Mapping mHealth (mobile health) and mobile penetrations in sub-Saharan Africa for strategic regional collaboration in mHealth scale-up: an application of exploratory spatial data analysis

Mobile health (mHealth), a term used for healthcare delivery via mobile devices, has gained attention as an innovative technology for better access to healthcare and support for performance of health workers in the global health context. Despite large expansion of mHealth across sub-Saharan Africa, regional collaboration for scale-up has not made progress since last decade. As a groundwork for strategic planning for regional collaboration, the study attempted to identify spatial patterns of mHealth implementation in sub-Saharan Africa using an exploratory spatial data analysis. In order to obtain comprehensive data on the total number of mHelath programs implemented between 2006 and 2016 in each of the 48 sub-Saharan Africa countries, we performed a systematic data collection from various sources, including: the WHO eHealth Database, the World Bank Projects & Operations Database, and the USAID mHealth Database. Additional spatial analysis was performed for mobile cellular subscriptions per 100 people to suggest strategic regional collaboration for improving mobile penetration rates along with the mHealth initiative. Global Moran's I and Local Indicator of Spatial Association (LISA) were calculated for mHealth programs and mobile subscriptions per 100 population to investigate spatial autocorrelation, which indicates the presence of local clustering and spatial disparities. From our systematic data collection, the total number of mHealth programs implemented in sub-Saharan Africa between 2006 and 2016 was 487 (same programs implemented in multiple countries were counted separately). Of these, the eastern region with 17 countries and the western region with 16 countries had 287 and 145 mHealth programs, respectively. Despite low levels of global autocorrelation, LISA enabled us to detect meaningful local clusters. Overall, the eastern part of sub-Saharan Africa shows high-high association for mHealth programs. As for mobile subscription rates per 100 population, the northern area shows extensive low-low association. This study aimed to shed some light on the potential for strategic regional collaboration for scale-up of mHealth and mobile penetration. Firstly, countries in the eastern area with much experience can take the lead role in pursuing regional collaboration for mHealth programs in sub-Saharan Africa. Secondly, collective effort in improving mobile penetration rates for the northern area is recommended.