I attended a session this morning called “Transformations: Discovering New Strategies Using Proven [mHealth] Technologies” but the truth of the matter is my attendance was clearly based on my constant desire to be enveloped in mHealth concepts, which the line-up of Paul Meyer (Voxiva), Ashifi Gogo (mPedigree), and Andrew Zolli (Pop!Tech) clearly satisfied.

Paul Meyer was a great speaker to have at the top of the lineup.  It was great to be reminded that mHealth strategies have been around since 2001.  And sustainability?  They’re already sustainable because the subscriptions are already paid for, but now that people are beginning to recognize how over 4 billion mobile phone subscriptions exist worldwide (to complement the world’s population of ~6.7 billion), we should all think a little bit harder about our models of improving health outcomes and design them so they can be scalable.

To complement this blog post regarding the same session (http://www.capacityproject.org/hris/blog/index.php/2009/05/ghc-conference-talking-about-mobile-health/), I want to draw some attention to some critical concepts presented by each of the individuals above.  The first remark is to develop some thoughts on counterfeit drugs after this morning’s session, as well as to express the importance of strong collaboration as exhibited by Project Masiluleke.

Back in February, I had the privilege of meeting Bright Simons and Kathryn Boateng, who are both on the mPedigree team with Ashifi Gogo.  What they are doing is a huge undertaking with complex dynamics.  The market system of drugs and medications are only becoming increasingly complex with further globalization, and current information and supply management systems are not in place to withstand this expansion.  Not only is the infrastructure weak to withstand worldwide drug pressures, but counterfeit drugs have important public health implications.

Malaria control, for example, consists of drug treatment – once chloroquine, now artemisinin and sulfadoxine-pyrimethamine.  Gogo made the statement that 20% of deaths associated with malaria could be prevented with mHealth strategies.  As more counterfeit drugs infiltrate the market, clinically effective drugs will be crowded out on the individual level, the community level, and the population level – perpetuating the difficulty for disease control.  On the individual level, drug resistance aggravated by cross resistance among different drugs which then requires chemically different drugs to be in the R&D pipelines at pharmaceutical companies – that is, if pharmaceutical companies have an incentive to divert funds to malaria control.  On the community level, some regions are more at risk than others.  In rural Ghana, when individuals are sick, the first point-of-contact for health care and/or treatment are often chemical sellers, which can be fake or licensed.  Only recently has the government and other agencies made an active effort in pushing licenses on chemical sellers with proper training in symptom-based treatment and drug selling.  In Nigeria, a similar drug market exists with what are called patent medical vendors, and as Gogo mentioned, a study in Lagos, Nigeria found 4 out of 5 drugs to be counterfeit.  Lastly, on the population level, a flood of counterfeit drugs inhibits the ability for herd immunity to occur, further complicating malaria control.  mPedigree is working on the issue of counterfeit drugs by collaborating with drug makers who are producing real drugs, and offering individuals the opportunity to send a text message to verify whether or not a drug they purchased is legitimate (“Yes”) or fake (“No”).

A good question was asked during Q&A (side note: the session moderator prioritized questions through twitter over questions directly from the audience) about how mPedigree was assuring that the sellers couldn’t trick or take advantage of the system.  Gogo remarked that the goal of mPedigree is to make it economically difficult to counterfeit, and that if a counterfeit drug was masked to be legitimate, the system could quickly deactivate its authenticity.  I believe this is definitely a step in the right direction.

Andrew Zolli from Pop!Tech described another mHealth strategy in South Africa called Project Masiluleke (mah-sah-loo-lick-ay) which has a wise approach towards reinvigorating HIV/AIDS messages by sending 1 to 1.5 million “Please Call Me”s a day through SMS.  Zolli mentioned how misinformation, disinformation, and competing theories and narratives of HIV/AIDS have all played a role in fueling the stigma that has made HIV and AIDS so difficult to prevent, treat, care, and mitigate.   Through the power of “Please Call Me” tactics, Project M has increased the average call volume to the National AIDS hotline by threefold with the help of MTN mobile network service provider, and has done a remarkable job at enhancing the meaning of collaboration to have a global and local impact.  Project M should be applauded because of its large-scale effectiveness, tailored approach to the population it targets, and active exploration of user friendly, at-home HIV testing kits.  This last element, working with frogdesign, is an exhibition of the movement towards ultra low-cost, distributive diagnostics.  The collective interest of all those involved in Project M is impressive (http://www.poptech.org/project_m_partners/), and the global collaboration has made a service – the largest of its kind – that has broken through the difficult barrier of stigma.

(If you are still curious, check this – http://www.frogdesign.com/services/project-masiluleke.html – out for a closer peek at how collaborations and collective interest can target effective behavior change.  At the bottom is an imbedded presentation designed by frogdesign that is great to flip through.)

So, in summary, what is important for new strategies and proven technologies?  Context.  Collective Interest.  Strong Collaboration. [Measured Impact.]