Developing Countries Lead the Way in Mobile-Health Technologies

By Eryn Gable. Cross-posted with permission from - see original here

Imagine being able to carry one of today’s most powerful diagnostic tools in your pocket—a medical device that will tell you if a pregnant woman’s fetus is developing healthily, if an injured soldier requires immediate evacuation or if a mountain climber is suffering from pulmonary edema.

Sound like science-fiction fantasy? Not anymore. Thanks to advances in imaging technology, Redmond, Wash.-based MobiSante, Inc. has developed a smartphone-based ultrasound device that allows healthcare workers to perform ultrasounds almost anywhere and share images via secure Wi-Fi, cellular networks or USB.

“Our big goal is to make ultrasound imaging accessible to everybody so cost and complexity are not a barrier—that could make a big difference in people’s lives,” said Sailesh Chutani, MobiSante’s CEO and cofounder. “It’s a proven, safe technology. It just needs to be available to everyone who needs it, and that’s what we’re trying to do.”

The company is just one example of the ways in which startups are changing the face of healthcare in the developing world. From mobile eye exams to medical recordkeeping to smartphone microscopes, companies worldwide are finding innovative ways to use the latest technologies to improve healthcare in developing countries.

Marc Mitchell, a lecturer on global health at the Harvard School of Public Health and founder and president of D-tree International, said many people incorrectly assume that people in poor countries don’t have cell phones. In fact, mobile technology is widespread in these areas.

“They don’t have a computer sitting on their desk at home, so having a phone with access to the Internet is critical,” Mitchell said. “It is an enormous and growing market that the telecommunications operators understand, but most people working on the latest app for you to chart your sleep cycle in the United States are clueless about the range of things it’s being used for.”

Mitchell noted that people in developing countries now use their mobile phones to do everything from reminding patients to take their medications to allowing remote clinics to track their medical supplies. Mitchell’s own company, which designs software that delivers clinical protocols on mobile devices, seeks to improve healthcare in low- and middle-income countries by helping health workers and patients make better medical decisions.

For example, in Zanzibar, D-tree worked in collaboration with the Ministry of Health, Jhpiego and with funding from the Bill and Melinda Gates Foundation to register and screen pregnant woman, as well as arrange transportation to medical clinics for their deliveries.

While the recent Ebola epidemic grabbed headlines in the United States, more women died in childbirth than from Ebola in the affected countries during the outbreak, Mitchell said. Similarly, more people died of malaria than Ebola during that time.

Mitchell acknowledges that the concern over Ebola spurred funding that has sparked innovations in treating that particular disease. However, he says focusing on epidemics “is not, in my view, the best way to develop long-lasting solutions to improving health systems in the developing world.”

The role of outbreaks in innovation

Even so, outbreaks have led to advances in so-called mHealth. For example, Justin Lorenzon, head of software development for eHealth Africa noted that his team developed an Android-based app to help caseworkers trace people who’d had contact with Ebola patients.

“That’s a huge deal in controlling an outbreak—making sure that if there’s a new case, that it’s followed up on and that person is isolated as quickly as possible, so you don’t have just a continuation of transmission,” Lorenzon said, speaking from the organization’s main office in Kano, Nigeria.

The app is an example of how epidemics can lead to innovations that address a current public health crisis. Originally designed to track and prevent polio, eHealth Africa’s Ebola contact-tracing app helped to cut reporting times for new Ebola cases by 75 percent. Lane Goodman of theCenter for Health Market Innovations noted that many analysts believe contact tracing was instrumental in helping Nigeria to eradicate the disease.

However, one downside of developing new technologies in the midst of an outbreak is that there’s less time to perfect it. Given the seriousness and rapid spread of the outbreak, eHealth Africa designed its app within a week under intense time pressures.

The quick turnaround time led eHealth Africa to rely on an open-source survey app as a stopgap measure until they rolled out their app and also led to many mistakes, including accidentally disabling the ability to save data—an issue developers caught quickly.

Another issue was poor cell reception.

“It was especially difficult to develop iteratively as sometimes contact tracers would go out for a few days in terrible reception, so it was hard to ensure everyone had the latest version,” Lorenzon wrote in a followup email.

