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m-Health – The Next Frontier Of Medicine In Pakistan

Our Thinking

Health Care For The Next Billion People

by Umair Mohsin
Published Daily Dawn – Sunday, May 24th, 2009

CAN new technologies help to tackle the health problems of the world’s poorest people? It seems such a silly question. After all, the public-health systems in much of sub-Saharan Africa and parts of Asia and Latin America are rudimentary at best. With many villages having no clean water or basic sanitation, let alone reliable access to clinics and doctors, modern wizardry like molecular diagnostics and digital medical records seem irrelevant.

Not only this, such nations which also include Pakistan also face infrastructural, awareness & resource crunches including non availability of timely medical information or guidance, lack of mass awareness of various issues, accessibility, lack of basic facilities, lack of regulation which leads to quackery & fake medicines, lack of affordable health care, lack of monitoring & feedback mechanisms. Epidemics and a shortage of healthcare workers also continue to present grave challenges for the government and health providers.

Yet increasingly, the ubiquitous & increasingly smarter mobile phone is becoming the de facto choice for providing access to quality health care even for the world’s most remote and resource poor environments and there is a growing body of evidence that is demonstrating the potential of mobile communications to radically improve healthcare services. The field of mHealth – the transmitting & enabling of various eHealth data contents & services using wireless technologies – is set to boom.

The Case For m-Health
Pakistan spends less than one percent of its GNP on health in public sector which is one of the lowest in the world. Healthy people are a prerequisite for economic and social development and building nations on weak foundations is hard e.g. the infant mortality rate of live births is still high for a country at the stage where Pakistan is. The major killers in children are pneumonia and diarrhea, whilst the complication of pregnancy in women of child bearing age is very common. For those who survive malaria, tuberculosis and drug abuse continue to be a potential threat, whilst communicable, infectious and parasitic diseases remain to be a severe burden. Less than 43% of women have proper antenatal care, whilst only 15% receive post-natal care. 38% of the women are undernourished. We are plagued by inadequate primary health care, high rates of population growth, prevalence of communicable diseases, lack of awareness, managerial deficiencies, inadequacy of funding and trained manpower and centralized administrative and financial powers.

Thus the mobile communication explosion has the potential to improve health service delivery on a massive scale. With low-cost handsets and the penetration of mobile phone networks into the most remote regions of our country, tens of millions of citizens that never had regular access to a fixed-line telephone or computer now use mobile devices as daily tools for communication (80 million mobile connections to around 7 million WLL & fixed lines). This growing ubiquity of mobile phones is a central element in the promise of mobile technologies for health. For example, mobile technology can support increasingly inclusive health systems by enabling health workers to provide real-time health information and diagnoses in rural and marginalized areas where health services are often scarce or absent altogether. Among those who had previously been left behind by the ‘digital divide,’ millions now have access to reliable technology.

m-Health Projects In Pakistan
Though the mHealth field is still in its early stages, it has already begun to transform health delivery. Projects throughout the developing world are demonstrating concrete benefits, including:
• Increased access to healthcare and health-related information, particularly for hard-to-reach populations
• Improved ability to diagnose and track diseases
• Timelier, more actionable public health information
• Expanded access to ongoing medical education and training for health workers

In Pakistan, there are a host of companies working in this area, two amongst them are Healthline & Phonecast.

Health-Line: Communication and Training for Healthcare Workers
An acute shortage of healthcare workers is a major challenge facing our country’s health sectors. Community health workers in developing countries are often trained only for a few months before they begin providing health services, and have a great need to access updated and reliable health information. Training new cadres of health professionals and empowering current workers, as well as connecting health workers with sources of information via mobile technology is a strong basis for empowerment, as it provides the support they need to perform their functions effectively and self-sufficiently.

