Mobile health and app-iness in the developing world
March 10, 2014

Der Spiegel recently noted that there were more cell phone contracts in 11 African countries than in the U.S. (>98 contracts per 100 population). In these nations, with half of their population being under 15 years of age, there may be more than 1 billion additional cell phone users by 2050. This vast penetration of mobile phones coincides with the globeaEUR(TM)s largest population that lacks health care, both in regard to services and information about managing their conditions. For mobile health (mHealth) technology, emerging markets represent a huge opportunity. Low- or no-cost mHealth apps could greatly assist patients to preserving and improving their well-being.

Some readers may be surprised to learn that the use of apps, including mHealth, is already well developed in emerging countries. The Fogarty International Center at the National Institutes of Health recently launched a program to advance mobile health research in low- and middle-income countries (LMICs) to foster the development and adoption of mHealth. Several examples of this effort already exist.

In Africa, Johns Hopkins University’s Electronic Mobile, Open-source, Comprehensive Health Application, or eMOCHA, has developed a platform that is being used by PEPFAR, the U.S. PresidentaEUR(TM)s Emergency Plan for AIDS Relief. It connects 17 health-care centers throughout Uganda to optimize HIV counseling, testing, treatment, and adherence. The program’s nerve center is at Mulago hospital in the capital city, Kampala, which has a group of local HIV experts and a strong technological base. The experts at Mulago are able to effectively develop and distribute tools, such as touchscreen data forms, to rural areas, improving treatment practices.

In Peru, 2 million out of its 30 million population (according to 2012 data) are diagnosed with diabetes, and half go untreated. Patients can enroll in C@reNet, a platform that sends text messages (SMS) with information on diabetic risk factors, lab test results, and reminders to patients to take their medications and show up for appointments. Nearly twice as many patients who received the SMS intervention took their meds according to their prescription compared to those who did not enroll.

In remote areas of northern Bangladesh, 75 percent of women give birth at home in the absence of skilled medical personnel. Most have had no prenatal care and are unable to go to a hospital during childbirth, facing complications that could be life-threatening without medical assistance. The mobile phone-based platform known as mCARE is a pregnancy and neonatal health information system that connects rural health workers and facilities with pregnant women and their newborns. It is currently being piloted in a study involving 800 pregnant women. MCARE sends automated reminders for antenatal, postnatal, and essential newborn care, notifies health-care centers of patients in labor and births, provides decision-making support for rural women and families, and notifies patients of available emergency health dispatch teams.

In both emerging and affluent nations, mHealth is improving health through the tracking and timely delivery of essential information to both patients and providers. Is this the new MA(C)decins sans FrontiA?res? Maybe not. But as Bill Gates said, aEURoeBecause itaEUR(TM)s new technology we should let 1,000 ideas blossom. I think we have to approach these things with some humility, though. I think we have to hold ourselves to some pretty tough metrics to see if weaEUR(TM)re really making a difference or not. I think itaEUR(TM)s always valuable to go back to aEUR~what is the key metric youaEUR(TM)re trying to improve?aEUR(TM) Maybe the simplest one is the number of kids who die under the age of five…aEUR?