Scaling Digital Health in Developing Markets: Opportunities and Recommendations for Mobile Operators

"Digital health is taking its first steps in some African, Asian and Latin American markets, with a widespread view that greater use of technology and digital solutions can help address key healthcare issues: expanding healthcare coverage (access), enhancing services (quality) and optimising resources (cost)."

Based upon its stated need for "ecosystem collaboration" in digital health technology, this analysis document from GSMA "outlines the role of mobile operators as ICT [information and communication technology] and digital service partners for governments, health providers and health tech companies. The study highlights how a holistic approach that looks at digital health as an integrated - as opposed to fragmented - portfolio of services is crucial to drive partnerships and opportunities, both locally and regionally." The report gives an overview of the healthcare landscape and key issues that digital health can address. It examines enablers, challenges, cases, and evidence of positive impact, "demonstrating how digital health solutions help address national healthcare issues" so that government investment can be stimulated. 

Through primary research, GSMA gathered views and insights from organisations and companies in developing countries. It describes the difference in key healthcare expenditure drivers in developed and developing countries including a predicted shortage of health workers in developing countries. Funding, cost, access, and outcome are charted as indicators on page 11 of the report, showing differences in low, middle, and high income countries, for example, physicians per 1,000 inhabitants is .07 in low income countries and 2.92 in high income countries, while maternal mortality per 100,000 live births is 571 in low income countries and 80.1 in high income countries.

Health system inefficiencies burdened by poor ICT infrastructure include negative effects on coordinated care, communication and data sharing, and drug inventory and supply chain management. The expenditure gap on healthcare infrastructure includes low private investment and low government spending. In addition, healthcare staff is low in rural areas of developing countries.

In describing the progress in digital health - both electronic (e-health) and mobile (mhealth), the document reviews collaborative models, multilateral models, government engagement and initiatives and solutions that include, for example, diverse applications, such as remote diagnostics, mobile health records, workforce management and training, data collection and records, anonymous advice and consultation, and access to health and wellness information. The recommended foci for digital health initiatives include: "help to expand coverage of healthcare (access), enhance services (quality) and reduce/optimise resources (cost)", primarily through use of mobile networks that include SMS, voice, and data capacities. Some examples include:

• Wired Mothers (Tanzania) provides SMS information and support for antenatal care and contact with primary care providers. Perinatal mortality decreased from 3.6% to 1.9%.
• Telehealth service Mobile Obstetrics Monitoring (MOM) in Indonesia is an app-based solution, one for midwives on collecting vital data on pregnancies, one for doctors to view data, linked with healthworker services to guide care in difficult pregnancies. The programme reduced anaemia by 99%.
• MAMA Bangladesh (Mobile Alliance for Maternal health Action), known locally as Aponjon, is a public-private initiative that provides a voice and SMS broadcast service, including a helpline and mobile app, which scaled up to 1.9 million subscribers.
• The Mobile Ultrasound Patrol Project in Morocco issued doctors and nurses backpacks containing ultrasound devices that were wirelessly connected through 3G to specialists in hospital clinics, reducing feedback to patients from two weeks to 24 hours.
• Stock Visibility Solution (SVS) in South Africa was implemented in 3,126 clinics as a way to monitor availability of medicines.

ICT services operators, large and small, provide these and other health service access options, often using the opportunities for growth in business size and revenue. “Interviewed organisations largely concurred that governments are the largest clients for digital health initiatives." Among the scaling recommendations for the industry are the following: 

1. Digital health stakeholders need to demonstrate the value of digital solutions to drive greater government investment.
2. Ecosystem collaboration is needed to address current fragmentation and create a holistic digital health model.
3. Industry collaboration is needed to address current interoperability issues and drive healthcare data integration. 

Further recommendations for operators include: pursue a holistic role; position at the centre of the ecosystem; and establish strategic partnerships. The report details a holistic business model and describes seven case studies including several of those listed earlier to illustrate details about the operators, the problems and solutions, and the business model used