Mobile Technologies for Health (mHealth)

One of K4Health’s growing practice areas is mHealth—the use of mobile technologies (including phones, tablets, and netbooks) to improve public health.

mHealth is of particular interest in low- and middle-income countries, where widespread mobile networks and access to devices are connecting people like never before, leap-frogging older technologies to dramatically improve information flow, data collection, social and behavior change, and emergency response.

For example, SMS/text-based campaigns can be an effective way to share health information with people who lack reliable internet access.

There are now more than 5 billion mobile phone subscriptions globally, making it the most pervasive information-sharing platform ever. Recognizing the potential of mobile technologies and approaches to transform knowledge-sharing, K4Health is an active participant across the mHealth value chain. Our activities include:

Looking for the mHealth Toolkit? K4Health is building a brand new website to provide easy access to all of our mHealth tools and resources. In the meantime, you can access all of K4Health's latest mHealth information on this page. Can't find what you're looking for? Email us at mhealthknowledge@k4health.org for assistance.

Learn more: K4Health Focus on mHealth (.pdf) and other mHealth-related content appears below.

  • Blog post

    For thousands of people living in rural Bangladesh, Health Assistants (HAs) and Family Welfare Assistants (FWAs)—collectively called field workers—are the first line of health care, and for many, the only cadre of health professional they have access to for health, population and nutrition (HPN) information and services. It therefore becomes very important that these field workers have the necessary skills and confidence to provide quality counseling services.

    Field Workers in Bangladesh with their Netbooks

    Field workers in Bangladesh with their netbooks.

    Credit: Vanessa Mitchell

    The Bangladesh Knowledge Management Initiative (BKMI) implemented an eHealth pilot whereby 300 field workers (150 HAs and 150 FWAs), mostly women, received netbook computers loaded with digital resources (brochures, flipcharts, videos, job aids, etc.) and eLearning courses to facilitate HPN counseling and also improve their own knowledge. The results are in, and knowledge levels for both FWs and mothers in communities increased dramatically across HPN during the short 3.5 month implementation period.

    Just as important, and not a finding we necessarily expected, is that the netbooks empowered the field workers. During our routine monitoring, the research team conducted interviews with FWs and found that having the technology and a wealth of information at their fingertips made them feel proud, confident, and important. In fact, the elevated confidence observed from having the netbook actually changed how members of the community perceived them. Their improved social status resulted in more people seeking out HPN services from them.

  • Blog post

    Muhhamad Yunus, pioneer in microcredit, founder of the Grameen Bank, and Nobel Peace Prize winner, was a keynote speaker at the mHealth Summit last week. He described mobiles as an “Aladdin’s lamp” that can give women access to a digital genie. In the health and development arena, mobiles can indeed be a life-saving tool for women that can serve a number of functions from delivering information on stage of pregnancy to improving skills frontline health workers through mobile trainings.

    An Indian woman works to become an Accredited Social Health Activist (ASHA)

    An Indian woman works to become an Accredited Social Health Activist (ASHA).

    © 2008 Meenakshi Dikshit, Courtesy of Photoshare

    On the opening day of the 2013 mHealth Summit, I attended a panel in the global health track on mobiles for women. This panel featured a rich discussion with panelists from MAMA, BBC Media Action, the Society of Elimination of Rural Poverty in India and the University of San Diego.

    Of note for me were remarks made by Sara Chamberlain, Head of ICT from BBC Media Action, who talked about how important it is to understand the culture of the people we are trying to communicate with or develop a mobile solution for. She spoke about how people from media dark communities don’t organize and categorize information like societies who have access to libraries and the Internet do. Information is often more narrative and more driven by characters. People learn through identification with a character that takes them on a journey rather then just going through a hierarchical system of information. In the area in which she works as a partner on Anaya, which strives to improve maternal and child health in Bihar, India, 100% of the health workers have access to a mobile phone but most of their basic phones don’t support the local language. This made it difficult to develop and deliver trainings. They overcame this by launching a mobile academy that includes interactive voice response – or IVR- as well as audio visual job aids and audio messaging services. Of note are the early results in the mobile academy with more than 18,000 graduates. This is quite possibly the largest mobile-based training of this type. Their development process included putting the user at the center of the design.

