29 November 2011

How Haute Couture Can explain mHealth

This post originally appears on the Health UnBound blog.  I wrote it awhile ago (July-ish), but I am lucky that the timing of it was not pressing.  Fortunately for me, it is posted just ahead of the mHealth Summit in DC that I will be attending.  Be on the lookout for posts and tweets from the event next week.  If there are any speakers that you think I should check out or report on please let me know and I will try to accommodate

mHealth has become one of the latest super models walking down the runway. The ideas are sexy and potential high as innovators develop the latest app to analyze if a person has malaria on a smart phone. However, like fashion, the excitement for what could be must be tempered by what is possible.
Haute couture is stunning when first shown since it is modeled precisely for the body that will wear the piece, but every designer must also offer a prêt-à-porter (ready to wear) version. Although the buzz surrounds the runway events and the discussions gravitate to the couture piece, it is the prêt-à-porter that will bring in the money to the fashion designer. A large audience is reached by reducing price, making it more available and constructing a pragmatic design.

Other industries, like cars, go through the same cycle from proto-type to actual solution. As the mHealth hype grows the focus upon what ideas will lead to actual solutions cannot be lost. Ambition will lead to innovations, but poorly constructed ideas will lead to miserable failures. The graveyard of failed ideas in development and aid projects looks more like a giant dump filled with as much wasted promise as physical parts.

In the ICT world, One Laptop per Child (OLPC) has been the gold standard of failure. The idea preceded the need rather than the other way around. OLPC set out the mission to “provide each child with a rugged, low-cost, low-power, connected laptop.” In doing so, they imagined classrooms transforming from blackboards to a room full of children on alien looking laptops as a way to overcome barriers like not enough books.

An admirable goal, but OLPC started with the assumption that every person needed a laptop and designed a way to make it happen. Unfortunately, the technology led the way rather than the solution. As Linda Raftree points out, “you can be pretty sure that you have things backwards and are going to run into trouble down the road, wasting resources and energy on programs that are resting on weak foundations.” OLPC ran into simple issues like not having adequate power sources. Yes, a power efficient product was designed, but the battery does eventually run out.

In a 2004 article in the Boston Review, Kentaro Toyama addressed the question of whether technology can end poverty. He answered by saying, “technology—no matter how well designed—is only a magnifier of human intent and capacity. It is not a substitute. If you have a foundation of competent, well-intentioned people, then the appropriate technology can amplify their capacity and lead to amazing achievements.” mHealth is a field where well developed solutions can be the magnifier that Toyama describes. Rather than seeing innovations as solutions, mHealth developers will be served by shifting their perspective towards magnifying the abilities which already exist and enable them to be more effectively utilized.

With 5.3 billion mobile phone users, there is no question that there is a significant space for mHealth in addressing poverty and under-resourced areas. However, the majority of people not using smart phones which account for only 23.6% of the global market; certainly lower when high income countries are removed from the data. For the time being, low-tech solutions can more effective than smart phone apps which tell a mother how to care for a newborn.

Sproxil is an example of a solution that utilizes the ubiquity of phones to allow consumers to check if a recently purchased drug is counterfeit. By sending a code found on a scratch off area on the drug’s packaging, a confirmation is instantly received telling the individual that status of the drug.

Though a much less attractive solution, Sproxil should be trumpeted as loudly as others. Counterfeit drugs are rampant throughout sub-Saharan Africa and India and can be hard to catch at the point of entry. By adding a scratch off to the packaging and allowing pharmacists and/or patients to use SMS to check the drug immediately, the problem of counterfeit drugs can be significantly. This is not a major technological advancement. Rather it is a solution to improving health systems. It does not sound as appealing as other ideas, but it could have a further reaching impact.

A way around the problem of balance is to address failure head on. Mobile Active has been one of the leaders in this regard by organizing FailFaires to bring together those in the ICT field and share what they did wrong in order to prevent unnecessary replication. One example of learning comes from Text to Change. The program design was to educate people in Uganda about HIV/AIDS through a SMS quiz. However, when it came the date of launch the program was assigned the SMS number 666. With the connotations to the devil's number, the idea almost completely failed if it were not for a change of the number to 777. Even with a well-designed and planned intervention, an externally assigned number nearly undermined the initiative.

By sharing this small failure, Text to Change can tip off other innovators to consider the minute detail of what number is assigned when designing an SMS-based product. Failure is rampant in any industry, especially technology. By continuing to take part in forums like FailFaire, mHealth developers can lean on a larger pool of knowledge to encourage innovative product design.

The newest couture dresses strutting down the runway or electric car prototypes spinning on display are what get people excited about the respective industries. In the tech world it is 3D television, tablets, faster processers, phones that can do more and apps that can cook; but practicality cannot be ignored. Just like the dress that ends up at Neiman Marcus and the car at your local dealership, the designs have been re-imagined under the constraints of what will most interest the consumer.

With mHealth, the consumers are the clinics utilizing the technologies and the doctors being trained in how to put them to use. Usability is always a concern, but the need for the app and the ability to use it effectively must be considered. Overselling the promise of tech based solutions can allow for sexy ideas like OLPC to continue while practical ones like SMS reminders to be ignored.