mHealth for Persians (Part 1): A perspective on Iran mHealth development

As with many other medium to low-income countries, Iran’s health system can benefit from mHealth solutions. Moreover, with mobile networks servicing 90 percent of the country through two main operators and upgrades to 3G networks expected sometime this year, mHealth for Iranians is expected to grow quickly.

But for some reason adoption rates remain low. Adoption of mHealth in Iran is stagnated because of our many unique barriers, as well as a number of common international barriers to mHealth.

The difference may lie in what steps Iran takes to implement mHealth over the next two years. Because of the rapid progress of mobile technologies, there is a risk that the country will fall behind in technological advances.

There are five main issues which will impact mHealth development and adoption throughout Iran:

1. There is no powerful copyright policy in Iran. One of the most useful and well-developed components of mHealth is mobile software’s underlying architecture. However, the lack of preservation of publishers’ and developers’ rights is a huge barrier to expanding mHealth development. No one can deny that mobile software development offers the most economic benefits when intellectual property is protected. However, IP protection remains stagnant, further stunting the adoption of mobile health technologies within Iran. There is a need to gain support from governmental and non-profit organizations or ICT companies to further mHealth adoption.
2. Lack of basic IT knowledge of healthcare providers and health system professionals has a big effect on the implementation of mHealth within Iran. Health systems should be ready to embrace the adoption of mHealth technologies. But because health IT curricula receive little or no coverage within our health and medical university curricula, health systems have become a possible barrier for mHealth development. From another aspect, there is a need for alert and knowledgeable healthcare providers both to implement and develop mHealth ecosystems in Iran. However, new education trends for improving healthcare providers’ acumen for health IT knowledge seem to be occurring in graduate and post-graduate health education. As healthcare providers’ knowledge increases through targeted robust curricula, new doors will be opened for mHealth activities.
3. Health policies remain a complicated matter for mHealth development both in Iran and internationally. In Iran, health policies are established by the Ministry of Health. Unfortunately the ministry hasn’t paid any attention to mHealth yet, or if it has, there is no outright policy on the issue. So at this time, the ministry doesn’t have any initiative role in m-Health development or associated incentives. This offers a great opportunity for non-governmental organizations and private companies to make their mHealth projects come true. mHealth is at a critical junction in Iran’s health systems. The ICT sector is vibrant, with growing and emerging technologies. Fast mHealth innovation, coupled with slow health system adaptation, could affect mHealth interventions and impact healthcare delivery. It could take a year or longer to arrange and triage mHealth interventions by priority and importance in Iran.
4. Economic lockout. In comparing mHealth’s initiation in Iran with similar countries, we see international organizations’ footprints on the development path in other countries, but because of the economic lockout there is less international collaboration here. This lockout tempers the speed of mHealth development and initiation. Due to the lack of a reassured investment environment, most of the internal and external investors have no desire to become involved in mHealth development in Iran. As a result, rapid development of mHealth seems more like a dream over the next two years. However, the recession does provide an opportunity to improve mass knowledge and create a base of knowledge for health system professionals, ICT professionals and anyone who can assist in mHealth development. The current economic environment may also provide an opportunity to align the strategic goals of Iran and address a number of outlined barriers to advance mHealth.
5. Lack of health IT professionals. There is a shortage of health and ICT intra-disciplinary individuals in Iran. mHealth is an intra-disciplinary area of knowledge and there is a need for individuals to link health and ICT. With this gap, there is an unavoidable shift of focus to one side, health or mobile. Most often ICT engineers and healthcare providers don’t understand the complexities of the mobile environment coupled with the intricacies of healthcare delivery. This causes concern that mHealth projects don’t function as well as they should or they don’t adequately stratify the divergent needs of various professionals. Again there is a need for educating intra-disciplinary individuals to avoid failure of mHealth projects. Of course the mHealth professionals in other countries can help us to cover this shortage as consulters in related projects.

As outlined above, some of the barriers and problems facing mHealth development in Iran are the same as those in other countries. These similarities remind us that we should use the experience of other countries to reduce waste and redundancy in growing mHealth.
Unfortunately, we believe that mHealth development in Iran over the next two years will have little improvement on the delivery of healthcare and, unfortunately, the speed of progress may fall behind global trends.

The first initiation of mHealth in Iran happened in January 2011 at the 1st National Health Digital Media Festival. The term “initiation” is used because one of the categories at the festival was mobile gadgets in health, especially applications in public health. However, there were limited participants – this will hopefully increase during the next festival. Another example of mHealth activities was an “mLearning” project associated with H1N1 flu presented by the Iranian Ministry of Health. However, the term “mLearning” may not necessarily reflect or encompass all aspects of mHealth.

It appears that most of the individuals working or thinking about mHealth projects don’t realize that “mHealth” is a word and have no idea what it means or the wealth of international expertise. This lack of knowledge surrounding mHealth will reduce the speed of development in Iran because the individuals don’t know the name of the field in which they are conducting their projects. The other consequence related to this lack of knowledge will be that Iranian innovators and mHealth “adventurists” will actually experience what others internationally have experienced before.

A speech during the mHealth Summit in December 2011 revealed that only 12 percent of countries conduct surveys on their mHealth projects, and the overwhelming lack of supporting documents in this field impacts the adoption of mHealth. However, there is enough information to avoid some pitfalls and broad industry support of mHealth as a “disruptive” technology, a phrase commonly invoked by Dr. Eric Topol.

Health and ICT intra-disciplinary professionals can play both an initiative and formative role in advancing mHealth. But, unfortunately there is a shortage of these individuals in Iran. Future business benefits surrounding mHealth and improved market conditions should engage health professionals and IT engineers to move toward working on mHealth projects. Future exposure to knowledge and the benefits of mHealth will hopefully attract additional industry participants and potential international organizations to work on advancing mHealth projects. However, the quality of these projects is mostly affected by the project income coupled with the need to provide a sustainable and cost-effective solution. There is a need to highlight the main goals of mHealth for improving the quality of healthcare in addition to addressing the financial incentives necessary to implement mHealth properly in Iran.

The Iranian Ministry of Health, like many government institutions around the world, is recognizing the need for engagement and may introduce some mHealth projects through 2012 and into 2013. Much of this depends on the political environment of the country over the next two years. The development of mHealth in Iran will certainly happen, but the quality and quantity of the progress absolutely depends on how health systems adapt to new changes. There is a need for a convergence of industry knowledge, bolstered by financial incentives, to move Iranian mHealth forward.

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Aidin Parnia is CEO and founder of the Iran mHealth group at the Isfahan University of Medical Sciences, Isfahan, Iran. Editing assistance was provided by Maryam Fakhri, co-founder at Iran mHealth. He can be reached at draparnia@gmail.com