    This simple reminder about putting the end user at the center of design really resonated with me. All of our K4Health products are designed with the same principle in mind. We need to ensure we use the best format, language and delivery mechanism for our audiences. We need to remember to put the end user front and center if mobile programs are truly going to be the “Aladdin’s lamp” that Yunus spoke about.

  • Blog post

    How does the “market” play into mHealth interventions for global health and development?

    A woman in Medinipore, India, stands in her marigold field while speaking to a customer on a mobile phone

    A woman in Medinipore, India, stands in her marigold field while speaking to a customer on a mobile phone.

    © 2012 Nimai Chandra Ghosh, Courtesy of Photoshare

    Last week at the mHealth Summit, I had the privilege of attending the panel From Starting to Sustaining: Models for Low-and Middle-Income Countries. As a social scientist and public health professional, I understand basic math and statistics, but working in a nonprofit environment, business and market value doesn’t always make the most sense to me.  Alexis Ettinger from CycleTel™ at Georgetown University explained the need for market testing and validation for mHealth products and services. With government funding, we often don’t think about the market and how it might be a good place to turn to see the feasibility of introducing a new project or product in an emerging or developing country.

    CycleTel™ is a mobile based opt-in SMS tool that follows the Standard Days Method® (SDM). SDM is a fertility awareness-based family planning method that is based on avoiding unprotected intercourse on 12 specific days around the middle of the women’s fertile cycle. A customer would opt-in by sending a shortcode to a number and then providing the system with her menstruation start date. Throughout the month the customer receives alerts during her fertile days each month indicating when she should avoid unprotected sex.

    Ettinger and her team were interested in pilot testing CycleTel™ in New Delhi, India. They wanted to see if their product was viable in a market environment. The categories they were interested in testing were the product desirability, feasibility, and financial viability.

  • Blog post
    @HarvardHealth Tweet

    @HarvardHealth Tweet: "Eric Dishman of Intel: Majority of people believe traditional hospital will become obsolete."

    When Eric Dishman, Fellow & General Manager of Health & Life Sciences at Intel discussed the popular perception that hospitals will become obsolete, he got my attention. He also reminded me of one of the keynote speakers from last year’s Summit, venture capitalist Vinod Khosla, who talked about healthcare without doctors. This excerpt from my blog about the Summit last year describes Khosla’s argument:

    In Tuesday’s Super Session at the Summit, Pushing the Limits of Mobile Health – Can we Have Health and Healthcare Without Doctors, Vinod Khosla, founding CEO of Sun Microsystems, challenged the notion that humans are best suited to deliver healthcare. He discussed the difficulties providers face when trying to recall 10,000 diseases and syndromes and 1,100 lab tests. He discussed their cognitive biases when making decisions and their tendency to avoid the naïve questions that are necessary to provide objective care. These very human limitations can lead to misdiagnoses, which he said could be a bigger killer than either car accidents or breast cancer. Due to these limitations, he argued computers would do a better job as decision makers in the context of integrative medicine. Computers, he said, “can be care maximizers and cost minimizers”. His view that comprehensive mHealth might be adopted in the developing world before it’s adopted in the developed (since the need is more urgent), also caught my attention.

    Eric Dishman's vital signs presented in real time during the mHealth Summit

    Eric Dishman’s vital signs presented in real time during the mHealth Summit. Via Amy Gleason/Twitter.

    Dishman’s argument similarly revolved around information management but incorporated the use of an individual’s continuous, real time data. During his presentation he wore a wireless monitoring device on his wrist and shared his vital signs with us.

