Health communication systems designed for rural, developing countries -- where hospitals are often understaffed and transportation is inadequate -- are being adapted to improve care in U.S. cities.
In the last decade, community health efforts have been made more effective by a simple insight: that time, money, and sometimes even lives can be saved through texting. At St. Gabriel's Hospital in Malawi, for example, 75 community health workers were trained to use text messages to communicate patient information, appointment reminders, and other health-related notifications to patients. Through this mobile health, or mHealth, initiative, the hospital saved approximately 2,048 hours of worker time and $3,000 in fuel, while doubling the capacity of the tuberculosis treatment program.
The case for this growing field in the developing world provokes some controversy, however. Tina Rosenberg, writing in The New York Times, argued recently that the field is in flux. "Roughly a decade after the start of mHealth ... these expectations are far from being met," she writes. "The delivery system is there. But we don't yet know what to deliver." Most of the testing done in the field, she goes on to argue, has focused on feasibility, not real health impacts. What's needed, many insist, is the use of randomized control trials -- the gold standard in science -- to help determine what actually helps the world's poor, versus what development workers and funders assume will.
After about a decade of attracting big philanthropic investment without enough measurable results, Uganda and South Africa have both put a hold on any new mHealth pilots in their countries. And as the developing world closes its doors, some nonprofits are turning their sights to the U.S. for further study. "While there is still much to do in low and middle income countries, there is a lot that can be learned and transferred from the experience of designing and implementing mHealth systems in resource constrained settings here in the U.S.," explained Patricia Mechael, the executive director of mHealth Alliance at the United Nations Foundation. If they can improve health outcomes through randomized control trials, they may be able to renew the philanthropic sectors' belief in the viability of the field.