It’s really great to see so much effort being channeled towards innovation in international maternal and child health. The text4baby service was launched just one month ago. Our last post was about a USAID-supported mHealth eConference for maternal and child health. This post is about a maternal health innovations competition put on by Ashoka.

There are now nine days left to enter the Healthy Mothers, Strong World competition, billed as THE NEXT GENERATION OF IDEAS FOR MATERNAL HEALTH. The best innovations will be awarded prizes totaling US$600,000. More information is available at the competition website.

Two early entry prizes have already been awarded. One of the prizes went to Aadharbhut Prasuti Sewa Kendra, a privately-run birthing center led by nurse-midwives in Nepal. It is described “the first and only initiative taken by Nepalese nurses in a low resource setting, where they have never ever taken such a step independently”. The other prize went to Maternova, an portal for innovations in maternal and neonatal health that we first reported on in November 2008.

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• The New National Health Plan Is Texting (science.slashdot.org)

Addendum (6-Mar-2010): The conference announcement and call for abstracts was only distributed as an image (see below), but that isn’t too useful for search or for general information dissemination. As a service to our readers – and for the benefit of this conference – I processed the image through a free, online OCR tool. Not responsible for misspellings:

HOW CAN MOBILE PHONE TECHNOLOGIES IMPROVE FAMILY PLANNING,

MATERNAL AND NEWBORN SERVICES IN THE DEVELOPING WORLD

Online Conference May 5, 2010

The United States Agency for International Development’s (USAID) Strengthening Health Outcomes through the Private Sector (SHOPS) Project is launching an annual eConference to advance private sector innovations in the sustainable provision and use of quality family planning/reproductive health and other health information product. and services. The theme of the 20l0 eConference is mHealth which is the use of mobile technology to improve health program effectiveness and efficiency.

Abstract submission deadline: March 17, 2010

Call for abstracts: The SHOPS Proiect and die mHealth Alliance invite you to submit an abstract by March 17, 2010 to present at this online conference which will focus on how mobile technologies can improve family planning, maternal and newborn services in the developing world. Priority will be given to those submissions that are evidence-based. Abstracts should fall into one of the five categories below:

• Family planning
• Pregnancy
• Delivery
• Post partum (newborn care. family planning)
• Cross-cutting (e.g.. gender barriers, low literacy populations, training requirements, administrative management, supply chain)

The deadline for abstracts is March 17th and the conference is on Cinco de Mayo. Let’s hope they have some results and some data,  all info in the image below:

Kopernik: Connecting Innovative Technologies with Poor Communities
We are lucky to have a guest post today by Ewa and people like her in general who are doing what they can for global health. She and her team have just launched a new web platform connecting you with poor communities and technologies that might be needed there via an online store. I cannot emphasize enough that is this is long long overdue and that we should all be embarrassed that this hasn’t happened before. So major kudos to Ewa and her team for pulling this platform together and giving it a shot. Please visit their website and spread the word (you can also read there Tech for development blog here):

Guest Post by Ewa Wojkowska, a former UN worker, is the co-founder of TheKopernik.org.
As the rubble is cleared in Haiti, as a measure of stability comes to Sudan, as Sri Lanka holds a bitter peace and as Burundi faces its first election in the wake of massive civil war, a new development opportunity presents in some of the world’s poorest and most troubled places.

Online social entrepreneurship for the poor is one of the most compelling ways to fight poverty—and to reshape our development practices. Examples like Kiva and Global Giving are already leading the way, linking people anywhere in the world to better assistance and real results. The internet has created the opportunity for a transparent virtual marketplace: communities in developing countries identify their local needs, individuals anywhere in the world directly respond. Today our site—www.thekopernik.org—joins the force, connecting breakthrough technology to the poor through an online marketplace. It’s a simple, direct idea for real assistance to people in need.

Here’s our idea: Registered local organizations provide short proposals explaining their needs—simple water filtration in Freetown, Sierra Leone, self-adjusting eyeglasses in Manado, Indonesia. Any visitor to the site, anywhere in the world, can review the proposals and make donations to fund the plan of his or her choice. We connect these breakthrough technologies—water filters and drums, self-adjusting eye glasses, and solar lights, just to name a few—to the people who need them most.

