mHealth: New Horizons for Health Through Mobile Technologies

Based on the findings of the
second global survey on eHealth
Global Observatory for
eHealth series - Volume 3
mHealthNew horizons for
health through mobile
technologies

WHO Library Cataloguing-in-Publication Data
mHealth: New horizons for health through mobile technologies: second global survey on eHealth.
1.Cellular phone - utilization. 2.Computers, Handheld - utilization. 3.Telemedicine. 4.Medical informatics.
5.Technology transfer. 6.Data collection. I.WHO Global Observatory for eHealth.
ISBN 978 92 4 156425 0 (NLM classification: W 26.5)
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Printed in Switzerland.

Based on the findings of the
second global survey on eHealth
Global Observatory for
eHealth series - Volume 3
mHealthNew horizons for
health through mobile
technologies
2 0 1 1

Acknowledgments
This report would not have been possible without the input of the Observatory’s extensive network of
eHealth experts and the support of numerous colleagues at the World Health Organization headquarters,
regional, and country offices. Sincere thanks are due to over 800 eHealth experts in 114 countries
worldwide who assisted with the design, implementation, and completion of the second global survey.
Special thanks to the many authors and reviewers who contributed their expertise to this publication
including: Patricia Mechael, Nadi Kaonga, and Hima Batavia from the Center for Global Health and
Economic Development at the Earth Institute, Columbia University for their significant contributions
to this report; Hani Eskandar of the International Telecommunication Union for his detailed advice on
security issues in mHealth Deployment; Joan Dzenowagis for serving as a primary reviewer; and Lilia
Perez-Chavolla for writing the case studies.
We would like to thank the following professionals who contributed to the case studies. In Bangladesh
– Abul Kalam Azad, Ministry of Health & Family Welfare of Bangladesh; Cambodia – Ly Sovann, Ministry
of Health of Cambodia; Canada – Kim Fraser, First Nations Inuit Health, Saskatchewan; Deborah
Kupchanko, First Nations Inuit Health, Saskatchewan; Christine Labaty, Health Canada; Shirley Woods,
Northern Inter-Tribal Health Authority; Ghana – Samuel Quarshie, Ghana Health Service; Eric Woods,
Switchboard; Sodzi Sodzi-Tettey, Ghana Medical Association; and Senegal – Adele Waugaman, United
Nations Foundation.
Guidance for this report was provided by Najeeb Al-Shorbaji, Director of Knowledge Management and
Sharing at WHO. The report was reviewed by David Aylward, Chris Bailey, Peter Benjamin, Alison Bloch,
Garrett Mehl, Robin Miller, Neil Pakenham-Walsh, Getachew Sahlu, Chaitali Sinha, and Diana Zandi.
We are grateful for the financial support and collaboration of our partners: the Rockefeller Foundation,
United Nations Foundation, and mHealth Alliance.
We acknowledge the important role of our partner organization, the International Telecommunication
Union, in the global deployment of mHealth.
Special thanks to Jillian Reichenbach Ott for the design and layout, and Kai Lashley for editing.
The global survey and this report were prepared and managed by the WHO Global Observatory for
eHealth: Misha Kay, Jonathan Santos, and Marina Takane.iv

