Tuesday, 29 July 2008

What's Ailing Mobile Health?


The world is abuzz about the potential of mobile communications. When the number of mobile subscribers topped 3 billion earlier this year, it was widely noted that more than half of these people were in emerging markets. With mobile coverage expanding further in poor countries every day, development experts and business people alike are excited about what mobile phones might do.

Many expect that mobiles will provide users with much more than phone calls. In the same way that the spread of PCs and internet connections have changed everyday life for those in rich countries, mobile phones and GSM networks are beginning to do the same for the poor. Banking, education, trade, governance, healthcare—services which have been traditionally paper-based and in-person—are all now poised for a mobile transformation. The exciting outcome is more efficient, affordable and accessible services targeted for low-income users.

Of these service areas, mobile banking is the most advanced to date. Early success stories such as Safaricom’s M-PESA service in Kenya, and Globe and Smart’s competing services in the Philippines have contributed to a growing number of mobile banking startups across the developing world. It is estimated that there are now over 10 M people in emerging markets regularly using mobile banking services.

By comparison, mobile health has yet to blossom. Though the concept of using mobile networks to increase the reach of healthcare in developing countries has been tested repeatedly over the past decade, there is yet little scale to show for it.

This week I'm in Italy at a small conference on mhealth for the poor, hosted by the Rockefeller, UN and Vodafone Foundations. One of the research reports issued in advance of the conference, by Vital Wave Consulting, estimates that less than 100,000 people in developing countries have used mobile health services to date, and that of 50 known pilot projects around the globe, the majority have been discontinued.

What lessons can mBanking offer mHealth?

The success of mobile banking has led many here to ask "what can mhealth learn from mobile banking?" Even more specifically, folks are looking for an early success story that can catalyse market activity and awareness, asking "what is going to be the M-PESA of mHealth?"

I believe the catalytic model may be already underway in several markets, but it may have been overlooked because these models are quite simple and very commercial. Healthline in Bangladesh, Teledoctor in Pakistan, and MediCallCentre in Mexico each offer a simple consumer proposition: "Call a Doctor." For a premium but affordable call rate (or a monthly subscription fee in the case of Mexico) individuals can simply dial a number and speak with a doctor in a call centre. Healthline, relaunched 9 months ago, claims to have circa 10,000 callers per day, while Teledoctor - which started about 6 months back, has up to 2,000 per day. Meanwhile MediCallCentre in Mexico, which started in 2001, had 1M customers after 5 years but ballooned to 7M in 2007/8 due to changing their billing structure to charge households a fee on their fixed line bill (admittedly, not a pure mobile service.)

I presume that these medical call centre services, not included in the Vital Wave report mentioned above, and largely unknown to the people I've met at this mHealth conference, haven't been consider as bona fide mHealth. By comparison, most of the donors and public health organizations are focusing on more sophisticated services like disease surveillance, remote diagnosis, etc. which are predominantly built for institutions (hospitals, NGOs, Ministries of Health) rather then for consumers.

Furthermore, Healthline and TeleDoctor may violate taboos that make them less attractive to the public health community:

o Clients paying

o Profiting

o Care provided is “helpful” but not complete

o Taking doctors away of hands-on work

o Patient –generated (rather than doctor or PH generated) action

But I am enthusiastic about these services, both on the merit of their own value (validated by each customer who decides to call back) and in terms of the building block that I believe it could represent for a more sophistocated mHealth industry. I say this because they mimic many of the characteristics of early-stage m-banking platforms:

o Leverage strong & widescale mobile operator brand

o Provide easier access to clients

o Low-cost delivery of service

o Not panacea or terribly robust service at the beginning – just a simple consumer proposition marketed to the "person on the street."


We need many more of these models to come to market to catalyse the mobile health market in developing countries. mHealth will take off when services are:

(1) designed for end-user needs

(2) simple service offerings (i.e. "Call a Doctor")

(3) affordable compared to existing alternatives

(4) can scale profitably


(5) The services will get more sophisticated later

(6) They will be controversial (but shouldn’t be)