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The Mission of the mHealth Alliance The mHealth Alliance champions the use of mobile technologies to advance health and well-being throughout the world, with a focus on low-income countries. The Alliance works with diverse partners to mobilize the effective integration of mHealth into global health practices, programs, and policies, and serves as a convener for the mHealth community by sharing tools, knowledge, experience, and lessons learned that support efforts to overcome common challenges.

Founding Partners

annual report 2012


Greetings,

December 2012

As this year comes to a close, I am thrilled by the significant progress the mHealth Alliance has made toward the mainstreaming of mobile technology to address global health challenges in collaboration with the mHealth community. Strategic investments are being made in mHealth by both the public and the private sectors. Increasingly, through the work of the mHealth Alliance and many of our partners, Ministries of Health, donors, bilateral and multilateral organizations, academic institutions, corporations, and NGOs are working together to systematically address the barriers of scalability and sustainability of mHealth.

Partnership Board

2012 by Numbers Here’s a look, by the numbers, at how the mHealth Alliance grew its work in 2012 in several critical areas:

2 7 54 66 130 6,700 3.4 million

Number of initiatives that the Alliance is serving as partnership secretariat to improve health outcomes of pregnant women, newborns, and children and support frontline health workers through countryspecific engagement and global learning

The mHealth Alliance is governed by a partnership board comprised of industry leaders from the health, technology, and business sectors, as well as representatives from government bodies, foundations, and NGOs. The Partnership Board’s purpose is to guide the Alliance in all matters, including decisions related to its mission, programmatic focus, growth, and ongoing development of the Alliance.

Tom Wheeler, Chairman

Managing Partner, Core Capital

Through larger implementations and more rigorous research, we are starting to see more robust evidence that mHealth is having an impact on health outcomes. We are also witnessing a shift from mobile technologies in search of problems to a better informed health sector exploring how to more effectively leverage the ubiquitous nature of mobile telephones to accelerate progress against global health challenges, including maternal, newborn, and child health (MNCH); non-communicable diseases; HIV and AIDS; tuberculosis; malaria; and weak and broken health systems. I am profoundly grateful for the continued support and commitment of our donors, partners, and members, whose work is advancing the use of mobile technologies to strengthen global health systems and improve health outcomes. This report provides an overview of the Alliance’s efforts and showcases a number of our successes working in partnership with the mHealth community over the course of the year. I hope you will appreciate as much as I do the collective action and effort represented throughout this report, without which none of the achievements would have been possible. We kicked off 2012 with the implementation of a revised strategy and business plan that helped define the mHealth Alliance’s mandate and core priorities. The strategy outlines five strategic focus areas for our work aimed at mobilizing the community to address the following critical barriers and gaps to unlock the full potential of mHealth:

Number of countries where law firms have partnered with the Alliance to engage in a comprehensive review of mHealth privacy and security regulation

Karl Brown

Number of individuals engaged through the mHealth Alliance’s active groups to help shape and advance collective action in the areas of Evidence and Technology Standards and Interoperability

Kathy Calvin

Number of organizations that have partnered with the Alliance to provide in-kind support to advocacy, capacity building, and thought leadership activities

Director, The Vodafone Foundation

4. Researching and sharing effective policies that support mHealth

Paul Ellingstad

5. Building community capacity to design and deploy mHealth programs

Number of organizations that have joined the mHealth Alliance as members

Haitham El-Noush

Number of individual users of the Alliance’s Health­ Unbound (HUB) online knowledge-sharing platform Amount of money in USD granted to 16 organizations working in 11 countries in Africa and Asia through the Every Woman Every Child Innovation Working Group (IWG) mHealth catalytic grant mechanism aiming to reach 1 million mothers and children, 6,000 health facilities, and 100,000 health workers

Associate Director of Applied Technology, Rockefeller Foundation Chief Executive Officer, United Nations Foundation

Andrew Dunnett

Director, Global Health, HP Senior Adviser, Department for Global Health, Education and Research, Norwegian Government (Norad)

Chris Locke

Managing Director, Development Fund, GSMA

Martha Newsome

Global Director, Health & Nutrition; Water, Sanitation, & Hygiene (WASH), World Vision

I. Improving the evidence base for mHealth 2. Integrating technology and interoperability of health information systems 3. Identifying and promoting sustainable financing models