Photo credits: Front cover - Top, Centre, Bottom: ©Dreamstime , PAGE vii - Top, Bottom: ©Dreamstime ,
PAGE 1 - Left, Centre, Right: ©Dreamstime , PAGE 4 - ©Dreamstime , PAGE 5 - Left: WHO/Nadia Bettega
- Centre, Right: ©Dreamstime , PAGE 8 - WHO/Girish Babu Bommankanti, PAGE 9 - Left, Centre, Right:
©Dreamstime , PAGE 18 - WHO/Nadia Bettega, PAGE 19 - Left: WHO/Jessica Otieno - Centre, Right:
©Dreamstime , PAGE 29 - WHO/Nadia Bettega, PAGE 30 - ©Dreamstime , PAGE 32 - Ministry of Health
and Family Welfare, Bangladesh, PAGE 36 - ©Dreamstime , PAGE 37 - Brian Levine, 2009 (Courtesy of
Switchboard), PAGE 41 - WHO/Damien Walmsley, PAGE 44 - ©Dreamstime , PAGE 45 - UN Foundation/
Dalberg, PAGE 47 - WHO/Nadia Bettega, PAGE 48 - ©Dreamstime , PAGE 49 - Jim Holmes, WHO/WPRO
Image Bank, PAGE 50 - Ministry of Health, Cambodia, PAGE 51 - ©Dreamstime , PAGE 55 - WHO/Girish
Babu Bommankanti, PAGE 56 - ©Dreamstime , PAGE 56 - File Hills Qu’Appelle Tribal Council, First Nations,
Saskatchewan, Canada, PAGE 58 - Touchwood Agency Tribal Council, First Nations, Saskatchewan,
Canada, PAGE 63 - Left, Centre, Right: ©Dreamstime , PAGE 70 WHO/ Alberto Aguayo, PAGE 71 - Left,
Centre, Right: ©Dreamstime , PAGE 74 - ©Dreamstime , PAGE 75 - Left, Centre, Right: ©Dreamstime ,
PAGE 78 - ©Dreamstime , PAGE 98 - ©Dreamstime , Back cover - Top, Centre, Bottom: ©Dreamstime.v

Table of contents
Acknowledgments iv
Acronyms and abbreviations viii
Executive summary 1
1 Overview 5
1 1 Defining mHealth 6
1 2 Second global survey on eHealth 6
1 3 Overview of findings 7
2 Global results 9
2 1 mHealth initiatives globally 9
2 2 Categories of mHealth initiatives, globally 12
2 3 Adoption of mHealth initiatives by WHO region 14
2 4 Adoption of mHealth initiatives by World Bank
income group 16
3 Results and analysis by mHealth category 19
3 1 Health call centres/Health care telephone help line 19
3 2 Emergency toll-free telephone services 22
3 3 Treatment compliance 23
3 4 Appointment reminders 25
3 5 Community mobilization & health promotion 26
3 6 Raising awareness 27
3 7 Mobile telemedicine 34
3 8 Public health emergencies 40
3 9 Health surveys and surveillance 42
3 10 Patient monitoring 52
3 11 Information initiatives 54
3 12 Decision support systems 60
3 13 Patient records 61vi

4 Barriers to mHealth Implementation 63
4 1 Barriers by WHO region 66
4 2 Barriers by World Bank income group 68
5 Evaluation of mHealth initiatives 71
5 1 Survey results 71
5 2 Relevant literature 73
6 Conclusion 75
7 References 79
Appendix 1 Methodology of the second global
survey on eHealth 83
Purpose . . . . . . . . . . . . . . . . . . . . . . 83
Survey implementation . . . . . . . . . . . . . . . . . 84
Literature review . . . . . . . . . . . . . . . . . . . 92
References . . . . . . . . . . . . . . . . . . . . . 92
Appendix 2 Member States by WHO region and
World Bank income group 93
Appendix 3 Global mobile phone subscriptions of
responding Member States a 99vii

Acronyms and
abbreviations
3G Third generation mobile telecommunications
AIDS Acquired immunodeficiency syndrome
DataCol Data Collector
eHealth Electronic health
EHR Electronic health record
EMR Electronic medical record
EMRS Emergency medical response systems
H1N1 Influenza A (H1N1)
HIV Human immunodeficiency virus
ICT Information and communication technologies
IMCI Integrated Management of Childhood Illness
ITU International Telecommunications Union
mHealth Mobile health
MDGs Millennium Development Goals
MMS Multimedia messaging service
GMA Ghana Medical Association
GDP Gross domestic product
GNI Gross national income
GOe Global Observatory for eHealth
GPRS General packet radio service
GPS Global positioning system
OECD Organisation for Economic Co-Operation and Development
PDA Personal digital assistant
RFID Radio frequency identification
SIM Subscriber identity module
SMS Short message service
SQL Structured Query Language
TB Tuberculosis
UN United Nations
WAP Wireless application protocol
WHO World Health Organizationviii