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      mHealth in Sub-Saharan Africa

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          Abstract

          Mobile phone penetration rates have reached 63% in sub-Saharan Africa (SSA) and are projected to pass 70% by 2013. In SSA, millions of people who never used traditional landlines now use mobile phones on a regular basis. Mobile health, or mHealth, is the utilization of short messaging service (SMS), wireless data transmission, voice calling, and smartphone applications to transmit health-related information or direct care. This systematic review analyzes and summarizes key articles from the current body of peer-reviewed literature on PubMed on the topic of mHealth in SSA. Studies included in the review demonstrate that mHealth can improve and reduce the cost of patient monitoring, medication adherence, and healthcare worker communication, especially in rural areas. mHealth has also shown initial promise in emergency and disaster response, helping standardize, store, analyze, and share patient information. Challenges for mHealth implementation in SSA include operating costs, knowledge, infrastructure, and policy among many others. Further studies of the effectiveness of mHealth interventions are being hindered by similar factors as well as a lack of standardization in study design. Overall, the current evidence is not strong enough to warrant large-scale implementation of existing mHealth interventions in SSA, but rapid progress of both infrastructure and mHealth-related research in the region could justify scale-up of the most promising programs in the near future.

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          Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa

          Background Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings.
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            Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya.

            Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS. This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals. Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009. All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers. MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS. Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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              A text message-based intervention to bridge the healthcare communication gap in the rural developing world.

              Healthcare delivery in the rural developing world is limited by a severe shortage of health workers as well as profound communicative and geographic barriers. Understaffed hospitals are forced to provide care for patients that reside at a great distance from the institutions themselves, sometimes more than 100 miles away. Community health workers (CHWs), volunteers from local villages, have been integral in bridging this patient-physician gap, but still lose enormous of amounts of time in transit between hospital and village. We report the results of a retrospective mobile health (mHealth) pilot at St. Gabriel's Hospital in Malawi designed to eliminate many of these trips in favor of communication via text messages. A group of 75 CHWs were supplied with cell phones and trained to utilize the network for a variety of usage cases, including patient adherence reporting, appointment reminders, and physician queries. At the end of the pilot, the hospital saved approximately 2,048 hours of worker time, $2,750 on net ($3,000 in fuel savings minus $250 in operational costs), and doubled the capacity of the tuberculosis treatment program (up to 200 patients). We conclude that mHealth interventions can provide cost-effective solutions to communication barriers in the setting of rural hospitals in the developing world.
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                Author and article information

                Journal
                Int J Telemed Appl
                Int J Telemed Appl
                IJTA
                International Journal of Telemedicine and Applications
                Hindawi Publishing Corporation
                1687-6415
                1687-6423
                2013
                4 December 2013
                : 2013
                : 482324
                Affiliations
                1Ben Gurion University of the Negev, Medical School for International Health, New York, NY 10032, USA
                2NYU School of Medicine, Bellevue Hospital Center, New York, NY 10016, USA
                Author notes

                Academic Editor: Jocelyne Fayn

                Article
                10.1155/2013/482324
                3867872
                24369460
                597c9e82-b057-4554-b8f7-bc9bc558bfe5
                Copyright © 2013 Thomas J. Betjeman et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 May 2013
                : 31 October 2013
                Categories
                Review Article

                Medicine
                Medicine

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