Disease Management Gets Mobile

In the country of Rwanda, 3.1 percent of the adult population is thought to be now living with HIV or ill with AIDS, and some 21,000 people die from the virus every year. Like many African countries besieged with AIDS, Rwanda has little modern medical infrastructure, few physicians, and a rudimentary system for gathering public health information.

That last factor could change soon, with the deployment of a new software application for mobile phones that will make it much easier for doctors and health officials to track the disease and monitor patients. Developed by Voxiva, a Washington-based application services provider with a focus on sustainable technology to solve public-health issues in the developing world, and distributed under a pilot program with the support of the GSM Association (GSMA) 's Development Fund, the new mobile client could help transform the way epidemics -- including AIDS, cholera, avian flu, and other diseases ravaging Third-World communities -- are tracked and managed.

As expensive drug "cocktails" for managing the disease become available to large segments of the population, the handling of information becomes critical, says Dr. Anand Narasimhan, co-founder and CTO of Voxiva.

"These people will need treatment for the rest of their lives. They're taking these expensive drug combinations, and they need to be monitored on a frequent basis to see if the regimen is working," says Narasimhan. "It's a very expensive treatment and care environment for a large population under treatment, and it's not sustainable long-term without an effective information management system."

In African and Asian countries like Rwanda and Indonesia -- where a parallel program using the new software is underway to track avian influenza, or "bird flu" -- access to the Internet from remote villages is often nonexistent. Cellphone coverage, however, is nearly ubiquitous. Voxiva's suite of software solutions, which go under the collective name of Health Management Information Systems (HMIS), can now be accessed using the new mobile-phone client, which works on GSM/GPRS devices. In places where even GPRS is unavailable, the Java-based client uses an SMS data channel to transmit the information.

Health workers can use the software to quickly relay critical disease information including disease-outbreak alerts, patient information, disease tracking data, orders for new medicines and supplies, and so on. In cases like bird flu outbreaks, getting timely information from remote locations is often critical to limiting the disease's spread and saving lives.

Voxiva was founded in early 2001 by Narasimhan and a pair of former Clinton administration officials: Paul Meyer, who led the effort to set up the post-war telecommunications system in Kosovo; and Pamela Johnson, the deputy director of the White House Task Force on Reinventing Government. Combining their years of experience working on Third-World public-health and telecommunications systems, the trio focused on keeping their health-management systems low-tech and cost-effective.

"The premise of the company is that we need to leverage whatever infrastructure is already in place," observes Narasimhan. "A lot of organizations have put in expensive, sophisticated computer systems in low-resource environments where they can't be sustained. But at the same time the mobile-phone markets in these countries are exploding."

According to some estimates, mobile-phone subscriber growth in sub-Saharan Africa has reached 150 percent annually, and there are now almost 10 mobile phones for every 100 people in Africa -- up from three in 2001.

"This technology is revolutionizing how medical data is captured in the field," said Dr. Louis Munyakazi, director general of Rwanda's National Institute of Statistics, in a statement.

Following the success of the pilot program, the GSMA and Voxiva plan to roll out the mobile software client across Rwanda and other African countries, including Nigeria, Tanzania, and South Africa.

— Richard Martin, Senior Editor, Unstrung

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