Possibility of mHealth intervention in Nepal

Nepal is located in the Himalayas and contains eight of the world’s ten highest peaks. Its remoteness has created inaccessibility and limited the access to health information and delivery of health services. Apart from by foot, no better alternatives of transportation for seeking health services are available in most of the rural parts of the country. Because of which, a significant delay occurs in getting appropriate treatment in the short run. Opposite, a significant gap of information about sexual and reproductive health among adolescents has been measured in recent years. This is mainly because the application of traditional approaches occupies major part of disseminating health related information.

For instance, according to the National Demographic Health Survey (NODS-2011), knowledge level with regard to family planning among 15-19 years age group among married women is 99.9% whereas current use of contraceptives is only 14.4%. However, 41.5% of these women still reported to have unmet needs. Similarly, 97% of male and 88.7% of female of age group 15-19 years have heard about HIV and AIDS, but at the same time while comparing the comprehensive knowledge on preventive measures amongst the same group was found only 32.7% and 25% respectively. 

Furthermore, According to Nepal Adolescents and Youth Survey, 2012, there is poor communication among youth when it comes to discussion about sexual health. 51.80% young girls (10-24) were reported having discussed about the issues related to marriage, pregnancy, menstruation, love, family planning, sexual intercourse, wet dreams and puberty which is more than 48.2% young boys. Observing the scenario, better options for providing health information and services are to be identified. The stigmatized sensitivity of the SRHR issue demands youth friendly, easily acceptable and immediate source of information.

mHealth may be an effective way of reaching the people mostly in the remote areas in a cost-effective way. mHealth involves the use of mobile phones and other wireless devices to promote health education and raising awareness among target groups, by delivering health information and services, disease management, treatment protocols and linking data of clients to health insurance providers, etc.

Mobile technology has made a recent and rapid appearance into low- and middle-income countries like Nepal, along with the improvements in telecommunications, technology infrastructure and reduced costs of mobile handsets. Nepal Telecommunication Authority states that over 75% of the population has now access to a mobile phone. Mobile technology can be a method with enormous potential of disseminating knowledge to people who do not have easy and immediate access to health information or health facilities in Nepal. Considering the fact that a large part of the population is connected with the communication network based on an explosive increase of smartphones and mobile internet access, the possibility of delivering health information and services to the needy people using mobile technology is high.

The National Adolescent Sexual and Reproductive Health (ASRH) Communication Strategy, 2011 has further suggested for the application of effective media advocacy toolkit as well as harnessing wireless Technology. It strongly advocates that the Mobile technology can play a vital role in raising awareness about ASRH and creating demand for services by promoting Adolescent Friendly Service centers and Services. Reach out to mobile companies and others in mobile technology to reach adolescents – through texts, downloadable mobile applications that are games, ringtones, downloadable adolescent ‘real’ stories, etc.

There have been several success stories of mHealth in various parts of the world. CycleTel is one of the example which was implemented by Georgetown University’s Institute of Reproductive Health (IRH). CycleTel empowers women by providing them with accessible reproductive health information through SMS. The prototype was tasted in two cities of India, Lucknow and New Delhi. A woman learns about CycleTel and opts to join the service by sending an SMS to a designated number. She sends the date of her last period to the service and begins using CycleTel. The service alerts her of her fertile days during each cycle. Additional messages support correct use of the method, help her monitor her cycle length, and offer information on other reproductive health issues, such as the importance of optimal birth spacing.

Some other successful cases are Wazazi Nipendeni from Tanzania, Project Masiluleke of South Africa, Andhra Pradesh Encephalitis Syndrome Surveillance Information Management System (AESSIMS),  Nacer from Peru, National Immunization Programme (Measles Rubella Campaign 2068-69), Nepal.

With the rising mobile penetration rate in Nepal, and existing policy framework provide a very plausible reason in the urgency of mHealth intervention in Nepal. There is a need of coordinated effort among the works being conducted by different development stakeholders. After studying several success stories of mHealth intervention, the time has now come it be used in Nepal as well.

The technological intervention can be made for several reasons. Some of the areas, where the intervention could be implemented but not limited to are, for immunization tracking during institutional delivery; for continuous information supply for immunization schedule; for antenatal checkup of young pregnant girls; for sending reminders and information of family planning methods and frequency, eg. Send SMS at the interval of every 3 months for the reminder of Depo; for tracking and sending useful information to track and monitor the growth of children; for several awareness campaigns; for increased accountability of youth friendly health services and for coordinated effort among various stakeholders like Government, I/NGOs, Telecommunication operators, existing health service providers, and activists is the key to the success of such future technological interventions in the sector of Health in Nepal.