Every morning, mother of six Mariama rises early to sell fish in her local market in Senegal. For the past decade, she has lived with diabetes, and takes insulin regularly. But her medication is not the only tool she relies on to look after her health – her mobile phone plays a critical part of her diabetes control regimen.
Thanks to Senegal’s mDiabetes programme during the Islamic holy month of Ramadan this year, Mariama has found it easier to cope with the condition and have the energy needed to work and care for her family. “These messages really help me manage my condition,” she says. They have also allowed her family to actively engage in her care.
“Every day I would ask my son to check if there was a new message,” Mariama adds. “He would help me understand what I needed to do to stay healthy and control my diabetes, and we would then talk about it together.”
The role of the mobile
Information and communications technology, or ICTs, especially the mobile phone, are changing expectations around access to health information. Mobile phones can support diabetes prevention by providing simple tips on good management or prevention, usually around diet, exercise and checking for signs of complications such as diabetic foot complications.
Since 2013, WHO has been working with the International Telecommunication Union (ITU) to help countries like Senegal introduce large-scale mDiabetes services using mobile phones. The joint initiative, Be He@lthy, Be Mobile, works to design, deploy and scale up prevention and management services for diabetes and a number of other noncommunicable diseases (NCDs).
Diabetes was one of Be He@lthy, Be Mobile's first major programmes. The initiative has created a global handbook to help countries introduce large-scale services, including content for the SMS messages and support for other areas such as technology, promotion and evaluation.
Using SMS to deliver advice to patients speeds up the diffusion of information to help people manage or prevent the disease. This reduces prevalence and treatment costs, and helps patients live longer, healthier lives.
A global perspective
Diabetes continues to be a serious public health challenge. Since 1980 the number of people with diabetes has increased four-fold to 422 million, and in 2015 an estimated 1.6 million deaths were directly caused by diabetes. This does not account for the additional impact of high blood glucose, which causes around 2 million deaths annually by increasing the risk of cardiovascular and kidney disease and tuberculosis. Poorly controlled diabetes aggravates the risk of debilitating and costly complications, such as blindness, kidney failure, heart disease and stroke, and lower limb amputations.
Senegal was the first country to launch a targeted mDiabetes campaign in 2014 to help people manage fasting during Ramadan. This has now become an annual service, and saw over 100 000 registrations in 2017.
But other countries are quickly following suit. In July 2016 the initiative launched an mDiabetes service in India which currently supports over 96 000 users. It also runs annual campaigns in Egypt to help people with diabetes manage fasting during Ramadan. The 2017 campaign there reached over 175 000 people.
From information to action
One of the service’s key lessons learned to date is the importance of making recommendations on diabetes management easy for patients to follow.
“It is important to frame facts in a way which encourages people to apply what they have learnt, in order for them to adopt new behaviours,” says Dr Douglas Bettcher, Director of WHO’s Department for the Prevention of NCDs, which runs the Be He@lthy, Be Mobile initiative. “By providing information in a format which is simple and action-oriented, it is easier for subscribers to incorporate the information into their daily routines and make positive changes in their diet, exercise and habits.”
It is also a key step in moving towards patient empowerment. By giving people the right information at the right time, they can take charge of their condition in between contacts with their doctor or health worker. For chronic diseases this is essential to improve quality of life and treatment outcomes.
Dr Prebo Barango, WHO’s focal point for the Be He@lthy, Be Mobile initiative in Africa, explains that better knowledge from the mDiabetes programme is impacting the way doctors support patients. “The programme has changed the format of medical consultations,” Dr Barango says. “Doctors ask their patients if they have received the SMS messages, and which ones they need more information about to make sure they understand what it means. The dialogue is more constructive.”
For Mariama, the benefit is clear. A programme which started as a simple six-week service has changed the way she manages her diabetes for good. “Thanks to the messages, I understand that I constantly need to pay attention to what and when I eat,” she says.