Yesterday was “World Bank Day @ mHealth Summit” in Washington DC, an event by the eDevelopment Thematic Group focusing on mHealth especially in the context of developing countries.

In the following the blog posts for the different sessions are listed.

• World Bank Day @ mHealth Summit – Opening session
• World Bank Day @ mHealth Summit – Part 2
• World Bank Day @ mHealth Summit – Part 3
• World Bank Day @ mHealth Summit – Part 4
• World Bank Day @ mHealth Summit – Part 5
• World Bank Day @ mHealth Summit – Part 6

There is also a World Bank Day @ mHealth Summit FlickR group, and Oleg Petrov took some videos and uploaded them to Youtube:

• Rachel Glennerster at WB Day @ mHealth Summit
• Erica Kochi at WB Day @ mHealth Summit
• Haji van Bejima, from Text to Change at WB Day @ mHealth Summit
• Erica Kochi, UNICEF at WB Day @ mHealth Summit
• Eric Rasmussen at World Bank Day @ mHealh Summit

To track the lively Twitter discussion, look at the hashtag #mhealth09.

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mHealth – as a reminder – is defined as the “delivery of health care services via mobile communication devices” as it was also stated during the event.

The general consensus at the event was that mHealth has really great potentials, especially in developing countries. Obiageli Katryn Ezekwesili, Worl Bank Vice-President for the Africa Region already used strong words during the opening of the event – Africa can’t let this unique possibility mHealth and ICTs offer pass by.

In the first sessions of the event, the potential of mHealth was emphasised and the commitment of all the participating countries was underligned. Several projects were presented and the effects of mHealth systems were introduced – but only on an anecdotal base. The need to focus on the patient to create succesful solutions was stressed.

Later the question about policy was posed – at what time should the state create regulations, not to inhibit innovations? Here the need for introducing regulations previous to policies and for including the private sector was expressed. It was pointed out that probably in 20 years nobody would talk about mHealth or eHealth anymore – as it would be completely integrated in the regular health system. Therefore it was questioned if mHealth even needs a policy seperate from a general health policy.

The fourth session had “scaling up” as topic – an issue that isn’t limited to the mHealth sector alone, but to all eServices currently running only as pilote projects. It was claimed that in the mHealth sector the “developing” and the “developed” world can learn from each other. Other important claims in the discussion was the need for partnerships and standards to enable interoperablity of different systems.

In the fifth sessions of World Bank Day, several mobile technology systems already used in the health sector were presented. The primary technology for these systems seemed to be SMS. What the experiences and lessons learned of these projects showed in the first place was that the main focus of succesful projects always lies on the end users, the local community and their need, not on technology. Interoperability was also a big topic in this session, although it was put forward that the current funding mechanism with competitive grants lowers the willingness of organizations to share their data and experience.

While there were different opinions about the claim that mHealth can even help to fix broken health systems, the general benefits were proven in the last session of the event, where “measurable health outcomes” and evaluation of projects were picked as the central theme. Especially Rachel Glennerster of MIT Poverty Labs presented interesting and encouraging research results. Still, the need for scientific evaluations and objective research on outcomes of mHealth systems was expressed by many participants and should be addressed in the future.

My resumé – the event was very complete and covered most important aspects of mHealth. The speakers were well chosen, they came from different sectors and provided different viewpoints and opinions. However, in my opinion the focus was slightly too much on advocacy. I would have been even more content if the session on evaluation and lessons learned would have been a bit more elaborate. Still I got a feeling that mHealth has really great potential and I was fascinated by the various possible uses and applications. I’m sure there’s a lot more to come concerning mHealth in the next few years – and that especially developing countries will benefit a lot from these developments.

Notes from the eDevelopment Thematic Group event World Bank Day @ mHealth Summit – mHealth from policy to implementation.

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Session 6: Operationalizing mHealth: How do we translate mHealth applications into measurable health outcomes

Beyond the widespread global usage of mHealth applications, there remains a gap due to the lack of data and long-term impact assessments on health outcomes to validate the effectiveness of mHealth. Evaluation frameworks and studies are currently in process to fill this gap and this will be the subject of discussion between the panelists in this session along with the importance of monitoring and evaluation frameworks for this nascent sector.

Chairs: Armin Fidler, Advisor, Health, Nutrition and Population and Claire Thwaites, UN Foundation

This is an important question

• how can outcomes be measured?
• some people may even say it can’t be measured

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Panel Discussion

Patty Mechael, mHealth and Telemedicine Advisor for the Earth Institute

Unfortunately the evidence is quite thin

• study on pilot projects
• randomized control trials
• but still developing this and figuring what works and what doesn’t

mHealth in Millennium Village project

• bringing connectivity to villages
• improving internal communication
• toll-free emergency numbers

Several applications

• child monitoring system

eHealth ecosystem

• closed loop system
• linking to the other systems – interoperable

Tested hypotheses:

• mobile technologies can improve access to health access -> health outcomes
• quality of care -> health outcomes
• improving efficiency & lowering cost

Focus on your goals and work your way backwards

Gold standard in health research: randomized control trials

• Also on mHealth solutions

Everybody who works on a project should think of how to evaluate it

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Julie Smith, Director of Public-Private Partnerships, CDC Foundation

Project: Phones for Health

Partnership with several organizations

Performance metrics – various areas of focus

• also focusing on partnership performance
• evaluating public-private partnerships

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Rachel Glennerster, MIT Poverty Labs

We run randomized control trials

What are the challenges?

• patients behaviour – is generally irrational
• health care workers – are acting irresponsible

Several measures to improve the behaviour

• upfront incentives
• deadlines
• …

Implications – health worker reliability

• reliable objective monitoring

Taking the result to existing evaluation to create an mHealth product which is working

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Andrew Stern, Partner, Dalberg Global Advisors

Evaluation – Theory of Change logic frame

Why do some projects work and some not?

