Tuesday, January 13, 2015

Is mobile-health going to improve on health literacy and healthcare services in Cameroon?

Mobile-health (mhealth) is the use of mobile application for healthcare (8). With an increase use of mobile phones do we have reasons to think that health literacy – that is people’s knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course (12) - of Cameroonians and access to healthcare services going to increase? Answering this question requires an understanding of the Cameroonian health system, some specific programmes and services delivered by this system and the Cameroonian IT sector. This article wants to highlight on the one hand the long-term benefits doing research both in the IT sector and health sector can have on the wellbeing of populations because evidenced-based decisions would have been made and on the other hand raise awareness and advocate on the need to develop robust and sustainable health literacy programmes at all levels of the Cameroonian society as well as defining the term in context (13). In fact, in the Plan National du Development Sanitaire (PNDS)(16) made by the Ministry of Public Health, research in health and all what it entails is in the agenda this year (2015). How has this initiative in the previous years enabled research in health in Cameroon to advance? A recent study showed that no information on health literacy initiatives is available in Cameroon (13). Yet the need is pressing as accessing health/healthcare information can systematically change health behaviours and healthcare delivery and eventually improve on the wellbeing of the populations. The need to invest more in operational research in health is one of the best ways to enable a sustainable management of health resources. It is worth mentioning then that the PNDS has not scheduled capacity building on operational research this year (2015). Interestingly, the document (p.70) reports that the promotion of results in health research   has been done since 2010 and are on-going (2015). There is indeed a big need for the communication of the results of health researches to be made readily available to every citizen. This contributes to health literacy improvement and health promotion. 

GiftedMom mhealth App By Cameroonian Nteff Alain. The photo shows the interface of the platform Photo Didier De Masso

            ICT and Kulture informs, educates and communicates with respect to ICT innovations, solution and problems. ICT and Kulture aims at enhancing productivity (that is how an ICT orientated idea can be used to increase well-being at all levels of human development). The challenges faced by global citizens living in the digital world are unique in terms of the culture they are exposed and immersed into. The information age affects thus important aspects of our lives including health and education. The importance of health to world-wellbeing is reflected in the eight millennium development goals (MDG) among which three are dedicated solely to health and of most relevance to Cameroon:
-          Goal 4: Reduce child mortality
-          Goal 5: Improve maternal health.
-          Goal 6: Combat HIV/AIDS, malaria and other diseases.
 Almost 800 women die every day due to complications in pregnancy and childbirth (14). One third of total global deaths are in two countries (India and Nigeria) – (14). What are pregnant women dying from? 28% pre-existing medical conditions exacerbated by pregnancy (such as diabetes, malaria, HIV, obesity ; 3% Blood clots, 8% Abortion complications 9% Obstructed labour and other direct causes 27% Severe bleeding 14% Pregnancy-induced high blood pressure, 11% Infections (mostly after childbirth) – (14). In Cameroon the percentage of Antenatal care coverage - at least one visit (ANC1) from 2005-2012 is 85 % significantly above African average (73%) - (10). There was no data available for the percentage of Antenatal care coverage - at least four visits (ANC4) from 2005-2012.  This data is not alarming and would even seem reassuring. However,   “the number of women dying due to complications during pregnancy and childbirth decreased by nearly 50% from an estimated 523 000 in 1990 to 289 000 in 2013 (11). While such progress is notable, the average annual rate of decline (AARD) is far below that needed to achieve the MDG target (5.5%), and the number of deaths remains unacceptably high” (11). Even if these indicators are estimates with uncertainties due to data collection procedures and other issues particular to country records, they reveal a clear trend, that is maternal mortality is still a health problem as such even in Cameroon.What role can  health literacy, healthcare/health information play in saving the lives of mothers and their children?
GiftedMom enables pregnant women to access healthcare information  in remote areas in  Cameroon  Photo Didier De Masso                                             

