Day 2 at the mHealth summit can be summed up by one word: failure. A session on maternal and child health in Africa offers opportunities in which participants might learn from past mistakes.
Dr. Koku Awoonor-Williams discussed the Mobile Technology for Community Health (MoTeCH) project in Ghana; a collaboration between the Ghana Health Service, Columbia University and the Grameen Foundation, he told a story that was also shared at the World Bank’s FailFaire. The preparation for the project seemingly had all of the elements needed for a successful pilot. A survey found that 80% of households had access to a mobile phone, making it ideal for implementing a mobile-based health intervention.
Using a snazzy randomized control trial, the program sought to determine if mobile-phone-based health information can improve outcomes and information collection. The trial was to focus on pregnant and new parents by providing weekly messages in the language and format (sms vs voice) chosen by the client. Health workers in the trial used the phones to collect patient data.
The trial came back with surprising results about the clients and the health workers. Despite the survey saying that the majority of women had access to mobile phones, the truth was that the men largely had control meaning that women were not seeing the messages. The health workers were a bit more mixed. They liked the simplification of the process, but problems arose when they did not complete all parts of the reports.
What the trial captured was a failure that will lead to an improved intervention; though it does highlight one of the challenges on the ground when it comes to ICTs. There are plenty of big statistics about mobile phone use and penetration in Africa, but those numbers do not capture levels of access among users.
Study Design Failure
In the same panel, head of D-Tree International Marc Mitchell spoke of a trial to determine of a mobile phone based Integrated Management of Childhood Illness (IMCI) was better than the traditional paper based. The trail split 18 health centers in Tanzania into a control and treatment group. The control group was to continue following the standard paper-based IMCI while the treatment group were given an hour training in using mobile phone-based IMCI application. Mitchell shared results that pointed towards the mobile phone intervention being used more correctly by health workers and improved outcomes for patients.
What this proves is that the treatment group had improved outcomes, but the cause is not quite clear. One person asked Mitchell if it may have been the additional training that led to an improved understanding of implementing IMCI. Could the phone be the incentive to act? Mitchell deferred on the question saying that he would talk with the individual on the side, so the rest of the attendees were unable to know the answer to the question.
The interaction drove home one of shortcomings of mHealth research. Even when there is impeccable design, the research is often limited to small groups of people in a single region. The results make it hard to understand how this can be translated to national plans in a given country.
It is where interaction with practitioners is necessary. These studies do not capture outside influences like when a government strikes a deal with a telecoms company and are forced to use a single network. They do not take into account when an NGO is donated hundreds of phones and then must implement mobile programs on the donated device. Such variances are not going to be captured in a small well-executed study.
Failure to Fail
This round up should end on a high note, because this has been a great conference so far. The summit has pulled together a diverse group that will support the growth of mHealth. As I write this, I am sitting in on a panel that looks critically gathering evidence to know more about mHealth. The growth of the conference in three years from 300 to 3,000 is a sign of the growing sector. Innovations that are here in the National Harbor and others designed in the field right now will help to close the gap in health services around the world.