mHealth: Saving Lives with the Mobile Phone

BANGALORE, India--In the battle to provide reliable health services to millions of rural poor worldwide, the cellular phone has quickly emerged as the most powerful weapon.

In Malawi, a country with two doctors for every 100,000 residents, and where more than one in five children is underweight, the national government partnered with UNICEF to track juvenile malnutrition in real time, with mobile phones and an open source platform called RapidSMS. Because the source code of the RapidSMS platform is non-proprietary, it can be quickly and easily customized by government agencies and NGOs who wish to use the software for remote health diagnostics, patient monitoring or health data collection.

In the Philippines, camera-enabled Nokia N73 phones have been outfitted with microscopes by a team from the University of California at Berkeley, who are now able to analyze patients' blood samples for traces of malaria and sickle cell anemia.

In Botswana, where treatable forms of cervical cancer are the leading cause of death among women, according to the World Health Organization, Click Diagnostics is supporting the work of health care workers who are helping to identify high-risk patients through mobile phone-based consultations.

As it stands, every 10 minutes two women die from cervical cancer worldwide, said Dr. Erere Otrofanowei the Director of Sponsorship for the National Cervical Cancer Prevention Programme (NCCPP). Eighty per cent of those cases are recorded in Africa. By introducing universal screening for cervical cancer, the lives of thousands of women could be saved, she said. Alerting women about the need for early detection through cervical cancer screening can be done simply and easily via SMS.

Fifty-seven countries now face a critical shortage of health care workers, representing a deficit of more than 2.4 million medical professionals worldwide, according to the WHO. Often hampered by poor infrastructure, lack of trained doctors and high costs of treatment and medication, relative to income, people in developing countries struggle to receive anything resembling the levels of care and access to health information that citizens of wealthier nations often take for granted. But innovations in mHealth - as mobile phone-based health care is known -- are starting to close those gaps, albeit slowly.

"In places where roads remain unpaved, and where basic infrastructure such as clean water and electricity are scant, mobile phones already have become an empowering force for millions," said David Aylwar, executive director of the Mobile Health Alliance.

"Mobile technology represents a high-reach, cost-efficient method for making health care more accessible, affordable and effective,"according to mHealth for Development, a document prepared by mHealth Alliance. The alliance is an initiative sponsored by Vodafone, the UN and The Rockefeller Foundation to tackle gaps in provision of rural healthcare through the use of mobile phones. In particular, the report focused on six areas where mobile phones can help overcome critical shortages in the provision of healthcare: remote data collection and patient monitoring, disease tracking, education and awareness, and healthcare worker training.
In early December, the mHealth Alliance Awards were announced, creating a $50,000 prize intended to "spur innovation in the development of wireless solutions to global health challenges," according to their Web site.

African countries are at the forefront of mobile health trends, said Navi Radjou, executive director of the Centre for India and Global Business at Cambridge University, UK. Many countries in Africa today have little to no physical or public health infrastructure, Radjou said. With the introduction of mobile technology, they are able to leapfrog into the 21st Century health system virtually over night, he said.

However, while Africa may be at the forefront of mHealth techniques, India is still the largest single market for mHealth, telemedicine and mobile diagnostics, Radjou said.

In India, for instance, 90 percent of secondary and tertiary health-care facilities are in cities and towns, said Dr. B. S Bedi, former senior director and head of the Indian government's telemedicine department. Yet more than 80 percent of India's population of nearly 1.2 billion still live in rural areas.

"In a vacuum of proper health information, people will turn to anything," said mDhil founder, Nandu Madhavan, a Goldman Sachs banker and Harvard Business School graduate turned social entrepreneur. To help ensure that people get the right information, startup mDhil will send three health messages to a user's mobile phone for a subscription fee of just 1 rupee per day (about two cents). The health alerts are written by public health professionals such as registered nurses and physicians, and the most popular topics are sexual health, weight management and H1N1 information, Madhavan said. Currently, mDhil has 150,000 paid subscribers.

One of the reasons that mobile health services stand such a good chance of succeeding in India is that India's mobile phone market is red hot: 10 million new cell phones are activated each month, according to the news agency Reuters. The majority of those new phones end up in the hands of people Dr. C.K. Pralahad called "the bottom of the pyramid," or those living on less than one dollar per day.

Handset makers are scrambling to cater to this enormous and largely untapped market. In India, low-end phones can be purchased for around $20. India also has the cheapest voice calling rates in the world, with fierce price competition between the country's largest carriers. In fact, all of them offer calling plans with the low rates of one rupee per minute. It is common for subscribers with prepaid calling plans to top off their phones with 10-to-20 rupees (20-to-40 cents).

Madhavan said he came to the realization that something had to be done to get basic health care information to the poorest of people when he was working as a Peace Corps volunteer in the Dominican Republic. As he put it, getting children vaccinated for polio is not expensive, but too often parents are unaware of the need to do so, or they believe that children don't need to see the doctor as long as they appear healthy. That means, he said, that finding new ways to deliver health information to those without regular access can hugely improve public health with what is in fact minimal effort.

"The easiest thing you can do in the world to improve public health is to promote immunization," Madhavan said. "These are things that information can prevent."