Health at our fingertips

The Philippines currently boasts the “biggest growth rate” of smart phone sales in Southeast Asia, a whopping 326 percent. Worldwide, and speaking of cell phones in general, the Philippines ranks 10th, with almost 107 million cell phones in a population of 94 million, meaning cell phone ownership has hit an astonishing 113.8 percent (some Filipinos, apparently, own more than one cell phone). The numbers are expected to grow. According to Business Monitor International, cell phone ownership here is expected to hit 117 million by end of 2016.

Of course, that’s minuscule compared to China, which ranks number one in cell phone ownership in the world, at over 1 billion cell phones in a population of 1.35 billion.

But consider this. Africa now has more cell phone users than the United States and the European Union combined. The continent chalks up the largest growth rate—at 40 percent—in cell phone ownership in the world. Kenya tops the list of African countries in terms of cell phone ownership, registering 28 million cell phones in a population of 42 million, resulting in 71.3 percent penetration, placing it 31st in the world.

“Health at Your Fingertips” was the title of a workshop on “Increasing Information and Service Delivery through Mobile Technology” at the recent “Women Deliver” conference in Kuala Lumpur. In a conference devoted to women’s health and increasing investments in and health services to women and children, this workshop bridged health service delivery and mobile technology, showing how something as small and humble as a cell phone—whatever the age and model—could prove useful in managing health systems and saving lives.

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Alain Labrique, an assistant professor at Johns Hopkins University, began his presentation with a slide of the empty interiors of a Boeing 747. He asked us to imagine the plane “filled with mothers,” and said one such plane “crashes every day in Africa and South Asia.” Such is the toll of maternal mortality in the developing world.

But at the same time, he said, there are 5.2 million mobile phones in developing countries, and linking this technology with the mothers and infants in need of information, services and reassurance could go a long way toward drastically cutting the number of maternal and newborn deaths.

One such model is “M4RH,” or mobiles for reproductive health, in Kenya and Tanzania, which provides subscribers basic information on health, sexuality and family planning, and also a “clinic locator” to help women find the nearest facility for a safe delivery. The network also runs a “role model story” every two days, presenting in cliff-hanger, episodic fashion, a dramatized story about family planning choices.

The “MAMA Project”—for “Mobile Alliance for Maternal Action”—runs projects in Bangladesh, South Africa and India. Guided by WHO and Unicef standards, global director Kirsten Gagnaire says the messages sent through the networks, and the exchanges fostered, provide “emotional support, reminders, nutritional information,” among others, to mothers and health workers. “The messages are also localized for culture, context and language,” she added. In the pipeline are “post-partum family planning messages,” messages addressing “cultural myths about family planning,” and impact studies.

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Labrique, who runs the “Global Health Initiative” from Bangladesh, works with more than 168,000 families in a remote district in the north, where 71 percent of households own cell phones.

By registering in the network, a pregnant woman gets a monitoring service that calculates her gestational age (the approximate time she will deliver) and schedules her prenatal visits (and reminds her about them) and vaccinations. It also gets the woman in touch with her local clinic and health providers, increasing “accountability and equity.”

Josh Nesbitt, on the other hand, is the CEO of Medic Mobile, a company he founded after a visit to Malawi where he met a community health volunteer who would trek hundreds of miles from his village to the nearest health center, often lugging voluminous files of his patients to be recorded by the center personnel.

Thinking there had to be a better way to do things, Nesbitt sought to bridge the distance by way of mobile technology. These days, his friend no longer needs to walk all the way to the clinic, he can just use SMS to provide the patient information the clinic needs. At the same time, Nesbitt notes, “health officials can use mobiles to keep track of the workers and volunteers, and monitor their performance.”

Mobile technology is also used to monitor stock levels, since “stock-outs,” the disappearance or unavailability of contraceptive supplies and other medical needs in clinics, take place too often. Now, central authorities can receive reports about stocks running low almost instantaneously, spurring action. Nesbitt says mobile devices can also be used to monitor the temperature of containers for cold storage, warning authorities when vaccines, for instance, are in danger of expiring because the “cold chain” has been broken.

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“There is no silver bullet,” warned Gagnaire of the growing link between technology and service delivery. “There are many models available, and different settings may call for different solutions.”

One big issue, warns Donna McCarraher of the M4RH project, is the gap between the demand created by mobile technology, and the availability of commodities or services. “Our messages should be in synch with service delivery,” she says.

Mobile technology may indeed create a “health system without walls.” But what happens when the system cannot meet the expectations and needs of the people it serves?