Health Systems & mHealth

In the spring of 2020, I began my graduate school education by taking a course titled Global Health Technology & Innovation.  In this course I have had the opportunity to learn about the basics of how global health operates, the ethical, political, and financial implications in healthcare, and the life changing technologies and innovations implemented. A few of these life changing innovations are Oral Rehydration Therapy to treat dehydration, omniprocessors to improve water and sanitation conditions, or even solar technology to make cooking and lighting more affordable and accessible.  Below I will describe how health systems operate, how they can be strengthened in underdeveloped communities, and the impact that Mobile Health (mHealth) technology can make in strengthening health systems.  

Health systems are mechanisms, resources, and processes that together meet the health needs of a population.  The World Health Organization establishes six key components that make up a health system (Swanson et al, 1-4); service delivery, health workforce, information, medical products, financing, and leadership & governance.  Together, these elements create the strongest health systems in the world.  However, there are countless examples of low and middle-income countries where a missing key component leads to the failure of the entire health system. 

Effective health systems strengthening (HHS) is critical to improving these systems and the healthcare of communities.  Three approaches exist that can dramatically improve health systems; collaboration across disciplines, iterative learning, and transformational leadership. (Swanson et al, 54-60)  These three tools focus on strategies that empower the entire system to work together holistically and not as individual components, a practice frequently used in health systems today.  

Mobile Health (mHealth), a provision of health services and information via mobile technologies  (Swanson et al, 1-4), is the greatest piece of technology that we have to make a meaningful impact in strengthening health systems.  As a tool, mHealth specifically allows for immediate feedback between healthcare disciplines.  This transfer of information is critical.  From a community leader communicating with a health system about an infectious disease epidemic to an emergency department having accurate information before a patient arrives in a life threatening situation.  mHealth also allows for iterative learning, an activity focused on education and feedback.  Effective health systems have feedback systems built into their organizations that empowers them to reflect on previous experiences, evaluate opportunities and improve.  Iterative learning encompasses the sharing of healthcare education with the community, an action that is critical in preventative care.  From a mother preparing for her child’s birth to a father understanding why vaccines are valuable for his family.  Education and feedback between the community and the health system is vital for success.  

mHealth provides a medium for this dialogue to happen.  This is evident through simple historical examples such as a feedback form on a phone or a mass text message sharing an announcement with the community about a relevant healthcare item.  Strategies similar to this were effective in educating communities about HIV in South Africa, supporting HIV-positive patients in Kenya, or sending emergency dispatches to a community similar to 911 in the United States.   While there will be challenges with scaling mobile phone access across the world in rural communities, these phones don’t have to be new smart phones, and are more commonly older and more durable phones like the “indestructible Nokia”.  In 2012 it was also estimated that there were over 5 billion mobile phones across the world, a necessary component to mHealth (Swanson et al, 1-4).

mHealth deployment has the capability to alter the state of health systems across the world through the increased sharing of information and education, a component of health systems that holistically impacts the leadership & governance, financial, medical product, service, and healthcare workforce components of health systems.  

Swanson, Robert C., “Toward a Consensus on Guiding Principles for Health Systems Strengthening” PLoS Medicine, vol. 10, no. 12, December 2010, pp. 1-4

Swanson, R. Chad, “Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change” Health Policy and Planning, 2012; 27:iv54–iv61 doi:10.1093/heapol/czs090