Results tagged “mHealth”


Recently Priya Jaisinghani, Teressa Trusty, and I brought together a few folks to have an informal Technology Salon around the pertinent question of how can the development community get technology to scale?

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We all know we have a problem - just look at the map above. We say our work in ICT4D, M4D, mHealth, ICT4E, etc will reach "scale" and even (financial) sustainability, yet the reality is a profusion of similar software and technology applications around the world that never leave the pilot phase. We focus on responding to RFP's that ask for something new or innovative with limited, bespoke solutions that die the day after funding ends.

We keep reinventing the flat tire.

This problem isn't confined to one group - funders, implementers, techies, dev experts, we are all complicit. We all have sinned in the name of scale and sustainability. It is time for us to come clean, make amends, and seek a better way forward. To that end, we came to three key conclusions:

1. Have Buy-in From the Beginning or Walk Away

Too often both "scale" and "sustainability" means a vague paragraph in a long-forgotten proposal. We need to get serious about both.

For scale, we need to recognize is it relative to the project size. Some projects reach scale when 100% of a small community changes their situation, others when a majority of citizens in a country change their behaviours. Yet, not every project is going to be regional, national, or continental - and that's okay. "Scale" does not need to mean "global". This is a lesson that many funders can afford to learn.

At the same token, "sustainable" does not need to mean free from donation funding - as most religious organizations can attest. It does mean that as international actors, we need to have local buy-in to the intervention, where whomever we are working with agrees from the beginning to not only support the project long-term, but also have a clearly defined plan for that support.

Now this can be government adoption (and funding) of the activity as a new service to the community. Or it can be fee for service, a social enterprise, or even a for-profit service. The business model can take many forms, but as implementers, we have the responsibility to make sure there is a clear handoff that is expected and planned for.

For both of these parameters - scale and sustainability - all of us have to be braver. We must be willing to point out when either parameter is failing and be willing to walk away from a project if it's not corrected. Yes, that's easier said than done. So is real scale and sustainability.

2. A/B Test Everything

In web design, there is a concept called A/B testing, where you develop two (or more) version of a page and test to see which one has the better response rate. In fact, every Salon invite is an A/B test - 10% receive one email, 10% receive another, and the version that is opened more is sent to the remaining 80%.

What if interventions were A/B tested? Say the top two ideas were awarded pilot funding and the service that had the best intervention result received full funding to scale - something like USAID's Development Innovation Ventures. Or if proposals were written to be honest about the need for local consultations, and rather than prescribing a solution after a short bout of rushed research between RFP announcement and deadline, implementers won based on their post-award intervention research and solution design, in addition to actual implementation methodology.

A/B testing doesn't stop at project start. You can A/B test every step of the intervention process, constantly tweaking the project to make sure its optimized for the outcomes desired. Yes, you can say we do that now - but are you tweaking your formula hundreds of times every year like Google?

3. Stop Developing Software

The most contentious point that came out of our Salon was the idea that international development organizations should not be software development organizations. Specifically, with the reality that specialized software development organizations exist, and that they will be better than development organizations at software development, if you focus on health, education, agriculture, etc, you should focus on the intervention itself, not the technology that you use to achieve your goals.

In fact, we should have a registry of industry leading solutions - ranked software tools where we can all plainly see which are the few (3 to 5) tools that we should concentrate our efforts on. Like say this list of mobile data collection systems that came out of a previous Salon.

Only then, when we are all bought into the same tool set, can we really get scalable solutions that are robust, with the longevity for our lengthy project life cycles.

Ideally, all these tools would be Open Source to allow everyone to build on the code base and use it freely. In fact, one participant was adamant that all software development funded by the international community should be Open Source. And really Open Source - licensed as such and on GitHub.

OpenMRS, the world's leading open source enterprise electronic medical record system platform, was put forth as a great example of this process. I personally think Tangerine should be next, becoming the leading electronic data collection software for early grade reading and mathematics skills assessments.

