Countries failing to assess mHealth

[CAPE TOWN] Mobile health (mHealth) initiatives that could "revolutionise" health outcomes are hampered by a lack of evaluation data, which prevents policymakers from committing resources and policies for scaling them up, according to a WHO report.

"Although the mHealth evidence-base is growing, there are major research gaps that must be addressed," said the report, launched during the Mobile Health Summit held in South Africa, this week (6–9 June).

The report, 'mHealth: New horizons for health through mobile technologies', looked at the state of mHealth projects from 112 WHO member countries in 2009.

mHealth initiatives use mobile devices to deliver information to researchers, health practitioners and patients, and are booming around the world, but just 12 per cent of initiatives globally, and seven per cent in developing countries, have been critically evaluated.

"There is little published evidence on the effectiveness of mHealth interventions or their cost-effectiveness, particularly in low-income settings … This is not entirely unexpected as mHealth is still relatively new, and therefore unexplored, but this practice needs to change," said the report.

The lack of a strong evidence base to verify the impact of mHealth on health outcomes and health systems means that funding often goes to competing healthcare priorities — the main barrier to mHealth uptake.

A lack of knowledge and policies was also a big barrier, highlighting the need for evaluation studies, public awareness campaigns and guidelines for use aimed at policymakers.

Around 75 per cent of countries from Africa are involved in mHealth. Examples of initiatives include Cam e-WARN, which monitors disease outbreaks via SMS in Cambodia, and the Mobile Doctors Network, which aims to improve communication between doctors in Ghana by giving them free phonecalls and text messages on mobile phones.

Most of these have been independent, local initiatives — usually technical proofs-of-concept or a solution for a single problem, according to the report. This approach is unlikely to be cost-effective or efficient in large-scale deployment, yet detailed cost-benefit analyses are another big gap in mHealth research.

Misha Kay, the head of the WHO Global Observatory for eHealth, said they were concerned by the low evaluation rates because it is difficult to say what type of projects work and what do not.

Adele Waugaman, senior director of the technology partnership of the UN Foundation, said most mHealth projects were hampered by a lack of appropriate policies, operation costs, knowledge of opportunities, and, by unreliable infrastructure.

Kay said the WHO is developing a tool kit for use as training material in mHealth evaluation, scheduled for release by the end of this year.

Reward Kangai, managing director of Net One, a mobile service provider in Zimbabwe, told SciDev.Net: "We are not at an evaluation stage yet, but any guiding framework would be beneficial in our provision of service".

Link to full report  [3.24MB]

Link to SciDev.Net's Mobile Health Summit 2011 blog by Africa Analysis columnist Linda Nordling