• differences between countries

Learnings

• mHealth is not a solution to broken health care systems

Identifying critical challenges that constrain success

• decision making & budget
• lack of authority or money

Once again – data without action is worthless

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Q & A session

A lot of sessions mentioned that mHealth is not a fix for the health system – but particular aspects can be improved definitely

How do we get the results of the evaluation back to the policy?

Anybody experience in dealing with mental health with ICTs?

Aswers:

Rachel Glennerster:

• There is definitely a role of ICT to fix the health system, not for every single mHealth project – but some are very helpful
• Mental health? Really challenging for health systems in developing countries – no study seen so far
• every sector says – we have no time to evaluate, we need to act now, but it’s not an excuse

Patty Mechael:

• Getting systems to work can be very challenging
• Even being able to study a situation before implementing a project is a way of getting to success easier

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Closing Remarks

Armin Fidler, Advisor, Health, Nutrition and Population, World Bank

Repeat what I heard during the day

• Mobile phones are a cross cutting platform, it’s a means to an end
• There is evidence that it can improve the functioning of health systems and also the outcomes – although it is hard to measure
• It’s not only about scalability, also about sustainability
• Funding has an implication on competition
• eHealth policies can impede innovations – when is the right time?
• How to creat good business models to create win-win for all stakeholders?
• Leapfrogging

The way forward

• maybe in 20 years eHealth will be just usual and be an integral part of health
• exchaning information, how to collaborate – we should be doing more of that
• evaluation – more concerted effort to disseminate lessons learned
• scaling up – if we know something works, let’s make it big
• we need to keep an eye about the next step of technology
• it’s about health, it’s about people, it’s about change

Notes from the eDevelopment Thematic Group event World Bank Day @ mHealth Summit – mHealth from policy to implementation.

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Session 5: Showcasing mHealth Applications

This session will spotlight several mHealth applications that are being piloted and implemented. The panelists will provide demonstrations of their respective applications, provide an overview of why the applications were created and the direct impact in l countries where the technology has been introduced.

Co-Chairs: Armin Fidler, Advisor, Health, Nutrition and Population, World Bank

We always need to be aware of unintended consequences

• We should learn from our failures

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Eric Rasmussen, CEO, INSTEDD

mHealth system interoperability is a critical task

we looked at the gaps – and how can we fill them with FOSS

• GeoChat – SMS based, geotagging, mapping system, very successful
• Mesh4x – synchronizing different tools to share information
• Riff – collaborative decision support, cognitive analysis, sending messages when a problem appears
• Innovation Lab – teaching people everything that we know to make it their own and make it sustainablee, we use all other tools we find useful as well
• Trackernews.net

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Pamela Johnson, Co-Founder and Chief Health Officer, Voxiva

This is where everything started, thank you to the World Bank and Infodev to have been there from the beginning

Since 2001 we wokred on mHealth innovations around the world

• first pilot on Peru – increased to a country-based system and was adapted in other countries
• we learn from the developing world about things we want to deploy in the US

Project in 2009 – Mexico, flu and diabetes system

We looked in mobile phones because we were interested in scale

Lessons learned:

1- It’s not just about technology

• it’s about health, mobiles are only tools for health
• it’s about people
• our approach – we look at services which can use different technology, depending on different needs
• If you want to scale, you have to meet people where they are

2- Different technologies are for different things

3- Change is a constant

• the future will be different for sure

4- The regulatory requirement is really important

How to scale?

• It’s about people
• Avoid stovepipes – overkill of systems, devices, … may not be an improvement, standards are substantial
• Plan for sustainability – total cost of ownership: discuss who will take the responsibility for every sector of a project

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Josh Nesbit, Executive Director, Frontline SMS

Story how FrontlineSMS:Medic was developed

Internship in a rural hospital in Malawi

• Community health workers were disconnected from the hospital
• Trying to use FrontlineSMS for this purpose
• Training health workers how to use text messages

Effects:

• Patient care – became digital and much more efficient
• Logistics – partially automatized
• Community workers – became connected

Taking this forward – introducing the FrontlineSMS:Medic tool all around the world

New project: FrontlineForms

Linking with OpenMRS and Ushahidi

Lessons:

• focus on the end users and do programs their way
• low cost, available tools
• innovate on expressed needs

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Erica Kochi, Co-Lead Innovation Group UNICEF

We work directly with governments, giving them policy advice

Today: talking about RapidSMS

• open source framework to build SMS-based systems
• built on exisitng practices in the health system
• UNICEF will use it in 23 countries next year

Story starts in Ethiopia

• monitored distribution of food via RapidSMS – SMS data collection, online visualization
• cutting down the time needed for health workers

Other application in Malawi

• real time government information

Motivation for workers:

• sending symptoms and response SMS with diagnosis

Nigeria – Roll Back Malaria

Lessons learned:

• scale as a constraint
• partnerships are important
• utility for end users
• reinforce existing communication channels
• people have to find it useful
• build a local tech community

If you don’t use your data for action – it’s basically worthless

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Hajo van Beijma, co-Founder of Text to Change

mHealth in developing countries

• 5% is software, 95% is programs
• It’s about impact
• Challenges – we work with problems all day
• Scalability
• Focusing on the end user – what works?

We work with partnerships

• governments
• local NGOs

Key points:

• We believe in African software – strengthening the economy
• Look at the demands of local organisations & look at local content
• Interactive projects
• Create awareness
• Local languages
• Local content

Demand driving with new incentives – social incentives

Strengthening companies will help the mHealth movement in the end

Open source eveything – we are not there yet

Scaling is important – we are working on it

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Commentator: Arleen Cannata Seed, Senior e-Government Specialist, CITPO, World Bank

A lot of projects have been recently developed so there is no evidence on impact yet

Some of the results can be attributed to the link between mobile phones and changing of behaviour

Mobile phone has great attibutes – which can influence behaviour as much as no other thing recently

We must stay vigilant with this technology

We have to make use of technology as it evolves

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Q & A session

How are all these different programs working together?