This year, the mHealth Alliance was called upon to lead and mobilize community efforts and inputs to several global initiatives, including serving as a convener for the Child Survival mHealth Working Group in the lead-up to the Child Survival Call to Action. The Alliance co-lead with PATH the Best Practices and Innovation Working Group on the UN Commission on Life-Saving Commodities for Women and Children, an initiative of the UN Secretary-General and the governments of Nigeria and Norway, to harness technology supply, demand, and monitoring of key commodities to improve MNCH. Additionally, the Alliance coordinated the development of a dedicated Global Health track at the fourth annual mHealth Summit in Washington, DC. When I first began my research on health-related uses of mobile phones nearly 12 years ago, I could not have predicted that we would one day have 6 billion mobile subscriptions in a population of 7 billion or that the technology would become as advanced as it is today. Mobile technology has the potential to improve the health and save the lives of millions – even billions–particularly as it rapidly advances toward national scale through a more supportive and collaborative enabling environment. We thank you for joining us in this effort and look forward to working in partnership with you in the coming year. With much appreciation,

Patricia N. Mechael, PhD MHS Executive Director, mHealth Alliance Cover Photo Credit: Mobile Alliance for Maternal Action


2012 mHealth Summit

Photo Credit: Sandhya Rao

Together with the Health Information Manage­ ment Systems Society (HIMSS), the Foundation for the National Institutes of Health (FNIH), and the National Institutes of Health (NIH), the Alliance is co-hosting the 4th annual mHealth Summit. At the December 2012 mHealth Summit, held near Washington, D.C., the Alliance ensured that diverse global voices and the United Nations (UN) perspective were represented in all aspects of the Summit. The Alliance worked closely with a committee of 16 partner organizations to shape the program and agenda for the inaugural Global Health track, examining mHealth in low and middle-income countries (LMICs).

Launched on Mother’s Day 2011 by U.S. Secretary of State Hillary Rodham Clinton, the Mobile Alliance for Maternal Action (MAMA), an innovative public-private partnership between the United States Agency for International Development (USAID), Johnson & Johnson, the United Nations Foundation, mHealth Alliance (the Alliance), and BabyCenter, engages an innovative global community to deliver vital health information to new and expectant mothers through mobile phones. MAMA is making a 3-year, US$10 million investment to create and strengthen programs in three countries: Bangladesh, India, and South Africa. The mHealth Alliance is the secretariat of MAMA and provides support to enhance global capacity with a focus on evaluation and global learning. In October 2012, MAMA was awarded the Fast Company Innovation by Design Award in the Service Design Category, chosen among more than 1,700 nominated organizations. MAMA’s adaptable messages are now being used in 35 countries from Afghanistan to Zambia with the goal of reaching 20 million moms.

Photo Credit: Mobile Alliance for Maternal Action

Mobile Alliance for Maternal Action

Earlier this year, the mHealth Alliance and USAID announced mPowering Frontline Health Workers, an innovative public-private partnership designed to improve children’s health by accelerating the use of mobile technology by millions of health workers around the world. The mHealth Alliance, serving as the partnership secretariat, coordinates and amplifies the resources and expertise of 10 founding members: USAID, The United Nations Children Fund (UNICEF), Frontline Health Workers Coalition, Qualcomm, Vodafone, Intel, MDG Health Alliance, Glaxo­ SmithKline, Praekelt Foundation and Absolute Return for Kids. The partnership was announced at the June 2012 Child Survival Call to Action, convened by the Governments of the United States, Ethiopia, and India, and organized in close collaboration with UNICEF.

Photo Credit: Maria Chily

mPowering Frontline Health Workers

2012 Milestones and accomplishments Every Woman Every Child Innovation Working Group Catalytic mHealth Grants In 2011, the mHealth Alliance, with funding from the Norwegian Agency for Development Cooperation (Norad) and technical support from the World Health Organization (WHO), developed a catalytic mechanism to provide Innovation Working Group (IWG) grants and technical assistance in support of innovative and scalable uses of mobile technology to advance maternal, newborn, and child health (MNCH). In 2011 and 2012, eight catalytic grants of approximately US$200,000 each were awarded to organizations with the capacity to scale-up evidence-based mHealth interventions. These 16 grantee projects are active in 11 countries throughout Africa and Asia. As part of the program, the mHealth Alliance and WHO are providing technical support in strengthening capacity to evaluate the impact of these programs, helping to build the evidence base for mHealth, and developing frameworks to promote sustainability and gender consciousness in the design and implementation of grant-related activities. Collectively, these grantees are aiming to reach 1.5 million mothers and children, 6,500 health facilities, and 100,000 health workers.

