Opportunities and Challenges of Integrating mHealth Applications into Rural Health Initiatives in Africa

Opportunities and Challenges of Integrating mHealth Applications into Rural Health Initiatives in Africa

Patricia Mechael
DOI: 10.4018/978-1-61520-670-4.ch034
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Within the broader field of eHealth, a new sub-specialization is emerging from the dramatic uptake of mobile phones throughout the world, namely mHealth. mHealth is characterized by the use of a broad range of mobile information and communication technologies including mobile phones, personal digital assistants, and remote medical devices and sensors to support medical and public health efforts. Mobile technologies serve as an extension of existing health information and telemedicine systems as well as stand-alone support systems for health professionals and individuals within the general public. This chapter highlights the developments and trends within mHealth and how the integration of mobile technology has been used to support the Millennium Villages Project. Each of the Millennium Villages, which serve populations ranging from 5,000 to 55,000 people, are located in ten countries throughout Africa, and they have been established to illustrate how targeted interventions valued at approximately $110 USD per capita can be used to achieve the Millennium Development Goals.
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The Millennium Development Goals (MDGs), set at the Millennium Summit in 2000, are quantified targets aimed at reducing extreme poverty, hunger, disease, gender inequality, environmental degradation, poor access to safe drinking water and sanitation, meant to be achieved by 2015 (Sanchez et al., 2007). Figure 1, developed by the World Health Organization (WHO) provides an overview of the MDGs, with a specific detailed presentation of health-specific objectives, targets, and measures of success. In 2005, the United Nations Millennium Project identified practical ways to achieve the MDGs, however, questions arose regarding sub-Saharan Africa’s ability to achieve their targets given its low productivity of food, heavy burden of infectious disease, and insufficient core infrastructure - including water, roads, power, and telecommunications. In March 2004, the Millennium Villages Project (MVP) was conceptualized and the first villages launched at the end of 2004 and the beginning of 2005 in Kenya and Ethiopia, respectively. Ten additional villages were established in 2006 with an additional two added in 2007-2008 for a total of 14 Millennium Village clusters. These village clusters (serving populations that range from 5,000-55,000 people with an average of 30,000 people per cluster) are located in Ethiopia, Ghana, Kenya (2), Malawi (2), Mali (2), Nigeria (2), Rwanda, Senegal, Tanzania, and Uganda. The overall strategy of MVP aims to apply evidence-based practices and technologies to address agricultural productivity, public health, education, and infrastructure through an integrated approach.

Figure 1.

To be reached by 2015, the Millennium Development Goals were set at the United Nations Millennium Summit in 2000 (Reprinted with permission from the World Health Organization Press)


In October 2007, in its effort to strengthen the infrastructure component within the villages, MVP launched a strategic partnership with Ericsson to bring enhanced connectivity and broadband access to the Millennium Villages in the 10 countries in Africa in which the project operated. In the MVP, the first sector prioritized to leverage connectivity and for targeted applications was health. Beginning with the targets presented in the figure and the selected interventions being implemented by MVP in Africa, an mHealth Strategy was developed and key interventions prioritized to ensure that the benefits mobile technology offer could be harnessed in a way that directly contributes to the achievement of the MDGs for health. As part of this process, an intensive review of what is known in the field of mHealth was conducted to ensure an optimal approach to the integration process (Mechael and Sloninsky, 2008).

This chapter aims to encourage a more strategic approach to the integration of mobile and other information and communication technology to support the achievement of the health-related MDGs. It begins by providing an in-depth review of mHealth literature relevant to the MDGs, including trends, opportunities, challenges, and lessons learned that influence implementation in rural Africa. It then describes how what is known in the field is being applied to the Millennium Villages context, providing country-specific case studies with some early learning. In conclusion this chapter will reflect on future directions within mHealth in low- and middle-income countries, including taking pilot efforts to scale and promoting sustainability.

Key Terms in this Chapter

Hotlines: Services for health-related extensions have included hotlines where individuals can benefit from having the ability to call a number to access health information or services. By increasing conversation about health-related issues, topic-specific hotlines have demonstrated usability for family planning information, HIV testing, and emergency response systems, with added benefit of having a rich source of monitoring and evaluation information through call records.

