Transforming health care: one SMS at a time?

I’m Fred Hersch, a medical doctor and techy with a passion for global health. I’m interested in the role of technology for improving access to essential healthcare. With years of experience developing web solutions (prior to studying medicine though I still do it), I bring a bit of pragmatic reality to the discussion about technology and healthcare. Don’t get me wrong, I’m a believer that technology has a huge role to play but it’s no silver bullet either. It’s what you do with it that counts. This article is the first that looks at what is going on in the health technology space and thoughts about how technology can be harnessed to improve the health of people everywhere.

mHealth is everywhere you turn these days. The mobile phone has become the new “must have” for any serious “innovative” global health project. Everyone’s doing it, hell, we’re even making jokes about it! Have you heard the one about how there are more pilots in mHealth than there are in the US Air Force? So, what is it about the mobile phone that has the global health community so excited, and what are the opportunities offered by technology and innovation?

The context

Health for all has been a long held goal.  The Alma Ata declaration of 1978 laid out the Primary Health Care (PHC) model which emphasised people centered care and advocated for equitable access to essential services. The Millennium Development Goals re-invigorated efforts at PHC in many countries, and as we attempt to deal with the growing threats of non communicable diseases, strong primary care systems are essential.

At the heart of this definition lies access and equity which in turn bring up two very important issues; that of an adequate health workforce to deliver the care, and who pays the bill.

On the first, according to the WHO, there is a global health work force shortage of 4 million health workers. In 57 countries, this shortage is at critical levels.

In terms of who pays the bills, it is not just the USA that lacks some form of universal health care. A quick look at the map, and it becomes apparent very quickly, that universal access (in green) is the exception not the rule.  In many poor countries (most of the gray), out of pocket health expenses can be so great that they lead to poverty.

Towards solutions

Mobile telecommunications have been a true revolution. Many countries have leap-frogged traditional “copper wire” landlines and gone straight to mobile. In 2012 there are approx 6 billion subscriptions. 4.5 billion in developing countries with approx. 1 billion in each of India and China. It is the ubiquity and the accessibility – in terms of both affordability and equity that make the mobile phone such an attractive platform for healthcare.

The global health community has been quick to see the potential opportunities across the health system spectrum. Over the past few years there has been a proliferation of activities, pilot projects and (mostly small scale) implementations. Examples include: (i) improving health care services at the community level e.g ChildCount or Project Mwana based on RapidSMS, (ii) real time public health promotion e.g.  Project Masiluleke – HIV/AIDS prevention via SMS in South Africa, (iii) clinical decision support and patient management e.g. via CommCare, (iv) real time data collection in the field e.g. EpiSurveyor.

The list goes on.

The mHealth arena whilst still in its infancy is maturing. Companies like DataDyne (makers of EpiSurveyor/Magpi) and CommCare provide supported hosted cloud-based solutions. The RapidSMS framework is open source and freely available for download. The mHealth alliance and TechChange have teamed up to run a course: “mHealth: mobile phones for public health” (in which I recently participated). And smart phones and tablet computers are becoming more available in low and middle income countries, providing another avenue for supporting primary care workers e.g. for clinical decision support in rural India.

The transformation of health care

Disruptive innovation is a transformational process by which the existing “status quo” is challenged to such an extent that a new model takes over or “disrupts”. Often driven by technology, it is the process innovation that leads to new value networks or outcomes. In our case, “affordable healthcare” for example.

And this is where the exciting opportunities lie.

Solving the health care problem for the ‘bottom 3 billion’ will take new partnerships and new ways of working together. It will require smart use of technology (such as the humble mobile) and the development of affordable health care devices (such as diagnostics) that enable health workers to deliver more for less. And most importantly it will require new ways of thinking. How technology is used by innovative minds trying to solve this problem in the field will lead to the new approaches and models.

The final word?

For all of us interested in the health of populations, the mobile phone is an exciting tool for improving health service delivery. As global health professionals we need to understand this potential and how to harness it for driving innovation. Whether it be m-health or e-health, we are at an exciting time where if used properly, technology can move us towards reimagining health care in such a way that “health for all” is a bit closer.

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