mHealth potential in South Africa: mHealth potential in South Africa: mHealth potential in South Africa: mHealth potential in South Africa: mHealth potential in South Africa:

The experience of Cell

mHealth potential in South Africa:

The experience of CellThe experience of CellThe experience of CellDr Peter Benjamin peter@cell-Dr Peter Benjamin peter@cell-Dr Peter Benjamin peter@cell-Dr Peter Benjamin peter@cell-

BackgroundBackground

South Africa is a country where mHealth holds great potential to benefit the health sector as there is:

• A huge burden of diseasei;• A huge burden of diseasei;

• A weak conventional health infrastructureii;

• A staggeringly high usage of mobile phonesiii.• A staggeringly high usage of mobile phonesiii.

This poster describes recent developments in mHealth in South Africa, in particular the work of Cell-Life.This poster describes recent developments in mHealth in South Africa, in particular the work of Cell-Life.

Cell-LifeCell-Life

Cell-Life is a not-for-profit company based in Cape Town that develops open-source computer systems

to support the health and HIV sector.

Cell-LifeCell-Life

to support the health and HIV sector.

Cell-Life has 29 staff (mainly technical programmers, business analysts and support, as well as four Cell-Life has 29 staff (mainly technical programmers, business analysts and support, as well as four

researchers). We have three main products:

1. iDART (Intelligent Dispensing of Anti-Retroviral Therapy) is a pharmacy

dispensing system used in over 70 clinics nationally, dispensing ARVs dispensing system used in over 70 clinics nationally, dispensing ARVs

and related drugs to around 170,000 patients monthly. It was

developed together with the Desmond Tutu HIV Foundation.developed together with the Desmond Tutu HIV Foundation.

2. EMIT is a mobile data collection tool, which is a small program on a

cellphone allowing form-filling that then sends data to the server (for cellphone allowing form-filling that then sends data to the server (for

the techies: it is a J2ME applet connecting over GPRS to a LimeSurvey

back-end). It is used by 23 organizations and over 1,000 data capturers back-end). It is used by 23 organizations and over 1,000 data capturers

for monitoring of community HIV training, patient encounters and

related data. related data.

3. Cellphones for HIV has been a three-year project exploring the many 3. Cellphones for HIV has been a three-year project exploring the many

ways in which mobile technology can support the HIV sector. Our

technology capacity includes:technology capacity includes:

• SMS (Broadcast, scheduled, incoming keyword);• SMS (Broadcast, scheduled, incoming keyword);

• USSD (basic text menus that all GSM cellphone can use that allows simple information retrieval and

data collection);data collection);

• MXit (a massively popular cellphone instant messaging system, especially used by youth);

• Location Based Services (using the location of a phone for 'Where is my nearest _____?' services);• Location Based Services (using the location of a phone for 'Where is my nearest _____?' services);

• Please-Call-Me (a means for someone with no ‘airtime’ to ask a colleague to phone them back –

which is the only free way to send a signal from a cellphone which we use for people to subscribe which is the only free way to send a signal from a cellphone which we use for people to subscribe

to services at no cost);

• WAP and Mobi-sites (websites on a cellphone);• WAP and Mobi-sites (websites on a cellphone);

• Cellbooks for downloading large volumes of text to a cellphone.

We use these systems to support different areas of HIV and health communications, including:

1. Mass communication for prevention (including interaction linked to TV or radio broadcast) with 1. Mass communication for prevention (including interaction linked to TV or radio broadcast) with

over 2,500,000 messages sent;

2. Information for positive living;2. Information for positive living;

3. Linking patients and clinics (adherence and appointment reminders);

4. Text counseling (we have set up a link between MXit users and the National AIDS Helpline, which 4. Text counseling (we have set up a link between MXit users and the National AIDS Helpline, which

has supported over 15,000 text-chat counseling conversations since Sept 2009);

5. Organizational capacity building (providing subsidized or free SMS and USSD services to 5. Organizational capacity building (providing subsidized or free SMS and USSD services to

government, NGO and community HIV organizations);

6. Monitoring & evaluation;6. Monitoring & evaluation;

7. HIV info available via MXit, with over 1 million mobile page views.

We work with over 100 HIV & health organizations, including the national Department of Health, SA

National AIDS Council, Soul City, Treatment Action Campaign, the Community Media Trust, the AIDS National AIDS Council, Soul City, Treatment Action Campaign, the Community Media Trust, the AIDS

Consortium and loveLife. Our leading funder has been the Vodacom Foundation. Other projects are

supported by PEPFAR, Johns Hopkins Health & Education South Africa, Right To Care, the Canadian supported by PEPFAR, Johns Hopkins Health & Education South Africa, Right To Care, the Canadian

International Development Agency, and the Raith Foundation.

