1. SMART HEALTH I 40
An interview by Beatriz Cortiles
Technology is certainly a possibility of
great significance in the health world
and you have been pioneer in this area.
From your experience, where was
eHealth then and where is it today?
The eHealth ecosystem is immense. In
terms of my experience in the area, I
must begin by saying that I was incredibly
fortunate to be selected to join the newly
created eHealth Unit of the World Health
Organization (WHO) following the passage
of the eHealth Resolution in 2005. So, I
guess this makes me pioneer within that
context. Prior to the eHealth Resolution I
was involved in a project in WHO that was
in essence an eHealth Project.
The eHealth Revolution, as it has been
coined, has evolved rapidly gaining hard
ground. In those early days, everyone
wanted to do eHealth. Then came
mHealth. This is, in my opinion, a natural
evolution as mobile is the most ubiquitous
technology even in the development world
and the potential there is huge. Mobile
Health was recognized within the United
Nations as a “game changer”. So we had an
mHealth Revolution. This translated into
a crowded landscape of mHealth pilots
in developing countries – also known as
“mhealth Pilotitis“. In fact, the government
of Uganda called a Moratorium on
mHealth Projects a few years ago. I think
that this is very significant and it signals
a determination of governments in
developing countries for taking control and
leading the expansion of eHealth in ways
that are strategic and integrated onto the
overall health and technological goals of
the countries.
Today, thanks to a stronger body of
evidence about “what works” in terms
of using technology to improve health
outcomes, leadership and governance
through policy and robust sustainable
business models, eHealth / mHealth is on
track and well positioned to move towards
becoming an essential ingredient for health
systems strengthening.
INDEPENDENT ADVISER AND RESEARCHER IN mHEALTH AND eHEALTH
FÁTIMA SANZ DE LEÓN
After ten years working for the World Health Organization coordinating different programmes
to bring technology to healthcare, Sanz de León is now reasearching for international private
companies a manner to introduce mobile applications in different areas, such as maternal and
child health, VIH and Ebola
There was great need to develop effective risk communication at the population level to control the
spread of Ebola
“WE HAD AN mHEALTH REVOLUTION”

2. SMART HEALTH I 41
INTERVIEWINTERVIEW
““El uso de
plataformas
como Emminens
eConecta hace
posible un
seguimiento
personalizado
y mucho más
continuado”
“
Let’s give some specific examples in
developing country contexts, far away
from communication hubs. For them, is
this a science fiction movie?
I don’t think so but I agree that some of the
things that technology has achieved for
health can be science fiction in any corner
of the world. Many eHealth applications
now used in developing countries have
emerged from developing countries,
mainly out of needs and availing of the
technological infrastructure in place.
mPedigree is a good example, it originated
in Ghana and it’s an anti-counterfeiting
solution. Counterfeit drugs are a huge
problem in Africa. Another example is
mobile money which is now being used as
a health financing mechanism. Branded as
mPesa, it emerged in Kenya and it’s widely
used.
In crisis situations like Ebola, there have
been numerous initiatives undertaken
to develop effective communication
strategies that support a rapid response.
You have been involved in this work. Can
you explain?
In view of the magnitude and the
contagious characteristics of the Ebola
epidemic, there was great need to develop
effective risk communication at the
population level to control the spread of
Ebola. I had the opportunity to undertake
research and interview key stakeholders
to support the mapping of the key
components for population-centered
communication for behavior change via
mobile phones. For example, much of the
transmissions happened during traditional
The eHealth
Revolution has
evolved rapidly
gaining hard
ground
mHealth was
recognized
within the United
Nations as a
‘game changer’
“
burial ceremonies. An important challenge
for the international community, in
terms of prevention, was how to change
risky behavior and stop the chain of
transmission. Messages went out to the
population via radio, TV, and also mobile
phones. But there were many challenges.
I put together a framework that maps
the key components for such strategy
to overcome some of these challenges.
For example, in terms of sending the
message via mobile phones to the
population, a major challenge that I
identified in my research was the lack
of experience in collaborative programs
between public – Ministry of Health and
Fátima Sanz de León, independent researcher in mHealth and eHealth

3. SMART HEALTH I 42
FÁTIMA SANZ DE LEÓN
Telecommunications – and the private
sector -mobile phone operators and
service providers. The rigidity in terms
of regulation and protocols can be a
key barrier in face of providing a rapid
response to an emergency.
