By Aman Bhandari and Jaspal Sandhu, with Hassan Masum
The recent 36th annual Global Health Council meeting in Washington, DC hosted 2500 participants from over 100 countries, who converged to talk about technology’s role in reshaping global health. The agenda was packed with a variety of innovations and technologies: diagnostic tests, vaccines, anti-shock garments for pregnancy, mHealth (mobile phones for health), vouchers for health services, and even turntables for global health.
Two critical themes emerged from this conference: both context and measured impact matter.
Thinking about designing, developing and implementing technologies around measured impact raises a key question: How do innovative technologies fill existing gaps and extend the health system? This is especially critical given the explosion in global health over the past decade of funding, high-tech professionals, technology-based solutions, and social ventures and start-ups.
While technology-based solutions are clearly not the sole answer, the pace at which people are using technology to innovate has dramatically increased. Dial back about a decade and there was no Google, Kiva, or Gates Foundation. Mobile phone penetration was less than 1 percent in developing countries, and social entrepreneurship wasn’t common vocabulary. Where we were ten years ago was a profoundly different world from where we are today.
The application of technology for social change and global health is going to increase. In this decade, the convergence of movements in philanthropy, entrepreneurship, and technology - all enabled by the Internet and mobile phone revolution - has allowed people to collaborate, innovate and communicate on an entirely different level. There were some great examples of innovation and maturing thought at the conference:
No Magic Bullets: Technology, People and Systems
During a session on reproductive health innovations in stemming blood loss during pregnancy (a major problem also known as postpartum hemorrhage) Susheela Engelbrecht from PATH reinforced that technology is only a tool in a much more complex system. Innovations are not magic bullets, she said, and larger supporting systems (be they human resources or essential drugs) need to be in place in order for these technologies to be most effective. In addition, there are opportunities for improving the impact of innovations by improving the design and usability of products.
On a related note, one of the key challenges Mitul Shah of the UN Foundation highlighted during his talk about mHealth was the need for better understanding the relationship between people and technology, and for more market research, impact evaluations, and understanding of cultural perceptions of technology. This is where context matters. It’s not just a matter of phone versus no-phone - culture, age, and gender all matter too, and can dramatically impact how technology is used, for better or worse.
Mobile Phone Innovations and Scalability
In the session on “Transformations: Discovering New Strategies Using Proven [mHealth] Technologies,” Paul Meyer of Voxiva reminded us that mHealth strategies have been around since 2001. They’re already sustainable because the subscriptions are already paid for. But now that people are beginning to recognize that more than 4 billion mobile phone subscriptions exist worldwide, we should all think harder about our models of improving health outcomes, and design them so they can be scalable.
Giving one example of a project that has been successful in scalability, Andrew Zolli from Pop!Tech described an mHealth strategy in South Africa called Project Masiluleke (mah-sah-loo-lick-ay, meaning hope and warm counsel). The project, profiled last fall on Worldchanging, reinvigorates HIV/AIDS outreach by sending 1 to 1.5 million “Please Call Me” requests a day through SMS. Zolli mentioned how misinformation and competing narratives of HIV/AIDS have all played a role in fueling the stigma that has made HIV and AIDS so difficult to prevent, treat, and mitigate. Project M has increased the average call volume to the National AIDS hotline by threefold, and has used technology to break through the stigma. Project M should be applauded because of its large-scale effectiveness, tailored approach to the population it targets, and active exploration of user friendly, at-home HIV testing kits. This last element, working with Frogdesign, is an exhibition of the movement toward ultra-low cost, distributed diagnostics.
Another innovation targeting the end user, this time on preventing the use of fake medications, was presented by Ashifi Gogo of mPedigree (also recently profiled here on WorldChanging). mPedigree is a great example of incorporating context and trust into a broken system. The drug distribution and delivery system is becoming increasingly complex, not only with cocktail therapies and drug resistance, but also with globalization and lack of adequate information and supply management systems. Health systems infrastructure is being weakened by counterfeit drugs, which has important public health implications. Gogo made the statement that 20% of deaths associated with malaria could be prevented with mHealth strategies. In rural Ghana, when individuals are sick, the first point-of-contact for health care and/or treatment is often a “chemical seller,” who can be fake or licensed. The solution mPedigree has developed, based on the local Ghanaian context, is to use an SMS system to let individuals verify whether or not a drug they purchased is legitimate.
Data Driven Global Health
While the large and well known players are having an impact, there are a multitude of small outfits that are pushing the envelope (who George Ayittey refers to as cheetahs). One future opportunity is to get a much better understanding of the landscape of global health start-ups, and a map of the technology development pipelines. Without more data on outcomes and on the field as a whole, we may continue to muddle through in an inefficient manner.
Hans Rosling, who never fails to impress, captured this sentiment for moving forward with his plea that “We have to start to use data in global health”. While he was specifically referring to all the myths on HIV which can be disputed by data (“people should be forbidden from talking about ‘HIV in Africa’”), his call for a data-driven approach extends to measuring impact as well as the state of the field.
The annual Global Health Council meeting left us with hope, but also with questions large and small: how will open source collaboration contribute to solutions? What is the overall evidence base for technology’s impact on health outcomes? Will tweeting for global health be around in five years, and for whom and what purpose? Will we be doing complete cause marketing and health education campaigns via mobile phones and how will this evolve? Will the flow of innovation and products from “South” to “North” become a noticeable theme? And can we organize a TED just for Global Health, so we can begin to understand how much impact technology might have?
Thanks for the article. You're absolutely right to point out how new this space is and already there is so much interest.