What lessons learned do you have from your #mhealth experiences? #mhs10

Patricia Mechael, PH.D., Earth Institute - Top 10 Lessons learned across the globe in the mobile technology space for health: introduce participatory #mHealth models set benchmarks, create outcomes-based research, collaboration.

1. "Capitalized on what others have done, what others have learned"
2. "Evaluate impact of mobile tech to support behavior change"
3. "Localize mobile solutions around content: need to use user-centric design models and involve end users all along the the prodcut development chain"
4. "Look @ health outcomes in terms of mobile health"
5. "Be realistic"
6. "Invest in local talent"
7. "Collaboration is more fun than competition - in the end we all benefit or suffer from how we collaborate"
8. "Recycle, repurpose - Don't reinvent the wheel""
9. "Public-private partnerships in ecosystem"
10. We must unpack the pathways to mobile mediated behavior change" #mhs10 

http://www.mhealthsummit.org/conference/program/super-session-panel-lessons-learned-across-globe-0

Can you heal me now? Potential (and pitfalls) of mHealth

Americas Quarterly

BY David Aylward, Beatriz Leao, Walter Curioso, and Fabiano Cruz

Original Post: http://www.americasquarterly.org/node/1699

Mobile phone subscriptions have overtaken fixed lines as the preferred method of communication across Latin America and the Caribbean, with penetration rates of almost 90 percent. Some forecasts indicate that subscriptions in the region could grow by 8.2 percent in 2010. According to the International Telecommunications Union (ITU), mobile subscriptions globally will surpass the 5 billion mark by the end of the year—an estimated two-thirds of which are expected to be in low- and middle-income countries.

That puts the mobile industry in a position to play a pivotal role in tackling health care for the underserved. Yet health policy leaders have only just begun to address the opportunities of the wireless information revolution sweeping their countries.
“Even the simplest low-end mobile phone can do so much to improve health care in the developing world,” said Dr. Hamadoun Touré, secretary-general of the ITU during the ITU Telecom World Conference in October, 2009. For example, he added, mobile subscribers could be sent reminder messages about medical appointments or prenatal checkups.

That could make a major difference in a country like Peru with a maternal mortality rate estimated at 185 cases per 100,000 births.1 Worldwide, about 10 million women each year suffer serious complications such as infection or disease following childbirth.

Mobile digital technology can empower both patients and practitioners by providing them with the information they need to make informed decisions about critical health issues ranging from healthy living habits to health care provision and monitoring of diseases. For health care officials, the rapid expansion of wireless networks represents a particularly exciting opportunity to reach those who are currently isolated by distance and lack of communication by using mHealth programs. In this respect, health care is no different from other economic sectors that have gained enormous efficiencies and improved outcomes through the use of modern information and communications technologies (ICT). With their ability to reach much further into developing countries than any other technology, wireless networks today power the collection of health data, support diagnoses and treatment, and advance education and research in even the most remote and resource-poor environments—with the potential to do far more.

MORE: http://www.americasquarterly.org/node/1699

Happy b'day 2 u SMS! May u live long and may u cont delivering on what matters most

The equation is fairly simple, the formula is proven and the outcome is predictable:
Number of SMSs ÷ Mobile Subscribers > Number of Calls ÷ Subscribers

Image via Wikipedia

Originally developed to send control messages to phones to update configuration settings, Short Message Service (SMS) became available when telecommunications providers installed GSM services in the mid-1990s. And, next week on July 23rd 2010, SMS will celebrate its 18th birthday!

SMS is a text-only message delivery system on mobile phone networks. As a compliment to voice calls, text messages travel through the wireless service provider’s network, routed and delivered much like a voice call. The messaging server for SMS or text messaging routes all messages to the appropriate mobile phone or application based on the number in the destination address (source: CTIA).

