In honor of World AIDS Day 2012 (Dec. 1), we compiled a list of health initiatives in Africa that utilize technology. 80 percent of African illnesses stem from preventable infectious diseases and the percentage of African adults who are infected with HIV/AIDS is 21 times the world average. The number of those infected must (and can) decline at a faster rate.

The great mHealth Africa logo. {mHealthAfrica.com}

eHealth (the use of any form of information and communication technology for health services and information) has slowly improved the level of African healthcare for years. mHealth, a subset of eHealth, has existed for nearly as long. Still, the WHO finds that nearly 90% of the world’s population still could benefit from the opportunities provided by mobile technologies. Financial support (from governments and private donors) and knowledge on how to implement these solutions are greatly needed. Further regulation is required as to not make healthcare a commodity, among other things.

Infrastructure is another limiting factor – most rural areas lack mobile Internet access and 3G will not be common for years to come. Mobile devices may be affordable to healthcare givers, but not for patients. Additionally, creating useful mHealth applications isn’t about throwing up a website that is useful for government organizations; it’s about understanding needs on the ground. The more people know and understand what can be done using mobile technologies, the greater the demand and distribution of such mHealth interventions will be.

Either way, hundreds of mobile health pilot projects have potentially saved hundreds of thousands of African lives over the years. Many are still active. Still, formidable challenges exist. Measuring the effectiveness of a project remains difficult. Additionally, mHealth may contribute to the patient gaining health information knowledge, but low literacy rates limit potential of certain applications. Sharing of cellphones in rural areas poses challenges to the confidentiality of information. Finally, it is no simple task to track the efficacy of sending SMS messages to ask people to test themselves for HIV.

Key African mHealth facts suggest huge room for expansion of health services:

• A recent study by international audit firm PwC showed that Africa is bound to witness tremendous growth in the health sector with the adoption of mHealth initiatives, with 68% of doctors recommending it.
• 75% of WHO-surveyed African nations (29 of them) report at least 1 mHealth initiative.
• The majority of patients in emerging markets are not familiar with the terms “mobile health” or “mHealth”.
• In 2010, the use of mobile devices for emergencies was the most widely reported mHealth initiative in Africa.
• According to Google in mid-2011, Swaziland had a higher share of ‘health’ searchers than any other nation and Lesotho and Malawi showed similar trends. In fact, of the 19 of the 25 nations with the highest ‘health’ search density were African.
• Six African countries have developed an official e-health strategy.
• The Pan-African mHealth Initiative aims to reduce fragmentation of mHealth services by creating a collaborative business framework, support implementation of scaled services, and align health and mobile industries around common goals (value propositions)

Selected examples of mHealth deployment in Africa (keep in mind there had been over 50 mHealth pilots in Uganda through 2010!):

