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  • South Africa uses 3D printing to cure deafness

    3D printing technology is a rapidly expanding method to manufacturing across numerous industries, including health.  Recently, a South African team of medical doctors took advantage of this disruptive technology to become the first to cure a patient’s deafness.  This advancement in surgery will offer hope to many suffering from hearing loss.

    The operation was performed by Professor Mashudu Tshifularo and his team from the University of Pretoria (UP) Faculty of Health at the Steve Biko Academic hospital on March 13, 2019. Using 3D technology, the team was able to recreate the bones of the middle ear to replace the damaged ones.  The surgery was successfully completed in under 2 hours and immediately restored the patient’s hearing. 

    The best part about the surgery is that it will be available to patients of all ages, from newborns to the elderly.  The use of 3D printing also offers a cost advantage over conventional ENT surgeries addressing hearing loss, thus making it accessible for all patients.

    This has become the next prestigious medical achievement for South Africa after having performed the first heart transplant in 1967 and demonstrates the innovations health care workers are undertaking to achieve universal healthcare coverage in Africa.

  • WHO digital health guideline: 6. targeted client communication for behaviour change

    The sixth part of the WHO Guideline on Digital Interventions for Health Systems Strengthening deals with targeted communication.

    WHO recommends targeted client communication via mobile devices for behaviour change regarding sexual, reproductive, maternal, newborn and child health, under the condition that concerns about sensitive content and data privacy are adequately addressed.

    The idea of sending health messages to help people find care, or to retain them in care, has been around for some time. Digital channels allow progressively more precise targeting of those messages, based on a person’s health status or demographic profile. Channels include text messaging, voice, interactive voice response, multimedia and gamified apps on mobile devices, social media.

    Targeted communication appeared in two previous communicable disease guidelines. The 2016 guidelines on the use of antiretroviral drugsinclude a recommendation on the use of text messaging to support adherence to antiretroviral therapy; and the 2017 guidelines for treatment of drug-susceptible tuberculosis and patient care recommend the use of text messages and voice calls to support health education and treatment adherence.

    Effectiveness evidence evaluated for the Digital Interventions Guideline revealed the following.

    1. There may be positive impacts on some behaviours and health outcomes for:

    Oral contraception use by adolescentsModern contraception use by adultsAdherence to antiretroviral medicationsAttendance of antenatal care appointmentsTaking iron and folate tablets during pregnancySkilled birth attendanceReceipt of childhood vaccinationsAttendance of HIV appointments among exposed children.

    2. There may be little or no difference to:

    Health status as assessed by CD4 count Adherence to prenatal antiretroviral medication.

    3. Very low certainty of evidence for:

    Adherence to antiretroviral medicationAttendance for STI/HIV testing among adolescentsBreast and cervical cancer screeningWomen’s attendance for neonatal appointments.

    4. There may be some unintended negative consequences, such as women experiencing physical violence in the context of receiving targeted communications for sexual and reproductive health services.

    Evidence suggests that targeted communication is generally acceptable to individuals, creating feelings of support and connectedness. Nevertheless, some have concerns about the confidentiality of health information, particularly those with HIV infection and other aspects of sexual reproductive health, and may be difficult for people with low literacy, or limited or controlled access to mobile devices.

    There is extensive additional discussion in the Guideline. Pertinent comments include that measures should be taken to address issues such as mobile device access inequities and concerns about sensitive content and data privacy. Attention is also needed to implement adequate consenting procedures, ensuring that clients are aware of how to opt out of receiving the communication. Issues around policy, infrastructure and sociocultural considerations are discussed too.

    My next piece in this eHNA series will summarise recommendations on health worker decision support.

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    The WHO Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    Topics are:

    Acceptability and feasibility findings Birth and death notification via mobile devicesStock notification and commodity management with mobile devicesClient-to-provider telemedicineProvider-to-provider telemedicineTargeted client communication for behaviour change Health worker decision supportDigital tracking of clients’ health status and services Training and education via mobile devices

    Evidence is presented under headings of:

    EffectivenessAcceptabilityFeasibilityResource useGender, equity and human rights.

