Posts

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.

I Report on the First African Youth Forum on Maternal infant health and development in Africa.

Maureen, Laiton, Sean & Dr. Simon

The first ever African Youth Forum took place from 17th to 19th July 2010 at the Imperial Botanical Beach hotel  in Kampala Uganda.  This took place ahead of the African Union summit. The focus of the youth forum was to capture the voices of the youth from various African Countries and make sure that their concerns are addressed.
Sponsored by UNICEF, the theme was “maternal infant and child death: The youth call for action”, a number of questions had to be answered to find solutions to the epidemic “maternal mortality”. Majority  of the questions based on the “WHY”
·         Why do young Mothers die more than old mothers?
·         Why are young girls getting pregnant?
·         Why are the young boys/men getting them pregnant and not taking responsibility?
·         Why do so many lose their lives when pregnant of giving birth?
·         Why is the issue a young person’s issue?
·         Why do/don’t young girls abort?
·         Why don’t teachers teach about maternal death and continue to harass them?
·         Why does the community make them vulnerable?
If you cannot understand why, you cannot take the right decision
At the forum, it was noted that the patricial system affects the girl child and yet  many a times, society  doesn’t take action. The only way to reduce on maternal motality was to involve all parties; the individuals, the community and the Government .
In his speech during the official opening of the forum, Mr. Ben the Pan African Youth Union president said that the youth should have the spirit of UBUNTU to help enhance unity and development.  Mr. Alhaji who spoke on behalf of UNICEF Executive director Mr. Anthony Lake expressed his gratitude to Uganda for hosting the first African Youth Forum ahead of the African Union Summit. He acknowledged that the youth were the majority on the African continent and therefore had a big role to play in transforming the continent, he however mentioned that highest leadership as adoption of modern technology like mobile phones for rural communities are some of the factors that can enhance youth involvement.
Mr. Alhaji said that UNICEF supported the forum to mainly capture the voices of the youth from rural areas to make sure they are heard and their concerns addressed. He concluded by pledging UNICEF support to accompany youth effeort.
His excellency the president of Uganda Mr. Museveni wondered if the theme was relavant for the youth, he said that to be young , you have to not only be health but productive in a social, economic sense and not biologically. Mr. Museveni mentioned four key issues that could reduce on maternal and infant deaths in Africa; Immunization, Hygiene, Nutrition and behavior change to avoid catching HIV/AIDS. He said that Youth a lone cannot bring change, they need a conducive atmosphere like good infrastructure and electricity which are not clearly defined in Africa.
He conclude that if the youth are to get actively involved in issues that concern them, then we need a complete socio-economic transformation of the entire African continent.
On my part, I represented the Special Interest Group on Mobile health in Kampala. Together with UNICEF Kampala, Mobile Monday Kampala and the Faculty of Communication and Information technology, makerere, we were show casing some of the currently used mobile health applications for projects in rural Uganda  like Rapidsms, Find Diagnosis as well as OpenXdata.
The youth forum started on 17th and ended on 19th Jull 2010.

Cervical cancer: A threat to Women’s life expectancy

Cervical cancer is the most common cancer affecting women worldwide and the leading cause of cancer deaths among women in developing countries. According to the Programme for Appropriate Technology in Health (PATH), global statistics show that nearly nearly half a million new cases of invasive cervical cancer are diagnosed each year. And more than a quarter million women die of this disease annually, with the highest incidence and mortality rates being in sub-saharan Africa, Latin America and South Asia. Cervical cancer is the most common female cancer in Uganda. At Mulago hospital alone, 80 percent of women diagnosed or referred with cervical cancer, have the disease in it’s advanced stage.
The causes of cervical cancer have been attributed to early engagement in sexual activities, multiple sexual partners and multiple marriages. Cecil Helman in her book Culture, Health and Illness, identifies that the disease is rare in nuns and common in prostitutes. And while in recent years, there has been a growing understanding of how people’s gender identity determines the nature of their ill health, their vulnerability to disease, their ability to prevent disease and their access to healthcare.  The dimension of feminist theory and females experience puts males’ hostile sexuality at the biopsychological core of men’s subjugation of women. In most situations, a woman’s risk of getting cervical cancer will depend less on her sexual behavior but more on that of her husband or male partner since the disease can be transmitted from woman to another, with men acting as carriers. This mostly applies in communities with cultures that expect men to have many premarital and extra marital affairs as proof of their masculinity, while barring women and looking at them as eminently available and seducible.
Usually women contract the Human Papilloma Virus (HPV) between their late teenage years and their early 30’s. But most often cervical cancer is found much later, usually after age 40, with a peak incidence around 45. There is a long delay between infection and invasive cancer, hence killing many annually often because it goes undiagnosed for many years. And yet the disease is preventable and can be detected and treated at an early stage when the cure rate is virtually 100 percent. Ignorance of the disease of the disease might not be the only threat, but limited access to screening and therapy for precancerous lesions and the low acceptability of pelvic examinations are also contributing factors towards the high prevalence of cervical cancer. Women might also have no control over possible disease transmission if they fail to decide when and where to seek medical attention or when and how they have sex. The imbalance of power between women and men in gender relations curtails women’s sexual autonomy and expands male sexual freedom, thereby increasing women’s vulnerability.
According to PATH, prevention of cervical cancer can be done in two ways; Preventing infection initially or detecting the precursors to cervical cancer and providing treatment. The former can be accomplished by avoiding exposure to the virus through abstinence from sexual activity or through mutual monogamy(when both partners were not previously infected). Condoms only offer 70 percent protection against HPV when used all the time. Vaccination is the other preventive method. PATH is working on incorporating HPV vaccination into a comprehensive cervical cancer prevention programme, through developing a vaccine delivery strategy, a communications strategy for out reach to communities, and an advocacy strategy for outreach to policy makers. Vaccination can be combined with screening. Every woman deserves the right to the highest attainable standard of health, especially the many millions of women who confront illiteracy, poverty, poor sanitation, and medical facilities that are inadequate and physically/ economically inaccessible.