Photo Credit: Talia Frenkel

Photo Credit: Talia Frenkel

Health UnBound Powered by the mHealth Alliance, Health Unbound (HUB) is the interactive network and online knowledge resource center for the mHealth community. HUB enables the exchange of ideas, projects, connections, and collaborations. Through HUB, the Alliance brings together organizations and individuals from all disciplines to generate solutions and inspire new innovations that will transform health with technology. HUB now boasts over 6,700 users and 850 entries in its database of mHealth technologies, programs, organizations and policies.


A number of mHealth reviews and landscape scans have identified evidence as a critical barrier to scale-up and sustainability of mHealth. Evidence will help governments, industry, non-governmental organizations (NGOs), and other stakeholders know where and how best to invest their limited resources. In 2012, the mHealth Alliance’s Evidence Working Group (EWG) – comprised of 25 leading experts in mHealth evaluation and research from around the world–was created to help set the research agenda by identifying gaps in research and evidence that are required to address mHealth sector gaps and build the mHealth knowledge base, using it to communicate and advocate to players in global health. The EWG focuses on the development of resources related to the availability, quality, and dissemination of evidence, as well as indicators assessing the impact of mHealth and eHealth interventions. Achievements of the EWG include: review that analyzes gaps in the evidence base at the intersection of mHealth and MNCH. This • Areport titled, “mHealth and Maternal, Newborn, and Child Health (MNCH): State of Evidence” compiles evidence from published literature reviews, peer-reviewed journals, and key informant interviews. The aim of the review is to ensure that Ministries of Health, implementers, donors, and others working in the fields of mHealth and MNCH have a synthesis of the most up-to-date state of evidence to support informed decision-making and investments in mHealth for MNCH

efforts to build an Evidence-related Community of Practice, develop a theory of change • Sub-coordination for mHealth, and identify and promote standard indicators for evaluation 2013, the EWG will begin to catalyze collective action and capacity building at the country and • Inregional levels, beginning with a regional workshop planned for early January in Zanzibar, Tanzania

Technology Standards and Interoperability Similarly, the Technology Standards & Interoperability Working Group (SIWG) of the mHealth Alliance aims to improve alignment on health informatics standards that support scale-up and promote greater interoperability among mHealth deployments. The mHealth Alliance and SWIG members serve as liaisons to international standards organizations, including the International Organization for Standardization (ISO) and Health Level Seven International (HL7), to represent low- and middle-income requirements and considerations. The SIWG strives to address gaps by:

capacity among governments, implementers and other stakeholders by promoting training and • Building educational opportunities and materials barriers to standards access and adoption by building an online repository of relevant health • Lowering informatics standards, catalyzing development of implementation guides, and advocating for open access to standards for LMICs

the connection between foreign stakeholders and LMICs by establishing regional mHealth • Mediating and eHealth standardization collaboratives, and representing unique local requirements to international standards development organizations

coordination and alignment between donors, standards developers, implementers, and other • Promoting key stakeholders through developing mHealth and eHealth alignment principles, incentivizing standards-based approaches by implementers and vendors, and establishing a forum for stakeholder alignment with national eHealth strategies

the mHealth standards landscape and compiling current approaches to eHealth architecture • Mapping and standards adoption

mHealth and eHealth governance through documenting best prac• Promoting tices, hosting in-country and regional workshops, and empowering ministries and national standards bodies To inform this effort, the mHealth Alliance published a report to highlight critical gaps and opportunities in the ability of existing health informatics standards and interoperability to support mHealth systems at scale. The report, based on a literature review, landscape scan of health informatics organizations and initiatives, and 30 key informant interviews presents a conceptual framework to mobilize governments and the global community to bridge the standardization gap.

