Apply Computer and Mobile Health

Technology
 IDENTIFY THE EXISTING HEALTH TECHNOLOGIES

• OVERVIEW
1. Introduction to computers operating system
2. Internet browsers
3. Existing new technology
 MHealth
• The mHealth ecosystem is created through the
collision of three sectors
1. – health
2. technology
3. Finance
– with the backdrop of government policy and
regulation
 Government
Legislators Health
Regulators Health system
Legal system Health care workers
Ministries Medical supply chains
Patients

mHealth Health
applications funding

mHealth
Service delivery

Technology Finance
Software Banks
developers Mobile Insurance
Mobile platforms companies
operators Private investors
Handset Philanthropists
makers Donors

4
Source: Dalberg research and analysis
 Introduction to computers operating system

• An Operating system is software that creates a relation

between the User, Software and Hardware.
• It is an interface between the all.
• All the computers need basic software known as an
Operating System (OS) to function.
• The OS acts as an interface between the User,
Application Programs, Hardware and the System
Peripherals.
• The OS is the first software to be loaded when a
computers starts up.
• The entire application programs are loaded after the OS.
 Types of computers operating system

• An Operating System can be of Three Types:

1. Single User MS-DoS
2. Multi User UNIX, Linux..
3. Network,
• Single User: If the single user os is loaded in
computer’s memory; the computer would be able
to handle one user at a time.
• Multi user: If the multi-user os is loaded in
computer’s memory; the computer would be able
to handle more than one user at a time.
• Network:If the network os is loaded in
computer’s memory; the computer would be able
to handle more than one computer at time.
 Purpose of computers operating system

• The purpose of the OS is provided an

environment in which the user can execute
programs. The primary goal of an OS is thus to
make the computer convenient to use. A
secondary goal is to use the computer hardware
in an efficient manner.”
• Computer Hardware – CPU, memory, I/O devices
provide basic computing resources.
• Operating System – Controls and coordinates the
computing resources among the system and
application programs for the users.
 Operating System Components

– Operating System Components

• Main components are
1. process, memory
2. File
3. I/O system
4. secondary storage management
 Responsibilities of operating system
• Process Management responsibilities.
1. Creation and Deletion of user and system
processes.
2. Suspension and resumption of processes.
3. Provision of mechanisms for process
synchronization.
4. Provision of mechanisms for process
communication.
5. Provision of mechanisms for deadlock handling.
• Main Memory Management responsibilities
1. Keep track of which parts of memory are
being used and by what processes.
2. Decide which processes are to be loaded into
memory when memory space becomes
available.
3. Allocate and de-allocate memory as needed.
 File Management responsibilities
1. Creation and deletion of files.
2. Creation and deletion of directories.
3. The support of primitives for manipulating
files and directories.
4. Mapping of files onto secondary storage.
5. Backup of files onto stable storage media.
 I/O System Management
• I/O System Management – hides the
peculiarities of specific hardware devices from
the user
 MHealth
• The mHealth ecosystem is created through the
collision of three sectors
1. – health
2. technology
3. Finance
– with the backdrop of government policy and
regulation
 Government
Legislators Health
Regulators Health system
Legal system Health care workers
Ministries Medical supply chains
Patients

mHealth Health
applications funding

mHealth
Service delivery

Technology Finance
Software Banks
developers Mobile Insurance
Mobile platforms companies
operators Private investors
Handset Philanthropists
makers Donors

18
Source: Dalberg research and analysis
Framework for mHealth impact
Outcomes Better
health

Access, affordability, quality, matching of

Intermediate resources, behavioral norms
outcomes

ICT literacy Complementary

mServices
Multipliers Health literacy Complementary capital
Health training investments
ICT maintenance and
M&E repair capacity
mHealth
service
delivery
Outputs

Health system
needs
Health care Financing
best practices Network installations
Procurement & Distribution channels
Inputs Supply chains Research & Development
Cultural attitudes

Policies & Related Regulation & Leadership & Communication &

Strategies Infrastructure Standards Governance Education
19
Source: Dalberg research and analysis
 WORKING DRAFT – FOR DISCUSSION PURPOSES ONLY

Examples of mHealth interventions

Health services Description of mHealth usage and applications Example Cases

1 Usage of mobile handheld devices to collect data remotely (e.g., by
Data Collection / Disease community health workers); additionally, use of remote diagnostic tools
Surveillance for disease surveillance and treatment; includes civic participation in
reporting outbreaks and disease information

2 Utilization of messages and voice to communicate treatment and

Treatment Adherence / procedural reminders to patients (e.g., automated SMS reminders to
Appointment Reminders patients on chronic medication)

3 Emergency response tools , including creation of EMR via mobile

Emergency Medical phones, and ambulance services whose reach is extended with mobile
Response Systems usage in remote areas

4 Collection and analysis of patient data, particularly at clinics or related to

Health Information call centers that are used to triage services and treatment; information to
Systems & Support Tools help health worker prioritization; information on inventory (Note: overlaps
for Health Workers with supply chain management)

5
Management of inventory and supply chain steps by mobile tracking and
Supply Chain Management communication; includes advocacy informed by supply chain
information

6 Use of smart-cards, vouchers, insurance and lending for health services

Health Financing linked to mobile platforms (e.g., m-Pesa) or otherwise enabled using
mobile

7
Disease Prevention and Use of mobile and SMS-based health information and education to
Health Promotion inform individual patients of preventive care and treatment

Source: Dalberg research and analysis 20

 Adherence
• Adherence is a huge issue in treating patients who
are HIV-positive and taking antiretroviral therapies
(ART), thus, WelTel provides weekly SMSes from
clinic nurses to patients, inquiring regarding their
treatment, and patients are required to respond
within 48 hours; if no response is received, the
nurse follows up with a call and referral if needed
• Social-enterprise model, funded by PEPFAR and
CDC
• Founded in 2007
 Advantages:
• With reminders, patients adherence improves, leading to better outcomes in
terms of suppressed viral loads
• Cost-effective means of extending health system reach where roads are bad and
travel expensive, but mobile service is inexpensive and reliable; basic handset is
required (rather than a smartphone); utilizes existing clinic nurses
• Cost of the offering decreases with scale; also reduces overall health system
costs by estimated 1-7% due to ability to more efficiently following patients, and
keeping patients healthier via improved compliance, meaning they use less
emergency health services and avoid development of drug resistance and need
for 2nd line medications
• Potential to move “horizontally” beyond HIV given simplicity of system
• Results:
• In recent RCT, patients receiving SMSes had better adherence and suppressed
viral loads
• Beneficiaries and willingness to pay:
• Patients receiving antiretroviral therapies (ART), primarily in
the pastoral Masai communities of Kenya; ART funders who can
receive better return on investment
• Patients at Kajiado and Pumwani Health Centre receiving ART
indicated a willingness to pay up $0.50 to $1 USD.
•Current scale: Pilot and RCT in 273 patients
•Costs/revenue: Budget for RCT was $719k
•Estimated costs to scale:
oScaling to 400k PEPFAR patients on ART
would result in 26,000 additional patients
with suppressed viral loads
oAt $8/patient, this would cost $3.2M, which
is