Capacity for using HIM one of many hurdles to scaling mHealth in underserved settings

Researchers in South Africa have performed a systematic appraisal of the potential opportunities and challenges of scaling mHealth technology as part of that that country's community-based services. The lessons learned from the study may be useful for policy and practice decision-making in other low- and middle-income settings, according to a Nov. 5 article published in BMC Medical Informatics and Decision Making.

By applying a framework adapted from reviewing sustainable information and communication technology (ICT), the qualitative study reviewed the benefits and challenges of mHealth in community-based services (CBS) in South Africa through a combination of key informant interviews, site visits to local projects and document reviews. The study's four key areas of assessment included government stewardship and the organizational, technological and financial systems involved.

The researchers concluded that "against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation."

While the opportunities for successful implementation of mHealth in South Africa include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry, the article cited weaknesses in other key health system areas such as organizational culture and capacity for using health information for management, as well as the poor availability and use of ICT in primary healthcare.

Among the technological challenges identified in the study was the complexity of ensuring interoperability and integration of information systems and securing privacy of information. In addition, in the area of finances, researchers noted the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings.

A report from may by the World Health Organization found the use of e-health technologies, including mHealth, is spreading rapidly in low- and medium-income countries around the world. However, WHO revealed that less than 25 percent of the surveyed health programs used e-health technologies, and their reliance on private donors--which provided nearly half of their financing--is one factor limiting their expansion.

In the end, the study's authors called for South Africa to adopt a "developmental approach" to the implementation of mHealth. Under this strategy, their recommendation was that the health department should follow a "building blocks" approach that involves encouraging the initial implementation of smaller, phased and heavily evaluated "lead" projects in selected areas where organizational capacity for implementation exist.

To learn more:
- read the full study