8 minute read

As you might have guessed from my tongue-in-cheek #mHS10 drinking game (pilot=1 shot, 1k flowers=2, feature phone=3, “going global with sms phone support” = finish bottle), I got a bit tired of “Pilot-itis,” which was finally called out as a problem on stage by Christopher Bailey of the WHO during the Wednesday morning plenary.

This pilot-itis was my biggest overall frustration with the discussions and presentations this year - a seemingly endless march of “new” pilot programs around (1) SMS for outreach/awareness (2) SMS and mobile for low-touch scheduled reminders and interaction or (3) Apps for various forms of monitoring. Perhaps it’s my relative unfamiliarity with the health field, but do programs do controlled studies every time they plan to release a new paper, or put a PSA ad at bus stops? There is so much that can be done today, with a few hours of hacking, to advance at least #1 and #2 above, settle on a few solutions, and move on to more impactful territory. Take a page from Nike (who have one of the most successful fitness monitoring apps in the wild) and Just Do It. Too many mHealth projects are focusing on “feature” and smartphones. Feature-phones are the Ericsson and LG-y phones that can access the web and run (mostly pre-installed, or installed by a technician) apps written in Java or BREW. These are increasingly common around the world, but remain reliant on the user to be able to get the custom apps installed and pay for a GPRS internet connection (if it’s available). Admittedly, some things are simply too complex to be manually encoded and sent via voice and SMS, which is where solutions like DataDyne fit in brilliantly. Nevertheless, we must do our best to empower everyone with access to a mobile, not just those who also have expensive phones and plans which include internet access.

The flip side of that coin is that the wide net of basic mobile - voice+sms - has serious privacy concerns. While privacy gets sliced and diced in many different ways around the world, medical information about often-taboo subjects can have life-destroying effects if it is inappropriately shared. SMSes of course are completely plain text - so no unique identifier is “secure” and no data sent via SMS can realistically be protected - from others in your family, security breaches at the wireless carrier, unfriendly government prying eyes, and so on. Even on feature and smartphones, it’s not a pretty picture - go search “crypto” in the iPhone app store, you get games and some $4 apps which might work.

Those were all the annoying, grating points. The conference had some great highlights too. Open source and open standards were popular topics and mentioned multiple times on stage and off. Social entrepreneurship bubbled up over and over again throughout the conference, with many shout-outs to Ashoka, buzz around eHealthPoints, and many Ashoka and Changemakers “family” being around and visible. The people at the conference were all the right people, though many implementers seemed trapped in the exhibit hall instead of giving presentations.

Bill Gates discussed his clear vision for global health, and its direct impact on environment, education, and economic wellness worldwide. He also claims that the robots are coming.

The geek set among the conference attendees self-organized an impromptu “unconference” Tuesday night, where we talked about shared reputation systems for problems like quitting smoking, where you’d designate a friend as an accountability partner who could tattle on you. Expect hactivist Fred Trotter to hack something up on that.

Rockefeller Foundation’s Dr. Rodin put the conference back on track (momentarily at least) by focusing us on the value of innovation, open source, and shared, open standards. Beyond that, she also called for systems-level change by reminding us that Edison didn’t actually invent the light bulb, he created the system where the light bulb was a revolution, not a parlor trick by delivering electricity. Right now, there are too many mobile parlor tricks and not enough work on the core systems changes to take them to real scale. There is a ton of innovative work going on around mobile-for-development with things like Mobirtu’s virtual sim-card system (affording some level of privacy), but a big disconnect between the fast-moving innovators and the seemingly slow-moving health world. Christopher Bailey followed on with the value of learning from the mistakes of others, “so that all your mistakes will be original,” which may be the best piece of advice I’ve ever heard at a conference.

Overall, I found the mHealth summit to be a weird mix of techno-positivism and fear of failing which creates an infinite-pilot-project vortex. Here’s hoping for an implementer track next year, to hear more exciting stories of successes and failures, and some rally points to start thinking about global scale, not just pilots which one day aspire to national-level scale.