    Implementation considerations address key topics from the WHO/ITU National eHealth strategy toolkit, such as:

    Legislation, policy and complianceInteroperability and standardsWorkforce.

    Explore more eHNA coverage of WHO initiatives here.

  • WHO digital health guideline: 5. provider-to-provider telemedicine

    Countries need more than warm bodies to staff their health systems, they need those health workers to have appropriate competencies, skills and behaviours. Distance can be a serious barrier to health workers’ interactions. The role of telemedicine in overcoming this is the subject of the fifth recommendation of the WHO guideline on Digital Interventions for Health Systems Strengthening.

    WHO’s review of evidence suggests that provider-to-provider telemedicine “may improve health worker performance, reduce the time for clients to receive appropriate care or follow-up, and decrease length of stay among individuals visiting the emergency department”. It also notes that the opportunity to communicate with one other can help to reduce professional isolation, in particular helping lower-level health workers to access advice to enable better quality of care.

    Nevertheless, evidence also suggests that this form of telemedicine may have little or no effect on health outcomes and some health workers worry about liability and loss of control of their clients’ care.

    WHO recommends provider-to-provider telemedicine in settings where patient safety, privacy, traceability, accountability and security can be monitored.

    Additional comments include a recognition that telemedicine methods are changing with technological advances and that standard operating procedures may help address liability concerns. Implementation considerations include exploring integration with clinical record systems to support provider consultations, reviewing distribution of roles and responsibilities, and considering policy updates to clarify liability issues.

    My next piece in this eHNA series will summarise recommendations on targeted client communication for behavioural change.

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    The WHO Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    Topics are:

    Acceptability and feasibility findings Birth and death notification via mobile devicesStock notification and commodity management with mobile devicesClient-to-provider telemedicineProvider-to-providertelemedicineTargeted client communication for behaviour change Health worker decision supportDigital tracking of clients’ health status and services Training and education via mobile devices

    Evidence is presented under headings of:

    EffectivenessAcceptabilityFeasibilityResource useGender, equity and human rights.

    Implementation considerations address key topics from the WHO/ITU National eHealth strategy toolkit, such as:

    Legislation, policy and complianceInteroperability and standardsWorkforce.

    Explore more eHNA coverage of WHO initiatives here.

  • What's preventing eHealth adoption in Africa?

    African countries are converging under a common desire: to transform African healthcare through technology. But they also share a common frustration: African healthcare's slow and unsteady embrace of new technology. 

    Why do so many seemingly great technologies fail to penetrate the health care system?

    This was a question I asked myself while undertaking my master’s research. I hope the following answers shed some light on the realities of technology adoption in healthcare. 

    1. Many eHealth innovations don’t address the real problem 

    eHealth innovators start by discovering a useful technology. Later, they figure out how people can use it. eHealth should not only address a problem, but needs to be goal directed. Meaning, innovators should start with the goals of the end-user. The solutions come next. When the order is reversed, the results usually disappoint.

    As an example, the introduction of wearable health tech has excited innovators in the industry. These wristbands, watches, sensors and headsets can obtain and transmit large amounts of data on heart rhythms and blood pressure. However, there’s little evidence those wearing them overcome abnormal heart rhythms or elevated blood pressures better than those who don't. 

    2. No one wants to pay for new technologies 

    Creating an innovative technology to help doctors and patients isn't enough. Patients, doctors, healthcare facilities and insurance companies long for the benefits and value that these technologies provide, however, each thinks someone else should pay for it.

    Furthermore, new technologies that lowers costs and reduce patient visits discourage doctors and healthcare facilities from embracing these technologies because they work on a fee-for-service model instead of a fee-for-value model.

    3. The infrastructure to share information is underdeveloped 

    The introduction of the electronic health record (EHR) allows healthcare providers to share patient information and collaborate across different specialties to provide holistic treatment plans for the patients.  However, in Africa the supporting infrastructure, policies and standards for data sharing across multiple platforms and geographies are lagging.  Several African countries have started investing in strategic working groups to address this challenge.

    4. Technology slows down users

    For many healthcare providers, entering data into an EHR takes longer than keeping a paper record.  The structured format of the EHR also frustrates healthcare provider when the application prevents them from skipping steps or leaving out clinical details. 

