Applying a health systems "lens" to the evaluation of mobile healthcare initiatives, a recent article in the peer-reviewed journal Global Health: Science and Practice argues that mHealth should be integrated into existing health system functions, rather than as stand-alone solutions.
"Communicating mHealth technologies as tools that can enhance delivery of life-saving interventions through improvements in health systems performance, such as coverage, quality, equity, or efficiency, will resonate with health decision-makers," asserts the article.
The authors, who are mHealth researchers and implementers at the World Health Organization, the Johns Hopkins University Global mHealth Initiative, the United Nations Children's Fund, and global innovation firm Frog Design, make the case that despite the rapid proliferation of mHealth projects--mostly pilots--the large-scale implementation or integration of mHealth innovations into health programs has been limited, which they attribute to a shortage of empirical evidence supporting their value in terms of cost, performance, and health outcomes.
In an effort to better evaluate mHealth initiatives and their value, the authors believe the focus should shift from assessing whether these initiatives "work" to first identifying the key obstacles, or constraints, to delivering proven health interventions effectively, and to then apply appropriate mHealth strategies that could overcome these health system constraints. Part of the problem, they say, is the lack of a "common framework" which makes it hard to explain mHealth innovations to mainstream health-sector stakeholders.
As a potential solution, the article points to the "mHealth and ICT Framework" jointly developed by the authors to describe mHealth innovations in the reproductive, maternal, newborn, and child health (RMNCH) field.
This framework lays out a list of 12 common mHealth applications used as "health system strengthening" tools. According to the authors, the apps in the framework "largely serve to catalyze the effective coverage of proven health interventions." The 12 common mHealth apps, which the authors claim have "been vetted, through multiple iterations, by a wide group of mHealth stakeholders and thought leaders, ranging from academic researchers to program and policy implementers," include:
1. Client Education and Behavior Change Communication
2. Sensors and Point-of-Care Diagnostics
3. Registries and Vital Events Tracking
4. Data Collection and Reporting
5. Electronic Health Records
6. Electronic Decision Support: Information, Protocols, Algorithms, Checklists
7. Provider-to-Provider Communication: User Groups, Consultation
8. Provider Work Planning and Scheduling
9. Provider Training and Education
10. Human Resource Management
11. Supply Chain Management
12. Financial Transactions and Incentives
"This framework not only helps individual projects articulate their mHealth strategies through a shared tool but also facilitates identification of gaps in innovation, solutions, and implementation activity by overlaying multiple projects onto a single visualization," concludes the article.
A recent article published in the American Journal of Preventive Medicine concludes that "rigorous research" is needed to examine the potential and challenges of using mobile technologies to improve health outcomes. Acknowledging that evidence is "sparse" for the efficacy of mHealth, the article calls for research that is able to "assess when, where, and for whom mHealth devices, apps, and systems are efficacious."
Despite the rapid growth and proliferation of mHealth over the past decade, a similar article in the Journal of Medical Internet Research concluded that systematic research on the impact of new mobile technologies on health outcomes remains scarce.
To learn more:
- read the article