Africa: Mobile Phones Improve Health Across Continent

[Guest guest]

Africa: Mobile Phones Improve Health Across Continent

Frederikse

13 June 2011

interview

is the general manager of Cell-Life, a South African non-profit

organisation that uses cellphones to assist with healthcare in the HIV/Aids

sector. Cell-Life is funded by South Africa's Vodacom Foundation and the United

States and Canadian agencies for international development.

was invited to make a presentation at the recent mHealth Summit in Cape

Town and to participate in the summit's Leadership Forum. He spoke to

allAfrica's Frederikse about how Cell-Life is using one of Africa's

biggest social networking platforms.

Why does Cell-Life focus on HIV/AIDS in its work in mHealth?

We started off focusing on HIV in 2001, when it was the biggest killer in South

Africa but the government was in denial so there wasn't a coherent response from

the government health department. As an NGO it seemed the most important

priority was to see if the tools of cellphones and computers could assist with

this crisis. With HIV there is still such stigma that people can feel isolated,

so if they have access to a cellphone they never need to feel alone.

What we've done is to link in to the MXit instant messaging service. The way

MXit works is it does a little trick that sends text messages – not through SMS

but through sending data, like downloading a website or ring-tone. It's charged

completely differently so in effect it doesn't cost 50 [south African] cents per

SMS, but less than one cent per message.

In South Africa anyone under 25 knows about MXit as the coolest way to connect

with their friends for free. The numbers on MXit are close to unbelievable –

more than half the country's population (of 49 million) is on MXit! So it's the

way to reach people, particularly the youth, at very low cost for Cell-Life.

UN Foundation

Specialists in mobile technology say it can profoundly improve healthcare in

developing countries.

So Cell-Life is the HIV content on MXit, where you can get basic information,

ask questions, get formal counseling. And you can access the National AIDS

Helpline for free, even from a cellphone. We've set up text counseling: you type

in your questions to the counsellor. It's going quite well, we've had about

35,000 text counseling sessions over the last year and a half.?

Which mHealth initiatives have had the most attention internationally?

So far it's the ones that are mainly around managed healthcare in the developed

world. For example there is Welldoc, which is a most impressive self-managed

healthcare system in the U.S. Say you may be diabetic, then you fill in lots of

information on the phone and serious algorithms are applied, dependent on your

situation, which then tell you what to do.

Those successful systems are great but they they don't change the health system

at all for the vast majority of people. Most people with a smartphone have

medical aid, they're on the Internet, so putting lots of attention into what

they can do on those phones will ultimately make for only minimal changes to the

overall health of most people. There is desperately little that addresses real

issues of people in the developing world. So what mHealth could do is to lower

barriers to entry for all people who want to access the health system.

Can you give any examples of mHealth initiatives that are working well in

Africa?

That was the best thing about this summit – meeting people and hearing about

what others are doing in other parts of Africa. One of the most impressive

projects I learned about is called MOTECH in Ghana. It's mobile technology

applied to midwives and maternal care, supported by the Grameen Foundation and

the Earth Institute at Columbia University. They've developed a really

impressive system, giving cellphones to midwives in a few Ghanaian health

districts so they can collect data on pregnant women and women with young

babies. This is linked to SMS systems, using proper database systems that can

analyse data as it comes through and spot problems before they become medical

emergencies. I think it's one of the best uses of rather high tech, but for

basic maternal health.

In your presentation you quoted a prominent thinker on the Internet, Clay

Shirkey, who said, " These tools don't get socially interesting until they get

technologically boring. " Do you mean that mobile technology will be most useful

when it becomes second nature to people?

Exactly. Right now much of what's called mHealth is focused on clever devices

and gadgets, like ways to measure glucose levels. But what is potentially

transformatory for Africa is if you can turn the 500 million phones in the hands

of ordinary people into tools to assist them with health issues. This will

happen because they are so familiar with the technology – simple technology,

like using SMSs for doctors to get important advice while in the field or to for

ordinary people to call for emergency care.

Would you agree with the view expressed at the first African mHealth Summit that

there is an urgent need to formally evaluate the many small programs piloting

mHealth?

Yes, but there must be proper evaluations. There are lots of studies that say

we've sent a huge number of SMSs to participants and the feeling is, that's nice

but so what? Most of what is being called evaluation looks like customer

satisfaction surveys: Yes, I'm glad I received that SMS.

There's starting to be some evidence through randomized control trials, which

are ways of assessing whether interventions are effective or not.

