
Africa
Mobile Innovations for Social and
Economic Transformation
Cairo,
Egypt
Johannesburg,
South Africa
September 16, 2009
Lagos,
Nigeria
United States
Palo Alto,
California (Headquarters)
Brendan Smith
Senior Consultant
Agenda
1
mHealth overview: Definition, applications and impact
2
mHealth Building blocks for success
3
Discussion
1
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Mobile Health (mHealth) Defined
mHealth (n) – the delivery of health care
services via mobile communication devices
Health
Services
mHealth
Electronic
Health Services
Photo: UN, UN Foundation, and Praekelt Foundation
2
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Opportunity – New Health Delivery Platform
Explosion of Mobile Phones in Developing World
Technologies and Health-Related Statistics
for Developing Countries (Millions)
6,000
6
5,300
5,000
5
4
4,000
3
3,000
2,293
2
2,000
1
1,000
0
11
Hospital Beds
305
Computers
Mobile Phones
Sources: Vital Wave Consulting, Business Monitor
International (BMI), International
Telecommunications Union and the World Bank’s
World Development Indicators.
Population
Mobile Phones reach further
into developing countries than
other technology and health
infrastructures
3
Photos: DataDyne
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Meeting Health Needs
Broad Array of mHealth Applications
Remote Data Collection
Education & Awareness
Applications using mobile devices to
collect real-time patient data, often
where patients live.
SMS/text messaging in support of
public health and behavioral change
campaigns.
14
6
Diagnostic & Treatment
Support
Use the mobile phone as point-ofcare device.
Remote Monitoring
9
10
9
5
Disease & Epidemic
Outbreak Tracking
Use mobile devices to send and
receive data on disease incidence,
outbreaks and public health
emergencies.
Maintain care giver appointments or
ensure medication regime adherence
via one-way or two-way
communications on mobile devices.
Communication &
Training For Health Care
Workers
Programs by
Application Area
4
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Distribution of mHealth Programs
Worldwide:
FrontlineSMS
Education & Awareness
Remote Data Collection
Remote monitoring
5
Communication & Training for Health Care Workers
Disease & Epidemic Outbreak Tracking
Diagnostic & Treatment Support
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Impact of mHealth
Promising indicators but a need for more research
Uganda
Text to Change’s SMS-based
HIV/AIDS awareness quiz led to
an increase of nearly 40% in the
number of people coming in for
free HIV/AIDS testing.
Peru
Cell-Preven health workers
use mobile phones to send
SMS messages with real-time
data on symptoms
experienced by clinical trial
participants. Enables
immediate response to
adverse symptoms.
South Africa
Project Masiluleke’s SMS
message campaign
promoting HIV/AIDS
awareness resulted in nearly
a tripling of call volume to a
local HIV/AIDS helpline.
Thailand
Phoned Pill Reminders for TB
Treatment. TB patients were
given mobile phones and
called daily with reminder to
take their TB medication—
90% did.
“When talking about efficiency versus health impact, it shouldn’t be about either/or.
Improving efficiencies can ensure that more people receive life-saving interventions.”
—John Stephenson, Dalberg Global Development Advisors
6
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Shifting Health Needs in Developing Word
mHealth Addresses Current and Future Health Needs
Current Health Care Picture
Global & Demographic Changes
Tomorrow’s Healthcare Picture
• Communicable diseases.
• GDP growth increases spending
on healthcare.
• Current healthcare picture issues
continued.
• Traditional diseases controlled
(TB, smallpox) and new diseases
appear (SARS, avian flu).
• Shift from “late stage”
treatments to prevention and
early detection.
• Aging populations means
increase in death from noncommunicable causes.
• Increased focus on health issues
of elderly.
• Lack of immunizations.
• Lack of safe water sources.
• Declining birth rate and climbing
life expectancy.
• Continued health worker
shortages and distribution
inequities.
• Adoption of “developed country”
behaviors.
Evolution toward chronic diseases – diabetes, heart disease and strokes
By 2025, 80% of all new diabetes cases will originate in developing countries
Diabetes, heard disease and strokes will cost approximately:
• $556 billion in lost national income in China
• $300+ billion in Russia and India
• $49 billion in Brazil
7
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Technology in mHealth Applications
Simpler, broadly accessible technology prevails
Other (sensors, GPS, etc)
SMS/MMS
More advanced technologies allow for
sophisticated diagnostic and logistical
applications, but cost and hardware
specifications limit their utility
(approx. 2/3 in research stage or are
not active)
10
17
5
Voice
The relatively high cost of voice
calls, particularly in sub-Saharan
Africa, limits the feasibility of largescale mHealth applications, though
these show promise in lower cost
regions such as South Asia. Voice
applications are not constrained by
low literacy rates
SMS and MMS are the least expensive
and most ubiquitous technologies in
developing countries. Though it ranks
second in program count, SMS-based
projects are among the longest lasting
and most prominent mHealth
examples
(more than 50% are active)
Data (typically PDAs)
33
Programs by Technology Type
Data collection and transmission
using mobile-enabled PDAs is used
primarily by health workers for the
collection and transmission of health
indicators
(approx. 2/3 in research stage or are
not active)
mHealth applications intended to reach a mass consumer audience
tend to rely on simple, ubiquitous formats like SMS,
while those for use by health workers often use more advanced technologies
8
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Technology in mHealth Applications
Advanced technology brings with it greater capacity, costs
ensive
re
reach
m
y
gy
ments
cost
ram
ntation
cost
ce
One-Way
Data
Two-Way
Data
Clinical
Services
(not real-time)
(not real-time)
(real-time)
• Public awareness,
BCC campaigns
• Emergency advisories
• Regimen adherence