Nowadays, SMS has gone far beyond people-to-people (aka person-to-person or human-to-human) communication. From an interactions perspective, the communication path can fall into the following categories: person-to-person (P2P), person-to-machine (P2M), application-to-person (A2P) and machine-to-machine (M2M). I will talk more about that in another post.

Reaching the incredible mark of 4.5 Trillion SMS text messages sent in 2009 and 3.6 Billion users (source: Tomi Ahonen, 2010), out of over 5 billion mobile phone connections worldwide mobile phone, is by far the most versatile, ubiquitous, prolific and successful DATA application in history (i.e., worldwide email user base is 1.4 Billion).

North Americans got into SMS through voting on American Idol, with the Obama presidential campaign of 2008, more recently with the mGive's Red Cross text message fundraising campaign (Text HAITI to 90999) that raised over $37 million for Haiti, the Text4Baby project that provides timely and expert health information through SMS text messages to pregnant women and new moms, and the list goes on and on. Today, more than half of Americans are active users of SMS text messaging and being fast learners; the US average has reached 4 SMS text messages sent per day across the total mobile phone subscriber base. This means the USA has caught up with average European SMS text messaging usage levels.

SMS for development:

There are a growing number of projects taking advantage of the widely available SMS technology to provide practical solutions to communities and to deliver social change. Here is a short list:

• ChildCount+: an mHealth platform developed by the Millennium Villages Project aimed at empowering communities to improve child survival and maternal health. ChildCount+ uses SMS text messages to facilitate and coordinate the activities of community based health care providers, usually community health care workers (CHWs).


• Text to Change: interactive SMS quizzes based on Text to Change's existing SMS platform to get employees to answer questions about HIV/AIDS, and to encourage them to get tested for HIV/AIDS. The pilot ran for four weeks in November and December of 2009, and had an overall response rate of 43%.


• Ushahidi: a platform for map and time-based visualizations of text reports that has been used most prominently in crisis mapping. The first instance of Ushahidi tracked the post-election violence in Kenya in 2007, closely followed by an instance covering outbreaks of xenophobic violence in South Africa in early 2008. Following the Haiti earthquake in early 2010.


• Farmer's Friend (Powered by Google SMS): offers farmers an affordable and targeted way to search for agricultural tips through a SMS-based database. Keywords in the query are matched against the database and the farmer receives a reply with a tip related to his or her query terms.


• Jokko Initiative: Mobile Technology Amplifying Social Change: makes it possible to communicate with a network of people by sending a text message. This means that a nurse, literacy leader, representative of a women’s association, or the village imam can communicate with community members about events or other important activities in the village (for example, a vaccination campaign or a literacy group meeting).


• Happy Pill: uses "flashing" - where you call a number and hang up immediately to "ping" someone. HappyPills takes this basic, essentially binary interaction and applies it to help improve adherence rates for prescription regimens. A medical center can send out flashes to their patients, and the patients are reminded to take their pills and would then flash back to signal that they took their medicine.

Feel free to add to this list!

[1990-2008] LAC and OECD’s PCs and Mobile subscriptions through the light of the moving bubbles

I am a big fan of Swedish professor Hans Rosling and his work at the Gapminder Foundation, fighting against what he calls the most chronic disorder reported: DbHd (data base hugging disorder). Prof. Hans is noted for his groundbreaking work with compiling and transforming development data into moving bubble diagrams and flowing curves that make global trends clear. Indeed as he usually says in his talks: Power Pointer presentations look like stuffed animals when you compare them with live interactive graphs and maps.

I recently started playing with Google Motion chart to visualize ICT trends and dynamics over time. There are plenty people mastering this king of graph and creating very interesting visualizations and mash-ups. If you are not familiar with this work, I highly recommend that you have a look at the Google Charts Tools, in particular the motion chart. It's a dynamic chart to explore several indicators over time. The chart is rendered within the browser using Flash.

So, here is the final product.

Overall, the following interactive graph shows LAC countries' performance lagging behind OECD countries regarding Personal Computers (PCs) per 100 inhabitants, while Mobile Telephone Subscriptions really took off in the region and grew from 9.9 to 81.6 from 2000 to 2008, respectively.

