Notes from day 1 at the GSMA Mobile Health Summit

 

Here are the in-depth notes taken on the first day of the Mobile Health Summit. A big thanks to Thomas Brennan, Indra de Lanerolle and Peter Benjamin for taking them!

 

[SESSION 1: Keynotes and state of the Industry. 900am]

Thanks to Thomas Brennan for the notes.

 

Moderator: Vicky Houseman (Dalberg Consulting)

 

Keynote: Helen Zille (Premier of Western Cape)

  • VIP Welcome to Cape Town
  • The application of mobile technology in healthcare is crucial, especially in developing world context
  • How can you make high quality healthcare affordable and accessible?
  • Context - increasing health costs
  • Seeking cost-effective ways for dealing with chronic disease
  • mhealth has great potential to deal with these challenges - cut costs, reduce illness, change patient experience, increase access
  • Africa is the fastest growing mobile market in the world, 20% each year for the past 5 years
  • Doesn't need fixed line infrastructure
  • 649 million users across Africa
  • 65 / 100 have mobile connectivity in Africa
  • 750 million in the continent by end of 2012
  • mhealth is gaining interest globally
  • example: use of SMS to remind patients, drug and apt reminders, HIV testing
  • mhealth tackling appointment system
  • SMS messaging can change stigma and perceptions
  • SMS used for behaviour change
  • SMS & MXiT for p2p exchange
  • mobile data collection services for field workers, real time analysis, storage, faster feedback, trend identification
  • Eg. MDC stopped typhoid breakout in uganda
  • Eg. MedAfricaApp in Kenya (6000 to 1 doctors to patients) helps users to diagnose their symptoms and connect with healthcare providers
  • Remote Patient Monitoring has great potential
  • PGWC has strategic plan Healthcare 2020 - excellence in care and patient experience
  • PGWC wants technology to support Healthcare 2020
  • Cape Town is a hub for mHealth development
  • Eg. Cell-Life fine example of collaboration (founded UCT & CPUT) for ARV dispensing (300 ART sites), many mHealth services
  • Eg. Ian de Vega by PGWC won IT@2012 in Brussels for PHCIS, started in 2006 (103 facilities, 3.75 million patients)
  • PGWC drafting e-health strategy
  • All patients on SMS system by 2015
  • PGWC committed to pioneering mhealth technology to achieve health and wellness targets

 

Keynote 2: Dr Gwen Ramokgopa - DOH, Deputy Minister of Health

Thanks to Peter Benjamin for the notes.

  • Global barriers for ICT4H include poor government leadership, limited evidence, interoperability, no best practices, poor regulations, capacity, cost, culture of ICT use, connectivity
  • DOH has approved ehealth strategy: integrated approach for ICT4H (available on website)
  • 10 principles of strategy of eHealth strategy
  • DOH started to train 60K CHW
  • mhealth can support CHWs
  • NHI pilot sites (x10) have been launched
  • DOH established eHealth/ICT4H steering committee, MRC secretariat
  • 6 working groups: policy & regulation, interoperability, capacity dev, infrastructure, research, lighthouse projects
  • Leon and Schneider (2011) Review of mHealth experiences in South Africa confirms increased efficiency, improved data security
  • mHealth for HIV AIDS: broad partnership between DOG, HISP, MNOs, DFID, Cell-Life
  • Monitoring indicators: # patients on treatment, # patients remaining in care
  • 10K phones donated by MNOs

 

Axel Nemetz, Vodafone GE, Head of mHealth Solutions

Thanks to Peter Benjamin for the notes.

  • Vodafone has been Active in mhealth since 1990s, mostly in R&D in beginning, now providing services for GE clients and M2M
  • mHealth unit established in October 2009
  • Vodafone mission: improve healthcare outcomes and quality of life by giving patients and healthcare professionals increased flexibility and freedom"
  • Vodafone support 5 areas: remote care services, mobile flexibility working, access to medicine, clinical research, marketing & engagement
  • MNOs work in consumer world BUT healthcare is on national, regional & local level
  • Vodafone has segmented market by payers
  • Connectivity of medical devices, eg. Boston Scientific
  • Pharmaceutical companies trend to complement products with services, eg. Baxter homecare, drug anti-counterfeiting mPedigree
  • Payers & providers are different between emerging and mature markets
  • Mature markets are having paperless hospitals: tablets, smartphones, wifi
  • Emerging markets are bridging lack of infrastructure, eg. SMS for Life
  • Local example: Nompilo, supporting CHWs to capture patient information
  • Learn from role models (Daktari1525 - Kenya, Virtual Hospitals - Holland, Whole System Demonstrator - UK, eHealth strategy - RSA)
  • Ask for support from NGOs and donors to provide initial funding in emerging markets
  • Keep mhealth solutions as simple as possible


Dr Jane Chege, World Vision International, Director of Research and M&E for Global Health

Thanks to Peter Benjamin for the notes.

