Informative article, Jaspal. It raises challenging questions about convergence between the healthcare needs of “developed” and “underdeveloped” markets. Interesting that Immelt/GE seem surprised to discover that context-appropriate and cost-effective design and innovation from emerging economies suddenly shows the potential to turn profits in mature markets.
Has our dysfunctional US healthcare system reached a point where solutions designed for developing world conditions are needed, or does the arrival of mHealth technologies to the US herald more pragmatic and rational thinking on the part of US healthcare providers? As someone involved with the design of appropriate health technologies, I’m encouraged to think that the interest in mHealth may signal a shift from technology-centric towards user-centric perspectives on design and innovation.
Great article! As mobile phone penetration is SO much higher overseas, it would be wise for the U.S. to take your advice look and see where innovation is happening. You also covered many of the key barriers to implementing an innovative program developed overseas in the U.S., as the systems and carrier service structures vary considerably, with the U.S. quite different than structures in Africa and Asia.
A point of note: The very first text messaging service for health information in the U.S. was launched in 2005 by San Francisco Dept. of Public Health and ISIS (AJPH 2008). This service was one of the inspirations for Text4Baby, as Paul Meyer (Voxiva) and I chatted many times, and sat on panels together at Stanford University’s Text4Health conference and others, during the time Text4Baby was in development.
Hope to see more of these types of articles in the future. Thank you for leading the field.
Great article! As mobile phone penetration is SO much higher overseas, it would be wise for the U.S. to take your advice look and see where innovation is happening. You also covered many of the key barriers to implementing an innovative program developed overseas in the U.S., as the systems and carrier service structures vary considerably, with the U.S. quite different than structures in Africa and Asia.
A point of note: The very first text messaging service for health information in the U.S. was launched in 2005 by San Francisco Dept. of Public Health and ISIS (AJPH 2008). This service was one of the inspirations for Text4Baby, as Paul Meyer (Voxiva) and I chatted many times, and sat on panels together at Stanford University’s Text4Health conference and others, during the time Text4Baby was in development.
Hope to see more of these types of articles in the future. Thank you for leading the field.
Most of the young, African American and Hispanic, low-income families we work with do not have land lines, may not have computers at home, but all have cell phones. These are great ideas of ways to reach the people in our own large cities who experience disparities in health care. I’d love to see some of these technologies in Los Angeles.
Great article focused on the intersection of mobile technology growth and public health! Innovation with mobile technology is not only limited to health—it’s creating linkages in small business growth! For example, InVenture (http://inventure.org/) has just announced the release of new mobile technology that acts as a Quickbooks for small businesses in the developing world, measuring not only finances but also social performance measurements. Check out more information here: http://www.prweb.com/releases/2011/11/prweb8929331.htm
This article is based on desktop research and very little insight into what is actually happening on the ground in connection with the projects and activities it describes. MoTech has not been active for more than 6 months now and is reviewing its operating model. Project Masiluleke was active in 2008 - 2009 and has been winding down since. And it is ridiculous to talk about stock-out services without mentioning SMS 4 Life or anti-counterfeiting with mobile phones and to leave out MPedigree.net. The latter has such a wide and growing footprint that if the author is not aware of it then it has not been following the space. Most of the article is patched up from snippets of past coverage with very little original insight. This contributes little to knowledge about mhealth and shouldnt have been considered for ssir.
First of all, thanks for mentioning EpiSurveyor mobile data collection (http://www.episurveyor.org), which just hit 6000 users, with more than 250,000 forms uploaded, in more than 170 countries—and still growing strong. It’s been great to see it used for many health applications, and now expanding into conservation, water management, economics, and many other topics.
METRICS, VAPORWARE, AND TRUE INNOVATION
I do think that the previous poster, Donna Muchero, has a very important point, however: in the current mHealth world, it’s often impossible to distinguish between a concept, an active pilot, a scaled project, and something long dead—and this article does not help in this regard at all.
