Cell phones have the potential to be a powerful tool in improving health care.
Mobile telephone service is the fastest-growing technology in Latin America and the Caribbean. Some 360 million people—many of them in the region’s low-income population—have cell phones. The challenge now is to take advantage of these phones’ increasingly sophisticated technology.
Interview with Rafael Anta emphasizes the opportunities that mobile telephone service offer for making health services more efficient and effective, especially primary care and services in remote areas that are far from urban centers.
Why is the IDB interested in mobile telephone service, especially in the health sector?
Mobile telephone service is the first technology that makes it possible to provide customized information and services to most of the population. This includes approximately 160 million people who earn less than US$300 a month but have a cellular phone.
There are three key factors driving the mobile telephone sector: the high penetration of mobile telephone service into Latin America and the Caribbean; mobile phone networks that already provide coverage to many of the region’s populated areas; and the capacity of these networks for data transmission, where SMS (Short Message Service) is second only to voice service.
In addition, three trends that boost the potential of mobile telephone service have come together: the number of users is growing; mobile phone networks keep expanding and offering more and more bandwidth, especially in metropolitan areas; and the phones themselves continue to get smarter and can process more sophisticated applications.
In the IDB’s Science and Technology Division, we are interested in using cellular phone technology to take advantage of this communications capacity, so we can jump-start innovation and develop mobile services that can contribute to economic and social development. The health sector, together with financial services, government and trade, is one of the sectors where mobile services can have a major impact on people.
What is the role of cellular telephone service in the health sector? What can it do?
There are many roles for cellular telephone service, from conducting health surveys of local residents to improving emergency care.
Cell phones can be used to remind a patient about an appointment or a child’s vaccination. Wireless communications networks can be used to disseminate information about sexually transmitted diseases and preventive health habits.
Then there is the potential for follow-up care, which includes, for example, sending a photo of the scar from an operation or keeping track of when medications are taken. In some cases a cell phone can be used for diagnostic purposes, such as measuring a diabetic’s glycemia level and sending the information to the doctor in order to get instructions and advice. The possibilities are enormous.
Health coverage is one of the major challenges facing Latin America and the Caribbean. How can cellular telephone service help with this?
Mobile services in the health sector can help increase the focus on preventive health care and improve monitoring of patients in remote areas, which saves them visits to health centers and improves time management for doctors and nurses. You can also have remote follow-up care for people with chronic illnesses, and even generate electronic clinical histories. All in all, any mobile service that connects doctors with patients—especially patients who live far from health centers—helps improve access to health services.
What remains to be done for this to become a reality?
The region is ready in terms of cellular telephone infrastructure. But we see three key factors that must be dealt with in order to make this opportunity into a reality.
First, there is still a significant deficit in the use of information and communications technologies to manage health care (e-Health), and a number of mobile services will only be viable in places that already have health information systems.
Second, there is the cultural factor. Doctors and patients must begin to accept cell phones as a tool that enables them to send and receive health information. What’s in our favor here is that the region’s population is relatively young, and young people easily accept using cell phones for new purposes.
Finally, the most complex factor: getting mobile services to operate with financially sustainable business models. Most mobile service pilot projects have been successful, but very few have made the leap to large-scale success, because they lack a workable business model.
Then what we must add to all of the above is the need for health system decision-makers to have management ability and especially a focus on innovation. We also have to take action with other important factors, such as the legal framework and user privacy—but we know that the earlier points are what demand the most attention.
Can the private sector—cellular telephone companies, in this case—contribute to a social need and make a profit at the same time?
Of course. If we understand that cellular telephone companies want more customers, and that customers are consuming more voice and data services, then mobile health services should be on these companies’ business development agendas. Mobile health services mean a big increase in data transmission between the health system and the country’s residents, especially in the form of text messages or SMS. Cellular phone companies can play different roles in the business models and are an essential part of the formula that can ensure sustainability.
Can you provide concrete numbers on this new sector’s potential?
Mobile health services represent a growing business sector in the region, and they promise to be profitable on a grand scale: millions of users and millions of messages at a cost of fractions of a cent. The value added will be in the capacity to generate customized information for the user and send it at exactly the right time, and in the capacity for “smart” responses in patient interactions. Mobile health services could generate 600 to 900 million dollars of business a year. And to that you have to add the economic impact it would have on the management of health systems.
We are aware of this potential but at the same time aware of the complexity of achieving sustainable business models. Our goal for 2009 is to support the implementation of various pilot mobile health services projects and, after several months of operation, invest in measuring their economic and social impact. The first thing we have to do is learn more about how to do this well, so that we can share our new knowledge with our countries.
What are the benefits for the health system in general?
Every country in the region is facing challenges of different magnitudes, priority levels or levels of severity. The key is to find the right combination of different types of services. Each type of service provides specific advantages. I’ll give you three examples:
- The monitoring applications can be used to analyze the evolution of epidemiological patterns within the population and, for example, rapidly detect localized areas of infectious diseases. This information is essential for the people who are designing policies and making decisions.
- Mobile diagnostic and follow-up services can reduce the number of medical visits and occupied hospital beds. This helps boost the health system’s efficiency.
- Reminder services can improve patients’ medicine-taking habits and also improve time management in doctors’ offices.
These services benefit the health system as much as they benefit users.
What are the benefits of cellular phone service for society’s low-income sectors?
We have to begin by recognizing that in recent years there has been tremendous progress in bringing health care to the region’s low-income sectors. Within this environment, cellular phone service can make health care more accessible to people and make them feel more included. It can also provide educational information about habits related to their health, which helps improve preventive care in low-income populations and high-risk groups.
