Today, with more than 400 million mobile phone users in India and almost 220 million in rural areas, mHealth is a natural vehicle to extend the reach of public health interventions especially in low resource and rural areas of the country.
Governments, international funders, and stakeholders are recognizing the transformative role that mHealth can play in strengthening health systems and achieving the Millennium Development Goals (MDGs), especially in improving maternal health (Goal 5) and reducing the spread of communicable diseases like HIV/AIDS and TB (Goal 6). Currently, mHealth applications are being tested in public health areas of surveillance data gathering, patient care management, improving supply chain of necessary drugs, delivering critical health promotion communication and enhancing the skills and diagnostic ability of the health care provider. Some examples of these are discussed below.
Educating the Educator
MSakhi (www.msakhi.org) or ‘mobile friend’ is an interactive tutorial designed by Intrahealth International for village level frontline health workers aka ASHAs (Accredited Social Health Activists) to deliver key health promotion messages via SMS, audio and illustrations. Over 153 topics in local languages and dialects related to key maternal and child health issues including prenatal and postnatal care, delivery, newborn and early childhood care can be accessed. Results from a pilot test of ASHAs in two districts in Uttar Pradesh has shown that the tool has raised the confidence levels of ASHAs to provide better counseling to their patients.
Managing Patient Compliance and TB Care
World Health Partners, an NGO focused on using social franchising and economic strategies to bring healthcare to the poor, in collaboration with partners such as the Bill and Melinda Gates Foundation has launched a TB management system that allows local frontline health workers to track patients’ progress using mobile technology. Tools such as IVR and dashboard alerts can provide better coordination between rural health care providers and laboratories to ensure that specimen samples are tracked, analysed and results reported to providers and in turn, patients in a timely manner. Suspected TB patients are sent daily messages of the importance of enrolling for immediate treatment at a DOTS clinic. Once enrolled, they will receive informational texts about the importance of medication, potential side effects and reminders for appointments through IVRs, call backs and SMS messages. A growing amount of research points to the fact that a patient’s perception of the care they receive is a critical indicator of patient compliance with treatment protocols and continuing use of health services, especially important in communicable diseases like TB.
HIV Informational messaging
The Indian Ministry of Health and Family Welfare in collaboration with AIDS Healthcare Foundation, Department of Telecommunications and National AIDS Control Organization has launched a mobile application called HELP (HIV Education and Linkage to Prevention) that is aimed at providing information about HIV/AIDS through alerts, texts, and IVR. Once the geographic locality is set, the application will provide a comprehensive list of the nearest HIV testing facilities, targeted health education messages on HIV prevention and prompts to remind users to access HIV testing services that are free of cost.
If using mobile phones as a low cost way to increase knowledge, coordinate health care services and spur positive behaviour change can amplify the effectiveness of public health interventions, the Government of India, funders and mHealth technology companies should waste no time in partnering to develop and scale up these strategies at both regional and national levels.
Smruti Shah is a public health consultant with expertise in program monitoring and evaluation, based in New Delhi.