The vast majority of ICT4D projects, including mHealth, amount to nothing in the end: a promising pilot that dies when the funding ends. We won’t be able to determine which pilots or projects should be used as a model until we start applying more rigorous thinking to the issues of sustainability and scale.
A good new idea = invention
A good new idea sustainably and scalable executed = innovation
We need to recognize the difference between simple invention and true innovation.
I counted more than 20 projects named in this article. For three of them (Sproxil, Text4Baby, and Project Masiluleke), the author lists a single metric, and for the rest there is no objective measure indicated. Of course even these three show the need for more sophisticated analysis: noting that T4B has 190,000 users is nice, but it is critical to recognize that even after several years and millions of dollars spent this represents less than 3% of the target group of 6 million pregnant women each year in the US.
Some standard metrics might be applied to the projects described in this article, when applicable: how many distinct users (or user organizations), how many countries, how many messages sent, how many data uploads, and how many paying users and revenue generated.
Much harder, of course, will be measurements of impact, but at least we can start with measurements of process, usage, penetration, and profitability (i.e. sustainability).
To get ideas for how to evaluate mHealth (and other ICT4D), you only have to look at the financial section of any website or newspaper: standard metrics—applied across the board to thousands of enterprises working in thousands of different fields—allow for some comparison and understanding. We could use a bit of that in mHealth.
ENGAGING THE CARRIERS/OPERATORS
I do not understand why there is a widespread belief that the mobile carriers will or should play a central role in mHealth. Internet Service Providers are not expected to provide guidance or leadership on web content; why should mobile carriers be provided to do so for mobile content? The carriers are the “dumb pipes”, providing the infrastructure upon which others can build great content and apps, but this will only happen if no active participation on the part of the carrier is required.
Continuing the analogy of ISPs: I don’t need to contact, or collaborate with, my ISP in order to create a great website about diabetes or HIV (or horse racing or flower arranging). Because of this, we have websites for every possible topic. If we continue to believe that every mHealth project should involve meetings and MOUs with carriers we will never develop a similar situation with mobile.
As an example, EpiSurveyor is now used to collect mobile data in more than 170 countries. We have never met with a carrier, and have not made any agreements with carriers. This is because most of the time EpiSurveyor uses the internet (typically GPRS) to move data, and the carrier simply runs the network. Even when we use SMS, we only have to make an arrangement with one or two SMS “aggregators” (e.g. Textmagic or Twilio) to ensure that our application will work with every country and every carrier.
Currently, the mobile carriers remain at the center of mHealth only because they have the money to pay for big conferences (and to pay for articles like this one), and they do so because they WANT to be at the center of creating more “value added services” and profit. But wishing it won’t make it so.
A correction to the comment from Donna Mucheru- MOTECH is actually still quite active (I am the Director of the program). The program has been running consistently in Ghana since 2008. The programatic work has been replicated to a second district in Ghana and recently received a Saving Lives at Birth Grand Challenge Award to continue work for the next two years. The focus now is on expanding to additional districts in Ghana as part of a transition to national scale.
It’s great to see that this article has sparked so much discussion.
David: I really do believe that we have started to shift toward considering people first, but we certainly have a ways to go. On the positive side, this means that there are still plenty of opportunities for innovators and entrepreneurs.
Deb: Thanks for adding your own experiences with Isis here in the US.
Ellen: I think we’ll be seeing much more in this space in the next 18 months. I’d be happy to chat with you. Please feel free to reach out.
Janet: My life would certainly be easier if I could base my work on desktop research alone. I think you’ve seen Tim Wood’s note about MOTECH still being active. Sproxil, which I highlighted in the article, is actually the technology provider for mPedigree. As for leaving out examples and highlighting a campaign project (Project Masiluleke), I think you may have misunderstood the purpose of this article. The article is not intended to be a complete and current inventory of existing mHealth projects, but rather a curation of key examples that can inspire US-focused innovation. If you - or anyone else - is interested in understanding the current mHealth landscape, healthunbound.org is a great starting point.
