Clearing m-health hurdles

The demand for ICT-assisted healthcare solutions like mobile health (m-health) is growing exponentially in developing countries due to the lack of suitably qualified doctors and specialists, says Yashik Singh, lecturer at the University of KwaZulu-Natal's department of tele-health.

Singh adds, however, that there are limitations to what m-health can do. “Like with all technology there are drawbacks. The prerequisite of the use of m-health applications by patients themselves is that they will be required to understand basic health information, medication, nutrition, and treatment regime to manage their disease.

“M-health may contribute to the patient gaining this knowledge, but in the short-term patients with low health literacy will not benefit as much.”

He adds that ethical and confidentiality issues must be taken into account, as many rural families or communities share a single cellphone. “There must be mechanisms put in place to ensure the security of the patient's condition, as, for example, having an HIV support application on a cellphone immediately indicates someone is likely to be HIV-positive.”

According to Gustav Praekelt, MD of the Praekelt Foundation, a developer of mobile tools aimed at communities in poverty, a major challenge is integration and collaboration, to ensure continued provision of care.

“For example, we can send awareness SMSes asking people to test themselves for HIV, but if our SMS service is not integrated with all the VCT [voluntary counselling and testing] sites in SA, it is difficult to track the efficacy of the SMS in prompting certain behaviours.”

Another problem is the churn of mobile numbers, says Praekelt. “SIM cards are a challenge, which will be met by the new Rica laws, forcing each mobile owner to register a SIM card against their name.” He says this will enable more targeted communication with end-users.

In developing m-health services, says Ericsson's director of innovation and new business services, Konstantinos Tzingakis, it is important to look at needs holistically, and identify where mobile technologies can be used in providing an end-to-end solution.

“This means we need to look not only at the needs of the individual potential patient, but at the needs of healthcare and social workers, healthcare institutes and facilities, as well as other stakeholder needs, such as governmental and educational needs.

“However, in all this the most important factor we always consider is sustainability,” says Tzingakis. “This usually means there needs to be a sound business model behind the solution, a model that not only benefits the institutions maintaining the technology, but the users thereof.”

Developing applications that communicate vital healthcare information can also be a challenge in a country with 11 official languages. Singh notes that simply asking the person what language they want to use doesn't always ensure the information being communicated is understood.

He says a study is under way at the University of KwaZulu-Natal's department of tele-health to determine whether Zulu-speaking patients will be able to understand an informed consent form which includes the use of tele-medicine.

“The problem is that many of the words used in current consent forms are scientist jargon and cannot be translated in a fully understandable way into languages where the culture does not include such ideas. Right now, all we can do is to try our best using simple language and multimedia.”

According to Praekelt, on mobile, character limits are always at play: “An SMS has only 160 characters and a 'please call me' tag-on only 115 to 120. Zulu and Sotho are, compared to English, far more expressive languages and it takes more characters in Zulu than it takes in English.

“On the other hand, it is extremely important to communicate to people, especially on sensitive issues such as HIV/Aids, in their mother tongue.”

He adds that Project Masiluleke, a collaborative initiative using mobile technology to address HIV/Aids challenges, has tested seven languages to date, including English, Afrikaans, Zulu, Xhosa, Sotho, Setswana, and Sepedi. “We see far better results, in terms of calls to the National Aids Helpline, when we send out messages in vernacular than in any other language,” notes Praekelt.

Peter Benjamin, MD of Cell-life, a developer of technologies to improve the lives of people living with HIV/Aids, says cost is the main issue for those using the systems. Efforts are being made to make services cheaper by, for example, allowing people to subscribe via a 'please call me' message, as opposed to having to call a number or send a standard SMS, explains Benjamin.

“In developing markets, the cost of mobile access and even the coverage can often be a major obstacle,” says Tzingakis, “but that is slowly changing. Coverage is spreading and mobile access is becoming more and more affordable.”

Another challenge, according to Benjamin, is getting the message out to people, so they know about these services. For this reason, Cell-life partners with various organisations and offers them free SMSes, which can then reach groups of 100 000 members, says Benjamin.

“It's all about awareness and education,” notes Tzingakis. “The more people know and understand what can be done using mobile technologies, the greater the demand and distribution of such m-health interventions will be.”

“It's also an issue of imagination,” Benjamin points out. “Lots of NGOs have beautifully designed Web sites, but they are largely irrelevant for most of the population. Only about 15% of people access the Internet via a PC, while 85% have a cellphone. It's about scaling services so they can be mass-used.”

“The more connected the world becomes, the more the reality of m-health will move into our everyday lives,” notes Tzingakis.

“Things we see as innovative today will become part and parcel of our everyday lives tomorrow, to the point where we may even take them for granted. We will wonder how we ever did things differently.”