Sustainable Financing The Alliance began its work on sustainable financing in late 2012, developing a report to inform the decisions of an advisory group of government representatives, donors, multilateral institutions, and corporations in regards to sustainable financing for mHealth interventions. This advisory group will share plans for upcoming activities and identify specific, concrete opportunities for collaboration at the global and country levels. The report and recommendations will then be disseminated to the wider mHealth community. The report on sustainable financing for mHealth is also in line with the achievement of the United Nations Millennium Development Goals (MDGs) 4 and 5���reduce child mortality and improve maternal health through the use of mobile information technologies.

Policy To identify guidelines for regulatory environments that are conducive to effective and secure use of mHealth at scale, the mHealth Alliance partnered with the Thompson Reuters Foundation’s TrustLaw Connect initiative, Baker & McKenzie, Merck, and law firms in 7 other countries to undertake a landscape analysis of national policies, laws, rules and regulations that address mHealth privacy and security issues. In 2013, the Alliance and its partners will publish a policy landscape analysis that will outline best practice and recommend steps to close identified policy gaps in the ethical and secure use of mHealth data. To increase the availability, affordability, accessibility and rational use of essential commodities for women’s and children’s health, the mHealth Alliance co-led the Best Practices and Innovation Working Group, a part of the UN Commission on LifeSaving Commodities for Women and Children. Leveraging its convening power and expertise, the mHealth Alliance mobilized expert inputs into the Commission’s recommendations and implementation plan. In October 2012, the Alliance participated in consultations with the governments of Nigeria, Tanzania, Democratic Republic of Congo, Uganda, Senegal, and Sierra Leone to begin exploration of capacity-building gaps in implementing mHealth-related recommendations related to supply chain management, demand generation, point-of-care support for health workers, and accountability.

Capacity Building Capacity building is central to everything the mHealth Alliance does. Through its larger programs, HUB platform, education programs, and publications, the Alliance strives to empower those who are interested in working in the field of mHealth with the information and tools they need. The mHealth Alliance has worked with multiple partners to develop white papers and research reports including “Advancing the Dialogue on Mobile Finance and Mobile Health: Country Case Studies” and “mHealth Education: Harnessing the Mobile Revolution to Bridge the Health Education & Training Gap in Developing Countries.” These papers identify characteristics of successful models and explore barriers to implementation to leverage mobile finance as part of mHealth implementations.

Photo Credit: Mobile Alliance for Maternal Action

Evidence

Advancements in Our Strategic Focus Areas

In 2011, the mHealth Alliance, in collaboration with a broad range of stakeholders identified five strategic focus areas: evidence, standards and interoperability, sustainable financing, capacity building, and policy. To address each, the Alliance works to systematically identify gaps and then engages expert community members through working groups to prioritize and mobilize collective action and resources.


Case Study: mHealth Alliance Innovation Working Group Grantee

Photo Credit: Clinton Health Access Initiative

programs at work

Clinton Health Access Initiative The Clinton Health Access Initiative (CHAI) is a global health organization committed to strengthening health systems throughout the developing world, focusing particularly on access to care and treatment for patients with HIV/AIDS. The CHAI SMS Printers to Accelerate Return of Test Results for Early Infant Diagnosis of HIV/AIDS (SMART) program, a partnership between CHAI and the Federal Ministry of Health of Nigeria, uses SMS-activated printers to reduce the turnaround time for early infant HIV diagnosis by simultaneously transferring test results from the lab to the health facility where the blood sample was collected. Early evidence shows that using this technology reduces test result turnaround time, allowing HIV-positive infants to begin life-saving antiretrovirals more quickly and thereby increasing the likelihood of infant and child survival. As of October 2012, CHAI had installed SMS printers in 130 health facilities in Nigeria, with plans to install 90 more by year-end. CHAI will scale the SMART program nationally, purchasing additional SMS printers to expedite over 50,000 early infant diagnosis test results each year. The SMART program has the strong backing of the Nigerian government, and plans to transfer complete ownership of the program over to the government, allowing for program sustainability and long-term impact.

Case Study: mHealth Alliance Innovation Working Group Grantee

Ministry of Health, Rwanda

Photo Credit: Ministry of Health, Rwanda Photo Credit: Talia Frenkel

Photo Credit: Mobile Alliance for Maternal Action

Photo Credit: Mobile Alliance for Maternal Action

Through the support of NORAD, the mHealth Alliance provides catalytic funding to promote mHealth for MNCH. These competitive grants include support for program expansion, and targeted technical assistance from WHO, the Alliance and other partners. Partners help the grantees generate evidence for a variety of stakeholders, build partnerships, and develop sustainable business models.