Personal Data Assistants (PDAs): PDAs are handheld devices for storage and organization of information as well as secondary capabilities in the transmission and access to information depending on the nature of the device and the capacity of the networks to support the Internet. Because they are portable, durable, powerful, and easy-to-use, they have become an attractive and efficient tool for collecting data for health statistics or laboratory results and transferring information which can aid diagnosis and treatment as well as training.

mHealth and Telemedicine in the Millennium Villages: The strategic objectives of mHealth in the MVP include: reducing child and maternal mortality and morbidity; improving disease surveillance and control for HIV and AIDS, malaria, tuberculosis, diarrheal and respiratory illnesses; improving the access to emergency and general health services; improving clinical practice for enhanced health outcomes; and improving monitoring and evaluation of health system activities.

Monitoring & Evaluation (M&E): In this context, M&E provides a dashboard of measurable indicators of the progress towards reaching the goals of a public health intervention and assessing the impact and outcomes attributable to the program. In terms of program evaluation, there are three ways to evaluate the effectiveness of particular programs: formative evaluation, process evaluation, and summative evaluation. These assess the quality of a program’s design, implementation, and effects. They can provide important documentation for stakeholders about the progress of the intervention.

Millennium Development Goals (MDGs): Declared by the United Nations in September 2000, the MDGs are eight development goals and 21 targets. World leaders and their nations have committed their efforts to these goals and recognize a target date of 2015. They aim to reduce poverty through a series of time-bound targets with efforts to address hunger, education, gender equality, child and maternal health, HIV and AIDS and other diseases with global burden, environmental sustainability, and global partnerships.

MHealth: mHealth is defined as the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems with the express purpose of improving healthcare, public health, and well-being. mHealth technologies have yielded activities that include emergency response systems through toll-free access numbers; disease surveillance and control; human resources coordination, management, and supervision; telemedicine diagnostic and decision support to remote clinicians; clinician-focused, evidence-based formulary, database and decision support information available at point-of-care; remote patient monitoring; mLearning; and health promotion and community mobilization.

Millennium Villages Project (MVP): Being implemented through a tri-partite partnership between Millennium Promise, the United Nations Development Program, and the Earth Institute at Columbia University, the Millennium Villages Project seeks to offer a scalable model for reaching the MDGs. The approach emphasizes strengthening agricultural, educational, health, and infrastructure activities at the village-level, which can then be expanded to the district level and other countries across Africa. Currently, there are 14 villages all together, which are located in 10 countries: Ethiopia, Ghana, Kenya (2), Malawi (2), Mali (2), Nigeria (2), Rwanda, Senegal, Tanzania, and Uganda.

Community Health Workers (CHWs): CHWs have been seen in various countries as the mainstay of primary health care promotion, and their roles are determined by their skill levels and the public health needs. In the MVP, for community-based, public health interventions, community health workers are generally the preferred mechanism for engaging in health-related outreach to household.

Sustainability: The United Nations defines sustainable development as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” and contains the balance of environmental protection, economic growth, and social development (UNEP, 1991, p. 9).

Connectivity: Connectivity refers to the communication links made among individuals and communities, with an emphasis on the ability for individuals to communicate with one another and for information transfer to occur. Particularly for individuals living in remote areas which have traditionally lacked fixed-line telephony, increased mobile network connectivity provides a wide range of benefits particularly for people in developing countries.

Electronic Data Collection: Collecting data on health statistics can be quite challenging because of the importance of getting quality samples with statistical power and the difficulties of reaching members of a population. Population level data is integral to estimations of disease burden to inform health promotion efforts and health service delivery in addition to the strategic allocation of resources. A number of initiatives have begun to explore the use of PDAs for electronic data collection specifically for large-scale health surveys, such as the Demographic and Health Surveys (DHS), which can improve the timely acquisition and processing and validity, reliability, and consistency of quantitative data metrics. Such systems are increasingly being migrated to SmartPhones (mobile phone/PDA hybrids).

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