Module 6: Mobile Technology and Community Health Workers
In 2009, 3.3 billion people were using mobile phones, the majority of whom lived in developing countries. In an article entitled “Harnessing the Mobile Revolution,” Thomas Kalil discusses the trends of mobile technology use in developing countries. He advocates for the U.S. to include in its development agenda the expansion of mobile services abroad, believing that it will promote such advancements as “safe drinking water, new vaccines, therapies, point-of-care diagnostics, clean energy, and improved crops.”(1)
Describing the potential of mobile technology in the field of health, he writes that “Global health practitioners are increasingly excited about the variety of different ways that mobile communications can be used to strengthen health systems and delivery in developing countries. For example, increasing the effectiveness of community health workers, creating new mobile diagnostics, improving the collection of public health data, and persuading people to adopt healthier behaviors are all ways in which mobile services can improve health care in developing countries.”(2) Mobile technology can be used by both CHWs to improve their services and community members to better communicate with healthcare professionals. For example, studies in Bangladesh, Laos, and Egypt reveal that mobile phones are used by patients - especially mothers - to solicit health information from CHWs and to seek more health services.(3)
Point-of-Care Support
For CHWs, numerous new technologies are being invented to increase their efficacy in diagnosis, treatment, and delivery. Researchers from the University of Washington and University of California at Berkeley have developed a mobile phone-based software called CommCare that aids CHWs in a variety of tasks, including screening for illnesses such as TB and malaria, providing accurate information on family planning and safe drinking water, noting upcoming follow-up visits, and keeping track of new births or deaths.(4) CommCare is an example of “point-of- care” support, which includes “mobile telemedicine devices and patient monitoring systems in low- to middle- income countries.” Moreover, CHWs can use these devices to transmit patient information, to more quickly refer and transport patients to health facilities, and to improve detection, diagnosis, treatment, and monitoring. They can also improve CHW adherence to standardized protocols and treatment guidelines.(5)
CommCare also allows for CHWs to “organize their work, track patient visits, access health protocols, and collect and access data.” With the improved documentation of public health data with mobile technology, CHWs can help guide a more appropriate allocation of resources. Lastly, the developers of CommCare are attempting to develop electronic education with this application that would enable CHWs to engage in refresher courses and continuing education.(6) Innovations continue to develop to improve and ensure the effectiveness of CHWs.
Rapid Diagnostics
Also out of the University of California at Berkeley is the development of a high-resolution camera that can be attached to a cell phone. With this camera, health personnel, including CHWs, can take pictures of blood smears or infected skin and send them to professionals around the world to analyze them. This technology allows for accessible and rapid diagnosis.(7)
Adherence
Mobile communication can also be useful for strengthening adherence and spreading health education messages. As stated in other modules, many CHWs work as adherence counselors for those with tuberculosis (TB) or HIV. For example, in Cape Town, South Africa, a doctor has created a database of his TB patients’ cell phone numbers, and his computer automatically sends out a personalized text message that reminds them to take their medications. This allows the healthcare staff, many of whom were spending significant amounts of time to ensure patient compliance, to focus on other health issues, and specifically on those patients who have the most trouble with adherence. In order to entertain and further educate his patients, the doctor includes jokes and lifestyle tips in the texts. Similarly, researchers are beginning to test the ability of mobile communication to influence healthy behaviors such as physical exercise, nutritious diets, and avoidance of risky sexual practices. CHWs could similarly use texts to amplify their impact on the health of their communities.(8)
Footnotes
(1) Kalil, Thomas. “Harnessing the Mobile Revolution.” New Policy Institute 2008.
(2) Ibid.
(3) Mechael, Patricia N. “The Case for mHealth in Developing Countries.” innovations 2009.
(4) Kalil, Thomas. “Harnessing the Mobile Revolution.” New Policy Institute 2008.
(5) Mechael, Patricia N. “The Case for mHealth in Developing Countries.” innovations 2009.
(6) Mechael, Patricia, Gerry Douglas, Neal Lesh, Ada Kwan. “Mobile point-of-care support and data collection tools for health workers in low- and middle- income countries.” AMIA Spring Congress (2009). Accessed on 14 February 2011. < 2009springcongress.amia.org>
(7) Kalil, Thomas. “Harnessing the Mobile Revolution.” New Policy Institute 2008.
(8) Ibid.