As the New York UN meeting on Non Communicable Diseases NCDs draws to a close, one big takeaway that everyone seems to agree on is that NCDs are reaching epidemic proportions worldwide. This may be bad news; however it does present some tremendous opportunities for mHealth in developing countries.   NCDs include cardiovascular conditions, some cancers, chronic respiratory conditions and type 2 diabetes. These conditions account for 60% of all deaths worldwide, with 80% occurring in low and middle-income countries[1]. It’s time we put as much funding and emphasis on NCDs in developing countries as we do with infectious diseases.  NCDs have twice the number of deaths than infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies (nature link). [2]

There is no refuting the fact that there are significant problems to overcome. The fact is Global health is challenging, but not all challenges are equal, some challenges are more challenging than other.   Let me elaborate: If you are attempting to find a cure for HIV or a vaccine for malaria. This would be difficult from a scientific perspective; it would also be expensive and will likely take a long time to achieve.  On the other hand, if you attempt to educate a population on diets, lifestyle changes, encourage exercise and reduce smoking; then you will likely prevent an epidemic of extreme proportions that is on the way to developing nations.

There are some low hanging fruits that can be tackled right now with existing mobile technology and know-how that would make a significant impact on the future of Global health.  The traditional model of NCD episodic care in clinic and hospital-based settings is inadequate in developing countries due to scarce resources. The low hanging fruit could be plucked by using a mHealth diagnostic and monitoring platform to diagnose health conditions and address the common risk factors, such as smoking, diet and sedentary lifestyles. There are a multitude of studies that show how cellphones can have a positive impact on lifestyle and behavior changes, tying this notion to medical diagnostics and monitoring  (continuous or periodic)could have a profound effect. There is a need for diversity in the funding criteria to allow funds to be diverted to develop viable and sustainable innovations in urban areas to address NCDs, there seems to be too much emphasis on rural health in developing nations. Yet there is strong evidence the urban dweller will be far worse off in the future due to the growing obesity rates.[3] Mobile operators in the developing world are in a great position to use their 3G networks to exploit the new health data and services that will surely be unleashed.



[1] World Health Organization Preventing Chronic Diseases: A Vital Investment (WHO, Geneva, 2005).

[2] Nature 450, 494-496 (22 November 2007) | doi:10.1038/450494a; Published online 21 November 2007

[3] Overweight and obesity in urban Africa: A problem of the rich or the poor? http://www.biomedcentral.com/1471-2458/9/465

Digital Health 4 Digital Development was the theme of choice for the 2011 South-South awards that took place earlier this week. The United Nations-supported awards ceremony, held September 19th, honors governments, organizations and individuals accelerating progress toward the Millennium Development Goals (MDGs), and this year awards were given for utilizing ICTs for the advancement of the MDG health goals.

Prime Minister of Bangladesh receives South South award from

Photo Credit: thefinancialexpress-bd.com

The awards were organized by South South News, a digital media platform launched by the United Nations General Assembly High-level Committee in 2010. The platform disseminates development news and allows countries in the global South to share best practices in advancing implementation of the MDGs. As health remains a high priority within the international development field, with three of the eight MDGs calling for health improvements by 2015, this year South South chose the “catalytic and unifying force of ‘digital health’” as its focus.

Awardees were recognized for policies, programs and projects that address global health using ICTs as a mechanism for “scalability and replicability of the broad development agenda.” Awards were given on health categories such as Women and Children’s Health and HIV/AIDS, TB and Malaria with special consideration given to achievements in the fields of mobile, broadband, Internet, medical, and pharmaceutical applications.

Among the winners was Bangladesh’s prime minister Sheikh Hasina who received recognition for the use of ICTs in addressing women and children’s healthcare. The government of Bangladesh has made increasing the use and availability of ICTs a priority over the past decade, declaring IT a “thrust” sector and implementing a national ICT policy in 2002. The prime minister has been a catalyst for ICT development in Bangladesh, launching the Digital Bangladesh 2021 program, reducing taxes to make computers and other electronics more affordable, and giving free internet services to schools. This is not the first time she has been recognized for her ICT work in the country. The PM noted during the ceremony that most of Bangladesh’s 11,000 community health clinics have been digitized, allowing for free treatment of diseases like malaria and AIDS and reducing maternal and infant mortality rates.

