After finishing the day at the mHealth Conference 2010 conference in Dubai by moderating a panel exploring the commercial aspects of mHealth with a particular focus on start-ups, I was left with some new concepts to consider in global healthcare engagement.
The conference focused on the worldwide mobile healthcare (mHealth) environment and featured delegates and speakers from regions including Japan, Australasia, India, the Middle East, Africa, Europe and the USA.
In this article I’ll share some of the impressions I came away with. I won’t try to cover all the case studies and insights from the conference; you can expect to see some of these covered in detail in future editions of Healthcare Engagement Strategy e-journal, including some excellent video interviews conducted by Paul Grant, which will also appear on the Creation Healthcare Youtube Channel in the future.
Global strategy; local implementation
Whilst mHealth solutions must be implemented at a local level, a clear message coming from many speakers and participants was a call for global strategies, integration and standardisation of systems internationally. Dr Nosa Orobaton, Deputy Executive Secretary of the World Health Organization’s Health Metrics Network, described a mission to strengthen global health information systems through international partnerships and called for an end to repeated, uncoordinated and fragmented pilots that duplicate spend at a cost to society.
When I asked Dr Orobaton what role the World Health Organisation is playing in supporting a move away from fragmented systems, he said that the Health Metrics Network, which has gained 85 country members in its first three years, is playing a key role by mobilising partners to work together, to strengthen global information systems. He also said that a platform exists for collaboration through working groups established by convention; and pointed out that the World Health Organisation’s availability at meetings such as the mHealth conference also plays a role in supporting worldwide collaboration.
Other work taking place to bring global standards includes the work of the Continua Health Alliance which includes major global health and technology stakeholders. Chuck Parker, Continua Health Alliance’s Executive Director, spoke about the Alliance’s vision to establish an ‘ecosystem’ of interoperable health systems. An exciting aspect of the Alliance’s activity with standardisation stakeholders includes working with regulators to encourage a global regulatory approach. There is a similar kind of global regulatory vision behind Creation Healthcare’s call for action on regulatory-compliant pharmaceutical communications, which seeks to address the issue of cross-boundary, international regulatory compliance in pharmaceutical engagement.
mHealth innovation led by the ‘developing world’
The case studies of mHealth solutions illustrated during the conference reminded me that there seems to be a tendency in the developed world, where smartphones are commonplace, to look at mobile technologies and ask questions such as ‘how could mobile play a role in healthcare?’; whereas in the developing world the questions that have been asked are more along the lines of ‘how can we solve this health problem?’
It’s no wonder then, that the most significant innovation with tangible health outcomes is taking place in the developing world. In this environment, mobile happens to be the channel of choice for many healthcare solutions because it is relatively low cost, and is the only way to reach people in rural communities quickly – it is the right healthcare engagement channel in this context.
So does mHealth have a role to play in the developed world? Certainly! And some good examples were shared at the conference. I still think we have a long way to go to fully realise the potential of mobile technologies for health outcomes in the developed world. I would suggest that it’s likely we will start to see the potential of mobile technology realised when the focus is moved away from the technology itself to consider healthcare engagement in a broader, multi-channel context.
Healthcare: luxury or lifestyle?
It was also interesting to witness the divergence between the kinds of mHealth solutions in the developing and developed worlds. As Dr Zaki Ahmad, National Coordinator for eHealth in the Government of Pakistan’s Ministry of Health put it, “In my country, health is seen as a luxury by 80% of people”. For these people, access to better healthcare in remote areas is literally a matter of life and death.
We learned for example from Shainoor Khoja of Afghanistan’s GSM provider Roshan that in Afghanistan, only 30% of the country’s 32 million people are literate. For the 70% who are not, text-based health information is useless without additional innovation. Dr Ahmad said that in Pakistan, this literacy divide is crossed through a text-to-speech mHealth solution.
Meanwhile, in the developed world, health is taken for granted by the majority of people and this means that many of the applications being developed and deployed focus more on lifestyle. This is natural if you consider Maslow’s hierarchy of needs.