The HealthLine project’s goal is to specifically target this need. They have designed an information access system specifically for such health workers, which they can call any time, toll-free, from any cell phone or landline. Through a spoken conversation with the system in their native language, they are able to learn more and/or fill in any health information gaps that they may have. This in turn enables them to provide better health services to their community. HealthLine is a collaborative research project involving Carnegie Mellon University (Pittsburgh, PA), Agha Khan University (Karachi, Pakistan) and the Health & Nutrition Development Society (Karachi, Pakistan).

PhoneCast’s CallDOC – Diagnostics and Treatment Support
Diagnostics and treatment support are vitally important in healthcare—misdiagnosis or the inability to diagnose a condition could have serious, even fatal, ramifications. Given that upto70% of the health cases in Pakistan can be handled with first-level support, CallDoc in partnership with Pakistan Medical Association, has taken the step and their applications in this area are designed to provide diagnosis and treatment advice to remote patients through wireless access to medical staff and a subsequent connection to professional health workers certified by PMA. CallDoc’s diagnostic and treatment applications use the phone as a point-of-care device. Health workers will leads the patient through a step-by step diagnostic process. Once data are entered into the system, remote medical professionals can diagnose the illness and prescribe treatment or recommend the patient to a PMA certified doctor close by.

CallDoc is a 24/7 Tele-health information and consultancy service thus patients are able to receive treatment in their villages and homes, averting the need for expensive hospital visits, which are beyond reach for many. As pilot CallDoc is working with John Hopkins and USAID on their Pakistan Initiative for Mothercare And Newborn ( PAIMAN) headed by its Chief of Party Dr Nabeela Ali, by operating a 13 district support through a combination of mhealth and e- health based Call Center from Karachi for 13 districts to provide first level support and referral for Maternal and Newborn deaths and complications. This operation is first of its kind for a bid to save the death of 37,000 young mothers every year during the pregnancy related issues and to prevent the severe complications among the 400,000 mothers every year during their pregnancy stages. CallDoc project is also being supported through initiatives by Asian Development Bank and Ministry of Finance.

Mr. Abdullah Butt, CEO of PhoneCast Said “ By eliminating the need for patient travel, our applications have the potential to dramatically increase access to care. Our network will provide basic, affordable, timely and genuine first level medical support and referral to the nearest health facility on figure tip of millions of Pakistanis through mhealth for achieving the millennium goal objectives, which has not been possible since the inception of Pakistan”, we are working on setting up the largest mhealth facility in Pakistan very shortly, through a combination of multimedia based telemedicine and mobile technology platform.

M-Health Future:
A recent report funded by the UN Foundation and the Vodafone Foundation, two charities, documented more than four dozen projects in m-health across the developing world in Education & Awareness, Remote Data Collection, Disease & Outbreak Epidemic Tracking and Remote Monitoring.

In Uganda, Text to Change uses an SMS-based quiz to raise awareness among phone users about HIV/AIDS that brought a 40% increase in the number of people getting tested. A study in Thailand in 2007 showed that compliance with a drug regimen to tackle TB jumped to over 90% when patients were sent daily text reminders to take their pills on time.

The field of mHealth is at an inflection point. With dozens of projects implemented and proven benefits, all trends indicate that investment will continue and mHealth projects will serve an ever wider range of constituents in the years ahead. At the same time, technological innovations will bring enhanced benefits, particularly in the areas of data collection, patient monitoring, and remote diagnostic and treatment support, where application development is already proceeding at breakneck speed.

So should the poor be given access to new technology? Bill Gates was one of the people who used to be on the side of the skeptics. Nearly a decade ago, he delivered a speech at a conference on technology for the developing world, inveighing against the idea that modern technologies like satellite communications links, solar power and internet-enabled computers could magically improve the lives of the poorest. Did they have any idea, he asked his listeners, what it meant to live on less than $1 a day? “You’re just buying food, you’re trying to stay alive.” His decade’s experience with his foundation’s work in public health seemed to have changed his mind however about what is good for the developing world. He now says that “poor people absolutely deserve better technology.”