• Mobile Doctors Network, which focuses on improving communication between doctors in Ghana by giving them free phone calls and text messages on mobile phones.
• D-Tree International offers Tanzanian (among other) health professionals easy-to-use mobile phones enabling them to screen, examine, counsel and treatment of patients, as well as offer safe and affordable meningitis vaccine through their CommCare project.
• In Tanzania, a team of trained but non-physician health professional, equipped with cervical screening and treatment tools, use smartphones to screen for cancer.
• Health eVillages organization aims to deliver medical education via mobile devices to clinicians in some of the most underserved parts of Africa.
• In Uganda, a pilot project launched in October of 2010 in which community health workers use eMOCHA to provide HIV awareness and prevention information with rural residents.
• In Kenya, text messages improved recovery rates in malaria treatment programs by 25 percent.
• M-Pedigree, a mobile app, helps users determine the authenticity of medication in Ghana, Nigeria, and Kenya.
• MAMA (Mobile Alliance for Maternal Action) works with low-income and at-risk South African mothers and families to provide vital health information through SMS text messaging and simple voice messages.
• Botswana: Kgonafalo allows for remote diagnosis of health ailments. A pilot project served 6 areas but is ready to expand to 25. Handsets have been replaced with Android tablets.
• Kenya: Changamka MicroHealth links health care providers with medical insurance companies. It is still mainly confined to Nairobi after 4 years of use.
• Senegal: RapidSMS saves costs by using SMS aggregation to send text messages to multiple recipients for a single cost. RapidSMS is used in many other African countries as well.
• South Africa: Cell-Life works with over 50 organizations to notify patients to take medication. One of their solutions is the CellPhoens4HIV project. Similar projects have been trialed in South Africa.
• HIVSA is a mobile site dedicated to providing information about HIV/AIDS.
• Online activists like Leah Auma Otieno are using the Internet to fight the stigma of HIV in their communities.
• MedAfrica, a medical content app, is creating awareness and also connects consumers with health practitioners in many African countries.
• The Tanzania Ministry of Health and Social Welfare leads the Integrated Disease Surveillance System and Wazazi Nipendeni free (healthy pregnancy) SMS service.
• Rwanda uses TRACnet to collect, store, retrieve, and disseminate critical program, drug, and patient information related to AIDS patients through mobile phones.
• Uganda uses satellite to link rural clinics to city doctors with email-enabled PDAs. The Uganda Health Information Network also relies on PDAs to transmit health information.
• EpiSurveyor is used to collect health data via mobile phone. In 2008, the application was used in Kenya to contain a polio outbreak.
• The free SMS software FrontlineSMS:Medic is used in multiple countries, including Malawi.
• Ushahidi is used to map epidemics and health facilities in many regions.
• OpenMRS, a collaborative open-source software to support the delivery of health care in developing countries, is used in dozens of African nations.
• Sana, a system for data capture, is used for health service delivery in Sierra Leone, Swaziland, and beyond.
• Vumi, developed by the Praekelt Foundation, is used by SangoNet in South Africa, the Bill & Melinda Gates Foundation in Kenya and Zambia, and by Marie Stopes International in Madagascar.
• Text To Change is a platform that allows the sending and receiving of text messages, along with content development and analysis. Projects in at least 7 African countries use the platform – many are focused on health delivery.
• HealthMap, a mapping platform, monitors public health threats around the world. Numerous alerts are currently active for Central Africa.
• Nigeria’s Federal Ministry of Communication Technology has teamed up with the Federal Ministry of Health in an effort to drive the country’s healthcare system to become more ICT-focused.
• Students at Strathmore University in Kenya developed a program by which thousands of health workers can report and track spreads of diseases in real time through mobile phones.
• Mobile4good, the company behind Learning about Living, allows Nigerian youth to discretely seek sexual health advice through SMS messaging. The service launched in 2007 and has received more than 400,000 messages.
• Childcount+ software allows medical professionals to monitor the health of young children and babies using SMS messaging. Many Millennium Villages use the software.
• TxtAlert is a messaging tool that uses SMS to encourage patients to attend checkups or take medication.
• Ghana Health Service spoke of how their national Information Technology (IT) agency has helped not only in crafting a national eHealth strategy.
• iAfya Health Information provides answers to health questions in both English and Kiswahili.
• Vodacom Foundation Tanzania supports the Early Infant diagnosis program that allows parents to receive HIV test results of newborn babies via SMS.
• Distance Diagnosis in Rural Tanzania, a project supported by IICD and the Evangelical Lutheran Church of Tanzania, allows officers to use mobile phones to take pictures and notes of patients in remote areas.
• Expedited Results System to Improve Early Infant Diagnosis has reduced the time it takes for clinics to receive HIV test results in Mozambique. A similar program is used in Kenya.
• Fitun Warmline AIDS Hotline provides health-care professionals across Ethiopia with answers to their questions about HIV/AIDS care and treatment.
• Ethiopia‘s Federal HIV and AIDS Prevention and Control Office sent free HIV testing information to all 2.5 million mobile users ahead of New Year’s 2009.
• Mobile phone games are used to help combat the spread of HIV/AIDS and fight stigma and discrimination through the Freedom HIV/AIDS program in six African countries.
• HIV Confidant has been used in South Africa, aiming to encourage HIV/AIDS testing by ensuring secure distribution of test results through the use of handheld computers.
• A public-private partnership in Kenya allows home-based HIV counseling and testing using PDAs and GPS devices.
• ICT4MPOWER aims to increase the effectiveness of the Ugandan health system and empower Community Health Workers for better health outcomes of the rural population.
• The m-Money for Women with Fistula project uses a combination of mobile banking, public information, and free treatment in order to give women access to fistula repair.
• Movicel uses mobile to help in vaccination campaigns in Angola.
• Mapping of malaria in Botswana is made easier with mobile phones relying on cloud storage.
• A mHealth partnership seeks to support a scalable, cost-effective and sustainable national health information system in Tanzania.
• Mobile Midwife project in northeast Ghana aims to improve antenatal and neonatal care among the rural poor and to empower women to take control over their own health.
• Mobile Technology is used to improve communication links between villages and health centers in Senegal by donating prepaid mobile phones that enable a network of community workers to call the nearest health center in case of an emergency.
• Africa Teledermatology Project, initiated in 2007, operates in six African countries, using ICT to capture and send images of patients to specialists in other African countries, Austria and the United States.
• Pambazuko PALM, a web-based application delivered on PDAs, was developed and tested in 2007 to collect patient risk assessment data in Kenya.
• Project Masiluleke uses free text messages to connect mobile users to existing HIV and TB call centers in South Africa.
• Certain drug stock levels are monitored in real-time using mobile phones in The Gambia. Similar programs operate in multiple nations, including Tanzania.
• Capacity Kenya uses a bulk text messaging system to speed-up communication between 700 health workers.
• The Wired Mothers pilot project aimed to examine the beneficial impact of use of mobile phones for health care on maternal and neonatal morbidity in Zanzibar.
• The SIMpill medication adherence product notifies patients in South Africa to take medication.
• The WelTel trial in Kenya involved sending weekly messages to patients asking whether they were well or whether they were experiencing problems with their treatment.
• Dozens of videos from these and additional organizations can be found on YouTube.

Again, there are too many mHealth initiatives to accurately quantify. Please share health additional projects in the comments so we can increase awareness of how mobile is helping save lives!