This document discusses mobile health (mHealth) initiatives in Uganda and outlines a proposed mHealth service called "Medical Call" that would allow Ugandans to call doctors for medical advice and information via their mobile phones. Some key points: - Uganda faces health challenges like low doctor-patient ratios and high child and maternal mortality. Existing mHealth services have had limited impact. - The proposed Medical Call service would allow callers to speak with doctors via a call center for basic medical consultations and information on health services. Calls could be extended to directly connect callers to specialist doctors. - Benefits include lower costs than physical doctor visits, easier access to medical advice and information, and potential reduction in unqualified medical

1. Health and Technology
“A Ugandan Experience”
Dr.John B. Niwagaba
(MbChB,Mmed)
Mobile Health Care Ltd

2. Uganda

3. Uganda at a glance
• Land locked,found in E.Africa
• Area-241,038km2,(85% Land,15%water)
• Ethnic groups-52 tribes
• Languages-English ,Kiswahili,Luganda etc
• Population estimate-35 million (2014 UBOS)
• History:British Protectorate,got independence in 1962
• Religion-84%christian
• Tourism :Game parks (Giraffes,Mountain
Gorillas,birds,lions) Source of R. Nile,The Uganda
Martyrs….

4. Uganda`s Health Indicators*
• Doctor Patient Ratio 1:20,000
• Child mortality:128/1000 live birth (under5 years)
• Maternal mortality:432/100,000 live births.
• Life Expectancy: 49(men),51 (Women)
• Literacy %age:52-57 (total),83.5 (youth)
• Delivery by skilled health worker-33%
• HIV Prevalence-6.5%
• Diabetes, Hypertension and other NCD-5%
*Data from multiple sources

5. Health is a state of complete physical, social and
psychological wellbeing of the body ,not mere absence
of disease or infirmity (WHO)
Medical information:
Consult the Gods… Speak To the
oracle…
HIV KILLS…Use a Condom
Safe Blood saves lives
TB is curable

6. The Information era
E-Health
E-Medicine
Telemedicine
Telehealth
Mobile Health
Mhealth

7. Mobile Health/Mhealth
• Use of a phone for health related services.
Simple Advanced
Call a doctor Mobile apps for
Text for health monitoring
Advice glucose

8. What has been done locally….?
GoogleSMS
SMSDoctor
TXT 2 Change
999
NDA
UMDPC
Hotlines for Domestic violence,rape.etc…
VERDICT: Insignificant!
Why: More Technology, less human !

9. MTN at a glance…
• MTN subscriber base-7 million
• Value added services (Mobile Money
>1Million subscribers)
• “Another first from MTN!”
Innovation distinguishes between a leader and a follower (Steve Jobs)

10. Mobile Heath Care Ltd
Vision
Bringing health care to the people
Mission
To create a reliable, timely and cost effective
health information interface between the
community and the health sector

11. The Medical Call..
Facts
• Patients always call friends and relatives when
sick
• 60% outpatient consultations need information
only(UDHS 2006)
• “The Golden 4 Minutes”
• 70% diagnosis is from history(Hutchinsons Clinical Methods
21st Edition)
• Estimated 80% Ugandans speak either
English,Kiswahili,Runyakitara,Luo or
Luganda(Ethinologue)

12. Models
Single call model/Call extension model
Caller
Call
Centre
Remote
doctor/service
provider

13. The Single Call Model
• Tag line: Hello Doctor
• Service No:0902900800 (MTN only)
• Call cost:Sh.600 per minute.
• Revenue share: 60%(MTN),40% (MHCL)
• Extensions:5 active channels (30 channel PBX hybrid system)
• Staffing:24 hour cover by 4 health workers
• Database : >6000 health care providers (hospitals,clinics,pharmacies)
and 20000 health care workers
• Information: Basic consultation, location and cost of health services
+counseling
• Languages:English,Luganda,Runyakitara and Kiswahili (soon)
• Call density :0-5 calls per day
• Advertising: Information leaflets, radio shows,articles,clinic royalty
program, SMS doctor…
• Expenditure: Full office, full time doctors/clinical officers

14. The Extended Call Model
• Tag line: Hello Doctor
• Service No:0902900800 (MTN only)
• Call cost:Sh.600 per minute. Extension-Sh100
• Revenue share: 60%(MTN),40% (MHCL)
• Extensions:50
• Staffing:25 doctors (10 gyn,10 paed,5 general)
• Database : direct consultation with doctors
• Call density :20-100 calls per day
• Advertising: Strip in Red Pepper daily, social media
• Expenditure: Minimal(little rent and small stipend to doctors)

15. Benefits
• Cheaper than physical consultation (UGX5000-50000)
• Off the counter medicine buyers more certain what to buy
and pricing
• Saves time and money commuting too and from facilities
• Saves on appointment fixing, waiting and queuing.
• Enhance competitiveness in public and private sector
• Reduces quack practices
• Increase uptake of emergency and first aid services
• Cost of medication and health insurance to drop
• Another value added service-using your phone to do
MORE!

16. Challenges
• Reduce the doctor patient contact
• Mistrust, unsure of doctor on line
• Delays,unneccesary questions, increase cost
• Double payment if sent to doctor physically.
• Language barrier and communication hitches
• Medico-legal issues in case of bad/misleading
or fatal information.

17. The future: A holistic healthcare
product
Funding the call
• Out of pocket: The caller
• Health insurance packages: Member
subscription, Mobile Money based
• Heath Providers: Subscription(extension)
• Mobile Network(MTN)-Royalty program e.g.
Simcard registration
• Government/Development Partners: Social
service

18. The doctor of the future will give no medicine, but
will interest her or his patients in the care of the
human frame, in a proper diet, and in the cause and
prevention of disease.
Thomas A. Edison
US inventor (1847 - 1931)