mHealth Strengthening Rural Health

In this week's guest blog, biomedical engineer Franz Josef Allmayer talks about the challenges rural health workers face and the potential of mobile devices to make a difference between life and death.

Health is an information-dependent resource and mobile technologies can make information accessible wherever it may be needed. When this phrase is put alongside the number of cell phones and their ubiquity around the world, it is easy to see why the concept of mobile health (mHealth) has such a strong potential. With low-cost handsets and the strong global penetration of mobile phone networks, people today use mobile devices as daily tools for communication and data transfer. In theory, every phone used by an individual in any location of the world, rural or urban, has the potential to be a channel for the delivery of health care, improving the health of individuals and populations.  Although the access to medical services has been significantly improved in the effort to reach the Millennium Development Goals (MDGs), meeting the healthcare needs of rural populations still remains a challenge. Especially in remote areas, where access to health care is non-existent or difficult to access, mHealth has the potential to make the difference between life and death.

By building on top of an already existent infrastructure and harnessing an already ubiquitous resource mHealth can result in low cost access to health care services. In terms of financing, in a context where nations have limited resources to apply in the health sector, it is considerably more cost efficient to implement health care workers empowered with smart phones than to construct and maintain clinics near all existent rural populations.  It is in such rough environments that mHealth can offer an effective means to the provision of health care within the context of sustainable and scalable development.

mHealth - Challenges and Potentials
In its simplest definition, mHealth is the delivery of health service using mobile phones.  This can range from simple SMS reminders for patients to take prescribed medicines to more complex approaches where an in-built algorithm can diagnose a disease while a patient file is created and sent to a centralized server. A specialized doctor then reviews the file in the server and submits an input with a suggested treatment for the patient, in real time. In addition, the data collected from the patient can be used to map and track disease outbreaks.  Some additional areas of impact that mHealth addresses include education and dissemination of information, remote data collection, remote health diagnostics, monitoring and treatment support, as well as communication and training for healthcare workers. Most programmes combine different areas in order to achieve a greater impact.

Empowering Rural Health Workers through ICT
A multidisciplinary programme I have been working with aims to empower nurses and midwives through information technology and seeks to improve the knowledge, skills, and retention of rural community workers, especially midwifes and nurses. The programme aims to meet the healthcare needs of rural populations which still remains a challenge. Globally, more than 75% of doctors, 60% of nurses, and 58% of other health workers live in urban areas. Sub-Saharan Africa bears more than 24% of the global burden of diseases but has access to only 3% of the world's health workers. To fill this gap, community-based health workers have become an integral component of rural healthcare programs throughout the world. Working with minimal training in isolated rural areas, these health workers are the bridge between the community and facility-based services. In addition to being responsive to healthcare needs within the community and providing other benefits to the health system, rural health workers still have several challenges to overcome. Some of these challenges are:

•    Lack of support and supervision from supervisors
•    Infrequent access to technical updates, life-saving information and expert advice
•    Isolation from professional peer networks
•    Few referral resources for health complications or emergency situations
•    Limited capability to improve technical competencies
•    No opportunities to continued education
•    Limited skills, training, and lack of empowerment

The project was designed to overcome these challenges in order to maximize the impact of rural health workers. Therefore, within the framework of the project, a package of solutions was established to create a network for training, knowledge, and peer support. A part of the solution included on- and offline casting of interactive courses enabled for smart phones or laptops for health workers in remote areas. These sessions put the emphasis on knowledge sharing across health care professionals, usually in the form of presentations and dialogs between experts in different countries.

Knowledge Centers serve as a gateway for reference to health professionals, community health workers and others to access health information and health education material that aims to enhance the effectiveness of healthcare delivery to the public.

Mobile diagnostics and treatment applications use the phone as a point-of-care device. Health workers’ phones are equipped with specialized tools, such as built-in software, that leads the worker through a step-by step diagnostic process. Once data is entered into the system (e.g., symptoms and an image captured on the mobile phone, illustrating the clinical presentation of the patient), remote medical professionals (specialized doctors in another location) can diagnose the illness and prescribe treatment in real time. By reducing the need for patient travel, these applications have the potential to dramatically increase access to care. Data collected and GPS coordinates are automatically stored in a database which can be used in scientific studies and provide data to policy makers for disease tracking and management.

In the component for Mentoring systems, mobile phones and special mobile applications are used to unite and support the rural health workers. Senior health workers will be offered the opportunity to act as “mentors” to the other acting rural health workers. Their role will be to assist and communicate with other health workers in the field and provide assistance and support.

Evidence has suggested that when rural health workers have better supervision, opportunities for continuing their education, and access to up-to-date information and peer networks, the quality of health services improves considerably. Current methods of educating health workers are limited and insufficient. In order to break the cycle of ill-health and poverty innovative, cost-effective and sustainable solutions must be found to support the continuing education of individuals working in remote rural areas. Information technology in combination with mobile technology and other already existing solutions offer a package of opportunities to overcome this hurdle and empower health workers to reach their full potential and, therefore, take us closer to reaching the MDGs.

Franz Josef Allmayer is a biomedical engineer dedicated to the holistic and multi-disciplinary field of global development. Having gathered experience in Africa, Europe, and Latin-America he has attained an in-depth knowledge of how to reach sustainable development worldwide.  Franz has collected considerable know-how working with Advanced Development for Africa (ADA), where he engaged on different approaches to address the Millennium Development Goals, especially those involving health in combination with Information and Communications Technology (ICT). Working in close collaboration with the World Health Organization (WHO) and a number of other institutions, both within and outside of the UN system, has allowed Franz to build strong links with governments, multilateral agencies, foundations, as well as the private sector. Since 2011, Franz is Ambassador for the World Summit Youth Award.