In recent years, Mobile Health has emerged as a promising approach to resolve health challenges in low and medium -income countries (LMICS). Along with the increase in mobile phones in remote areas, mHealth solution provides innovative ways to improve healthcare access, quality and efficiency in resources.

The Rise of mHealth in LMICs

Mobile technology has seen an unprecedented growth in LMICS, with mobile phone membership more than 5.3 billion worldwide. In the sub-Sahara Africa alone, the mobile penetration in 2000 has reduced by 10% which has exceeded 80% today. Thiswidespread adoption has created a unique opportunity to take advantage of mobile technologies for healthcare delivery. MHEALTH covers several applications from SMS-based health information systems to monitoring of the patient, electronic medical records and refined smartphone apps for telemedicine platforms. These technologies can help remove geographical obstacles, healthcare workers and limited healthcare infrastructure that plague many LMICs.

Successful mHealth Implementations

Several mHealth initiatives have demonstrated significant impact in LMICs:

MomConnect (South Africa)

This national program uses mobile phones to register pregnancy and provides expected mothers with stage-appointed health information via SMS. Since its launch in 2014, Momconnect has greatly improved over 2 million pregnancies and maternal health results. Momconnect operates through a simple USSD code that pregnant women can dial from any mobile phone to register for service. Once registered, they receive twice-weekly SMS messages to suit their phase of pregnancy, covering nutrition advice, warning signs and appointment reminder. The program also has a helpdesk where mothers can ask questions and provide feedback about health services, creating accountability in the healthcare system. The implementation included cooperation between South Africa’s health department, mobile network operators and NGOs. The program faced initial challenges with network coverage by designing low bandwidth solutions and working with telecommunications provider for zero- by-day, making it free for users. Participation features in Momconnect have played an important role in an increase of more than 40% to 75% of postpartum care and have increased the vaccination rates by about 25%.

mTRAC (Uganda)

his SMS-based system enables community health workers to report disease outbreaks and drug stock levels in real time. The system has improved the response time for outbreaks and reduced drug stockouts by more than 30%. By 2018, MTRAC was included in all 112 districts in Uganda, covering over 7,000 health facilities. MTRAC implementation equipped health workers with basic phones and trained them to send coded SMS messages about disease monitoring, drug stock levels, and healthcare distribution. The system created a direct channel between frontline health workers and district health offices, bypassing traditional bureaucratic delays. The platform has been particularly effective during disease outbreaks, enabling rapid responses to cases of cholera and Ebola. For example, suspected Ebola cases reported through MTRAC triggered response teams within hours instead of days. Additionally, the transparency brought by real-time drug reporting reduced ghost workers and drug leakage, saving the Uganda health system an estimated $5 million annually.

Mwana (Zambia)

This mobile application speeds up the delivery of HIV test results for infants, reducing the waiting time from months to weeks. Early diagnosis enables the timely initiation of antiretroviral therapy, greatly improving survival rates. The program has achieved a 50% decrease in turnaround time for test results. Prior to MWANA, the results of HIV testing for infants could take 2–3 months to reach rural clinics, causing treatment delays and high infant mortality. The MWANA system uses SMS technology to transmit processed results from central laboratories to rural health facilities. MWANA implementation requires minimal infrastructure—just basic mobile phones and a central server. The program trained local health workers on SMS protocols and established partnerships with mobile network operators to ensure reliable service. Beyond rapid diagnosis, MWANA created a broad follow-up system, tracking maternal-infant pairs throughout the continuity of care, and increasing retention rates by 35%. Improved efficiency has led to more than 90% of HIV-positive infants starting treatment within two weeks of diagnosis, compared to less than 30% before implementation.

Challenges to mHealth Adoption

Despite the promising results, many challenges obstruct wide mHealth adoption in LMIC: –

Infrastructure Limitations

Inadequate electricity, limited internet connectivity, and poor network coverage in rural areas create major challenges for mHealth implementation. In sub-Saharan Africa, only 43% of the population has access to electricity, making it difficult to continuously maintain and charge mobile devices. In Northern Nigeria, a maternal health project had to distribute solar chargers to community health workers after discovering that many villages had electricity for less than five hours daily. Similarly, a telemedicine initiative in rural India included offline functionality after finding that 60% of health posts had internet connectivity less than 50% of the time. These infrastructure challenges often require a hybrid approach. For example, Medico Mobile in Kenya combines smartphone data collection with SMS transmission when 3G/4G networks are unavailable. Some programs have established community charging stations or partnered with local businesses to provide charging services. Despite these adaptations, infrastructure remains a fundamental barrier that shapes which mHealth solutions are viable in different contexts.

