Uganda-created app mHero is on a fast-track to implementation on the Ebola epidemic’s frontlines.
The death toll from the Ebola outbreak continues to climb. As of December 21, 7,588 deaths had been reported to the World Health Organization. As the international community ponders how to respond to the Ebola crisis from afar, an mHealth response has emerged from Uganda.
In largely rural villages, community health workers and emergency responders are faced with fluctuating levels of potentially life-saving supplies, a lack of time-sensitive information, and feelings of isolation.
mHero (Health Worker Response and Outreach) is one potential mHealth solution to the many barriers to communication for those working on the frontlines – and those managing the crisis – of the Ebola epidemic in West Africa.
Originally developed to help combat malaria in Uganda, mHero is a free, SMS-based mobile communication system between Ministry of Health staff, health providers and community health workers.
Its developers believe that information is power, and their goal is to
“equip health workers with the right kind of information about the diagnosis, treatment, and prevention of disease.”
The app is receiving rapid development support by UNICEF’s Global Centre for Innovations, USAID, IntraHealth, ThoughtWorks, and Jembi Health Systems.
Interoperability Vital to Digital Responses in Public Health Crises
mHero enables real-time monitoring, complex surveys, and detailed analysis of health events.
mHero supports interoperability between HRIS systems, UNICEF’s RapidPro messaging system, and uses an Open HIE architecture, all of which enable the sharing of health information. It is also compatible with DHIS 2, the preferred information management system of many governments.
Isolated frontline support workers can get outbreak updates and progress reports, as well as request supplies or additional personnel, and inform the government about new infections or deaths.
RapidPro uses logic mapping and keywords to organize and prioritize messages. Additionally, each message sent through mHero becomes usable data based on trigger words input by health workers. The mHero app has patient confidentiality measures in place.
mHero’s messaging system is ideal in an organized international response to disease outbreaks, as health workers often speak different languages and have varying levels of education. mHero’s messages can be adjusted to a user’s language preference and reading ability, and includes picture-based references.
The Feasibility of Widespread mHealth Use in Africa
A few international officials have voiced concerns that smartphones might not hold the answer to the Ebola epidemic. In a blog post that was later removed from UNICEF’s website, Chris Fabian, UNICEF's senior innovation adviser, wrote:
“it might be better to dump the smartphones into an ocean than to dump them onto the emergency Ebola response.”
Fabian admitted that his words might have been too harsh, but maintained his view that West Africa does not have the infrastructure to support an influx of smartphone users (i.e., the bandwidth required for data transfer or, in some cases, the electricity required to charge devices). ITU, a specialized agency within the United Nations committed to connecting people across the globe, indicated in a recent report:
“improving coverage is particularly challenging in [the] vast rural areas [of Africa] and where the reach of basic infrastructure, including electricity, is limited.”
According to global rankings recently published in ITU’s Measuring the Information Society report, 29 of 38 African countries are considered among the least connected countries in the world. Uganda, where mHero was developed, ranks 146 of the 166 countries. In Ebola ridden West Africa, the ICT rankings are even lower: Liberia ranks 152; and Guinea ranks 161. There was not enough data from Sierra Leone to include the country in the rankings.
Certainly, connectivity and the infrastructure that supports it will need to be addressed before an mHealth solution can be fully scalable.
Hope in Collaboration
A review of scholarly literature on mHealth in developing countries, published in Journal of Medical Internet Research, found that there have been very few formal outcome evaluations of mHealth in low-income countries, and that few mHealth platforms are running at scale in developing countries.
Reviewers were hopeful that collaborations between governments, technologists, academics, and non-governmental organizations would bring pilot projects, such as mHero, to scalable use. mHero, developed in Africa for Africans and supported by international agencies, may be one such solution.
About the author: Jenn Lonzer has a B.A. in English from Cleveland State University and an M.A. in Health Communication from Johns Hopkins University. Passionate about access to care and social justice issues, Jenn writes on global digital health developments, research, and trends. Follow Jenn on Twitter @jnnprater3.