Mobile phones to speed up healthcare delivery in EastAfrica

Renowned economist Jeffrey Sachs has called the mobile phone “the single most transformative technology for development.”

Mobile applications have revolutionised the way information is spread in developing countries, finding a wide range of functions in such diverse sectors as agriculture, personal banking and cash transfers.

The mobile phone is now set to be the information portal for health workers, many of whom work in remote areas where access to reference materials is limited.

An emerging set of applications will shake up the delivery of health care in the region, which has been long plagued by staff shortages and lack of funding.

A new report by the iheed Institute and Dalberg Global Development singles out “mHealth Education” or “mHealthEd,” a novel set of mobile applications thatcould ease the skills shortage in the health sector by providing training, testing, support and supervision of health care workers. The applications can also be used to remind patients to take their medication, or keep an appointment at the local health centre.

Workers can learn new treatment procedures, test their knowledge after training courses and take certification exams, look up information in medical reference publications, and trade ideas on crucial diagnostic and treatment decisions, all through their mobile phones.

For example, the Health Education and Training in Africa (HEAT) Programme in Ethiopia is a comprehensive online bank of freely accessible learning resources, designed to be easily downloaded for printing and distribution. eMOCHA is another application that is gaining ground in Afghanistan and Uganda; it stands for “electronic mobile open-source comprehensive health application.”

In addition to data collection and communication tools for health workers, the eMOCHA application provides multimedia courses and lectures recorded in MP4 format, followed by quizzes to test users’ knowledge of the information. In Kenya and Uganda, “Text to Change” provides HIV/ Aids information to individuals via SMS.

In East Africa, the shortage of trained health workers is dampening prospects of achieving the health-related Millennium Development Goals (MDGs). According to the WHO, East Africa is suffering from a serious shortage of doctors — there is only one physician per 10,000 of the population in Kenya and Uganda; the figure drops to less than 0.5 in Tanzania. The global average is 14 physicians per 10,000 of the population.

Even when low-income countries go to great expenses to train doctors and nurses, they often have a difficult time retaining them because of low salaries and poor working conditions. The reality on the ground is that nurses and community health workers provide the bulk of health services to patients, particularly in the rural areas.

Uganda has an estimated 26,000 enrolled nurses, Tanzania has an estimated 11,000. Kenya has about 34,000 enrolled nurses, but Dr John Ouma Odondi, head of primary services at Kenya’s Ministry of Health says that the country is still suffering a staff shortage.

“We should have hired an additional 35 nurses in every constituency annually from 2009, but we haven’t been able to fill the numbers,” he says.

Dr Odondi says that a major challenge is retention of staff, and that the ministry is working on strategies to retain talent and skills. About $335,000 is allocated by the ministry to training every year.

“We have short-term courses delivered in institutions as well as in-service training, but admittedly, this portfolio is thin,” says Dr Odondi.

The iheed report cites a 2007 study by McKinsey which estimated that if sub-Saharan Africa continues to rely on professional doctors and nurses, then closing the gap in healthcare human resources would require a total of $33 billion in spending between 2007 and 2030, together with the addition of 300 new medical schools to the 90 that are there today, and 300 new nursing schools, approximately doubling the number today.