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