A mobile health model supporting Ethiopia’s eHealth strategy

Critical health information technology (IT) system deficiencies have left many low-income countries (LICs) the inability to support locally sustainable communicable and non-communicable disease prevention and screening initiatives and new therapeutic treatment plans that could save millions of lives. This is due, in part, to a lack of timely clinical intelligence from their peers at the point of care and the implementation of effective post-visit patient engagement tactics for self-care and treatment compliance. [1–7] The current solutions in LIC healthcare and Life Science domain are primarily third-party vendor systems, which require unsustainable IT infrastructure and software management support, or heavily paper-based processes supplemented with standard IT desktop applications and databases. Collectively, these systems do not enable the robust capabilities needed to sustain near-real-time and offline patient engagement and clinical innovation or meet the regulatory standards for local, national, and international collaboration efforts. As a result, LICs cannot transition effectively from manual administrative efforts to participate in multi-national clinical trials and public health innovation, which directly impedes their ability to mature as an organization. [1–7] This has left most public health analysts and health care teams that perform population health surveillance and treat high-risk patient population groups in these regions of the world, with little to no alternative but to reactively address disease outbreaks with inadequate biosurveillance and care management intelligence. Ultimately, this results in poor outcomes for preventive health and wellness programs. This impacts LIC’s ability to increase their capacity and take a more prominent role in collaborative research efforts with their peers internationally. As a result, they suffer from lost opportunities for expanded innovation and thought leadership initiatives that enrich the entire global research community in the advancement of public health worldwide. [8–13] Key drivers that impede sustainable adoption of information, communication, and technology in low income countries As a result, global health organizations, such as the WHO, and their member organizations, have been promoting the development and adoption of scalable health IT solutions that are sustainable in low-resource care settings to mitigate these healthcare disparities. The use of mobile technology has been shown to provide the most promising impact, given the ubiquitous use of mobile phones in the most resource constrained areas of the world. The introduction of mobile health (mHealth) capabilities for preventive health programs and patient engagement efforts that bridge gaps in care for vulnerable patient populations, are gaining momentum in all global health communities. However, their impact and sustainability are still uncertain due to the following factors as identified by the WHO:[9–13] Conflicting health-care priorities Unsustainable operating costs Inability to consistently measure clinical and cost effectiveness Lack of harmonized health-care policy and governance models to support mHealth initiatives Lack of knowledge concerning the possible application of mHealth and public health outcomes Lack of IT infrastructure to support mHealth programs Patient literacy, privacy, and cultural issues. This is evident in the current trend of health disparities associated with cervical cancer in LICs, due to low-resource constraints. According to the World Cancer Research Fund International 2012 report:[14] Cervical cancer is the fourth leading cause of cancer death in women worldwide About 84% of cervical cancer cases occurred in less developed countries The highest incidence of cervical cancer was in Africa and Latin America and Caribbean and the lowest incidence in Northern America and Oceania. PROGRESS IN CERVICAL CANCER SCREENING AND TREATMENT IN ETHIOPIA There is progress in LICs such as Ethiopia, that are developing national initiatives to overcome infrastructure and policy-based barriers to improve the outcomes of the preventable spread and prognosis of cervical cancer, with revitalized public health efforts. In spite of Ethiopia’s health care infrastructure constraints, its Ministry of Health is shaping a progressive approach to addressing health disparities by embracing mobile health technology, as an extension of their eHealth strategy to address these gaps in care. Demographic profile of cervical cancer within Ethiopia Ethiopia has an estimated 7000 new cases of cervical cancer each year, and nearly 5000 deaths from cervical cancer yearly. [15] This data is collected primarily from those who present to Addis Ababa for treatment, as currently Addis Ababa is the only oncology treatment center in the country with radiation capacity. The number of women with cervical cancer identified in Addis Ababa was inversely related to the distance the woman lived from the capital (Abate, 2015). [16] Women at risk for the development of cervical cancer are primarily those without access to screening and preventive measures. In Ethiopia, 0.8% of the eligible population have ever been screened for cervical cancer. [16] Further risk factors relevant in the Ethiopian region include exposure to chronic smoke inhalation, as Edelstein et al. 2008[17] reported 80% of the rural women in the Gondar region have exposure to chronic smoke inhalation with poor ventilation due to cooking practices. High-fertility increases the cervical cancer risk, as does young age at first pregnancy. [18] According to the Ethiopia’s Demographic and Health Survey (EDHS), the fertility of Ethiopian women is 4.8 children per woman, with more children born in rural areas per woman than urban. In addition, the median age of first birth in Ethiopia ranges from 18.1 in Amhara to 23 years old in Addis Ababa. In sum, there are significant risk factors for cervical cancer in Ethiopia, an already apparently high incidence, and yet missing data.