mhealth for development - vital...

Vital Wave ConsultingField Teams

Latin AmericaRio de Janeiro,Brazil

San Jose,Costa RicaCosta Rica

Cabrera,Dominican Republic

Mexico City,Mexico

mHealth for DevelopmentmHealth for DevelopmentAsiaBhopal, India

Beijing, China

ppMobile communications for HealthMobile communications for Health

March 6, 2009

Phnom Penh,Cambodia

Eastern EuropeTallinn,Estonia

AfricaCairo,Egypt

Karen Coppock

Johannesburg,South Africa

Lagos,Nigeria

U it d St t Karen Coppock VP of Consulting ServicesUnited States

Palo Alto, California (Headquarters)

Agenda

mHealth overview: Definition applications and impact 1

2

mHealth overview: Definition, applications and impact

mHealth evolution: requirements and opportunities2

3mHealth case studies: Building blocks for success

3

4Dynamics of mHealth sustainability: value chain analysis

Call to action5

© 2009 Vital Wave ConsultingTM

Proprietary and Confidential: Do not copy or distribute.

1

Urgent NeedImprove Health in Developing World

• 1 million die from effects of malaria

p p g

• 1 million die from effects of malaria each year

• 25% of children in developing countries are underweight and undernourished

• 1 woman dies each minute from pregnancy-related causespregnancy-related causes

• 2.5 Million people newly infected with HIV/AIDS in 2007

• 57 countries have critical shortages in health care workers (Total deficit of 2.4 million health professionals worldwide) million health professionals worldwide)



Photo: Vital Wave Consulting

2

Mobile Health (mHealth) Defined

mHealth (n) – the delivery of health care mHealth (n) the delivery of health care services via mobile communication devices

Electronic Health H lth Electronic Health Services

Health Services

mHealth



Photo: UN, UN Foundation, and Praekelt Foundation

3

Mobile Health (mHealth) Defined

mHealth is also a subset of mServices, which mHealth is also a subset of mServices, which includes mBanking, mEducation, mGovernment…

Mobile ServicesHealth H lth Mobile Services(mServices)

Health Services

mHealth



Photo: UN, UN Foundation, and Praekelt Foundation

4

Opportunity – New Health Delivery PlatformExplosion of Mobile Phones in Developing World

Technologies and Health-Related Statistics for Developing Countries (Millions)

p f p g

5,300

4 000

5,000

6,000

2,293

2,000

3,000

4,000

11305

0

1,000

H i l B d C M bil Ph P l iHospital Beds Computers Mobile Phones Population

Sources: Vital Wave Consulting, Business Monitor International (BMI) International

Photos: DataDyneMobile Phones reach further into developing countries than International (BMI), International

Telecommunications Union and the World Bank’s World Development Indicators.

into developing countries than other technology and health

infrastructures



5

Meeting Health NeedsBroad Array of mHealth Applicationsy f pp

Education & Awareness Remote Data CollectionEducation & AwarenessSMS/text messaging in support of public health and behavioral change campaigns.

Applications using mobile devices to collect real-time patient data, often where patients live.

14

Remote MonitoringMaintain care giver appointments or

d dh

Diagnostic & Treatment Support

146

ensure medication regime adherence via one-way or two-way communications on mobile devices.

SupportUse the mobile phone as point-of-care device.

10

9

9

Disease & Epidemic Outbreak Tracking

Communication & Training For Health Care W k

9 5

Use mobile devices to send and receive data on disease incidence, outbreaks and public health emergencies.

Programs by Application Area

Workers



6

Distribution of mHealth Programs

Worldwide:FrontlineSMSFrontlineSMS

Education & AwarenessRemote Data Collection

Communication & Training for Health Care WorkersDisease & Epidemic Outbreak TrackingDi i & T S



Remote monitoring Diagnostic & Treatment Support

7

Impact of mHealth

Uganda

PeruCell-Preven health workers use mobile phones to send

SMS ith l ti

Text to Change’s SMS-based HIV/AIDS awareness quiz led to an increase of nearly 40% in the number of people coming in for

free HIV/AIDS testing.