Health literacy and Healthcare/Health Information can save lives

There is a clearly established relationship between health and formal education. In fact, literacy levels have been shown at least with the case of HIV/AIDS to significantly influence its prevalence (9). In the present Cameroonian context, the need for educational systems therefore to develop education programmes for health  issues becomes thus an imperative and the role of guidance and counselling services to implement their programmes a necessity.  In fact, educators should be put in the frontline in the process of enabling health literacy become a reality in Cameroon. Notwithstanding, “people are dying for lack of knowledge”. Healthcare providers and the general public needs to be informed. One of the greatest challenges that might face the development of a health literacy programme in Cameroon though, would be to identify the need for health literacy this at an organisational or individual level. There is reason to think more research has to be done on the health behaviours of Cameroonians. For instance there is presently an increase in the number of stroke cases been recorded.  Doing research on the impact of health literacy levels on the health behaviours of Cameroonians might seem little, yet it would be determinant especially that the motivation to take a health-related decision also stems from a certain need to do so either because the individual is informed or for other evidenced reasons.  In other words, what are the health information needs of youths, women and children in Cameroon that might engage them to be sensitive to healthcare information or health content? What prompts a Cameroonian to seek or not to seek for healthcare services?  There is little or no evidence on these areas of health research in Cameroon and it is becoming necessary that the Government invest more on research in health to enable informed and evidence decision making to be possible. This is cost effective. It is worth mentioning here that the Ministry of Public Health of Cameroon produced an important strategic document called “Plan National De Développement Sanitaire (PNDS) 2011-2015”. Briefly , this document  highlights the following points : 1) MDG 4 , 5 , and  6 are top priorities in the plan 2) Health policies have been reoriented through the Sector Wide Approach and the admission of Cameroon into the International Health Partnership (IHP) 3) the PNDS is the efforts of multidisciplinary health planning teams working at the regional and district levels. The expenses on health are still very high as compared to investments. The sustainability of the investments which would end up reducing health expenditures can effectively be assured through investing in health literacy and health promotion. Experientially there is a gradual mistrust of modern healthcare systems in preference to alternative or traditional healthcare systems. It is not surprising taking into account the African Culture and worldview on health and illness, the mind and body. Moreover, even if it is factual that Africans rely mostly on their traditional health practices, a regain of interest in the area merits attention. Indeed, it is not a novelty to realise in Cameroon’s city private radios and television; newspapers advertise the services of traditional healthing doctors. Recently, one observation has been made, health-related messages especially about sexually transmitted diseases, including HIV and other top killing or disabling diseases (hepatitis, haemorrhoids, gastritis etc.). It is said and known in the streets that HIV/AIDS has a cure.  It is not rare to see advertising posts of traditional doctors posted in administrative areas of Yaoundé, Douala, Baffoussam and Buea- big Cameroonian towns. It is imperative to stress here the merits of African medicine and its intent to maintain harmony in the environment where man lives. African medicine is in fact sustainable. However, it is important taking into account the context we are living in to adapt new methods to solve new problems. Or to the least modify old methods to solve new problems. The information age indeed possess new challenges to health professionals from diagnosis to treatment. The challenges are much more enormous in developing countries since information and communication technologies have a different functionality because of the way they are perceived. 
            The aforementioned analysis puts forwards certain ideas which merit attention even if this is not the aim of this article. 1)  The quality education and training of health professionals should be a priority. 2) Health information should be controlled but made readily available.  On the one hand, the quality of the education and the training of health professionals have recently gained attention by the Ministry of Public Health and Ministry of Higher Education with the regulation of the opening of medical schools, mostly from the private sector. This is a great step, yet more still needs to be done in what concerns the practicum, residency and internships of the trainees. For instance clinical psychologist students ought be systematically admitted into hospitals and monitored to complete their training. On the other hand, health information is not like other information. Its content might be thought to elicit specific coping strategies/salutogenic factors or processes which could be either harmful or protect full of the health of an individual. Health behaviour which is targeted by the Ministry of Public Health might then be hampered because of negative interference. This hypothesis needed to be evidenced though. The idea of the control of health information pertains mostly to our context where the source and content of the information been transmitted are not verified by the consumer of health information or are not certified to be evidenced-based. In fact, the issue of misinformation and under information in developing countries such as Cameroon with respect to health information is known.  It is worth mentioning that “studies in low-income countries suggest a gross lack of knowledge about the basics of how to diagnose and manage common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous health care practices” (7). Notwithstanding, the broadcasting of health information should be controlled systematically and reviewed by the competent health authorities. Policies and legislation of knowledge management are important to mention. Health education programmes ought to be thought systematically at all levels of the educational system. Efforts are been done in the primary level of education with basics in hygiene and sanitation. However, taking into account the health challenges the programmes need to be comprehensive and developmental in nature. These educational programmes should include informing learners on sources to get reliable healthcare/health information. We think these measures would greatly improve on the health literacy level of Cameroonians and contribute to their wellbeing
    Today thousands of children, women and men die needlessly every day. Many would still be alive today if their mother, caregiver or health worker had known what to do and when and where to seek help: these are some statistics from The Healthcare Information For All (2015) information data bases. HIFA2015 is a global campaign dedicated to the dissemination of healthcare information its vision is to see a world where every citizen and every health worker has access to the information they need to protect their own health and the health of others. Did you know that :
-          8 in 10 caregivers in developing countries do not know the two key symptoms of childhood pneumonia*
-          4 in 10 mothers in India believed that they should withhold fluids if their baby develops diarrhoea*
-          3 in 4 doctors caring for sick children in district hospitals in Africa and Asia had poor basic knowledge of leading causes of child death*
-          7 in 10 children with malaria treated at home are mismanaged*
-          7 in 10women giving birth in health facilities in Africa and South Asia were incorrectly managed during the 3rd stage of labour, increasing risk of death from postpartum haemorrhage*
Healthcare providers in low-resource settings do not have access to relevant, reliable healthcare knowledge, contributing to high levels of unnecessary death and suffering. Individuals also should know that health and healthcare information are universal rights and the need to have the right information can save their lives.

