Monday, 16 November 2015 13:51

Report from the Global mHealth Forum

Written by 

Dear all,

Here is a report on the mHealth Summit this week (8-11 November 2015) in Washington DC.

QUICK SUMMARY

There were about 250 people in the global mHealth Forum from around the world (US and Africa most represented). There were many interesting presentations on projects, mostly small, with a few substantial ones (Indian maternal health, our MomConnect in SA, Village Reach in Malawi, Saving One Million Lives from Nigeria).  There is now clear evidence that mHealth can lead to considerable health system benefits. There was talk of the role of mHealth in achieving the Sustainable Development Goals for health.

There are sections below on:

  • Setting
  • General themes
  • Frameworks for mHealth
    • 9 Principles of Digital development
    • MAPS toolkit
  • Interesting organisations and projects
    • SA MomConnect
    • Indian maternal mHealth scale up
    • mPowering Frontline Health Workers
    • Village Reach
    • Nigerian mHealth Experience
    • mDiabetes Project in Senegal
  • Useful resources
    • mPowering frontline health workers
    • Knowledge for Health
    • mHealth Evidence
    • mHealth Working Group

Best wishes,
Peter

=-=-=-=-=-=-=-=

MORE DETAIL

SETTING

This was the 7th annual mHealth Summit, now renamed ‘Connected Health’, of which the global mHealth forum was one sub-conference (others were Cybersecurity, Population health and mHealth). There were 3,500 at the whole event, which was down on last year.

The conference happens in a weird huge hotel, the Gaylord, which is a surreal artificial airless place. There was a conference next door on planetary science, announcing that Pluto had huge canyons, and 5 km high volcanoes with erupting frozen methane (irrelevant to mHealth, but I enjoyed it).

There were 5 South Africans there: Michael Mol (HelloDoctor), Jonathan Dixon (Palladium), Debbie Rogers & Marcha Bekker (both Praekelt Foundation) and myself Peter Benjamin (Health Enabled). Thanks to all for contributing to this message, especially to Michael who wrote much of the following.

Many parts of the forum were disappointing (several things disorganized, agenda badly planned with too many parallel sessions so you missed many interesting things). This might be the last year in this format.

GENERAL THEMES

It is now widely accepted that mHealth is not an intervention itself – no one got better by receiving an SMS – but mobile and related tech can improve the access, quality and coverage of proven life-saving interventions. The shift in thinking is from “Does mHealth work?” to “How does mHealth optimize what we know works?”. The mobile phone is an enabler of healthcare delivery, not a new form of healthcare

The debate has moved on over the years. Initial “Do the mHealth systems work?”, then “Is there any health impact?”, followed by “How does mHealth make money?”, next to “How do we take the many small pilots to scale?”, and this year now that there are some national-level systems the new question is how to embed and ‘institutionalize’ them so that they become a normal part of national health systems. The large Indian maternal mHealth project and SA MomConnect are the largest examples globally, and were the most frequently cited examples.

Many people said that mHealth is not a useful term any more – we have grown out of the silo of fetishizing the cellphone, and the division between it and eHealth, telemedicine, health informatics and general health systems is artificial and not particularly useful. The terms ‘digital health’ and‘connected health’ were more used

Technology is not the goal: It’s not the technology that matters, it’s the appropriate use of innovation within an ecosystem that is both sustainable, impactful and scalable that really matters. In many instances low-tech trumps hi-tech because it is appropriate for enabling health interventions. My favourite quote from Clay Shirky is, “These tools don’t get socially interesting until they are technologically boring”

The last session on empowering women through digital technology was particularly good. WeTech is a stunning organization supporting women in ICTs in 17 African countries.

The Internet of Things (IoT) is a trending term, with some extending this to the Internet of Medical Things (IoMT) – a universe of connected devices (wearables, body sensors, environmental) connecting to everything. Cybersecurity was also well covered, the fact that there are many people sending data and not a lot of policies or focus on keeping the data safe.