    Frustrating as it may be, the added information reduces the risks of medical error, avoids redundant testing, and facilitates easier access to test results.  The benefits to the patient are clear, but less so for the healthcare provider. Getting healthcare providers to embrace these more effective approaches is the next big challenge for innovators to overcome.

  • WHO digital health guideline: 4. client-to-provider telemedicine

    Human resource shortages are a significant obstacle to Universal Health Coverage (UHC) in many countries. Telemedicine, by definition, supports “the provision of health care services at a distance”. The WHO 2010 report Telemedicine Opportunities and Developments in Member States provides a recent update on the factors affecting telemedicine and the WHO guideline builds on this.

    WHO recommends client-to-provider telemedicine:

    Under the condition that it complements, rather than replaces, face-to-face delivery of health servicesIn settings where patient safety, privacy, traceability, accountability and security can be monitored.

    Effectiveness evidence suggests that telemedicine may improve some outcomes, such as reducing mortality for some conditions, though little or no difference on other outcomes, such as hospital admissions. Qualitative evidence suggests that health workers appreciate being able to offer prompt advice and care, even if physical contact with the patient is not possible, though have concerns about telemedicine reducing client-health worker relationships, leading to poorer care, making health workers work beyond their capabilities, and leading to clinical liability.

    Despite the mix of available evidence, the guideline development group felt that telemedicine has the potential to expand access to health services, though should not detract for health workforce strengthening and needs standard operating procedures to be established. In African countries, where large distances compound health access barriers, telemedicine may be an important part of a national digital health strengthening plan.  

    This is the fourth piece in an eHNA series on the WHO guideline Recommendations on Digital Interventions for Health Systems Strengthening. The previous chapter was about using mobile devices for birth and death notification. The next one deals with provider-to-provider telemedicine.

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    The Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    You can find more eHNA coverage of WHO initiatives here.

  • Join leaders and innovators at the Digital Health Conference in Johannesburg on the 29th of May

    As digital health progresses across Africa in innovative and exciting ways, it becomes important to share ideas and leverage on each others knowledge to harness the full benefits of ICT-for-health.

    Leaders, innovators and experts will be gathering at the Gallagher Convention Centre in Johannesburg to do just that on the 29th of May. The conference agenda boasts an exciting line-up themed around “Digital Health Maturity: Fulfilling the Potential Towards Better Patient Care”. Featured topics for discussion include; 

    Digital health collaboration: Changing the way the department of health manages informationE-health tools for hospital equipment management: From guidelines to realityLeveraging IoT in healthcaree-Patients role in a sustainable digital health systemOpportunities and challenges in leveraging digital health for planning and policy implementation and monitoringUsing design thinking and community engagement to create improved human-centred health solutionsDigital health: the past, present and futureThe change from conventional theatre design to full digitalBeyond chat. Towards impact.Digitising the South African human hand

    Register your attendance for Africa Health's Digital Health Conference and take advantage of networking with speakers from across Africa.

  • WHO digital health guideline: 3. stock notification and commodity management via mobile devices

    The availability of health supplies at the point of care is critical to providing effective health services. This guideline explores the opportunity that increasing mobile phone penetration may provide to improve availability and reduce stock-outs.

    Evidence on effectiveness is limited and while qualitative evidence supports the principle of making stock availability data available digitally, it highlights feasibility challenges such as a mismatch of national and local order routines and obstacles of connectivity, electricity and application usability. WHO therefor recommends the use of stock notification and commodity management via mobile devices in settings where supply chain management systems have the capacity to respond in a timely and appropriate manner to the notifications.

    Additional comments include that stock notification via mobile devices is:

    Likely to provide a more expedient means of effecting stock notifications and ensuring the subsequent availability of commodities at the point of services, despite feasibility barriersA relatively low-risk intervention with potentially high impact.

    A policy issue includes that implementers should ensure there is no harm or reprisal to health workers for reporting stock-outs or wastage. Other considerations address workforce and interoperability.

