Mobile technology can help bridge health systems gaps and improve reproductive, maternal, newborn and child health outcomes. It has the potential to give every family access to information and services, support health workers, and create a more accountable health system. There are now over 137 mHealth projects at Johns Hopkins using mobile tools in various ways, such as providing education and referrals to communities, decision support and monitoring for health workers, and improving data collection and reporting across the health system. Rigorous evaluation is still needed to demonstrate the impact of mHealth on health outcomes and health systems strengthening.

1. ICMNH Seminar, JHSPH February 22, 2015
mInnovations
Mobile Technology to Bridge Health Systems Gaps
and Improve RMNCH Outcomes
Alain B. Labrique, PhD, MHS, MS
Director
JHU Global mHealth Initiative
Associate Professor
Dept. of International Health & Dept. of Epidemiology
Johns Hopkins Bloomberg School of Public Health
JHU School of Nursing
JHU School of Medicine (Health Informatics)
Chair
WHO mHealth Technical Evidence Review Group

2. Maternal mortality data from 2000, Worldmapper.org

3. WHO 2013: ~289,000 maternal deaths = ~484 per day = 1 every 3 minutes

8. A future where:
• Every family has access to
information, services and
medicine
• Every health worker has the
skills, training and support to
do his/her job consistently
well
• A health system counts and is
accountable for every life.

10. Euclidean map of 10 million of the 850 million
Facebook users friend networks
© Paul Butler, FB
The World is Rapidly Changing

11. 0
.2.4.6.8
1
2008 2009 2010 2011 2012
Year
Lowest Quartile WI (n=17,176) Low Quartile WI (n=19,789)
High Quartile WI (n=6,472) Highest Quartile WI (n=1,032)
Mobile Phone Ownership by WI over Time
Household Mobile Phone Ownership over time in rural
Bangladesh, by “Wealth Index” (n=44,469)
Labrique, Tran et al, 2013 (JMIR, in press)
ProportionofHHreporting“MobilePhoneOwnership”

12. mHealth

13. www.jhumhealth.org
137 mHealth Projects at JHU, as of February 2015

14. mHealth:The Four C’s
Harnessing ubiquitous information
and communication technology to
collect data, connect individuals,
compress time and create novel
opportunities to improve
individual and public health.

15. Labrique, Vasudevan, Kochi et al, mHealth Innovations as Health
System Strengthening Tools. Global Hlth Sci Prac 2013
*Most downloaded / cited mHealth article 2013-14.

16. 12 Common Applications of mHealth
Labrique et al. GHSP, 2013

17. mHealth is not a single THING.
Mobile tools can be used to strengthen
different parts of the health system.

19. mHealth Technical Evidence
Review Group for RMNCH
http://bit.ly/who-mterg
“Providing governments and implementing agencies
objective, evidence-based guidance for the
selection and scale of mHealth strategies
across the reproductive, maternal,
newborn and child health continuum”
-mTERG Mission Statement 2012

20. Health System
Adequacy
Provider
Competency and
Accountability
Patient
Knowledge and
Self-Efficacy
ARTICULATING
mHEALTH
STRATEGIES
AS
HEALTH
SYSTEMS
INNOVATION
• INFORMATION
• DEMAND CREATION
• SUPPORT SYSTEMS
• WORK MANAGEMENT
• DECISION SUPPORT
• ENUMERATION
• SURVEILLANCE
• SUPPLY CHAIN
• STAFF AND FACILITY
PERFORMANCE
MONITORING
• REFERRAL SUPPORT

21. Frontline
Health
Worker
Task Shifted
Responsibiliites
Community
Education
Referral / Linkage
to Facilities
Screening
Treatment
Monitoring /
Support
Agarwal S, Perry H, Labrique AB, mHealth for FHWs, In press 2015

22. INTERVENTION
OF KNOWN
EFFICACY
EFFECTIVE
COVERAGE
mHEALTH:
A Health Systems Catalyst
Jo Y, Labrique AB et al. PLOS One 2013
Shift focus from “Does mHealth work?” to
“Does mHealth optimize what we know works ?”

24. mHealth doesn’t work in a Vacuum

26. Targeting the CLIENT

27. Global PPP
Initiative
“If you have any
bleeding during this
month, seek medical
attention right away”
Expectant women/
new mothers sign
up for service
Users receive 2
health-related SMS
or Audio Message
weekly
NGO Partnership and
“Freemium” Model of
Subscription
“Your baby needs an
immunization this week
to stay healthy:
Available free at all
EPI clinics”
US, Bangladesh, South Africa, Russian Federation, India

30. Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A
Meta-Analysis of Randomized Controlled Trials
David J. Finitsis, Jennifer A. Pellowski, Blair T. Johnson
PLOS ONE 2014

31. Client-Driven Event Notification in
“real-time”
Try it:
SMS
“birth” to
+1 443 393 2228

33. Targeting the WORKFORCE

35. https://www.youtube.com/watch?v=hAgzvD7WNFI

36. Mobile Academy
for Frontline
Health Workers

38. Burden has grown on health workers
to collect and report data
Multiple Paper Tools & Registers

39. Inaccessible, Unusable data

40. Tremendous time and effort is invested in
manual data summarization and reporting.
19 registers contain 473
unique data fields !
Approximately 60 fields
would be required for a
digital system to process the
same information.

44. SmartRegister.org

45. Emphasis on user-focused design to facilitate FHW utilization and feedback.

46. Nutrition (6) >
Integrate workforce and client training as part of the exposures

47. mCARE: Community-Health Worker System to improve delivery of
ANC/PNC and increase client demand

48. mCARE Tripled ANC and Doubled PNC
in Rural Bangladesh

49. mTikka – Mobile phone enabled
virtual vaccination registry
http://tinyurl.com/mtikka-video

50. Targeting the SYSTEM

53. Project Mwana:
SMS to reduce Infant HIV PCR Turnaround Time
(Median 46% Reduction in DAYS)

54. New frontiers!
Remote, Point-of-care Diagnostic tools
Breslauer D., et al. 2009 Mobile Phone Based Clinical Microscopy for Global Health Applications. PLoS ONE 4(7): e6320

55. New frontiers!
• US FDA Approved
• 2-lead ECG

56. Start simple –
leverage ‘mhealth’ in its natural state

57. m-Labor
Notification
System
Pilot Study
Source: Gernand, JiVitA Data 2011
(Unpublished)
306 (88.9%)
Births Attended

58. Don’t underestimate the power of a
phone… as a phone.

61. mHealthEvidence.org / mHealthKnowledge.org

63. Rigorous Process / Outcome / Impact Evaluation
eg. RCTs
mHealth requires BOTH
Engineering and Public Health Approaches
NEED ADEQUATE FUNDING
FOR THIS

65. Mobiles ?
alabriqu@gmail.com
alabriqu jhumhealth
www.jhumhealth.org
THANK YOU