Use of PDA by the nurses at ICDDRB hospital in Dhaka, Bangladesh

Photo credit: Bytesforall "ICT4Health" Network

Other development agencies and UN-affiliated organizations are also choosing to give awards to those using ICTs to advance public health initiatives. The Elena Pinchuk ANTIAIDS Foundation, rising from the work of UNAIDS High Level Commission on HIV Prevention, has launched a competition to find innovative start up projects that use social media and mobile phones for HIV prevention. The competition is taking applications until October 1st and the winners will receive up to $10,000 to implement one-year projects.

As global health becomes a pressing priority, it is essential to utilize, innovate, and increase access to ICTs within the healthcare sector. The South South awards have set a precedent by recognizing the success of ICT4Health in accelerating the Millennium Development Goals and could encourage Global South countries to follow in the footsteps of nations like Bangladesh.

 

This article by Andrew Quinn originally appeared on Reuters.com.

  A Somali resident purchases a cell-phone handset at a shopping centre in Mogadishu, November 4, 2009.  Credit: Reuters/Feisal Oma

A Somali resident purchases a cell-phone handset at a shopping centre in Mogadishu, November 4, 2009. Credit: Reuters/Feisal Oma

Cell phones may bring relief to famine victims in parts of Somalia controlled by al Shabaab insurgents as donors seek new ways to circumvent the hard-line militants, a senior U.S. official said on Tuesday.

Rajiv Shah, head of the U.S. Agency for International Development, or USAID, said that despite al Shabaab’s ban on foreign aid in regions they control, progress was being made to reach about 2.7 million people desperately in need of help.

“It is difficult to provide large-scale commodity support. Food convoys have been attacked, so we’re trying a number of more innovative approaches,” Shah told Reuters on the sidelines of the U.N. General Assembly in New York.

Cell phone networks and the traditional “hawala” money transfer system used in many Islamic societies are two such routes, Shah said, while aid groups from Gulf Arab countries and elsewhere were also making inroads.

“We’re trying cash distributions through the hawala system and through mobile phones and then concomitantly flooding border markets with food so that traders can then make the connections,” Shah said.

Al Shabaab, a hard-line Islamist group linked to al Qaeda which controls most of the southern part of Somalia, banned food aid last year and kicked many groups out, saying aid creates dependency.

Some 3.7 million Somalis are at risk of starvation in the worst drought in decades, including some 2 million in rebel-held regions were most major aid agencies cannot reach.

Some local agencies are allowed to deliver aid to these areas, but this is not enough for all those who need it.

The rest of Somalia is expected to slide into famine by the end of the year as the drought gripping the Horn of Africa affects more than 13 million people.

Shah said U.S. efforts to improve agricultural techniques and technology in the region, coupled with economic support programs to make local communities more resilient, had helped to prevent the famine from broadening into a wider crisis as it did 1984-85 and again in 1998-2000.

But he said the situation remained critical, and new strategies aimed at enabling people to secure food supplies close to home were aimed at forestalling a broader flood of refugees to already overburdened camps.

“People leaving their communities going on these treks where they almost certainly will be assaulted, robbed, often raped,” Shah said. “The risks of participating in humanitarian action in the place they are is probably considerably lower.”

EXEMPTIONS NOT ENOUGH

The United States in August said it would not invoke anti-terror laws to prosecute nongovernmental groups working in southern Somalia if some aid falls into the hands of al-Shabaab, which is on the official U.S. terror blacklist.

But Shah said the exemptions had had little effect as most foreign aid organizations continued to have almost no safe access to al Shabaab-controlled regions.

The United States has contributed about $600 million to famine relief efforts in the Horn of Africa, more than half the total global response.

But Shah said he was worried that future efforts could be hobbled as U.S. lawmakers try to find a further $1.2-$1.5 trillion in budget cuts to trim the huge U.S. federal deficit.

“I am extraordinarily worried because that would be very counterproductive,” he said, saying a further destabilization of Somalia and strengthening of al-Shabaab could have direct security consequences for the United States.