  • WHO (2011) mHealth: new horizons for health through mobile technologies (from 112 member states)
  • World Vision works in 90 countries around the world
  • There are mhealth frameworks in place but not yet implementing
  • mhealth network from DOH to national facilities to district and community levels
  • Focus on MDG targets
  • Desired future of mhealth: national scale, mature business models, solid mhealth evidence


Gabi Zedlmayer - HP, VP of Sustainability & Social Innovation

Thanks to Peter Benjamin for the notes.

  • Collaborating to improve global health
  • HP started to focus on health in 2009
  • 300,000 employees
  • Strong partners with CHAI (NGO) and Ministry of Health (Kenya)
  • Project in Kenya early diagnosis of HIV in neonates
  • Needed 5 distinct data centres, from labs, to districts and send results via SMS
  • Reduced lab result delivery to 21 days (65,000 babies tested)
  • Scaling neonatal testing up to Uganda and Mozambique
  • HP partnering mPedigree to check counterfeit drugs, 5-second SMS response, scaling up to India (incl syringes)
  • Challenges for private sector: need to showcase skills, create business model around shared value

 

[SESSION 3: Market Access and Reimbursement Strategies. 2.00pm]

Thanks to Peter Benjamin for the notes.

Mark Brand, Brand Consulting. Traditional market access process for suppliers of health tech is well defined. Present clinical evidence, economic evidence, inform policy (quality of life, social, ethical issues).  Each scored, value of tech is added up, and then decision on overall benefit. mHealth falls within this. To ask a payer to pay for this, we should go through the same process. mHealth needs to develop a clear value proposition (ref clinical health impact and economic cost-benefit). The rigour of research for health tech is often very expensive (e.g. cost of formal trials of pharmaceuticals – major element of cost). Can we afford to do this with mHealth?

Craig Frierichs, Head of mHealth, GSMA. From the mobile environment, GSMA works with over 800 operators worldwide, with huge market share. Services driven by low-cost, high volume services direct to consumers.  mHealth challenges that business model – disruptive to investment. We released a paper today over 695 mHealth services – 90% are business à consumer.  But relying on out-of-pocket expenses of users is small part of medical expenses.  mHealth needs to move to business à business as well, but not yet at scale.  Desire to move to “enterprise solutions”, but there is not a full ecosystem yet.

Clint McClellan, Qualcomm. Qualcomm worked with many different tech in health – mHealth is next, worked on it for 4 years.  Now better interoperability with Android and iPhones. Continua Health Alliance works on standards and guidelines for end-to-end connectivity – e.g. linking iphone to sensors, plug & play systems for medical peripherals with mobile.  We need to make systems scalable – developers kits being set up for mHealth. Start an App development environment, with standards and inter-operability working.

Simon (Price Waterhouse Coopers). Speaking as a health service provider – what is the motivation for providers to be involved with mhealth? Where is the win-win, with no clear benefits for providers to be involved.

Facilitator: How can mHealth community access a large proportion of health spending? Wellness has not been considered much, more focusing on hospital and treatment. What business models are there for engaging the larger health companies?

Craig (GSMA): There is no one-size fits all.  Many different business models.  Much cross-subsidisation, with donors, NGOs and various providers. Two industries are being brought together, and hard to put dollar-value on services.

Clint (Qualcomm): One market that has moved fast is employers.  The big companies are looking at Wellness, linked to a health savings account. Carlos Slim Institute (Mexicao) and Apollo (India) running health clinics with $1 medical check-ups. There is a business here – special focus on screening diabetes and hyper-tension. How can we build tools that will do that? He showed an example of iPhone ECG that picks up heart problems early.

Mark: Doctors developing protocols for chronic conditions, and then manage in risk-share with health insurers. mHealth can play a huge role here. Currently mainly reactive after an event; only a few preventative services – a major role for mHealth.

Craig: There must be a clear value proposition to all the different role players, with clarity on who the main payer is (e.g. end user, dept of health, health insurer).  Global health economics of health industry, we need to reduce the burden on end-consumers (grudge payment) that needs to be overcome. Need to evaluate the ecosystem – end payer could be consumer, institutional payer. We’ve looked at over 20,000 research papers, and only 3% mention health economics. We need to demonstrate the value proposition.

Clint: There is evidence of real economic & health outcomes benefits of some mHealth. Many studies show mHealth can reduce doctor or hospital visits, e.g. Partners In Health showing reduced re-admission rates.  At least 6 studies show mHealth benefits employers in reducing absenteeism, Congestive heart failure example reducing hospital admissions.  Need coherent economics to go to scale.

