• Articles (2,439)
  • WHO digital health guideline: 8. Digital tracking of clients’ health status and services

    Patient tracking is the topic of the eighth part of the WHO Guideline on Digital Interventions for Health Systems Strengthening. Key points are summarised below.

    The WHO recommendation is to use digital tracking with decision support (with or without targeted client communication) in settings where the health system can support implementing these interventions in an integrated manner and for tasks that are already defined as within the scope of practice for the health worker. Furthermore, potential concerns about data privacy and transmitting sensitive content to clients must be addressed.

    WHO describes digital tracking as “the use of a digitized record to capture and store health information on clients in order to follow-up on their health status and services received”. It may be combined with decision support systems and may also be linked with targeted demand-side interventions to engage clients/patients, such as via mobile devices

    Evidence is mixed. It suggests that the digital tracking may improve health service use such as attendance of antenatal care appointments, taking iron tablets during pregnancy, immediate breastfeeding, receipt of the third dose of polio vaccine, and use of postpartum contraception six months after birth, though makes little impact on other indicators, such as proportion of children under five who are vaccinated, proportion of women who give birth in a facility, or women breastfeeding exclusively for six months.

    The recommendations align with recommendation 11 of the WHO guideline on health policy and sys­tem support to optimize community health worker programmes, which suggests that practicing community health workers should “document the services they are providing” and “collect, collate and use health data on routine activities, including through relevant mobile health solutions”.  Evidence suggests that most health workers, and particularly those working in rural settings, see advantages to digital tracking to help overcome geographical barriers and link patients to the broader health system, they regard it as a burden to maintain paper-based systems in addition to digital systems.

    As with the guideline on client communication via mobile devices, measures should be taken to address inequities of access to mobile devices and concerns about sensitive content and data privacy.

    There is extensive additional discussion in the Guideline. Emphasis includes the need to address legal implications, such as accurate client identification, and recognising that these multifaceted interventions may pose challenges in infrastructural and technical complexity

    The next and final piece in this eHNA series deals with using mobile devices for training and education.

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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.

    There are nine main topics. Each is summarised in an eHNA post:

    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.

  • South Africa’s new Digital Health Strategy emphasises person-centred health services

    South Africa's National Digital Health Strategy 2019-2024 has been published online. It updates the previous National eHealth Strategy 2012-2017. It presents a vision of Better health for all South Africans enabled by person-centred digital health.

    People are at the centre of the strategy. They include health workers, helping them experience better working lives; patients and their families, helping them access better care, and citizens, supporting them to make sound health-seeking choices. This strategic focus is encapsulated in the first of five cross-cutting strategic principles, which emphasises person-centeredness. The other four principles are expanded access to services, innovation for sustainability, workforce for economic development and a whole-of-government approach.

    Nine strategic components are:

    Leadership: develop leadership capacity for digital health innovation and adaptive management Stakeholder engagement: undertake appropriate multi-stakeholder engagement for shared opportunities and successful digital health implementation Strategy and investment: develop sustainable interventions and appropriate investment and funding mechanisms for digital health implementation Governance: review and strengthen governance structures and oversight mechanisms for the implementation of the strategy Architecture and standards: establish an integrated information architecture for interoperability and effective, safe sharing of health information across health systems and services Applications and services: develop appropriate digital applications and services that improve health services for patients and health workers Infrastructure: establish a robust physical and network infrastructure and broadband connectivity for priority digital health applications and services Legislation, policy and compliance: formulate national legislative, policy and regulatory framework for digital health Capacity and workforce: develop enhanced digital health technical capacity and skilled workforce for digital technology support and implementation.

    An important aspect is the National Digital health Platform, which builds on previous standards and interoperability work. It will provide online technical resources to support developers in the digital health space to achieve:

    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 platform will “help to democratise the health information systems development space for more stakeholders to participate” by creating reusable tools and architecture. 

    Now that the strategy has been published, and we enter the phase of implementation, collaboration becomes critical. We need to get better at how we do this, as we explore how to cooperate to achieve the aspirations of the strategy. It’s an exciting time for those of us who believe in digital health and its role as an enabler of health systems transformation.

