Keeping track: phones for health in Rwanda

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Roughly nine million people live in Rwanda, and nearly 200,000 of them are infected with HIV. Healthcare facilities often lack the appropriate supplies, reliable Internet connections, and have a limited ability to track patients or the spread of HIV across the country.

With Phones-for-Health, though, cell phones could soon make it possible to track epidemics in this and other developing countries.

The Phones-for-Health partnership – composed of the GSM Association’s Development Fund, the US President’s Emergency Plan for AIDS Relief (PEPFAR), Accenture Development Partnerships, Motorola, MTN, and Voxiva – aims to use cell phones to enter medical data. Dawn Hartley, manager of the GSMA Development Fund, says, “Our role is primarily interfacing with our operator community, bringing operators onboard and supporting implementation from the mobile handset side.” Motorola provides the phones, and Voxiva created the software that runs the entire system, which lets clinics communicate patient information, order medicine, and get treatment information.


To make such a system work with cell phones, a country needs widespread cell signals. Hartley says that Phones-for-Health looks to work in countries with good coverage. “Good coverage” in developing parts of the world varies substantially from the meaning in other countries, where people get frustrated if a cell signal fades in any spot in their house. Perhaps surprisingly, that’s not much of a problem in Rwanda, or even in Africa in general. Right now, about 60% of the population of Africa lives in areas with mobile-phone coverage. By 2010, that figure should rise to 85%. In Rwanda, for example, health officials could need to climb a nearby hill to get a cell-phone signal and upload data.

Hartley and her colleagues expect that the system will eventually be used for more than just tracking the spread of HIV/AIDS to other major healthcare issues, such as diphtheria and malaria. Bob Mayes, senior informatics advisor for PEPFAR focuses on an even bigger goal, saying, “We’re looking at this as supporting the development of a national health information system in these countries.”

Taking Phones-for-Health from a plan to a program, though, faces some obstacles. “There can be agreement at higher levels, but still be a struggle getting down to an implementable product,” says Mayes. For example, Phones-for-Health officials must negotiate with local health officials and cell-phone carriers in every place that the system hopes to work. “By and large,” says Hartley, “reception to the system has been extremely positive.” Consequently, the plan is moving ahead.

In September 2006, Phones-for-Health tested the system in Rwanda, but has yet to get the system up and running. The first wave of installation will include 100 Motorola handsets and scale up to a total of 500. That process is going on now. Once Rwanda’s system works, Phones-for-Health will turn to Nigeria, where “we’ve begun the ramping up,” says Mayes. “The goal, he says, is implementation in 10 countries in the next three years. “We’re in the process of talking to about a dozen other countries … to identify two more countries for 2007 to move to implementation,” Phones-for-Health plans to add around six countries in 2008. “We’ve had a number of expressions of interest from countries already,” Mayes says. Vietnam is a country where we do lots of work in PEPFAR, and that country could potentially participate in this type of program.”

With cell-phone coverage, software, and record keeping, Phones-for-Health might sound like a technology challenge, but it’s not. “The technical challenges are quite addressable,” says Mayes. “It’s not like Field of Dreams where ‘If you build it, they will come.’ You have to build it and provide the support for people to begin to use it and perceive the value added.” He goes on: “It takes a while for the value added to be apparent. You need to accumulate the data.” To Mayes, the primary value of Phones-for-Health is “connecting millions of people to a broader world in looking at their health and the health of their children and their families.”

While never intended to mimic the US phone dialing of 911 that brings medical attention to the caller’s door, Phones-for-Health should still benefit patients and governments. Looking ahead, Hartley says, “For patients, we expect to see faster and better interventions in receiving medical treatment, and governments will be able to respond to the size and scale of epidemics.”

Source: BioTech 360