Thoughts on Innovation from Michael Mol

  • Technology is not the key, it’s just the enabler – are we meeting a real need with the appropriate use of technology? is the key question.
  • To accommodate for the user / consumer, Hi-Tech may need to be replaced with Low-Tech (appropriateness)
  • If we knew what the next innovative product was, it wouldn’t be innovative!
  • If the Health App / intervention is for a consumer then User Interface (UX) is the most important aspect, not the technology, nor the Doctors / companies needs … consumer first – otherwise it won’t scale.
  • Another Focus Shift in healthcare system: Improving outcomes; Lowering costs; Increasing overall access to care
  • Information (top down) doesn't impact on behavior change - don't just tell me what to do. What does effect behavior is when I can choose my health interventions and what I want information or education on.
  • The HUMAN BODY is the next digital frontier

FRAMEWORKS FOR mHEALTH

There were sessions on two useful frameworks for considering mHealth / digital health.

Principles for digital development

These 9 principles have been developed over the past year, and if you haven’t heard of them, they are worth reading. These are the things every development project using ICTs must consider if they want to go to impactful sustainable scale. They are:

  • Design with the user
  • Understand the ecosystem
  • Design for scale
  • Build for sustainability
  • Be data driven
  • Use open data, open standards, open source & open innovation
  • Reuse and improve
  • Address privacy and security
  • Be collaborative

For much more detail see www.digitalprinciples.org

The MAPS Toolkit

The mHealth Assessment and Planning for Scale (MAPS) is a newer approach which was launched at the global mHealth forum. Developed by the WHO, UN Foundation, Johns Hopkins University and others, this is a toolkit for considering the 6 axes of large-scale systems (as they call them). For each axis there is an explanation and a checklist of things to consider, leading to recommendations for how to take the project forward. It is designed for large & national scale initiatives. The 6 axes are:

  • Groundwork
  • Partnerships
  • Financial health
  • Technology & architecture
  • Operations
  • Monitoring & evaluation

For the full toolkit check http://www.who.int/reproductivehealth/publications/mhealth/maps/en/

INTERESTING ORGANSATIONS & PROJECTS

SA MomConnect

There was a lot of interest in our MomConnect, which really is one of the global leading mHealth projects (probably the Indian maternal health national project is bigger). Debbie and I spoke about it, and it was mentioned in about 6 other presentations I heard as an example of a Department of Health-led nationally scaled project.

Indian maternal mHealth scale up

Started as the Ananya program in Bihar state 4 years ago, this has now been scaled nationally and so far 850,000 users. It provides voice messaging to pregnant women, voice recording of key topics to strengthen community health worker (Aisha) visits, and a mobile-based training course for the CHWs. Great success in getting national government ownership, and one single coherent operator.

mPowering Frontline Health Workers

Global NGO supporting mobile tools for health workers. ORB is a free communal online platform aggregating vetted content for training of CHWs. Th idea is to share relevant content as widely as possible, across geography, language & cultural bias. It is medically accurate, relevant & effective for frontline worker education & training http://health-orb.org 

Village Reach

US NGO working in Malawi. They have a hotline for health calls, and the caller gets appropriate messaging post call (SMS / IVR). They have now partnered with Airtel (main operator) to provide a ‘dial-a-doctor’ service nationally, Airtel providing free calls and marketing. It is stage gate triage: CHW – Nurse – Doctor (appropriate management).

Nigerian mHealth Experience

  • Saving One Million Lives (around maternal health) has been a success in coordinating ICT for health
  • Biggest challenge: guidance / lack of direction
  • Pilotitis - pilots start, get traction and die in frequent cycles
  • 36 states, often means 36 different countries.
  • No matter how appealing the program is - if there is no Nigerian government ownership, the intervention will die!
  • Country Director ICT4SOML (ICT for Save One Million Lives) This email address is being protected from spambots. You need JavaScript enabled to view it.

mDiabetes Project in Senegal

SMS & Apps to address the following issues:

  • mAwareness (90% undiagnosed)
  • mEducation (prevent disease and better manage it)
  • mTraining: educate healthcare workers
  • mTracking / mDiagnosis (tools for remote diagnosis of DM)

GOOD RESOURCES

mPowering frontline health workers is the global body coordinating mobile tools for nurses and community health workers. It includes a repository of good-quality content and messages from rojects around the world www.mpoweringhealth.org

Knowledge for Health of Johns Hopkins University is a repository of ICT and related knowledge for health projects www.k4health.org

mHealth Evidence is a site put together by the WHO and K4Health to bring together all the good-quality and peer-reviewed evidence on mHealth from around the world. www.mhealthevidence.org

mHealth Working Group. The main convening group for mHealth, who run the main and very useful email list https://www.mhealthworkinggroup.org/

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