Wednesday 27 February:

• 14:00 – 15:30: Health: Achieving Scale through Partnerships
• 16:00 – 17:30: Health: Innovating for Global Health

Thursday 28 February – Room C1.1

• 11:00 – 12:15: Solving a global problem – mHealth for non-communicable diseases
• 12:30 – 13:30: mHealth making a positive difference to end users
• 13:45 – 14:45: The Mobile World Capital m-Health Competence Center Kick-off
• 15.00 – 16.00: Government Activity in mHealth and Opportunities for Mobile

For more information have a look at the Congress agenda here.

GSMA Ministerial Programme
We are happy to confirm that mHealth will form an important part of thematic Ministerial Programme workshops covering Current Status of the Global mHealth Proposition and Policy ask on mHealth. Ministerial Programme will also hold Africa Regional Summit where our mHealth Director Dr Craig Friderichs will be moderating one of the panels.

GSMA Pavilion
Stop by the GSMA Pavilion in the heart of Congress Square to learn about GSMA’s many programmes and initiatives. Among other things you will be able to demo the Connected Living Tracker – a customised tool which collates mobile products and services around the globe, including the mHealth Tracker.

For more information about Mobile for Development events, take a look at the agenda.

This impact pathway highlights focus areas across a sample of literature, and suggests that collectively these indicators represent a set of actions to which development outcomes are being achieved. Collecting and organising information in this way shows which indicators are being used, which areas are receiving attention within the selected research, and the theory of change for impact. Conversely, it also serves as a gap analysis by showing which areas have less attention in the literature and may need further investigation.

In particular, Impact Pathways illustrate a ‘theory of change’, demonstrating how access to mobile services for development can bring about short, medium, and long term change that improves lives.

Populating Impact Pathway

• Develop Draft Pathway: The MDI team and PWC designed a blueprint pathway and identified key indicators related to international development outcomes.
• Define literature: The GSMA mHealth team identified key literature to use to catalogue quantitative and qualitative development results to be populated in the impact pathway.
• Review literature: A team of researchers from PwC undertook a review of the literature provided to extract and tag all relevant data points and categorise according to the agreed development outcome indicators.
• Summarise results: The results communicate concentrations of outcome results as well as gaps.

Impact pathway for mHealth and Monitoring

Disease and the lack of adequate preventative care have a significant effect on emerging markets and their populations.

Evidence shows that strict adherence to a medication regime is essential for effective treatment of a variety of health conditions, from HIV/AIDS to diabetes. In addition, monitoring patients at home for chronic conditions dramatically improves survival rates.

However, many patients in emerging markets do not have access to local healthcare services.

The impact pathway for mHealth and Monitoring focuses specifically on mHealth remote monitoring applications, including services to improve treatment compliance and appointment attendance, remote monitoring of vital signs, and provision of medical advice via call centres/health hotlines.

View the mHealth Interactive Impact Pathway

The GSMA mHealth team would like to encourage everybody to contribute to the Impact Pathway by sending research, reports, or other forms of evidence to mdi@gsma.com

Each year, approximately 350,000 women around the world die unnecessarily as a result of preventable causes related to pregnancy and childbirth. Half of the 7.5 million deaths among children under five years of age occur during the first 28 days of life, also from largely preventable causes. These deaths occur primarily in the Global South – in sub-Saharan Africa and South Asia.

Cell phones could be saving their lives.

Mobile Technology Is Everywhere

In a world with 7 billion people, 6 billion of them are mobile phone subscribers. A new report “Leveraging Mobile Technologies to Promote Maternal and Newborn Health,” found that combining mobile technologies with existing health system resources would provide women and newborns with:

• Timely interventions that promote decisions to seek care and stimulate demand for available services– such as text messages that provide health education and increase awareness of health resources;
• Improved access to health services and facilities, for example through services that equip community-based health workers with mobile tools, extending health coverage into households and the community; and
• Health care that is delivered efficiently and expertly, through communication services that connect women to peer networks or local expert resources.

Mobile technologies are rapidly expanding throughout the world. The question is whether we can harness these technologies to impact the health and lives of women and children (“mHealth”), particularly in the Global South.

New mHealth tools are emerging, including:

• mCheck, which helps women in India identify health risks in the first week after delivery and seek treatment;
• Cellphones4HIV in South Africa, which aims to prevent the transmission of HIV/AIDS from mother to child through text messages with educational information and reminders for appointments, tests and treatment; and,
• Mi Bebe, which enables health workers to monitor women with high-risk pregnancies remotely to provide early warning of abnormalities and refer them to treatment in a timely way.

