SMART HEALTH I 40

An interview by Beatriz Cortiles

Technology is certainly a possibility of great significance in the health world and you have been pioneer in this area. From your experience, where was eHealth then and where is it today?!e eHealth ecosystem is immense. In terms of my experience in the area, I must begin by saying that I was incredibly fortunate to be selected to join the newly created eHealth Unit of the World Health Organization (WHO) following the passage of the eHealth Resolution in 2005. So, I guess this makes me pioneer within that context. Prior to the eHealth Resolution I was involved in a project in WHO that was in essence an eHealth Project.

!e eHealth Revolution, as it has been coined, has evolved rapidly gaining hard ground. In those early days, everyone wanted to do eHealth. !en came mHealth. !is is, in my opinion, a natural evolution as mobile is the most ubiquitous technology even in the development world and the potential there is huge. Mobile Health was recognized within the United Nations as a “game changer”. So we had an mHealth Revolution. !is translated into a crowded landscape of mHealth pilots in developing countries – also known as “mhealth Pilotitis“. In fact, the government of Uganda called a Moratorium on mHealth Projects a few years ago. I think

that this is very significant and it signals a determination of governments in developing countries for taking control and leading the expansion of eHealth in ways that are strategic and integrated onto the overall health and technological goals of the countries.

Today, thanks to a stronger body of

evidence about “what works” in terms of using technology to improve health outcomes, leadership and governance through policy and robust sustainable business models, eHealth / mHealth is on track and well positioned to move towards becoming an essential ingredient for health systems strengthening.

INDEPENDENT ADVISER AND RESEARCHER IN mHEALTH AND eHEALTH

FÁTIMA SANZ DE LEÓN

After ten years working for the World Health Organization coordinating di!erent programmes to bring technology to healthcare, Sanz de León is now reasearching for international private companies a manner to introduce mobile applications in di!erent areas, such as maternal and child health, VIH and Ebola

!ere was great need to develop e"ective risk communication at the population level to control the spread of Ebola

“WE HAD AN mHEALTH REVOLUTION”

SMART HEALTH I 41

INTERVIEWINTERVIEW

“

FÁTIMA SANZ DE LEÓN

“El uso de plataformas

como Emminens eConecta hace

posible un seguimiento

personalizado y mucho más continuado”

“Let’s give some specific examples in developing country contexts, far away from communication hubs. For them, is this a science fiction movie?I don’t think so but I agree that some of the things that technology has achieved for health can be science fiction in any corner of the world. Many eHealth applications

now used in developing countries have emerged from developing countries, mainly out of needs and availing of the technological infrastructure in place. mPedigree is a good example, it originated in Ghana and it’s an anti-counterfeiting solution. Counterfeit drugs are a huge problem in Africa. Another example is

mobile money which is now being used as a health financing mechanism. Branded as mPesa, it emerged in Kenya and it’s widely used.

In crisis situations like Ebola, there have been numerous initiatives undertaken to develop effective communication strategies that support a rapid response. You have been involved in this work. Can you explain?In view of the magnitude and the contagious characteristics of the Ebola epidemic, there was great need to develop e"ective risk communication at the population level to control the spread of Ebola. I had the opportunity to undertake research and interview key stakeholders to support the mapping of the key components for population-centered communication for behavior change via mobile phones. For example, much of the transmissions happened during traditional

The eHealth Revolution has evolved rapidly gaining hard ground

mHealth was recognized within the United Nations as a ‘game changer’

“

burial ceremonies. An important challenge for the international community, in terms of prevention, was how to change risky behavior and stop the chain of transmission. Messages went out to the population via radio, TV, and also mobile phones. But there were many challenges.