But there are very few published studies to show the effectiveness of mHealth.

Only a few make any formal demonstration of medical benefit, and on top of that

only two or three have gone to scale, meaning that they actually are being done

at national level so they could be integrated into a national health system en

masse. And only a handful have gone to any scale with a business model, meaning

that all stops if and when the donors stop. So it really is a very embryonic

sector.

Has Cell-Life done any formal evaluations of its programs?

We are running a randomised control trial to see if sending different sorts of

SMSs can influence people to take an HIV test, to see if using cellphones could

lead to behavior change or not. We've done another on the Prevention of

Mother-to-Child Transmission of HIV, to see if supporting mothers will achieve

an end result of them staying in the program, finishing the drugs, and then

testing to see if their babies are born HIV positive or negative. And we are

currently running two different adherence trials to determine if sending

messages and support through MXit makes people more likely to take their pills.

But remember, to do proper randomised control trials takes about two years. It

has to go through formal ethics approval, which takes months, and you have to

run for a year to test and then get data. And what's more is that it's more

tricky in our sector, because with mobile there's always a new thing on the

market that people will be doing with their phones.

Are evaluations of mHealth programs being done elsewhere in Africa?

Call to Assess Role of Mobile Technology in Health

NEWS — Africa: Call to Assess Role of Mobile Technology in Health

NEWS — Africa: Exploring Mobile Communications for Healthcare

Yes, in Kenya last late year we saw the first study, in the respected medical

journal, The Lancet, showing that SMSs can improve adherence to ARVs. Another

encouraging example is in Egypt, where a lot of health clinics have been linked

up through cellphones in a health management system. What they used to have to

report on paper is now being done over cellphones and it seems to be improving

the efficiency of the health system in those clinics.

In Tanzania they're using cellphones to do stock checking of drugs from

pharmacies. It has reduced stock-outs – when clinics run out of drugs – from 26

percent to one percent through better supply chain management. It wasn't that

there were not enough drugs, but they were sitting in the depots because the

delivery system didn't know which clinics needed what drug.

So what's next in the field of mHealth?

We need to set up an advocacy body, which is largely what has come out of this

summit. Many of us in the field have come together into an informal group and we

aim to launch such an organization soon.

http://allafrica.com/africa/

[Guest guest]

Africa: Mobile Phones Improve Health Across Continent

Frederikse

13 June 2011

interview

is the general manager of Cell-Life, a South African non-profit

organisation that uses cellphones to assist with healthcare in the HIV/Aids

sector. Cell-Life is funded by South Africa's Vodacom Foundation and the United

States and Canadian agencies for international development.

was invited to make a presentation at the recent mHealth Summit in Cape

Town and to participate in the summit's Leadership Forum. He spoke to

allAfrica's Frederikse about how Cell-Life is using one of Africa's

biggest social networking platforms.

Why does Cell-Life focus on HIV/AIDS in its work in mHealth?

We started off focusing on HIV in 2001, when it was the biggest killer in South

Africa but the government was in denial so there wasn't a coherent response from

the government health department. As an NGO it seemed the most important

priority was to see if the tools of cellphones and computers could assist with

this crisis. With HIV there is still such stigma that people can feel isolated,

so if they have access to a cellphone they never need to feel alone.

What we've done is to link in to the MXit instant messaging service. The way

MXit works is it does a little trick that sends text messages – not through SMS

but through sending data, like downloading a website or ring-tone. It's charged

completely differently so in effect it doesn't cost 50 [south African] cents per

SMS, but less than one cent per message.

In South Africa anyone under 25 knows about MXit as the coolest way to connect

with their friends for free. The numbers on MXit are close to unbelievable –

more than half the country's population (of 49 million) is on MXit! So it's the

way to reach people, particularly the youth, at very low cost for Cell-Life.

UN Foundation

Specialists in mobile technology say it can profoundly improve healthcare in

developing countries.

So Cell-Life is the HIV content on MXit, where you can get basic information,

ask questions, get formal counseling. And you can access the National AIDS

Helpline for free, even from a cellphone. We've set up text counseling: you type

in your questions to the counsellor. It's going quite well, we've had about

35,000 text counseling sessions over the last year and a half.?

Which mHealth initiatives have had the most attention internationally?

So far it's the ones that are mainly around managed healthcare in the developed

world. For example there is Welldoc, which is a most impressive self-managed

healthcare system in the U.S. Say you may be diabetic, then you fill in lots of

information on the phone and serious algorithms are applied, dependent on your

situation, which then tell you what to do.

