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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 Tallinn, Estonia

Africa Cairo, Egypt

Johannesburg, South Africa

Lagos, Nigeria

United States Palo Alto, California (Headquarters)

mHealth for Development

Mobile communications for HealthWorld Bank Group

Mobile Innovations for Social and Economic Transformation

September 16, 2009

Brendan Smith Senior Consultant

© 2009 Vital Wave ConsultingTM Proprietary and Confidential: Do not copy or distribute.

mHealth Building blocks for success2

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Agenda

mHealth overview: Definition, applications and impact

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3 Discussion


Mobile Health (mHealth) Defined

Electronic Health

Services

Health Services

mHealth

mHealth (n) – the delivery of health care services via mobile communication devices

Photo: UN, UN Foundation, and Praekelt Foundation

3


11305

2,293

5,300

0

1,000

2,000

3,000

4,000

5,000

6,000

Hospital Beds Computers Mobile Phones Population

Technologies and Health-Related Statistics for Developing Countries

(Millions)

Sources: Vital Wave Consulting, Business Monitor International (BMI), International Telecommunications Union and the World Bank’s World Development Indicators.

Photos: DataDyne

Opportunity – New Health Delivery PlatformExplosion of Mobile Phones in Developing World

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Mobile Phones reach further into developing countries than other technology and

health infrastructures

6

5

4

3

2

1


Meeting Health NeedsBroad Array of mHealth Applications

Education & AwarenessSMS/text messaging in support of public health and behavioral change campaigns.

Remote Data CollectionApplications using mobile devices to collect real-time patient data, often where patients live.

Remote MonitoringMaintain care giver appointments or ensure medication regime adherence via one-way or two-way communications on mobile devices.

Disease & Epidemic Outbreak TrackingUse mobile devices to send and receive data on disease incidence, outbreaks and public health emergencies.

Diagnostic & Treatment SupportUse the mobile phone as point-of-care device.

Programs by Application Area

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Communication & Training For Health Care Workers

14

10

9 5

9

6


Worldwide:FrontlineSMS

Education & AwarenessRemote Data Collection

Remote monitoring

Communication & Training for Health Care WorkersDisease & Epidemic Outbreak Tracking

Diagnostic & Treatment Support

Distribution of mHealth Programs

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Impact of mHealthPromising indicators but a need for more research

“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

PeruCell-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 AfricaProject Masiluleke’s SMS

message campaign promoting HIV/AIDS

awareness resulted in nearly a tripling of call

volume to a local HIV/AIDS helpline.

UgandaText 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.

ThailandPhoned Pill Reminders for TB Treatment. TB patients were given mobile phones

and called daily with reminder to take their TB

medication—90% did.

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Current Health Care Picture

• Communicable diseases.

• Lack of immunizations.

• Lack of safe water sources.

Global & Demographic Changes • GDP growth increases spending on healthcare.

• Traditional diseases controlled (TB, smallpox) and new diseases appear (SARS, avian flu).

• Aging populations means increase in death from non-communicable causes.

• Declining birth rate and climbing life expectancy.

• Adoption of “developed country” behaviors.

Tomorrow’s Healthcare Picture

• Current healthcare picture issues continued.

• Shift from “late stage” treatments to prevention and early detection.

• Increased focus on health issues of elderly.

• Continued health worker shortages and distribution inequities.

Shifting Health Needs in Developing WordmHealth Addresses Current and Future Health Needs

Evolution toward chronic diseases – diabetes, heart disease and strokes

By 2025, 80% of all new diabetes cases will originate in developing countriesDiabetes, 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

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Technology in mHealth ApplicationsSimpler, broadly accessible technology prevails

SMS/MMSSMS 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)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)

VoiceThe relatively high cost of voice calls, particularly in sub-Saharan Africa, limits the feasibility of large-scale mHealth applications, though these show promise in lower cost regions such as South Asia. Voice applications are not constrained by low literacy rates

Programs by Technology Type

9

175

33

10

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

Other (sensors, GPS, etc)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)


Technology in mHealth ApplicationsAdvanced technology brings with it greater capacity, costs

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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

