This post was authored by Ben Bellows and Jared Stamm of the Population Council.
Mobile phone use in Africa is growing fast, from 16 million handsets in use in 2000 to 246 million in 2008 and more than 500 million by early 2013. In Kenya, 78% of households have mobile phones. In spite of these high numbers, there is still concern that mobile interventions are failing to reach the most in need. We believe this will become less of an issue as mobile phone use continues to rise.
The Population Council’s voucher survey data reflect a growing uptake of phones in poor households, and a substantial increase in the use of mobile phones between 2010 and 2012 among the voucher-eligible population (you can learn more about our study here and initial findings here). And according to another recent study in Kenya among people who have a mobile phone and make less than $2.50 per day, there is high demand for telecom services—low-income consumers will forgo spending on some necessities in order to buy airtime—and growing interest in receiving health information via mobile devices.
That’s good news for programs like Baby Monitor, a screening tool being tested by the Population Council and Duke University among pregnant women and new mothers in rural and remote areas of Kenya—places where a mobile signal is more likely to reach them than a skilled birth attendant or community health worker.
Baby Monitor brings low-cost clinical assessment directly to mothers and their infants through their mobile phones. With Baby Monitor, women sign up to get phone calls 90, 60, and 30 days before their due date, and on days 1, 3, 7, and 10 after birth—the most critical days for a new baby and a new mother.
Using interactive voice-response (IVR) technology, women listen to a free phone call and respond by key press to a series of pre-recorded, algorithm-selected questions that screen for potential physical and mental health issues. The cloud-based, highly scalable program automatically flags cases that warrant additional follow-up and then sends information, makes referrals, and/or dispatches community health workers.
Early analyses of Baby Monitor indicate that it’s better than nurses at detecting higher probable levels of depression, possibly because women feel less stigma answering recorded questions by phone.
Programs like these hold a lot of promise for the poorest women in the poorest communities. Next stages could be coordinating transport to facility referrals; sharing screening data with receiving facilities to speed intake; beginning the process of providing informed choice for preventive care like family planning methods; helping patients adhere to treatment for HIV or tuberculosis; and, in the case of reproductive health vouchers, distributing credits by mobile phone that could pay for health care or transport services.
With mobile phone penetration increasing in developing countries and among the poorest, we have an opportunity to create lasting change in the way valuable health services are delivered. Programs like Baby Monitor may provide the blueprint for developing additional effective mhealth programs or improving current programs like the reproductive health voucher program in Kenya.
Harnessing the power of mobile phones to improve health will be a challenge, but with strategic investment, collaboration between public health researchers and technology developers, and a focus on creating mhealth applications that are easy to use and available to the most vulnerable, we can make great strides in improving health and saving lives.
(Listen to an interview Ben did with Smart Monkey TV on the potential of mhealth to create greater efficiencies in the delivery of reproductive health vouchers.)