Those successful systems are great but they they don't change the health system

at all for the vast majority of people. Most people with a smartphone have

medical aid, they're on the Internet, so putting lots of attention into what

they can do on those phones will ultimately make for only minimal changes to the

overall health of most people. There is desperately little that addresses real

issues of people in the developing world. So what mHealth could do is to lower

barriers to entry for all people who want to access the health system.

Can you give any examples of mHealth initiatives that are working well in

Africa?

That was the best thing about this summit – meeting people and hearing about

what others are doing in other parts of Africa. One of the most impressive

projects I learned about is called MOTECH in Ghana. It's mobile technology

applied to midwives and maternal care, supported by the Grameen Foundation and

the Earth Institute at Columbia University. They've developed a really

impressive system, giving cellphones to midwives in a few Ghanaian health

districts so they can collect data on pregnant women and women with young

babies. This is linked to SMS systems, using proper database systems that can

analyse data as it comes through and spot problems before they become medical

emergencies. I think it's one of the best uses of rather high tech, but for

basic maternal health.

In your presentation you quoted a prominent thinker on the Internet, Clay

Shirkey, who said, " These tools don't get socially interesting until they get

technologically boring. " Do you mean that mobile technology will be most useful

when it becomes second nature to people?

Exactly. Right now much of what's called mHealth is focused on clever devices

and gadgets, like ways to measure glucose levels. But what is potentially

transformatory for Africa is if you can turn the 500 million phones in the hands

of ordinary people into tools to assist them with health issues. This will

happen because they are so familiar with the technology – simple technology,

like using SMSs for doctors to get important advice while in the field or to for

ordinary people to call for emergency care.

Would you agree with the view expressed at the first African mHealth Summit that

there is an urgent need to formally evaluate the many small programs piloting

mHealth?

Yes, but there must be proper evaluations. There are lots of studies that say

we've sent a huge number of SMSs to participants and the feeling is, that's nice

but so what? Most of what is being called evaluation looks like customer

satisfaction surveys: Yes, I'm glad I received that SMS.

There's starting to be some evidence through randomized control trials, which

are ways of assessing whether interventions are effective or not.

But there are very few published studies to show the effectiveness of mHealth.

Only a few make any formal demonstration of medical benefit, and on top of that

only two or three have gone to scale, meaning that they actually are being done

at national level so they could be integrated into a national health system en

masse. And only a handful have gone to any scale with a business model, meaning

that all stops if and when the donors stop. So it really is a very embryonic

sector.

Has Cell-Life done any formal evaluations of its programs?

We are running a randomised control trial to see if sending different sorts of

SMSs can influence people to take an HIV test, to see if using cellphones could

lead to behavior change or not. We've done another on the Prevention of

Mother-to-Child Transmission of HIV, to see if supporting mothers will achieve

an end result of them staying in the program, finishing the drugs, and then

testing to see if their babies are born HIV positive or negative. And we are

currently running two different adherence trials to determine if sending

messages and support through MXit makes people more likely to take their pills.

But remember, to do proper randomised control trials takes about two years. It

has to go through formal ethics approval, which takes months, and you have to

run for a year to test and then get data. And what's more is that it's more

tricky in our sector, because with mobile there's always a new thing on the

market that people will be doing with their phones.

Are evaluations of mHealth programs being done elsewhere in Africa?

Call to Assess Role of Mobile Technology in Health

NEWS — Africa: Call to Assess Role of Mobile Technology in Health

NEWS — Africa: Exploring Mobile Communications for Healthcare

Yes, in Kenya last late year we saw the first study, in the respected medical

journal, The Lancet, showing that SMSs can improve adherence to ARVs. Another

encouraging example is in Egypt, where a lot of health clinics have been linked

up through cellphones in a health management system. What they used to have to

report on paper is now being done over cellphones and it seems to be improving

the efficiency of the health system in those clinics.

In Tanzania they're using cellphones to do stock checking of drugs from

pharmacies. It has reduced stock-outs – when clinics run out of drugs – from 26

percent to one percent through better supply chain management. It wasn't that

there were not enough drugs, but they were sitting in the depots because the

delivery system didn't know which clinics needed what drug.

So what's next in the field of mHealth?

We need to set up an advocacy body, which is largely what has come out of this

summit. Many of us in the field have come together into an informal group and we

aim to launch such an organization soon.

http://allafrica.com/africa/