Steve Snyder, partnerships and development manager at Cambridge, Mass.-based Dimagi, Inc., noted that working on longstanding public health issues such as HIV/AIDS has allowed the company to fine-tune its approach to meet customers’ needs.

“When you have a disease outbreak like Ebola, which was really on such an unprecedented scale that you can’t compare it to any other disease outbreak, you just have to jump quickly because you’re trying to stem the tide of the outbreak and you can’t be as deliberate about how to develop these types of tools,” Snyder said.

That could be good news for startups looking to break into mHealth, though, since startups are typically more adaptable and responsive than larger companies, allowing them to respond quickly in a crisis.

“In a lot of ways, as a young startup, you’re able to experiment and fail fast because you’re willing to take those risks,” Synder said.

Christina Synowiec of the Center for Health Market Innovations, whichreleased a report last Wednesday on more than 1,400 innovative health programs worldwide, said startups play a key role in healthcare disaster responses by connecting public health ministries with the communities that are most affected by the epidemics.

“Startups can be a really interesting intermediary for the two different groups most affected by the epidemic,” she said.

Sometimes outbreaks can also draw attention to broader deficiencies in the global health system.

“A lot of times these types of events or situations really put a magnifying glass on a lot of the challenges faced in global health,” said Patricia Mechael, a principal at HealthEnabled and senior mHealth adviser at the U.N. Foundation.

Indeed, some mHealth innovations developed not in reaction to one particular epidemic, but rather out of recognition of long-standing issues that came to light in addressing these situations.

Case in point: Dr. Joel Selanikio, cofounder and director of Magpi, got the idea for his company while working for the Centers for Disease Control as a medical officer and outbreak investigator who responded to crises in Borneo, Haiti and elsewhere.

“I was usually the guy out doing surveys and typing paper forms into the laptop, and I saw repeatedly and ad nauseam the problems that created and the time required to correct those errors,” Selanikio said.

Magpi’s mobile technology now allows users to create mobile forms, enabling workers to easily collect and share data. Tens of thousands of field workers already use Magpi for everything from tracking vaccinations to responding to natural disasters.

Selanikio said the key is to get such systems in place before a disaster hits. Even when officials recognize that a new technology could address an epidemic, they may struggle to put that technology into action, particularly if there are competing options.

“I think people have much less tolerance for trying new things during emergencies,” he said.

Similarly, eHealth Africa’s Lorenzon says public health systems may experience institutional paralysis, leaving viable solutions on the bench.

“There’s no mechanism I know of during health emergencies for public health systems to evaluate and decide between technological solutions that are perceived to be competing,” he said.

The demise of mHealth?

Despite these challenges, there’s broad agreement that the field of mHealth has rapidly advanced even in the last few years, especially as smartphones have become more affordable and widely available. mHealth is now seen as an indispensable part of healthcare in the developing world, both in responding to epidemics and improving general public health.

“Ten years ago, I had many, many people say to me that I was crazy and what I imagined couldn’t be done,” said D-tree’s Mitchell. “Five years ago, when we were doing it, people said, ‘Yeah, you could do it, but you can’t do it to scale and make an income.’ Now, people have acknowledged that we can do it to scale and we do have an impact even, and now all these m-skeptics have become enthusiasts.”

As mHealth becomes more widespread, one key to its successful implementation will be ensuring that products are adequately tested before being brought to market.

“We see a lot of products right now that are developed in a clinic or university laboratory that are expected to work in all settings, and that’s simply not the case,” said Stewart Jordan, cofounder of Peek Vision, a U.K.-based startup that’s working on mobile-based eye exams.

Peek Vision is currently in the process of testing its products, not only to ensure that they work as expected, but also that they lead to improved healthcare outcomes. The company expects to release its products in October.

Another key future development for mHealth will be ensuring that mobile technologies integrate into other uses of technology in healthcare—a process that’s already underway. As this integration occurs, Mechael suggests, mHealth could become virtually inseparable from other aspects of healthcare, making even the use of the term seem passé.

“I think we’ll see less and less use of term mHealth in the next year,” she said, “and in two years or three years I doubt anybody will be using the term mHealth.”


-Eryn Gable

​Photo © eHealth Africa