At Boston University School Of Public Health we have developed a project-based course, Using Mhealth Technology to Improve Health Outcomes, that creates partnerships between student teams and global public health organizations to design and develop mHealth applications. Our mobile applications have included a developmental screening application for anganwadi health workers in India, a comprehensive chronic disease survey tool for a remote area in Mexico, and a decision support tool for community health workers in Namibia.
Other than the technology, what are key factors that can affect the success of an mHealth initiative?
People. Knowing your end user is a large determinant of whether or not your application will be a success. Do you know your end user’s literacy level? Their technological literacy level? What about the amount of time that they have to dedicate to the application? Are they being paid to use the application, or are they using the application themselves? You need to make your end user happy. The overall functionality and design of an application is rendered useless if uptake is minimal, or if the target end user is encumbered by its use. This issue is likely more ubiquitous than should be the case, but there also have been innovative solutions that demonstrate an intimate knowledge, not only of the environment, but the intended user population.
Within maternal health, where do you see mHealth as having the highest impact or highest potential for impact?
Consider these two facts:
- Coverage for most MNCH interventions (except for immunization) is hovering somewhere around 50%. That means that half of all mothers and children are not getting access to lifesaving health care. To improve health outcomes, we are going to have to increase coverage of key MNCH services by building demand, expanding access to and improving the quality of these services.
- By 2019 there will be 9.3 billion mobile phone subscriptions and over 5 billion of these will be mobile broadband subscriptions. One billion of those with cell phones will continue to have very limited access to health care. For those people with cell phones but limited health care access, phones have the potential to expand access, increase demand and improve quality and accountability of health services that will directly result in greater coverage of the population.
Taking these into consideration, we believe that mHealth could have the highest impact on health education, both for clients as well as health care workers (HCW). mHealth can support HCWs to follow protocols for treatment, and connect patients to the nearest health facility in the event of an emergency.
Are there limitations to the extent to which mHealth can be used to improve maternal health?
mHealth applications are rarely a solution in and of themselves, but merely one piece of a puzzle that constitutes a greater campaign or program. Highlighting this, the risk of maternal mortality is highest intra- and post-partum and is often caused by complications such as hemorrhage and obstruction, which are challenging to address with mHealth tools.
Further, while the vast majority of the world’s inhabitants have access to a cell phone, over a billion people lack access, either because they can’t afford one or because there is no cellular reception in their area. Worryingly, this 1 billion represents the population that we often need to reach the most urgently.
Do you have an opinion on the role mHealth can play to improve maternal health? What do you see as the biggest advantages of mHealth? The limitations? If you are interested in submitting a blog post for our ongoing guest blog series on mHealth for Maternal Health, please email MHTF Research Assistant Yogeeta Manglani at firstname.lastname@example.org.