Contributed by Kati Wilkins
As information and communication technology (ICT) becomes more prevalent in low and middle-income countries (LMICs), both lay users and medical professionals are finding new and innovative ways to incorporate mobile health (mHealth) and electronic health (eHealth) tools into their everyday lives. However, few regulations exist around the development and use of these tools. Additionally, data on how they are used is hard to find. This leaves many experts to wonder what are the major challenges facing users and patients, and how can we best protect them from possible abuse, misinformation and/or inequalities?
At the Fourth Global Symposium for Health Systems Research (HSR2016) in Vancouver, Canada, in November, the Impact Initiative hosted a panel discussion titled “Opportunities and challenges: integrating mHealth into low and middle income health systems.” Panelists were invited to tackle these questions and to give their input based on the research they have done in the field.
Chaired by Gerry Bloom, Institute of Development Studies, the session explored ICT and health research in Africa and Asia, engaging health systems and development experts in conversation about mHealth futures.
- Sabrina Rasheed, Associate Scientist, International Centre for Diarrheal Disease Research, Bangladesh (Icddr,b), Bangladesh
- Simon Mariwah, Head of Department, Geography and Regional Planning, University of the Cape Coast, Ghana
- Alain Labrique, John Hopkins Bloomberg School of Public Health, USA
- Kate Hampshire, Reader in Anthropology, Durham University, UK (pictured below).
Picture: Vivienne Benson/IDS. The Impact Initiative at HSR2016
Quality of information?
One of the major concerns regarding the use of mHealth and eHealth is the lack of quality control of the information that patients may be receiving. According to Simon Mariwah, many young people in his study use the internet to look up information about their health. However, there is no control over who qualifies as a doctor or who can put health information online, including posting untested or false remedies, which can lead to increased use of medications or worse health outcomes.
These problems are exacerbated by widespread health illiteracy. Use of poor quality health information is especially problematic in areas with limited access to health care or where trust in health care providers has been eroded, particularly in rural areas, where people may rely on the internet and TV or radio stations to provide information about their health in lieu of a doctor.
Clearly there is a need for training to increase health literacy, and to improve the quality of information online. However data on these indicators is lacking, and there are questions about how to create and enforce regulations around who can post health information and how it’s used.
Lack of knowledge or training
Even when eHealth and mHealth is being used by healthcare practitioners, training can be inconsistent or non-existent, leading to under-use of ICTs for health. When looking at community health workers (CHWs) in Africa, for example, many rely heavily on mobile phones throughout the course of their daily work. However, Dr. Kate Hampshire found that many of the CHWs in her study were not using mHealth for healthcare purposes. Rather, they are using it to support their work, such as calling their doctors in the case of emergencies, or as a tool for patients to get in touch with the CHWs. When they are using their phones for health, they tend to use Google or social media to look up information, similar to how patients use eHealth. Most eHealth and mHealth is used by health care practitioner's own initiative, rather than through formal training in ICTs for health. Considering that many CHWs view mobile phones in particular as critical to their work, more training is needed in the tools and uses of mHealth and eHealth.
Mobile and internet enabled technologies are becoming more widespread throughout many LMICs, and can be found in a number of different arenas, including health. However, growth has not been uniform, with the majority of users being young, urban and higher income, explained Dr Rasheed.
Guidelines or regulations at the local, national or global level are limited. It’s becoming clear that the healthcare sectors in many countries have done little to either influence this shift or to gather data on its impact on health, which means developing policies can be difficult. However, there are groups that are working on changing this, including the Johns Hopkins Bloomberg School of Public Health, which has recently convened the first meeting to develop guidelines on the use of mHealth. Alain Labrique emphasised the importance of understanding that ICTs for health exist as an ecosystem, and should not be lumped together as a single tool or technology in guideline or regulation development. This is particularly important as eHealth and mHealth continue to scale, especially in places where formal health care systems are lacking.
Understanding how different technologies are used and interact with existing health interventions is critical to developing effective regulations which are patient centered. Countries such as Bangladesh, which has a mandate to synthesize mobile health into their health policy, can be seen as case studies for policy makers.
Future opportunities and challenges
It’s becoming quite clear that ICT for health is going to continue to scale with or without the health systems community’s input. In order to ensure that more patients and practitioners are using ICTs for health appropriately and safely, however, requires the health systems community to embrace the new reality moving forward.
There have already been some promising examples of countries taking the lead in incorporating ICTs for health into their health agenda. Bangladesh, for example, has developed a mandate to synthesize mobile health into their healthcare system, as mentioned above. Widespread use is still uncommon, however, and generally is more widespread amongst youth and the rich. Focus on improving knowledge and access, as well as the quality of both information available to patients and practitioners, and the data available on use of ICTs for health will help ensure that patients are protected. However, questions remain about how to ensure data remains private and secure, especially once interventions begin to scale.
Overall, no one is sure what the widespread use of ICT means for health, but this leads to many opportunities to provide healthcare to patients in innovative ways. However, it is also important to protect patients from misinformation, exploitation and potential fraud or other abuses.
Related news, resources and blogs:
- News: Strengthening health systems - Impact Initiative at the HSR2016
- Blog: Gender, leadership and governance: what did we learn from the World Health Summit?
- Blog: What does a decade of social sciences research tell us about health?
- Key Issues Guide on Inequality in Access to Health Services