    This is the third piece in an eHNA series on the WHO guideline Recommendations on Digital Interventions for Health Systems Strengthening. The previous chapter was about using mobile devices for birth and death notification. The next one will summarise the fourth guideline chapter on client-to-provider telemedicine.

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    The Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    You can find more eHNA coverage of WHO initiatives here.

  • Is a freemium model the way to go for eHealth apps?

    The proliferation of medical apps for disease prevention and health promotion has made healthcare ever more accessible. It is further facilitated by the ubiquity of smart phones and demand for better healthcare.  

    The number of digital health apps available in the market has reached over 300,000 apps on the top app stores worldwide, almost double the number available in 2015. Over 200 apps are added daily.  

    Sadly, many of these apps aren’t sustainable for more than a year, fail due to a number of reasons, including poorly structured revenue models.  A number of the businesses I evaluated during my master’s research relied on fragmented funding from various sources such as donor organisations to support development of their products.  When this funding is depleted, other revenue models need to be put in place to ensure sustainability. 

    Freemium is a popular model in which the basic application is free for users to download and use for as long as they like, though enhanced functionality is available at a price. Eventually, some of these satisfied, non-paying users will want to upgrade to a better version of the app or make in-app purchases, and hence become paying customers.

    In order to generate revenue from freemium apps, these three attributes need to be fulfilled;

    Capture high market share - the market strategy needs to revolve around capturing as much of the market share as possible because only a small percentage will become paying consumers and support the cost of non-paying users.Have a strong competitive advantage - the free offering must fulfil a need for the user in order to create a positive buzz, and the paid version has to create added value for customers to induce them to upgrade.Continued value creation - the freemium product should continue to add value as the user uses it over time in order to encourage non-paying users to switch over, and to maintain a consistent base of paying users.

    This model works well for innovations that are highly adaptive and iterative. Motivation to become a paying consumer relies on the value that the product adds for the user.  As soon as the value diminishes, interest in using the app wanes as well. The challenge for these companies becomes staying ahead of a rapidly evolving and innovative industry.

  • HELINA 2019 will be in Botswana – submit your paper by 10 July

    The Health Informatics Africa (HELINA) conference is a highlight on the African digital health calendar. The 2019 event will take place in Gaborone, Botswana, 20 to 22 November. eHNA will be there and we hope to see you too.

    The conference theme is “From Evidence to Practice: The implementation of digital health interventions in Africa for achievement of Universal Health Coverage (UHC)”. Its UHC focus provides a timely opportunity for countries to learn from one another’s experiences. Topics include:

    The maturity model approach to implementation of digital health solutionsDigital health learning systemsQuality and use of health data and systemsBig Data Analytics in health careHealth Information Systems InteroperabilityContinuous quality Improvement of health data and systemsDevelopment of competent human capacity for digital healthSustainable ICT-solutions for health service deliveryArtificial Intelligence and frontier technologies in digital health.

    Original presentations are invited in English or French. They should follow HELINA rules and be uploaded by 10 July 2019. Accepted papers will be published in electronic conference proceedings and some will be included in a special edition of the Journal of Health Informatics in Africa.

    Hosts include the Botswana Ministry of Health and Wellness, University of Botswana e-Health Research Unit, Botswana Institute for Technology Research and Innovation, Botswana Health Information Management Association. The event is supported by the US Centers for Disease Control and Prevention and Health First.

    For more information, read the online announcement, email the conference chair Dr. Tom Oluoch or local organizing committee chair Kagiso Ndlovu, or email the scientific committee chair Prof. Nicky Mostert.

    Digital health continues to expand in Africa. We look forward to the Gaborone update on countries’ health strengthening successes.

  • WHO digital health guideline: 2. birth and death notification with mobile devices

    A global effort is underway to strengthen Civil Registration and Vital Statistics (CRVS). Its ambitious goal is to achieve “universal civil registration of births, deaths and other vital events, including cause of death, and access to legal proof of registration for all individuals by 2030”. It’s led by World Bank and WHO.

    The guideline confirms that there is limited evidence on the effectiveness of using mobile devices for birth notification and no evidence of its effectiveness for death notification. It summarises qualitative data that suggest some acceptability, feasibility and equity issues that arise when using mobile phones for CRVS.