What are important technology trends aside SMS – it’s pretty old?

How do we foster collaboration between those multiple initiatives?

Open source and open standards?

How to scale up pilot projects?

Answers:

Pamela Johnson:

• Integration of technology? We are working with other organisation which are active in the country – integrating services
• When is the right time for creating policies?

Hajo van Beijma:

• There is collaboration – e.g. Open mobile consortium

Josh Nesbit:

• We are trying to find rallying points to collaborate with systems in the same sector

Eric Rasmussen:

• Next technology? Utilization of new technology is increasing very fast – mCommerce will come soon; development of sensors – using mobile phone as platform for laboratory diagnosis
• It is difficult to see how hard it is to collaborate – because of the grant-making mechanism, which makes us all natural opponents

Erica Kochi:

• mHealth is not going to fix a broken health system
• Collaborate with the users on the ground

Notes from the eDevelopment Thematic Group event World Bank Day @ mHealth Summit – mHealth from policy to implementation.

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Part 2: Scaling-up Mobile Technology Innovations in Health Sector Projects

Session 4: Scaling Up Mobile Innovations in World Bank Health Sector Projects

This session will provide an overview of the potential contributions of ICT to health services in the countries that are facing greatest health problems, and how mHealth (and eHealth in general) can provide a new set of tools for Africa and other developing countries to tackle the long-standing health challenges. The session will discuss how ICT can help the Bank’s health operations to achieve their goals more efficiently and effectively as well as the key constraints. The session will also brainstorm how Bank can play a more active role in exploring and using ICT and the ways of scaling up ICT applications in World Bank health projects.

Chair: Eva Jarawan, Sector Manager, Africa Health Department, World Bank

Presentation by Feng Zhao, eHealth Coordinator, Africa Health Department, World Bank

eHealth and mHealth present tremendous opportunities, especially for developing countries

Tour to Telecomm 2009 Geneva – Open Network – Connected Minds

• Paul Kagame: Africa must be seen as an opportunity
• Communication is a basic human right
• Consensus:
• - world is different than just recently – due to mobiles
• - ICT is an engine to economic growth everywhere
• - ICT as answers to many challenges
• - ICTs are part of almost everything we do

We are dealing with a new – increasingly connected – world

Potential of ICT in health has not been well studied – mostly anecdotal stories

• Evidence can be seen in the initiatives of many countries
• ICTs contributions to service delivery are easy to see and systematic

Demystifying mHealth

• wrong perception that developing countries are not ready for mHealth

We should start a demand from the application side – then the connectivity will come

• There are urgent health problems – waiting is not an option

Currently people in Africa are paying too much for mobile services – but prices are decreasing and low-cost models for developing countries are possible

• eHealth can even be money saving

Developing countries are in greater need for ICT – for them eHealth is not an option, but a necessity

Bottlenecks

• knowledge
• integration and coordination
• policy
• capacity
• lack of evidence

Why is mHealth important for the World Bank?

• ICT can help reaching the MDGs – part of the responsibility of WB
• ICT can tackle structural problems in a new way
• WB has comparative advantages to promote mHealth and eHealth

Options for the World Bank:

• knowledge sharing
• capacity building
• evaluation
• mainstream ICT in health

eHealth requires strong partnerships

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Panel Discussion

Deepak Bhatia, Lead eGovernment Specialist, Global ICT Dept, World Bank

Value chain for mobiles – many different stakeholders involved

• how are they coming together to allow for mobile services to be delivered

World Bank can be an agent for standards

The success of mobile finance is something that should help promote mobile health services

Standards and interoperability of systems becomes extremely important

Cross cutting view – look at channels of eLearning and eFinance and use them

Evaluation of projects is important

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Souheil Marine, Head of ICT Application and Cybersecurity, International Telecommunication Union (via videoconference from Geneva)

Infrastructure:

• backbones are still lacking in developing countries
• We need this to enable mobile phones to access to the internet
• the digital divide is there

Cost:

• we dont have yet evidence that large scale application of mobile services can happen cost effective
• we don’t know the value chain for all stakeholders
• we need to build partnerships

In developing countries, eHealth is about making the scarce resource of a doctor more efficient

It’s health which is important, not eHealth

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Najeeb Al-Shorbaji, Director for eHealth, World Health Organization (via video conference from Geneva)

Partnership:

• like being invited to a party, everybody needs to bring something
• the big organisations start to undertand that

Cost-benefit analysis

• Like information itself it’s diffiecult to measure its impact
• Assumption: because the health sector is knowledge based, the more information is there and organized, the better outcome there is

Capicity building leads to more efficiency and better usage of ICT

Without content – high quality data – services will not take off

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Agnes Soucat, Advisor, Africa Health Department, World Bank

ICT is high on the agenda – but why?

• In developing countries, eHealth is probably a revolution
• we see more and more evidence that eHealth can leapfrog traditional healthcare systems in Africa

We should focus on redesigning their health systems

• instead of helping them build yesterday’s solutions

We haven’t given enough notice to public sector potential

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Q & A session

Microsoft – how do we jump in the development of the whole thing?

How do we incentify responsible behaviour in doctors by telemedicine?

Are we heading towards globalizing our health services and do we want that?

Answers:

Souheil Marine:

• In a developed country we can chose different doctors, but in developing countries mHealth services may allow to connect to the only doctor in the area

Najeeb Al-Shorbaji:

• Developing and developed world have to learn from each other
• We can’t impose tools to problems we never experienced
• Globalizing services? Happens already, giving people the choice is one of the most important thing we can do

Feng Zhao:

• This is about forming partnerships – we want to get to know all the stakholders, especially from the private sector
• World Bank – we are now caring more about output, not input – focusing on results
• We have had enough advocacy, we really need to get going

Notes from the eDevelopment Thematic Group event World Bank Day @ mHealth Summit – mHealth from policy to implementation.