An image from past share fair

Credit: ShareFair

Agriculture professionals will converge at the Headquarters of the International Fund for Agricultural Development (IFAD) next week in Rome for the 2nd Global Agricultural Knowledge Share Fair.

As I write this, it is days away from kick-off of the 4-day event in Rome from the 26-29 September. With all the excitements that ShareFair brings, participants will be expecting to discover and share new creative and innovative learning and sharing opportunities; and equipping themselves with tools to better influence future agricultural development activities. With the advent of the new information and communication technologies (ICTs), the approach to agricultural knowledge sharing has evolved enabling people of all background to participate and contribute. ShareFairs present unique opportunity for participants to share and discuss the ways in which they have applied new methods of communication and knowledge sharing to improve the effectiveness and impact of their work.

Being the fourth ShareFair and the second of its kind with global focus, participants are expected from all regions of the world with over 160 presenters. This includes farmers, students, academicians, researchers, practitioners, journalists, entrepreneurs, politicians, and policy makers. They will be sharing their knowledge on a variety of rural development and agriculture related topics such as food security, climate change and green innovations, gender, ICTs, mobile technology and social media, new technologies and innovative agricultural and farming practices, markets and private sector, water, livestock, young people, networks and communities of practice. These presentations will take forms such as TedTalks, market place, world café, chat shows, peer assist, fish bowls, and open space.

Knowledge fairs are face-to-face events in which participants set up displays to share their undertakings. Share fairs are interactive events that employ various knowledge sharing formats such as market stalls and booths, and workshops and presentations designed to encourage discussions. They are “free-flowing,” open, flexible, and non-hierarchical. The aims of knowledge share fairs are to provide opportunities for multiple parties to broadcast their achievements, exhibit their products, and market new programs to donors, policymakers, other institutes and potential partners; facilitate face-to-face networking and promote South-North exchange on common agendas; help people benefit from each other’s experiences; and stimulate interest in future collaboration and the development of new programs. ShareFairs can be internal to an organization or open to partners and the public.

Since 2009, the ICT-KM Program of the Consultative Group on International Agricultural Research (CGIAR) has helped organize three Share Fairs: ShareFair 09, Rome; ShareFair Cali, Colombia in May 2010; and AgKnowledge Africa Share Fair, Addis Ababa, Ethiopia October 2010. This fair is being jointly organized by Bioversity International, FAO, IFAD, WFP, CGIAR, and CTA.

To follow events:

Live webcast of the keynote addresses, plenary sessions and sessions to be held in the Italian Conference room and Oval room via: http://sharefair.ifad.org/

Other social media channels include:

Conference hashtag: #sfrome

Twitter: http://twitter.com/sharefairs, http://twitter.com/ifadnews, http://twitter.com/faonews

Blog: http://blog.sharefair.net/ and http://ifad-un.blogspot.com

YouTube: http://www.youtube.com/user/sharefair

Flickr: http://www.flickr.com/groups/sharefair09/

Facebook: http://www.facebook.com/KnowledgeShareFair

“Daily Corriere” – the Share Fair daily newspaper – will feature blogposts, tweets and stories from the event.

Mobile Health Live recently held a live broadcast webinar from Kuala Lumpur to examine the role of mobile operators in the delivery of mobile health services.

The webinar was moderated by Richard Cockle of the GSMA and featured contributions from Claire Margaret Featherstone of Maxis, Irfan Goandal from Qtel, Dr Mubbashir Iftikhar from KPJ Healthcare and Craig Friedrichs from the GSMA.

The panel discussed the opportunities open to operators working within the mobile health sector, and highlighted a number of specific areas of interest where operators can provide tangible benefits to healthcare partners and their patients. According to the panel, support for a stretched public sector and the remote monitoring of patients with lifestyle diseases, such as diabetes and hypertension, are two key services that mobile operators can provide for the mobile health sector

The panel recognised the complex nature of the healthcare industry with multiple stakeholders and country specific regulation affecting local markets and discussed some of the work being undertaken to help facilitate the integration of mobile services into existing value chains.

If you weren’t able to tune in live to the webinar, you can now watch it on demand.