    Longitudinal and unobtrusive data collection was also the theme of the research session, Using New Technologies and Modeling Techniques to Understand Health Behavior, Behavior Change, and Maintenance: Findings from an  International Workshop. It was a big title for big ideas. Ilkka Korhonen, Professor at the Tampere University of Technology in Finland, said wearable monitors that can discriminates between stress and recovery can helps deliver real time health reminders, such as when someone might be about to eat something unhealthy. The panelists said that while understanding what influences behavior is difficult, wearable monitors and will help researchers fill the gaps in recording human behavior that piecemeal data collection cannot.

  • Blog post

    This year’s mHealth Summit had an impressive mix of attendees: for-profit, non-profit, public sector, non-governmental, telecom, academia, and mobile start-ups. The conference gave everyone in that mix a little bit of what they’re looking for. In the work I do for the Knowledge for Health (K4Health) project, I’m mainly interested in the intersection of international health and mobile health. With that in mind, here are my five key takeaways from the Summit.

    mHealth Alliance Tweet

    mHealth Alliance Tweet

    1. mHealth is not a magic bullet: though mHealth can get someone to a clinic, it can’t make the clinic have the right supplies. We must design projects to include many different points of intervention and service delivery to ensure we’re not, for example, increasing demand while not matching supply.
    2. Innovation doesn’t mean recreating the wheel: there are many ways to think about innovation, but it doesn’t have to mean starting from scratch. Often taking a proven approach and improving or adding to it will be more successful than starting over. Let’s not innovate just to innovate.
    3. User-centric design: beginning with the user is best place to start. Without knowing who you’re designing for, a product is virtually useless.
    4. Sustainability: the idea of sustainability is important for any project or service in the nonprofit or for-profit world. I have heard this theme since I attended my first mHealth Working Group meeting in 2011, and it still rings true. We must think through interoperability of technology so it can work with different platforms and start with government buy-in and/or country ownership instead of bringing them to the table late.  
    5. Importance of connecting with new partners: throughout the sessions and walking around the exhibit floor, I saw the great need to find new partners, especially public private partnerships. In order to find solutions to the hardest problems facing the world today, is it extremely important to take lessons from the private sector as well as the non-profit and public sector. Knowing if a product is market viable can be the difference between a success or a fail

    I look forward to using these takeaways in my future work at K4Health. K4Health was interested to see what others think Global mHealth is… from the Summit, so we created this K4Health Twitter Campaign on Storify. 

  • Publications & Resources

    Learn about K4Health's mHealth expertise. Note that this promotional publication is designed to be printed and folded.

  • Blog post

    I’m excited to be attending the 5th Annual mHealth Summit this year in the National Harbor. Along with spending time at the K4Health Booth (Exhibition Hall C, #1016), I’m thrilled to be attending some really great events and special sessions. The ones on the top of my list are:   

    1. Keynote Speaker – Muhammad Yunus: 2006 Nobel Prize winner Muhammad Yunus is an amazingly moving speaker and a pioneer in micro finance. Yunus, often known for the creation of the micro loan, has the ability to inspire. I hope to take that inspiration back into the work I do for K4Health to push forward innovations to improve global health.
    2. mHealth + SocialGood Event: with a strong interest in innovation and social media for global health, I’m interested to see how mobile will add to the great success +SocialGood has already had in getting the global community together around the shared vision of “leveraging the power of technology and new media to make the world a better place.”
    3. Beyond Bihar: Lessons Learned in Bringing mHealth to Scale in India: one of the biggest challenges for mHealth practitioners is moving to scale. This presentation will give best practices, challenges, and lessons learned from implementers on mHealth. With K4Health’s next five years just beginning, we need to learn from others’ achievements and failures so we can do better work.
    4. From Starting to Sustaining: Models for Low- and Middle-Income Countries: in this session I look forward to hearing Johns Hopkins’ Alain Labrique speak on his experience with mobile interventions in the field. Labrique has the unique insight of seeing mHealth interventions from both an academic and practitioner perspective.
    5. A Trifecta for mHealth Implementation: Tools for mHealth Programs focusing on Low and Middle-Income Countries: technology is constantly changing and improving in the world of mHealth on a frequent basis, it is often hard to keep up. Opportunities like this session to sit with innovators in the mHealth arena and learn about their products are extremely important. I’m particularly interested in hearing mHealth Alliance’s Peter Benjamin speak about the mHealth Expert Learning Program (mHELP) and how that might play into the work we are doing with capacity building.