Yet even now, how many other medical records or education data collection software exist? Do we really need more? Shouldn't the development industries - software and international - come together and focus on the proven tools instead of inventing more?

Or are we destined to see more mHealth moratoriums?

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mHealth Summit 2010

On the occasion of the 2010 mHealth Summit, please join the United Nations Foundation, the Vodafone Foundation Technology Partnership, and the mHealth Alliance for a luncheon discussion of the forthcoming report:

sms solution
  • Health Information as Health Care: The Role of Mobile in Unlocking Health Data

    This report examines the ecosystem of patient-related health information, tracing data pathways throughout the continuum of care, and from patients in villages to international health organizations and the most important steps in between.

    It aims to serve as a map for identifying barriers, choke points and other inefficiencies in current system that may impede progress toward effective health systems transformation, and maternal health goals, and provides recommendations for leveraging modern ICTs to address health data flow challenges.

Please join us to discuss the impact and role health information flows, and information and communications technologies (ICTs), particularly wireless, have on global health. We will open with a brief overview of key findings from our forthcoming report, and then move into a discussion of the key gaps in data flows in health systems.

Health Information as Health Care: The Role of Mobile in Unlocking Health Data
mHealth Summit luncheon discussion
11:30 a.m. - 1:00 p.m.
Wednesday, November 10, 2010
Washington Convention Center
801 Mount Vernon Place NW
Washington, DC 20036 (map)

R.S.V.P. to UN Foundation is required and seating is limited. A link to the draft report and room information will be provided upon confirmation of R.S.V.P. Highlights from this discussion will be captured in the final draft of the report, which will be published later this year.

Note that you must register to attend the Summit to join us for this event. If you do not plan to attend the Summit in full, please contact Trinh Dang for more information.

While everyone is amazed at the quick proliferation of mobile phones in the developing world, here's a startling statistic which should check our unbridled enthusiasm for m-everything: 73% of women in Sub-Saharan Africa and South Asia do not have a mobile phone.

Across all developing countries, adult women are 21% less likely to have a phone than men. In absolute terms, that's a 300 million-woman gender gap. Yet that gap is not evenly distributed. For instance, rural women who work outside the home are more likely to pay for phone use themselves and spend more on mobile phones as a percentage of income than their urban counterparts.

Why do women own and pay for mobile phones? Because they see tangible benefits: across all women, 90% feel safer and more connected thanks to their mobile phones and almost 50% used a mobile phone to search for employment or increase their income.

And mobile line operators should take note. The annual incremental revenue opportunity in closing the gender gap would be $13 billion per year, and even at current rates, 66% of all new mobile subscribers will be women. Simply put, women are the face of growth for the mobile industry in the developing world.

Such are the findings of the Women & Mobile: A Global Opportunity (PDF), authored by Vital Wave Consulting and sponsored by the GSMA Development Fund and the Cherie Blair Foundation for Women.

But Brooke Partridge, CEO of Vital Wave, took this concept a step further. She gave us a new development formula to challenge our conventional thinking:

Women + Mobile Phones = Economic Development

We all know that equipping women in low-income countries with productivity tools earns tremendous returns for development - it's not just good for them, it's good for their families, villages, societies, countries.

We know that women spend up to 90% of their income on their families and are responsible for up to 80% of food production in many low and middle-income countries. These women run families and businesses.

And we also know that mobile phones are uniquely positioned as tools for growth in our era. Research has shown that mobile phones are associated with faster economic and business growth.

Combining the two - the role of women and the power of a mobile phone - has the potential for exponential impact. It's the perfect, and the obvious combination; empowering women through the benefits of mobile phone ownership is the easiest and most straightforward measure we can adopt to advance social and economic growth in developing countries.
Speaker notes of Brooke Partridge, Vital Wave Consulting

The Role of mServices

After dropping that bombshell on the Technology Salon, Brooke went on to explain that closing the mobile phone gender gap will not be easy. Of course cost and access are issues, but she found that perceived need is the largest barrier to female adoption.