The Rwandan Ministry of Health uses two mobile systems to support the work of its community health workers (CHWs): 1) “RapidSMS,” which tracks the health of pregnant women and newborns 2) “mUbuzima,” which collects health data and produces monthly reports on progress toward health-related Millennium Development Goals, such as those related to nutrition and vaccinations. IWG catalytic funding will enable the Ministry of Health to scale-up use of these tools to the national level. Expanding these services nationally will allow the Ministry to record and track pregnancies, follow high-risk events during pregnancy, and track antenatal care information for each of the 15,000 villages throughout the country. By the end of 2012, the Ministry of Health will have brought these mHealth applications to scale throughout all 30 districts in the country.


TechChange

Creation of Online Certificate Course on mHealth The mHealth Alliance and TechChange partnered to develop a 4-week online certificate course on mHealth. This first-of-its-kind global online certificate course will run from November 12 to December 7, 2012 and provide user-level mHealth training through a systematic introduction to mHealth and the presentation of diverse mHealth perspectives, including those from governments, private sector, academia, NGOs, multilateral organizations, and donors from Africa, Asia, and Latin America.

Stop TB Partnership

Co-published a paper on mHealth and Tuberculosis The mHealth Alliance, together with the Stop TB Partnership, published a paper highlighting the ways in which mHealth is currently being used in the fight against tuberculosis (TB), and the ways in which the TB community could further embrace mobile technology for health. The paper, “Pushing the Frontier: The Role of mHealth in the Fight Against Tuberculosis,” calls for the wider adoption of mHealth in combating the global TB epidemic and provides several examples of successful mHealth projects that are advancing TB care.

Elizabeth Glaser Pediatric AIDS Foundation

Workshop on the Elimination of Mother-To-Child Transmission of HIV For the July 2012 International AIDS Conference in Washington, D.C., the mHealth Alliance partnered with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Johnson & Johnson, UNICEF, and Frog Design to bring together 25 public health, mHealth, and design constituencies in an all-day workshop on the Elimination of Mother-to-Child Transmission (EMTCT) of HIV. This workshop resulted in the development of a framework for how mHealth can best be leveraged and utilized to support the tools, processes, and systems connected with EMTCT programs to achieve the maximum health outcomes.

A LOOK AHEAD Moving into 2013 and beyond, the mHealth Alliance will work to accelerate and promote the growth of proven mHealth interventions at scale in countries where there is strong political will. At the global level, the Alliance will continue to build on foundational activities and accomplishments of 2012 to enhance the enabling environment through work in evidence, technology standards and interoperability, sustainable financing, capacity building, and policy to mobilize collective action, technical support, and catalytic funding to address critical gaps as needed. The mHealth Alliance will continue to lead efforts to mainstream mHealth into global health policies, practices, and programs. In the coming year, the Alliance will also focus on building other core aspects of our work including:

a technical support facility to support country- specific and organizational • Establishing requests for support and facilitating the coordination of in-country workshops and stakeholder meetings • Leading reports, tools, and other publications with our growing pool of strategic partners • Developing enhanced membership activities including events and webinars • Providing a tailored user experience for Health Unbound (HUB) • Delivering basket funds to provide catalytic funding support critical gaps We • Creating look forward to your continued support and partnership as we collectively work to promote the use of innovative mobile technology to improve health around the world.

Photo Credit: Mobile Alliance for Maternal Action

Members receive regular updates about the Alliance’s work, exclusive offers to upcoming events, promotion of their own work through the mHealth Alliance online networks, and the ability to actively engage with the Alliance and other members. This includes the Alliance’s annual Member Forum, where organizations can provide input on the strategic direction of the Alliance.

ALLIANCE MEMBERS

In February 2012, the mHealth Alliance launched a membership campaign, inviting organizations to join the Alliance and like-minded institutions to support our efforts to mainstream mobile technologies into global health. Membership is open to institutions across all sectors that are actively engaged in or interested in mHealth. As of October 2012, the Alliance had over 130 member organizations.


mHealth Annual Report 2012