    There is lots to be done and how we work together will be an important success factor. What parts of the strategy will you be helping to implement?

  • In-silico to replace in-vivo in clinical trials?

    When it comes to clinical trials, patient recruitment is laborious, ethically contentious, medically risky and can be expensive too. But what if there was a safer and more economical way to test drugs?

    With the advancement of AI, machine learning and bioinformatics, it becomes possible to simulate real biological processes in virtual settings through the use of big data. In-silico is the term scientists are using to describe the modelling, simulation, and visualisation of biological and medical processes in computers.

    The main advantage of in-silico trials is the ability to trial the effects of new drugs or treatment options in a virtual setting without real consequences for either animals or humans. It’s also an enhancement for personalised medicine where it can be used by doctors to try out treatment plans, to get to know the behaviour of drugs or to identify the most appropriate drug dosage.

    While completely simulated clinical trials are not yet feasible with the current technology, its development would be expected to have major benefits over current in vivo clinical trials. The FDA is already planning for a future in which more than half of all clinical trial data will come from computer simulations.

  • Is FHIR a disruptor to help democratise the health information space?

    There are five disruptive technologies that healthcare organisations can embrace, according to Dennis Brown’s silicon republic article.  Robotics, virtual reality, automation, 3D printing and drones.  I agree with Brown, and I would add one more; the Fast Healthcare Interoperability Resources (FHIR) standard for exchanging electronic data.

    FHIR is a recent innovation of the Health Level Seven (HL7) internationally messaging standard. HL7 helps to create message structures for electronic exchange of patient information between systems, applications and compliant devices. HL7 is maintained by the sustained efforts of a large global community.

    FHIR is a highly flexible and can be found in a variety of electronic health information structures, such as the Electronic Health Record (EHR), Clinical Context Object (CCOW), Continuity of Care Document (CCD), Clinical Document Architecture (CDA), and Care Record Summary (CRS). FHIR is scalable, supporting information exchange within a single healthcare facility, a group of facilities or a multitude of electronic systems across a diversity of healthcare systems, facilities or services.

    FHIR provides a standardised messaging protocol for the communicating messages about a unique patient encounter. A FHIR server has unique characteristics:

    It is onlineIt is secureDefinitions are searchableIt can empower users, including patients, by shifting control of siloed proprietary data from individual vendors to an open, vendor-agnostic platformIt makes information available to authorised people, systems and devicesIt has substantial international support and investment.

    FHIR can help democratise the information space, level the playing fields, and spark healthy competition among information systems service providers, emphasising serving users’ needs, rather than data control.

  • WHO digital health guideline: 7. Decision support for health workers

    Decision support is the topic of the seventh part of the WHO Guideline on Digital Interventions for Health Systems Strengthening. Key points are summarised below.

    The main WHO recommendation is to use health worker decision support via mobile devices for tasks that are already defined as within the scope of practice for these health workers.

    Electronic decision support systems help health workers to make better decisions, using available patient data to generate patient-specific assessments or recommendations for the clinician to consider. In many countries, where quality of care is suboptimal, decision support tools can offer guidance to health workers and help to improve adherence to recommended clinical practices.

    Decision support tools can support numerous clinical interactions, including diagnosis, treatment and referrals, to minimize errors and improve care. They use various techniques, including algorithms and rules based on clinical protocols, to create case management checklists and to assist with activity planning and scheduling. Over the last decade, they have progressed to mobile devices, providing unique opportunities for point-of-care assessment, diagnosis and management.

    For community health workers, effectiveness evidence suggests that these tools may have positive effects on their support for patients taking prescribed medication, though may make little or no difference to the clients’ overall health status and their satisfaction with the information they receive.

    Qualitative evidence suggests that health workers find decision support tools useful and reassuring for guiding the delivery of care. However, some health workers perceive algorithms as too prescriptive, and are concerned that they may lose their clinical competencies by blindly following treatment algorithms.

    Health workers are advised to explain to patients that they will use a digital device and seek clients’ permission first, to help ensure that use of the device does not impact negatively on the relationship with the patient.

    While health workers based in peripheral facilities and rural communities may find these interventions particularly helpful, they are also exposed to obstacles such as less access to electricity and network coverage. Challenges related to network connectivity, access to electricity, usability of the device, and sustaining training and support are noted.

