Patterns of Mobile Phone and Mobile Internet Use in Rural India and China

With an additional 274 million mobile broadband subscriptions, 2014 was the first year in which mobile internet access has outpaced mobile phone diffusion in developing countries (ITU, 2015). One in four mobile subscriptions in developing countries now provides broadband access. Given that developing nations continue to face pressing challenges in areas such as healthcare, will the rapid pace of technology diffusion offer a fast track to essential development goals? The nearly 1,000 mobile-phone-based healthcare products and solutions contained in the GSMA’s “mHealth Tracker” in 2013 make such considerations plausible (GSMA, 2013).

My presentation at Connected Life 2015 will explore patterns of mobile phone use, mobile Internet use, and their application in healthcare contexts through survey data from 800 respondents, collected in 2014 in rural Rajasthan (India) and rural Gansu (China). The survey captured a range of mobile phone uses among owners and non-owners alongside self-perceived healthcare landscapes and people’s behaviour during illnesses. The field sites were chosen because of their particularly challenging healthcare environments while exhibiting comparable mobile subscription rates.

On the face of it, the conditions for mobile Internet use seem favourable. 78% of the rural households in the Rajasthani field site and 90% in Gansu own a mobile phone. Because of sharing patterns, only 4% in Rajasthan and 15% in Gansu would say that they do not have access to a phone. Amongst the phones to which people have access, nearly a third in Rajasthan and more than two-thirds in Gansu are Internet enabled.

Yet a closer look at the reported use of mobile phones in general and mobile data services in particular reveals substantial differences between the two contexts. Although an index of average mobile phone use in Rajasthan is with 0.33 only 0.1 units lower than Gansu’s average score of 0.43 (on a scale from 0 to 1), mobile data use in my Rajasthani field sites is almost non-existent (with an average index score of 0.02). It is considerably higher in Gansu (with a score of 0.29), but Internet use in each place is nearly or entirely absent for illiterate persons and people in the age group 45-and-above. In addition, hardly anyone borrows a phone to browse the Web.

Do these differences matter in healthcare? After all, people are no strangers to mobile phones when seeking care: one in five Gansu respondents and one in thirteen in Rajasthan report the use of mobile phones during recent illness episodes. Even more claim that they would use phones to help other people, and that they could access healthcare providers using a mobile. Alas, no one reports the use of mobile data when recalling how they navigated the healthcare system (while 80% of respondents did have an illness to report). The picture looks only mildly more promising in Gansu when the possibilities of access to various healthcare providers and third-party use are contemplated. Should we then wait for more technological learning until people master the mobile Internet for their healthcare needs? Caution is in order because preliminary analysis results suggest that the existing mobile phone use in the field sites—especially in Rajasthan—is rather a conduit of adverse behaviour.

What this tells us is that adoption, diffusion, and access configurations of technology are informative indicators but can mask important patterns of mobile phone use. In addition, though indigenous mobile-phone-aided healthcare solutions emerge in both contexts in spite of sanctioned mobile health services, they remain so far limited to basic modes of use. Whether we can consider the emergent use of phones for healthcare desirable, and whether future phone-based solutions would not just rectify the predicament earlier caused by the platform itself, requires more evidence than we presently have.

Marco Haenssgen
University of Oxford