ThailandPhoned Pill Reminders for TB Treatment. TB patients were

SMS messages with real-time data on symptoms

experienced by clinical trial participants. Enables

immediate response to adverse symptoms

South AfricaProject Masiluleke’s SMS

message campaign promoting HIV/AIDS

lt d i l

pgiven mobile phones and

called daily with reminder to take their TB medication—

90% did.

adverse symptoms. awareness resulted in nearly a tripling of call volume to a

local HIV/AIDS helpline.

“When talking about efficiency versus health impact, it shouldn’t be about either/or. Improving efficiencies can ensure that more people receive life-saving interventions.”

John Stephenson Dalberg Global Development Advisors



—John Stephenson, Dalberg Global Development Advisors

8

Shifting Health Needs in Developing WordmHealth Addresses Current and Future Health Needs

Current Health Care Picture Global & Demographic Changes

GDP th i di

Tomorrow’s Healthcare Picture

• Communicable diseases.

• Lack of immunizations.

• Lack of safe water sources.

• GDP growth increases spending on healthcare.

• Traditional diseases controlled (TB, smallpox) and new diseases appear (SARS avian flu)

• Current healthcare picture issues continued.

• Shift from “late stage” treatments to prevention and

appear (SARS, avian flu).

• Aging populations means increase in death from non-communicable causes.

D li i g bi th t d li bi g

early detection.

• Increased focus on health issues of elderly.

• Continued health worker • Declining birth rate and climbing

life expectancy.

• Adoption of “developed country” behaviors.

shortages and distribution inequities.

Evolution toward chronic diseases – diabetes, heart disease and strokes

By 2025, 80% of all new diabetes cases will originate in developing countriesDi b t h d di d t k ill t i t lDiabetes, heard disease and strokes will cost approximately:

• $556 billion in lost national income in China• $300+ billion in Russia and India• $49 billion in Brazil



$

9

Case StudyProject Masiluleke

Disease Awareness

j

Health ObjectiveB ild f HIV Build awareness of HIV status, encourage HIV/AIDS testing and treatment and halt the disease’s spread

CountrySouth Africa

Techniques Used‘Please Call Me’ service - free text messages

Impact• 365 Million text messages – one per day – being sent (2008-2009)

g

PartnersPraekelt Foundation, iTeach, National

• Encourage people to be tested and treated for HIV/AIDS and TB

Geographic, Nokia Siemens Networks, MTN, Ghetto Ruff, Children of South African Legacies, Aricent, PopTech!, frog design and National AIDS HelplinePh P k l F d i



and National AIDS HelplinePhoto: Praekelt Foundation

10

Case StudyText to Changeg

Disease Awareness Health ObjectiveI i HIV/AIDS d i i h Improving HIV/AIDS education with anonymity

Country

Impact

CountryUganda

Techniques Used• 15,000 mobile phone subscribers in rural Uganda sent the quiz in the three month pilot test

40% i i th b f

Techniques UsedHIV/AIDS awareness via an SMS-based multiple choice quiz in exchange for free airtime; correct answers provided;

• 40% increase in the number of patients who came in for HIV/AIDS testing

• Actionable insight: Many quiz takers

pparticipants encouraged to come in for testing (fee waived for participants)

Partners• Actionable insight: Many quiz takers did not think AIDS testing was accurate nor anonymous

PartnersCeltel, AIDs Information Centre (AIC), Merck, and the Dutch Ministry ofForeign AffairsPh T Ch



Foreign AffairsPhoto: Text to Change

11

Case StudyData Gatheringg

Data Gathering Health ObjectiveContaining the spread of the Dengue virus

CountryB il

Impact

Brazil

Techniques UsedC t i d ti i di t ib t d t • Data collection times dramatically

reduced (from months to days)

• 400 test results gathered by 20 fi ld f i l i t d ll

Customized questionnaires distributed to field health agents’ mobile phones. Health data and GPS location information are integrated to enable immediate analysis

field professionals in two days, all with GPS information (paper-based system would have taken 2-3 months for lesser

integrated to enable immediate analysis and identification of areas with high infection levels.