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Session 3: Policy Perspectives on Using Mobile Technology for Better Health Outcomes

A key step in the process of mainstreaming and scaling-up mHealth is a sound eHealth and mHealth policy at the country level. The panelists in this session will present their views on developing a successful e/mHealth policy and provide examples of best practice and learning from around world.

• Panel Discussion

Chair: Elizabeth J. Ashbourne, Lead, Global Health Information Forums, World Bank/Health Metrics Network

Questions?

• can mHealth policy be created without a eHealth policy?
• are the policy priorities that are also connected to mHealth but lie in a different sector?
• who should be at the table discussing mHealth services to push the frontiers?

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Najeeb Al-Shorbaji, Director for eHealth, World Health Organization (via video conference from Geneva)

mHealth is an integral part of eHealth

• Important: mHealth as part of eHealth plan, not an island

Expected: 45% of traffic on phone will be data

Some global concerns related to mHealth

Importance of mHealth

• it’s used
• it’s people-centered

Research literature: mHealth is here to stay

Currently WHO conducting second global eHealth survey

• 75 countries
• end of November
• 15 of 20 African countries have eHealth initiatives

Lack of knowledge is #1 reason which prevent applications of mHealth, other reasons: operating costs, infrastructure, policy

Comparison Europe – Africa

• different barriers in mHealth
• no solutions can be just transferred

Issues in mHealth

• sustainability
• data exchange & interoperability
• data security

Important points

• Involving all stakeholders
• We need to find solutions which work on different networks and work everywhere if possible
• Multilingualism – not only English

WHO – big global eHealth initiative & we are happy to collaborate with other institutions

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Alison Bloch, m-Health advisor, GSMA

Mobile vs. Internet

• centralized & no competition vs. decentralized & everybody can put up their service
• slow innovation vs. easy innovation
• easy to identify people vs. anonymous

There are very many issues around health systems which include policy

How to engage public and private sector to work together in creating good regulations – fostering innovations

“Information makes markets work and markets improve welfare” – but also question of data ownership, privacy and security

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Karl Brown, Assistant Director for Applied Technology, Rockefeller Foundation

Issue: ordering when policy comes into discussion

• technology arrives first
• then policy
• then capacity building

Role for policy? How to foster innovation?

Over time mHealth, eHealth and traditional health information systems will merge

mHealth shouldn’ be a seperate policy sector, should be part of general health sector

Currently – eHealth councils are emerging in various countries

• private and public organizations discussing about regulations

We need to have a sense what such systems cost in the long term

Should there be a standardization in eHealth policies or just a checklist?

• Approaches to these policies is very varied in different countries
• Even in different ministries

How to link national policy efforts to international policy efforts?

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Patty Mechael, Earth Institute

What are we trying to achieve with this technology?

We should start to have guidelines to help countries figure out where to focus towards achieving the objectives concerning mHealth

Take a look at existing eHealth policies and see where the gaps are

The industry of mHealth around mServices has also to be taken into account

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Q & A session

Ghana:

Security and legislation – mHealth presents a lot of issues, World Bank can help member countries to develop a frameworkfor that

How can we identify projects that have potential?

Russia:

It’s important to develop a legislation to back up tele-medical services

We are ready to share our experience and knowledge about mobile & telemedical systems in rural areas

Tanzania:

Is it necessary to have a seperate policy for eHealth – if eGovernment is already covering that sector?

D.C. Audience:

How do we align comercial with public policy interests? What is being defined in terms of economic cost-benefit analysis?

We are talking about two different policies – we must remember health policy and how to integrate eHealth and mHealth in the traditional health sector. What makes sense and what doesn’t?

How to target the appropriate level of policy?

How is the role of the academic sector?

Answers:

Patty Mechael:

• Security & flexible policies – example: Ghana was open to developing guidelines before policies
• mHealth and mFinance should work together
• mHealth vs. eHealth vs. eGovernment: you have to have the connections between all these and find out where to get economies of scale

Najeeb Al-Shorbaji:

• What we are trying to do is to improve the health situation of people
• We have to make sure the content in high quality, no matter if m- or e-
• The “e” will disappear when “e” will be everywhere – the important thing is health
• There is an economic value in ICT – time saving, quality data, … – we need consisten, evidence based approaches to prove that to the governments
• Policy first or practice first? There are problems around eHealth – so we have to put in some guidelines, we can’t develop a policy for something we don’t know
• We have to keep health data of people away from other data

Alison Bloch:

• How to empower users / patients
• Business models? Can we do good and do well? Larger topic – bringing many groups to the table and try to create such models

Karl Brown:

• The future of eHealth is health
• Pilot projects? The country should think of what the long term costs are, that may benefit sustainable projects
• m-Pesa was informal system and evolved by itself
• As much innovation in mHealth should be fostered – without constraining it with policies upfront

Notes from the eDevelopment Thematic Group event World Bank Day @ mHealth Summit – mHealth from policy to implementation.

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Session 2: Global Overview, Country Cases and Perspectives

According to a recent UNF-Vodafone Foundation study, the use of mHealth is being implemented in several developing countries with using a number of applications such as data collection and analysis; education and awareness; and monitoring and surveillance. The panelists in this session will provide an overview of the mHealth movement and describe actual project implementations in the field followed by an interactive comment and Q&A video conference session from several country representatives.

• Panel Discussion

Chair: Deepak Bhatia, Lead eGovernment Specialist, Global ICT, World Bank

Global Overview: Mitul Shah, Senior Director, the UN Foundation

What’s being done currently around the world concerning mHealth?

We need a cross cutting tool which can address different challenges

• This tool is the mobile phone

mHealth: delivery of health care services via mobile

communication devices

how does it fit in the whole eHealth sector?

We don’t need train the individuals to use their mobile, it’s also becoming ubiquitous

What can be done specifically to leverage the potential of this tool which is already in the peoples’ hands?

