mHealth enthusiasts are, well, enthusiastic—as demonstrated by the big turnout for our 7 a.m. mHealth session on day three of the International Conference on Family Planning in Addis Ababa. Perhaps the delicious Ethiopian coffee helped drive the rich dialogue that ensued! As I sipped and listened, the dynamic of the participatory session helped me learn in two ways. First, I heard about the individual projects people were working on, and second, the questions and answers between the program managers revealed additional nuances. These are the nuts and bolts of programming that managers contend with every day but rarely get shared—often because it is experiential and fleeting. But in retrospect, many of the more elusive aspects of this work are what separate the successful efforts from the others.
As part of these conversations, and others as the conference, a few themes emerged…
- The term “mHealth” is often confusing or not quite applicable. For some the word “mobile” means it can be carried around, and for others it signifies connectivity. Also, the distinction between mHealth and eHealth can be as muddy as the distinction between fruits and vegetables. And in the end, who cares? (They’re all good for you.) One conference participant suggested we just call it all “technology.” While it’s often fruitless to get too caught up in terminology, this discussion is indicative of the rapidly changing field.
- Brave health programmers and donors continue to forge ahead into often uncharted territory of mHealth, through trial and error, and strategic partnerships. I learned how SMS messages in Cambodia weren’t working so Marie Stopes International is using voice messaging instead. This affected the budget by calling for a separate, special kind of phone line that has to be provided by the phone company. A D-Tree supported effort in Tanzania enables community health worker records to synchronize with health facility systems while also generating two-way referral tracking. Among other benefits, this kind of model means patient records can be sustained long after a project is gone.
- The discussion continues as to whether to depend on health workers to use their own phones(a.k.a. BYOD—Bring Your Own Device). One key issue—patient privacy concerns if health records are stored on a phone, especially a personal device which may vary as to security features. Also, if any such phone is lost or stolen, what happens then? Reimbursing personal phone owners for airtime can also present challenges—as does the risk of company phones used for personal calls. Finally, what are the employment and performance implications of requiring health workers to provide their own phones? Funny enough, this same debate is raging within the USA’s private sector as well—as described in Wired Magazine.
Despite these challenges, and many others—Pandora’s box has been opened. There’s no going back! With the number of SIM cards even exceeding the population (in South Africa), we need to keep putting our heads together to figure out how digital technology and connectivity can help meet the enormous unmet need for family planning. This kind of collaboration does happen at a global level—but barely at a regional and national levels. This needs to change, immediately. Already, e/mHealth working groups are emerging in countries. In global health we understand better than ever the potential of working groups and other communities of practice. However, like the e/mHealth work I've been talking about, creating an effective community of practice is both an art and a science. More on that in another blog post!