Digital Literacy

Low digital literacy among both healthcare providers and patients can limit the effective use of mHealth solutions. Training programs require significant time and resources, which may not be readily available in resource-constrained settings. A tuberculosis surveillance program in Indonesia found that 40% of community health workers required more than three training sessions before they could use the application independently. Similarly, a patient-linked diabetes management app in Mexico achieved only 23% adoption among elderly patients without additional support. Successful implementations have addressed literacy challenges through thoughtful design approaches. Voice-based systems like Mobile Kunji in Bihar, India, use interactive voice response to support text messages with audio explanations. Graphical interfaces with minimal text have proved effective in low-literacy settings, as demonstrated by the Peak Vision I Care application in Kenya. A multi-level training approach has shown better results, including early workshops, ongoing mentorship, and peer learning networks.

Data Privacy and Security

Concerns about data privacy and security, combined with a limited regulatory framework for digital health, are particularly relevant. Many low- and middle-income countries (LMICs) lack extensive data security laws, raising serious concerns about the collection and use of sensitive health information. A 2022 review found that only 17 out of 54 African countries had implemented a comprehensive data protection act. This regulatory gap poses risks to both personal privacy and public trust in health systems. For example, a TB tracking application in Southeast Asia faced backlash after a data breach raised community concerns. Progressive implementations address these challenges through both technical and governance approaches. Technical measures include end-to-end encryption, the principle of data minimization, and strong authentication systems. On the governance side, programs such as Motec in Ghana have established community inspection boards that include patient representatives in decisions about data use. Many countries, including Kenya and India, have developed specific health data policies that adapt international standards to local contexts.

Sustainable Financing

Many mHealth initiatives rely on donor funding, making long-term stability challenging once the initial funding ends. Developing a sustainable business model remains a critical challenge for mHealth interventions in LMICs. An analysis of 47 mHealth projects in Africa found that 60% of operations ceased within two years of the donor funding ending. The transition from proof-of-concept to continuous operation often fails because the business model is not considered early enough. Government absorption of costs is often discussed but rarely planned systematically. Programs that have achieved stability typically adopt hybrid funding models. Bangladesh’s Aponjon maternal healthcare service combines free basic services with premium content for paying customers, ensuring accessibility across income levels. In Kenya, M-TIBA created a digital health wallet that enables targeted subsidies through health savings, insurance payments, and the same platform. Public-private partnerships, such as the SMS for Life program by Novartis, leverage corporate resources for public health goals. Government integration has proven to be the most durable approach when mHealth costs are included in existing budget lines rather than treated as separate technology projects.

The Way Forward

To maximize the capacity of MHEALTH in LMICS, stakeholders must consider the following approaches:

Human-Centered Design

Successful mHealth solutions must be designed with input from end-users, taking into account the local context, literacy levels, and cultural factors. User-centered design approaches ensure that solutions address real needs and are accessible to the intended users.

Concrete implementation of human-centered design includes conducting contextual inquiries before technology selection, iterative prototyping with representative users, and continuous feedback mechanisms. Dimagi’s work on CommCare in India exemplifies this approach—initial designs were completely overhauled after observing community health workers struggling with hierarchical menu structures. The revised interface used a simplified linear workflow with contextual images, dramatically improving usability.

Effective projects also consider the broader ecosystem in which the technology operates. A maternal health app in Ghana incorporated traditional birth attendants into the design process, resulting in a collaborative rather than competitive relationship with the formal health system. In Bangladesh, bKash’s integration with health apps emerged from observing financial barriers to care-seeking behaviors.

Community co-design workshops, where end-users participate directly in solution development, have proven particularly effective. These approaches require more upfront investment but typically lead to better adoption and sustainability. Organizations should allocate 20-30% of project resources for user research and iterative design, rather than treating these as optional add-ons.

Integration with Existing Health Systems

Instead of creating a parallel system, mHealth initiatives should integrate with the current health information system and workflow. Standardized interoperability is important to enable various systems to work effectively together. Integration requires both technical and organizational approaches.

On the technical side, following standards such as FHIR (Fast Healthcare Interoperability Resources) or facilitating Open Data Exchange is crucial. Countries like Rwanda and Tanzania have established National Health Information Exchanges, which provide integration points for mHealth initiatives.

Organizational integration focuses on alignment with existing workflows and reporting structures. For example, Kenya’s integrated mHealth platform, Community Health Swayamsevak, connects the app to the District Health Information System (DHIS2), ensuring that mobile data collection supports, rather than mimics, the official reporting requirements. In India, the ANMOL program for assistant nurse midwives integrates tablet-based equipment with the existing responsibilities and supervision structures of health workers.

Practical steps for integration include mapping information flows before introducing new technology, involving health system managers in design decisions, and planning for integration rather than the disruptive replacement of existing systems. Programs should also consider non-digital touchpoints—when required records are needed by regulations, or when technology fails, integration with backup paper systems and in-person supervision mechanisms is necessary.

Evidence-Based Implementation

A more rigorous evaluation of mHealth interventions is essential to determine what works and to create evidence that informs policy decisions. Moving beyond feasibility studies to more impactful evaluations can strengthen the case for investment in mHealth. The evidence base for mHealth is currently characterized by small-scale studies with varied methodologies. Effective implementation requires a diversified evaluation approach, beyond randomized controlled trials, to include methods suited for complex, adaptive systems in order to strengthen the scientific foundation.