Two client sets:

• patients
• ministry of health

key application

• education and awareness – campaigns
• data collection – health data which is critical
• monitoring and medication compliance
• disease emergency tracking
• health administration systems
• diagnostic tool – most interesting application, maybe in a few more years we’ll see

where is it currently being used?

• Africa is on the forefront

What has the impact been?

• mobile health reaches out to very different audiences
• health care providers, mobile providers, individuals, …

Where do we go from here?

• there is a growing momentum
• we need to focus on solid research, proving the impact

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Mexico Case: Rodrigo Saucedo, mHealth Lead Researcher, Carso Institute

What are the things crucial to mHealth projects?

empowering individuals, focusing on the patient

Technologies are increasingly becoming a part of people’s daily lives

Four solutions

• CardioNet – assessing health indicators and giving advice to change the lifestyle
• Diabediario – reminders on medications and dates, monitoring it on the website to see how users react to various measures
• VidaNet for people with HIV/AIDS – they receive medication, appointments; monitoring, also the ministry of health
• A solution on H1N1 flu

Standardized methodology

• Strategic Planning
• Operation
• Scaling

None of the projects have been scaled so far

Field workers have to be trained

How to take the most of technologies – even without too much knowledge about technologies

• partners

Governments are open to initiatives but they are very risk-averse

Technology is seen as an expensive intervention

Conclusion and outlook – what’ important:

• Training
• Social marketing
• integration into national health system
• funding in the long term

Need for evidence of success

• Networking
• Evaluation
• Best practices

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Kenya Case: Yusuf Ibrahim, Training and Support Manager, DataDyne and Kenyan Ministry of Health

mHealth as a solution to fight polio

EpiSurveyor is used in the ministry

traditional life cycle

• data collection
• data entry
• data analysis
• data reporting
• action

mHealth can drastically decrease the time from data collection to action

February 2009:

• polio outbreaks
• vaccination campaigns
• mHealth was used to support this campaign – making paper work more efficient
• daily information review with EpiSurveyor

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Cambodia/Mekong Region Case: Romdoul Kim, Director of Government Affairs, Mekong Region, InSTEDD iLab (via VC from Phnom Penh) and Eric Rassmussen, CEO, InSTEDD

InSTEDD is an NGO from California

Provides health related tools to actors in the public health sector

Cambodia facts

• 30% mobile phone
• health situation not too good
• but all public health workers have access to mobile phones

Tool: GeoChat

• Open Source
• Vertical Communication
• Used for disease surveillance
• Also horizontal communication – server-independent

Mekong Basin Disease Surveillance

• Six countries
• Instedd helping the countries in ICT adoption
• Keeping whole team updated by using GeoChat

HIV Clinical Management

• mHealth system connecting to current patient database
• using SMS
• purpose: HIV healthcare delivery, not losing the HIV patients

One health – animal health

• working with ministry of agriculture
• telephone hotline to report sick animals
• veterinary in the village receives advice via SMS

GeoChat is also conncted with other tools to maximise impace

In Cambodia there is no reliable way of communication except mobile phones

What we are learning:

• even though almost 100% of health workers for the health centre staff have mobile phones, using English mobile phone technology has proven difficult
• we are working on other ways – e.g. machine-driven way to deliver the correct information

Innovation Lab

• live and work in the field
• training local staff & partner staff
• it’s an open source technology, can be expanded also when Instedd leaves

Instedd does also web synchronisation of data in various countries

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Uganda Case Study: Fiona Lee, Project Lead, Google Africa & Grameen Foundation

Vision for Applab initiative

• Bring accurate, relevant, localized information to the poor
• Partner: Google

Process

• working with users – look at the demand, where are the gaps, how is information consumed
• partnering with local organizations
• piloting and testing lots of applications
• iterate & fail fast
• building sustainable models
• you have to have incentives for all involved

information that is timely, trusted, and specific is important, there are also local customs which have to be

People want specific answers

SMS works on any phones

We tried ten pilots, reaching a lot of peopl

Google SMS service in Uganda was launched

• Google Trader – supporting traders
• Google Seach – for news, sport results, …
• Google SMS tips – agriculture tips, health tips

Providing information to the most vulnerable in a community

• women
• youth
• farmers

SMS Tips has gotten 1.5 million queries in the first months

There is a huge demand – even at the bottom of the pyramid, if there’s value in the services

We want to extend Google Tips to other regions

• We need more content
• there were a lot of queries on health which we didn’t cover
• We need a lot more health information

Google will build a platform for everybody to add relevant health information

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Questions & Remarks by Participating countries: Armenia, Russia, Moldova, Ghana, Rwanda, Tanzania, and Kenya

Moldova:

There is a need for a participatory approach in creating mHealth technologies including public health sector, patients, …;

mHealth seem to rely on a quite sophisticated marketing

What about data protection?

It must be made sure the data is not monopolized by any of the service providers

Services should be designed before thinking about technology

Russia:

Mobile systems should be based on a developed informatio infrastructure;

We try to gather data on every citizen with all disease data – database which is open to the entire country

Mobile technology is important means to support other services

Ghana:

Ghana has an ICT policy, but it needs to be reviewed in the light of developments in the health sector

Different stakeholders which emerged on the screen need to be included

Currently developing an eHealth strategic plan

We need to reach the targets of the MDGs, we need to strategically deploy mHealth for that purpose

Kenya:

We tend to prescribe solutions to the poor – is there any suprising innovation the poor have come up with using the mHealth systems?

Rwanda:

Whatever program you have, you need to have a national plan to introduce it

Instedd in Cambodia – what is the cost of ownership? What is the cost of scalability?

Google Uganda – did you assess the willingness of poor people to pay? Is the SMS cost a barrier for people to access the service?

Tanzania:

We have an initiative of eGovernment & eHealth – mHealth is a subdivision of that and is currently being coordinated – there is a recent project on that

New project using mobile phones tackling the transport costs to the hospitals

Ethiopia:

Ethiopia is going through a business process reengineering process currently

One achievement – free broadband for health institutions

D.C audience:

Are there any policies that were already in place in the countries the organizations the presenters worked in?

