Beyond domestic health policy

While TDI is a key player in domestic health care reform debates, and thought-leaders here often focus on comparisons between the U.S. healthcare system and those in other developed nations, healthcare policy and practice in developing nations receives attention as well. For example, we've had speakers lecture on the health traumas facing Sudanese refugees, the ongoing threat of HIV/AIDS in sub-Saharan Africa, and the issue of chronic diseases compounding infectious disease burden in many developing nations.

A number of students built on these lectures by focusing thesis projects on health issues in developing countries. One paper looked at primary care in Afghanistan, another studied HIV/AIDS patients in Ethiopia. Although I focused my thesis on domestic issues, I'm interested in financially feasible solutions to health issues, and a number of health programs in developing nations have recently piqued my interest. I find mHealth initiatives particularly compelling. (As does the United Nations. Check out their report on mHealth projects in developing nations.)

For some of us, using mobile health technology means perusing WebMD on an iPhone in search of a suitably severe – but not too nasty – affliction that will explain an absence from work. In developing nations, a number of projects combine cell phones and health care resources for very different reasons. Indeed, mobile health (mHealth) technology initiatives are helping patients in these countries return to work, avoid disease, and maximize limited health care resources.

Project Masilueke is an example. The mHealth initiative fights HIV/AIDS in South Africa by sending text message reminders of scheduled clinic appointments. Planned developments include “virtual call centers” with highly-adherent HIV+ patients advising others on medication regimens. Early patient outcomes are positive. A beta test showed that the project helped triple call volume at an HIV/AIDS helpline. In a country where HIV prevalence is estimated at 25% but only 3% knows their status, Project Masilueke promises notable improvements in patient health.

Along with individual patients, mHealth initiatives also benefit other stakeholders. These include private corporations. Among the supporters of Project Masilueke, Nokia lends telecommunications services, and National Geographic is documenting the initiative. These corporate entities stand to gain subscribers, licensing revenues, and brand recognition. With the large and growing population of mobile phone users in the developing world – South Africa has nearly 100% penetration – the potential for scaling and profit will continue attracting corporate interest in mHealth, and mobile phones will continue to help some play hooky and others save lives.

The U.N. report also lists other stakeholders that benefit from mHealth projects. These include:

Stakeholder - Benefit
Patient (Mobile Subscriber) - Improved health outcomes
Health Care Provider - More efficient and effective delivery of services
NGO - Advance organizational mission, attract funding
Foundations - Advance organizational mission
Government - More efficient health care provision, more effective government
Equipment Provider - Device revenue generation, improved brand recognition
Service Provider - Revenue from service fees, increased subscriber base
Application Solutions Provider - Revenue from additional applications license fees
Content Management - Increase in volume of readership or revenue
Platform Provider - Revenue from sales

-Sam W.