A decade ago, around half of the people in the world’s richest countries had a mobile phone. Mobile penetration in Africa was under 2%. Today there are more than 5.3 billion mobile phone subscriptions globally. Penetration in a number of African countries is now over 40%. More than half of households in majority of developing countries including in rural  areas – have a mobile phone.  Despite the vast outreach of this technology, the potential has not been fully tapped by the public health or tobacco control community.This is due to a number of reasons, the most notable being an absence of well documented studies/demonstration projects to show the population wide impact in a cost effective and sustainable fashion.

For the last six months WHO has been researching the mhealth tobacco control market and looking for possibilities to leverage m health and tobacco control.   The challenge we see are few studies or projects that are currently using mobile phones and tobacco.

The few studies we have found have focused on sms for cessation in developed countries but the results are impressive. From the sms cessation projects in the UK, New Zealand and now the US, we see that using sms for cessation is highly effective. As we know, the spread of tobacco use is moving to the developing world and we could have the same impact in developing countries.

Of course it is not just about individual smoking behaviour and cessation. Our research and outreach has pointed to the possibility of using mobiles for individuals to access quit services, raise awareness and communicate about the dangers of smoking. Mobile networks can give WHO and our partners access to the largest market in the world, this is very important for anti smoking messages which can have a far greater reach than through TV, print or other media campaigns. Mobile phones can be used as a geotagging mechanisms to provide advice on smoke free places and to improve compliance of smoke free laws, to provide a platform for social networking, gaming and competition, and to monitor and collect data on the tobacco epidemic.

With approximately 6 million tobacco attributable deaths very year it is critical that we move quickly, leveraging technology such as mhealth, to build awareness, improve enforcement/compliance of tobacco control laws and to help existing tobacco users to quit.

As the space for tobacco control and mHealth is relatively empty we have a unique opportunity to bring together tobacco control and mHealth players to develop successful interventions that can be used both by developed and developing countries in their tobacco control work. WHO is looking to engage with interested organizations and foundations to partner with us such as mobile associations, telcos, academics, application developers, foundations etc.This is a public health intervention where there is an opportunity for you to develop appropriate public-private partnerships with governments.

We hope that we can connect through this HUB – form new partnerships, share lessons learnt and best practices, validate what works and what doesn’t, monitor existing projects and create new ones, and spread the word on effective mhealth solutions for tobacco. Eventually we plan to create a matrix of population wide cost effective solutions for our member states detailing the top mHealth solutions for tobacco control.
Image credit: Matthias Weinberger (Flickr)

 

Somali women in search of food and shelter

Credit: Associated Press

An 11-year-old Ghanaian schoolboy is spearheading a campaign in support of Somalis after seeing footage of people walking in search for food.

With an ambitious target of $13 million, Andrew Andasi has raised over $4000 for victims of the famine in the Horn of Africa as of August, and is joining the ranks of celebrities such as Lady Gaga, Justin Beiber and Rihanna by using social media to advocate for famine relief. This ability to instantly transmit images and videos on issues as they happen could have a unique impact on disaster response and humanitarian assistance.

Social media (SM), which embodies the emerging online relational tools, methodologies, and applications that allow groups of people to interact with one another by exchanging content, opinion, and insight, continues to have significant impact on awareness creation and dissemination of information in times of emergency. The on-going humanitarian crisis at the Horn of Africa is a testament to how SM could be of immense help in times of disaster.

In addition to the immediacy of SM to responses, the new technologies and applications have shifted power from the hands of the few to the masses. SM has proven to better facilitate two-way communication than the traditional media, and also ensures richer interaction between and among people. It is relatively inexpensive and easily accessible with minimum investment of resources.  SM also by their nature, are very decentralized and less hierarchical thereby providing scale and high capability of reaching a global audience. It requires minimal training, skills and expertise to use.

How is SM being used Differently in this Crisis?