Language: is anyone looking at none text-based mHealth solutions?

Twitter:

What is the strategy for Goggle sms health tips beyond the ‘free’ period? Still plans for charging premium SMS rates?

Google/grameen sms health mentioned 1.5 million queries. How are they promoting the service to public?

Instead of prescribing ICT for the poor, what are the local “killer apps” that we should note?

what are the poor actually using these mhealth apps for? and do they think that this is useful for their lives?

Answers:

Language? Software used for end-users: French, Spanisch, Swaheli

Google

• Killer-app? Facebook; there’s no magic killer app, we are continuing to experiment
• Google tips Costs? We offer the service for free for a while, since the launch we started charging for some services – still very cheaply
• How were Google SMS services promoted to the public? Our carriers – e.g. short message by checking their balance
• Language? Uganda: very difficult to provide Google service in other languages
• When you make a service free you devalue it in the eyes of the user

Grameen

• Always looking for sustainability – that’s why we don’t provide them for free
• Langauge? Often it comes down to the kids – they tend to speak English and often translate for their parents

Instedd

• everything we do is free, open standards
• Language: Instedd – we are translating everything in various languages, but we also do
• we try to work with the ministries

Notes from the eDevelopment Thematic Group event World Bank Day @ mHealth Summit – mHealth from policy to implementation.

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Part 1 : Global Policy Dialogue on mHealth

Welcome & Site introductions

Deepak Bhatia, Lead e-Government specialist, Global ICT, World Bank
Oleg Petrov, eDevelopment TG coordinator, Global ICT, World Bank
David Aylward, Executive Director of the mHealth Alliance

mHealth as catalyst for measurable health impacts

Especially World Bank mHealth projects are being looked at

There are a lot of opportunities for synergies

How can we work together more effective to deliver more efficient health care?

It’s extremely exciting, there’s a lot to be done – we have an important mission

Introduction of country offices – a lot of participants and discussions there

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Session 1: Opening & Keynote

• Introduction

Yaw Ansu, Human Development Director, Africa Region, World Bank

Africa is facing great challenges

mHealth and eHealth in general has great potential for the continent to help

We are working closely with a lot of partners in several projects

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Philippe Dongier, Sector Manager, Global ICT, World Bank

It’s not just about technology but also about other issues – about which we will discuss today as well

We didn’t see the boom in mobile phones coming, now we have a tremendous opportunity to reach people and do things differently – in many fields

The future of the internet is mobile or wireless – as well in the health sector

Challenges are about regulations – telecom operators and about the business model

What’s the role of developers, public sector, private sector, …

Where will the innovation come from? Actually from all the sectors

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• Opening Remarks

Rakesh Nangia, Operations Director, Human Development Network, World Bank

There will be challenges and innovations – we will only be limited by our creative thinking, not by technology

There are shocking statistics on health in developing countries

Mobile technology has already achieved quite some things – e.g. empowering women in Bangladesh

“Leapfrogging” is discussed often – maybe too often

We need to to think of how technology can bring healthcare to the people when the physical proximity is hard to overcome

Example: Uganda

• quiz to increase knowledge about HIV/AIDS
• increased testing of HIV of 40%

Example: South Africa

• only 5% of people get tested for HIV
• government sent out phone numbers of places where people can be tested

Example: Rwanda

• SMS to remind people to take their pills

Lots of interesting uses

Similarly – health workers are trained to look at epidemics

mHealth is an innovative way to get health care closer to the people

But it’s not about technology, as Phillipe already said

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Obiageli Katryn Ezekwesili, Regional Vice-President, Africa Region, World Bank

In many ways we haven’t pushed the frontiers of technology yet

We have to realize the potentials of ICTs, we can’t just let that pass by us

We do well with tackling poverty if we focus of the asset of the poor

• they assume the ownership of a mobile as one of the biggest thing in their life
• we have to focus on that

Innovation can push us to look at solutions – which is reflected in this kind of summit the World Bank is hosting

Mobile phones are omnipresent in Africa – the mobile revolution, an important progress

seven years ago Nigeria had just about 250 000 fixed line phones

• which brought with itself various forms of corruption
• the regulations which came improved the whole situation
• the World Bank was involved in that, which is a great benefit
• now: 250 million mobile phones

Knowledge is power – telephones in Africa are not just a tool for communications

• it’s a social, political, knowledge tool
• we have the opportunity to use it a health delivery tool as well

Lack of access to health infrastructure prevent us from reaching our goals

ICTs presents us a lot of opportunities

The patient the primary focus, the results must focus on the patient

With only seven years left to the MDGs we need to be really bold and embrace new ways of getting things done – tradition can sometimes kill, we need to rethink our ways

It’s not just politics which is the answer to all problems, there’s also technology which can achieve things

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• Keynote Address

Dr Agnes Binagwaho, Permanent Secretary, Ministry of Health (via Videoconference from Kigali)

When we in Rwanda look at the agenda we are happy, because it focuses on the use of health in the development countries and countries facing the greatest health problems

We need to combine health with effective communication

Communication technologies have become effective tools to fight diseases

Technology is making health care more possible and more precise

Helahtcare is being turned into a ICT industry

Rwanda has adopted the use of technology in all sectors – health included

• technology in hospitals
• building manpower by education
• adopting national and international standards

Use of mobile phone is dependent on other indicators

• coverage 98%
• penetration 21%
• we try to increase the penetration

TRACNet – mobile phone & internet based tool which we use

• significantly improved the way AIDS is treated in Rwanda
• people are well monitored

Also more application – mobile based – are being developed

Rwanda: 45 000 community health workers all around the country, several projects to realize their potential – AIDS and maternal health

Trying to foster exchange between grass roots initiatives and hospitals

mHealth is an indispensable tool to deliver helathcare today and a key priority in Rwanda

Again it’s time to make a resumé what has happened in the last three months – same as the last two times:

• Internal #Q2 2009
• Internal #Q1 2009

While Martin Konzett was in Zanzibar, he screened our movie Hello Africa at ZIFF (Summary of ZIFF by Dan Hamm), made some valuable contacts and set up our Zanzibits Support project which is now running with Dan Hamm and Fritz Grabo as teachers.

