In the past few years, mobile health (m-health) has gone from a sideshow act to main attraction, as technology vendors, NGOs, healthcare providers and governments realise its potential.
Like the revolutions in banking and education, mobile healthcare represents an opportunity to leverage the developing world's high cellphone penetration to meet some of its most pressing health challenges.
These opportunities, and the accompanying hurdles, will be the focus of the upcoming GSMA and mHealth Alliance Mobile Health Summit, taking place in Cape Town next week. International and local government leaders, innovators and industry players are set to thrash out some of the sector's burning issues.
Konstantinos Tzingakis, head of innovations and partnering at Ericsson, who is presenting at the summit, says the event is significant for the continent as a whole. “There's been genuine interest for African countries to address the health gap and m-health is one of the best ways to do it.”
He adds, however, that there are still many unknowns in a field that merges lightning-fast technology with long-established healthcare policies and protocols.
“The big issue is that healthcare is a huge ecosystem and many m-health players don't understand the complexity of that ecosystem,” says Tzingakis. “It's important to remember that you're dealing with people's lives.”
He notes that governments and m-health vendors haven't taken into account the need to bring together all the components of the ecosystem, from pharmaceutical companies to the biotech industry to insurance firms to operators.
“The question now is how to mesh different players together in order to create a complete and sustainable solution. That's the next evolution that needs to happen.”
If someone gets misdiagnosed through an m-health application, who is going to get sued?
Konstantinos Tzingakis, head of innovations and partnering, Ericsson
According to Tzingakis, the response by government has generally been one of cautious enthusiasm. “Government is eager to bring in these solutions but they don't really understand all the elements involved. It requires big changes, so government is a bit hesitant.”
But Tzingakis believes this is the right approach. “With so many people jumping on the mobile health bandwagon, you really have to be sure about what you're doing.”
Healthcare professionals are also showing interest while keeping the potential pitfalls in mind. “If someone gets misdiagnosed through an m-health application, for example, who is going to get sued?” asks Tzingakis. “There are a lot of serious issues we need to consider.”
He adds that the speed and novelty of m-health solutions in Africa can quickly lead to dangerous assumptions about what it can achieve, especially in a profession that's used to trial and approval procedures that take years.
“The lifecycle of a drug typically involves 20-odd years of research, testing, and patenting, before it's brought to market. Compare that to the very short lifespan of mobile technologies. These are two very different industries being brought together.”
M stands for...
One of the most keenly anticipated topics to be discussed at the summit is that of monetising mobile health services. Until very recently, m-health has typically consisted of a scattered collection of pilots and projects, usually dependent on outside funding to stay afloat.
Tzingakis says most m-health providers haven't found a clear way to make their offerings profitable, and that the ability to create sustainable, scalable solutions marks the next step for the industry.
While there are a multitude of m-health solutions out there, very few have been able to demonstrate clear results in bringing benefits to society, he explains.
Dr Peter Benjamin, MD of Cell-Life, agrees, saying the hype around m-health has overshadowed concrete findings around its usefulness. “It's a field with a huge amount of potential, but we don't yet know exactly what it can do.”
Benjamin explains that health professionals will not be impressed until m-health applications have undergone randomised controlled trials - the standard way of formally testing any sort of medical intervention - which demonstrate significant health benefits, and to date only a handful of these have been published.
The GSMA Summit in Cape Town is significant, says Benjamin, because it's the first serious meeting in which m-health is being described in terms of business models.
“Previously, mobile health consisted of a few dozen pilot projects in various parts of the world. The GSMA's aim is to find a way for these projects to enter the business environment.“
Benjamin points to the commercial success of mobile banking services such Mpesa as an example of how mobile development projects can be turned into a profitable business.
He says the key lies in offering healthcare professionals a way to do what they already do - for less. Mobile connectivity could bring great efficiency benefits, for example, in areas such as stock control, patient record management, and other back-end systems.
Mobile before meltdown
On one level, says Benjamin, mobile-health simply marks the next form of telemedicine, which has been using communication technologies in healthcare for some time.