    There is extensive additional discussion in the Guideline. Pertinent comments include that the validity of underlying algorithms and decision-logics must be carefully considered and that decision support tools should not be used for tasks that are beyond the health workers’ current scope of practices.

    My next piece in this eHNA series deals with digital tracking of clients’ health status and services.

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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.

  • HELINA 2019 paper submission deadline extended to 31 July 2019

    The deadline for submission of papers and poster abstracts for the Health Informatics Africa (HELINA) conference has been extended to 31 July 2019. They should be uploaded through this site.

    The event will be in Gaborone, Botswana, 20 to 22 November. The conference theme is “From Evidence to Practice: The implementation of digital health interventions in Africa for achievement of Universal Health Coverage (UHC)”.

    Read more about it in the eHNA announcement or the call for papers.

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    Image from here.

  • Global DHIS2 users join this vibrant community of practice

    “A wise man learns from his mistakes. A wiser one learns from others mistakes. But the wisest of all learns from others’ successes.”

    I can certainly relate to this Zen proverb adapted by John C. Maxwell. It sums up my experience with the DHIS2 community of practice and my adventures with the DHIS2 open source platform for the collection, management, analysis and use of information.

    With the DHIS2 now in 67 countries, the number of ways to use DHIS2 is growing rapidly. Fortunately,  the number and proficiency of DHIS2 users is growing too. Sharing and learning from one another’s experiences and successes has become an invaluable part of creating sustainable, robust DHIS2 projects. It has led to the creation of this community of experienced DHIS2 practitioners who share a common goal; to use DHIS2 to implement information systems to better the health of all.

    As the lead of a large Data Science lead team at HISP South Africa, which works with a number of Africa partners, I am frequently responsible for conceptualising new and innovative ways of configuring DHIS2 to meet a wide variety of information management requirements. The community of fellow DHIS2 users is my first port of call when I have face challenges, need some additional assistance, or want to show off a new success.

    The global DHIS2 community is dynamic and highly productive. It has all three distinctive traits for a community of practice:

    Domain – what we care about: DHIS2Practice – our shared body of knowledge, experience, and techniques: decades of experience implementing DHIS2 and developing the DHIS2 platformCommunity – our self-selected group of individuals who care enough about DHIS2 to participate in regular interactions: implementers from Ministries of Health, Partners and NGOs who voluntarily subscribe to and interact in this community.

    If you are a DHIS2 user, join the community today and help us share, learn and explore DHIS2 together.

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  • A treasure trove of global goods revealed at DHIS2 2019 conference in Oslo

    Midsummer in Oslo, Norway has become synonymous with the DHIS2 conference, an annual meeting of the global DHIS2 community. This week I have had the pleasure of being part of it, along with 267 other participants from 61 countries and 118 organisation, 17 to 20 June.

    I have seen big changes over the three years I’ve been attending this event. Technology, people and ideas are maturing and aligning to provide a formidable vehicle for positive change, all brought together around the DHIS2, a remarkable global good supporting health strengthening and Universal Health Coverage efforts around the world.

    Hot topics this year include the DHIS2 FHIR adaptor, usability enhancements for a new DHIS2 Android App, extended analytics and visualisation, promising UX/UI enhancements, and many success stories of country DHIS2 use cases.

    I led a team to present on the Human Resource Information System work we have been doing in South Africa. In particular, we showcased an open standards-based interoperability architecture we've developed. It integrates a wide range of primary systems using OpenHIM, HAPI-FHIR, custom NodeJS, IHE mediators and DHIS2 to create a highly responsive, integrated environment. Key products are a Human Resources for Health Registry and a Data Warehouse. They will put data in the hands of various users, including the public, and give decision makers what they need to plan and manage the health workforce.

    A conference highlight is the picnic on Hovedøya Island. Some say that this is where the real work gets done. We will head across this afternoon to swim, barbecue and forge new partnerships for health systems transformation around the world.

    If you are strengthening your country’s health information systems, and haven’t attended a DHIS2 conference yet, then put a placeholder in your calendar for next year.

    I look forward to seeing you in Oslo.

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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.