Our volunteer Wambura Kimunyu attended M4Change Nairobi and wrote a blopost about it – Thoughts from M4Change Nairobi.

I, Florian Sturm, went to Ghana and visited some interesting projects there – for example the Don Bosco school in Sunyani, Suame magazine & SMIDO in Kumasi (SMIDO official website) and the OneVillageFoundation Ghana in Winneba. Furthermore I was lucky that two really exciting events just took place at the time I was around:

• IDDS – International Development Design Summit at Kumasi, Ghana- Summary of final presentations of IDDS
• Maker Faire Africa at Accra, Ghana

Especially Maker Faire was a unique possibility to show our movie Hello Africa and to make a lot of great contacts. I met and talked to many people from the IT scene in Ghana, several makers from around Africa, the organizers from Butterfly Works, Erik Hersman, Nii Simmonds, people from Inveneo, Nairobits, and lots more. Recap of Maker Faire on ICT4D.at

Later in august Martin Tomitsch and Martin Konzett attended the INTERACT2009 workshop Ethics, Roles and Relationships in Interaction Design in Developing Regions which took place in Uppsala, Sweden and online. They presented a paper on Designing an SMS-based application for seaweed farmers in Zanzibar (and why it failed for now). Notes on INTERACT2009 on ICT4D.at

Worlali Senyo, our volunteer from Accra helped us cover the efforts in Ghana towards more broadband for everybody – with posts on AfNOG EO Localiazation Workshop and Ghana to Develop a National Broadband Strategy.

In October we were already present at two events – Africa Gathering in London, and May You Live In Interesting Times in Cardiff, where our movie Hello Africa was screened – once again. Concerning Hello Africa there’s more great news – it made it to archive.org.

Also our partnership with the World Bank eTG group moved forward, we covered two workshops.

• Mobile Innovations for Social and Economic Transformation
• The Singapore Experience: Ingredients for Successful Nationwide eTransformation

Now we are preparing the next interesting event focusing on the potentials of mHealth – “World Bank Day @ mHealth Summit” on 28. October.

For the future we are planning to collaborate more with OLPC Austria in our efforts to create an ICT4D scene in Austria and some ICT4D-related events.

So, a lot of things are happening in ICT4D and we are excited to be a part of the whole scene. Looking forward to the next months.

As announced, on 28 October the eDevelopment Thematic Group of the World Bank is organizing the “World Bank Day @ mHealth Summit“, where speakers from various sectors share their views on mHealth and sample projects are presented. The event was planned in the context of the mHealth Summit, but focuses more on the situation in developing countries.

If you want to watch the event online – follow the link to the live webcast registration.

If you want to get updates, ask questions or post comments, please follow the eDevelopment group on Twitter and use the hashtag #mhealth09 for the World Bank day, and the hastag #mHS09 for the general summit.

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AGENDA (from the Wold Bank Day event page)

• 8:15am – 9:00am: Registration and Breakfast

Part 1 : Global Policy Dialogue on mHealth

• 9:00am – 9:15am: Welcome & Site introductions

Deepak Bhatia, Lead e-Government specialist, Global ICT, World Bank
Oleg Petrov, eDevelopment TG coordinator, Global ICT, World Bank
David Aylward, Executive Director of the mHealth Alliance

Session 1: Opening & Keynote

Co-Chairs: Eva Jarawan, Sector Manager, Africa Health Department, World Bank & Philippe Dongier, Sector Manager, Global ICT, World Bank

• 9:15am – 9:25am: Introduction

• 9:25am – 9:40am: Opening Remarks

Obiageli Katryn Ezekwesili, Regional Vice-President, Africa Region, World Bank
Rakesh Nangia, Operations Director, Human Development Network, World Bank

• 9:40am – 9:55am: Keynote Address

Hon. Dr. Richard Sezibera, Minister of Health, Rwanda (via videoconference from Kigali)

Session 2: Global Overview, Country Cases and Perspectives

According to a recent UNF-Vodafone Foundation study, the use of mHealth is being implemented in several developing countries with using a number of applications such as data collection and analysis; education and awareness; and monitoring and surveillance. The panelists in this session will provide an overview of the mHealth movement and describe actual project implementations in the field followed by an interactive comment and Q&A video conference session from several country representatives.

• 09:55am – 11:20am: Panel Discussion

Chair: Deepak Bhatia, Lead eGovernment Specialist, Global ICT, World Bank

- Global Overview: Mitul Shah, Senior Director, the UN Foundation
- Mexico Case: Rodrigo Saucedo, mHealth Lead Researcher, Carso Institute
- Kenya Case: Yusuf Ibrahim, Training and Support Manager, DataDyne and Kenyan Ministry of Health
- Cambodia/Mekong Region Case: Romdoul Kim, Director of Government Affairs, Mekong Region, InSTEDD iLab (via VC from Phnom Penh) and Eric Rassmussen, CEO, InSTEDD

Questions & Remarks by Participating countries: Armenia, Russia, Moldova, Ghana, Rwanda, Tanzania, and Kenya

• 11:20am – 11:35 am: Coffee Break

Session 3: Policy Perspectives on Using Mobile Technology for Better Health Outcomes

A key step in the process of mainstreaming and scaling-up mHealth is a sound eHealth and mHealth policy at the country level. The panelists in this session will present their views on developing a successful e/mHealth policy and provide examples of best practice and learning from around world.