So, how do we make sure every mobile user can access these kinds of tools?

Bringing mHealth to the broader public

Currently, mHealth applications for maternal and child health are in the formative design and test stages of implementation. As a result, evidence of their effectiveness is only now emerging. It is critical that we develop and implement more rigorous evaluation of mHealth tools currently in place. If these are shown to positively impact maternal and child health outcomes, we also need to make sure we can bring these tools to those countries, cities, and towns that need them most.

We cannot look at mHealth technology in a technology vacuum, though. For us to take it to scale in the places worldwide where it is most needed, we will have to address many other related issues, such as social factors, strategic partnerships and business models. For example, by addressing social factors like literacy and inequities in women’s access to mobile phones, we can remove barriers that impede the reach of mHealth services. We can also adapt services to meet user needs—such as using voice messaging instead of text messaging where literacy is low. Helping to remove barriers to using the technology will ultimately lead to broader adaptation and better health outcomes.

Innovation will also need to be flexible and adaptable to the quickly evolving nature of technology, and build on existing information and communication technology capabilities. We don’t need to reinvent the wheel.

The Innovation Equity Problem

Not everyone has equal access to mHealth. Countries as diverse as Kenya and Peru lead in the level of innovative mHealth activity among the countries reviewed – as evidenced by the integration of mFinance with mHealth in Kenya or the role of Universidad Peruana Cayetano Heredia in promoting local capacity development in Peru – while Liberia and Brazil lag behind. This cannot be explained on the basis of health, development, and technology indicators alone.

We need to identify critical existing resources – such as each country’s human resources, scientific and technological research infrastructure, regulatory frameworks, and business and investment environment – and assess how they may influence any country’s capacity to innovate. Many countries need support in developing the infrastructure that would improve their ability to develop and scale up mHealth interventions.

Mobile technology has the power to transform health systems and to save lives. The solutions are, quite literally, in our hands.

Photo: © 2012 Kim Blessing/JHU CCP, Courtesy of Photoshare

Summary of main topics:

mHealth Background: As written by the authors, “mHealth programs provide a range of educational and support functions for achieving family planning and reproductive health goals. While these programs can be categorized in myriad ways, in general, they fall into two broad categories of mHealth practice: client centered and health system strengthening.”

Why is the practice important? “Mobile phones are seemingly everywhere, and the growth of mobile phones is being driven by demand in developing countries.  In 2010 alone, developing countries saw a 20% annual growth rate in mobile subscriptions with no signs of slowing down (ITU 2012; World Bank 2011).  From 2005 to 2010 mobile subscriptions in developing countries grew 221% (ITU 2012).”

What is the impact? “Evidence documenting the impact of mHealth on health and system outcomes is sparse and only recently available. Two journals – the Bulletin of the WHO and the Journal of Health Communication – released mHealth themed issues in 2012, helping to push the mHealth evidence base forward.”

Peer reviewed evidence on mHealth for family planning: Limited evidence is available documenting the use of mobile phones for family planning with some of the key findings:

• SMS network bridges gap between district staff and CHWs
• Information about FP methods can be delivered effectively by mobile phone
• SMS reminders improved OCP continuation

Peer reviewed evidence on mHealth for Other Topics: Selected mHealth studies showing their relevance and potential utility for expanding access to family planning:

• Text messaging is a feasible and acceptable way for youths to receive information and service referrals
• SMS reminders improved ART adherence
• SMS reminders increased skilled delivery attendance
• SMS reminders improved quality of pediatric malaria case management
• Rich media clinical guidelines on mobile phones reduces CHW errors
• SMS reporting reduced stock\outs of anti\malarials
• Reporting on patient\specific clinical information showed no improvement in outcomes

How to do it: tips from the implementation experience (Synthesis of guidance from published literature, gray literature, and in-depth interviews with 18 experts in the field.)

• PLANNING DESIGN: Determine if your proposed mHealth solution is appropriate for the context.
• TECHNOLOGICAL CONSIDERATIONS: Determine to what extent the proposed mHealth project will work with existing technologies, infrastructure, and capacity.
• SCALE UP: Determine the potential for the project to be implemented on a larger scale.
• SUSTAINABILITY: Consider the accessibility of resources for the long>term operation of the project.
• EVALUATION: Assess the potential contribution of evidence generated by this project.