Notes: Mexico is included in LAC and not in OECD. Countries are coded as OECD regardless of when they became OECD members (i.e., the Slovak Republic joined the OECD in December 2000, but the country is coded as OECD from 1990-2008).

Sources: Prepared by the IDB's Science and Technology Division based on the data from ITU Statistics online database and World Telecommunication / ICT Indicators Database 2009.

Reference: The Imperative of Innovation: Creating Prosperity in Latin America and the Caribbean (LAC)

You can find some more visualizations such as this one, using World Bank's Open Data and on the Gapminder website.

Now, if you are wondering how to extract the data from a Microsoft Excel (tm) spreadsheet and translate it into a Motion Chart, here's a tip: you can use an excellent Python package called xlrd, which works on any platform (including Mac!) and allows you to programmatically make these transformations (too boring and time-consuming to do it by hand). Note that this is a library target to software developer and it is not an end-user tool. I will discuss this in more detail in a future post. The source code looks like this - note that the code snippet is not complete.

import xlrd # Import the package
    
book = xlrd.open_workbook("yourfile.xls") # Open an .xls file

sheet = book.sheet_by_index(0) # Get the first sheet

regs = sheet.nrows

while rowNumber <= MAX_NUM_YEARS:      

 currentYear = str(sheet.cell_value(rowx=rowNumber, colx=2))      
 
 for counter in range(regs):              
  country = sheet.cell_value(rowx=counter, colx=0)         
  year = str(sheet.cell_value(rowx=counter, colx=2))         
  pcs = str(sheet.cell_value(rowx=counter, colx=5))         
  mobiles = str(sheet.cell_value(rowx=counter, colx=6))         
  region = sheet.cell_value(rowx=counter, colx=1)                  

  if (year == currentYear):             
   print "['",country.rstrip(),"'",             
   print ",new Date (",year,             
   print ",0,1)",             
   print ",",pcs,             
   print ",",mobiles,             
   print ",'",region.rstrip(),"'],"          

  elif (year == "NEXT"):             
   rowNumber += 1             
   break                       

Acknowledgement and thanks:
Alison Cathles (Research Fellow at the IDB's Science and Technology Division)

Mobilizing Reproductive Health: How Cell Phones Are Revolutionizing Women’s Health

I am thrilled to participate in the panel on How Cell Phones Are Revolutionizing Women’s Health @womendeliver Conference next Wednesday June 9, 1:30-3:00pm. The session is organized by the mHealth Alliance, launched in 2009 by the Rockefeller, UN and Vodafone Foundations to facilitate cross-sector collaboration to bring mHealth to sustainable scale.

Maternal mortality remains a major challenge to health systems worldwide.

According to the World Health Organization (WHO), every minute, at least one woman died from complications related to pregnancy and childbirth, about 585,000 women each year. To make matters worse, for every woman who dies in childbirth, 20 more suffer injuries, infection or disease (about 10 million women each year). And 4 million babies die before they are 30 days old. Millions more die from diseases such as malaria that has largely been eradicated in the developed world.

The following [interactive] map shows the huge number of maternal deaths in Latin American and the Caribbean (LAC) countries. Although Chile is better placed than the other countries in the region, appearing as 46th in the global league table, 21.1 women die for every 100,000 live births. In the case of Haiti, the worst performer in the region and 155th (out 181) in the MMR global rank (numbers before the earthquake), the report shows 582.5 deaths for every 100,000 live births.

Maternal mortality ratio (MMR) - the number of maternal deaths per 100,000 live births - in the LAC countries.

DATA: download the full datasheet

Source: Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5.

Why is there so high maternal mortality?