Practical considerations include integrating evaluation into the implementation process from the beginning, with clear indicators and baseline data collection aligned with health system priorities. Mixed-methods assessments that combine quantitative measures of health outcomes with qualitative insights into implementation processes provide more actionable insights than either approach alone. Cost-effectiveness analysis is a central component of mHealth literature. Programs such as Living Goods in Uganda have strengthened their case for sustainability by documenting health impacts as well as the cost per Disability-Adjusted Life Year (DALY). Collaboration between educational institutions and implementation organizations in implementation science can improve both rigor and relevance. For example, mobile technology initiatives for community health in Ghana combined academic evaluators with implementation teams, creating feedback loops that improved the program by generating evidence suitable for publication.

Recent Trends and Future Directions

1.Artificial Intelligence and Machine Learning

AI-operated MHEALTH applications are showing promise in areas such as clinical support, future analysis for the outbreak of diseases, and individual health recommendations. These technologies can help improve healthcare workers’ decision-making. In practice, AI apps in LMICs focus on specific high-value uses where algorithmic approaches address clear obstacles.

The ThinkMD application in Ethiopia uses a simplified clinical decision support algorithm that enables community health workers to identify pediatric diseases with the accuracy of trained physicians. In India, the Happiness Baby platform uses machine learning to identify high-risk pregnancies from community health workers, allowing limited resources to be directed towards women most likely to experience complications.

Implementation approaches are being developed to overcome obstacles in LMICs. Lightweight algorithms designed to run on edge devices reduce connectivity requirements. Transfer learning techniques optimize pre-trained models in local contexts using small datasets. Explainable AI approaches provide arguments for recommendations, building confidence with health workers and patients.

Ethical structures for AI are emerging in resource-constrained settings, with a focus on local data governance, algorithm transparency, and equity. The Path Digital Square Initiative has developed evaluation tools for AI applications in LMICs, which assess both technical performance and suitability for integration with health systems.

2. Internet of Things (IoT) and Wearables

Low-cost sensors and wearable equipment are capable of significant signals and distance monitoring of disease management, especially for chronic conditions such as diabetes and high blood pressure. These technologies can reduce the requirement of in-tradition visit and enable continuous monitoring. Adaptation for LMIC references focus on strength, durability and low-power operations. In Nigeria, the Ubenwa app converts the smartphone into clinical devices in clinical devices for birth, using the microphone of the phone to analyse the baby’s cry. In India, biosens’s touchb device enables the cost of laboratory test to screening anaemia without traditional blood draw in one-tenth place. Implementation models usually combine tools with human assistance systems. Add a low-cost glucometer with Cambodia’s Mopotsio Diabetes Program Peer Educator Network and SMS reporting. This human-in-loop approach addresses both technical and psychological aspects of chronic disease management. Power and connectivity obstacles are being addressed through new approaches. The University of Lagos has developed solar energy-powered important sign monitors for maternal health that can store data for weeks between synchronization. In rural Peru, Aries Network enables village-level connectivity to medical IOT devices without the need for cellular coverage in each house.

Conclusion

Mhealth offers an important opportunity to change healthcare delivery in LMICS. While challenges remain, potential benefits in terms of better access, quality and efficiency make MHEALTH a meaningful investment. By addressing the major obstacles and adopting colleagues, evidence-based approaches, stakeholders can use mobile technology power to advance healthcare in resource-granting settings. The Covid-19 epidemic has accelerated the adoption of digital health, creating new pace for MHEALTH initiative worldwide. Health systems investing in digital infrastructure demonstrated more flexibility during the crisis. In India, Aarogya Setu Contact Anurekhan app reached over 100 million users in record time, built on existing digital recognition systems. At Ghana, the National Health Insurance Mobile Renewal Forum processed more than 70% of all renewal during the lockdown period, maintained financial security for the weaker population.

Further, the integration of mHealth with comprehensive digital health ecosystems represents the next frontier. Countries like Rwanda are leading extensive outlooks that combine community-level mobile applications with convenience systems, national health insurance platforms and health worker training programs. This integrated approach increases the effect by addressing several health system functions simultaneously. As we move forward, it will be important to realize the full potential of mHealth in advancing universal health coverage, ensuring that these digital solutions promote equity and reach the weakest population. This requires deliberate design options – such as support for local languages, accessible interfaces for persons with disabilities, and penis dynamics in technology access. It also demands professional models that ensure the ability for the poorest users, whether through cross-safety, targeted public financing, or innovative payment mechanisms. The future of MHEALTH in LMICS will probably characterize strong integration with local ownership, more sustainable financing models, and health systems. Thinking of learning and emerging technologies since a decade of implementation experience, mHealth can fulfill its promise as a powerful tool to strengthen the health system in resource-developed settings.

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