Health impacts us all and most, if not, all of us want to lead a healthy and happy life. In my previous post about farming, I mentioned that agriculture is very existential for humankind. Healthcare can be treated in the same vein, the lack of which, can cause severe distress in our lives. It is certainly not as existential as food and water, but is an element that is necessary to ensure our longevity and in many cases, our survival.
With that introductory backdrop, technology has always played a vital role in both primary and advanced healthcare. And it is getting better with each passing year. For example, telemedicine has taken off in several parts of world and telemedicine uses a combination of mobile and internet based technology to deliver healthcare to remote or rural areas. Telemedicine could range from basic field diagnostics to advanced procedures like surgeries.
Despite these advancements, an overwhelming majority of our population does not have access to even basic healthcare in the form of qualified doctors, nurses and medicines. That said, the very high global pen-rate of mobile phones across all communities presents a huge opportunity to use this technology to deploy healthcare initiatives.
While the mobile phone is certainly no substitute to the doctor, it does help provide at the very least, a link to a form(s) of healthcare. Back in the day when the internet was exploding everything had the letter ‘e’ prefixed to it – “e-commerce”, “e-governance”, “e-advertising”, “e-health” etc. “e-health” was more of a follower than a leader perhaps a testimony to the legacy effects of technology in healthcare, myriad rules and regulations and the fact that the technology leaders focused most of their efforts in innovations that had the fastest path to money. “e” was then followed by “m” (as in mobile) and the same trend has been exhibited. “m-Health” is on a slow path compared to its peers. But increasingly, the focus on m-Health is getting stronger.
In the developed world, some of the innovations in the arena of mHealth are –
- Doctors being able to access patient reports on their phones or mobile devices. A doctor does not necessarily need to be in the office to see patient X-rays. Hi-res X-rays can be sent straight to their mobile devices for diagnosis and recommendations.
- Vital signs of patients can be monitored remotely by healthcare professionals.
- The of course there is telemedicine, where several doctors can join a procedure from other locations.
- Supply chain management – This is rather unique in that pharmaceutical companies are using mobile technology to prevent fraud by pharmacies or other companies (look-alike drugs or generics). For some drugs, patients need to SMS a scratch it code that is designed into to the medicine packaging. Once the code is validated, a message is sent back to the patient from the drug manufacturer.
- Use of mobitography for diagnostics. Cell phone cameras are now being used to send back images of wounds or affected areas for diagnosis and in some cases even treatment.
- A company called Voxviva has a really cool app that encourages smokers to quit. It’s called “text2quit” – check out this video – http://www.voxiva.com/video/mobile_video_new.html
These are just a few examples. But, what really interests me is the impact of ICT (Information and Communications Technology) in the developing world. Here again, there is pent up demand for healthcare. In many many countries the density of healthcare professionals per 10,000 people is abysmal. WHO has some interesting statistics regarding this –
The above table, while containing just a sampling countries, symbolizes the lack of available healthcare in many developing countries. As a consequence, large sections of populations in many countries are underserved. But these populations have access to mobile technology in the form of the mobile phone.
There are many examples where mobile phones are used to deploy healthcare initiatives.
- The mobile phone has been found to an effective tool to deploy field surveys. In many countries field surveys are used to collect valuable data that speaks to the health of the community. Community health programs are often crafted based on data from the field. But traditional survey mechanisms result in low response rates and are slow to administer besides being costly. There is paperwork involved and the questions cannot be changed. With mobile technology, community field workers are being equipped with phones pre-loaded with text based apps that are have levels of inbuilt sophistication.
- These apps allow for the questions to be changed based on the response
- It allows for a custom question bank for different locations that may have varying demographics
- The Apps are often vernacular based
- And finally, among other things the results can be quickly analyzed and published. This results in faster actionable intelligence for government and NGO’s to act upon.
- SMS based reminders are being sent to cell phones to inform pregnant women and patients to administer their medications on time.
- SimPill was used during a 2007 trial in South Africa to ensure people took their medication for TB, . In the pilot, 90% of patients complied with their TB medication compared to 22 to 60% take-up without it. Developed by David Green, a South African GP. SIMpill uses a prescription bottle with an embedded mobile phone chip. Basically, it is a pill bottle that uses mobile phone technology to remind people on medication to take their pills on time – and it warns the patent if they are about to take too much.
- Further, SMS based messages are also being used to send quick messages to patients that contain health related nuggets (m-learning). SMS based learning is also a great tool for health workers to be informed about latest techniques or even just to refresh their memories. Community health workers are often from the same communities that they serve and in many instances hold other jobs. For example, they could own a local grocery store and on a part time basis indulge in community health work. It is vital to keep them informed of various programs and techniques so that they could better serve their communities.
- To take this a step further, recently in India, Tata Indicom launched “Doctor on Call” service in partnership with Healthcare Magic to offer consultation services for acute and chronic emergency situations at a price of 9 rupees (approximately $0.16/min) for a minute. http://www.youtube.com/watch?v=0-gy3pYTs8g
Challenges abound in taking mHealth to market. Developing mHealth application requires knowledge of computing, engineering, medicine, design, behavioral sciences, communication, among other subjects. There also needs to be adequate carrier coverage in areas of deployment. Further, it requires training especially at the field level both with health workers and patients. mHealth applications really need to have a simple easy to understand interface.
And last, but not the least, the monetization model is not very mature. Someone has to pay for these services. Patients may be reluctant to fork out money mainly because they don’t have money to spare. In these instances, the government or foundations need to step in to subsidize these valuable services. But going forward, it will help entrepreneurs if monetization models are developed – perhaps through advertising – not just to the subscriber, but to entire communities.
Regardless, mHealth in developing nations just like mobile payments will build traction over time. The demand is there. It is just a matter of tailoring the right services to the right communities.