As defined by the World Health Organization (WHO), eHealth is the latest development in health that ensures cost-effective and secure use of information and communication technologies in promoting and supporting health and its related fields. However, eHealth is a general term; of its four distinct components, Mobile Health (mHealth) i.e., provision of health services and information via mobile and wireless technologies is one which is gaining traction in the developing world.
In this context, the African Strategies for Health (ASH) collaborated with the US Agency for International Development’s Africa Bureau (USAID/AFR), the mHealth Working Group and the mHealth Alliance to collate the Volume II of mHealth Compendium. This documents twenty-seven case studies which illustrate a range of promising mHealth applications being implemented throughout Africa in addition to other regions. Empirical evidence in this compendium has been consolidated under five programmatic areas, including, behavior change communication, data collection, finance, logistics, and service delivery. Given that the potential of mHealth is appropriately applied, it can significantly improve health outcomes including (1) disparities in access to health services, (2) inadequacies of the health infrastructure within countries; (3) shortage of human resources for health; (4) high cost of accessing health; and (5) limitations in the availability of financial resources. The key factors delineated for success of mHealth applications are country ownership and leadership, partnerships, and coordination amongst partners.
Volume II of mHealth Compendium features a case history from Pakistan that is selected under the broader “Health Financing” category. It is titled “Heartfile Health Financing – an mHealth enabled innovation in health social protection”. Heartfile Health Financing (HHF) is a health-equity fund-based demand side system which enables the system’s registered doctors and hospitals to seek financial support in an expedient and transparent manner for patients that run the risk of spending catastrophically on healthcare. HHF is comprised of three components including the mHealth-enabled technology platform, a system of validating poverty and prioritizing patients, and a health equity fund.
Since its inception two years ago, this program has provided financial assistance to more than 1,900 patients requiring high cost interventions. More than 150 healthcare personnel are engaged through the communication loop with 18 service points in 6 tertiary care facilities. Thus far, more than 8,000 outbound and 3,000 inbound SMS have been exchanged connecting patients, healthcare staff, volunteers and donors. Text messaging is done with patients in their local dialect.
The design and the deployment of this intervention have led to valuable insights for future such interventions that may occur in the developing regions. Firstly, the telemedicine-for-assessments (online validation of poverty status) and mHealth component of HHF allows it to be established as a scalable and replicable model for other developing countries, the options for which are being explored in two Africa countries. Also, the system’s reliance on technology significantly cuts administration fees that overcome need for extensive field operations. In fact, the use of low-cost internet access devices increases the system’s efficiency and convenience while the scalability and outreach relies on national and international partnerships. Additionally, the system’s innovative capacity to stratify patients based on preconfigured rules as opposed to subjective decisions and ingraining transparency are considered valuable. Furthermore, donors are more inclined to donate into the program because of the donor-empowerment feature and the micro-transactional tracking system of HHF.
To summarize, request processing, financing of services and donation management workflows of Heartfile Health Financing constitute an end-to-end solution for patient-centric demands related to catastrophic health expenditures and reflect novelty in the way technology of international standard has been used to map the local needs.
Dr. Faraz Khalid
Heartfile Health Financing