Mobile Medicine for the Developing World


By Neil Versel

July 29, 2008 | Digital HealthCare & Productivity | BELLAGIO, Italy—Mention telemedicine and mobile health care in the United States or Europe and thoughts turn to multimillion-dollar suites of high-tech equipment or personal digital assistants (PDAs) with hefty monthly data charges.

In the developing world, however, the concept is as simple as a cell phone.

“The growth that took place in mobile phones was because we were responding to a basic need to communicate,” suggests Strive Masiyiwa, founder and chairman of Econet Wireless Group (Bryanston, South Africa). “Health is a basic need. Mobile phones offer us a fundamental tool in all areas of the health delivery matrix.”

Masiyiwa, a native of Zimbabwe who moved himself and his company to South Africa in 2000, presented this thesis in a keynote address Monday to start the third of four weeks in a series of conferences called Making the eHealth Connection. The New York-based Rockefeller Foundation, which owns a bucolic retreat here overlooking Lake Como, is staging the global meetings to develop strategies and look for opportunities to apply health-IT to the myriad health challenges of Africa, South America, and South Asia.

“One of the key challenges in developing countries is that you don’t have enough doctors,” Masiyiwa says. Outside the major cities, the little care people get is delivered at village clinics staffed by health workers or by traveling doctors. “Suppose we could develop tools to bring doctors closer to people,” Masiyiwa offers.

Econet is piloting a project to help reduce the cost of medical care in impoverished communities. “The concept behind this project is to enable patients wanting to consult a doctor to do so over the phone without having to actually travel to see the doctor. This is important because of the shortage of doctors, and increasing transport costs,” Masiyiwa explains.

“Our system is based on a doctor setting up satellite diagnostic centers, staffed by nurses and orderlies, who refer to the doctor what they are observing over the phone, using a cell phone or PDA.”

Masiyiwa, a member of the Rockefeller Foundation board and a close advisor to Zimbabwean opposition leader Morgan Tsvangirai, even believes Econet can profit from connecting poor people to health care professionals. With cell phones now in the hands of an estimated 3.5 billion people—more than half the world’s population—including 300 million Africans, the major international wireless companies are looking to boost revenue by selling advanced services to existing customers.

“But what do you do when you are dealing with the poor? In their situation, they don’t have any disposable income,” Masiyiwa says. “All income amongst the very poor goes towards basic needs. We therefore have to find our increased revenues by making it cheaper for them to gain access to their other basic needs.”

For the last year and a half, Econet has been running a telemedicine pilot to connect South African doctors to remote clinics via text messaging. “We want to keep the simplest protocol in the hands of everybody,” Masiyiwa says. “If you move it to voice, it becomes too expensive.”

Econet would like to roll the project out to a wider audience, but is struggling with some technical issues such as authenticating users, and there are social barriers that need to be worked out as well. Masiyiwa wishes that physicians and the myriad non-governmental organizations that sponsor health programs in developing countries would show greater interest in mobile health.

One conference participant said that a similar trial in India ran into literacy and language problems with text messaging, and suggested that photographs might be more effective than words.

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