    The specific recommendations provided in the guide include an advisory that they only be applied after rigorous assessment of specific contexts and conditions. A number of other legal, workforce, infrastructure and ethical considerations are also discussed.

    WHO recommends the use of birth notification via mobile devices under these conditions:

    In settings where the notifications provide individual-level data to the health system and/or a civil registration and vital statistics (CRVS) systemThe health system and/or CRVS system has the capacity to respond to the notifications.

    WHO recommends the use of death notification via mobile devices under these conditions:

    In the context of rigorous researchIn settings where the notifications provide individual-level data to the health system and/or a CRVS systemThe health system and/or CRVS system has the capacity to respond to the notifications.

    The guideline development group (GDG) acknowledged that despite evidence limitations, the following potential advantages justify consideration of mobile notifications, after careful due diligence. The GDG notes that:

    Birth notification represents a vital first step in a care cascade that can ultimately lead to increased and timely access to health services and other social services, though birth notification should not be viewed as a substitute for legal birth registrationDeath notification Is recommended via mobile devices in the context of rigorous research and where notifications can be linked to health and/or CRVS systems, to address the lack of information on deaths, especially deaths outside of facilities.

    These CRVS recommendations and cautionary notes emphasise the complexities of digital health and the critical importance of understanding human contexts before promoting the use of mobile devices. African countries, which have numerous mobile health initiatives already underway, will find the discussion of this guidelines chapter useful to carefully consider mobile approaches to CRVS.

    This is the second piece in an eHNA series on the WHO guideline Recommendations on Digital Interventions for Health Systems Strengthening. The previous one was about acceptability and feasibility. The next one will unpack the third guideline chapter on stock notification and commodity management via mobiles.

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    The Guideline provides evidence-based recommendations for ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    You can find more eHNA coverage of WHO initiatives here.

  • WHO digital health guideline: 1. acceptability and feasibility

    This is the first piece in an eHNA series to unpack the WHO Guideline Recommendations on Digital Interventions for Health Systems Strengthening. The perspectives are relevant to digital health in African countries, where digital health is becoming a key driver of our health systems transformation.

    The chapter on acceptability and feasibility begins by describing factors that increase digital health acceptability for health workers, such as to:

    Help health workers to be more efficientSave travelling time, allowing health workers to spend more time with their clients or to provide more services, remotely to clients in rural areasAllow health workers to expand their range of tasks and take on tasks previously assigned to higher-level workers.

    It suggests that some health workers appreciate how digital technologies:

    Improve flexibility to work when convenient Reduce the need to be office-bound to access informationImprove coordination by connecting people, including clients and communities Raise health workers’ social status and increase the trust and respect they receive in communities.

    The guideline also recognises that digital health can be a double-edged sword, and some factors may decrease acceptability. It points out that some health workers may:

    Experience workload increases due by technological interventionsFace data costs that are not covered by the employerBe anxious about carrying multiple devices and fear loss, damage or theft of the devicesFear job security risks if they have poor digital literacy.

    The authors list factors that affected the feasibility for health workers to take up digital health opportunities, such as:

    Network connectivity and access to electricity to charge their mobile phones Usability of digital devices and integration with other digital systemsUser interface issues, particularly around language and utility of the interface for capturing and retrieving dataThe extent to which confidentiality of medical information and data security issues are addressedChange management issues such as training and familiarity with digital technologies to help support users Supportive supervision to build confidence in new approachesHealth workers’ perception about whether tracking and monitoring, which makes their work more visible, is positive or negativeThe extent to which health workers’ efforts are limited by broader health systems challenges, such as underlying medical supplies shortages that reduce health system effectiveness regardless of digital health interventions.

