- “WelTel is committed to providing evidence-based, patient-centered health solutions, through the use of mobile phone technologies such as low-cost SMS (text messaging) for the management of HIV/AIDS, TB, MNCH, PMTCT, immunization and other health issues”
As a mobile phone intervention, the foundation of the WelTel platform relies on the ubiquity of cell phones. Before we propose a telemedicine intervention in the developing world, it is important to ask a fundamental question: are cell phones accessible to the target population?
Intervention Focus: Sub-Saharan Africa
Sub-Saharan Africa is an area of concern for many chronic conditions, including HIV and Tuberculosis. It is also a region described as having “some of the lowest levels of infrastructure investment in the world” (Aker et al., 2010). With such low infrastructure investment, it may not seem feasible to introduce an intervention such as WelTel, which relies on the accessibility of mobile cellular infrastructure.
(Source: http://data.worldbank.org/indicator/IT.CEL.SETS.P2?locations=ZG)
In reality, mobile phones have already greatly reduced communication costs in Sub-Saharan Africa, and cellular subscriptions have increased at a rate or 49% per year from 2002 to 2007 compared to only a 17% annual increase in Europe (Aker et al., 2010). Additionally, there are ten times as many mobile phones as landlines in sub-Saharan Africa (Aker et al., 2010), and it is likely that “lacking fixed line infrastructure” has promoted the growth of mobile cell phone use in lieu of landlines (James & Versteeg, 2007). A 2010 study of cell phone dispersal in sub-Saharan Africa recorded 60% of the population as having access to mobile phone coverage (Aker et al., 2010).
Phone Sharing and Other Usage Trends
While a 60% access rate described by Aker et al. is promising, this still leaves 40% of the population without access to mobile phone coverage. Does this mean that an intervention using cell phones will only be able to reach 60% of the population? Not necessarily.
Although mobile cellular subscription rates are more abundant in middle and high income countries, other behaviours and practices exist, which narrow the digital divide between high income settings and emerging economiesThe practice of phone sharing is a common practice in many low income settings, and dramatically increases cell phone accessibility (Wasolowski et al, 2012). In addition, programs such as phone kiosks and temporary or pay-as-you go plans also have a role in advancing the spread of mobile technology worlwide (Agerwal et al., 2008).
Cell phone sharing is common in many low and middle income settings. This means that although data shows a disparity in cell phone access between the developed and developing worlds, in reality cell phone use in the developing world is significant. These trends are promising in terms of their implications for the scalability of digital health interventions such as WelTel. Mobile health interventions are a potentially good use of resources in developing regions.
References:
- Aker, J. C., & Mbiti, I. M. (2010). Mobile Phones and Economic Development in Africa. Journal of Economic Perspectives, 24(3), 207–232. https://doi.org/10.1257/jep.24.3.207
- James, J., & Versteeg, M. (2007). Mobile phones in Africa: how much do we really know? Social Indicators Research, 84(1), 117–126. https://doi.org/10.1007/s11205-006-9079-x
- Wesolowski, A., Eagle, N., Noor, A. M., Snow, R. W., & Buckee, C. O. (2012). Heterogeneous Mobile Phone Ownership and Usage Patterns in Kenya. PLoS ONE, 7(4), e35319. https://doi.org/10.1371/journal.pone.0035319
- Agarwal, S., Kumar, A., Nanavati, A. A., & Rajput, N. (2008). VoiKiosk: increasing reachability of kiosks in developing regions (p. 1123). ACM Press. https://doi.org/10.1145/1367497.1367687