What are the health needs and challenges?

Responsible for over 40 million deaths each year, non-communicable diseases (NCDs) are the leading cause of death worldwide and dominate health care needs and expenditure. They represent a complex global challenge impacting high, middle and low-income countries. While most high-income countries have integrated NCDs into public health policies for a number of years, significant gaps remain in low- and middle-income countries (LMICs). Certain lifestyle behaviours contribute to the prevalence and severity of NCDs, in particular tobacco use, unhealthy diet, physical inactivity and excessive alcohol consumption.

The use of mobile and wireless technologies has the potential to transform the face of health service delivery across the globe. There are reportedly more than 7 billion mobile telephone subscriptions across the world, over 70% of which are in low- or middle- income countries. In many places, people are more likely to have access to a mobile telephone than to clean water. This presents an opportunity to harness mobile technology for improving the availability of information regarding treatments and behaviour changes, enabling effective prevention and management of NCDs.

Partnership activities and how they address the needs and challenges

The Be He@lthy, Be Mobile initiative was set up to address this challenge by scaling up mHealth services for NCDs and their risk factors. This collaboration between the World Health Organization (WHO) and the International Telecommunication union (ITU) was first started in 2012, and since then mHealth programmes have been fully launched in India, Philippines, Senegal, Zambia, Tunisia, Egypt and Costa Rica, and are in preparatory phase in Sudan and Burkina Faso. Over 90 other countries have expressed interest in joining the initiative. Currently available mHealth programmes include mTobaccoCessation, mDiabetes, mCervicalCancer, mBreatheFreely (for asthma and COPD) and mAgeing, while mTB-Tobacco, mActive and mOralHealth are under development.

The initiative’s results are an impressive demonstration of the level of outreach which can be achieved with mHealth. As of December 2018, over 2.1 million people are registered in India’s mTobaccoCessation service, and over 100,000 people registered for the country’s mDiabetes programme. More than 50,000 people are enrolled in Tunisia’s mTobaccoCessation service. Senegal has had over 180,000 people sign up to receive SMS messages on managing diabetes during Ramadan, a programme which the country runs annually, while Zambia has used their mHealth system to send over 1 million messages on cervical cancer awareness. In the Philippines a new mTobaccoCessation service has recently been launched and is now available through the Facebook Messenger platform, further expanding the reach of the programme. In the meantime, preparatory work is on the way to launch the mDiabetes, mCervicalCancer and mBreastCancer programmes in Sudan.

A series of research studies recently published in the BMJ Innovations journal showed the positive impact of programmes on users’ health. The evaluation of the mTobaccoCessation service in India has shown a 19% quit rate (as compared to the estimated 5% population baseline quit rate), while a randomized control trial in Senegal has shown improved glycaemic control in patients participating in the mDiabetes service. The articles can be accessed through our website. The impact of the initiative has been recognized internationally and in 2018 Be He@lthy, Be Mobile has been awarded the GEC Catalyst Award for Catalyzing Disruptive Innovation.

The approach is deliberately designed to be scalable: instead of promoting specific products, the initiative provides cross-cutting health content and technical support which can be used and incorporated into other applications. For example, Senegal has used the same infrastructure as the mDiabetes service to run an emergency SMS-based Ebola prevention programme in September 2014. The initiative works to develop the broader ecosystem within which a national mHealth programme will sit, helping ensure that it is integrated with other health services. Each programme becomes a sustainable part of the health system, whilst also helping to promote health and wellbeing around the world.

Be He@lthy, Be Mobile is unique in that it adopts a multi-sector partnership structure at global and national levels, which engages in-country partners and governments to maximize success. The initiative is dependent on voluntary contributions from its global partners to supplement the funds that participating countries and local partners contribute domestically. These funds are used to support global technical work and country operations. Be He@lthy, Be Mobile holds a select number of partnerships with organizations who share their vision and believe that digital can help protect people from NCDs.