Joel: Thanks for thoughtful response. I agree that we need better metrics to evaluate mHealth efforts. The article, as I explained to Janet above, is focused on inspiration for US innovation. This is why the most important factor for inclusion here was the business model, not “messages sent” or “data uploads.” That’s also why the focus of the article was primarily on applications other than healthcare delivery and data reporting. As for operators, the recommendation to “engage smaller operators” is specific to the US context, and is based on the market differentiation among providers that is unique to this market. The recommendation is not that the operators must be the sole source of innovation, but rather that they can play a critical role. We might say the same for operators in LMICs.
Thanks everyone - . I hope we can keep these discussions going, here and elsewhere.
It may be that “the most important factor for inclusion here was the business model” but you seem to have kept that entirely to yourself: for most of the projects/pilots/companies/technologies that you talk about it in the article you don’t mention anything about their business models.
And those “business” models, to my knowledge, are mostly based on spending charitable aid dollars.
For example, you mention that Healthline is fee-based, but that’s all you mention about it’s business model. Project Masiluleke appears to be a charity project paid for by donated space on SMS messages. The business model for Text to Change? Not mentioned (I believe it is an aid project). For Text4Baby? Not mentioned. Trac-Net? Not mentioned. Medic Mobile? Not mentioned.
At DataDyne, we have developed a business model (datadyne.org/about) that is unique in international development, but you don’t mention that, either. Or did I miss something?
Great Article. There are lots of opportunities to provide mHealth services in developing countries given large rural population, prevalence of communicable disease and poor/inconsistent access to medical facilities. The ubiquitous reach of SMS technology supports mobile health applications ranging from health information and education to inform patients of preventive care and treatment e.g. family planning, maternal health, to the management of inventory and supply chain steps. As mobile internet becomes prevalent and affordable, then many of these applications can be ported to mobile apps.
Great article! The most interesting for me is that author mostly focused on the usefulness of mobile technologies for patients and almost neglected doctors. And I believe that doctors are the cornerstone of the healthcare system and they cannot be ignored. In reality, doctors in all developed countries already cannot imagine their life without mobile apps. Mobile technologies make life easier for doctors by saving time as mentioned at http://theappsolutions.com/blog/marketing/mobile-changing-healthcare. For instance, mobile technologies allow doctors to see all patients information, thus time is saved on roundups. Also, huge plus is the fact that results from a lab are directly sent on the device. Moreover, apps are also used as drug administration tools (http://www.businessinsider.com/10-ways-mobile-is-transforming-health-care-2014-6 ), though there are discussions of whether apps are reliable enough for this purpose. Also, according to Wikipedia https://en.wikipedia.org/wiki/MHealth#Diagnostic_support.2C_treatment_support.2C_communication_and_training_for_healthcare_workers doctors can always get a consultation from higher specialist and get information from houses of medical information.
correction to the comment from Donna Mucheru- MOTECH is actually still quite active (I am the Director of the program). The program has been running consistently in Ghana since 2008. The programmatic work has been replicated to the second district in Ghana and recently received a Saving Lives at Birth Grand Challenge Award to continue work for the next two years. The focus now is on expanding to additional districts in Ghana as part of a transition to a national scale. https://creditcardwave.com/
COMMENTS
BY David Kaisel
ON November 3, 2011 12:13 PM
Informative article, Jaspal. It raises challenging questions about convergence between the healthcare needs of “developed” and “underdeveloped” markets. Interesting that Immelt/GE seem surprised to discover that context-appropriate and cost-effective design and innovation from emerging economies suddenly shows the potential to turn profits in mature markets.
Has our dysfunctional US healthcare system reached a point where solutions designed for developing world conditions are needed, or does the arrival of mHealth technologies to the US herald more pragmatic and rational thinking on the part of US healthcare providers? As someone involved with the design of appropriate health technologies, I’m encouraged to think that the interest in mHealth may signal a shift from technology-centric towards user-centric perspectives on design and innovation.
