Although the U.S. health care system has dominated the media spotlight in recent months, innovative mobile technologies are helping to fundamentally transform health care in many developing countries.
Last month, the Rockefeller Foundation announced a $100 million initiative to strengthen health systems in Africa and Asia by building capacity, supporting policy interventions and promoting health IT applications.
As part of its health IT strategy, the foundation intends to leverage mobile phone-based technologies to improve health care access, quality and efficiency.
Karl Brown, Rockefeller's associate director of applied technology, explained that the foundation sees mobile health technologies "as sort of the front lines of e-health." He said that although servers, databases and Web sites will be necessary to support the mobile phone applications, health workers can use the devices to extend their reach to regions that lack adequate health care infrastructure.
An Environment Ripe for Mobile Health
According to Brown, mobile health tools are particularly suited to meet the needs of developing countries. "The thing that is very compelling about the mobile phone is that it's an infrastructure that is growing very fast of its own accord, and it exists for the most part in a lot of these countries," Brown said. He added, "The mobile phone is much more suited to a lot of these environments in some cases than a computer or a laptop or an Internet connection because it doesn't use a lot of power."
At the AED Satellife Center for Health Information and Technology, staff members work with local and international nongovernmental organizations to develop mobile data collection and dissemination tools. Andrew Sideman, Satellife's associate center director, says many regions of developing countries do not have reliable access to the Internet or even electricity.
"One of the reasons that we were interested in using PDAs, and now mobile phones is that they are very stingy with power," Sideman said. "Because the batteries can last for seven or eight hours between charges, and then they charge very quickly from a solar charger, we can circumvent the issues of not having a strong electric grid infrastructure."
Despite limitations in Internet and electricity access, most developing countries have some degree of mobile phone coverage. According to the U.N. Foundation, about 80% of the world's population lives in a region with mobile phone coverage and about 64% of all mobile phone users live in the developing world.
Brown explained that many people in developing countries already possess mobile phones and are familiar with basic functions such as making phone calls and sending text messages. Therefore, he said, it doesn't take long to train people to use new mobile phone applications such as Internet browsers or information systems.
Turning Mobile Phones Into Health Solutions
According to Brown, effective health system management requires active communication about regional health trends and medical needs. He said, "When we look at health IT systems [that] have been successful, it's really where they have been integrated horizontally and systematically so that a single piece of information is collected once, and then used for all sorts of different purposes." For example, mobile health tools could improve clinic management, facilitate disease surveillance, and enable clinical research, Brown said.
At Satellife, staff members are leveraging mobile phone applications to help health care workers access clinical research and collect information for local health ministries.
For example, the organization's GUIDE system converts large clinical documents into formats that are easily readable on the small screens of mobile devices. Sideman says the system allows physicians and nurses in developing countries to access current medical research and literature. "The idea was to put it on a device that was small enough so that they could carry it around with them during their working day," he said.
Meanwhile, Satellife's GATHER system is an open-source mobile phone application that allows health care workers to electronically submit reports to district health centers or health ministries. Officials then can use the data to monitor health trends or diseases in a particular region.
Sideman says Satellife also is working with health information exchanges in Uganda and Mozambique. According to Sideman, "Both of these are two-way communication networks, so that as the health workers upload the data that they've collected, and they're sending it to the Ministry of Health, they automatically are receiving a download of health information to their mobile device."
What's Next for Mobile Health Technology?
According to Sideman, mobile phone technology is advancing so rapidly that the cost of using these devices in the developing world is falling every year. Sideman said, "Five years ago, we started by using PDAs and people would say to us, 'That's way too expensive, we can't do that.' And now, because of changes in technology, we've been doing similar kinds of things on cell phones that cost less than half of what we used to pay for the PDAs."
He added, "And that's just technology; ... every two years things cost half as much."
Brown said he believes developing countries will see dramatic advances in mobile technology over the next several years as bandwidth access expands, connection speeds increase and costs go down.
He also noted that developing nations have the unique opportunity to benefit from earlier pilots of health IT tools in other countries. He said, "There's an opportunity to leapfrog, whereby you don't need to go through all of the learning of the past 30 years that we've done in the U.S., we can immediately jump to much more integrated, interoperable e-health systems that are based on open standards that already exist today."
Brown said he believes the next step will be to use mobile technology to promote patient-centered health. He said, "If you can put the patient at the center of the health care system and empower them to make better decisions, their portal and the way that they interact with the health system is going to be their mobile device."