From First Email in Africa – 20 Years of mHealth
05/05/2009
Andrew Sideman of AED-SATELLIFE on 20 years of pioneering mobile technologies in global health
Sometime in the recent past - no one is exactly sure when - a milestone was passed which marked a paradigm shift to which the international health community has failed to respond.
Sometime in 2007 or 2008 the number of mobile phones in the world passed the halfway point: the number of cell phones in use is now well more than half the number of people in the world.
In case you hadn't noticed, most of the developed world is already connected. As are the wealthy and elite everywhere else. So, even if we allow that some people tote more than one phone, where is this new growth coming from?
Between now and the year 2011, 900 million people in the global South will buy a handset and join the worldwide mobile telecommunications network.
For the past 20 years, AED-SATELLIFE has been demonstrating that people in low-resource settings are hungry for information and capable of mastering the skills and technologies needed to acquire and use it. Early on, we used low earth-orbit satellites to bring clinical information to doctors, nurses and public health practitioners across the global South.
To make this work, we trained local technicians in Nigeria, Kenya, Tanzania and 20 other countries to operate and maintain the equipment. SATELLIFE's HealthNet carried the first email in Africa - and we taught HealthNet's users how to use email to build global peer communities of practice, jobs, and to answer pressing health and medical questions.
Over the years, as we introduced new ways for health-care providers to get at the information they were desperate to acquire, we heard that the technologies were "too difficult to master," the equipment "too expensive," the local human resources "too limited." After 20 years of hearing that we can't share the benefits of the information and communications revolution that has changed our lives, we say, "Yes we can."
The global health community has had a two-decade long conversation about how to address the "public health crisis," which afflicts the lives of most of the world's population. We debate in symposia, we meet at conferences, we set up websites. We agree over and over again that health systems need reliable, accurate, timely data and health-care providers need access to dependable, appropriate and up-to-date information. This is reflected in the call for strategic information in RFP after RFP.
Yet donors and implementers consistently cut from the budget the technology and technical support needed to create these data flows and information systems. "Too expensive," "too difficult to maintain," "not sustainable."
We say it is not sustainable to rely on outmoded paper-based data systems. It is too expensive to rely on inaccurate data for program evaluation. It is impossible to maintain a broken system. We concede that maybe it's okay to use paper first, but never again paper only. We have to stop thinking that our peers are not up to the task of learning new processes, not up to the challenge of new technologies. It is time to stop saying it is too expensive to invest in health systems that provide real value.
Facing a world in which fully half of the "bottom of the pyramid" has access to cheap, reliable information and communications technology, how can we in the international health community continue to give the same old excuses for denying the health systems the information support they need?
Over the 20 years that AED-SATELLIFE has been working to put information into the hands that heal, we have seen great changes in technology and we have adapted to them.
The unrelenting expansion in the power of computers means that the newest tools are faster and more capable than ever, and the older tools which were once expensive are now cheap. In our work, we have transitioned from satellites and receiving stations to Personal Digital Assistants and then to mobile phones. We hope and expect to see many more innovations and make many more adjustments in our quest to apply the appropriate technology to the information need at hand.
Similarly, software has changed. Where we once used software proprietary to the individual device manufacturer (sometimes unique to a particular device), now we are actively supporting the growth of open source software solutions that are interoperable on the full range of information systems and that low-resource countries can afford to own and maintain.
Beginning today, no health project should go forward which does not include technology to collect data and communications systems to bring meaningful content to health-care providers. No program should be considered, which does not address how communities will be engaged using the full complement of communication tools - audio, video, radio, MP3, SMS and everything else that is developed in the future.
Beginning today, let's agree that no pilot team however small, and no project staff however large, will address these issues without building interoperable tools that can be integrated into national (regional!) systems. And no technologies will be introduced on the ground without ensuring that they are multi-purpose and applied to multiple tasks.
Beginning today, let's pledge to shrug off any suggestion that meeting the data and information needs of the world's health system is too expensive, too difficult to maintain, not sustainable. Addressing these needs is no longer an expendable item.
The unprecedented growth of the mobile telecommunications industry and mobile technologies in general, has shown that there is both need and desire to adopt technology among the poorest. The industry has shown that they can adapt to the market.
Telecommunications operators once commanded subscription rates of $100 per month from technophile "early adopters" in Scandinavia and the UK; today they scramble to build market-share in India among those paying less than $5 a month. Handset manufacturers still design and sell sleek top-of-the-line devices that are as powerful as desktops and cost much more, but they also compete with each other to produce phones that will retail for less than $25. Multi-billion dollar corporations realize that their futures lie at the bottom of the pyramid; they are committed to winning market-share among the poor who are no longer peripheral to their global marketing strategies.
AED-SATELLIFE and others have shown repeatedly that bringing meaningful technology to low-resource settings is doable. The cell phone industry has shown that it is doable. Now is the time for of us to end this discussion and say, "yes we can!"
Andrew Sideman is associate center director of the AED-SATELLIFE Center for Health Information and Technology, part of the Academy for Educational Development.
Wow great post, undoubtedly now a day’s one of the most utilized gadget in the world is the cell phone. It’s not only a source of communication but this high tech; dashing and trendy machine has multiple functionalities e.g. the ability to surf the Web, pump out tunes, capture your memories, and play full-length movies and TV shows. Mobile phones have become more than miniature long-distance walkie-talkies, utility of this electronic tool has further been complemented by cell phone accessories, making it not just a phone, rather a mini computer.
And now mobile banking has made this gadget more practical and a must have electronic machine as through sms or mobile internet, balance checks, account transactions, payments etc can be performmed via mobile devices.
— Annia on 2009-11-16