The majority of member states (83%) reported offering at least one type of mHealth service. However, many countries offered four to six programmes. The four most frequently reported mHealth initiatives were health call centres (59%), emergency toll-free telephone services (55%), managing emergencies and disasters (54%), and mobile telemedicine (49%). With the exception of health call centres, emergency toll-free telephone services, and managing emergencies and disasters, approximately two thirds of mHealth programmes are in the pilot or informal stage.

Higher-income countries show more mHealth activity than do lower-income countries. Countries in the European region are currently the most active, while those in the African region are the least active. mHealth is most easily incorporated into processes and services which historically use voice communication through conventional telephone networks. This would explain why the majority of countries are already offering health call centres, toll-free numbers and emergency services using mobile communications. The least frequently seen is the use of mHealth for surveillance, raising public awareness, and for decision support systems. These require enhanced capabilities and infrastructure to implement and therefore may not be a health priority in member states with financial constraints.

Consistently rated as the greatest barrier to mHealth adoption by responding countries was the problem of competing health system priorities. Health systems worldwide are under increasing pressure to perform under multiple health challenges, chronic staff shortages, and limited budgets, all of which makes choosing interventions difficult. In order to be considered among other priorities, mHealth programmes require evaluations. This is the foundation on which mHealth (and eHealth) can be measured - solid evidence on which policymakers, administrators, and other actors can base their decisions.

Evaluation is part of a process that can determine cost-effectiveness. It involves educating the public about the benefits of mHealth and leads to the creation of government policy, though these factors were reported as among the most persistent barriers to mHealth adoption by member states. Despite the need for evaluation, the survey found that results-based evaluations of mHealth implementations are not routinely conducted. Only 12% of member states reported evaluating mHealth services. A concerted effort needs to be made to promote the importance of evaluation and the sharing of results with all member states.

Effective policy will become increasingly important as the field of mHealth matures. Data security is a particularly important issue to address by means of policy. There are legitimate concerns about the security of citizen information by programmes using mobile health technologies. In particular, message transmission security and data storage security can put citizen information at risk if necessary precautions are not taken. Policymakers and programme managers need to be made aware of security issues in the mHealth domain so that appropriate policies and strategies can be developed and implemented. Policies will also be vital when attempting to harmonizing eHealth and mHealth initiatives and directions over the short and long term.

The survey results highlight that the dominant form of mHealth today is characterized by small-scale pilot projects that address single issues related to information sharing and access. There were only limited larger mHealth implementations (primarily supported by public-private partnerships). While it is anticipated that large-scale and complex programmes will become more common as mHealth matures, strategies and policies that integrate eHealth and mHealth interoperability into health services would be wise. mHealth is no different from other areas of eHealth in its need to adopt globally accepted standards and interoperable technologies, ideally using open architecture. The use of standardized information and communication technologies would enhance the efficiency and reduce the cost. To accomplish this, countries will need to collaborate in developing global best practices so that data can move more effectively between systems and applications.

Moving towards a more strategic approach to planning, development and evaluations of mHealth activities will greatly enhance the impact of mHealth. Increased guidance and information are needed to help align mHealth with broader health priorities in countries and integrate mHealth into the overall effort to strengthen health systems. To this end, WHO will undertake several actions.