    Since clients are often active participants in digital interventions, the guideline describes factors that may influence their acceptance of digital health. This includes that:

    Some clients appreciate the fact that someone is taking the time to send them messages, appreciating the support, guidance and information, reassurance and motivation.Individuals who are dealing with health conditions that are personal or stigmatized, such as HIV or family planning services, may worry that their confidential health information might be disclosed if they participate in digital healthSome clients prefer face-to-face contact to telemedicine services, yet these services can also help to give individuals who speak minority languages access to health workers who speak this language Telemedicine may help clients save money and reduce the burden of travel for specialist opinionsOut of pocket expenses may be an issue where clients are charged to participate in digital health Barriers such as poor access to network services, electricity or mobile devices, low literacy or digital literacy skills need to be addressed.

    My next eHNA piece will unpack the next chapter in the guideline, birth and death notification via mobile devices.

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    The Guideline provides evidence-based recommendations of ways to use digital health to improve health services. It has a specific focus on mobile devices and emerges out of guidelines on digital health interventions for RMNCAH developed by this team.

    You can find more eHNA coverage of WHO initiatives here.

  • Successful eHealth needs capacity building

    Africa’s health-care system is undergoing an eHealth revolution. The technology is new, but it must be used by the existing health workforce.

    A critical finding in my master’s research, is that eHealth needs better investment in educating and capacitating users of eHealth. Another report by the British National Health Service found that a lack of training for healthcare providers created barriers to eHealth care. In Africa, we face the same challenge. 

    Technology on its own, no matter how effective, cannot bring about healthcare revolution without acceptance and proper use by healthcare workforce. An implementation strategy which addresses the barriers to effective adoption of these technologies will be critical to their success.

    Capacity development has multi-layer benefits;

    For staff it can increase overall job performance and satisfaction. For the healthcare organization or facility, it can improve effectiveness and profitability.Even at the societal level, training and development can increase the quality of the labour force, which in turn is a contributing factor to national economic growth.

    By developing a workforce that is able to confidently use eHealth technologies and services, African countries could implement their national eHealth more successfully and move closer to achieving universal health coverage.

  • Why eHealth needs business modelling

    A substantial number of businesses and start-ups pursuing opportunities to bridge healthcare challenges with eHealth technologies are often confronted with “pilotitis” or failure to implement their technologies in a sustainable way.  In my last article, I described some of the challenges eHealth businesses face. 

    Constructing a business model during the development of eHealth technologies can guide a value-driven evaluation of what is necessary and what is not, in order to overcome implementation failures. A review of the literature suggests that the business model canvas proposed by Osterwalder is a suitable business modelling tool for the eHealth industry.

    The one-page canvas consists of nine building blocks that provides a conceptual framework to describe the business’ activities from four perspectives;

    Value offering – what need is being fulfilled by the business?Value communication and transfer – who are the customers and how does the business communicate with them?Value co-creation – what are the business inputs, including collaborating partnerships? Value capture – how does the business maintain profitability?

    A key observation in my master’s study was that there is a strong focus on the value offering and value capturing activities of the business model, although little focus on value co-creation and value communication and transfer activities.

    While eHealth businesses are aware of the importance of these activities, challenges of the environment create barriers to prioritising these activities. To overcome these challenges, transformation is required in both the micro and macro eHealth environment.

  • Have your say on WHO’s draft Global Strategy on Digital Health
    April 2019 has been a busy month for global digital health, with two key announcements by the World Health Organization (WHO). One is the call for comments on the draft Global Strategy on Digital Health. It is the first strategy of its kind for digital health and an opportunity not to be missed. WHO invites consultation from all stakeholders in the digital health arena on a strategy aiming to help focus our efforts on digital health that achieves maximum impact. It identifies four strategic objectives: Work togetherHelp to accelerate the digital health agenda in countriesAddress global issuesSet the future direction for innovation and research.

    The period for commenting closes 30 April 2019, 00:00 CEST. Inputs can be provided via a web-based accessible here or you can email WHO for more information.

    A second pivotal event was last week’s publication of the WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening, a much anticipated and important milestone in digital health’s journey to maturity and health systems impact. It has emerged out of a group that developed guidelines on digital health interventions for RMNCAH and health systems strengthening. 

    As we invest in our African National Digital Health Strategies and implementation plans, global publications like these are timely and helpful. eHNA will unpack the contents and their implications for our African digital health initiatives over the next few weeks.