What sets us apart is the focus on technology and a review mechanism for local organizations, or ‘technology seekers’, to rate the products. By including a feedback mechanism on the effectiveness of these technologies, Kopernik gives voice and choice to local communities and organizations – simple elements that are so frequently missed in international development efforts. We’re looking to take out the delays and to spark new ideas in international aid, one click at a time.We believe this is the new face of development.

If more people everywhere have safe, unfettered access to clean water, more efficient means of transporting that water, clear eyesight, and reliable light, how would their choices change? How would they see the world and their place in it? What could their empowerment achieve?

We now have the technology to improve everyone’s lives, and the internet is the window to get these life-changing technologies into people’s hands, directly and efficiently. We’re building a resource that those in need can access for themselves.

Ewa Wojkowska, a former UN worker, is the co-founder of Kopernik.org. The website launched this past week.

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Post by David Van Sickle, guest blogger. Please see his very popular previous post: 7 Steps for Building Low-cost Open Source Technologies for Global Health. (Thanks to Andre of Pulse and Signal fame for cross posting this)

Missing Populations:
I’m currently in the United Arab Emirates, attending a conference sponsored by the UAEU in Al-Ain to raise awareness of global health problems in the Middle East and neighboring Asia, and to draw attention to the region and its populations and health problems among the global health community. As a result, I’ve been thinking about the scope of attention in global health, and about populations and settings that are, for some reason, out of focus right now; one group in particular has come to mind.

This group is among the poorest in their country. Just under one in three lives in poverty (more than twice the overall rate).

• They have, on average, the lowest per capita income, earning less than half the average income of the general population.
• Nearly a quarter of their households are food insecure and as much as half of the population is unemployed.

Their families inhabit some of the most substandard housing in their country.

• Nearly 40 percent of households are without electricity.
• More than 30 percent lack a safe and adequate water supply and waste disposal system.
• Households are often crowded. The risk of death from tuberculosis is 600 percent higher compared to the general population.

Populations are often geographically isolated, living many miles from communities, employment and health care facilities.

• More than 60 percent of households have no landline telephone with most individuals relying on cell phones for routine communications.
• Migration to distant urban centers for employment is growing.

Overall the group experiences a major mortality disadvantage and significant burden of chronic diseases.

• The group shoulders considerable decrements in life expectancy and significantly higher rates of infant and maternal mortality.
• They suffer from increasingly high rates of debilitating chronic diseases tied to negative social and economic determinants of health.

Given this set of circumstances, I have long expected that the attention of the global health community would land on this group. The problems are compelling and the potential value of existing and promising social and technological interventions are obvious. For example, with widespread access to mobile phones networks, mobile phones could be used to deliver education, raise incomes, or improve health and health care. There are a host of applicable technological interventions that could mitigate poor housing or provide electricity.

Yet, very few academic or applied global health organizations include the group in their research focus or activities. I’m ready to see global health efforts applied to aid Native Americans.

Cross post by Alex from over at Tales of Water in Africa:

Over the last year or so, I’ve encountered a tremendous push for innovation in the fields of development and disaster relief. Organizations big and small are looking for the ideas that will catapult millions of people out of poverty. The next clever gadgets that will cheaply and quickly filter water, prevent malaria, and stop the spread of HIV/AIDS. These ideas are almost by definition just over the horizon – because once an idea has been around for a few months, it’s not that innovative anymore.

And so what happens to those innovative ideas? What happens when the clever creator has received his fellowship grant and begins to work out the tricky details? From what I’ve seen, the funding organizations have moved on to the next ‘innovation’ and left the creator to work out the Boring Stuff on their own. My experience in Africa has pointed to the Boring Truth – 90% of what’s needed is not innovation but ‘capacity building’ – training, logistics, and equipment purchases. Building systems that can scale up to help thousands more people.

