NYT Columnist: mHealth projects should focus on outcomes, not technology

New York Times columnist Tina Rosenberg writes in a March 13 blog that mobile healthcare projects should focus on "better health outcomes" instead of how well mobile technology actually performs.

Rosenberg asserts that the most important lesson for mHealth is the fact that "technology is the easy part," adding that mobile health projects are "just as complicated as any other health project, just with a phone attached."

She makes the case that "if mHealth projects have been evaluated at all, they've been evaluated for feasibility…rather than impact on health," citing dismal results when mHealth projucts are evaluated for health outcomes.

Echoing these sentiments, two new reports from the mHealth Alliance highlight the lack of quality evidence and rigorous research for mobile healthcare. According to the reports, the evidence base supporting mHealth is "underdeveloped and young," with some in the development and global health communities demanding more research evaluating if and how mHealth helps global health programs.

In her blog, Rosenberg argues that "even the successful programs ... tend to be tiny islands," in which the pilot program "is successful in a small group of clinics--but the project can't grow." The reasons for this stunted growth, she suggests, could be that they use an operating system that doesn't mesh with the nationwide system, they require a platform that can only handle a few users, or that it is too costly a solution.  

Rosenberg reports that "the proliferation of [mHealth] pilots has gotten so chaotic that at least two countries, Uganda and South Africa, took the extraordinary step of limiting further pilots, at least until each government can set its health strategy and technical specifications and make sure that the projects fit."

However, she concludes that important lessons are emerging from mobile health projects. She writes that most mobile health projects that have been able to grow have included lots of different partners, with both the government and the private sector--mobile phone providers, for example.

According to Rosenberg, one of the few mHealth projects that has been successful on a large scale is Mwana, which tests to determine whether babies are HIV-positive in Zambia and Malawi and trains health workers to send the information by text message, cutting the total time by more than half and resulting in fewer lost results. She writes that Mwana works because it is simple, easy to use, and was designed from the beginning to be able to work on a large scale.  The program employs community health workers' own mobile phones and an open-source SMS platform.

To learn more:
- read the Rosenberg blog in the New York Times