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mHealth Summit 2012 review

by on December 21, 2012

mHealth Summit

Guest post by Khou Xiong and Nena do Nascimento

Over 4,000 people from approximately 50 countries attended the mHealth Summit in December 2012 to share, learn and discuss recent mHealth innovations throughout the world. A key theme for the conference was “2013 would be the year of scale” for mHealth in the developing world – moving away from pilots to large-scale mHealth projects.

Activities we found of interest from a M&E and global health perspective include:

Summary of highlights from the Global Health Track

Policy Environment and mHealth Architecture

  1.  mHealth should be understood as a catalyst for conducting proven public health interventions. mHealth is a mechanism that can bridge problems of known effectiveness – it is not an end in itself.
  2. mHealth should be viewed as an integral component of e-health and the health system (continuum of care), not a separate intervention. Governments still see mHealth representatives as a vendor, rather than a tool that can be integrated throughout a health system, or a tool that can help CHWs manage their workflow.
  3. Additional work needs to be done to create an enabling environment for easy integration of mHealth into community health – particularly developing the mHealth policy environment at the government level. Contextual factors that contribute to the success or failure of mHealth need to be documented.
  4. Private-Public partnerships were also noted as necessary elements for the sustainability of mHealth. It is important that mobile network providers understand their role in mHealth and partner with governments and non-profit organizations wanting to implement mHealth programs. Most often, mobile network providers are difficult to work with because they have the money and thus, the power. Furthermore, the public health community and the mobile health community have a long way to go in terms of cooperation and understanding.
  5. mHealth can be used to network private sector health providers (pharmacists etc.). The SHOPS project (Strengthening Health Outcomes through Private Sector) used cell phones to do follow-up quizzes with private pharmacist staff trained to ensure that they used the information they had received in their daily work and remembered it.
  6. Only 10% of mobile operators are involved in mHealth activities in Africa.
  7. mHealth community needs to move away from “pilot-itis” and towards interventions at scale. International funders (i.e. USAID and WHO) are now requiring that plans for scalability to be included in all mHealth interventions.
  8. Governments are still reticent about investing in mHealth interventions because a) it can do harm and b) they would have to divert scarce resources to it. Furthermore, now there is the challenge of which mHealth activity to invest in.

    Community Health Workers (CHWs)

  9. “Empowering CHWs with mHealth” was identified as the single most strategic priority for mHealth. However, applying mHealth at the community level will continue to be difficult, because in most places, because CHWs are not paid workers. As a part of enabling the environment, CHWs will need to be trained and treated as professionals.
  10. There has been a lot of emphasis on getting information into the field for health promotion and prevention purposes. However, there is a growing realization that the real benefit of mHealth in a global setting is getting information from the field. Non-profits, governments, and agencies want M&E information from the field about the efficacy of their programs.
  11. It is important for mobile data collection efforts to be integrated into the existing work flow of CHWs – diagramming out these work flows will ensure that CHWs use the technology and it is seen as a helpful tool, rather than a tool hindering their work. Because CHWs are already overburdened, new technology can easily be seen as just one more tool they have to use. Recommend user-engaged design and testing from the MOH, frontline works etc.

    SMS and Global Health

  12. Text messaging was identified as the most applicable international technology, though it is limited in many ways. Its primary restriction is its limitation to 150 characters, as well as issues with literacy of those receiving the text messages. It is also not cost effective because there is a cost associated with each text message, whereas larger amounts of data can be sent via the mobile internet at a relatively less expensive cost.
  13. Another way to enable the mHealth environment is to invest in the mobile data/internet infrastructure. It is ultimately cheaper than text messages and allows for a much larger quantity of data transmission and a variety of functionality with mobile applications.

    Monitoring and Evaluation of mHealth

  14. There is now a lot of preliminary evidence available to support the effectiveness of mHealth pilot interventions.  Nonetheless, there are still gaps in the evidence, particularly looking at these interventions at scale. Moving forward, mHealth implementers need to consider planning for evaluations that will capture evidence appropriate for different stakeholders:  international organizations funding projects, governments, community-level users and technology experts.
  15. Different stakeholders think differently about the effectiveness of mHealth – you can think in terms of return on investment, user satisfaction, functionality, number of bugs in the program, operability, privacy, efficacy and effectiveness.
  16. Question from the donor perspective: How much evidence is enough for stakeholders? What is the threshold?
  17. Evaluations of pilot results continue to be context-specific – not generalizable. We need to document contextual factors.
  18. There is also a need to share lessons learned from previous mHealth projects.  The majority of literature available is around the impact of specific pilot projects.
  19. M&E of mHealth initiatives is still needed. WHO has pulled together a working group to identify cross-cutting indicators that could be applied across the mHealth spectrum?
  20. There are research designs that enable researchers to get results faster for pilots such as MOST, SMART and stepped wedge.

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