The Journal of mHealth Vol 2 Issue 4 (August) | Page 42

mHealth in Developing Countries

Exhibit 4: EHRI HarmoniMobile (EHR)

(image sources: http://ehrinternational.com/harmonimobile/)
Continued from page 39

patients, prescribe medicine, take photos of injuries, and scan
QR codes that identify a patient via a code on a wristband or
card. It also follows the international standards for data capture,
enables remote access, structures treatment plans, includes surgical checklists, has communication abilities, and more (Exhibit
4). The data is encrypted and protected by a strong firewall.24
It costs an astonishing $3,000-$5,000 to set a hospital up with
this system.
Reverse Innovation
McKinsey identified two factors that explain why some of the
most compelling innovations in healthcare come from developing nations rather than developed ones. First, the sheer necessity of improved healthcare makes it absolutely imperative that
local entrepreneurs innovate.25 Second, a weakness in infrastructure means that there are fewer constraints from e ntrepreneurs. Included in this is the lack of institutions, regulations,
and resources.25 Also, because developing nations are battling
the high-cost of healthcare, these healthcare innovations must
be low-cost to adhere to a low-income, rural population. This is
also referred to as “frugal innovation,” which involves simplifying ideas and focusing on just necessities.26 Finally, these innovations must be stable and reliable because they are being used in
rugged, remote environments. In this context, developing countries serve as a laboratory for global health care innovation.27
One successful example of reverse innovation in mHealth is
the mini pacemaker developed by Medtronic in India to tackle
the issue of the high cost of pacemakers, as well as the shortage in healthcare professionals. India only has 100 electrophysiologists for a population of over one billion people.28
Cardiologists traditionally have to create a pocket in the chest
to insert the pacemaker while threading leads through blood
vessels and into the heart. Not only is this procedure complex,
but it also requires highly trained and skilled healthcare professionals, which there is a shortage of globally. Medtronic’s
mini pacemaker is the size of a vitamin pill, and is inserted
via catheter through the femoral artery and up into the heart
(Exhibit 5). This process does not require the use of a highly
skilled specialist, it costs significantly less than a traditional
pacemaker, the surgery is less complex and therefore less

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August 2015

risky, and remote sensors in the pacemaker send out signals via
smartphone to a cloud network.29 This innovation will make
its way to Europe and the U.S.
Challenges
While all these projects and pilots show promise for the use of
mHealth in developing nations, there are some challenges to
globally implementing these technologies and processes. These
challenges are also areas of opportunity for global healthcare
innovators and entrepreneurs. One of the main challenges
involves a lack of theory. In The Promise and Peril of mHealth
in Developing Countries, Arul Chib argues that there is a failure
of pilot projects in mHealth to replicate and scale to become
sustainable ventures. He attributes this to a lack of theory. While
mHealth studies do a good job of focusing on the technology
and the methodology, they lack the theory, or the theoretical
support. We do not fully understand mobile technology; particularly its usage, penetration, and adoption in healthcare and in the
nations where studies take place. Therefore, we have no knowledgebase for the implementation of mobile health technology.30
Patricia N. Mechael, in her study titled The Case for mHealth
in Developing Countries, argues that before we consider where
mHealth can be applied, we must first look at organic examples of mHealth use in developing nations. Her first organic
example of the use of mobile technology to exchange health
related information comes from Egypt, where a new mother,
now living with her husband’s family in a rural area away from
access to educated individuals who could consult her on healthrelated issues, uses a mobile phone to contact her mother.10 This
exchange of health-related information between mother and
daughter is common in Egypt. From studying this behavior, we
can further identify opportunities in mHealth.
Additionally, mHealth studies focus heavily on technology
usage and job-related data as performance indicators rather
than impact factors such as how the mHealth technology has
improved the individual using it, the health worker using it, or
the whole community. Therefore, while the technology and
the usage of the technology in a given developing nation for
a given disease and/or set of patients and a local clinic may
prove successful, we lack clear evidence of overall improvement