WHO identifies main barriers to m-health
By Issa Sikiti da Silva, Dakar, Senegal
Despite the successful pilot of m-health programmes in developing countries, especially in Africa, the World Health Organisation (WHO) says m-health implementation is still being hampered by competing health system priorities, which it has identified as a top barrier globally across high, upper-middle and lower-middle income countries.
WHO says that most health systems are severely overburdened, which means they are constantly challenged by the need to make difficult decisions about competing priorities.
Dakar-based industry watcher Leopold Camara agrees, saying that most African governments already have ‘very little food’ on their plates to share among ‘so many people’, which he said making a decision about who will take what and who will get little or who won’t get nothing, becomes very difficult.
“Concepts such as e-health and m-health can seriously change the face of a country’s health system, but implementing such initiatives becomes problematic if there is no adequate funding, especially in the face of unknown cost-effectiveness of available m-health solutions,” Camara says, adding that that is the reason why many m-health initiatives in developing countries are privately-funded.
“Sometimes, I have the feeling that technology is putting too much pressure on Africa, and forcing already-burdened African governments to bite more than they can chew.”
The Geneva-based UN agency also says competing priorities generally indicates that funding is allocated to other programmes ahead of m-health, or can reflect a lack of general interest or understanding of the field.
Camara explains: “It becomes difficult when you have so little to spend to solve your problems. Africa has too many health needs, from lack of drugs to medical staff asking for a pay increase, no electricity at state hospitals, not enough beds, no ambulances, replacing obsolete equipment, building more clinics, and so on.
“African decision-makers firmly believe these needs must be taken care of, first, before they think of investing in m-health, which they may think is ‘less important’. This lack of interest or knowledge continues to constitute a dangerous obstacle to the development of e-health and m-health in Africa.”
The Royal Tropical Institute, which says the majority of m-health initiatives in resources-poor settings are pilots and few have been identified for scaling up, lists about 50 Africa m-health programmes, most of which have been implemented in countries such as Kenya, South Africa, Ghana, Tanzania, Uganda, Mozambique, Ethiopia, Botswana, Malawi, Nigeria, Rwanda, Gambia and Senegal.
Senegal’s well-known m-health initiative is called Djobi, which was financed by the Fond Francophone des Inforoutes and set up by RAES (Réseau Africain d’Education pour la Santé), an NGO, in partnership with Orange, PAMAS and Gaston Berger University.
Djobi, which is also implemented in Mali, aims to reduce child mortality by 30% among children of under five in both countries. Djobi was among the eight m-health initiatives which received grants from the Norway-owned Innovation Working Group (IWG) and mHealth Alliance in September 2012.