Elsevier

Health Policy and Technology

Volume 4, Issue 3, September 2015, Pages 225-231
Health Policy and Technology

Literature Review
Mobile health and maternal care: A winning combination for healthcare in the developing world?

https://doi.org/10.1016/j.hlpt.2015.04.002Get rights and content

Highlights

  • mHealth is a growing phenomenon in developing countries, little documented so far.

  • mHealth redefines the roles of different public health actors.

  • mHealth contributes to the emergence of new actors in the field of public health.

  • mHealth is likely to modify the relationship between caregivers and patients.

  • mHealth raises major issues in terms of data security and anonymity.

Abstract

Worldwide, concerted efforts are made to stimulate the use of information and communication technology (ICT) in health care. From online Personal Health Record (PHR), treatment and appointment reminders by SMS, to the e-mailing of confidential clinical data, healthcare systems are increasingly using technologies to provide better services with less financial and human resources. Among ICTs for health, eHealth – i.e. health on the Internet – has been extensively studied whereas the use of mobile technologies for health called “mhealth” or mobile Health has been less documented so far. In 2013, almost 6.8 billion people were mobile phone users, mobile-cellular penetration rates stand at 96% globally (89% in developing countries). Access to the Internet, by comparison, is a reality for only 39% of the world population (77% of the developed world population is online). During the last three years, many health stakeholders and mobile technology providers have understood the high potential of mHealth and launched more than 600 operational projects in developing countries. In this article we are discussing this issue first by assessing the current state of knowledge on mobile health in developing countries, as well as the issues and challenges raised by mobile health. We then focus our discussion on maternal health to discuss the potential applications of these new techniques in this specific field. Finally we suggest several avenues for further analysis on the implications of using mobile phones as a tool for women׳s health.

Introduction

There are many potential applications of digital technologies in the health sector. Whether online “patient records”, clinical data digitalized and transmitted electronically, or appointment reminders by SMS, health systems around the world are increasingly using these technologies in the context of reduced health resources and expenditure but also of increased involvement of patients and lay personnel. Substantial research has been conducted on eHealth – health on the Internet, mainly regarding the nature and the value of health information on the web [1], [17], the redefinition of the roles of lay and expert in health [2], [83], [84], the subsequent transformation of the patient–caregiver relationship [3], [7] or the consequences of eHealth on work organisation. The use of mobile phone and wireless technology within health programs, called “mHealth” or mobile health, is more recent and has been less studied. And yet mHealth is likely to change how health is defined, to modify the relationship between caregivers and patients, to influence medical information, etc. These issues are particularly acute in developing countries in the context of increased access to mobile phones, which has been shown to be associated with great invention in use and a certain number of technological innovations (Chéneau-Loquay, [11]; Hahn et Kibora, [33]). In this paper, we address these transformations first by assessing the current state of knowledge on mobile health in developing countries, as well as the issues and challenges raised by mobile health. We then focus our discussion on maternal health to discuss the potential applications of these new techniques in this specific field. Finally we suggest several avenues for further analysis on the implications of using mobile phones as a tool for women׳s health.

Section snippets

Mobile health: a growing phenomenon in developing countries

Access to mobile phones is becoming increasingly common in developing countries, and is increasing much faster than access to the Internet: in 2013, there are almost 6.8 billion mobile phone lines worldwide, with 128 lines per 100 inhabitants in developed countries and 89 lines per 100 inhabitants in developing countries, where only 37 out of 100 people have access to the Internet [40]. Over the past three years, many actors in the health (NGOs, pharmaceutical companies, hospitals) and telecom

Maternal health, a productive sector for mHealth applications

Half a million women die each year worldwide as a result of pregnancy or childbirth, almost all (99%) in developing countries. Millions of women experience pregnancy-related morbidity, sometimes with severe consequences (infertility, fistula, incontinence) that could be avoided through better information and better monitoring of pregnant women [78]. Clinicians report that postpartum hemorrhage is the main cause of death for women in labor, that can be linked to nonattendance or late arrival in

Challenges of mHealth

The use of this “mobile” technology in the field of health raises a number of issues that should not be hidden by the apparent simplicity of the “mobile phone” tool.

mHealth indeed redefines the roles of different public health actors, may contribute to give them new roles and redistribute powers and responsibilities. We see for example pharmaceutical companies channeling public health information through SMS.

mhealth contributes to the emergence of new actors that have been little involved in

Research on mHealth is only beginning

The first academic studies focused on mHealth were conducted within the past six years. Several papers have presented the results of pilot projects on: aid or emergency lines [14], [41], [66], appointment reminders by SMS [18], [15], [28], [55], reminders to take anti-malarial [59] or antiretroviral medication [64], support to stop smoking or improve physical activity [39], [46], prevention of risk behaviors among youth [45], [53], [75], follow-up of diabetic [12], [23], [34], [65] or asthmatic

The lack of cross-national studies

The studies on mHealth mentioned above are implemented within single observation geographical spaces and relate to single applications of mHealth. Yet multi-or transnational research on this issue would be relevant for several reasons. Multi-site analysis, that encouraged field research in multiple and heterogeneous spaces – championed by anthropologist GE Marcus [51] and adopted by many researchers such as Fischer [22], Jasanoff [42], Fassin [20] and Rajan [67] – is particularly suitable for

Shaping future research

The recent multiplication of mHealth projects worldwide illustrates the overall trend towards the globalization and technologization of biomedicine. The idea that ICT contributes to improving care, reducing health disparities and optimizing health systems has taken shape in recent years in a diverse set of technical devices: eHealth, mHealth, telemedicine, big data, etc. mHealth or mobile Health is a particular vector of this global movement, which goes beyond the use of mobile phones, and

Conflict of interest

The author assures that all data, models, or methodology used in the research are proprietary.

The author certifies that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Ethical approval

Not required.

Funding

Marine Al Dahdah benefits from a doctoral scholarship from the French National Agency for research on AIDS and viral hepatitis.

Competing interests

None declared.

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