mHealth in Africa: challenges and opportunities

TLDR

Abstract

Over the past decade, Africa has experi- enced an incredible boom in mobile phone use. In 1998, there were fewer than 4 million mobile subscriptions on the continent, but today, there are more than 800 million subscriptions, and this is pro- jected to reach 1.12 billion subscriptions by 2017.1 Various studies2,3 on pilot pro- jects implemented in Africa support the claim that mobile technologies have the potential to transform the face of health- care by serving as vehicles for delivering specific health interventions. This form of health service delivery, known as mHealth, is seen as a complementary strategy for strengthening health systems and achiev- ing the health-related Millennium Development Goals (MDGs) in low- income countries.DEFINING mHEALTHThe term mHealth was coined by Professor Robert Istepanian, who described it broadly as the use of 'emerging mobile communications and network technologies for healthcare'.4 Essentially, mHealth is the use in medi- cine and public health of mobile commu- nication devices 'such as mobile phones, patient monitoring devices, personal digi- tal assistants (PDAs), and other wireless devices,'5 to 'enhance access to health information, improve distribution of rou- tine and emergency health services, or provide diagnostic services'.6mHealth platforms operate on the premise that technology integration with the health sector has the potential to improve health outcomes.7 Today, countries such as Ethiopia, Kenya, Nigeria and South Africa are leading the way in using mHealth solutions for health service delivery,8 and this is driven by the convergence of a myriad of factors - expanding penetration of mobile net- works in rural communities, reduced costs of mobile handsets, general increase in non-food expenditure and innovative technologies that integrate mobile applications with traditional health service delivery models. mHealth has found applications in treatment compli- ance, data collection and disease surveil- lance, health informa- tion dissemination, point-of-care support for health workers, health promotion, emergency medical response, as well as drug supply-chain management.OPPORTUNITIESmHealth implementa- tion in Africa has the potential to improve health outcomes in many ways. The portability and 'always on' features of mobile phones, along with their increasing capability to carry and transfer data, make them unique for relaying health information.9 In addition, the functional and structural properties, namely, low start cost, text messaging and flexible data plans make mobile phones attractive for use in healthcare interventions.10In pilot projects across the continent, the short messaging service (SMS) appli- cation has been successfully used to remind patients to take drugs and attend appointments. Studies on the use of SMS as a drug use reminder, conducted in Kenya and Uganda, showed improved adherence to antiretroviral therapy (ART) without additional counselling among HIV positive clients.2,3 While most of these projects have focused more on infectious disease treatment adherence, chronic disease management applica- tions will become more relevant as epi- demiological shifts to chronic disease accelerate on the continent. However, poor or inconsistent access to health services and drug supplies may frustrate mHealth implementation in the context of treatment compliance in some areas; thus, strengthening health systems is important for successful implementation.10mHealth projects that focus on data collection and dis- ease surveillance leverage on mobile phones' abilities to collect and transmit data in real time. While studies have shown that mobile phones and PDAs are more effective in data collection compared with traditional pen and paper data collection methods, there is very little evidence that they improve health outcomes.10-13 However, one primary benefit of projects utilising mobile phones' data gathering and storage capabilities is that they could actually save government money. …