Women, it turns out, just see a phone as a communication device for talking with those that they already know. And if everyone they know is near to them - in their family or community, they don't feel the need for a device to reach them. Either they can easily walk to them or can borrow someone else's phone to call them when needed.

So how to drive adoption, close the gender gap, and increase economic development? mServices. In the Salon, we brainstormed on what those mServices could be, and came up with these four:

  1. mPayments: With M-Pesa reaching throughput equal to an astounding 11% of Kenya's GDP in 2009, its the killer mServices application. In her research, Brooke found Kenyan women to be more aware of the value that mServices could provide them, because of their exposure to M-Pesa.
  2. mEmployment: Remembering that 50% of women looked for jobs or increased income through mobile phone usage, we quickly agreed that mobile job boards or an mCraigslist would be popular if targeted at women.
  3. mHealth: Women are usually the home health provider, so offering them healthcare services (advice to diagnosis to treatment) over mobile phones should be an obvious mService
  4. mAgriculture: Women are responsible for up to 80% of locally-consumed food production, so they should be the target farmers in mobile agriculture services.

mServices have barriers to deployment. The services need to be very low cost, and yet high volume to be sustainable over millions of often rural and poor users. And to scale them beyond interesting pilots, there needs to be ongoing early-stage support - both capacity building and financial - that's often missing in the gap between public donor program and private venture capital.

And of course, as we've found in previous Salons, sustainaiblity and scale are relative and contentious. Scale can be a community, a province, a country, or a continent depending on who is measuring sustainability. In the world of mobile phone operators, its almost always in the millions - either subscribers or revenue.

Women + Mobile Phones + mServices = Economic Development

Brooke concluded the Salon by remind us that while the mobile phone gender gap may look like $13 Billion dollar for-profit problem, mServices deserve attention from women's groups and development organizations.

Scaling mServices is the key to closing the mobile phone gender gap, mobile phone ownership will empower women across the developing world with new access to information, services, and goods, and therefore mobile phones usage by women is directly linked with, and will result in, overall economic development.

Where the last SMS4D Technology Salon reminded us of the unique gift of mobile technologies to be implemented in the field, The Cloudy SMS4D Salon really drove home mobile phones as a multifunctional tool whose true impact is tied more to the usage than the technology itself.

While we gathered to discuss SMS4D, we really talked about heath reporting and outreach, education, and community building through knowledge management and sharing. It just so happened that these health projects were using SMS codes to report longitudinal child health statistics.

Data gathering in health, and even knowing when to gather data, is a huge burden, often relying on community health workers doing the healthcare version of the Training and Visit system of the agricultural extension world. Waiting around for a planned infrastructure is hopeless, but working with the more incremental nature of mobile can improve reporting rates and reduce errors -- "utter chaos works everywhere" being the best quote of this Technology Salon.


Childcount builds on existing SMS reporting to enable community health workers to rapidly register children, note any symptoms or diseases they might have, improve patient tracking (and thereby reducing duplication), and schedule immunizations and outreach. The SMS "encoding" builds off of a simple and familiar paper form, which is handy for training (but less useful than a mango tree, as we'll see).

The runner-up quote from this Salon dealt with discussion around the potential risk of intentionally fabricated data -- "humans are awful at falsifying data" -- digitizing and quick, auditable reporting exposes both errors and lies.

Happy Pill

Winning the award for innovative ideas in mHealth was the HappyPill project -- instead of boring old SMS, HappyPills uses "flashing" - where you call a number and hang up immediately to "ping" someone. Usually, flashing is just a free way to ask someone to call you back, or you can sometimes work out extensive codes -- one missed call is just saying hi, two is call me back, three means an emergency, etc..

HappyPills takes this basic, essentially binary interaction and applies it to help improve adherence rates for prescription regimens. A medical center can send out flashes to their patients, and the patients are reminded to take their pills and would then flash back to signal that they took their medicine. It's naturally not foolproof, but hugely more cost effective (almost cost-free) in comparison with sending a community health worker out to the patient on a motorcycle to witness their pill-taking.

