BackgroundRates of cervical and oral cancer in India are unacceptably high. Survival from these cancers is poor, largely due to late presentation and a lack of early diagnosis and screening programmes. Mobile Health (‘mHealth’) shows promise as a means of supporting screening activity, particularly in rural and remote communities where the required information infrastructure is lacking.MethodsWe developed a mHealth prototype and ran training sessions in its use. We then implemented our mHealth-supported screening intervention in 3 sites serving poor, low-health-literacy communities: RUHSA (where cervical screening programmes were already established), Mungeli (Chhattisgarh) and Padhar (Madhya Pradesh). Screening was delivered by community health workers (CHWs – 10 from RUHSA, 8 from Mungeli and 7 from Padhar), supported by nurses (2 in Mungeli and Padhar, 5 in RUHSA): cervical screening was by VIA; oral cancer screening was by mouth inspection with illumination. Our evaluation comprised an analysis of uptake in response to screening and follow-up invitations, complemented by qualitative data from 8 key informant interviews and 2 focus groups.Results8686 people were screened through the mHealth intervention – the majority (98%) for oral cancer. Positivity rates were 28% for cervical screening (of whom 37% attended for follow-up) and 5% for oral cancer screening (of whom 31% attended for follow-up). The mHealth prototype was very acceptable to CHWs, who felt it made the task of screening more reliable. A number of barriers to screening and follow-up in test-positive individuals were identified. Use of the mHealth prototype has had a positive effect on the social standing of the CHWs delivering the interventions.ConclusionsmHealth approaches can support cancer screening in poor rural communities with low levels of health literacy. However, they are not sufficient to overcome the range of social, cultural and financial barriers to screening and follow-up. Approaches which combine mHealth with extensive community education, tailored to levels of health literacy in the target population, and well-defined diagnostic and treatment pathways are the most likely to achieve a good response in these communities.

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The growing cancer epidemic is a major public health challenge globally but especially in low- and middle-income countries where patients often have to make long and complex journeys to receive care. Extending cancer prevention, diagnosis, and treatment to low- and middle-income countries through innovative solutions such as digital health systems is an urgent health priority. We contend that such digital systems will achieve success and scale only when existing gaps in cancer care and control policies and practices are addressed to strengthen health systems and improve outcomes. We call for concerted action to focus on the effective implementation of cancer care and control policies and practice in last-mile settings to improve pathways to care for people with and at risk for cancer.

mHealth offers a unique opportunity to improve access, quality, and adherence of care in last mile and low-resource settings around the world. However, the path to scale for mHealth interventions can be complex and challenging due to the barriers presented by fragmented infrastructure, policy gaps, and more. This chapter proposes a framework of nine key components that are essential for the successful scale-up of mHealth including mature infrastructure, a conducive policy environment, strong institutional partnerships, well-designed and contextappropriate technology, a skilled health workforce, financial sustainability, interoperability, and an evidence-based approach to mHealth. While not exhaustive, this framework offers implementers and policymakers a potential path to scale up mHealth interventions in order to strengthen health systems and improve health outcomes-particularly in remote communities around the world.

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educated our local team on how to utilize the SOP and monitoring protocol and have seen great success with this to date. We have been able to monitor patients' adherence to the medication and have observed positive clinical results.Going Forward: With the success in our pilot clinic, we hope to continue to expand the use of hydroxyurea to additional clinics in Angola, which will impact and improve the quality of life of more patients living with SDC in Angola.Funding: This project was funded by Chevron and the medication was donated by AmeriCares in partnership with Bristol-Meyers Squibb.Abstract #: 1.004_TECMobile health innovations for low-resource settings: Experiences from a mental health community screening project in rural India Abstract #: 1.005_TEC