Partnersinformation)

• End-user acceptance very high

PartnersNokia, Amazonas State Health Ministry

Ph Wiki di C



Photo: Wikimedia Commons

12

Building BlocksSustainable & Scalable mHealth Programsg

• Forge strong partnerships• Forge strong partnerships

• Be accessible

• Design with the end user in mind and maintain a focus on usabilityusability

• Build a long-term funding plan

• Set measurable goals

• Collaborate with other mHealth organizations

Photo: UN Foundation/Nothing But Nets



13

Value Chain Models for mHealthPlayers and Incentivesy

Player IncentivePatient or Citizen (Mobile Subscriber) Improved health outcomes

Health Care Provider More efficient and effective delivery of health services

NGO Advance organizational mission, attract funding

Foundations Advance organizational mission

Government More efficient health care provision, effective government

E i t P id D i ti i d b d itiEquipment Provider Device revenue generation, improved brand recognition

Service Provider Revenue from service fees, increased subscriber base

Application Solutions Provider Revenue from additional applications license fees

Content Management Increase in volume of readership or revenue

Platform Provider Revenue from sales

A solid understanding of the needs and incentives of the multiple players involved in the mHealth value chain is required in order to

marshal their energy and resources.



gy

14

Value Chain Models for mHealthOne-way mHealth Applicationsy pp

Delivery of services,operational efficiencies,program expansion,achieving mission

Revenue (short - and long-term), brandand business development, opportunitiesfor network expansion projects

Equipment Vendor Doctor/Health

ProviderProject

HOperational efficiencies,healthcare

Revenue (short- and long-term)

Application/Solution Developer

jManagement Home

MonitoringDevice

Revenue (short- and long-term)

MobileSubscriber

Platform Operator

( g )

MobileServiceProvider

Revenue (short- and long-term), expanded user base

Scale Required for Sustainability



High Medium Low

15

Call to Action

Operators• Combine mHealth with delivery of other mServices• Combine mHealth with delivery of other mServices• Leverage handset maker relationships• Be pro-active in developing joint solutions• Enhance mHealth infrastructureEnhance mHealth infrastructure

NGOs• For best results, think big and join forces• Partner• Provide proof of concept by using the simplest available technology

Policy Makers• Define an mHealth policy and provide incentives

F dFunders• Ensure project sustainability• Provide resources for impact assessment

Photo: RAMP and ENACQKT



Photo: RAMP and ENACQKT

16

mHealth Report

Report available at: http://www.vitalwaveconsulting.com/insights/mHealth.htm

Vital Wave ConsultingVital Wave Consultingwww.vitalwaveconsulting.comTel: (US) 650-964-1316Fax: (US) 916-404-5905( )

Contact: Cheri Voisine, Director of Marketing [email protected]



17

Thank YouThank YouThank YouThank You

Millennium Development GoalsProgress on Health-Related Goals Less than Encouraging

Progress on health-related

g g g

Progress on health-related MDGs less than encouraging

• Children's mortality rate is not improvingChildren s mortality rate is not improving

• 27 countries made no progress in reducing childhood deaths (1990-2006)

• Maternal health statistics are poor

• Half a million women died during pregnancy, childbirth or in the six weeks after delivery - 99% of these in the developing regions

Source: 2008 Global Monitoring Report

Photo: UN/Marie Frechon



19

Building BlocksSustainable & Scalable mHealth Programsg

• Forge strong partnerships• Forge strong partnerships

• Be accessible

Design with the end user in • Design with the end user in mind and maintain a focus on usability

• Build a long-term funding plan

• Set measurable goals

• Collaborate with other mHealth organizations

Photo: Mobiles for Malawi



20

mHealth Improves OutcomesBenefits in Patient Health & Health Systems Outcomes

Patient Health Outcomes

f y

Patient Health OutcomesEffectiveness Gains • Improved disease management• Improved disease management

• Improved public awareness of communicable diseases

• Improved medication compliance

Health Systems OutcomesHealth Systems OutcomesEfficiency Gains

Services delivered at reduced cost Photo: DataDyne

• Services delivered at reduced cost, increased speed and accuracy



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