Last week (June 19th) I attended, on behalf of HIFA, a seminar in London entitled: “Apps, maps and cyber chats: how technology can be harnessed for global health“, organised by the Royal College of Physicians and the Alma Mata Global Health Network. This seminar, which was attended by about 40 people and chaired by Dr Caroline Free from the London School of Hygiene and Tropical Medicine, was to explore how technological innovations can be employed in low-resource settings to address global health issues.

Discussion was led by a panel comprising:

– Chris Phillips, MapAction (specialist in provision of geographical information systems in emergency situations)

– Dr Tariq Sadiq, St. George’s University/eSTI2 Consortium ( director of eSTI2 – electronic self-testing instruments for sexually transmitted infections) ;

– Alan Hardiman, T-Systems (manager, telemedicine and tele-health solutions)

– Dr Susie Whitwell, Medicine Africa (mental health lead for the King’s-THET-Somaliland Partnership )

Key points from the discussion included: 

Access

– Mobile phones were becoming widespread even in remote areas and already being used in imaginative ways (e.g. banking) and mobile health apps were beginning to spread

– For financial sustainability in the developing world mHealth applications will need to be “at cost”  – similar to essential drugs

– Need to guard against risk of widening health inequalities– technology is not always the answer – keep things simple!

Efficacy

– The technology needed to be tailored to the situation e.g. a maternal health application had originally intended to use text messaging but switched to voice messaging when participant literacy levels were checked

– “Gameification” has proved useful in getting messages across

Developments

– There were exciting developments in the pipeline e.g. on use of mobile phones as part of a “lab on a chip” package for rapid diagnosis of TB, malaria etc.

– Distance learning in health care was a potential growth area – useful interaction  between mLearning and mHealth

– In recent years some applications, like disaster mapping using mobiles, have moved from “nice to have”  to “must have”

– Offline applications had lots of potential, especially now storage capacity was rapidly increasing, although issues of updating and data security would need addressing

Scaling up 

– Some mHealth applications, e.g. smoking cessation, started in high income countries but are now being used in middle and low income ones

– Difficulties in scaling up pilots were sometimes owing to technical issues such as lack of access to smartphones but often because funding is available only for short pilots

– Another problem with scaling up is that people do not pay sufficient regard to getting key people on side – attention has to be paid to local and national politics

Privacy and other legal issues 

– Security of private health-related information was an issue, although many users e.g. younger people were less concerned about this than is often assumed; danger of seeking to impose western views on this

– Some development was being slowed by fears of legal action if an application leads to a wrong diagnosis

– Corporate ownership of software was a problem in developing countries – although open source software was becoming more used

Evaluation

– There was a potential problem with indiscriminate use of unevaluated information – there was a case for regulation or at least for giving health workers help in critical appraisal

– Similarly there was a potential problem in using software applications that had not been properly evaluated.

– Funding was often not available for longer evaluation studies

– However, evaluations often needed to be rapid to avoid being left behind by rapidly advancing technology, although functions (like text messaging) changed more slowly than devices

HIFA colleagues will be pleased hear that seminar participants showed lively interest in our work, including of course the mHIFA challenge, and many took away with them further information about the HIFA network.

Regards, Geoff Royston

HIFA profile: Geoff Royston is former Head of Strategic Analysis and Operational Research in the Department of Health for England and is currently President-Elect of the UK Operational Research Society. He has had a range of activities and responsibilities involving analysis and research to inform the design, implementation and evaluation of evidence-based policies and programmes in health and social care. These include modelling for understanding the performance of complex systems, analysis and communication of risk, and horizon scanning and futures thinking. He has also worked on information and communication technology in the health sector, notably in leading the design and national launch of NHS Direct.  He has served on both scientific and medical UK Research Council panels and is a member of the editorial board for the journal Health Care Management Science, for which he was Guest Editor for the Special Issue on Global Health published in 2012.  He has been a consultant for the World Health Organisation on the use of information and analysis to improve the management of healthcare and population health.