Take for example the work my fiancée does in health care. She is deploying an innovative new computer and mobile phone-based system to track and process health claim forms. It promises to reduce overhead and errors, increasing the rate at which health providers are reimbursed by funding agencies such as KFW (the German development bank). And yet the health providers she partners with, while supportive of her new claims system, are more excited by the equipment and training she is giving as part of the research. They’re excited about the opportunity to purchase laptops, check email, and learn how to track patients on Excel. And they want to do it on laptops, not smart-phones, as are being so heavily touted in development circles. They want to do things like we do in developed countries. Given the option, they’re taking the boring stuff before the innovative.

To a large extent I’ve found the same to be true in the work I do with water. The basic work – building gravity flow systems – has been done since the Romans! It’s not exactly cutting-edge technology. But the great improvements are coming from the Boring Stuff – GPS devices to mark pipe and tank locations. Creating a database to manage the hunt for new sources of water. These behind the scenes changes are making it much easier to build and manage a water system.

But unfortunately the Boring Stuff isn’t sexy enough to get funding. The truth is, nobody wants to fund it because they can’t put their names on it. The funding organizations can’t brag to their peers and donors about the Boring Stuff – “look we gave $10,000 to train X health practitioners on how to enter and process data!” But when they put out $10,000 to fund the Next Big Thing, out come the press, book agents, and dollars.

This trend points to a glaring fact – we in the developed world are more interested in creating a system that makes us feel good rather than creating a system that provides the resources people in the developing world need to succeed. And I will be the first to confess of this – I want to feel good about myself just as much as anyone else.

Now, all this is not to say that innovation is inherently bad – far from it. It is only to say that innovation should not be the absolute focus, or even the primary focus. We need to support the Boring Stuff, the physical and educational infrastructure that will be the foundation on which the vast majority of people are lifted out of poverty.

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• A conversation with Bill Gates (seattletimes.nwsource.com)

Yesterday we were invited to sit in and meet the CEO of GSK, Andrew Witty, as he announced the new GlaxoSmithKline Open Innovation Strategy To Aid Poor Countries. The following entry is by one of our new bloggers, Sarah Searle (@sarahsearle on twitter) from the Johns Hopkins International Health program:

“Big Pharma as a Catalyst for Change”: GSK “Open Innovation” strategy

It’s estimated that one-third of the world’s population go without essential drugs–often drugs for treating diseases that disproportionately affect the world’s poorest. The pharmaceutical world proves to be especially difficult to navigate for those seeking to provide such medicines to underserved populations, however. Pharmaceutical science is a field with billions of dollars in R&D, ironclad patents and intellectual property rights that are prohibitive to making drugs available to the poor. Andrew Witty, CEO of GlaxoSmithKline, claims that he’s looking to change this nature of big pharma, in the same way that the open source movement has revolutionized the tech world.

I love the word “innovation” combined with anything related to global health, so the prospect of sitting in on a blogger’s roundtable with GlaxoSmithKline CEO Andrew Witty was exciting enough just from the topic at hand: “Breaking Down Barriers to Innovation and Access to Medicines in the Developing World.”

The ante was upped in a press conference this morning, when Andrew Witty announced GSK’s “Open Innovation” strategy to make drugs more available and break down barriers to access. This strategy includes several components.

“Open Lab” initiative
$8 million in seed funding has been provided establish an “Open Lab” at GlaxoSmithKline’s research facility in Spain. As many as 60 scientists from around the world will be able to work at this lab, which will be devoted to research for drugs that target diseases of the developing world.

13,500 malaria-combating compounds in the public domain
This is perhaps the most exciting announcement. GlaxoSmithKline has been collaborating for years with PATH and other organizations in the development of a malaria vaccine. Scientists at GSK have screened all compounds that have ever been created in their labs, and identified 13,500 compounds that successfully combat P. faciparum, the deadliest form of malaria. The big news? The chemical structures and other recorded data regarding these compounds will be open sourced, in hopes that malaria vaccine research will be accelerated.

New pricing model for GSK’s malaria vaccine candidate
GlaxoSmithKline is in the process of developing the world’s most advanced candidate for a malaria vaccine—it’s the only vaccine in Phase III clinical trials, and could be available to the public as early as 2012. Maintaining that a tiered pricing model simply isn’t feasible for a drug which is needed almost exclusively by the world’s poor, Witty announced a pricing model for the vaccine which covers the cost of the vaccine with a marginal return for GSK, all of which will supposedly be channeled back into R&D for “next-generation” malaria vaccines.