ReferencesReferencesi. Prof Hoosen Coovadia, Prof Rachel Jewkes, Peter Barron, Prof David Sanders, Prof Diane McIntyre (2009). The Lancet, Volume 374, Issue

9692, Pages 817 - 834, 5 September 2009

ii. Ibid

ReferencesReferences

ii. Ibid

iii. Mobile penetration in South Africa is about 74%, accounting for individuals with more than 1 SIM. (Personal communications with Arthur

Goldstuck of WorldWideWorx, 23 August 2010)Goldstuck of WorldWideWorx, 23 August 2010)

iv. Nokia 5230 and 2710

mHealth potential in South Africa: mHealth potential in South Africa: mHealth potential in South Africa: mHealth potential in South Africa: mHealth potential in South Africa:

The experience of Cell-Life

mHealth potential in South Africa:

The experience of Cell-LifeThe experience of Cell-LifeThe experience of Cell-Life-life.org.za www.cell-life.org.za-life.org.za www.cell-life.org.za-life.org.za www.cell-life.org.za-life.org.za www.cell-life.org.za

National projects & focus on mHealthNational projects & focus on mHealth

Over the past few years, several mHealth project have been implemented by SA organizations:

• GeoMed: Nompilo community healthcare support, ‘SMS for life’ pharmacy stock reporting system ;• GeoMed: Nompilo community healthcare support, ‘SMS for life’ pharmacy stock reporting system ;

• Centre for Scientific & Industrial Research Meraka Institute: Range of mHealth projects;

• Medical Research Council: Leader in telemedicine and has developed several mHealth applications;• Medical Research Council: Leader in telemedicine and has developed several mHealth applications;

• Praekelt Foundation: Health messaging in advertising space in ‘Please Call Me messages’ (SocialTxt)

and appointment reminders (TxtAlert);and appointment reminders (TxtAlert);

• Stellenbosch University researching many mHealth applications;

• Clinical usage of mHealth with Right To Care and the Reproductive Health Research Unit (RHRU). • Clinical usage of mHealth with Right To Care and the Reproductive Health Research Unit (RHRU).

In October 2010 the Vodacom Foundation launched a 5-year mHealth program with four implementing In October 2010 the Vodacom Foundation launched a 5-year mHealth program with four implementing

organizations – Cell-Life, GeoMed, Praekelt Foundation and RHRU.

In September 2010 the first national seminar on mHealth was held, hosted by the MRC and supported by

MTN. Over 30 organizations attended including network operators, government health officials, medical MTN. Over 30 organizations attended including network operators, government health officials, medical

insurers, private medical providers, technology companies and NGOs. A committee to take forward

mHealth in South Africa has been formed, linked to the global mHealth Alliance. mHealth in South Africa has been formed, linked to the global mHealth Alliance.

In 2010 the national Department of Health started distributing 15,000 high-end cellphonesiv to all 4,300 In 2010 the national Department of Health started distributing 15,000 high-end cellphonesiv to all 4,300

health facilities and health managers nationally. This holds the promise of a national health informatics

network after a decade of largely failing to have an internet computer in all health facilities (today, about network after a decade of largely failing to have an internet computer in all health facilities (today, about

1,400 of the 4,300 health facilities have a working email). The first project announced is mobile

monitoring of the HIV Counseling & Testing campaign, and the expanded ARV rollout. Health Minister Dr monitoring of the HIV Counseling & Testing campaign, and the expanded ARV rollout. Health Minister Dr

Aaron Motsoaledi has announced his interest in using telemedicine and mHealth applications at a

national scale to improve the health system, and in 2010 a telemedicine policy has been developed national scale to improve the health system, and in 2010 a telemedicine policy has been developed

including mHealth.

ConclusionConclusion

In the coming years, mHealth has a great potential to strengthen an over-burdened health system in

South Africa. Interventions being considered include:South Africa. Interventions being considered include:

• Data reporting (linking to the District Health Information System and other data sources);

• Supplies systems (e.g. ordering drugs and supplies, stock-out reporting, linking with lab result);• Supplies systems (e.g. ordering drugs and supplies, stock-out reporting, linking with lab result);

• Decision support for health officials at various levels;

• Training and back-up materials to support health care workers;• Training and back-up materials to support health care workers;

• Remote diagnosis;

• Case management (e.g. supporting down-referral and other management of patients between • Case management (e.g. supporting down-referral and other management of patients between

facilities);

• A national patient record system.• A national patient record system.

There is even greater scope for providing health services directly to the population. As Clay Shirky has There is even greater scope for providing health services directly to the population. As Clay Shirky has

said, “These tools don’t get socially interesting until they get technologically boring”. The fact that the

vast majority of youth and adults have a cellphone can lead to a transformation – a disruptive vast majority of youth and adults have a cellphone can lead to a transformation – a disruptive

intervention – to the way that health care is delivered to the population. Interventions could achieve

primary health information and preventive healthcare, self-managed care of chronic conditions, remote primary health information and preventive healthcare, self-managed care of chronic conditions, remote

triage services and more.

South Africa has a huge burden of disease, and needs to use all tools available in meeting this challenge.

mHealth is being and can be more widely used in the fight against HIV (Millennium Development Goal 6); mHealth is being and can be more widely used in the fight against HIV (Millennium Development Goal 6);

women, maternal & child health (MDG 4 & 5) and in reducing gender violence & crime (MDG 3 & 5). The

‘mHealth ecosystem’ of public, private, clinical, NGO, donor and community is emerging to make a ‘mHealth ecosystem’ of public, private, clinical, NGO, donor and community is emerging to make a

significant contribution to the fight for health.

Mobile usage is around 74% in South Africaiii. This is approximately 90% of all youth and adults. The map

below shows where iDART (in blue), EMIT (in green) and Cellphones4HIV (in red) are currently being used.below shows where iDART (in blue), EMIT (in green) and Cellphones4HIV (in red) are currently being used.

In South Africa (with a population of 48 In South Africa (with a population of 48

million):

• 5.1 million people use web

through a normal computerthrough a normal computer

• 9.8 million use the web through a

cellphonecellphone

• 20.1 million are MXit subscribers

• 36 million have a cellphone36 million have a cellphone