We recently attended the mHealth Summit 2011 to learn more about the latest developments in the mobile health field. The conference brought together developers, practitioners, NGOs, representatives from corporate industries, and government officials to discuss the current state and future of mobile health.
Several key trends emerged among the discussions, focusing on: local buy-in and capacity building, the importance of building partnerships and trust among communities, and the need to transition from short-term pilots to scalable, sustainable mHealth projects.
Scale, Sustainability, and Hype
There was a lot of discussion at the mHealth Summit 2011 about the number of failed pilot projects and the hype around mobile health. More productively, there was considerable discussion on what steps can be taken to reduce the waste (including financial, time, and community good-will) that results from launching unusable, unscalable, or unsustainable mobile health projects. The honest assessment of challenges in the m-health field led to discussions about scalability and sustainability.
Dr. Krishnan Ganapathy of the Apollo Telemedicine Networking Foundation spoke about m-health in India and how although there are many m-health pilot projects, few succeed with large-scale and long-term adoption. He noted that there needs to be behavioral changes from both doctors and patients in order for mobile health projects to become normalized, saying that physicians need incentives to encourage using mobile tech, and patients need to maintain a connection to trusted, human interactions. Dr. Donna Ramos-Johnson added to the conversation by speaking about her work with the Washington, D.C. Primary Care Association, saying that although mobile phone use was high among the minority populations her organization serves, mobile health has yet to become the norm. She explained that there needs to be a move away from an encounter-based health care system (a reactive system that focuses on treatment once diseases are present) to a steady, proactive system that focuses on daily prevention techniques and the potential for mobile health to meet this need.
Paul Meyer of Voxiva discussed text4baby, a free SMS information service for expecting mothers that has more than 250,000 subscribers in the US. Meyer spoke about how mobiles are “a whole new model for public health,” as they are accessible for groups who previously may have been held back from receiving medical care due to finances, location, or service availability and that mobiles have the potential to scale due to their ubiquity.
Dr. Gwen Ramokgopa, Deputy of the Ministry of Health in South Africa, spoke about the potential for mobile health projects in South Africa due to the popularity and ubiquity of mobile phones, but stressed that programs must be sustainable. In talking about how many pilot projects fail to materialize into long-term programs, she said that “systems designed in isolation are not scalable or sustainable,” and that there is a need to “engage the whole health and ICT ecosystem” to ensure that resources aren’t wasted or that failed projects and ideas aren’t repeated.
The core message was that technology alone doesn’t lead to successful, scalable, and sustainable projects.
Local Buy-in, Participatory Design, and Building Partnerships
Many of the speakers discussed the importance of building projects within their local context. Heather LaGarde of IntraHealth International spoke about the importance of “including the health worker in the discussion from the beginning,” in order to ensure that mobile tools are accessible, needed, and useful within the local context. She said that when developing and deploying mobile health tools for community health workers, it’s important to advocate for in-country development and to encourage local content building and sharing. She concluded by saying that building successful, sustainable mobile health projects takes “time, experience, training, trust, participation, and design from local users.”
Representatives from UNICEF’s Project Mwana, a mobile health service for mothers and infants in rural health clinics in Zambia, and Frog Design’s Project Masiuleke, an HIV prevention and testing service in South Africa, spoke about their projects’ use of participatory design and how they consulted with end users in order to develop mobile tools that the end users wanted and needed. Merrick Schaefer of UNICEF stressed how important it was to have one-on-one interviews with beneficiaries and ask open-ended questions to find out what people want, what will work in the deployment area, and what beneficiaries think of existing systems and how they could be improved in order to develop local-specific mobile tools.
Robert Fabricant of Frog Design discussed his work with Project Masiuleke in the KwaZula-Natal district of South Africa. He explained that because HIV and sexual health is a taboo topic in some areas of South Africa, it was important to find trusted voices within the community in order to find out what mobile solutions would be appropriate and would actually be used by the target beneficiaries. He said that including the community and asking them what they wanted and needed built trust among the community that the service was designed for their benefit.
Eric Woods of Switchboard, which set up closed networks for free phone calls and SMSs among doctors in both Ghana and Liberia, spoke about how his organization focused on meeting the needs of all stakeholders: both the doctors using the service and the telecoms providing it. He said that before implementing a project, it’s important to “look at the core users and understand their daily realities,” as mobile tools have to be relevant to beneficiaries for the tools to be accepted. Woods said that his organization approached the project with a business model focus, highlighting the financial benefits for both the doctors (who can consult with other doctors via mobile phones for free) and the telecoms (which gain revenue from the subscribing doctors).
Kevin Adomayakpor spoke about One World’s HIV prevention initiatives, which offer a toll-free SMS platform that allows young people in Morocco, Nigeria, and Senegal to text in questions about sexual health to trained counselors. Adomayakpor said that mobiles are seen as a “safe space” in Africa, and that youth who may be unable or unwilling to ask questions about sexual health in person feel comfortable using mobile devices to seek out health information.
Each presenter spoke about the importance of delivering content and tools that are applicable and accessible to their core audiences. A common theme was that all the players within an m-health project are important stakeholders that need to be considered – from telecoms, to end users, to developers, to the actual beneficiaries. Similarly, speaker after speaker reiterated the need for respecting the local context in which a given mobile project is deployed.
The conference focused heavily on the potential of mobiles, but many of the speakers were careful to temper the promise with frank discussions about the reality of challenges in mobile health work such as local buy-in, sustainability, patient adherence, and technological capacity and capabilities. Ultimate takeaways from the mHealth Summit 2011 were that while there is a lot of hype around the industry, practitioners and developers are learning what works and what doesn’t and are able to begin more honest and productive conversations about what makes m-health work in the long run. By focusing on the actual beneficiaries, building local capacity and partnerships, and planning for scale and sustainability, m-health seems to finally be moving away from hype to more context-specific, integrated approaches and platforms.