Published byAnnette Gerritsen
Published on15 March 2017
“In the world we live in, cross-pollination is more important than ever,” said Maud Olofsson, former Swedish Deputy Prime Minister. “We have a crucial role to play to open borders for new ideas and new relationships. We need new energy to change the world.”
“Currently politicians don’t know the possibilities in mHealth,” continued Olofsson. “You have to explain the social and economic benefits of changing the system to them.”
Olofsson was speaking at the fifth STIAS-Wallenberg Roundtable held in February which focused on image-based mobile technologies to improve access and equity in health care. The event attracted over 60 participants from 16 countries and provided an opportunity for cross-sectoral and cross-disciplinary discussions and networking. The emphasis was on finding solutions and mapping out a future rather than focusing on obstacles and barriers. The Roundtable brought together representatives from the clinical, research, policy, business, media and social sectors.
Sessions ranged from overviews of the landscape; unpacking the practical experiences of using mHealth in clinical settings; how to overcome challenges in implementation; barriers and facilitators; and, the need for leadership and change agents.
“Health care is a complex ecosystem,” said Shiletsi Makhofane of Ericsson South Africa. “Policy is the key enabler. mHealth must not be sector wise or isolated. It must empower people.”
The emphasis throughout was on the need to focus on the end user; to move away from endless pilot studies to scale up of successful interventions; for appropriate policy and regulation including data safety and patient protection; and, to ensure that issues of cost and access don’t further divide the world.
“Everyone talks about mHealth but no one really understands what it means,” said Mohammed Dalwai, COO of Essential EMGuidance. “We are suffering from ‘pilotitis’ and need to start studying the clinical impact and scaling up. Projects don’t reach scale up due to regulatory, technology and user-related issues.” Dalwai pointed to the need in South Africa for a government mHealth body; a national eHealth strategy; and, stakeholder engagement. “We also need to create sustainable revenue models and design apps with usability in mind,” he continued. “One size doesn’t fit all.”
Eddie Mukooyo of the Ugandan Ministry of Health pointed to the unprecedented growth in mobile access. “More Africans have phones than toilets,” he said. “But we must ensure than patient centredness and equity provide the framework – user acceptability is central.”
Speaking specifically about the Ebola crisis Ousmane Ly, Director General for eHealth in the Mali Ministry of Health pointed out that ICT played a substantial role in the emergency response. “However, the challenge is sustainability,” he said. “Many of the tools developed during the outbreak are not used anymore.”
Challenges on the ground highlighted by nurses Halima Adam and John Bosco Kamugisha from Uganda – included regulatory and policy barriers; cost, internet accessibility and airtime; power shortages; lack of training; use of personal phones and safety issues around phones; data accuracy and security.
“Staring blindly at a technology to solve a problem is not the way to go,” said Debré Barrett, Product developer of the Vula App. “It’s important to speak to users during the design process.”
“Just because you can do something using mHealth doesn’t mean you should,” added Lee Wallis of the African Federation of Emergency Medicine. “We must be guided by the burden of disease.”
Generating a roadmap
Small group and plenary discussions focused on key questions, namely:
- How should the most important barriers to the implementation of image-based mHealth in the clinical setting be overcome?
- How can frontline health care workers be enabled to adopt image-based mHealth in their practice?
- Which are the key strategies to overcome organisational challenges to the implementation of image-based mHealth within the health sector?
- Which are the key strategies to overcome technical challenges in implementing image-based mHealth within the health sector?
- For each category of stakeholders represented, what are the most important priorities to build and sustain leadership in mHealth?
These generated statements which were prioritised by voting in the final session. The results will be compiled into a Roadmap for the implementation, expansion and up-scaling of image-based mHealth in resource-constrained settings. In addition, the Roundtable will lead to a special issue of the journal Global Health Action devoted to mHealth. Many of the high-profile participants were also interviewed and these interviews will be disseminated further.
mHealth as the new normal
Speaking of the future possibilities, Jan Gulliksen of KTH Royal Institute of Technology Sweden emphasised: “We should be striving for societal digitisation. Not just developing technologies for context but changing the context. It means increasing skills for a digital society not increasing digital skills. The end users are the biggest innovators and we must engage citizens in research.”
Continuing on this theme Sara Aulin, Economic Counsellor of the Swedish Embassy said: “Only our imagination sets the limits for what mHealth could become”.
“Up to 80% of communication in future will be image based. Low-cost image-based diagnostics show great promise,” said Johan Lundin of the University of Helsinki. “Adding in artificial intelligence will change the face of mobile diagnostics.”
Isaac Bogosh of the University of Toronto cautioned, however, about the need for quality. “The goal of mobile microscopy must be to deliver equitable health care by bringing quality laboratory diagnosis to low-resource settings,” he said. “We need more validation research in real-world settings. The cost of the device is trivial as long as it is robust, has sufficient optics and is designed for efficient throughput. We must resist the urge to build the cheapest microscopes that sacrifice image quality.”
“We need to focus on fewer apps and those that can go viral,” added Stefan Fölster of the Swedish Royal Institute of Technology. He outlined four criteria that make this possible – there should be no extra cost for the end user (so not all apps should rely on smartphones); the adopting agency should be able to recoup the costs; mHealth should not raise costs by raising demand more than the cost savings allow; and, there shouldn’t be duplication of other mHealth investments.
“It’s important to look for technology leaps, for example, artificial intelligence and systems that learn along the way,” he added.