It goes without saying that some present at the roundtable were wary of the corporate world’s ability to selflessly decide change the mechanics of drug information and pricing in order to benefit the world’s poor. Witty has struck a nice balance between acknowledging that GSK is a profit-driven company but maintaining that he strives to keep a “restless” socially-conscious agenda.

And let’s be honest—GSK won’t be suffering much financially with this move. First of all, the malaria drug market isn’t very competitive to begin with, because of the very fact that it is a poor person’s disease. Secondly, GSK is already the developer of the leading candidate for a malaria vaccine. It’s unlikely that, even with the compound information made publicly available, anyone can come up with a vaccine to rival GSK’s in any short amount of time.

Indeed, as Witty acknowledged, making drugs and drug knowledge more universally available is an investment in the future. Drugs will not be provided for free, he stressed, but rather provided at a marginal price that won’t completely alienate other pharmaceutical companies from healthy competition for lifesaving drugs.

Regardless of motivation, it’s refreshing to see big pharma recognizing the issues of access to medicines for the world’s poor. Moreover, Witty’s emphasis on being in step with progressive intellectual property movements is laudable. Whether or not GSK’s initiatives will stimulate other pharmaceutical companies to follow suit remains to be seen.

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The Global Forum for Health Research Forum 2009: Innovating for the Health of All took place in Havana, Cuba from 16-20 November. This is the sixth and final in a series of posts from the conference.

It’s now been a month since Forum 2009, so it’s time to wrap up any remaining thoughts from the meeting. My intention with these posts was never to provide a comprehensive view of the conference. If you’re looking for that, or simply additional insights into the meeting, I recommend the following resources:

1. Priya Shetty’s coverage of Forum 2009 for the SciDev.Net blog, five posts
2. TropIKA.net comprehensive coverage of Forum 2009, including daily reports and session reports

On my Cancún-bound flight out of Havana, on the morning of the 20th, the woman sitting next to me asked me for help with her Mexican immigration forms. As I was helping her, I asked what she did. “Terapista”. She asked what I was doing in Cuba. Attending “un congreso de investigaciones de salud pública”. She was a Cuban physical therapist going on a three month medical mission to Tecate in the Mexican state of Baja California, via Cancún, Mexico City, and Tijuana. I spent most of the short flight asking about her experiences on previous missions, all to Mexico, and probing for more details about the Cuban health system. Most memorably, she was quite proud of a unique surgical treatment the Cubans have developed for Parkinson’s disease.

I spoke about the medical assistance Cuba lends to other countries in an earlier post. The photo below of the 20 convertible peso note reinforces this. It touts Operación Milagro (Wikipedia link in Spanish), a joint program between Cuba and Venezuela with official aims similar to Cuba’s other medical mission efforts.

While I was speaking to this terapista on the plane, it occurred to me how important the setting of the conference was given the innovation theme. I don’t think that this was lost on many of the conference participants given external interest in the Cuban system, Cuban participation on panels, and various site visits. Still, there were three circumstances that limited knowledge exchange between the visitors and the Cubans:

1. Language barriers. There wasn’t very much communication between the several hundred Cuban participants and the external participants, especially those from outside Latin America. This was due in no small part to language barriers. Simultaneous translation took place during the larger sessions (UN-style headsets), but the smaller sessions didn’t have any and the informal exchange was visibly limited between the two groups.
2. An apparently flawless system. The Cuban health system may have been the talk of the week, but it was presented without fault. Even though it may be one of the best systems on the planet, it is not immune to needing improvement. Without a realistic understanding of the challenges, it was hard to understand the true effectiveness of the system. (In comparison, Minister of Health Chen Zhu was frank in talking about elements of the Chinese health system that need improvement, for example indicating in his plenary talk that many public clinics in China operate like private clinics.)
3. No U.S. government employees in attendance. There were certainly Americans at Forum 2009, but because of the restrictions associated with the U.S. embargo – it’s a bloqueo the Cubans said, since an embargo implies wrongdoing – there were almost no representatives of U.S. government institutions. I didn’t realize this myself until a colleague from the WHO pointed it out to me. He cited the example of his colleagues from the CDC who were not permitted to attend. Looking through the participant list, I only spotted one, someone from USAID. It’s unfortunate because there was a big opportunity for learning in both directions. In any case there were strong suggestions that we are months away from ending the embargo/bloqueo. Time will tell.

