Operational challenges in the Cambodian mHealth revolution

The use of mobile phones to deliver health programs (mHealth) has great potential in developing countries and mHealth initiatives such as the NightWatch malaria prevention program are becoming increasingly popular. However even when an mHealth intervention is known to be effective the structure of the telecommunications industry combined with user behaviours can make it extremely difficult to implement in some countries. This article describes the case of Cambodia where more than 90% of the population have access to a mobile phone due to limited accessibility of landlines but operational challenges plague even the simplest mobile interventions. The impact of this is already apparent with commercial mobile banking services. In Kenya the M-Pesa mobile banking system grew to around nine million users (21% of the population) within three years of launch. Despite Cambodians having a similar need for financial services an equivalent mobile banking product (Wing) has only reached around 250000 Cambodian users (2% of the population) in its first three years. Four significant operational challenges facing mHealth programs in Cambodia have been identified through the author’s own experiences implementing mHealth initiatives with the Cambodian Health Education Media Service (CHEMS). These challenges are potentially relevant to other countries with similar telecommunication markets: Switching Subscriber Identification Module (SIM) cards; Lack of functionality and Khmer language capability; Sharing mobiles; Competition with commercial spam.