    Don’t forget to stop by and see us at the mHealth Summit Booth #1016, follow us @K4Health and follow the mHealth Summit activities with #mHealth13

  • Blog post
    A man uses a cell phone

    A man uses a cell phone.

    © 2004 David Alexander, Courtesy of Photoshare

    On December 2, K4Health contributed to the buzz for the upcoming mHealth Summit during a Tweetchat using #mHealth13, the hashtag for the conference.  The Summit is in its fifth year and continues to “advance collaboration in the use of wireless technology to improve health outcomes, reduce costs and create a new paradigm in health care delivery both in the United States and abroad.” Last year, with the assistance of the mHealth Working Group and many other global health entities, the mHealth Summit added a Global Health track.

    As a knowledge management project in the Office of Population and Reproductive Health (PRH) at the United States Agency for International Development (USAID), K4Health has had a vested interest in moving the research and practice of mobile health (mHealth) forward to reach more of our target audiences. K4Health has a strong commitment to mHealth, and we are thrilled to attend this year’s mHealth Summit for the third year in a row. As a chair to the mHealth Working Group, K4Health has continued to be a convener in the space of mHealth.

    Not only have we increased our mHealth outputs such as the App for Contraceptive Eligibility (ACE) which was featured last year at the mHealth Summit, we have also added many different tools to assist program planners with creating mHealth elements to their global health projects and programs. These tools are:

    K4Health will be at Booth #1016 in Hall C this year in the Exhibition Hall to engage with the nearly 5,000 attendees and 300 exhibitors. We will be available to answer questions, give demos, talk about what we do and find out how to improve the work we do with all the great presentations throughout the three days.

  • Blog post
    Ann Hendrix-Jenkins discusses mHealth with a colleague at the International Conference on Family Planning mHealth Networking Breakfast

    Ann Hendrix-Jenkins discusses mHealth with a colleague at the International Conference on Family Planning mHealth Networking Breakfast.

    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…

    1. 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.
    2. 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. 
    3. 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
  • Blog post

    In this recent interview in Wired magazine, visionaries Paul Farmer and Melinda Gates highlight the critical role of knowledge exchange in improving health outcomes. Citing human-centered design, defined by Gates as "meeting people where they are and really taking their needs and feedback into account," as the innovation changing the most lives in the developing world, Gates and Farmer explore the vast potential of mobile technology for health. 

    Melinda Gates and Paul Farmer

    Melinda Gates and Paul Farmer. Credit: Marton Perlaki

    Paul Farmer and Melinda Gates have a lot in common. They’re both Duke University alums, and they’re both devoted to improving health around the world, especially in places with few resources. As cochair of the Bill & Melinda Gates Foundation, Gates is particularly dedicated to empowering women and girls, which in turn benefits the health and prosperity of entire communities. Farmer splits his time between Boston (where he runs the Department of Global Health and Social Medicine at Harvard Medical School), Haiti, and Rwanda. He’s founding director of Partners in Health, an international nonprofit that delivers health services to the rural and urban poor in a dozen countries. Gates and Farmer don’t often work together, but their work certainly unites them. In New York City for UN meetings, the two friends talked to WIRED about the best ways to improve health all over the world.

    WIRED: What innovation do you think is changing the most lives in the developing world?

    MELINDA GATES: Human-centered design. Meeting people where they are and really taking their needs and feedback into account. When you let people participate in the design process, you find that they often have ingenious ideas about what would really help them. And it’s not a onetime thing; it’s an iterative process.

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