Barriers to mHealth adoption in Sub-Saharan Africa

In Uganda, and Africa at large, the
populace face many challenges with regard to health including but not limited
to; poor facilities, poor social infrastructure, energy shortage especially
electricity and limited access to education. Despite Government’s effort to improve
on the health system, very few individuals, companies and organizations are
tapping into the potential of mobile Technologies for health, even when the
benefits are obvious to populations whose most accessible tool for communication
is a phone. Below are some of the reasons that I personally think contribute to
the little uptake of mhealth.
 
Photo Credit: Edward Echwalu
1.     
Content
The absence of
readily available mobile health related content on specific thematic areas is a
big barrier. Most organizations that implement mhealth projects have to develop
their own content based on the area of focus. eg HIV, Malaria, maternal health
etc. There is also no central database where this content is put for future
reference or to avoid duplication of already implemented mhealth issues. This
leaves room for data redundancy and duplication to target groups.
 
2.     Skills
Because of the
tremendous growth in phone penetration especially in sub-Saharan Africa, there
is a great demand for training in mhealth education. One cannot simply rely on
the assumption that because every at least many people own phones, they can
ably use them for mhealth campaigns. They need to be trained on how to operate
the phones, say for health related surveys or how to respond to health quizzes.
This is still lacking. Unless the mhealth campaigns are inform of interactive
Voice Responses (IVRs), the adoption will still remain slow with the use of
interactive SMS messages especially among the elderly populations.

3.     Gender
Although this
is an issue that is often under looked, it plays a key role in either the
success or failure of mhelath project. It’s obvious that the biggest percentage of those who bear
the burden caused by conflict ,disaster are women and children and they are the
key stakeholders in promoting good health and building stable, self-reliant
communities. Also most mhealth related campaigns target mainly women on issues
like maternal health, child mortality, HIV/AIDs, abortions etc. but ownership
of phones is predominantly male who control what kind of information comes
through the phone, whose mobility is not restricted and who are better economically
empowered to afford maintaining the phones especially in rural areas. Therefore,
Making these projects gender sensitive and involving men right from the onset
of the projects will reduce the barriers.
 
4.     Access/Affordability
This could be viewed in terms of
access to the actual handset especially for the rural folks in rural Africa and
affordability in terms of maintenance such as paying to have the phone charged.
Many people cannot afford a 30USD handset yet most mhealth implementing organizations/companies
only want to work with folks that already own phones. It’s a barrier because
you reach fewer people.

5.     Infrastructure
A lot of mhelath projects in Africa
depend so much on Telecom companies which are responsible for the general
telephony infrastructure eg masts for access to network, distribution of short codes
for those that intend to use SMS etc. In the event that an area does not have
access to a mast, then it is obvious that even if there is a genuine health
need to be addressed through the use of mobile phones, it does not get
attention simply because there are issues of network connectivity. This is one
of the biggest barriers for rural Africa. Also the issuing of short codes by
the Telecoms through communications regulators is bureaucratic.

6.     Attitude
Traditionally
especially in Africa, mobile phones are known for verbal communication. But
with mhealth projects comes a new paradigm shift to the use and application of
phones for accessing health information through SMS. Accepting this change and
adjusting accordingly can be a barrier to SMS based mhealth project. IVR
related mhealth campaigns could be more successful than SMS because voice
messages cut across literacy levels.

7.      Language
This is a barrier because of the fact that the commonly used
language for SMS is English yet sub-Saharan Africa is so diverse. However, this
barrier can be solved through voice messages and using community radios along side the mobile phones.

8.     Political
Will
The success of any project depends on the
positive political will and government support. Often times, mhealth initiatives
by NGOs are meant to compliment already existing government health services and
therefore they must work closely with Government. However, many initiatives
have been destroyed because the Government has not played its role. A case in
point is the moratorium that was issued in Uganda from the Ministry of Health
halting the implementation of all electronic and Mobile Health projects that
were not approved by the Director General. While this was a great initiative to
reduce on duplication of projects and to encourage wider coverage and eliminate
unnecessary pilots, the Ministry did not make the vetting process smooth. It
would take months to have the technical working group at the ministry meet and
approve the projects. This is a source of frustration for projects that have
defined timelines.
  • Very thoughtful, Maureen.

    David Aylward
    Ashoka

    • Thank you David for visiting my blog and leaving a comment. I have tried implementing mhealth projects and the challenges are the same. It's quite frustrating. I wrote this out of experience.

  • Thanks Maureen, good post, I would also add a lack of eHealth fundamentals, poor interoperability and a shortage of compelling costed evidence on the impact of mHealth interventions on health outcomes.

    I have no doubt that mHealth, in its various forms, will transform healthcare for the better in the future – we just have a lot of challenges to overcome.

    • Very true and useful addedum. The challenges are way too many yet the truth is that mhealth can tremedously transform healthcare. I hope the challenges are turned into opportunities.

  • Hi Maureen,

    Earlier also I said this is an insightful post. The situation is much similar to some of the poorest states in India. Bihar is one such example where maternal mortality rates are among the highest in the country. The people live with little or no access to mainstream media whereas mobile phones have a high penetration. But the infrastructure and literacy rates are awfully low.

    We have tried to tackle similar challenges in a project funded by the Bill and Melinda Gates Foundation. We have launched a number of large scale mHealth services most of which are IVR-based to overcome the barrier of low literacy. Call costs have been brought down to a meager fraction of market rates through collaboration with network operators. We tried to overcome the diversity of languages with innovation in language itself. We have a website http://www.rethink1000days.org. Request you to check out. Would like to know your thoughts.

    • Tanmay, Amazing work you are doing. I have visted the website and it's impressive. I like the approach you have chosen to overcome these challenges. Using IVRs is one of the most effective ones. I personally think that all these cut across many developing countreis.

  • Hi Maureen,
    Thank you so much for this blog! It is so insightful! I totally agree with each of the reasons explained, and would add that this does not only affect Sub Saharan Africa but also most of the African Culture! I also noticed that the problem of language and accessibility can be solved through local volunteers – these should be living with in the target communities, with access to mobile phones and can be in position to read and translate the content from English to the local languages. I work with a project that use this model to disseminate Ag Info, although it is quite hard to motivate these local volunteers to serve their communities on a daily basis!!

    • Hello Noah, you answered my concern in your last statement. How do you keep those volunteers motivated and for how Long? It's a tough one. Your approach is quite similar to that of Grameen foundation. They have a team of Knowledge workers who help farmers interprete the messages and who liase with experts to help solve some of the problems faced by these farmers. I believe most of these mhealth challenges are similar to those in mAgriculture.

  • Maureen Agena you share the interesting article with us. the journalists are the presenter of the country. I agreed with you there are many young journalists have been made to believe that the area of agriculture lacks the right stories that can draw attention and increase readership to their journalistic work.

    • Thanks thought this was meant for the blog on Agriculture.

  • Really thoughtful post you have here and I like the way you did it. Motivation can play vital role in the development of people because you can find these situations in a lot of areas of Africa so it is better to educate and guide the people about it. Journalists can play a vital role to motivate them.

  • Hi Maureen,

    Nice blog post, I really like the content in general. Keep it up and I hope you are well.

    Tom

    • Very much appreciated Tom. And thanks for checking out my blog. Yes I am well. Hope you are well too.