mHealth

In the land of the blind, the one-eyed man is king

Business Action for Africa recently released a new report on what businesses can do to sustain the Millennium Development Goals (MDGS) in Africa. The report brings together insights from various business leaders and NGOs, as well as from the likes of Paul Collier, Kofi Annan and Lord Malloch-Brown, among others. Many of the contributions seemingly follow the standard protocol of touting transparency, governance, business environment reforms, effective public-private partnerships, investments in the private sector, and other well-known policy prescriptions. As Richard Laing, Chief Executive of CDC aptly notes:

Much has already been said about the impact of the global downturn on Africa, but a great deal of the talk about solutions has been empty rhetoric full of generalisms that regard Africa as one homogenous place. Any simple prognosis for the continent’s economic future ignores the fact that there are 48 countries in sub-Saharan Africa with differing economies and at varying stages of development. It is action, not talk, that is required.

That said, there is one particularly worthwhile analysis, written by Dr. Peter Eigen, Chairman of the Extractive Industries Transparency Initiative. Eigen writes:

In the land of the blind, the one-eyed man is king. When it comes to knowing how the global financial crisis will affect Africa we are all living in the land of the blind. Usually we can rely on the IMF to be the one-eyed man, but the IMF’s growth predictions for 2009 give such a mixture of signals that it is impossible to form a clear overall picture. We do know, however, that 2009 will see a series of difficult social and political changes in Africa: elections, strikes, civil unrest, rising fuel and food prices, and a more challenging environment for exports. Because of Africa’s unique finance and liquidity circumstances, and due to volatile exchange rates and commodities prices, it is safe to assume that the financial crisis will be felt differently in Africa than elsewhere.

Eigen's acknowledgment of the uncertain is quite refreshing; for as much as we think we may know about Africa's future trajectory and development needs, there is indeed that much more than we don't. Eigen is also particularly prudent in his discussions of EITI - the very organization of which he is Chairman: "The Extractive Industries Transparency Initiative (EITI) has long been held up as a shining example of how multi-stakeholder initiatives can address these kinds of challenges. But much of this praise has been premature. The initiative is still young." Such rhetoric comes in stark contrast to others in the development field who proclaim with overwhelming conclusiveness the merits of their formulaic approaches to poverty alleviation/aid/whatever, embryonic though these approaches may still be. Every now and again it's nice to be reminded that there are people in the field who are guided not by grandiose visions but by practical, thought-out solutions to given problems. Thank you, Mr. Eigen


In any event, do read the report; it will surely be worth your while.

mHealth data from the Humanitarian Technology Challenge

Via UN Dispatch, Matthew Cordell writes:

Ken Banks, the brilliant creator of FrontlineSMS is now delivering a Lawrence-Lessig-style presentation at the Humanitarian Tech Challenge.  It's all interesting and worth comment, but right now he's talking about a friend of his who took "a laptop and 100 used cell phones" to St. Gabriel's Hospital in Malawi.

That small amount of equipment served 250,000 people, saved $3500 in fuel costs and saved 1,000 hours in travel time. Incredible.

The Humanitarian Technology Challenge is a partnership between the IEEE and the UN Foundation & Vodafone Foundation Technology Partnership, and seeks to define and develop sustainable solutions to humanitarian challenges in the developing world. These solutions should be able to be implemented locally and "within the environment, cultural, structural, political, and socio-economic conditions where they will be developed."

Rwanda: mHealth pioneer?

Rwanda has been in the news quite a bit lately, and appears to in many ways be emerging as a model for African development (ironic, isn't it?). Indeed, Kagame's mantra of entrepreneurship over aid has seemingly lead to a significant upturn in the country's development, and Rwanda appears to be rising.

Writing in the UN-Vodafone Foundation Technology Partnership blog (the Foundation is the leader in the mHealth field), Claire Thwaites reports that Rwanda is on the leading edge of the mHealth frontier:
Supported by the Rwandan Ministry of Health, Voxiva, and the Treatment Research and AIDS Centre (TRAC), TRACnet is an electronic records system that can be uploaded to mobile phones. In Masaka it is being used to track and record the distribution of anti-retroviral medications, ensure drug adherence, electronically create and submit patient reports, and access the most up-to-date information about HIV/AIDS care and treatment.

[...] In Masaka, I was guided through the health clinic by the local program manager, Hareuhana Diaedonne. During the tour, Hareuhana spoke at length about the simple but significant benefits that have been brought about by the introduction of mobile phones to the local healthcare system. Using TRACnet, he reported, data entry that used to take months to record and aggregate now can be collected in just 5 minutes.
A booming mHealth industry may not only be the ticket for improved public healthcare in Rwanda, but may also be the perfect opportunity to attract more investments into the country, in turn continuing to fuel Rwanda's rise.

mHealth for Development

mHealth (shorthand for 'mobile health') is a topic about which I admittedly know quite little, yet am beginning to gain interest in through various friends and colleagues active in the field. To the best of my knowledge, at the forefront of mHealth initiatives is the UN Foundation and Vodafone Group Partnership created in October 2005. Together they've recently released a report, mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World, in which is examined the potential for mobile phones in improving health in the developing world; future health needs in developing countries; and potential roadblocks for sustainable mHealth programs.

Mead Oliver offers a rather critical analysis of the report, addressing some of the pressing questions surrounding mHealth. Perhaps most importantly (at least from my humble perspective) is the question of how to design incentives for truthful data collection by cell phone:
The problem in using cell phones for flu surveillance is that of incentives. How does one induce the general public to accurately report outbreaks of flu? People might under-report for fear that an intervention would be draconian. This fear could be offset with a campaign describing the nature of the intervention and perhaps by rewarding those who report with free cell phone minutes. On the other hand, If one gives away cell phone minutes for reports of flu episodes, people might over-report. The [UN/Vodafone] report suggests that these incorrect reports were entirely due to a misunderstanding based on language, when intentional misreporting in hopes of receiving the promised reward may have instead been the problem.
Despite such persisting challenges, there are presently upwards of 50 active mHealth projects, the majority of which are in sub-Saharan Africa.  Among the most promising of these is Project Masiluleke, a mobile health project started in South Africa in 2008 which uses text messages to reach people in the most remote areas of the country to encourage them to get information and counseling on HIV/AIDS. The project delivers approximately 1 million HIV/AIDS and tuberculosis texts each day to personal cell phones providing contact information for the national AIDS helpline:
Callers to the national helpline can ask questions about HIV, get information about where to get tested and receive counseling.

The project takes advantage of a popular form of texting across Africa, called a "please call me" message, that can be sent for free from a phone even if it is out of pre-paid minutes. The empty characters on the free text are used to convey the health message.

Future phases of the project will allow users to text health questions, if they prefer not to call the line, and will provide an internet portal of information accessible by cell phone for people to learn about HIV. The ultimate goal, says the group, would be to provide free home HIV testing kits that would be supported by mobile counseling, so that people who aren't willing to visit a clinic can find out their status.
For now, much of such mHealth programs appear quite confined to sub-Saharan Africa, with a few projects scattered throughout Latin America and Southeast Asia. It will be most interesting to track the success of these projects to uncover whether they might prove equally successful elsewhere. Jumping the gun a bit, Nokia Research has already begun working with humanitarian agencies in India and psychiatrists in China to identify the potential m-technology might hold for remote populations there.