The Lancet “Mobile health-care information for all: a global challenge”



The Lancet Global Health mHealth info for all a global challenge

An interesting mHealth paper published in the Lancet by Geoff Royston, Christine Hagar, Lesley-Anne Long, Dennis McMahon, Neil Pakenham-Walsh and Nand Wadhwani on behalf of the mHIFA Working Group (Mobile Healthcare Information For All) looks at what might kickstart progress in access to healthcare info for citizens.

mHealth Insights

Access to health-care information for citizens is a key determinant to reach both the Millennium Development Goals (MDGs) and the emerging post-2015 Sustainable Development Goals, but this challenge has repeatedly been relegated to the sidelines. What might kickstart progress? An obvious candidate is the mobile phone, which is becoming ubiquitous in low-income and middle-income countries

Lots of progress is already being made in this area eg. check out the best practice that has been given enormous visibility on the world stage by the annual mHealth Summit (read my review from the first event they held in 2009 focused on the emerging market mHealth opportunity) and the
iHeed Institute (hosts of the annual GetHealth Summit that’s now in it’s 4th year – check out my review here) check out their 2014 Outcome Report here.

I think statements talking about mHealth kicking off are dismissive of the efforts of others and highlight how important it is for global healthcare industry analysts to look to understand the work of mobile industry analysts like Tomi Ahonen to help them understand the rapidly changing mobile market and begin to appreciate the opportunity to earn credibility by freely sharing data and insights eg. his annual mobile industry almanac.

After the Nokia Decade (2000-2010), Mobile isn’t just an ‘obvious candidate’ and nor is it merely ‘becoming ubiquitous’: since 2009 it’s been the only technology that is more distributed in low and middle income countries than it is in their more affluent counterparts.

We recently commissioned a survey of 1700 projects of mobile technology for health (known as mHealth). Our findings showed that none of these services provided essential, actionable, offline guidance for direct use by citizens addressing the range of acute health-care situations commonly encountered in low-resource settings, and very few provided any such content at all (an example is HealthPhone, see below)

I think this is another classic example that shows how easy it is to misread what’s happening. I’ve gone into detail about how the Gates Foundation misses the reality that no organisation that is looking for international financial support would want to boast about how they are sharing content offline via SD cards etc because it’s often content that is being shared without the permission of the copyright owners. When you appreciate the Cost of Knowledge protest by academics against the business practices of the Lancet’s publisher Elsevier surely it’s obvious that you’re not going to read in an Elsevier publication about expensive apps containing rich Clinical skills/reference content (like those used at Leeds Medical School, Stanford/UCIrvine, etc) that have had their DRM hacked and are being shared freely on SD Cards and file sharing app stores etc.

First, most mobile phones in low-resource settings are basic phones that can accommodate only voice and SMS text messaging with no internet connectivity or multimedia capability

This is another classic misunderstanding of the mobile market. Some of the most inexpensive Mobile phones have features that aren’t obvious to external analysts. In low resource settings it is common to have a mobile that features a radio which is an important source of content, similarly SMS text messaging has already evolved beyond the p2p uses that we typically use it for in affluent countries eg. it now enables the ability for citizens to make payments/send money (think m-pesa), access online information (think Wikimedia – the Wikipedia-via-SMS service), etc.

Alexandra Oswald gave a great TedxTalk in 2011 that I think helps us open our eyes to these opportunities.

Consequently there is a plethora of SMS messaging services that push short messages about health education to citizens. However, this approach is not appropriate to empower citizens with as-needed health-care information to deal with acute situations such as child illness, complications of pregnancy, and first aid

I’m interested to know what evidence there is for making this assumption. What if the SMS shared a link to a URL where you could download content (or in Cuban-style order the delivery of or a meetup with someone who has a USB/microSD card containing multimedia healthcare content)?

There is a real risk that the pharmaceutical industry and infant nutrition companies will take advantage of this gap in information provision to promote their own products, with potentially disastrous public health consequences

I wonder if there is any evidence of such unethical behaviour? It would be great if an organisation like ‘Mobile Healthcare Information for all’ could put together a cash reward for any citizens who can report such activities with camera phone pics.

Third, how to place the content onto individual phones? We believe the ideal approach is for handset manufacturers to preload health content onto mobile phones at the time of manufacture, in the same way that games and other content are currently made freely available. Content can also be made available on micro-SD cards, which cost just a few dollars each

I like the microSD card via community healthcare worker route as this empowers healthcare workers on the ground. I also think it’s much more grounded in reality eg. very few healthcare professionals have any idea about the complexity of provisioning new low cost phones with healthcare content eg. it’s not always clear what markets/languages mobiles are being produced to be sold into, network operators often reflash devices with local settings, margins are so slim that it’s unclear who would be paid to do this important work, etc.

We call on content providers, mobile phone manufacturers, network operators, application developers, and international health organisations to collaborate to empower citizens in low-resource settings with essential health care information. Production and free availability of such applications to directly empower citizens in low-resource settings with essential, accessible, actionable health-care knowledge, as and when they need it, could open up a new chapter in global health. For Mobile Healthcare Information for All see www.hifa2015.org/the-first-hifa-smart-goal-mobile-healthcare-information-for-all/

Overall the report is interesting and while it’s great to see that the ‘Mobile Healthcare Information for all (mHIFA) Expert Adviser’ Peter Benjamin has clearly dropped his pessimistic outlook for the mHealth market (back in 2011 he predicted mHealth might be just a transitory period that lasts ‘only another year or two’) it would be great if the organisation could start sharing the type of content that they feel would be useful to be downloaded onto a SD Card for use in low and middle income healthcare settings. I’ve looked around their website and I can’t find any links to healthcare informational content that can be downloaded to a mobile.

HIFA2015 mHealth

*** UPDATE: 11 July 2015 ***

Thought the feedback from Aschkan Abdul Malek, CEO/Founder of AlemHealth to a tongue in cheek post I made on Linkedin interesting:

LI comments

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2 Responses to The Lancet “Mobile health-care information for all: a global challenge”

  1. Just Haroon says:

    “it would be great if the organisation could start sharing the type of content that they feel would be useful to be downloaded onto a SD Card for use in low and middle income healthcare settings. I’ve looked around their website and I can’t find any links to healthcare informational content that can be downloaded to a mobile.”

    Interesting thoughts — could we derive this data from population health indicators ?

  2. @Just Haroon

    Why don’t you try and do that?

    (Don’t hesitate to let us know how you get on and if you think we can help in any way eg. perhaps we could ask for suggestions from the 7,500 member mHealth group).

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