Join mHealth Working Group’s Online Discussion Forum

To discuss the findings of this paper, the mHealth Working Group is organising an online discussion forum on January 22-25. According to Laura Raney from mHealth Working Group, the discussion will be guided by various guest experts from number of organisations that will contribute with key challenges, promising practices, approaches, gaps in tools, and resources and recommendations for future discussion. Topics include: planning and design of mHealth programs, technological considerations, scale-up, sustainability, and evaluation.

To join this discussion, send an e-mail to mhealth@my.ibpinitiative.org or submit a contribution to the mHealth Working Group community of practice.

In May, the U.S. telecommunications regulator announced plans to set aside spectrum to connect wireless medical devices for more convenient health monitoring or “Medical Body Area Networks”. Two spectrum bands for devices allow for doctors to monitor a patient’s vital signs at home or in hospital via low-cost wearable sensors. We wouldn’t be far off by quoting Neil Armstrong: “One small step for man, one giant leap for mankind”.

Another win for the U.S. was the House and Senate committee members’ agreement to amend legislation that would allow the FDA to go ahead with plans to regulate mobile medical apps. Hopefully this puts to bed the numerous reports and social media discussing how crowded app markets are with potentially harmful products.

The President of Smart Communications was quoted as saying: “… The role of the traditional telecom has become obsolete. In the digital era telecoms need to evolve into multimedia, intelligent companies.” To rebuff that, a number of mobile operators have invested significantly into healthcare: Japan’s Docomo, together with Omron Healthcare, a leading supplier of medical devices and services, invested into a subsidiary to offer a range of mobile enabled products and services. Vodafone is partnering with specialist firm Exco Intouch to launch a service that they say will enable pharmaceutical companies and researchers to better collect data from participants’ mobile phones during clinical trials. U.S. operator Verizon announced an equity investment in Nanthealth, a U.S. firm that is developing health services based on a combination of mobile devices, cloud computing and fibre network technology.

On the evidence front, mHealth’s ability to influence behavioural change seems to be gaining recognition but the jury is still out on the health economics of mHealth. What results can we expect to see in 2013 from the more than 220 [globally] registered RCTs in 2012?

With WellDoc paving the way for reimbursed health services supported by mobile, 2012 saw a handful of other companies successfully entering into agreements with payers and providers.

With a busy year almost behind us, we’re hoping that 2012 has been an incredibly good year for all GSMA partners, friends and colleagues.

In many emerging economies, the world’s poor seek healthcare in a marketplace that bears little resemblance to a coherent system. Unsure of where to seek proper treatment or unable to pay, patients often go to a doctor of suspect quality, self-diagnose and medicate, or skip treatment altogether.

To tackle these deeply ingrained problems in health systems, innovators around the world are experimenting with new solutions that help consumers to access appropriate treatment. Earlier this year, Safaricom and ‘Call-a-Doc’ partnered in Kenya to launch Daktari 1525, a hotline service providing phone-based health consultations from registered medical doctors. The service offers information and advice, as well as facility referrals for appropriate diagnoses or prescriptions. Daktari 1525 represents just one of many solutions being employed to create more informed consumers in the health market.

In Highlights: 2012, the Center for Health Market Innovations (CHMI) identifies a number of these new trends in solutions that are being applied to improve the quality, affordability and accessibility of healthcare for the poorest and most vulnerable. Although also looking at innovations outside of mHealth, the report shows that innovators are increasingly experimenting with information technology to achieve these goals.

Some mHealth highlights from the report include:

• The identification of 5 key mHealth interventions that are working to improve maternal and child health, including Changamka Microhealth Ltd., which uses mobile money systems in Kenya to help women steadily save money to pay for quality antenatal, maternity, and postnatal health services.
• An analysis of over 170 eHealth programs (including many mHealth programs), which surfaced some of the key goals of eHealth deployments, such as extending geographic access to healthcare (e.g. through telemedicine systems or call centers).
• A number of barriers that remain to effectively using information technology to improve health care. Among other barriers, program managers who were interviewed identified end-user acceptance of a given technology as a key challenge to successful implementation.
• Details on CHMI’s Reported Results Initiative, which collects clear, quantifiable, and self-reported measures of program performance across several key dimensions such as affordability, efficiency, clinical quality, and health outcomes. MedicallHome, which offers hotline-based health services to over five million subscribers in Mexico, reports that by referring patients to the appropriate level of care, the company saves patients US$19.7 million each year.

