Insights July 2010

From ehealth to mhealth: Celebrating the mobile phone at 5 billion

Neil Seeman

This just in: The number of mobile phones in use worldwide has exceeded five billion due to unyielding demand in India and China, Ericsson has shown in a new study. I’m not talking about Smart Phones (i.e., iPhones or Blackberries). I’m talking about basic cell phones. In many countries, such as India, cell phone penetration is highest in rural, poorer regions. In South Africa, cell phone penetration is virtually 100%, allowing healthcare workers to dish out SMS text instructions to millions who are suffering from one of the largest HIV/AIDS epidemics in the world.

So: The next time a vendor proposes any tool to improve healthcare, ask her about its applicability for the mobile phone. If she does not have an ‘mhealth’ application, ask why.

Return on investment in innovation using mobile phones for healthcare technology is astonishingly high. It also serves equity. Remember the arguments about the so-called ‘digital divide’ on the Web? That challenge is melting away  (if it ever even was of genuine policy relevance; my brother Bob says the worries about the digital divide were like arguing “the invention of the almost free public lending library circa 1900 hurt the poor”). The real digital divide is the big vendor and big purchaser bias in favor of fancy expensive portals; or, as my colleague Alton Ing taught me, a bias toward building Smart Phone applications for rich urban professionals who can afford iPhones – and ignoring low to no-cost SMS applications that inform the poor and forgotten about HIV prevention, clean water, or vaccination.

The influential mHealth Initiative sees healthcare applications on mobile devices (mDevices) as “the future conduit of interoperability for essential health information.” But this future has already happened.  Peter Singer, CEO of Grand Challenges Canada, tells me: “In the developing world, the mobile phone is increasingly like the person’s family doctor (it’s already their banker).” Peter, who also holds the Sun Life Financial Chair in Bioethics and is Director of the McLaughlin-Rotman Centre for Global Health, told me about a free service called text4baby that gives pre-natal counseling over SMS.   “If you want to know what it’s like for someone in the developing world to not have access to mhealth, imagine what it would be like for you to be cut off from the Internet,” says Dr. Singer.

As I have noted elsewhere, mhealth opportunities abound for patient education and awareness, remote disease monitoring and surveillance, treatment support, emergency response, human resource co-ordination (especially during outbreaks), and training for frontline healthcare workers. The United Nations mHealth Strategy for Development reported on more than 50 mHealth projects improving public health in developing areas right now. With 64% of all cellphone users now in the developing world, the UN Foundation notes that “mobile technology can support increasingly inclusive health systems by enabling health workers to provide real-time health information and diagnoses in rural and marginalized areas where health services are often scarce or absent altogether.”

Rapid-Fire Innovation for a bit of Fame and Fortune

With mhealth, innovation lifts at breathtaking speed and at very low cost. Recently the Innovation Cell and Longwoods awarded the Global Accelerator Award™ to Apps4Africa, “a contest to highlight the talent of local developers in Kenya, Uganda, Rwanda and Tanzania and to leverage the power of digital technology to make a better world.” The contest kicked off July 1st. To induce people to submit ideas and build applications, contestants are told that winners will receive a “small bit of fame and fortune — cash, gadgets, chances to improve your technical skills and the opportunity to hob nob with our judges panel of tech luminaries and civil society leaders at an awards ceremony in September.” As of the time of writing (July 17th), new mhealth ideas submitted – you can vote for them here – include:

  • Virtual Assembly Point: a Crisis Management System that will help Emergency Response Departments to evaluate a tragedy before they arrive at the site. “From the Virtual Assembly Point, the rescue team will be able to … sort people according to their needs, set priorities according to the ground data, pull individual records for accountability purpose and plan for and manage the available resources properly.”
  • A mobile application for Kenyan Farmers: “Farmers in Kenya face a big challenge when it comes to using new technologies to enhance their farming and increase their produce. They need an application to enable them to market their produce, learn how to control popular pests and diseases and know the prevailing weather conditions too.”
  • Visualizing community realms of influence: A way to map relationships among aid organizations, staff and initiatives that could be easily accessible via mobile and linked to GIS and related databases.
  • It would be a hybrid of social mapping; in this case, the ‘realms’ of influence would be sorted based on an area of interest – i.e., health, education, or neighborhood.
  • Academic Mobile Information System (AIMS): “Students in Higher Learning institutions in Tanzania are in need of services which will give them some information … to make decisions within reasonable timing and without hassle – e.g., getting Information (using mobile phones) about loan status, accommodation status, tuition fee status, exams results etc.”

Going Mobile for Fame and Fortune

The growing wave of open content, free software, and open access social movements will offer the poor greater access to richer digital information. If healthcare systems, public or private, want to support this, then they should aggressively provide incentives for mobile health SMS applications right now. The major media have reported intensively on a tiny subset of iPhone 4 users who are upset about poor antenna reception. Meanwhile, there’s a more important story: There are some beautiful health applications for the iPhone, yet their offerings have been designed for busy Western professionals concerned about counting calories. Nothing wrong with that. However, to meet the challenges of the developing world, the same developers building weight-tracking devices for the iPhone should be given a powerful incentive to build free applications for clean water, or for better pre- and post-natal care in the poorest regions of the world. I’d suggest a small dose of fame and fortune as an inducement: a dinner with Apple CEO Steve Jobs.

How about it Steve?



Call for Innovations

Do you have a mhealth application that “lifts innovation at breathtaking speed and at very low cost?” Does it improve healthcare, public health and living conditions? Send us a description. We want to hear about it and will feature all submissions that pass the smell test.* Send this to We will review your app with the Health Strategy Innovation Cell based at Massey College at the University of Toronto. We will share accepted applications by eLetter, web, by cell phone, twitter, facebook and other social media.

*. A metaphoric test applied by ordinary but clever people used to determine the legitimacy or authenticity of an idea.

About the Author(s)

Neil Seeman is Director of the Health Strategy Innovation Cell at Massey College.


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