Recently, the GSMA has launched a
Humanitarian Connectivity Charter,
to improve cooperation between these
sectors. This initiative underscores
the recognition of mobile phones in
supporting responses to emergencies.
In my opinion, this is a breakthrough
for enabling the use of mobile phone
communication in emergencies.
But, regardless of the medium used,
sending a message to a population,
particularly if it is about changing
specific behaviors that are deeply
rooted in traditions, one must have a
solid anthropological knowledge and
understanding of the target audience.
For example, in the context of Ebola in
West Africa, a major barrier was the
mistrust of governments and international
organizations. In these contexts, rumors,
myths and disbelief spread like wild fire. A
key to success was engaging community
leaders and key influencers. The initial
communication had limited impact,
some door-to-door messengers were
murdered. In fact, in a second phase, a new
communication campaign was launched
under the motto “Ebola is Real”.
You have also worked in the area of
mobile phones to improve Women’s and
Children’s Health. Can you provide some
examples?
Mobile technology has been identified by
the UN Secretary General as providing
great potential in accelerating progress
towards attaining the Millennium
Development Goals 4 and 5, which are
reducing child mortality and improving
maternal health. In this context, I
undertook some research work for
various organizations. Today, there are
numerous projects that - thanks to mobile
technology- are empowering women
by providing vital targeted information
about reproductive health, pregnancy, and
newborn health. For example, MAMA, the
Mobile Alliance for Maternal Action, with
an effective social marketing approach has
informed over a half a million women in
developing countries very successfully.
Is mobile the cornerstone of our
operability in our future health system?
Are there other alternatives?
Indevelopingcountrycontexts,particularly
in what we call the “last mile”, there are
no other alternatives. In those contexts,
mobile technologies have leapfrogged
other technologies like fixed lines. It will
take time to establish the infrastructure to
accommodate other solutions.
What is HINARI?
HINARI or Access to Research is very
special to me and the reason I joined
the WHO. It’s a groundbreaking initiate
launched in 2001 by WHO and major
publishers to bring access to biomedical and
health literature to low- and middle-income
countries. Talk about a solid business model
that responds to real needs in development
contexts and you get HINARI. It provides
free or very low cost online access to the
major journals. My role was to develop
the administrative strategy to manage the
memberships and communication with the
institutions.
Your engagement with these ethical and
social problems is a leitmotiv in your life.
Where is the origin of this vocation?
50% of the vocation is probably inherited
and the result of my Spanish education
and the values transmitted by my parents.
The rest of my vocation in development
work was first evident when I worked for
the United Nations Volunteers, my first
experience in the United Nations System.
UNV is the Volunteer arm of the UNDP,
the United Nations Development Program.
The Volunteer spirit is very contagious.
These are people who are devoted to
helping others through development work
and whose gratification for their work
is just inspirational. At the time, I also
supported the establishment of a databank
of ICT Volunteers covering all areas of
development not just health, ICT for
development.
You are already a relevant figure in the
sector. What are your expectations for
the future?
I would like to continue doing what I
do aiming at doing it better each time.
One of the mechanisms is through my
collaboration with other experts in this
space, the Global eHealth Consultants
which is a Swiss consulting firm. At the
same time, I am currently finalizing a
degree in International Health at the Swiss
Tropical and Public Health Institute. For
me, to do eHealth begins at understanding
what the health challenges are. It’s about
bringing technology to the service of health
and not the other way around.
My short-term goal to make a
contribution to the field of eHealth for
development is in the context of my thesis
planned at the end of this year. I would
like to engage the right partners to work
together on the right topic to bring about
meaningful research to support health
systems strengthening through technology
particularly mobile technology potentially
in the areas of maternal and child health or
emergencies such as Ebola.
eHealth and
mHealth are on
track and well
positioned to
move towards
becoming
an essential
ingredient for
health systems
strengthening
“
MAMA project, the Mobile Alliance for
Maternal Action