Learn more about new practices in health markets around the world in Highlights: 2012.  Visit HealthMarketInnovations.org to download the report and see photos of more than 15 of the world’s most innovative health models.

The ICT4D sector is developing and evolving in a rapid pace and ICT and mobile tools are increasingly interweaving and interacting. This not only makes it difficult to define the M4D sector, it is becoming increasingly more difficult to understand what programs exactly to pick up as Text to Change and what is better left to our ICT expert partners.

Technology VS context

Text to Change realizes that technology required for manufacturing smartphones is becoming cheaper, increasing accessibility and use of smartphones in a rapid pace for Africa. With the launch of Chinese manufactured 100$ smartphones in Africa, many will argue that smartphone adoption will only take little time, even in developing countries. However many technological and contextual hurdles have to be overcome before smartphones and tablets alike will be widespread adopted across the developing world. How can supply of electricity required for working with advances technologies be guaranteed in countries where the only reliable power outlet is a several kilometres walk, if any is available? Also, when will people at the BoP, earning 2$ or less per day, be able to afford expensive smartphones and the corresponding subscription fees? In an average TTC program, 85% of the time required for implementation is spent setting the context and adapting from a general setting to local factors. 15% of time is required for technical set up and the choice of appropriate technology. In the context of development work, most time and energy should be focused on adaptation to local context, because the technology will always be there to support your goal and can be tailor-made to fit your preferences.

Why Text to Change prefers simple mobile phones

TTC tries to overcome constraints as failing internet connectivity and network coverage, (technical) illiteracy, expensive irreparable equipment and subscriptions, lack of reliable power sources and lack of mobile technological infrastructure and capacity, by focusing on plain and simple mobile solutions. TTC applies basic mobile technologies as SMS text messaging and Voice response systems to ensure effectiveness and full involvement of beneficiaries in aid programs. Employing basic and feature phones for interactive, toll-free campaigns assures that individuals can participate regardless of phone brand, type, network coverage or location. Simple and plain solutions have proven over more advanced technologies in previous campaigns, especially in low-tech environments. In the future more programs will move towards employing more advanced mobile technology solutions, and Text to Change is preparing itself for this moment. Still, until mobile internet and general mobile networks increase to more widespread coverage and subscription fees descend; awareness and information dissemination and data gathering can best be performed employing simple, plain and workable mobile solutions. Text to Change has many ideas for employing new technologies that combine old, proven solutions to complex problems. Currently we are performing tests with a New York University designed open source GSM network , which could change the communication opportunities and behaviours of many in closed and small-scale communities throughout the developing world. This solution combines the power of open source technology with easy, ready available tools like SMS text messaging and Voice calling. The development of Formhub and ODK is another great example of combining best of options to find a solution to complex problems with tools already available on the market.

In current M4D and ICT4D programs, the key to workability, effectivity and positive results is simplicity and straightforward solutions. Text to Change will always try to implement simple solutions even to the most complex problems, in order to have mobile technology engage, connect and interact people throughout all levels of society.

Photo: Text to Change

Millennium Development Goal 6: Combat HIV/AIDS, Malaria and Other Diseases

There are three years to go to achieve MDG6! So many things are happening in working to address the goal, and yet more people than ever live with HIV. In 2011, 34.2 million people were living with HIV/AIDS and 1.7 million people died of AIDS-related causes.

I had interesting conversation with a group of young people few weeks ago in South Africa, a country where the percentage of HIV infected is among the highest in the world. Six of us, originally from South Africa, Nigeria, Colombia, Germany, Slovenia and USA, started discussing why men in South Africa don’t use condoms. It was shocking to hear how many do not use protection. Why? Is it a problem in awareness? Ignorance? A lack of responsibility? Or is it a lack of caring about the long term, when you are not sure whether you will still be alive next month?

With most of HIV infected people based in the rural areas, my concern is that this lack of caring is actually one of the main reasons for high number of HIV infected people. Do awareness campaigns help? Various mHealth services are focusing on prevention and promotion and with it trying to impact participation. The YoungAfricaLive service has reached over 1,262,000 people. Mother2Mother, through its Mentor Mothers service, is reaching 300,000 women living with HIV. There are 64 mHealth services in Africa addressing HIV/AIDS, but great impact is yet to be seen.

Click here to view infographic in a separate window and please share!