  • WHO launches digital health guideline, Wednesday 17 April

    Figuring out how to use digital health for health systems strengthening is an important task. Now World Health Organization (WHO) has a guideline document to help, launching 14:00 CEST, Wednesday 17 April 2019. Join the live stream here to be part of the launch and gain access to the guideline.

    The title is WHO Guideline Recommendations on Digital Health Interventions for Health Systems Strengthening. This is the first WHO guideline on Digital Health Interventions. It provides evidence-based recommendations for ten ways that countries can use digital health to improve health services.

    eHNA will have more news on what the guideline contains and how we can use it productively for our African initiatives, after the launch.

  • Competitive telemedicine platform to help achieve UHC

    AfriDOKTA is passionate about transforming the delivery of healthcare in Africa through people, processes and technology. They have developed a telemedicine mHealth platform dedicated to Sustainable Development Goal 3, “Ensuring healthy lives and promoting well-being for all at all ages”. Anyone with a smart phone or internet access can easily download the AfriDOKTA app and would have immediate access to quality outpatient care.

    The Kenyan government is the first African country that has supported the roll-out of AfriDOKTA as part of a nationwide campaign towards universal healthcare. The roll out is supported at the community level by community health workers (CHWs) that train users on how to access health services using the AfriDOKTA app. Users can easily create a personal profile and an electronic medical record to store details of consultations received. The app also gives users referrals to vetted pharmacies and labs with certified medical professionals. 

    A unique design feature of the AfriDOKTA app is that it complies with international data security standards and adheres to the US-based Health Insurance Portability and Accountability Act (HIPAA). The architecture also applies Health Level 7 (HL7), SNOMED, and DICOM standards. These are international principles used for the transfer of clinical data between various software and electronic applications.

    AfriDOKTA's use of international standards for storing, accessing, and processing medical images and related information, their plans for strategic collaboration and relevant product benefits make it a strong competitive differentiator in the market. This solid technical foundation should position the platform to support our Universal Health Coverage (UHC) aspirations too.

  • IoT “in the wild” may help us manage stress better

    In his TEDx talk, Pablo Peredes makes a case for using the Internet of Things (IoT) to help humans manage stress. He points out that to be stress free, humans need more outdoor activity than our modern lives allow, and suggests that our “new” natural environment of homes, offices and cars can be more intuitive and responsive to support what we need. In his talk, he uses a book to explain our current stress-increasing predicament.

    Why Zebras don’t get ulcers is a book by biologist Robert M. Sapolsky. Sapolsky explains that for animals such as zebras, stress is typically episodic, such as when avoiding being eaten by a lion, and this stress is well managed by abundant opportunities for the free Zebra to engage in stress-relieving activities rambling around the savanna. In contrast, modern human stress is often chronic, such as worrying about losing a good job or how to survive a stressful one, and our natural environment is no longer the ubiquitous outdoors, but confined to homes, offices and cars, which offer too few opportunities for natural stress relief.

    Since we are unlikely to abandon our homes, offices and cars, Peredes suggests that IoT can help repurpose common household objects to make these devices able to help us manage our health better, transforming our homes, cars and workplaces into environments that identify and manage our stress. He suggests starting existing devices, avoiding the costs of adding new sensors. By collecting and analysing data from things we touch, such as a PC mouse, or a steering wheel in a car, Peredes says we can identify stress and do something about it.

    Peredes describes two reasons for people not managing stress: lack of willpower and lack of time. He suggests that we use the time available during our commute from home to office to diagnose stress levels and improve our stress management, such as making car seats talk us through breathing exercises, office chairs remind us to stand when we’ve been sitting too long, and adding imperceptible screen colour changes to adjust our breathing and heartrates.

    Peredes believes that the everyday devices around us should help us to manage stress. He calls it “stress management IOT in the wild” and invites us to share new design ideas via email.

    Many of our African homes are still connected to the natural environment, providing ample opportunities to blow off steam. Nevertheless, in Africa people are urbanising rapidly too, and it is reassuring to know that people like Peredes are thinking about how to make our modern environments more supportive. I look forward to writing more eHNA pieces about his IoT adventuring in the wild. 