• Poor access to the health care system
• Access to family planning - counseling, services, supplies
• Low coverage of antenatal care (e.g. missing appointments)
• Inability or difficulties to communicate with providers and health-care team in case of emergencies and when needed
• No access to lab results
• No health care-related information easily available

The Promise of information and communications technologies (ICT) for Health: a paradigm shift towards digital health care

Modern information and communication technology (ICT) has a pivotal role to play in tackling health-related problems, by empowering individuals and equipping decision makers with timely information about critical health issues. It can, among other things, enable healthcare workers to conduct remote consultation and diagnosis, store and disseminate healthcare information, improve access to and use of information by patient, strengthen epidemiological surveillance and management, establish databases to track vaccination, raise awareness through knowledge sharing, improve quality of health services provision, improve patient compliance with treatment regimen, improve access to health services, expand access to ongoing medical education and training for health workers.

In the fight against maternal mortality, ICT can critically reduce the incidence of maternal death numbers by: facilitating access to information and healthcare services, and reaching women with information to prevent unnecessary deaths and complications.

Also, with the expansion of wireless networks, mobile technology became an important ally. It’s the most rapidly adopted technology in history and represents an exciting opportunity to “reach the unreached”.

According to ITU (International Telecommunications Union), mobile subscriptions globally will surpass the 5 billion mark by the end of 2010, two-thirds of which are in low- and middle-income countries (LMICs) – the total number of PCs in use worldwide including laptops is 1 billion.

Almost 90% of the LAC population has a cell phone. Some forecasts indicate that it could grow by 8.2% annually in the region in 2010. Cell phones have become firmly ensconced as essential goods rather than luxury items.

There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services — even in some of the most remote and resource-poor environments. The key applications for mHealth (defined as the use of mobile communications for health services and information) in developing countries are:

• Education and awareness
• Remote data collection
• Remote monitoring
• Communication and training for healthcare workers
• Disease and epidemic outbreak tracking
• Diagnostic and treatment support
• Appointment reminders (to patients and workers)

To sum up, ICT by itself certainly play a key role in helping saving lives but it isn't a silver bullet. Health system strengthening as a whole is the key to the success of any kind of eHealth/mHealth intervention.

ICTs are only as useful as the substantive requirements and expertise on which they are based. We need clinical and public health workers and community to determine the needs and challenges they face; then gather the ICT experts to find the points of intersection -- where ICT can help along the continuum of care for pregnant mothers and newborn children, and for those with serious diseases.

References:

[1] "mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World". United Nations Foundation/Vodafone Foundation Technology Partnership (2009); www.unfoundation.org/technology

[2] "Innovation: Applying Knowledge in Development". Authors: Lee Yee-Cheong, Calestous Juma, Jeffrey D. Sachs; UN Millennium Project 2005, Task Force on Science, Technology, and Innovation.

[3] "Focus on Five: Improving Women's Health to Achieve the MDGs". Author: Women Deliver No. of pages: 22. Publication date: 2009.

[4] "Barriers and Gaps affecting mHealth in Low and Middle Income Countries: Policy White Paper". Authors: Mechael, Patricia N., Batavina H., Kaonga N., Searle S., Kwan A., Goldberger A., Fu L., Ossman J. May 2010. The Center for Global Health and Economic Development (CGHED), Earth Institute at Columbia University and mHealth Alliance.

[5] "Mobile Technology for Community Health (MoTeCH): mHealth Ethnography Report". Author: Mechael, Patricia N.; Dodowa Health Research Center. The Grameen Foundation.

Leveraging ICT potential for Latin America’s poor

I borrowed the title from an interview I gave back in January.

Revisiting the data, the new studies show that Mobile data usage in Latin America, like mobile usage everywhere, is growing steadily and fast.

Cell phones have become firmly ensconced as essential goods rather than luxury items.

With mobile subscriptions having overtaken fixed lines as the preferred method of communication, mobile subscriptions penetration totals 89% of the population. Mobile subscriptions are forecast to grow by 8.2% annually in 2010, slightly below the 10.9% registered in 2009 but still strong growth. This is part of the stabilization of the market.

