Sunday, September 29, 2013

Reverse Innovation in Health: Interview with Patty Mechael, Director of the mHealth Alliance

During the Social Good Summit, I had the privilege to interview Patty Mechael, Director of the mHealth Alliance, a public-private partnership to provide valuable health information through mobile phones. Mechael was an early proponent of mobile health (mHealth), writing her PhD on mHealth in Egypt, a country that only had 3% mobile penetration at the time. 

"Mobile health in general is a reverse innovation," says Mechael. The developed world was slow to adopt healthcare delivery through mobile because of prior investments in computers and electronic records. Developing countries had limited infrastructure in place and these lower barriers to entry helped mHealth take off. Mobile health has been used to provide services for a number of demographics and healthcare issues- from maternal health to ageing populations. 

In Uganda, platforms like UReport collate information through voice and text messages from the general population on healthcare and other issues. This grassroots survey is being compared to compared to the country's official health system reports. And healthcare officials in Uganda are responding- creating a feedback loop that is far more coordinated and advanced than most countries.

The potential for mHealth in the developed world goes beyond governments and public health systems. According to Mechael, the pharmaceutical and insurance industries have a lot to gain from mHealth approaches. Indeed, the private sector has already been involved through private-public partnerships such as the mHealth Alliance. Multinational corporations have taken a service delivery approach and provided insights on how to plan for scale.

As the mHealth Alliance and other organisations aim to reach entire populations with mHealth services, they are focusing on simple innovations that can scale quickly. Interestingly, they are moving away from pilots in an approach tot think at scale from the outset. "While pilots were useful in the early days of mHealth, thinking in terms of pilots does not translate well to implementation at scale. We need to design for scale from the outset," says Mechael.

One of the keys to designing at scale from the outset is a participatory design process. Inclusive processes need to include beneficiaries to ensure relevance and buy-in. According to Mechael, "Whether or not people feel like a technology has been designed for them determines whether or not they will use it."

Mechael is optimistic about the potential of mHealth to expand beyond the current model of information delivery. "The two transformative technologies that I have seen are cell phones and rapid diagnostics," she says. Low cost, easy to deploy diagnostics are using basic biochemistry to reduce the cost and increase access to accurate diagnoses. The mHealth model also lends well to a more personalised approach to healthcare delivery, using sensor technology for self-monitoring. Given the shortage of doctors worldwide, mHealth can also be used to empower lower-level health workers.

A key challenge of mHealth is to implement models that work with today's mobiles whilst looking ahead to potential opportunities as technology advances. "You have to work fast enough to benefit from a current technology and simultaneously plan for the next upgrade in 12 months" Mechael recommends standardised approaches can be upgraded with new technology, but do not need to be drastically altered. Tools such as currently text messages can be expanded into a broader range of content when smartphones become more prevalent in the developing world.

Mechael is currently focused on the countdown to the Millennial Development Goals. She encourages us all to think about the ways that we can leverage mobile in an "all-out" way to tackle these pressing issues.

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