  • Successful eHealth needs better business models

    eHealth is a complex business type, integrating many stakeholders acting across interwoven networks. Yet the characteristics of successful business models remain understudied.

    Despite the promise of eHealth to overcome healthcare access challenges, reduce costs and improve quality , successful implementation is low, especially in developing countries.  In fact, over 50% of eHealth businesses find it difficult to sustain their implementations sustainably beyond the pilot phase. I have been investigating these dynamics and will be sharing them over the next few weeks in a series of eHNA pieces.

    Recurring challenges of eHealth include;

    Financial institutions unwillingness to fund eHealth start-upsHigh start-up costs and ongoing maintenance costsRegulatory legislation that lags behind technology developmentResistance from end-users to adopt new innovationseHealth technologies lack user experience designPoor scalability of eHealth technologies after their pilot phasePoor ICT infrastructure in the environmentLack of leadership and political supportLack of research.

    To overcome these challenges, change is required in both the micro and macro eHealth environment. I’ll be sharing ideas on what changes are needed in my next piece.

  • A Whole-of-Government approach to investing in digital technologies to achieve the SDGs

    What do school children, farm animals and patients have in common? Well, rather a lot, according to the International Telecommunications Union (ITU) and some of its partners. Especially when it comes to investing in Information Communication Technology (ICT) to advance progress towards Sustainable Development Goals (SDGs).

    The SDG Digital Investment Framework calls for countries to take a whole-of-government approach to investing in digital technology. The paper shows how to “identify which technologies matter most to achieve the SDGs.” The approach was developed by teams from ITU and the Digital Impact Alliance (DIAL).

    Its theory of change is shown in the figure below, extracted from the ITU document. It is about a small set of common ICT building blocks helping countries to deliver many high-impact use cases that support progress towards SDGs.

     

    Figure: SDG Digital Investment Framework theory of change.

    The paper provides an approach for countries to identify reusable ICT building blocks across sectors, particularly education, health and agriculture, and calls on governments and the private sector to work together to fund these shared foundation elements. The list of candidate ICT building blocks is extensive, including:

    Analytics and Business Intelligence ServicesArtificial Intelligence ServicesClient Case Management ServicesCollaboration Management ServicesConsent Management ServicesContent Management ServicesData Collection ServicesDigital RegistrieseMarketplace Services Mobility Management Services Geographical Information Services Identification and Authentication Services Information Mediator Services Messaging Services Payment Services Reporting and Dashboard Services Scheduling ServicesSecurity Services Shared Data Repositories Terminology Services Workflow and Algorithm Services.

    It’s a bold approach that resonates with other initiatives underway in African countries, and across African regions. eHNA looks forward to reporting on further developments.

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    Image from the SDG Digital Investment Framework report.

  • An ITU/WHO “how to” guide for building interoperable digital health infrastructure

    As we strengthen African national eHealth strategies, interoperability is gathering momentum too. It's a critical component of our national eHealth programmes. We are looking for a common, comprehensive framework, incorporating all data sources and information flows, both electronic and paper-based, providing a clear development and consolidation path for all components, along a digital development maturity model.

    Fortunately, there’s a handbook about how to do it: Digital Health Platform: Building a Digital Information Infrastructure (Infostructure) for Health, published by the International Telecommunications Union (ITU) in collaboration with the World Health Organization.

    The figure below provides a high level overview of the Digital Health Platform (DHP) concept, its components, and how users interact with it. 

    Figure: How a DHP interacts with external applications and users

    The handbook suggests that a well-designed DHP will help countries to achieve the following priorities:

    Overall quality and continuity of careAdherence to clinical guidelines and best practicesEfficiency and affordability of services and health commodities, by reducing duplication of effort and ensuring effective use of time and resources Health-financing models and processesRegulation, oversight, and patient safety resulting from increased availability of performance data and reductions in errorsHealth policy-making and resource allocation based on better quality data.

    The DHP Handbook illustrates how DHP components are derived from the National eHealth Strategy. It is a detailed guide including illustrative case studies from Liberia, Estonia, Canada, India and Norway. It’s essential reading for African countries’ as we invest in our national eHealth programmes.