We are now entering an era of connected health in which digital technologies including mobile health technologies (mHealth) are making the process of providing care more efficient, solving some of the challenges facing healthcare and improving clinical outcomes worldwide. Today, healthcare providers are using mobile health technologies to access clinical information, collaborate with teams, communicate with patients and peers, monitor patients in real-time and provide health care remotely. At the same time, patients are using mobile health technologies to track their own health, access their medical records and communicate with their healthcare providers.
In maternal and child health specifically, mobile technology has made it so much easier for women to manage their pregnancies. There are a host of applications that allow women to track their ovulation cycles, track their baby’s growth milestones, calculate due dates, set appointment reminders, receive health tips and access information on nearly all aspects of pregnancy and child birth like nutrition, prenatal and postnatal classes, medications and breastfeeding, to name a few. There are also apps through which you can directly send a message to a doctor or a pregnancy expert and have your queries addressed without having to physically go and see your provider.
mHealth has also made it possible to reach vulnerable women living in inaccessible and underserved areas who were earlier difficult to reach. It is a simple, low-cost solution to deliver important health messages, evaluate and monitor quality of services provided at the primary healthcare level and improve reporting mechanisms. This is especially important in a country like India where maternal, newborn and child mortality is so high.
Frontline workers (FLWs) like ASHAs, Anganwadi workers and auxiliary nurse midwives are being trained to use mHealth to monitor the nutritional status of women and children like tracking whether mothers are taking their iron and folic acid tablets and monitoring their weight especially during pregnancy. The Mobile Alliance for Maternal Action (MAMA) is a public-private partnership that delivers vital health messages to new and expectant mothers in developing countries via their mobile phones. Under BBC Media Action’s Kilkari project (part of the Ananya programme), a mobile voice message service delivers weekly messages to families in Bihar about pregnancy, family planning, nutrition, childbirth and maternal and child care. Continuum of Care Services (CCS) is a collaborative effort of CARE India, Dimagi, and Grameen Foundation under which FLWs use mobile applications to monitor patients during the critical 1000-day window from the beginning of pregnancy through the child’s second year of age and deliver messages according to the needs in different stage of pregnancy, delivery, post-delivery and newborn care. Last year, the government of Uttar Pradesh launched a mobile app M-Sehat in the state to record maternal and infant data in real-time. And more recently, the Ministry of Health and Family Welfare launched an application called ANMOL that allows ANMs to enter and update data for beneficiaries of their jurisdiction. This will ensure more prompt entry and data updation.
While mHealth is improving outcomes across medical specialties, it also poses certain concerns we need to be careful about. From a provider perspective, protecting patient privacy becomes more difficult with mobile technologies. Several apps allow users to post information anonymously and not all the information out there is credible or factually correct. There exists a risk of users self-diagnosing, self-medicating, overlooking symptoms or panicking over minor symptoms, all of which can be harmful and even fatal. To protect themselves, app users must not rely solely on the information being provided on mobile apps and must consult with their healthcare providers before starting on a treatment regime or making any changes to their existing regime.
Mobile and internet penetration is burgeoning in India. The number of people who own mobile phones here is greater than the number who own personal computers. In 2013, there were 525 million mobile phone users in the country and this figure is expected to rise to 813 million by 2019. With the set up of the government’s digital infrastructure to facilitate adoption of mobile internet, decreasing handset prices and affordable data tariff plans, the growth of mobile internet is expected to increase over the next four to five years. In rural India specifically, majority of active internet users use mobile phones as the main access point for internet. According to a report by the Internet and Mobile Association of India (IAMAI) and IMRB International (a market research firm), the number of active rural mobile Internet was 80 million in October 2015, and was expected to reach 87 million by December and 109 million by June 2016.
While the exponential growth of mHealth is transforming healthcare, its full potential has not yet been realized. According to WHO’s second global survey on eHealth, in the South East Asian region, the top four barriers to mHealth implementation were lack of eHealth policies and legislation, lack of knowledge concerning the possible applications of mHealth, lack of technical expertise and high operating costs. We have now been presented with an opportunity to overcome these barriers in the implementation of mHealth and ensure that its benefits reach all those in need.
By Rohit MA, Managing Director, Cloudnine Group of Hospitals