Jokko Initiative

It turns out that people are not just willing, but economically motivated and excited to use (and pay for) basic SMS-based services to improve their numeracy and literacy skills, improving their ability to communicate cheaply over their phones as well as better navigate market prices. In these low-technology communities, Tostan's Jokko Initiative is creating a curriculum to enable this via SMS.

Mango tree mobile phone menu navigation

They have also come up with an amazingly simple methodology to introduce people to menu systems using a mango tree metaphor which gracefully transitions from the concrete (planning a climbing route on a real tree to get to a specific mango) to the semi-concrete (the same, on a diagram of a tree), to the abstract (the tree diagram becomes the menu diagram, the mango a specific function).

Anyone who thinks that is too basic has never shown their grandparents a new shiny piece of technology, or had their entire worldview of user interface challenged by someone physically pointing a mouse at a screen).


Patatat is an early-stage solution, which puts SMS into the role of a community town hall, newsletter, or email list. It removes not only the normal geographic barriers that a listserv gets around, but also infrastructure barriers, so (for example) farmers across a region or the world can share knowledge around their crops without relying on the grid and hardwired phones/Internet to do so.

This also centralizes costs to one "host" and minimizes it to the community, so a farmer could send one SMS (free to receive, costs to send), and the host would re-broadcast it to the entire "community." With Twitter already showing that it can (technically) report earthquakes faster than the earthquake itself spreads, this rebroadcasting tool also has clear applications in emergency announcements, citizen journalism and a myriad of other fields.

Technology or Development?

So, was this technology salon about technology, or was it about development projects? Sure, all of the projects discussed at the salon happened to use server and cloud-based SMS technologies. They also use paper, physical transportation, and people. That the technology is now moving from the focus of a project to being a (cool, exciting, powerful, still new-and-shiny) tool in the toolbox is truly heartwarming.

It means mobile phone ICT solutions are maturing into a cross-sector role and not into another silo, but a "pillar of excellence".

In our September Technology Salon, we took on James BonTempo's pertinent question of What Does the "m" in mHealth Really Mean? in a spirited debate with technology and development practitioners.

We were seeking a better definition of mHealth than the current focus on devices, and specifically the hype around mobile phones. As one participant bemoaned, it seems that every health project with a mobile phone or PDA, no matter their usage, is now an mHealth project.

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Is this mHealthcare? (photo: Data Dyne)

So we sought to put parameters on what could be called an mHealth project, and through that, come up with a new definition for mHealth. After an hour of vibrant debate, we developed these four aspects for mHealth projects:

1. Field Mobility

First we all agreed that the "m" stood for mobility - health workers empowered with tools that allowed them to actually leave the clinic and visit with patients in the field. This concept of mobility could be as simple as a mobile community worker visiting clients with the original mobile data collection device: a clipboard. Yet, we felt that that was too basic - mHealth was more than just mobility, it had to include the collection of electronic health data.

2. Electronic Information

As much as mobility, we felt that the "m" in mHealth could just as easily stand for modernization - the digitization of health records systems. Its the storage and analysis of massive amounts of health data which is fostering a revolution in healthcare with Ministry and community worker alike. But more than just data, which implies numbers, we are really talking about health information - new treatments, activities, and practices shared with the community so they can improve health outcomes.

3. Timely Connectivity

Moving information means connectivity, but not necessarily constant connectivity. Asynchronous, store and forward or even sneakernet connectivity can be quite effective in remote locations. This led us to think of community health worker movement as more nomadic - many site visits between stints as a central health clinic - than always mobile all the time.

With nomadic movement, timeliness is relevant to location. In the health clinic, connectivity would be synchronous and aggregate information could be shared between clinician and Ministry, while in the community, connectivity could be asynchronous, with personal information shared between clinician and community.

