Fewer than a third of South Africans own a smartphone that can download apps and, as a result, those who might benefit from mHealth lack access to it, Maurice Mars from South Africa's Telemedicine Association said in an article in the Mail & Guardian.
"Even though I'm a strong supporter of it, mHealth can't do nearly as much to improve health outcomes in South Africa as people might think," claims Mars. "We are right at the beginning of the movement in South Africa. I don't think that in 10 years or even 20 the so-called digital divide will get smaller. It's getting worse, not better."
According to the mobile industry organization GSMA, there are 83 active mHealth products and services aimed at public health in South Africa, 43 of which address HIV. However, Mars argues that the technological environment is not advanced enough to handle many of the ongoing mHealth initiatives, with most limited to SMS technology given that apps can't be downloaded on basic phones.
Nevertheless, according to a recent report from GSMA, mobile healthcare in developing countries in sub-Saharan Africa could help save as many as one million lives over the next five years. The increased adoption of mHealth solutions could help save lives across the entire healthcare delivery chain, found the report, which credits the greater use of mobile connectivity in the fight against malaria, tuberculosis, HIV and perinatal conditions in developing countries in Africa which account for three million deaths annually.
"Some people have said it is the salvation for sub-Saharan Africa, that virtually everybody owns a cellphone. This is junk," said Mars. "A large number of people have phones and more will get but what developers need to think about is that people in need won't have access [to apps] as they only have basic or feature phones. These phones can perhaps access the Internet but can't download sophisticated applications."
Still, Mars admits that there have been some successes, particularly in the field of SMS-based educational initiatives, such as general messages that remind people to test for HIV or get their blood-pressure checked and telling them why it is important. One such example is Cell-Life, a nonprofit organization that provides technology-based solutions for the management of health in developing countries, which conducted a 2011 South African study and found that sending 10 text message reminders to go for HIV testing and for counseling, spread out over every three days for a month, resulted in a 70 percent higher uptake of testing compared to a control group who did not receive any messages.
"We can't make assumptions about what kind of phones people have so we do our research before we develop a service for a particular community," said Katherine de Tolly, the project manager of mHealth at Cell-Life.
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