Page 0070

order for vaccination to be effectively managed, basic data

needs to be collected from every recipient (name, age, date

of vaccination, dose) - an area where the mobile as data

collection unit has a clear use value. Other immunization

programmes, such as those for polio, have used SMS and

Interactive Voice Response Systems (IVRS) to connect with

beneficiaries and their families, allowing vaccine uptake and

coverage to be tracked (24). There has also been

geographical tracking of vaccine supply chains using mobiles

which has increased procurement and delivery efficiency

(25).

Follow-up

When the focus is not specifically on treatment, which tends

to be heavily disease-specific, the contribution of mobile

technology to health system strengthening can be

considered using examples from other disease areas (26).

Cancer researchers and practitioners have an opportunity

to leverage the experiences of mHealth in its application to

topics such as health system management (appointment

tracking and follow-up, patient reminders), health worker

training, and health promotion campaigns. The flexibility of

mobile technology for achieving this easily is one of its main

strengths as a disease support tool in health systems, since it

allows replicability and avoids the need to reinvent the

wheel for each new disease programme addition. Relevant

examples can be seen in appointment reminders for HIV

patients and gestational diabetes in low-income settings (27,

28, 29). Reviews of clinical trials of SMS appointment

reminders carried out in 2012 and 2013 concluded that the

intervention is moderately effective in improving

attendance (30).

Replicability

The mHealth technology is a strong example of the benefits

of layering multiple programmes: integrating cervical cancer

awareness with services for maternal and child health for

instance, by adding components from each into a single

mHealth platform or by using the same platform to deliver

different disease control services to the same users. The

mHealth initiative above demonstrated the feasibility of this

approach during the recent Ebola outbreak in West Africa,

where a 1-way SMS programme providing information to

people with diabetes was scaled up to send out 4 million

SMS messages on Ebola prevention in Dakar and St Louis.

This demonstrates the opportunity mSolutions offer to

reinforce the health objectives of multiple disease strategies

within a country. For example, given that at present more

women in LMICs die from cancer than any other condition in

Africa, it would be logical to combine early cancer screening

with health check-ups for other issues prevalent amongst

women such as pregnancy or post-natal care (31). This could

be managed directly through their own phones, by

delivering information to increase awareness or registering

patients and clinical results through SMS; alternatively it

could be managed by local health workers sending data via

SMS to centralized databanks to track patient check-up

attendance and results, as is currently done in other

maternal and child health programmes such as those run by

the MAMA Alliance in South Africa and Bangladesh.

From these studies, it appears that a good area for future

mCancer programmes to consider focusing on is the

reduction of existing barriers in areas which are hindering

the provision or uptake of basic services. It is anticipated

that mHealth will have the greatest impact when

programmes are focused on areas such as raising awareness

of cancer risks and symptoms, preliminary diagnosis by

health workers, clinical appointment management and

diagnostic follow-up.

Conclusion

Policy-makers, cancer researchers and practitioners have an

opportunity to leverage the experiences of mHealth in other

disease areas, avoiding reinventing the wheel (32). The

benefits of mobile interventions remain conditional on an

understanding of the technology's use value as a support

CANCER MANAGEMENT

68 CANCER CONTROL 2015

Box 1: Case study: Be He@lthy, Be Mobile

One effort to translate trial outcomes into large-scale national

programmes can be seen in the work of a new joint UN

initiative between WHO and the International

Telecommunications Union (ITU), which works to scale up

mHealth programmes targeting a range of NCDs including

cancer. In this initiative, Be He@lthy Be Mobile, the emphasis

is to create a blueprint which allows governments to adopt and

implement mHealth technologies such as mTobaccoCessation,

mDiabetes, mCervicalCancer, and mWellness, with an

emphasis on building an institutional framework. The

programmes are led by the government and fully aligned to the

national health programme priorities. In the specific case of

cervical cancer control, the initiative identifies the options

which best address the gaps and needs of existing national

cervical cancer control programmes. This allows greater

outreach of the service, increasing its role in primary health

care without portraying it as an additional burden for health

workers or a new and unfamiliar aspect of health care which

would see minimal population demand.

Further details on the initiative and its work can be found at:

http://mhealth4ncd.itu.int

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