I put together a framework that maps the key components for such strategy to overcome some of these challenges. For example, in terms of sending the message via mobile phones to the population, a major challenge that I identified in my research was the lack of experience in collaborative programs between public – Ministry of Health and

Fátima Sanz de León, independent researcher in mHealth and eHealth

SMART HEALTH I 42

FÁTIMA SANZ DE LEÓN

Telecommunications – and the private sector -mobile phone operators and service providers. !e rigidity in terms of regulation and protocols can be a key barrier in face of providing a rapid response to an emergency.

Recently, the GSMA has launched a Humanitarian Connectivity Charter, to improve cooperation between these sectors. !is initiative underscores the recognition of mobile phones in supporting responses to emergencies. In my opinion, this is a breakthrough for enabling the use of mobile phone communication in emergencies.

But, regardless of the medium used, sending a message to a population, particularly if it is about changing specific behaviors that are deeply rooted in traditions, one must have a solid anthropological knowledge and understanding of the target audience. For example, in the context of Ebola in West Africa, a major barrier was the mistrust of governments and international organizations. In these contexts, rumors, myths and disbelief spread like wild fire. A key to success was engaging community leaders and key influencers. !e initial communication had limited impact, some door-to-door messengers were murdered. In fact, in a second phase, a new communication campaign was launched under the motto “Ebola is Real”.

You have also worked in the area of mobile phones to improve Women’s and Children’s Health. Can you provide some examples?Mobile technology has been identified by the UN Secretary General as providing great potential in accelerating progress towards attaining the Millennium Development Goals 4 and 5, which are reducing child mortality and improving maternal health. In this context, I undertook some research work for various organizations. Today, there are numerous projects that - thanks to mobile technology- are empowering women by providing vital targeted information about reproductive health, pregnancy, and newborn health. For example, MAMA, the Mobile Alliance for Maternal Action, with an e"ective social marketing approach has informed over a half a million women in developing countries very successfully.

Is mobile the cornerstone of our operability in our future health system? Are there other alternatives?In developing country contexts, particularly in what we call the “last mile”, there are no other alternatives. In those contexts, mobile technologies have leapfrogged other technologies like fixed lines. It will take time to establish the infrastructure to accommodate other solutions.

What is HINARI?HINARI or Access to Research is very special to me and the reason I joined the WHO. It’s a groundbreaking initiate launched in 2001 by WHO and major publishers to bring access to biomedical and health literature to low- and middle-income countries. Talk about a solid business model

that responds to real needs in development contexts and you get HINARI. It provides free or very low cost online access to the major journals. My role was to develop the administrative strategy to manage the memberships and communication with the institutions.

Your engagement with these ethical and social problems is a leitmotiv in your life. Where is the origin of this vocation?50% of the vocation is probably inherited and the result of my Spanish education and the values transmitted by my parents. !e rest of my vocation in development work was first evident when I worked for the United Nations Volunteers, my first experience in the United Nations System. UNV is the Volunteer arm of the UNDP, the United Nations Development Program. !e Volunteer spirit is very contagious. !ese are people who are devoted to helping others through development work and whose gratification for their work is just inspirational. At the time, I also supported the establishment of a databank of ICT Volunteers covering all areas of development not just health, ICT for development.

You are already a relevant figure in the sector. What are your expectations for the future?I would like to continue doing what I do aiming at doing it better each time. One of the mechanisms is through my collaboration with other experts in this space, the Global eHealth Consultants which is a Swiss consulting firm. At the same time, I am currently finalizing a degree in International Health at the Swiss Tropical and Public Health Institute. For me, to do eHealth begins at understanding what the health challenges are. It’s about bringing technology to the service of health and not the other way around.

My short-term goal to make a contribution to the field of eHealth for development is in the context of my thesis planned at the end of this year. I would like to engage the right partners to work together on the right topic to bring about meaningful research to support health systems strengthening through technology particularly mobile technology potentially in the areas of maternal and child health or emergencies such as Ebola.

eHealth and mHealth are on track and well positioned to move towards becoming an essential ingredient for health systems strengthening

“MAMA project, the Mobile Alliance for Maternal Action