mHealth: Realizing its full potential in India's Public Health Systems

By Rahul Mullick, Head – ICT, India Programs, Bill & Melinda Gates Foundation

mHealth is a growing global market and the same trend is visible in India. A study by PwC projects the market to be around $0.6 Billion in India and $23 Billion globally by 2017. While India’s share seems relatively small, the growth trajectory is very promising.

mHealth has evolved in the past 2-3 years in India. For one India is now clearly distinguishing between conventional ICT systems which offer SMS/IVR based alerts/services v/s mHealth applications used on-the-go. This means that hand-held devices (phones or tablets) are also being seen as tools for information capture at source, health diagnostic and workflow management that can enable quicker health response, measurement and analysis, rather than just using them as job-aids, messaging or educational tools. Of course, there is still a great value in the mobile as a behaviour change tool using inter-personal messaging.

Mobile penetration in India has increased phenomenally over the last few years and this makes for a great opportunity to use mobile for healthcare. In India’s most populous states of UP and Bihar mobile penetration is upwards of 65-70%. The right health solutions when delivered through mobile can have immense impact and reach people who are conventionally not easy to reach.

A large part of the global mHealth market will focus on monitoring services. Mobility devices (bands, health apps on phones etc.) are the ones capturing global attention in mhealth. Many of these are however urban focussed. To address India’s health concerns, there are many projects in the rural areas that can be game changers. For example, real-time capturing of weight and height of malnourished children and monitoring growth remotely can help us take corrective measures in solving India’s nutrition concerns. Using mobility devices to capture key diagnostics (BP, Haemoglobin etc.) for rural women can help us proactively take remedial measures for high risk pregnancies and help reduce maternal mortality. Mobility devices can aid in monitoring treatment adherence, a critical need in managing Tuberculosis (TB) patients. All these projects are presently underway in India and present a great opportunity to leverage mobile technology.

The biggest challenge is whether mHealth solutions are being designed for scale, especially for the public sector. A large part of India’s health challenge is in the rural areas. Experiments and pilots have to be designed keeping in mind that they can be scaled across the country. This also presents a great opportunity for those developing robust platforms and scalable systems.

The other challenge is with maintainability of the mobile devices in the rural settings. Smartphones and tablets will get subjected to a lot of rigor and tough use and ensuring procurement of quality devices (and their maintenance) will be important.

For technology firms operating in the mHealth space, while ensuring they look towards designing solutions for scale, a key ask will be to bring stronger use case of the technology, focussed on maximizing impact of the solutions. This requires greater clinical perspective and focussing on user centric design besides the conventional needs of interoperatability and data privacy. The clinical perspective helps in looking a larger continuum of care instead of focussing on “point solutions”, which by no means are not important. However integrating point solutions can be quite a challenge especially if they are not built on common standards. Furthermore, for mHealth solutions especially in the public sector, effective beneficiary identification is critical to have a unified view of the beneficiary who may be covered across multiple point solutions. Building solutions which effectively manage beneficiary identification (for example, Aadhar-enabled systems, focussing beyond just capturing the UID number) is therefore critical.

The Government’s intent on using mobile technology for health is clearly visible. The ministry of health is forming the National eHealth Authority (NeHA). This could become a key part of the Digital India program and will help drive the focus on mHealth for healthcare delivery. As a policy, it is expected that the Government would encourage (or even mandate) use of mHealth platforms in the public health system. The efficiency and effectiveness these can bring in (if implemented and supported well) are enormous. This brings hope that paper registers would go in the years to come.

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