And here’s a post Aman wrote for Global Health Ideas about the Cuban health system two years ago: Lessons from Cuba: Healthcare Infrastructure and Information Systems.

We are really glad to have another guest blogger. Kriti from Epidemiology Tales: Stories Exploring Public Health & Life
is the author of the post below. We look forward to more posts in the future, be sure to check out her global health blog for more information.

Female Feticide: from Motherland to Diaspora

Up- country: Diya, an activist who educated women on female feticide, was recently married. She was 20 years old, and about to give birth. She was riding in a car hurtling over potholed roads toward the town hospital. Although at home, they claimed they would be happy for any child, “We like girl-children as much as boy-children,” her father-in-law would say, but she knew the reality was far different. Her mother in-law was next to her, looking tense with anticipation. She lived with her in-laws, customary in rural India, and did not have good relations with them: they were angry she had a love marriage with their son and a mind of her own.

“You had better give birth to a boy,” her mother-in-law hissed to her, as Diya’s labor pains intensified.

City: Jassi, the wife of a successful, well-known Bombay businessman, and already mother of two beautiful daughters, was pregnant with a third child. The women in her society (apartment complex) were anything but congratulatory. They admonished her, “why don’t you have a test done?” implying that she should make certain not to have yet another girl.

I was shocked to hear these stories. Both of these women, loosely based on women I’ve known, had healthy baby boys. But their problem is real, and getting worse: the number of girls for every 1,000 boys (sex ratio) went from 962 in 1981, and with the improvement of sex-testing technology, dropped to 927 in 2001. It was as low as 814 in Delhi.

At first glance, it seems like this is an economic issue, as some middle class families claimIn Spite of the Gods: The Strange Rise of Modern India, he talks about a woman from such a wealthy family, that her dowry included a Mercedes and Switzerland vacation. Even she was forced by her husband’s family to abort her baby girl, although many women themselves believe in this practice.

Shockingly, this practice continues in the US. Census data shows that for every child born subsequent born after the first in Chinese, Indian, and Korean families, the likelihood of that child being a boy increases.

Female feticide is because of many traditions and perceptions, as well as economic and social factors coming together. Girls are seen as economic liabilities destined to leave their homes, as they traditionally go live with their husband’s family after marriage. Male children, who never leave their parents (and doing so would raise eyebrows), support them in old age. Male children earn money for their parents through jobs and dowry. Female children, however, do not. Many are not allowed to work nor offered education, and dowry continues, even among educated, well-traveled, urban elites – furthering an already insidious gender bias.

There are some successful interventions, like empowering women through education, economic power, and allowing them to take greater control of their lives – and this is where I’d like my life to focus. Before translating and preparing training materials at CORD, I never realized how deeply rooted this practice is in Indian culture. To me, Indian culture is laced with quirks, visible and invisible, but I always felt some pride and loyalty in my heritage. But this level of hypocrisy and brutality is astounding. A sign in Mumbai reads, “It is better to pay 500 Rs now than 50,000 Rs (in dowry) later”.

Though the topic makes periodic appearances in international news, and many interventions are taking place, ultimately it rests on changing social norms: At weddings, including mine, there is a prayer to bless the new couple. It states tellingly, “May you have sons”. But Babaji (my grandfather-in-law), the eldest person at the event, added “or girls, because everyone is equal now.”. Andhra Pradesh, a more progressive state, offers hope with a girl-favoring sex ratio, closer to natural patterns. – but female feticide is rising fastest among wealthier couples. In Edward Luce’s

–
Thanks for checking back to this blog after a long time! I’m getting re-started, and continuing to explore issues in public health that pique my interest (or deeply sadden me, like this one). You’ll notice some changes in the look and layout, all to be easier for you. Would love your feedback, or forwards this if you know someone interested!