Regulation vs innovation
I believe there are other significant factors that enable healthcare engagement innovation in the developing world, and prohibit it in the developed world. This is likely to be a controversial point, but I think it’s an important one to consider in the global context.
Two components that are generally less developed in the developing world are regulatory constraints, and consumer attitudes to privacy of their data. Certain aspects of regulation in healthcare communications and data handling, for example, allow greater flexibility in the way that data is used in developing countries.
After pointing out that health is seen as a luxury by the majority of people in Pakistan, Dr Ahmed went on to say “They just want healthcare or they die. They don’t care so much how many people see their data. mHealth technology makes it possible for us to deliver healthcare.”
Dr Ahmed’s point illustrates that in the context of people’s needs, issues about data privacy are relatively unimportant in life-or-death situations.
Conversely, in the developed world, the challenge of innovating in healthcare engagement without falling foul of regulatory or data privacy obligations takes up much of the time and energy of innovators in healthcare engagement. This is certainly what I have found in my experience of developing and studying healthcare engagement strategies in Europe, Japan and the United States.
A commercial model for mHealth
One of the concepts that came up again and again was that successful mHealth must have a commercial model to be sustainable. Successful commercial mHealth examples included excellent initiatives from GSM provider Roshan in Afghanistan. Shainoor Khoja explained that Afghanistan is a difficult country to travel in, with more land mines than the rest of the world put together. Delivering health by mobile was a necessity.
Ms Khoja explained that the prime driver for Roshan is not the provision of telecoms, but the delivery of solutions for economic growth. “We must be profitable, but profit is not what drives us”, she said.
One of the interesting mHealth innovations shared by Ms Khoja was the deployment of multi-functional, mobile-connected rugged motorcycles which provided both communications and health resources to rural areas. These motorcycles were originally designed for clearing land mines and Roshan are deploying them as what is effectively an mHealth solution.
Shainoor Khoja presents Roshan’s multi-functional, mobile-connected mHealth motorcycles used in Afghanistan
mHealth and pharmaceutical companies
Amongst the lively debate taking place around the conference via Twitter, a question was asked about pharmaceutical companies and mHealth. Although this topic was not covered in depth by the conference program, it’s an interesting area to consider and I’ll provide some thoughts here.
Pharmaceutical companies play a role as key stakeholders in healthcare provision. There was much discussion in the conference about multi-stakeholder partnerships; and Dr Orobaton from the World Health Organization stressed the importance of public/private partnerships. I believe that this is one area where pharmaceutical companies can play a role.
I’m not thinking only about pharmaceutical companies making CSR donations to support mHealth initiatives. It is possible to find win-win commercial solutions. Pharmaceutical companies should look for opportunities that will ultimately benefit both patients and themselves.
One obvious area is in supporting patients who are taking the company’s medicines, to ensure adherence. I learned about an initiative by a major pharmaceutical company in India that is partnering with pharmacies and doctors to automate repeat prescription reminders for patients on a long-term course of medicine.
Other mHealth solutions that pharmaceutical companies are already involved with include health literacy initiatives; anti-counterfeit tools; and healthcare professional education.
Ultimately though, I don’t think it is constructive to look for mHealth solutions for pharmaceutical companies – or for any stakeholders, come to that. What we need to be considering is healthcare engagement. The same issues apply, regardless of the channel, when a pharmaceutical company engages other health stakeholders. The pharmaceutical company must consider:
- Commercial outcomes
- Patient / health outcomes
- Outcomes for other stakeholders, e.g. improved efficiencies for doctors, pharmacists, payers
In my article in last month’s Healthcare Engagement Strategy I advised against developing an mHealth strategy because of the risk of missing the point. mHealth must be considered as just one of many possible channels of engagement, and its particular characteristics seen as opportunities to engage more effectively in a relevant way to solve specific problems or achieve specific goals.
Creation Healthcare advises healthcare companies and stakeholders about improving the outcomes of engagement. If you want to make the most of emerging engagement channels to achieve health outcomes, contact us to find out how we can help.