Unlike earthquakes, tsunamis, and tornadoes, famine has a strong human component. Famines happen when countries and regions are not equipped to deal with extremes in weather. Notwithstanding, there have been a number of criticisms with the limited use of SM at the Horn of Africa for awareness creation and fundraising in support of the victims compared to other disasters such as the Haiti earthquake, and Japan tsunami. Examination of the use of SM at the Horn of Africa shows that these applications are progressive rather than instantaneous. Instead of a surge in the number of tweets and SMS messages as seen in natural disasters, there have been proliferation of Facebook groups such as Somalis without Borders for Drought Relief, and Africans Act 4 Africa among others. While several theories have emerged to explain the slow response – the volatile political situation in Somalia; the US debt ceiling; the mobile phone hacking scandals by the News of the World in Britain; and the killings in Norway, it is also important to understand the nature of the disaster – being progressive rather than instantaneous.

Time for Action

In July, the United Nations (UN) officially declared a famine in two regions of southern Somalia and this has extended to five regions in August. Over ten million people across the Eastern Horn of Africa are now suffering from one of the worst food crisis the world has seen in decades – United Nations World Food Program (WFP).

But the time now is for action – emergency rather than accusation. “We need the contributions of caring individuals here in the United States and around the world…we have seen this in previous crises, from the Indian Ocean tsunami in 2004 to the earthquake in Haiti; individual donations can have a tremendous impact” Said the US Secretary of State. This is why we need the power of social media. The active utilization of the new ICTs and SM for disaster response continues to improve over the years. Celebrities across the world are tapping into the magic of SM to garner support for innocent women and children. For the past few months, several news headlines have appeared showing how SM is reaching out to the public about the problem and also soliciting support for the people.

Simply capturing and transmitting images and videos that other people have posted could have a significant impact on ordinary citizens like Andrew Andasi to take action – that is the potential power of SM.

As the global health community gears up for the upcoming  United Nations High-Level Summit on non-communicable disease (NCDs), I thought it would be useful to explore the ways in which mobile technology can play a role in the efforts to reduce the burden of NCDs globally.  NCDs include cardio-vascular disease, diabetes, cancer, and chronic respiratory diseases. The combined impact of these diseases contributes substantially to global poverty rates and places strain on healthcare systems worldwide.

With a growing urban population and lifestyle changes, particularly in diets where fast foods have become a greater part of the local diet, obesity and diabetes rates tend to grow rapidly.  NCD rates are frequently driven by the combination of lifestyle changes and environmental shifts and require more innovative thinking around behavioral change and social movements in order to make long-term changes.

mHealth applications for NCDs are already quite common in parts of the world where diabetes rates, in particular, are high. This can be found in personalize-able mobile applications such as Glucose Buddy, or in social media campaigns such as TuAnalyze, which uses Twitter to drive higher compliance rates for hemoglobin A1c testing (a bit of a gold-standard when it comes to diabetes care).

Beyond diabetes, there are NCD prevention applications, such as the anti-smoking Text2Quit, demonstrating the potential to find interventions with the capacity to scale into national campaigns. On the respiratory disease front, Asthmapolis, is an innovative approach that combines sensors with mapping to track the contexts in which people with asthma use their inhalers and furthers our public health understanding of asthma and the environment. Tracking programs that enable dieters to monitor food intake and exercise can be effective tools for fighting obesity and cardio-vascular disease.

In order to realize the full potential of mobiles, however, we should take a few cues from the recent mass mobilizations and social movements in the Middle East where Facebook and Twitter were utilized to facilitate social change movements in Egypt and Tunisia.

Similarly, long-term efforts at prevention in public health have rarely succeeded without complementary sustained social movements that reduce the social barriers to behavioral change and create stronger enabling environments for personal lifestyle changes to succeed. This could include more walkable cities, better access to health foods, and changing environmental drivers that affect cardiovascular diseases and respiratory health outcomes.

We’ll likely need to move beyond the “app for that” ethos to engaging with social networks and technology in ways that can promote both well-being and the underlying social transformations required to sustain behavioral change in a health landscape that must navigate a long-term global financial crisis where resources are in short supply.

On paper? Online? On smartphone apps? Via SMS or voice?

This 89 pages mhGAP-IG is issued in 2010 and now available in several languages. The guide consists of decision trees for the most important psychiatric conditions.

1. Use of paper versions:

Reading: Additional shipping and transport costs can be a hurdle in low and middle income countries (LMIC). One can download the guide from the WHO website, but then one faces the high costs of (color) print and copies.

