Google’s Mobile Health Initiative Yields Unexpected Results
When Google partnered with the Grameen Foundation in 2009 to raise awareness in rural Uganda of sexually transmitted diseases, they did not foresee the promiscuous backlash the text-based program would encourage.
More than revolutionizing communication, the mobile phone has been used as an accelerant, a growth tool for many industries, including health. With subscriptions in developing nations at about 96 per cent of the global population, more than twice the number of Internet users, health organisations (and pharma firms and mobile providers) recognise the potential to improve the health of more people in these areas using mobile phones.
In the project set up by Google, Grameen and the local mobile-phone provider in the African country, participants sent questions on sexual health topics by text to the well-intentioned service. Using its search technology, key words in the texts were recognised and this allowed the service to respond with relevant templated answers. Ironically however, according to a (yet to be published) study by Innovations for Poverty Action, infidelity of those involved in the project actually more than doubled from 12 per cent to 27 per cent.
Prepare to fail…
In the world’s poorest nations, mobile health (mHealth) it offers an inexpensive way to reach many people, even in the most remote of locations. The World Bank and African Development Bank state that there are 650 million mobile users in Africa, surpassing the number in the United States or Europe. According to these agencies, in some African countries, more people have access to a mobile phone than to clean water, a bank account or electricity. But the complexity of rolling out such a health project cannot be underestimated. Just because the technology is available, the project’s agenda, structure and final goals must tally with the target population.
With the program in Uganda, study author Dean Karlan, an economics professor at Yale University in New Haven, Connecticut believes that infidelity may have risen as a result of women becoming more aware of the risks of promiscuity. According to Karlan, if their husbands resisted their requests to be tested, it may have led to these women to refuse to bed them, and subsequently the men sought solace elsewhere. Furthermore, the study found that usage of the texting service dropped by more than half the peak level after a three-month period – one of the possible issues cited being the algorithm-based program that wasn’t always reliable in responding appropriately to the text questions.
Secrets to success
Yet, other projects in the developing region have seen success – perhaps due to different project features. Another SMS-based program in the same country involving a quiz on HIV and AIDS and reminders of free screening led to a 100% improvement in test uptake. This may be because project participants have the same health outcome and goals in mind as the innovators – unlike the men in the Google/Grameen Foundation who were not determined to practice safe sex.
One of the projects that has proven very successful on a large scale is Mwana, which now covers virtually all of Zambia and Malawi, returning test results of babies born to H.I.V.-positive women back by SMS, in half the time than before. Apart from an agreement of end goals between the babies’ caregivers and project organizers, it is the simplicity of the Mwana program that has ensured its success – it makes things easier for its users rather than adding more complexity. Mwana was also designed from the beginning to be able to work on a large scale – a concept that many mobile health pilots have failed to address.
In development
The tsunami of pilots has become so frenzied that further mHealth projects have been limited in at least two countries, Uganda (full ban on pilots) and South Africa, while governments can set appropriate technical specifications as part of each country’s health strategy and make sure that any other nascent projects fit.
As a pipeline to transport information globally, the mobile phone has been a crucial tool. And since a lot of health revolves around information, public health experts had high expectations for mHealth. Ten years on, these expectations are far from being met but it is too early to write off relatively youthful mHealth, a field that is still maturing and being perfected– albeit rather slowly. Perhaps future success in mHealth can be achieved by recognising that the technology is the easy part – the project itself needs just as much analysis and forward planning as any other health scheme, regardless of the delivery method.