• 11:35am – 12:15pm: Panel Discussion

Chair: Elizabeth J. Ashbourne, Lead, Global Health Information Forums, World Bank/Health Metrics Network

- Najeeb Al-Shorbaji, Director for eHealth, World Health Organization (via video conference from Geneva)
- Alison Bloch, m-Health advisor, GSMA
- Karl Brown, Assistant Director for Applied Technology, Rockefeller Foundation

• 12:15pm – 12:45 pm: Q & A session

• 12:45pm – 1:45am: Lunch

Part 2: Scaling-up Mobile Technology Innovations in Health Sector Projects

Session 4: Scaling Up Mobile Innovations in World Bank Health Sector Projects

This session will provide an overview of the potential contributions of ICT to health services in the countries that are facing greatest health problems, and how mHealth (and eHealth in general) can provide a new set of tools for Africa and other developing countries to tackle the long-standing health challenges. The session will discuss how ICT can help the Bank’s health operations to achieve their goals more efficiently and effectively as well as the key constraints. The session will also brainstorm how Bank can play a more active role in exploring and using ICT and the ways of scaling up ICT applications in World Bank health projects.

• 1:45pm – 2:30 pm: Panel Discussion

Chair: Eva Jarawan, Sector Manager, Africa Health Department, World Bank
Presentation by Feng Zhao, eHealth Coordinator, Africa Health Department, World Bank

- Agnes Soucat, Advisor, Africa Health Department, World Bank
- Deepak Bhatia, Lead eGovernment Specialist, Global ICT Dept, World Bank
- Souheil Marine, Head of ICT Application and Cybersecurity, International Telecommunication Union (via videoconference from Geneva)
- Najeeb Al-Shorbaji, Director for eHealth, World Health Organization (via video conference from Geneva)

• 2:30 pm – 2:50 pm: Q & A session

• 2:50pm – 3:00 pm: Coffee Break

Session 5: Showcasing mHealth Applications

This session will spotlight several mHealth applications that are being piloted and implemented. The panelists will provide demonstrations of their respective applications, provide an overview of why the applications were created and the direct impact in l countries where the technology has been introduced.

• 3:00 pm – 4:00 pm: Panel Discussion

Co-Chairs: Armin Fidler, Advisor, Health, Nutrition and Population, World Bank, Deepak Bhatia Lead eGovernment Specialist, Global ICT, World Bank

- Paul Meyer (TBC), Voxiva
- Eric Rasmussen, CEO, INSTEDD
- Josh Nesbit, Executive Director, Frontline SMS
- Erica Kochi, Co-Lead Innovation Group UNICEF
- Hajo van Beijma, co-Founder of Text to Change

Commentator: Arleen Cannata Seed, Senior e-Government Specialist, CITPO, World Bank

• 4:00pm – 4:15 pm: Q & A session

Session 6: Operationalizing mHealth: How do we translate mHealth applications into measurable health outcomes

Beyond the widespread global usage of mHealth applications, there remains a gap due to the lack of data and long-term impact assessments on health outcomes to validate the effectiveness of mHealth. Evaluation frameworks and studies are currently in process to fill this gap and this will be the subject of discussion between the panelists in this session along with the importance of monitoring and evaluation frameworks for this nascent sector.

• 4:15pm – 5:00 pm: Panel Discussion

Chairs: Armin Fidler, Advisor, Health, Nutrition and Population and Claire Thwaites, UN Foundation

- Rachel Glennerster, MIT Poverty Labs
- Julie Smith, Director of Public-Private Partnerships, CDC Foundation
- Andrew Stern, Partner, Dalberg Global Advisors
- Patty Mechael, mHealth and Telemedicine Advisor for the Earth Institute

• 5:00 pm – 5:15 pm: Q & A session

• 5:15 pm – 5:30pm: Closing Remarks

Eva Jarawan, Sector Manager, Africa Health Department, Armin Fidler, Advisor, Health, Nutrition and Population, World Bank, Deepak Bhatia, Lead eGovernment Specialist, Global ICT, World Bank, Claire Thwaites, UN Foundation

On Wednesday, 28 October, an exciting event by the World Bank eDevelopment Thematic Group is taking place. Its title is “m-Health: From Policy to Implementation” or “World Bank Day @ mHealth summit” and it is held in conjunction with the mHealth Summit which takes place in Washington on the following two days. It is supposed to be a forum for exchange on mobile health topics and experiences, speakers from the public sectors will present the policy side, whereas successful implementations in projects such as FrontlineSMS or Text To Change will be showcased.

The event will take place in Washington again, but also be broadcasted over the web.

What: m-Health: From Policy to Implementation – World Bank Day @ mHealth summit

Where: Washington DC, also available via webcast

When: 28 October, 9:00 Washington time

ICT4D.at will of course cover the event on Twitter and here on the blog.

From the eDevelopment Thematic Group “m-Health: From Policy to Implementation” page:

Jointly sponsored by World Bank Group (HDNHE, AFTHE, GICT, IFC) and UN Foundation/mHealth Alliance, in collaboration with FNIH, NIH and others, the World Bank Day @ mHealth Summit will raise awareness of the possibilities for mobile-enabled innovations for improving health care and health care outcomes in developing countries and seeks to:

• Contribute to putting m-health on the map of the mainstream public health agenda.
• Explore options as to how to translate mHealth applications into measurable health outcomes.
• Provide concrete examples of experience at the country level – what questions to ask, what to look for, what tools are available, and what are the policy implications for implementation.
• Establish a basis for future collaboration and continued dialogue on mHealth.

This unique one-day workshop will bring together lessons, innovations, and perspectives from the practitioners and policy makers. The workshop will discuss specific case studies and country perspectives on mHealth and address scaling up mobile innovations in World Bank Health Sector Projects. World Bank @ mHealth Day is integral part of the mHealth Summit focusing on Mobile Technologies as a platform for health research and health care delivery. The mHealth Summit is an unprecedented event that will bring together researchers, policy-makers, collaborators and visionaries from around the world to exchange ideas, novel approaches, research and findings surrounding mHealth issues both in the United States and in developing countries.