London School of Hygiene and Tropical Medicine, UK

This article evaluates the strategy of using mobile phones as a tool for promoting maternal, newborn and child health (MNCH) in developing countries, using Egypt as a case study. Information presented in this article is based on a qualitative study conducted by the author in Minia Governorate, Egypt in 2002-2003, and uses a framework developed for the UK Partnership for Global Health and the Nuffield Trust in 2002 entitled "Integrating Information and Communication Technology to Improve Global Health: A Conceptual Framework".

Mechael begins noting that information and communication technology (ICT) is of "strategic importance" in the health sector in that it "facilitates the sharing of health data, information, knowledge and resources between the different stakeholders in the health sector". She points out that health is both knowledge- and communication-based, and argues that ICT can support both these elements in the presence of "strong political will to meet the health needs of women and children" and, by extension, to successfully reach the Millennium Development Goals (MDGs) for health.

One such opportunity to use technology to support health knowledge and communication has presented itself, and been implemented with life-saving results, in Egypt. This country is cited by the World Health Organization (WHO)'s World Health Report 2005 as having made significant progress in addressing maternal and child health; the author shows here that mobile phone technology has been central to that progress:


Direct Benefits:

1. reduced response time to obstetric emergencies through the use of mobile phones to contact formal and informal means of medical transport, leading to reduction in risk of complications and death during childbirth. For instance, in rural areas Egyptians have used mobile phones during home deliveries to mobilise assistance in extreme cases. Mechael finds that medical transport is typically arranged through private/informal transporters (who also tell of being consulted about which health service provider to visit), rather than through local ambulance services.
2. consultation between health professionals - e.g., between traditional birth attendants ("dayas") and nurse mid-wives and nurse mid-wives and physicians. "For them [dayas] consultation with health professionals has always been a sensitive subject as it somehow implies that they do not have things 'under control'. In spite of this traditional reluctance, nurse midwives with mobile phones shared that they have been on occasion summoned for assistance or consulted by dayas managing difficult deliveries."

Indirect Benefits:

1. increased ability for women to work outside of the home resulting in increased household income
2. savings in financial resources from transportation that is no longer necessary due to telephone access
3. increased education opportunities, particularly for young women - in Egypt it is seen as more important for young women to have mobile phones than it is for young men.

Beyond the health services context, Mechael points to some cultural and policy-related communication factors benefitting women and children. Her research revealed that "Most women prefer to contact their mothers or sisters when they require health-specific decision-making support when dealing with their own as well as their children's health. Mobile phones increasingly are facilitating access to this guidance as well as consultations with physicians when higher level information is deemed necessary. In Egypt, one can also place orders by phone with pharmacies to deliver medicines - saving time to treatment for basic childhood illnesses."

What other factors have contributed to the successful use of mobile phones as tool for promoting maternal and child health in Egypt? Mechael notes that Egypt has a large number of mobile phone subscribers (8 million of the world's 1.52 billion subscribers) and increased fixed line installations. Furthermore, Egypt has the health infrastructure to integrate technology to better respond to health needs. As an example, the author points to a programme under development in Egypt as part of the Healthy Mother/Healthy Child Initiative to establish communication links through land-lines and mobile phones between dayas and local health professionals. "While efforts and good decisions allows for immediate and local responses to health problems, there remains an opportunity to link work being done at the national level to activities at the district level," she holds; a strong telecommunications infrastructure and commitment to maternal and child health support this linkage. Mechael concludes that "the impact of mobile phones on maternal, newborn, and child health in poor countries depends on whether it is achieved as a by-product of its general integration into society or through direct engagement."