1. Vital Wave Consulting Field Offices Latin America Rio de Janeiro, Brazil San Jose, Costa Rica Mexico City, Mexico Asia Bhopal, India Beijing, China Phnom Penh, Cambodia Eastern Europe Tallinn, Estonia Africa Cairo, Egypt Johannesburg, South Africa Lagos, Nigeria United States Palo Alto, California (Headquarters) mHealth for Development Mobile communications for Health World Bank Group Mobile Innovations for Social and Economic Transformation September 16, 2009 Brendan Smith Senior Consultant

2. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. mHealth Building blocks for success 2 1 Agenda mHealth overview: Definition, applications and impact 1 3 Discussion

3. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Mobile Health (mHealth) Defined Electronic Health Services Health Services mHealth mHealth (n) – the delivery of health care services via mobile communication devices Photo: UN, UN Foundation, and Praekelt Foundation 2

4. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Technologies and Health-Related Statistics for Developing Countries (Millions) Sources: Vital Wave Consulting, Business Monitor International (BMI), International Telecommunications Union and the World Bank’s World Development Indicators. Photo: Photos: DataDyne Opportunity – New Health Delivery Platform Explosion of Mobile Phones in Developing World 3 Mobile Phones reach further into developing countries than other technology and health infrastructures 654321654321

5. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Meeting Health Needs Broad Array of mHealth Applications Education & Awareness SMS/text messaging in support of public health and behavioral change campaigns. Remote Data Collection Applications using mobile devices to collect real-time patient data, often where patients live. Remote Monitoring Maintain care giver appointments or ensure medication regime adherence via one-way or two-way communications on mobile devices. Disease & Epidemic Outbreak Tracking Use mobile devices to send and receive data on disease incidence, outbreaks and public health emergencies. Diagnostic & Treatment Support Use the mobile phone as point-of- care device. Programs by Application Area 4 Communication & Training For Health Care Workers 14 10 9 5 9 6

6. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Distribution of mHealth Programs 5

7. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Impact of mHealth Promising indicators but a need for more research “When talking about efficiency versus health impact, it shouldn’t be about either/or. Improving efficiencies can ensure that more people receive life-saving interventions.” —John Stephenson, Dalberg Global Development Advisors Peru Cell-Preven health workers use mobile phones to send SMS messages with real-time data on symptoms experienced by clinical trial participants. Enables immediate response to adverse symptoms. South Africa Project Masiluleke’s SMS message campaign promoting HIV/AIDS awareness resulted in nearly a tripling of call volume to a local HIV/AIDS helpline. Uganda Text to Change’s SMS-based HIV/AIDS awareness quiz led to an increase of nearly 40% in the number of people coming in for free HIV/AIDS testing. Thailand Phoned Pill Reminders for TB Treatment. TB patients were given mobile phones and called daily with reminder to take their TB medication— 90% did. 6

8. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Current Health Care Picture Communicable diseases. Lack of immunizations. Lack of safe water sources. Global & Demographic Changes GDP growth increases spending on healthcare. Traditional diseases controlled (TB, smallpox) and new diseases appear (SARS, avian flu). Aging populations means increase in death from non- communicable causes. Declining birth rate and climbing life expectancy. Adoption of “developed country” behaviors. Tomorrow’s Healthcare Picture Current healthcare picture issues continued. Shift from “late stage” treatments to prevention and early detection. Increased focus on health issues of elderly. Continued health worker shortages and distribution inequities. Shifting Health Needs in Developing Word mHealth Addresses Current and Future Health Needs Evolution toward chronic diseases – diabetes, heart disease and strokes By 2025, 80% of all new diabetes cases will originate in developing countries Diabetes, heard disease and strokes will cost approximately: $556 billion in lost national income in China $300+ billion in Russia and India $49 billion in Brazil 7

9. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Technology in mHealth Applications Simpler, broadly accessible technology prevails SMS/MMS SMS and MMS are the least expensive and most ubiquitous technologies in developing countries. Though it ranks second in program count, SMS-based projects are among the longest lasting and most prominent mHealth examples (more than 50% are active) Data (typically PDAs) Data collection and transmission using mobile-enabled PDAs is used primarily by health workers for the collection and transmission of health indicators (approx. 2/3 in research stage or are not active) Voice The relatively high cost of voice calls, particularly in sub-Saharan Africa, limits the feasibility of large- scale mHealth applications, though these show promise in lower cost regions such as South Asia. Voice applications are not constrained by low literacy rates Programs by Technology Type 8 17 5 33 10 mHealth applications intended to reach a mass consumer audience tend to rely on simple, ubiquitous formats like SMS, while those for use by health workers often use more advanced technologies Other (sensors, GPS, etc) More advanced technologies allow for sophisticated diagnostic and logistical applications, but cost and hardware specifications limit their utility (approx. 2/3 in research stage or are not active)

10. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Technology in mHealth Applications Advanced technology brings with it greater capacity, costs 9 The technology used for mHealth applications should align with the needs of the program it is designed to support. As applications move from one-way data towards clinical services, the technical capabilities increase, but so do cost and training requirements Technical capability Training required Cost

11. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Case Study Text to Change Disease Awareness Impact 15,000 mobile phone subscribers in rural Uganda sent the quiz in the three month pilot test 40% increase in the number of patients who came in for HIV/AIDS testing Actionable insight: Many quiz takers did not think AIDS testing was accurate nor anonymous Health Objective Improving HIV/AIDS education with anonymity Country Uganda Techniques Used HIV/AIDS awareness via an SMS-based multiple choice quiz in exchange for free airtime; correct answers provided; participants encouraged to come in for testing (fee waived for participants) Partners Celtel, AIDs Information Centre (AIC), Merck, and the Dutch Ministry of Foreign Affairs Photo: Text to Change 10

12. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Building Blocks Sustainable & Scalable mHealth Programs Forge strong partnerships Be accessible Design with the end user in mind and maintain a focus on usability Build a long-term funding plan Set measurable goals Collaborate with other mHealth organizations Photo: UN Foundation/Nothing But Nets 11

13. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. mHealth for Development: Mobile Communications for Health http://www.vitalwaveconsulting.com/pdf/mHealth.pdf mHealth for Development Report mHealth provides a singular opportunity to powerfully contribute to sustainable development “ ” Photo: UN Foundation/ Nothing But Nets 12 Sizing the Business Potential of mHealth in the Global South http://www.globalproblems-globalsolutions- files.org/unf_website/PDF/SizingBusinessPotential.pdf

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15. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Patient Health Outcomes Effectiveness Gains Improved disease management Improved public awareness of communicable diseases Improved medication compliance Health Systems Outcomes Efficiency Gains Services delivered at reduced cost, increased speed and accuracy mHealth Improves Outcomes Benefits in Patient Health & Health Systems Outcomes Photo: DataDyne 14

16. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. 1 million die from effects of malaria each year 25% of children in developing countries are underweight and undernourished 1 woman dies each minute from pregnancy-related causes 2.5 Million people newly infected with HIV/AIDS in 2007 57 countries have critical shortages in health care workers (Total deficit of 2.4 million health professionals worldwide) Photo: Vital Wave Consulting Urgent Need Improve Health in Developing World 15

17. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Source: 2008 Global Monitoring Report Progress on health-related MDGs less than encouraging Children's mortality rate is not improving 27 countries made no progress in reducing childhood deaths (1990-2006) Maternal health statistics are poor Half a million women died during pregnancy, childbirth or in the six weeks after delivery - 99% of these in the developing regions Photo: Photo: UN/Marie Frechon Millennium Development Goals Progress on Health-Related Goals Less than Encouraging 16

18. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Disease Awareness Impact 365 Million text messages – one per day – being sent (2008-2009) Encourage people to be tested and treated for HIV/AIDS and TB Case Study Project Masiluleke Health Objective Build awareness of HIV status, encourage HIV/AIDS testing and treatment and halt the disease’s spread Country South Africa Techniques Used ‘Please Call Me’ service - free text messages Partners Praekelt Foundation, iTeach, National Geographic, Nokia Siemens Networks, MTN, Ghetto Ruff, Children of South African Legacies, Aricent, PopTech!, frog design and National AIDS Helpline Photo: Praekelt Foundation 17

19. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Case Study Data Gathering Data Gathering Impact Data collection times dramatically reduced (from months to days) 400 test results gathered by 20 field professionals in two days, all with GPS information (paper- based system would have taken 2-3 months for lesser information) End-user acceptance very high Health Objective Containing the spread of the Dengue virus Country Brazil Techniques Used Customized questionnaires distributed to field health agents’ mobile phones. Health data and GPS location information are integrated to enable immediate analysis and identification of areas with high infection levels. Partners Nokia, Amazonas State Health Ministry Photo: Wikimedia Commons 18

20. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Building Blocks Sustainable & Scalable mHealth Programs Forge strong partnerships Be accessible Design with the end user in mind and maintain a focus on usability Build a long-term funding plan Set measurable goals Collaborate with other mHealth organizations Photo: Mobiles for Malawi Building Blocks for Sustainable & Scalable mHealth Programs 19

21. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Call to Action Operators Combine mHealth with delivery of other mServices Leverage handset maker relationships Be pro-active in developing joint solutions Enhance mHealth infrastructure NGOs For best results, think big and join forces Partner Provide proof of concept by using the simplest available technology Policy Makers Define an mHealth policy and provide incentives Funders Ensure project sustainability Provide resources for impact assessment Photo: RAMP and ENACQKT 20

22. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Value Chain Models for mHealth Players and Incentives PlayerIncentive Patient or Citizen (Mobile Subscriber)Improved health outcomes Health Care ProviderMore efficient and effective delivery of health services NGOAdvance organizational mission, attract funding FoundationsAdvance organizational mission GovernmentMore efficient health care provision, effective government Equipment ProviderDevice revenue generation, improved brand recognition Service ProviderRevenue from service fees, increased subscriber base Application Solutions ProviderRevenue from additional applications license fees Content ManagementIncrease in volume of readership or revenue Platform ProviderRevenue from sales A solid understanding of the needs and incentives of the multiple players involved in the mHealth value chain is required in order to marshal their energy and resources. mHealth value chain players and incentives 21

23. © 2009 Vital Wave Consulting TM Proprietary and Confidential: Do not copy or distribute. Value Chain Models for mHealth One-way mHealth Applications 22