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|
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.
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.
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.
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.
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.
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.
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.