In another way, however, m-health offers something radically different. “For the first time, ICT in healthcare can go outside the clinic, and talk to the individual.”
He explains mobile's potential in terms of the World Health Organisation's four categories of health services: promotive (promoting a healthy lifestyle such as exercising and not smoking); preventative (preventing conditions like diabetes, high blood pressure); curative (treatment while one's ill); and rehabilitative (readjusting to life after recovery).
“Of those four categories, telemedicine could only ever speak to curative healthcare,” says Benjamin, as services would typically be offered at the healthcare facility. Of course, once a patient reaches a clinic, they're already feeling ill, so any opportunities for promotive or preventative healthcare have already been missed.
It's a field with a huge amount of potential, but we don't yet know exactly what it can do.
Peter Benjamin, MD, Cell-Life
Benjamin compares the local situation to driving a car without ever taking it for a service, until it has a meltdown in the middle of the highway one day. “This is how healthcare is run in SA. There's almost no preventative care and trying to cure someone who's already ill is one of the most expensive forms of healthcare, compared to preventing people from getting sick in the first place.”
He hopes the summit will showcase some of the latest published studies that show proven medical benefits with m-health. At present, there's little conclusive evidence to show that sending an SMS results in some kind of behavioural change, such as a patient being more likely to take their medication, or go for a follow-up appointment, he says.
Tzingakis is hopeful about future solutions, saying the technology is improving, and that people are taking novel approaches to enduring challenges. “From people off the street with great entrepreneurial ideas for looking up medicines or tracking patient visits, to thinking around how m-health can address the Millennium Development Goals, it's very exciting from a technology point of view.”
He adds that the diverse societies in Africa also call for innovative problem-solving. “In Europe, people mostly suffer from chronic illnesses, such as cardiovascular diseases. In Africa, it's really about keeping people alive.”
Transformers
According to Benjamin, mobile health as a term has a lifespan of another three to four years, after which it will become such a natural part of the ecosystem the name itself will become obsolete.
“The things that work will simply become part of the way we do healthcare, and those that don't will fall away. No one talks about electric health, for example, it's simply about plugging in the machine and using it.
“The potentially revolutionary aspect of m-health is the ability to offer health services directly to individuals.”
He says the numerous consumer health apps entering the market may be helpful, but they aren't where the truly transformative potential lies, because those using iPhones and BlackBerrys most likely already have access to the Internet at work or home.
“What's going to change things is not the few thousand smartphones, but translating that impact to 42 million basic phones. In this way, people can access healthcare through basic services such as SMS and USSD, to find out what do when their child has a fever at 2am, or if they have an abdominal cramp, or if they're really sick, to be able to call an ambulance.”
Benjamin points out that the R113 billion national budget for healthcare is split more or less evenly between the public and private sectors. Given that only about 15% of the population has access to medical aid, it means the same amount used to service this 15% has to meet the needs of the rest of the country's people.
“Currently, if you're a person who doesn't have access to private healthcare and you feel sick, you have one of three options - leave it, which is what most people do, or try to access the public health system. This typically involves getting a taxi, waiting in a queue for two hours, after which you might get five minutes of attention by a nurse who hopefully has the right treatment, wait in another queue at the pharmacy, and finally travel home.
“Add to that all the arrangements you have to make for childcare, time off work and other duties. It's at least a day of grief. Also, the whole reason you were going to a clinic to begin with is because you were feeling horrible, so it really is an ordeal.”
The third option, notes Benjamin, is going to a sangoma or alternative healer down the road.
“The potential of m-health is to reduce the barriers of access to the second choice, to enable people to access the formal health sector without devoting a whole day to it.”
He explains the imminent power of mobile health by quoting Clay Shirky's notion that “communications tools don't get socially interesting until they get technologically boring".
When services can be offered directly to an individual who can choose to access basic healthcare services - whether promotive, preventative, curative or rehabilitative - that's when things are likely to get really interesting.
* Speak your mind: Would you make use of mobile health services?
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