4. Feedback Loop

Note the multiple mentions of information movement between Ministry and community. A real mHealth project must have bi-directional information sharing. No matter how important health data may be for Ministry-level decision makers, its even more important to have health data flowing back down to the very community health workers who are collecting it - for direct usage with patients.

As we looked at the four requirements listed above, we realized there needed to be one more change to the concept of mHealth, and that's the limitation of the word "health". We're really talking about a holistic approach to improving health outcomes, with an end-to-end communications infrastructure, so we're really talking about mHealthcare, not mHealth.

Yet even mHelathcare is still a subset of the more holistic eHealthcare, where these field-focused solutions tie into national electronic healthcare systems that can empower changes in people and policy at the country level.

Back down at the Technology Salon level, we concluded with a simple hope for our discussion. That this exercise would help each of us better discuss and explain what the "m" in mHealth means in our respective professions and promote a more inclusive and pragmatic concept of mHealthcare to the larger development and technology communities.

What Does the "m" in mHealth Really Mean?

In a recent Twitter exchange, James BonTempo asked a very pertinent question about the current mHealth buzz:

The only mHealth definition? (Img: DataDyne)
Should definition of #mHealth include devices (wondering specifically about netbooks) or simply the concept of mobility?

He followed up his initial query with a simple poll that asked if mHealth should include a list of specific platforms or just the concept of mobility. So far, Twitterers agree, the "m" in mHealth should represent mobility, regardless of form factor.

But that's different from the general notion of mHelth, represented by the mHealth Wikipedia entry, which focuses on equipment "mHealth is a recent term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs, and other wireless devices"

In our next Technology Salon, we'll explore what the "m" in mHealth means for those who actually practice mHelath, with these field-experienced experts:

  • James BonTempo who says, "Ask someone about #mHealth they'll mention (smart)phones and PDAs. But who's counting users with laptops? After all, they are "mobile" devices."
  • Josh Nesbit who says, "I tend to frame everything in reference to end users, so the "m" describes the mobility of healthcare workers, facilitated by devices."
  • David Isaak who says, "I am definitely in the "m" in mHealth being everything mobile. I usually use the acronym "mICT" for a broader view."
  • Wayan Vota who says, "Ask those in #mHealth hype and they say (smart)phones. Ask those who DO #mHealth and they talk about holistic ICT ecosystems."

But enough about what the four of us think. Come out Thursday morning to give your own voice to the conversation. Our goal: a shared definition of mHealth from an implementer's perspective, and a better understanding of mHealth for everyone involved.

What Does the "m" in mHealth Really Mean?
September Technology Salon
Thursday, September 10 8:30-10am
UN Foundation Conference Room
1800 Mass Avenue, NW, Suite 400
Washington, D.C. 20036 (map)

Do note that we'll have hot coffee and Krispe Kreme donuts to wake you up, but seating is limited and the UN Foundation is in a secure building. So the first fifteen (15) to RSVP will be confirmed attendance and then there will be a waitlist.

Epidemics and a shortage of healthcare workers continue to present grave challenges for governments and health providers in the developing world. Yet in these same places, the explosive growth of mobile communications over the past decade offers a new hope for the promotion of quality healthcare - billions now have access to reliable technology that can also support healthcare delivery.

Mobile-empowered healthcare (DataDyne)

How can this access to mobile technology, radically improve healthcare services - even in some of the most remote and resource-poor environments?

Please join Inveneo's Eric Blantz and Vital Wave Consulting's Dr. Karen Coppock in a discussion around mHealth - how technology can empower better and more efficient healthcare services throughout the developing world, with an emphasis on mobile and cellular technologies.

Of special focus is the recent United Nations Foundation and Vodafone Foundation Technology Partnership report, mHealth for Development, authored by Vital Wave Consulting

Opportunities for mHealth in Development
March Technology Salon in San Francisco
March 3rd, 8:30-10am
@ Inveneo
972 Mission Street 5th Floor (map)
San Francisco, CA

Please RSVP as we only have seating for 15 and after that, there will be a waitlist.


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