Farthest reach

Most comprehensive healthcare

Minimum cost per service recipient

Minimum cost per program implementation

Minimum Technology Requirements

Maximum scalability

Farthest reach

Most comprehensive healthcare

Minimum cost per service recipient

Minimum cost per program implementation

Minimum Technology Requirements

Maximum scalability

Two-Way Data

(not real-time)

Clinical Services

(real-time)

One-Way Data

(not 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

Low Medium HighApplication/Service Delivery Fit:

Two-Way Data

(not real-time)

Clinical Services

(real-time)

One-Way Data

(not 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

Low Medium HighApplication/Service Delivery Fit:

Technical capability

Trainingrequired

Cost


Case StudyText to Change

Disease Awareness

Impact• 15,000 mobile phone subscribers in rural Uganda sent the quiz in the three month pilot test

• 40% increase in the number of patients who came in for HIV/AIDS testing

• Actionable insight: Many quiz takers did not think AIDS testing was accurate nor anonymous

Health ObjectiveImproving HIV/AIDS education with anonymity

CountryUganda

Techniques UsedHIV/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)

PartnersCeltel, AIDs Information Centre (AIC), Merck, and the Dutch Ministry ofForeign AffairsPhoto: Text to Change

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Building BlocksSustainable & 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

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mHealth for Development: Mobile Communications for Health

http://www.vitalwaveconsulting.com/pdf/mHealth.pdf

mHealth for Development Report

mHealth provides a singular opportunity to powerfully contribute to sustainable

development

“” Photo: UN Foundation/ Nothing But

Nets

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Sizing the Business Potential of mHealth in the Global South

http://www.globalproblems-globalsolutions-files.org/unf_website/PDF/SizingBusinessPotential.pdf

Thank You


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

mHealth Improves OutcomesBenefits in Patient Health & Health Systems Outcomes

Photo: DataDyne

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• 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

Urgent NeedImprove Health in Developing World

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Source: 2008 Global Monitoring Report

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

Photo: UN/Marie Frechon

Millennium Development GoalsProgress on Health-Related Goals Less than Encouraging

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Disease Awareness

Impact• 365 Million text messages – one per day – being sent (2008-2009)

• Encourage people to be tested and treated for HIV/AIDS and TB

Case StudyProject Masiluleke

Health ObjectiveBuild awareness of HIV status, encourage HIV/AIDS testing and treatment and halt the disease’s spread

CountrySouth Africa

Techniques Used‘Please Call Me’ service - free text messages

PartnersPraekelt Foundation, iTeach, National Geographic, Nokia Siemens Networks, MTN, Ghetto Ruff, Children of South African Legacies, Aricent, PopTech!, frog design and National AIDS Helpline

Photo: Praekelt Foundation

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Case StudyData Gathering

Data Gathering

Impact• Data collection times dramatically reduced (from months to days)

• 400 test results gathered by 20 field professionals in two days, all with GPS information (paper-based system would have taken 2-3 months for lesser information)

• End-user acceptance very high

Health ObjectiveContaining the spread of the Dengue virus

CountryBrazil

Techniques UsedCustomized 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.

PartnersNokia, Amazonas State Health Ministry

Photo: Wikimedia Commons

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Building BlocksSustainable & 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: Mobiles for Malawi

Building Blocks for Sustainable & Scalable mHealth Programs

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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

Photo: RAMP and ENACQKT

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Value Chain Models for mHealthPlayers and Incentives

Player IncentivePatient 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.

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Value Chain Models for mHealthOne-way mHealth Applications

Operational efficiencies,healthcare

Delivery of services,operational efficiencies,programexpansion,achieving mission

Revenue (short- and long-term), expanded user base

Revenue (short- and long-term)

Revenue (short- and long-term)

Revenue (short - and long-term), brandand business development, opportunitiesfor network expansion projects

MobileSubscriber

PlatformOperator

Application/Solution Developer

Equipment Vendor Doctor/Health

ProviderProject

Management

MobileServiceProvider

HomeMonitoring

Device

High Medium Low

Scale Required for Sustainabilit

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vital wave consulting field offices latin america rio de janeiro, brazil san jose, costa rica mexico...

Documents

mobile health mhealth

health impact

health infrastructures

health care workers

support of public health

public health emergencies

healthrelated statistics

discussion slide