‘One Foot on a Glacier and the Other on a Bullet Train’: Forum participants discuss moving mHealth toward national health system integration
Last week’s Global mHealth Forum was, for the first time, a stand-alone event, distinct from the mHealth Summit but co-located and organized. With a dedicated platform for those focused on mobile interventions for health in low- and middle-income countries, the forum drew greater attention to speakers from international NGOs and representatives of foreign health ministries. This year’s summit held a stronger candle than ever to the issues of mHealth’s ecosystem integration, the value of partnerships and the importance of designing for user access, evidence-based evaluations and financial sustainability.
Patricia Mechael of the UN Foundation and the former executive director of the mHealth Alliance opened the forum with key mHealth highlights. Today, the proliferation of mHealth in development has helped progress the Millennium Development Goals, led to scaling of mobile health services in Uganda and Nigeria, and 1 million subscriptions to the Mobile Alliance for Maternal Action (MAMA) in Bangladesh. Mechael called for practitioners and governments to remember that the “people factor is more important than the technology,” inciting a round of applause from the audience.
Joseph Kvedar of The Center for Connected Health said, “mHealth represents the collision of two interesting worlds – mobile, which changes on what seems to be a daily basis, and health care, which changes infrequently, only after significant deliberations and usually much empirical analysis.” Or, in the words of Eugene Sickle of the RHI mHealth team, “We have one foot on a glacier and the other on a bullet train.” And as other speakers noted, the technology is only the first step.
Enabled Environments for Achieving Scale
Dr. Adetokunbo Oshin of the Nigeria Ministry of Health and Saving One Million Lives spoke of the potential for mHealth to help achieve greater health outcomes in remote rural areas. While the Nigerian government has successfully implemented conditional cash transfers for pregnant women and mothers, supply chain enhancement and midwife recruitment, these strategies all rely upon paper records and operate with unique reporting systems. Oshin discussed the need for baseline data, greater health worker capacity and a multi-use platform, not to mention improved ICT infrastructure.
As mHealth becomes widely implemented and studied, experts advise that moving toward scale and national health system integration will require greater focus on evidence, funding and country-wide and regional standards. There are currently thousands of systems in eHealth and mHealth, many of which lack rigorous evaluation. Governments face a “know-do” gap and a risk of high investment with low returns.
(The Government Plenary at the Global mHealth Forum, left.)
With so many apps and intervention techniques available in the private and public sectors – now more than ever – there’s a greater focus on these applications’ abilities to integrate and work as a system. When multiple structures are integrated into a single comprehensive design, governments can plan health systems that connect electronic and mobile interventions. Failing to create this system leaves government holding the loose ends of strings that do not tie together.
Dr. Alvin Marcelo of the Philippines Ministry of Health and AeHIN (Asian eHealth Information Network) outlined the path to mHealth successes in the Philippines. According to Marcelo, to achieve any level of interoperability in the multiple departments involved in mHealth implementation, it was necessary to link the Ministry of Health with the Ministry of ICT. To ensure that these departments spoke a common technical language, members of the government undertook rigorous enterprise architecture training. They created a multi-sector, three-tiered working group of practitioners, technical experts and officials who meet to resolve problems, reach consensus and implement systems. Most importantly, a regional network of peers was formed to address interoperability strategies and standards among eHealth and mHealth systems across multiple governments.
Overcoming Pilot-itis by Creating ’meHealth’
When asked what his government’s “a-ha moment” was concerning mHealth, Dr. Ousman Ly of Mali replied, “Two words: big results.” Ly, general director of National Agency of Tele-health and Medical Informatics, told the audience of NGO workers and practitioners that to convince governments of the benefits of mHealth, results must show evidence and capture data that can save lives. Many mHealth pilots come to Mali with donor funding, and leave once this funding is exhausted. Rather than seek new funding and build upon previous success, Ly says, many organizations come back with new funding, new pilots and new results.
In the side session “Leveraging meHealth,” Derek Ritz of ecGroup Inc. claimed that the greatest difficulty for mHealth is that pilots are not networked. mHealth relies upon the devices in the hands of people who use them, Ritz says, while eHealth operates upon a cloud-based infrastructure that links data to national systems. A linked system that includes m- and eHealth interventions will enable a continuity of care that can achieve true national scale. These technological interventions, Ritz noted, should not be confused for actual improvements in health. Instead, Ritz said, mHealth and eHealth interventions can operationalize health interventions, yield person- and population-centered data, and inform protocols and further operations. This networked system, he claimed, is all a part of improving health, but mHealth inventions and interventions alone are rarely responsible for better health outcomes.
What should mobile health programs and developers do to integrate into national health systems and achieve scale? Speakers said scale is possible when programs:
1. Measure indicators already expressed by ministries of health.
2. Cooperate with health ministries and clinics to ensure agreement and cooperation before implementation.
3. Investigate novel approaches to financial sustainability from the onset ? exclusively relying on donor funding does nothing to ensure governments that an mHealth project will continue beyond the pilot.
Eliminate the ’m’ in mHealth
According to Ritz and Mechael, mHealth will soon go the way of eBanking: When mHealth becomes the norm, we will drop the “m” and just call it “health” (just as no one calls it eBanking anymore). As mHealth interventions achieve successful improvements in health outcomes with evidence-based evaluations, they’ll become more integrated into national policies and health systems. However, NGOs, governments and mobile developers must commit to greater collaboration in order to build knowledge and reach scalable solutions.
Mobile health has seen great success when governments network to build support systems, and this style of joint learning may reflect the future of collaborative government. Indeed, one would assume that for the future of health technology to achieve integration into national health systems, government must also evolve to reflect the needs of a technology that is sustained by open data, crowdsourced innovations and equal access for all.