Smart Phones Improve Access to Health Information in Uganda

The widespread affordability of cell phones in developing countries, like Uganda, has led to experiments with voice and text message-driven health campaigns. Now mobile phone technology has become an important tool for groups looking to reach even the most rural communities.

The first campaign that Text to Change -- or TTC -- conducted in 2007 was a quiz about HIV, the virus that causes AIDS. 15,000 Ugandans received text messages with questions about the virus and were encouraged to respond. They also received texts telling them about nearby HIV counseling and testing services.

The result was a 40-percent increase in the number of people who showed up for testing at the highlighted centers. Bas Hoefman, one of the founders of TTC, says the campaign demonstrated the possibilities for using mobile technology to improve health care in the region -- a concept commonly called "mHealth".

"The importance of mHealth in Uganda, and in Africa in general, is that people leapfrogged from nothing to mobile phones. So all of a sudden, you have the huge potential to reach out to people with mobile phones with health information," explained Hoefman.

Since its initial campaign, TTC has worked with partner organizations to run increasingly refined projects about a range of health issues. The group collects cell phone numbers through radio advertisements or on-the-ground canvassing and then sends out texts or voice messages through a platform it built.

Some campaigns encourage people to share their knowledge about specific issues so organizations can better tailor their messages. Other efforts use texts to remind people to take their medicines.

Eunice Namirembe is a program manager at TTC. She says an important part of crafting the campaigns is going out to targeted communities to get a sense of what kinds of content will work best.

"When you go down to the community, you find that the challenges are different. The mobile coverage is different. The language they understand is different. Then you start interviewing them about what type of content they need. In what language do they need it? When do they want to receive these messages," Namirembe explained. "Because the timing is very important."

Kawempe Home Care, based in one of Kampala's poorer neighborhoods, provides health services to people living with HIV, cancer and tuberculosis.

Dr. Samuel Guma, the executive director of the organization, says it is critical for all of his patients to adhere to a regular treatment schedule. In 2010, a trial campaign with TTC targeting HIV patients was introduced. "We sent our patients text messages everyday. Actually, twice a day, in the morning and in the evening, basically to remind them that's when they're supposed to take their medicine," he said. "The outcomes were really fantastic. Actually, we saw a drastic increase in average adherence of our patients."

Five years after he started the organization, Hoefman says groups like Kawempe Home Care have demonstrated that technology is a viable tool for improving health care.

This week, a summit in Cape Town has brought many of those groups together to discuss the future of health and technology.

Hoefman says TTC is keeping an eye on evolving technology, but for the immediate future plans to stick with voice and text messages, because they have been proven to work. Even those modes still contain some hurdles that have to be overcome.

Despite the widespread use of cell phones in many developing countries, hundreds of thousands of people do not have access to them. Or, in Uganda, husbands sometimes retain control of the phone, making it difficult for targeted messages to reach women. Paul Hamilton, the chief of party for Management Sciences for Health in Uganda, worked with TTC on a handwashing campaign in two districts.

He says many people did not have access to phones, so they chose to provide information through handwritten forms. "So that's something we need to look at further before we really scale this up and see SMS technology as a way where we can spread as widely," Hoefman said. "Now, having said that, I think the potential is there."

As cell phone coverage continue to grow, Hoefman says so will the possibilities for health.

By Andrew Green
Voice of America
31 May 2012