The Global Forum for Health Research Forum 2009: Innovating for the Health of All took place in Havana, Cuba from 16-20 November. This is the fifth in a series of posts from the conference. Only one or two more after this one.

My reason for attending Forum 2009 was to participate in a session title “Innovation for Remote Populations”. This post is a about that session. What follows is taken from my recent report to the Global Forum for Health Research – edited only slightly.

Innovation for Remote Populations

Thurs-19-Nov-2009, 14:00-15:45, Global Café, Palacio de Convenciones, La Habana, Cuba

Coordinators/Facilitators:

• Patricia Mechael, mHealth and Telemedicine Advisor, Millennium Villages Project, Earth Institute, Columbia University, USA & Egypt (organizer & facilitator)
• Tim Hurson, Facilitators Without Borders (facilitator)
• Charles Gardner, Global Forum for Health Research (focal point)

Speakers (alphabetical order):

• Simon Adebola, NEPAD Council Global Health Commission, Geneva
• Najeeb al-Shorbaji, Director, Knowledge Management and Sharing, WHO
• Caren Serra Bavaresco, Student, Epidemiology, Universidade Federal do Rio Grande do Sul, Brazil
• Karl Brown, Associate Director, Rockefeller Foundation
• Arul Chib, Assistant Professor, Wee Kim Wee School of Communication, and Assistant Director, Singapore Internet Research Center, Nanyang Technological University
• Dziedzom Komi de Souza, Ph.D. Student and Research Assistant, Parasitology, Noguchi Memorial Institute for Medical Research, Ghana
• Bastiaan Hoefman, co-Founder, Text2Change
• Bernardita Labarca, Project Coordinator, Zoltner Consulting Group, Chile
• Claire O’Neill, Chairperson, Cell-Life-South Africa
• Ravi Ram, Head, Monitoring & Evaluation, African Medical Research and Research Foundation (AMREF), Nairobi Kenya
• Marco Salmen, OHR-GMCP Initiative for HIV/AIDS, Global Micro-Clinic Project, United States
• Jaspal S. Sandhu, Design Researcher, College of Engineering, University of California, Berkeley, USA
• Joel Selanikio, co-Founder and Director, Datadyne.org, USA
• Garance Upham, General Secretary, Direction, Safe Observer International, France

Additional participants – from the audience:

• Elmer Zelaya – Fundación Chica/Nicaragua
• Timothy Dye – SUNY Upstate Medical School/USA
• Jane Kengeya – WHO
• Oyewale Tomori – Redeemer’s University/Nigeria
• Lishandu/Zambia (full name/affiliation not available)
• Vargas/USA (full name/affiliation not available)

Summary:

