eDoctor

The new possibilities for healthcare in rural areas created by mobile phone uptake.

By the end of 2014 there will be as many mobile phones worldwide as there are people. Market coverage in developing countries will be at 89 percent. The number of mobile phone operators is continuing to grow, networks are expanding, the cost of phone calls and transferring data is falling, and more and more apps for more and more smartphones are coming onto the market. This phenomenon is precipitating many new innovations, particularly in developing countries, with the West in some cases lagging behind looking outdated. Many people who were previously excluded are now profiting from mobile phones, not only in the agricultural, financial and governmental sectors, but also in the health sector.

In 2005, the World Health Organisation (WHO) recommended its member states to incorporate ICT into their healthcare systems to improve the coverage and quality of patient care. Since then, health services are categorised under the labels “mHealth” and “eHealth” (mobile and electronic health), that work first and foremost via mobile phones and apps. Governments, NGOs and private companies have all acknowledged the potential of ICT for various aspects of healthcare: in administration and management, education and training, diagnosis and prevention, and, of course, in treatment. The World Bank study IC4D puts the potential of mHealth into hard figures. Maternal mortality rates would be lowered by 30%, and treatment of tuberculosis would significantly improve. There are currently around 4 billion people worldwide who have no access to a healthcare system. To eliminate this appalling situation, an accessible and affordable healthcare system is needed that takes local conditions into account. This is where ICT and the use of mobile phones comes into its own, presenting us with new and efficient ways of giving those with insufficient healthcare access to health services, and of supporting local healthcare professionals in their work. Many mHealth innovations were pioneered in Africa and South Asia, where huge gaps in the healthcare system coincided with the enormous boom of the mobile phone market (90 percent of people now have mobile phone reception, 75 percent have access to a mobile phone, and 63 percent have access to functioning sanitary installations).

Most innovations happen in developing countries

The African Medical and Research Foundation in Kenya has founded a Virtual Nursing School with the aim of training 20,000 nurses and doubling the number of healthcare professionals in the country. Alongside training and further education, the aim of the eHealth initiative led by the Egyptian government is to offer better diagnostic services in rural areas and to set up a database for storing medical records. Such initiatives are helped by the Open Medical Record System, or EpiSurveyor, which replaces the classic clipboard for collecting information, allowing healthcare workers to store or look up patient records or information on illnesses and the options for treating them. Using ICT, the national vaccine programme in Nicaragua was standardised, and prenatal care and care for the chronically ill was extended and made easier to monitor. And thanks to the internet, healthcare personnel in Peru can now access the tuberculosis lab results for their patients and information on treatment, as well as automatically receiving information on which patients are at risk.

The first telemedicine clinic was in Uganda

Telemedicine and remote diagnosis work in a similar way. In both cases, mobile phones can help improve the provision of healthcare and save costs. Instead of using an expensive ultrasound, MRI or X-ray equipment, much cheaper portable devices are now available that can be connected to a mobile phone or laptop. Community health workers forward the data to head office for analysis, meaning that a diagnosis can be made straight away. Examples of such devices are offered by Mobisante, a company that develops portable medical imaging equipment, whose stated aim is to reach a point where no more than 1 US dollar is charged per scan. In India, around 27 million people a year can receive optometry treatment using cameras and data transfer thanks to the Aravind Eye Care System. Local personnel can carry out the eye tests and treat eye problems without a specialist having to be present. In Uganda, the Indian hospital group Apollo Hospitals opened the first telemedicine clinic, which has an information centre and a telemedicine network. Due to the improved chain of information, using ICT also helps in the fight against corruption. According to the World Heath Organisation (WHO), 10 percent of all pharmaceuticals worldwide are counterfeit; in some regions in developing countries this figure is as high as 30 percent. With the help ofSproxil mobile phone users in Nigeria can now find out whether medicine is authentic or not.

Great Britain leads the way in the use of eHealth

A 2011 WHO study revealed that health call centres, free emergency mobile phone services, mobile telemedicine services and mobile disaster relief services are among the most commonly used features of eHealth. According to the study, Great Britain leads in the use of eHealth and has been electronically and centrally managing medical information and data for over 10 years. Some highly successful patient platforms also originated in Great Britain, such as Health Unlocked. This platform offers support to patients and their families and provides a forum for advice and patient reviews, as well as contact with doctors. The Estonia eHealth foundation, founded in 2005, also positions Estonia as a leader. as the foundation runs a centralised electronic system for medical records that is incorporated into the national electronic identification network.

Voice messages work better than SMS

Governments, NGOs and companies are all eager to demonstrate the effectiveness of ICT. Initial studies have been carried out in the USA by WellDoc, by Weltel in Kenya and by Project Mwana (UNICEF) in Zambia, which showed improved rates of taking medicine thanks to reminders sent by SMS. Mobile phones are also highly effective when it comes to the treatment of HIV/AIDS and raising awareness of it, since using a mobile phone or the internet allows users to make initial contact with organizations anonymously. Comparisons between text and voice messages show that users prefer voice messages, since many share their mobile phones with friends or family, and some are unable to read or write. The development of eHealth has been driven by technological advances. Initially, the West exported technologies to developing countries. In the second phase, new innovations from came from external specialists. The developments made during this time were so-called “disease-centred stand alone” devices, which failed to take into account the complexity of real-life situations in the countries in question. Nowadays, we see participative and “people-centred” approaches coming to the fore.

Conclusion

ICT is now a standard instrument in global healthcare. Scalability should be considered, however, when developing and piloting eHealth innovations. Cooperation in research and implementation between public authorities and the private sector is essential in shaping the trend reverting back to community or home-based healthcare. In practice, this means developing participative and “people-centred” solutions, as well as the integration of traditional and local healthcare facilities and better networking. This will also help us in setting unified standards of evaluation.