Training: Face2face trainings seem the most ideal option, but the in most LMIC there is a shortage of health tutors. And a face2face training necessitates the movement of the health worker away from the field, which interrupts the delivery of services and is expensive.

2. With the internet/desktop/laptop:

Reading: Distribution on CDs is cheap. Online reading offers also the use of go-to tabs, notes storage, information charts and a find-utility. The main disadvantages of internet/computer is the constant need of a computer nearby and standby, which is a rarity in most LMIC.

Training: Beside the benefits of no travel and no interruption of the daily work, the internet gives health workers also the opportunity to study on own pace and preferred time.

3. With mobile apps on smartphones:

Reading: Smartphones can have a high added value for previously unconnected people. Smartphone prizes drop and they are growing in popularity in LMIC. The guide can be read on an app.

Training: Education via a smartphone apps offers the same benefits as the internet learning, like nice attractive tools and designs. The extra advantages are the pocket format; easy taking it with you.

4. With mobile phones (no wireless internet):

Reading: Service in developing countries will rely heavily on text messaging and voice in the years ahead. One can convey parts of the guide by SMS or voice, piece by piece, or certain parts on request. One can even run an automated SMS reply manager.

Training: Conducting a training in the mhGAP-IG solely by mobile phones is possible, but only an option of one really can’t reach the health worker via another channel.

Conclusions and recommendations:

-Not one of the 4 distribution channels is the best of all, so create materials in all 4

-Concert international and implement what’s most suitable on a local level

-Connect and cooperate with innovators in LMIC

-Look for creative funding channels, including NGOs and telecom providers

-Learn, lend and copy from other health fields, which are a long way ahead in technical innovations.

Full article with links and examples on the in2mentalhealth website 

Closeup of a digital blood glucose meter reading

As a person living with type 1 diabetes, technology has been a medical part of my daily life for more than ten years. Diabetes is largely a self-managed disease, meaning that the person living with diabetes must manage the day-to-day balance between severe short-term effects and equally severe long-term effects. Technology can be a great help in this – in the last ten years I’ve tried at least about ten different types of blood glucose meters, four different insulin pumps, and I am always wearing a continuous glucose monitor.

I’ve also tried some of the mobile apps available to assist with diabetes management – tracking blood glucose levels, calculating carbohydrate and the amount of insulin to take with each meal, recording exercise events and so much more. I know I’m not the only one who has tried these devices; when technology plays a part in your own chronic disease management, you tend to incorporate technology from non-medical devices as well.

It should be no surprise to me, then, that a popular Twitter Chat group organized as Diabetes Social Media Advocates, or #dsma, recently devoted an entire hour-long discussion to the topic of mHealth earlier this month. Questions ranged from “What would you like your mobile device to help you with managing your diabetes?” to “What are your thoughts on the FDA regulating mobile apps that uses platforms for medical device functions?”

The answers were all over the place – some people weren’t interested in using their mobile phones for anything but making calls and receiving email, others wanted to see all of their devices, including medical devices and mobile phones, have the ability to communicate with one another. One person even said that he’d love a phone that could take a picture of a meal and estimate the amount of carbohydrate for you. Initially he was joking, but someone quickly told him that that function is in development, although struggling with accuracy right now.

Of all the topics and crazy ideas that came up, only one question received consensus: “Does mHealth have the potential to change the way we take care of our health or manage diabetes?” Everyone answered yes. But these are all smartphone-owning, diabetes-tweeting, tech-savvy folks. What about the rest of the 346 million people with diabetes around the world?

A quick check at the HUB Database will show you that 15 technologies, programs, and organizations have contributed to the database and tagged diabetes. Some focus on medication reminders, others provide vital information to health care workers. One program even developed a game-like system that monitors interaction with a virtual pet to let friends or relatives know that the person is active – allowing more opportunity for an independent lifestyle.

This is one of the great aspects of mHeatlh: it focuses on the health problems and identifies innovative solutions. Not remembering to take your meds? Your phone can help! Not checking in with your loved ones despite the fact you could fall into a coma? Your digital pet can help! In this day and age, when 70% of mobile phone subscriptions are in developing countries, phones can be seen as health tools – especially for those of us with self-managed diseases.

 


 

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