1. Diverse users and uses: The speakers presented a variety of mHealth/eHealth applications involving a wide variety of users, including both the health workforce and community members, e.g. educating teenagers about HIV/AIDS in South Africa (O’Neill), Internet access in western Kenya to improve uptake of HIV VCT (Salmen), mobile emergency response systems in Aceh (Chib), electronic IMCI in Tanzania (Brown), text-based health education and health service promotion in Uganda (Hoefman), training for health workers as a downloadable game package for phones in Kenya (Ram), telemedicine to improve the skills of health workers at primary levels in Brazil (Bavaresco), delivery of health information to communities in Chile (Labarca), a general set of tools for mobile data collection being used worldwide (Selanikio), and handheld computers to support rural healthcare delivery in Mongolia (Sandhu).
2. mHealth/eHealth is about enabling access: A common theme across diverse applications was that information and communication technologies are being used to enable access to health information and services in places where access is difficult because of remoteness and/or cost.
3. Coordination among the various players: Coordination among donors and projects is necessary to avoid unnecessary duplication of effort and to share what works. This is the role of the mHealth Alliance, supported by Rockefeller Foundation among others (Brown). While there were questions from the program side as to what data donors want (Chib), there was a simultaneous sentiment that donors need “stepwise” guidance (al-Shorbaji).
4. De-emphasizing technology: The mHealth Alliance has recently been discussing development of an “mHealth Toolkit”, to provide a common technical architecture and platform for those planning to implement mHealth programs (Brown). The existence of free technology platforms – in this case DataDyne’s tool – enables programs to focus on developing health content (Labarca). It is important to have a generalizable tool, as DataDyne has done, that can be used by anyone; if individual governments must approve technology “you’ve lost the battle” (Selanikio). Programs must focus on understanding people and applications more than technology; in response to a question from Dye about the use of ethnography in this field, three examples were given: ethnography of teen chat rooms in South Africa (O’Neill), multi-year ethnographic fieldwork as the basis for the program in western Kenya (Salmen), and design ethnography of the information management practices of rural health workers in Mongolia (Sandhu).
5. Defining good evaluation: There are challenges to seeing change in population health outcomes (Chib). It is difficult to measure behavior change (Hoefman) and to evaluate systems that provide health content to people (Labarca). Ethnography should be considered more seriously as a complementary evaluation strategy in mHealth (Sandhu). In evaluation, the metrics should match the intervention – mHealth is another intervention; in addition, we want to see the unintended effects of technology (Ram).
6. New modalities of engaging people: Mobile phones enable fundamentally new ways of engaging with people. As opposed to mass communication that is often used in social marketing, phones allow for interpersonal communication that can be tailored and cost-effective (O’Neill). There are two modalities, moving messages out to people and demand-driven services, where people demand the information that they need (Ram). Salmen lent his support to the importance of demand-driven services and argued that phones will bring more equity. This is all supporting the shift to citizen-centered healthcare (Mechael).
7. Cautions moving forward: In natural disasters, the cellular network is the first to go (Zelaya). An open question: Who owns the data? (al-Shorbaji). Nobody is thinking about “real sustainability” (Adebola). Reliable phone networks are a challenge (Lishandu). We should be careful that we don’t become too dependent on one tool (al-Shorbaji).
8. Need to think more creatively: We should be bolder with approaches; if we are, poor countries “could leapfrog” in health and development terms (Upham). Many of the applications discussed focused on SMS and telephony capabilities; we should think about leveraging more advanced capabilities of mobile phones (Kengeya).
9. Who should design technology? There is an assumption that Africans cannot develop software, but that is not true (Adebola). DataDyne software was already developed by Africans (Selanikio). Africans should develop software, but they shouldn’t redesign what has already been built (Brown).

Conclusions/Recommendations:

1. There is a need for increased knowledge-sharing about mHealth/eHealth within the global health community. This should definitely include policymakers. As Prof. Tomori elegantly stated, while we are thinking about how to reach remote populations, we should think about “hard-to-reach” African leaders.
2. While there was discussion of both eHealth and mHealth, the discussion focused primarily on the latter.
3. There is a need for a continuing dialogue about mHealth. It is unrealistic to expect policy recommendations to come out of this meeting given the state of the field (many open issues) and the limited engagement at the meeting.
4. Major mHealth topics to be discussed at future meetings: definitions; standards, including how to conduct evaluation; and successes and failures from the field.
5. The value of the meeting was threefold: (1) it helped extend the network of those working in mHealth; (2) it provided those outside the field with an understanding of the opportunities and challenges of using mobile phones to improve population health; and (3) it placed a much-needed emphasis on prioritizing people and applications over technology.
6. Mechael suggested reviving the Mobile Metrics and Evaluation Group as a means of maintaining an active mHealth community discussion outside of official meetings.

Other observations:

1. The fishbowl format was successful in eliciting relevant commentary from a large group of speakers as well as from the audience. Time was an issue, though, as several invited speakers only spoke once and several audience members had comments or questions that they were unable to share.
2. One key issue that was not explored – as I stated at the end of the session – was the link between social entrepreneurship and mHealth. This is especially relevant to issues of demand, incentivization, and sustainability.
3. There is a need for an ongoing discussion of these issues at Forum 2010 and beyond – while the conversation will continue in other settings, the Global Forum for Health Research should continue to be involved because of its systems focus, its emphasis on actionable research, and the unique mix of parties (policymakers, donors, implementers) it brings together.