• Disease, emergency tracking
• Client record access
• Vaccination monitoring
• Health information access
• Remote health clinics
• Remote emergency
health consultation
• Training








Technical

capability


Cost
Training
required
The technology used for mHealth applications should align with the needs of the program
 itis 


designed to support. As applications move from one-way data towards clinical
services, the technical capabilities increase, but so do cost and training requirements


Application/Service Delivery Fit:

9
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Case Study
Text to Change
Health Objective
Disease Awareness
Improving HIV/AIDS education with
anonymity
Country
Uganda
Impact
Techniques Used
• 15,000 mobile phone subscribers in
rural Uganda sent the quiz in the
three month pilot test
HIV/AIDS awareness via an SMS-based
multiple choice quiz in exchange for free
airtime; correct answers provided;
participants encouraged to come in for
testing (fee waived for participants)
• 40% increase in the number of
patients who came in for HIV/AIDS
testing
Partners
• Actionable insight: Many quiz takers
did not think AIDS testing was
accurate nor anonymous
Celtel, AIDs Information Centre (AIC),
Merck, and the Dutch Ministry of
Foreign Affairs
Photo: Text to Change
10
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Building Blocks
Sustainable & Scalable mHealth Programs
• Forge strong partnerships
• Be accessible
• Design with the end user in
mind and maintain a focus on
usability
• Build a long-term funding plan
• Set measurable goals
• Collaborate with other
mHealth organizations
Photo: UN Foundation/Nothing But Nets
11
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mHealth for Development Report
mHealth for Development: Mobile Communications for Health
http://www.vitalwaveconsulting.com/pdf/mHealth.pdf
Sizing the Business Potential of mHealth in the Global South
http://www.globalproblems-globalsolutionsfiles.org/unf_website/PDF/SizingBusinessPotential.pdf
“
mHealth provides a singular
opportunity to powerfully contribute to
sustainable development
”
12
Photo: UN Foundation/ Nothing But Nets
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Thank You
mHealth Improves Outcomes
Benefits in Patient Health & Health Systems Outcomes
Patient Health Outcomes
Effectiveness Gains
• Improved disease management
• Improved public awareness of
communicable diseases
• Improved medication compliance
Health Systems Outcomes
Efficiency Gains
• Services delivered at reduced cost,
increased speed and accuracy
14
Photo: DataDyne
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Urgent Need
Improve Health in Developing World
• 1 million die from effects of malaria
each year
• 25% of children in developing countries
are underweight and undernourished
• 1 woman dies each minute from
pregnancy-related causes
• 2.5 Million people newly infected with
HIV/AIDS in 2007
• 57 countries have critical shortages in
health care workers (Total deficit of 2.4
million health professionals worldwide)
Photo: Vital Wave Consulting
15
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Millennium Development Goals
Progress on Health-Related Goals Less than Encouraging
Progress on health-related
MDGs less than encouraging
• Children's mortality rate is not improving
• 27 countries made no progress in
reducing childhood deaths (1990-2006)
• Maternal health statistics are poor
• Half a million women died during
pregnancy, childbirth or in the six weeks
after delivery - 99% of these in the
developing regions
Source: 2008 Global Monitoring Report
Photo: UN/Marie Frechon
16
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Case Study
Project Masiluleke
Health Objective
Disease Awareness
Build awareness of HIV status, encourage