Also, 20% of mobile services revenue came from data in 2009. The region has entered a stage when data services are essential to the whole mobile business model (source: Pyramid Research).

Broadband penetration in Latin America is about 27% below the world average. This slow uptake has been largely due to the high prices charged by providers, which often have a virtual monopoly in their areas of operation. Countries that lead broadband penetration in Latin America are Chile (9.8 percent), Argentina (9.3 percent) and Brazil (5.8 percent). (Sources: IDC/Cisco; ITU; OECD).

Father of the Cell Phone Talks About His Child's Future

Today nearly two-thirds of the worldwide population has a cell phone (4.6 billion devices). And these numbers keep growing. In the Latin American and the Caribbean region, almost 90%, which is close to the world average. In South and Central America, the highest mobile penetration rates can be found in Venezuela, Uruguay, Argentina, El Salvador, Suriname, and Panama, which have all passed the 100% milestone (BuddeComm).

In this video, the father of the cell phone Marty Cooper who made the first public cell phone call in the sidewalks of New York in 1973, talks about — among other topics — the story of this invention, privacy, mobile health, sensors, and wearable cell phones. He is convinced that cell phone in its 37 is still on your infancy and that engineers tend to get enchanted by technology and neglect to consider consumer needs and behaviors.

As mentioned by Cooper and proved with numbers, the $153 billion wireless industry has its eye on mobilizing one industry in particular: Healthcare. According to one estimate, the healthcare industry will spend about $2.5 billion on wireless applications and services over the next few years (MobileHealthNews.com).

Over these 37 years, mobile technology has been traditionally offered voice calls and more recently, text message and Internet to connect people. Now, with improving capabilities, cheaper/flat rates and affordable handheld devices, it is undoubtedly a domain that provides a powerful space for innovation and new services.

Feel free to drop a line with your thoughts about the transformative power of cell phones and its potential impact on real world challenges.




Watch CBS News Videos Online

The Cell Phone: Marty Cooper's Big Idea
Hear the story of the invention of the cell phone from the man whose team came up with it at Motorola. The inventor, Martin Cooper, is still at it, improving the gadget he came up.

Information and Knowledge as the Fuel for Development

In today’s rapidly changing world, information and knowledge form the foundation of economic development, by creating jobs, driving growth, and replacing traditional labor-intensive systems as the primary engine of wealth creation. In addition, the technological developments of the 20th century have shifted advanced economies away from physically based structures and toward knowledge-based systems.

In this publication, The Imperative of Innovation: Creating Prosperity in Latin America and the Caribbean (LAC), prepared by the Science and Technology Division of the IDB for the EU-LAC Summit of Heads of State and Government, which took place in Madrid, Spain on 18 May 2010, the authors provide a comprehensive picture of the actual progress of science, technology and innovation (STI) in the region.

According to the paper, RYCYT (Red de Indicadores de Ciencia y Tecnología) estimates that R&D investments in the region in 2007 represented 0.67% of GDP compared to 0.52% in 1997. Nevertheless, during the same period, OECD countries increased R&D intensity from 2.1 to 2.3%.

This poor performance is mainly due to the scarce "learning" or "innovative" capacity, arising from low investment in human capital and STI infrastructure. LAC countries are not achieving as much as it should compared to similarly endowed countries such as Korea, Taiwan, and Singapore, which have accomplished unprecedented rates of economic growth while making heavy investments in STI.

The report examined indicators such as scientific publications, patents, high tech exports, investment in innovation by firms, ICT subscriptions, among others, which makes it worthy reading for anyone who is looking for a more accurate picture of the current situation regarding STI facing the LAC region. It shows, for example, that only five LAC countries have fiscal incentives for R&D as an innovation policy instrument.

Do then the LAC countries will have incentives to leapfrog other countries by embracing STI?

For more information about the content of this new report, the IDB's Science and Technology Division etc, please follow this link.