Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa

BackgroundAccess to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa.MethodsA systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards.ResultsForty-four studies on mHealth projects in Africa were included and classified as: “patient follow-up and medication adherence” (n = 19), “staff training, support and motivation” (n = 2), “staff evaluation, monitoring and guidelines compliance” (n = 4), “drug supply-chain and stock management” (n = 2), “patient education and awareness” (n = 1), “disease surveillance and intervention monitoring” (n = 4), “data collection/transfer and reporting” (n = 10) and “overview of mHealth projects” (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources.ConclusionsmHealth in Africa is an innovative approach to delivering health services. In this fast-growing technological field, research opportunities include assessing implications of scaling-up mHealth projects, evaluating cost-effectiveness and impacts on the overall health system.

[1]  Jim Barrington,et al.  SMS for Life: a pilot project to improve anti-malarial drug supply management in rural Tanzania using standard technology , 2010, Malaria Journal.

[2]  Cristian Pop-Eleches,et al.  Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders , 2011, AIDS.

[3]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[4]  Robert W Snow,et al.  Implementing school malaria surveys in Kenya: towards a national surveillance system , 2010, Malaria Journal.

[5]  Merrick Schaefer,et al.  Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results. , 2012, Bulletin of the World Health Organization.

[6]  Ira B. Wilson,et al.  Challenges in Using Mobile Phones for Collection of Antiretroviral Therapy Adherence Data in a Resource-Limited Setting , 2010, AIDS and Behavior.

[7]  Ronald H Gray,et al.  Responding to the human resource crisis: peer health workers, mobile phones, and HIV care in Rakai, Uganda. , 2008, AIDS patient care and STDs.

[8]  Mark Tomlinson,et al.  Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV , 2011, Trials.

[9]  Carrie L Kovarik,et al.  HIV-positive patients in Botswana state that mobile teledermatology is an acceptable method for receiving dermatology care , 2011, Journal of telemedicine and telecare.

[10]  S. Lund,et al.  Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster‐randomised controlled trial , 2012, BJOG : an international journal of obstetrics and gynaecology.

[11]  Agnes Binagwaho,et al.  Cell Phone-Based and Internet-Based Monitoring and Evaluation of the National Antiretroviral Treatment Program During Rapid Scale-Up in Rwanda: TRACnet, 2004–2010 , 2012, Journal of acquired immune deficiency syndromes.

[12]  I. Ogunwande,et al.  Exposure to anti-malarial drugs and monitoring of adverse drug reactions using toll-free mobile phone calls in private retail sector in Sagamu, Nigeria: implications for pharmacovigilance , 2011, Malaria Journal.

[13]  Jeremiah Scholl,et al.  LabPush: A Pilot Study of Providing Remote Clinics with Laboratory Results via Short Message Service (SMS) in Swaziland, Africa , 2012, PloS one.

[14]  Aniset Kamanga,et al.  Rural health centres, communities and malaria case detection in Zambia using mobile telephones: a means to detect potential reservoirs of infection in unstable transmission conditions , 2010, Malaria Journal.

[15]  Thomas P Giordano,et al.  Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. , 2011, AIDS.

[16]  Steven J. Reynolds,et al.  Impact of a mHealth Intervention for Peer Health Workers on AIDS Care in Rural Uganda: A Mixed Methods Evaluation of a Cluster-Randomized Trial , 2011, AIDS and Behavior.

[17]  Cornie Scheffer,et al.  Development of a mobile phone based ophthalmoscope for telemedicine , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[18]  A. Binagwaho,et al.  Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda , 2012, The Pan African medical journal.

[19]  Matt Berg,et al.  Use of an Innovative, Affordable, and Open-Source Short Message Service–Based Tool to Monitor Malaria in Remote Areas of Uganda , 2011, The American journal of tropical medicine and hygiene.

[20]  Bruce A. Larson,et al.  Costs and Cost-Effectiveness of a Mobile Phone Text-Message Reminder Programmes to Improve Health Workers' Adherence to Malaria Guidelines in Kenya , 2012, PloS one.

[21]  Pamela Andreatta,et al.  Using cell phones to collect postpartum hemorrhage outcome data in rural Ghana , 2011, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[22]  C. Kovarik,et al.  The African Teledermatology Project: Providing access to dermatologic care and education in sub-Saharan Africa , 2009, The Pan African medical journal.

[23]  G. Rutherford,et al.  Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. , 2012, The Cochrane database of systematic reviews.

[24]  Livia Bellina,et al.  Mobile cell-phones (M-phones) in telemicroscopy: increasing connectivity of isolated laboratories , 2009, Diagnostic pathology.

[25]  N. Mahmud,et al.  A text message-based intervention to bridge the healthcare communication gap in the rural developing world. , 2010, Technology and health care : official journal of the European Society for Engineering and Medicine.

[26]  J. Kirigia,et al.  E-health: Determinants, opportunities, challenges and the way forward for countries in the WHO African Region , 2005, BMC public health.

[27]  Evans Mupela,et al.  Telemedicine in Primary Health: The Virtual Doctor Project Zambia , 2011, Philosophy, ethics, and humanities in medicine : PEHM.