HIV/AIDS testing and treatment and halt
the disease’s spread
Country
South Africa
Techniques Used
‘Please Call Me’ service - free text
messages
Impact
Partners
• 365 Million text messages – one per
day – being sent (2008-2009)
Praekelt Foundation, iTeach, National
Geographic, Nokia Siemens Networks, MTN,
Ghetto Ruff, Children of South African
Legacies, Aricent, PopTech!, frog design
and National AIDS Helpline
• Encourage people to be tested and
treated for HIV/AIDS and TB
Photo: Praekelt Foundation
17
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Case Study
Data Gathering
Health Objective
Data Gathering
Containing the spread of the Dengue virus
Country
Brazil
Techniques Used
Impact
Customized questionnaires distributed to
field health agents’ mobile phones. Health
data and GPS location information are
integrated to enable immediate analysis
and identification of areas with high
infection levels.
• Data collection times dramatically
reduced (from months to days)
• 400 test results gathered by 20
field professionals in two days, all
with GPS information (paperbased system would have taken
2-3 months for lesser
information)
Partners
Nokia, Amazonas State Health Ministry
• End-user acceptance very high
Photo: Wikimedia Commons
18
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Building Blocks
Sustainable & Scalable mHealth Programs
• Forge strong partnerships
• Be accessible
• Design with the end user in
mind and maintain a focus on
usability
• Build a long-term funding
plan
• Set measurable goals
Photo: Mobiles for Malawi
• Collaborate with other
mHealth organizations
19
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Call to Action
Operators
• Combine mHealth with delivery of other mServices
• Leverage handset maker relationships
• Be pro-active in developing joint solutions
• Enhance mHealth infrastructure
NGOs
• For best results, think big and join forces
• Partner
• Provide proof of concept by using the simplest
available technology
Policy Makers
• Define an mHealth policy and provide incentives
Funders
• Ensure project sustainability
• Provide resources for impact assessment
20
Photo: RAMP and ENACQKT
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Value Chain Models for mHealth
Players and Incentives
Player
Incentive
Patient or Citizen (Mobile Subscriber) Improved health outcomes
Health Care Provider
More efficient and effective delivery of health services
NGO
Advance organizational mission, attract funding
Foundations
Advance organizational mission
Government
More efficient health care provision, effective government
Equipment Provider
Device revenue generation, improved brand recognition
Service Provider
Revenue from service fees, increased subscriber base
Application Solutions Provider
Revenue from additional applications license fees
Content Management
Increase in volume of readership or revenue
Platform Provider
Revenue from sales
A solid understanding of the needs and incentives of the multiple players
involved in the mHealth value chain is required in order to
marshal their energy and resources.
21
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Value Chain Models for mHealth
One-way mHealth Applications
Delivery of services,
operational efficiencies,
program expansion,
achieving mission
Equipment Vendor
Revenue ( short - and long-term), brand
and business development, opportunities
for network expansion projects
Application/
Solution Developer
Doctor/
Health
Provider
Project
Management
Home
Monitoring
Device
Operational efficiencies,
healthcare
Revenue ( short- and long-term)
Platform Operator
Mobile
Subscriber
Revenue ( short- and long-term)
Mobile
Service
Provider
Revenue ( short- and longterm), expanded user base
Scale Required for Sustainability
High
Medium
22
Low
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