The role that m-health can play in improving health literacy level by the promotion of health and healthcare information.

            The HIFA strategy to enable by 2015 a maximum number of persons to access healthcare information is directly linked to the demands of the present information age. Now that mobile telephony is readily accessible (read our previous articles for throughout statistics) by African populations especially youths and women.  Thus, it enables communication of another type to be possible. The mobile phone is a strategic communication tool which severs several purposes nowadays (mhealth, e-fiance, e-banking, e-commerce, mlearning). It can greatly impact if certain conditions are met not only on health service delivery but on the adoption of healthy behaviours through the formation of new attitudes. This would be possible because of the transmission of accurate health information.
            In 2013, Nteff Alain was named winner of the 2014 Anzisha Prize, an award for African entrepreneurs between the ages of 15 and 22, and received US$25,000 to grow his venture. African Leadership Academy in its site tells us this wonderful story (2). What was Alain’s idea about? GiftedMom, a new e-content platform for pregnant women that provides information to combat the high number of mother and infancy deaths in under-serviced communities in Cameroon. The idea behind GiftedMom came when Alain visited his friend who was a medical student and who had witnessed the death of several babies some days ago. Alain told Anzisha Prize team that the problems of this babies caused by disease and infections like chlamydia, syphilis and malaria. Normally, antenatalcare is very effective to prevent such deaths but as he told the Anzisha team, most women simply don’t go to antenatal clinics. Moreover, medical supplies needed to look after premature babies, such as incubators, are not available (2).  The reasoning patterns of Nteff Alain a telecommunication student is laudable as he tried as much as could to use what he had to solve a critical problem. This thought pattern is what students, youth, women and children of Cameroon should have. This is what he says to the Anzisha team (2)

                I noticed many necessary medical resources are already there for these women. For instance,  premature births can be caused by malaria and malaria treatment is free. The women just don’t know   it. They think if they go to hospital they will be charged a lot, so they seek traditional solutions which  invariably increase the complications of pregnancy. Help is often in place, but no channel to actually  educate these women on what’s available… there was a need to link the two” 

The experience of Nteff Alain leads us to make some important remarks and recommendations. Moreover, his experience blatantly pinpoints the role that healthcare/health information has in improving healthcare and enabling good health behaviours. Moreover, it shows us that the Cameroonian IT sector is ready to enable m-health to function and that the services it would offer would unavoidably have a high demand
Mobile telephony companies in Cameroon. Nextel cameroon is the new  company opened its services to the public with 3G connetion last year . Photo Didier De masso

            It is of utter most importance that the experience of Nteff Alain serves as a catalyst to Cameroon youths who want to engage themselves in solving problems in their communities using their intellectual capital. The role of educators in this endeavour should be highlighted as imperative as well. The role of education in Alain’s course should be noted and his modelling attributes can be used by guidance and counselling services around Cameroon to foster and emulate interest in Science Technology Engineering and Mathematics (STEM). Moreover, it is important to mention that with indeed just little, as Alain says intellectual capital a youths, a child, a woman. You can do a lot for your community. M-health in Cameroon can be an effective way to raise/improve the health literacy levels of Cameroonians and as such contribute to the wide spread of healthcare/health information. The necessity to adopt a multidisciplinary approach to knowledge sharing is valid. Alain indeed worked with medical specialist in the construction of his idea. It is necessary to mention that, Health Care information for all by 2015 ratified a fundamental strategic goal called the Mobile Healthcare Information For All (5). This goal states that:

            “By 2015, at least one telecoms provider, in at least one country, will endorse the vision of Health Information For All, and will provide free access to essential healthcare knowledge in     the local language, preloaded on all new mobile phones they may sell and freely downloadable to all those who already have mobile phones.”   