[28]  L. Swartz,et al.  Scaling Up mHealth: Where Is the Evidence? , 2013, PLoS medicine.

[29]  R. Westbrook,et al.  SWOT Analysis: It's Time for a Product Recall , 1997 .

[30]  Tassaneewan Laksanasopin,et al.  Mobile device for disease diagnosis and data tracking in resource-limited settings. , 2013, Clinical chemistry.

[31]  C. Anandan,et al.  The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview , 2011, PLoS medicine.

[32]  George Jagoe,et al.  Reducing Stock-Outs of Life Saving Malaria Commodities Using Mobile Phone Text-Messaging: SMS for Life Study in Kenya , 2013, PloS one.

[33]  Cnm Facnm Jody R. Lori PhD,et al.  Cell Phones to Collect Pregnancy Data From Remote Areas in Liberia , 2012 .

[34]  V. Odigie,et al.  The mobile phone as a tool in improving cancer care in Nigeria , 2012, Psycho-oncology.

[35]  Lawrence Mbuagbaw,et al.  The Cameroon Mobile Phone SMS (CAMPS) Trial: A Randomized Trial of Text Messaging versus Usual Care for Adherence to Antiretroviral Therapy , 2012, PloS one.

[36]  Aileen Y. Chang,et al.  Use of mobile learning by resident physicians in Botswana. , 2012, Telemedicine journal and e-health.

[37]  Quentin Eichbaum,et al.  Exploring the patterns of use and the feasibility of using cellular phones for clinic appointment reminders and adherence messages in an antiretroviral treatment clinic, Durban, South Africa. , 2010, AIDS patient care and STDs.

[38]  Emmanuelle Daviaud,et al.  Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa , 2012, BMC Medical Informatics and Decision Making.

[39]  Richard T Lester,et al.  Cell phones: tightening the communication gap in resource-limited antiretroviral programmes? , 2006, AIDS.

[40]  Dustin G Gibson,et al.  The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya. , 2013, Vaccine.

[41]  Robert W Snow,et al.  The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial , 2011, The Lancet.

[42]  K. L'Engle,et al.  Evaluating feasibility, reach and potential impact of a text message family planning information service in Tanzania. , 2013, Contraception.

[43]  J. Car,et al.  Telephone delivered interventions for preventing HIV infection in HIV-negative persons. , 2013, The Cochrane database of systematic reviews.

[44]  Victoria Nembaware,et al.  Investigation into the use of short message services to expand uptake of human immunodeficiency virus testing, and whether content and dosage have impact. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[45]  R. W. Jones.  The International Telecommunication Union , 1997 .

[46]  Christian Laurent,et al.  Adherence to Antiretroviral Treatment in HIV-Positive Patients in the Cameroon Context: Promoting the Use of Medication Reminder Methods , 2011, Journal of acquired immune deficiency syndromes.

[47]  Beatrice Wasunna,et al.  “Even if You Know Everything You Can Forget”: Health Worker Perceptions of Mobile Phone Text-Messaging to Improve Malaria Case-Management in Kenya , 2012, PloS one.

[48]  Mark Tomlinson,et al.  The use of mobile phones as a data collection tool: A report from a household survey in South Africa , 2009, BMC Medical Informatics Decis. Mak..

[49]  W. Jack,et al.  Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial , 2010, The Lancet.

[50]  Linda Richter,et al.  Collecting Maternal Health Information From HIV-Positive Pregnant Women Using Mobile Phone-Assisted Face-to-Face Interviews in Southern Africa , 2013, Journal of medical Internet research.

[51]  Doug Brock,et al.  Dermatological diagnostic acumen improves with use of a simple telemedicine system for underserved areas of South Africa. , 2011, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[52]  Robert W. Snow,et al.  Mobile Phone Text Messaging: Tool for Malaria Control in Africa , 2012, PLoS medicine.

[53]  Jessica E Haberer,et al.  High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a cross-sectional survey study , 2012, BMC Medical Informatics and Decision Making.

[54]  Michele L. Ybarra,et al.  Cell phone usage among adolescents in Uganda: acceptability for relaying health information. , 2011, Health education research.

[55]  Roy.  SWOT analysis : it ' s time for a product recall , 2022 .

[56]  Pamela Andreatta,et al.  Cell phones to collect pregnancy data from remote areas in Liberia. , 2012, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[57]  Patricia Mechael,et al.  Barriers and Gaps Affecting mHealth in Low and Middle Income Countries: Policy White Paper , 1970 .

[58]  Lehana Thabane,et al.  In-Depth Analysis of Patient-Clinician Cell Phone Communication during the WelTel Kenya1 Antiretroviral Adherence Trial , 2012, PloS one.

[59]  J. Hoffman,et al.  Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya. , 2010, American journal of preventive medicine.

[60]  J. Blaya,et al.  E-health technologies show promise in developing countries. , 2010, Health affairs.

[61]  David Amadi,et al.  Evaluation of an Android-based mHealth system for population surveillance in developing countries , 2012, J. Am. Medical Informatics Assoc..