BY Deb Levine, ISIS
ON November 3, 2011 12:27 PM
Great article! As mobile phone penetration is SO much higher overseas, it would be wise for the U.S. to take your advice look and see where innovation is happening. You also covered many of the key barriers to implementing an innovative program developed overseas in the U.S., as the systems and carrier service structures vary considerably, with the U.S. quite different than structures in Africa and Asia.
A point of note: The very first text messaging service for health information in the U.S. was launched in 2005 by San Francisco Dept. of Public Health and ISIS (AJPH 2008). This service was one of the inspirations for Text4Baby, as Paul Meyer (Voxiva) and I chatted many times, and sat on panels together at Stanford University’s Text4Health conference and others, during the time Text4Baby was in development.
Hope to see more of these types of articles in the future. Thank you for leading the field.
BY Deb Levine, ISIS, Inc.
ON November 3, 2011 12:28 PM
Great article! As mobile phone penetration is SO much higher overseas, it would be wise for the U.S. to take your advice look and see where innovation is happening. You also covered many of the key barriers to implementing an innovative program developed overseas in the U.S., as the systems and carrier service structures vary considerably, with the U.S. quite different than structures in Africa and Asia.
A point of note: The very first text messaging service for health information in the U.S. was launched in 2005 by San Francisco Dept. of Public Health and ISIS (AJPH 2008). This service was one of the inspirations for Text4Baby, as Paul Meyer (Voxiva) and I chatted many times, and sat on panels together at Stanford University’s Text4Health conference and others, during the time Text4Baby was in development.
Hope to see more of these types of articles in the future. Thank you for leading the field.
BY Ellen Cervantes, Child Care Resource Center
ON November 3, 2011 02:20 PM
Most of the young, African American and Hispanic, low-income families we work with do not have land lines, may not have computers at home, but all have cell phones. These are great ideas of ways to reach the people in our own large cities who experience disparities in health care. I’d love to see some of these technologies in Los Angeles.
BY LiAnn Ishizuka - InVenture
ON November 3, 2011 03:51 PM
Great article focused on the intersection of mobile technology growth and public health! Innovation with mobile technology is not only limited to health—it’s creating linkages in small business growth! For example, InVenture (http://inventure.org/) has just announced the release of new mobile technology that acts as a Quickbooks for small businesses in the developing world, measuring not only finances but also social performance measurements. Check out more information here: http://www.prweb.com/releases/2011/11/prweb8929331.htm
BY Donna Mucheru, consultant
ON November 4, 2011 06:12 AM
This article is based on desktop research and very little insight into what is actually happening on the ground in connection with the projects and activities it describes. MoTech has not been active for more than 6 months now and is reviewing its operating model. Project Masiluleke was active in 2008 - 2009 and has been winding down since. And it is ridiculous to talk about stock-out services without mentioning SMS 4 Life or anti-counterfeiting with mobile phones and to leave out MPedigree.net. The latter has such a wide and growing footprint that if the author is not aware of it then it has not been following the space. Most of the article is patched up from snippets of past coverage with very little original insight. This contributes little to knowledge about mhealth and shouldnt have been considered for ssir.
BY Joel Selanikio
ON November 6, 2011 02:15 AM
First of all, thanks for mentioning EpiSurveyor mobile data collection (http://www.episurveyor.org), which just hit 6000 users, with more than 250,000 forms uploaded, in more than 170 countries—and still growing strong. It’s been great to see it used for many health applications, and now expanding into conservation, water management, economics, and many other topics.
METRICS, VAPORWARE, AND TRUE INNOVATION
I do think that the previous poster, Donna Muchero, has a very important point, however: in the current mHealth world, it’s often impossible to distinguish between a concept, an active pilot, a scaled project, and something long dead—and this article does not help in this regard at all.
