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.
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| 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?
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| 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 |
Conclusion
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).
References
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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