The mobile telephony sector in Cameroon is occupied by Camtel, MTN, Orange Cameroon, and Nextell Cameroon. They are all welcomed to participate in this endeavour. We believe that Nteff Alain’s work is just one in a series of works that will be done to move from theory to practice in the domain of m-health in Cameroon. We firmly believe that with a minimum of collective efforts health literacy in Cameroon would improve through healthcare and health information accessed through ICTs (15). Health behaviour is linked to health literacy which is in turn determined by several interrelated and intertwined psychological variables, socioeconomic and technological factors (1, 15). The Ministry of Public Health would find it interesting to invest more on research, health literacy and health promotion.  If you would like to be part of the global campaign with regards health promotion you can sign in for free at http://www.HIFA2015.org.  Your participation in building up health knowledge and sharing it will certainly enable youths like Nteff Alain, girls or women interested in ICTs and STEM  to contribute significantly in the development of m-health in Cameroon. Research in Health in Cameroon proves thus, by the works of Nteff Alain and many others that the MDG 4, 5, 6 could or would have been attained faster! Finally, since there is mounting evidence that there is a growing emphasis on the importance of research having demonstrable public benefit (4). M-health provides a simple cheap and effective means to convey healthcare/health information imperative to health promotion because it contributes significantly in the adoption of healthy health behaviour (15, p.152).


1-   Albery, I., P. and Munafò, M. (2008).  Key Concepts in Health Psychology. Los Angelos : Sage Publications. ISBN 978-1-4129-1932-6
2-       African Leadership Academy (2014). How Africa’s top young entrepreneur in 2014 is solving health problems with technology. Retrieved from www.anzishaprize.org/2015/01/07/how-africas-top-young-entrepreneur-in-2014-is-solving-health-problems-with-technology/ January 7th, 2015
3   Cameroon  Factsheets of Health Statistics (2010)
4-       Cohen, G., Schroeder, J.,   Newson, R., King, .L.   Rychetnik, L., Milat, J., A. Bauman, A., E.   Redman, S.,   Chapman, S. (2015) Does health intervention research have real world  policy and practice impacts: testing a new impact  assessment tool Health Research Policy and Systems, 13:3 doi:10.1186/1478-4505-13-3
5-      Global Healthcare Information Network (2013). Healthcare Information For All by 2015. 2013 Progress Report (up to 6 November 2013 retrieved from http://www.hifa2015.org

6-      International telecommunication union (2014) Measuring the Information Society Report. Place des Nations CH-1211 Geneva Switzerland ISBN 978-92-61-15291-8

7-      Pakenham-Walsh., N & Bukachi, F. (2009) Information needs of health care workers in developing countries: a literature review with a focus on Africa. Human Resources for Health 

8-      Qiang, C., Z. Yamamichi, M., Hausman, V., and Altman, D. (2011).  Mobile Applications for the Health Sector ICT Sector Unit World Bank

9-      UNAIDS (2002) Inter Agency Task Team on Education
10-  World Health Organisation (2014). Atlas of African Health Statistics: Health situation analysis of the African Region. World Health Organization. Regional Office for Africa, ISBN: 978 929 023 2254.
11-  World Health Organisation (2014).World health statistics 2014. ISBN 978 92 4 069267 1
12-  World Health Organisation, Kickbusch, I, Pelikan, M., J.,  Apfel , F & Tsouros, A., D.(2013). Health literacy: The solid facts. ISBN: 978 92 890 00154
13-   Pleasant, A. (2013). Health Literacy Around the World: Part 1 Health Literacy Efforts Outside Of the United States. Commissioned by Institute of Medicine Roundtable on Health Literacy.
14-  World Health Organisation (2014). Saving Mothers Lives Infographic.
15-   Mccray, T., A. (2005). Promoting Health Literacy J Am Med Inform Assoc.12:152–163. DOI 10.1197/jamia.M1687
16-   Ministre de la sante publique (n.d) . Plan National De Développement Sanitaire (PNDS)  2011-2015

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