The vast majority of ICT4D projects, including mHealth, amount to nothing in the end: a promising pilot that dies when the funding ends. We won’t be able to determine which pilots or projects should be used as a model until we start applying more rigorous thinking to the issues of sustainability and scale.
A good new idea = invention
A good new idea sustainably and scalable executed = innovation
We need to recognize the difference between simple invention and true innovation.
I counted more than 20 projects named in this article. For three of them (Sproxil, Text4Baby, and Project Masiluleke), the author lists a single metric, and for the rest there is no objective measure indicated. Of course even these three show the need for more sophisticated analysis: noting that T4B has 190,000 users is nice, but it is critical to recognize that even after several years and millions of dollars spent this represents less than 3% of the target group of 6 million pregnant women each year in the US.
Some standard metrics might be applied to the projects described in this article, when applicable: how many distinct users (or user organizations), how many countries, how many messages sent, how many data uploads, and how many paying users and revenue generated.
Much harder, of course, will be measurements of impact, but at least we can start with measurements of process, usage, penetration, and profitability (i.e. sustainability).
To get ideas for how to evaluate mHealth (and other ICT4D), you only have to look at the financial section of any website or newspaper: standard metrics—applied across the board to thousands of enterprises working in thousands of different fields—allow for some comparison and understanding. We could use a bit of that in mHealth.
ENGAGING THE CARRIERS/OPERATORS
I do not understand why there is a widespread belief that the mobile carriers will or should play a central role in mHealth. Internet Service Providers are not expected to provide guidance or leadership on web content; why should mobile carriers be provided to do so for mobile content? The carriers are the “dumb pipes”, providing the infrastructure upon which others can build great content and apps, but this will only happen if no active participation on the part of the carrier is required.
Continuing the analogy of ISPs: I don’t need to contact, or collaborate with, my ISP in order to create a great website about diabetes or HIV (or horse racing or flower arranging). Because of this, we have websites for every possible topic. If we continue to believe that every mHealth project should involve meetings and MOUs with carriers we will never develop a similar situation with mobile.
As an example, EpiSurveyor is now used to collect mobile data in more than 170 countries. We have never met with a carrier, and have not made any agreements with carriers. This is because most of the time EpiSurveyor uses the internet (typically GPRS) to move data, and the carrier simply runs the network. Even when we use SMS, we only have to make an arrangement with one or two SMS “aggregators” (e.g. Textmagic or Twilio) to ensure that our application will work with every country and every carrier.
Currently, the mobile carriers remain at the center of mHealth only because they have the money to pay for big conferences (and to pay for articles like this one), and they do so because they WANT to be at the center of creating more “value added services” and profit. But wishing it won’t make it so.
BY Tim Wood
ON January 9, 2012 02:43 PM
A correction to the comment from Donna Mucheru- MOTECH is actually still quite active (I am the Director of the program). The program has been running consistently in Ghana since 2008. The programatic work has been replicated to a second district in Ghana and recently received a Saving Lives at Birth Grand Challenge Award to continue work for the next two years. The focus now is on expanding to additional districts in Ghana as part of a transition to national scale.
BY Jaspal Sandhu
ON April 13, 2012 10:14 AM
It’s great to see that this article has sparked so much discussion.
David: I really do believe that we have started to shift toward considering people first, but we certainly have a ways to go. On the positive side, this means that there are still plenty of opportunities for innovators and entrepreneurs.
Deb: Thanks for adding your own experiences with Isis here in the US.
Ellen: I think we’ll be seeing much more in this space in the next 18 months. I’d be happy to chat with you. Please feel free to reach out.
Janet: My life would certainly be easier if I could base my work on desktop research alone. I think you’ve seen Tim Wood’s note about MOTECH still being active. Sproxil, which I highlighted in the article, is actually the technology provider for mPedigree. As for leaving out examples and highlighting a campaign project (Project Masiluleke), I think you may have misunderstood the purpose of this article. The article is not intended to be a complete and current inventory of existing mHealth projects, but rather a curation of key examples that can inspire US-focused innovation. If you - or anyone else - is interested in understanding the current mHealth landscape, healthunbound.org is a great starting point.