Question from Metropolitan Health: We’ve been trying to find self-managed interventions.  Low-hanging fruit is around chronic care – anything you can do to keep chronic patient outside hospital (adherence, compliance) systems.

Craig: Agree this is a key area for benefit of mHealth. Issue of how willing the patient would be to pay. We are starting to see medical community starting to see value of Electronic Health Record (EHR) and Patient Health Record (PHR).

Clint: Big move in US healthcare: all payers moving to pay-for-performance (not current system of fee-for-service).  Need to find ways of monitoring health outcomes.

Closing round: Next steps for sustainable business models: value chain, wellness, evidence.

Mark: Things that we need to do: look at existing market access model, and see if appropriate for mHealth. We need a framework that all collaborators can work within.

Craig: Need to correctly target payer (not necessarily consumer).  Many mHealth systems improve operational efficiencies – and the value here must be explained to. Fee for service must be used.  Where is the value proposition for different mHealth applications, then move to fee for service.

Clint: Needs to be standards based – Health Ministers should look at the Continua guidelines, so that things can go to scale. App developers can focus on services and not worry on hardware. Develop protocol for general health screening.

Simon: Home nursing agencies are trying to reinvent themselves – mHealth can get in there. When billing systems were manual, electronic systems introduced.

My take away message: There is serious interest from telecomm and health industry players to find scalable business models – but except for a few isolated examples, we haven’t cracked it yet.  Few believe governments in Africa will be the payer at sustainable scale - most govts in Africa struggle to provide basic clincs and drugs, mHealth looks like a luxury. Still a lot of potential and hype, but few really clear ways to get payment for the value mHealth can bring.

 

[SESSION 4: 4pm on Wed 30 May: Strengthening Health Systems]

Thanks to Indra de Lanerolle for the notes.

 

Moderator Pam Riley ,Abt Associates

 

This session marked a welcome shift from presentations that focused on solutions to discussing what problems in public health systems actually need to be solved. The question, as the moderator posed it was ‘How can mhealth strengthen each of the WHO building blocks for public health?’ These building blocks include issues like governance, human resources, health information systems, pharma supply and service delivery.

 

Dr Muna Abdel Aziz, from the Public Health Institute in Sudan asked a fundamental question:  what will drive adoption? She argued that the two things that will drive adoption are solving problems that health systems need solved – that align to policy – and compelling business cases as to how mobile solutions can be paid for. She offered two examples from UK and Sudan. In Sheffield, UK, she described how a team introduced a system for sharing test results so that doctors could see all test results for a patient whether or not they had ordered the test. The business case rested on reducing the number of unnecessary tests.  Sudan is a very different environment – only 14% of population have a health facility within 5 km of where they live. She suggested that a strong example of a compelling business case in Sudan is improving health insurance coverage.  Less than 60% have coverage today. Policy is  to get to 100% coverage. Investing in mhealth solutions to increase take up offers a real business case for mobile solutions that would increase

 

Herman Ormel from Royal Tropical Institute, Amsterdam spoke about mhealth interventions on maternal and newborn health in Sierra Leone – a fragile health system in one of the poorest countries on the planet. Life expectancy is 47 yrs and literacy is 41% with women around 30%. He reported on the early findings of a long term study on how health workers and health system clients regard mobile phones. He emphasised simplicity and cost – in Sierra Leone the requirement is for low cost and low tech.

 

Dr Bob Fryatt from UK Department for International Development (DFID) raised an issue that no one else at the Summit has mentioned: IT failure risks. In the 1980s a faulty Soviet early warning system nearly caused WWIII,  in 1999, organisations around the world went into panic over the millennium bug. Like many speakers he questioned whether the evidence base for mhealth is strong enough – citing the recent WHO report on mhealth.  He offered a framework of questions that he thought mHealth projects should address: focus on empowering users and front line staff and assess impact. Effectivess, equity, impact on health system, implications of scaling up  and sustainability and finally offering up options for policy.

 

Alan Labrique, from Johns Hopkins Bloomberg School of Public Health told interesting stories from Northern Bangladesh, following 135,000 rural  women over 12 years. He offered  ‘3 C’s’: Connect patient to health system, Compress the time needed to reach a patient and  Create  new services. He argued that we need to move from piloting  vertical strategies to health system integration.

 

My take out message: if you want to address scale (a theme of the day) you need to think less about understand your project and invest much more time in understanding the problems of the health system you are aiming to intervene in.

 

 

[Evening reception by GSMA]
Craig Frederichs
of the GSMA welcomed everyone.  He announced the Pan-African mHealth Initiative has just been formed with the five major mobile operators in Africa agreeing to collaborate in taking mHealth services to universal access and coverage.  More will be announced soon.