There are many documented benefits for implementing Mobile Health in developing countries.  In developing countries, mobile technologies may have leapfrogged traditional fixed line infrastructures in their ability to reach and connect remote areas, and therefore provide an information channel to areas under-served by the traditional health.  Protocols for data security, encryption and reliability have also been built into the existing mobile standards, limiting the amount of net new work that needs to be done.  Also, as opposed to in developed markets, there is often less regulation around the provision of health or management of health data through innovative new channels due to the appetite of local health authorities for immediate and creative solutions.

That said, there are still a number of unique technical challenges facing implementors in developing markets which have to be considered:

Unique Identification 
In developing countries, many mobile phones are shared between the family, and the level of literacy may not be enough for users to uniquely identify themselves to the extent to which a Mobile Health solution requires.  Innovative and creative solutions, including voice biometrics, may have to be put in place in order to resolve these issues, but it is yet to be proven to have the necessary reliability.

Confidentiality and data quality
The presence of a local data manager is fundamental in maintaining data quality. Like developed countries, issues of security of the information and confidentiality are significant but for many developing countries support for these concepts varies. Since most of the present EMR implementations in developing countries are centered on HIV/AIDS treatments, the issue of social stigma is something that needs to be considered.    

Due to the nature of the donor community and structure of government programmes addressing specific health concerns, there are usually multiple fragmented and isolated systems forming islands of users disconnected from each other. Furthermore, most of these use proprietary standards which make them highly specific; hence interoperability is minimal. One initiative in place to overcome this issue is Open MRS (OpenMRS) – however, as an open source solution one requires suitable vendors to take up corporate liability or there would be difficulties in guaranteeing service levels and technology refresh. 

The available technological infrastructure is another limiting factor. These systems need computers and servers with 24×7 power supply, high physical security and clean dust-free, temperature regulated area. Off-site data back-up in a different location is an important feature of EMR implementations but a luxury from many developing countries’ perspectives. Internet access is the only modality that can promise uninterrupted access. So the accessibility of EMR systems in developing countries is higher if they are based on pure web-based systems (although in many developing / emerging markets, 24×7 connectivity is still a luxury resource). Furthermore if an internet-based system is deployed then to some extent the issue of asynchronous access could be addressed by maintaining a back of data locally.

Language and culture
Language is another notable factor that influences the adoption of EMR systems in developing countries primarily because of the language diversity that may exists in many developing countries. There has been notable research examining the cultural dimensions of technology and their impact on adoption of information technology in general. The beliefs and values ingrained in people by their cultural context significantly affect their ways of thinking and their perspective and therefore, their approach to technology.  Ethnographic studies of how Base-of-Pyramid consumers interact with and derive value from technology need to be considered before porting over products which are designed with the developed market consumer in mind.

The GSMA is involved in a body of research with its partners and operators involved in the implementation of Mobile Health in developing markets in order to identify solutions and success stories to overcome some of these challenges so that Mobile Health can achieve its true potential in emerging markets.

Kai-Lik Foh, Manager, Private Health & Wellness, GSMA