Joel: Thanks for thoughtful response. I agree that we need better metrics to evaluate mHealth efforts. The article, as I explained to Janet above, is focused on inspiration for US innovation. This is why the most important factor for inclusion here was the business model, not “messages sent” or “data uploads.” That’s also why the focus of the article was primarily on applications other than healthcare delivery and data reporting. As for operators, the recommendation to “engage smaller operators” is specific to the US context, and is based on the market differentiation among providers that is unique to this market. The recommendation is not that the operators must be the sole source of innovation, but rather that they can play a critical role. We might say the same for operators in LMICs.
Thanks everyone - . I hope we can keep these discussions going, here and elsewhere.
BY Joel Selanikio
ON June 26, 2012 01:29 PM
Hi Jaspal,
It may be that “the most important factor for inclusion here was the business model” but you seem to have kept that entirely to yourself: for most of the projects/pilots/companies/technologies that you talk about it in the article you don’t mention anything about their business models.
And those “business” models, to my knowledge, are mostly based on spending charitable aid dollars.
For example, you mention that Healthline is fee-based, but that’s all you mention about it’s business model. Project Masiluleke appears to be a charity project paid for by donated space on SMS messages. The business model for Text to Change? Not mentioned (I believe it is an aid project). For Text4Baby? Not mentioned. Trac-Net? Not mentioned. Medic Mobile? Not mentioned.
At DataDyne, we have developed a business model (datadyne.org/about) that is unique in international development, but you don’t mention that, either. Or did I miss something?
Joel
BY William Eng
ON October 6, 2014 05:38 AM
Great Article. There are lots of opportunities to provide mHealth services in developing countries given large rural population, prevalence of communicable disease and poor/inconsistent access to medical facilities. The ubiquitous reach of SMS technology supports mobile health applications ranging from health information and education to inform patients of preventive care and treatment e.g. family planning, maternal health, to the management of inventory and supply chain steps. As mobile internet becomes prevalent and affordable, then many of these applications can be ported to mobile apps.
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BY nataliab
ON March 28, 2016 03:19 AM
Great article! The most interesting for me is that author mostly focused on the usefulness of mobile technologies for patients and almost neglected doctors. And I believe that doctors are the cornerstone of the healthcare system and they cannot be ignored. In reality, doctors in all developed countries already cannot imagine their life without mobile apps. Mobile technologies make life easier for doctors by saving time as mentioned at http://theappsolutions.com/blog/marketing/mobile-changing-healthcare. For instance, mobile technologies allow doctors to see all patients information, thus time is saved on roundups. Also, huge plus is the fact that results from a lab are directly sent on the device. Moreover, apps are also used as drug administration tools (http://www.businessinsider.com/10-ways-mobile-is-transforming-health-care-2014-6 ), though there are discussions of whether apps are reliable enough for this purpose. Also, according to Wikipedia https://en.wikipedia.org/wiki/MHealth#Diagnostic_support.2C_treatment_support.2C_communication_and_training_for_healthcare_workers doctors can always get a consultation from higher specialist and get information from houses of medical information.
BY Jenny Astor
ON March 29, 2021 04:40 AM
Thanks Jaspal for sharing such a great article about mobile health.
BY creditcardwave
ON November 24, 2021 08:03 AM
correction to the comment from Donna Mucheru- MOTECH is actually still quite active (I am the Director of the program). The program has been running consistently in Ghana since 2008. The programmatic work has been replicated to the second district in Ghana and recently received a Saving Lives at Birth Grand Challenge Award to continue work for the next two years. The focus now is on expanding to additional districts in Ghana as part of a transition to a national scale.
https://creditcardwave.com/