We hope this infographic highlights how mHealth services are supporting the combat of HIV/AIDS, malaria and other diseases, especially in Sub-Saharan Africa. We invite you to share this infographic, and if you have any comments, email mHealth@gsm.org.

A soon-to-be released GSMA whitepaper reveals that U.S. healthcare providers, patients and consumers strongly believe that mHealth solutions have the potential to deliver significant benefits. Healthcare providers believe the primary benefits of mHealth relate to driving behavioural change among patients, whereas patients and consumers believe mHealth’s primary benefit is the ability to monitor progress towards health goals more consistently.

From December 3rd to 5th, visit us at the GSMA stand 311, where we will be showcasing innovative mobile health solutions from China Mobile, Etisalat, Orange and Telenor Connexion.

Building successful partnerships: the role of mobile operators in mHealth – GSMA Affiliate Session on December 4th, 5:00 – 6:15 PM.

Moderated by Dr. Craig Friderichs, Director of Health in GSMA Mobile for Development, this session will provide an overview of successful mobile operator propositions from AT&T, China Mobile, Orange, SMART and Telefónica and demonstrate how mobile and health can jointly achieve long-term investment into healthcare. There are over 800 mobile health products and services around the globe, and increasingly mobile operators are taking a leading role in these solutions. Examples of successful partnership models will be discussed in an interactive panel session.

Session objectives are:

• To provide a global overview of mHealth services being delivered by GSMA members
• To showcase the role of the mobile operator in mHealth solutions
• To highlight the value proposition in successful mHealth services between mobile operators and the health industry

And Speakers:

• Dr Craig Friderichs: Director of Health, GSMA
• Eleanor Chye: Executive Director, AT&T
• Carlos Martines: Head of Strategy and Innovation, Telefónica Digital
• Benjamin Sarda: Director, Orange Healthcare
• Li-Qun Xu: Chief Scientist, CMRI

Join us for this interactive panel session. Visit the website for more information and to view the conference programme.

About mHealth Summit

4,000 representatives from 50 countries are expected to attend the fourth annual event which, for the first time, will include a dedicated global health component focused on major developments for improving health systems in low- and middle-income countries through the best use of mobile technologies.

In addition to Dr. Nafis Sadik, Special Advisor to the UN Secretary-General, who is opening Day 3 of the summit, keynotes will be delivered by Dr. Francis S. Collins, Director of the National Institutes of Health; Mark T. Bertolini, Chairman and CEO of Aetna; Gary Shapiro, CEO and President of the Consumer Electronics Association (CEA), Ariel Pablos-Méndez, Assistant Administrator for Global Health at USAID as well as Jeff Sachs (Director, Earth Institute at Columbia University. The summit will also feature senior representatives from the Harvard School of Public Health, Johnson & Johnson, UNICEF and who will focus on ways mobile technologies can positively affect the health of millions worldwide, especially women, children and the underserved.

If this is the case, we’re missing out on one of the greatest opportunities to advance mHealth and prove its value to health systems. If you have the time, read through the work plans for all these initiatives and you’ll be amazed at the number of opportunities for global and country engagement, Government advocacy and convening, and mobilisation of health resources and organisations.

At the moment, the role of mobile and ICT is confined to two isolated areas in each of the recommendations. We have to do more to educate world leaders. This isn’t about the role that mobile and ICT play in recommendations 6 & 3 respectively. It’s about the enabling role that mobile and ICT can have across all the recommendations. We can showcase examples of services that are supporting the majority of those recommendations. True, we’re still battling to define scale and sustainability and a handful of other barriers common to any nascent industry, but success stories are starting to emerge.

If I had to define mHealth 101 for global health leaders, it would start with a lesson on the assets that the mobile industry wants to use to support health. In short, they have assets that they need to sweat more effectively:

1. Core network assets – minutes, data, text, short-codes, etc.;
2. Infrastructure – call centre, billing, support;
3. Reach – ability to reach the last mile of consumer;
4. Brand equity – trusted and established
5. Experience in low margin, high volume businesses

So, the message for health leaders that should be included on their priority agendas for all convenings and work plans is that mobile and ICT is already providing support to the majority of their recommendations, and secondly that mobile and ICT should be a priority, not a nice-to-have. I use “is already providing” deliberately to hopefully evolve the mHealth conversation and get people talking about the emerging success stories.

What is the next lesson in mHealth our global leaders should be taking on board?

Photo: Every Women Every Child Global Strategy