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  • Is connected eHealth enough to lead to healthier people?

    eHealth’s ICT network, and especially mHealth’s, offers considerable potential for healthier people. Like all eHealth, its probable impact is always less than its potential. A study in the Journal of Medical Internet Research (JMIR) by a research team in Montreal, Canada, identified the phenomenon for connected health tools.

    Is Connected Health Contributing to a Healthier Population? Reviews  mHealth’s health impact. It,

    It’s clear that mHealth enables more precise diagnostics, personalised health recommendations that enhance patient experiences and outcomes and contains healthcare costs. But, for mHealth to achieve its full potential, at least five issues need addressing.

    JMIR’s editor says JMIR Publications discourages the use of Connected Health (cHealth). It’s not clear if how it differs from eHealth, mHealth or Ubiquitous Health (uHealth). eHNA’ll stick with eHealth and mHealth.

    One issue’s achieving active engagement in mHealth use, privacy, security, quality, and developing evidence-based guidelines. The expanding mHealth market, at over 165,000 apps in 2015, conveys an urgent imperative to deal with these. With such a profile and plethora, it’s a bit odd that only 12% of health-related apps have 90% of downloads; a considerable underutilisation and corresponding limited impact on health.

    Maybe, as the study hints, the current focus technology may be too extensive, while simultaneously ignoring the need for a paradigm shift in healthcare providers from fixer to coach, that welcomes, encourages, requires and activates patients’ engagement in their own wellness and care. It could be that uptake strategies are needed to ensure individual’s mHealth engagement is their highest prior for health and illness issues. Succeeding may need a better understanding of the health literacy gap causes.

    Quality’s a challenge. Many consumers, developers and manufacturers aren’t aware of many of mHealth’s technological standards and regulations. Lacking supporting evidence, users often rely on subjective five-star ratings to gauge quality. Apple’s App Store advises that “medical apps that could provide inaccurate data or information, or that could be used for diagnosing or treating patients may be reviewed with greater scrutiny.” Recent initiatives might help overcome this risk and misplaced dependency:

    Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework evaluates health behaviourMobile App Rating Scale (MARS) assess and scores qualityConsolidated Standards of Reporting Trials (CONSORT-EHEALTH) encompasses initiatives developed by the CONSORT Group to alleviate problems arising of inadequate randomised controlled trial (RCT) reporting.

    Africa’s mHealth emphasis should take note of these. Without them, mHealth may become just a bit of Health.

  • How to deal with with ransomware

    A perspective on eHealth cyber-security is the challenge to cope with changes in government regulations, a revolution in medical device and mobile technology expanding at about 20% a year and healthcare transformation. Its eBook Ransomware: What every healthcare organization needs to know, Cisco sees this as a “Perfect storm of complexity and vulnerability” for information security. 

    Cisco Umbrella is a cyber-security platform for the cloud. Supporting advice in the eBook covers:

    What is ransomware?How prevalent is the threat?Why healthcare?How does infection happen?How does an attack work?How to protect organisations?The first line of defence.

    It sets out four main causes of infections:

    Phishing emailsCompromised web sitesMalvertisingFree software downloads.

    Cyber-attacks come from two sources, email and web sites. Clicking on an illicit link in an email or visiting a compromised or malvertising web site can trigger a sequence of events:

    Launching a download and installation of an exploit kit.Exploit kit identifies vulnerabilities in users’ systems and sends these back to the malicious infrastructureInstalling a targeted payload on users devices that can exploit the vulnerabilitiesCall-back to retrieve private malicious encryption keys that encrypt dataNotify users that a ransom payment will release the encryption key.

    Stopping ransomware attacks needs a set of actions to:

    Monitor global cyber-criminal activities for insight into where hackers are staging infrastructure for future attacksProtect patient devices, medical IoT endpoints, Protected HealTHInformation (PHI) and Personally Identifiable Information (PII) data systems, including ones that don’t support agentsDiscover and block likely malicious domains and Internet Providers (IP)Feed contextual threat intelligence into security management or incident response environments to identify which incidents need attentionKnow how unmanaged mobile and IoT devices connect to networks to prevent patient data exfiltration. 

    After a cyber-attack, assess what happened by:

    Identifying the root causeDeveloping a proactive cyber-security plan that leverages a multi-layer defenceUsing predictive intelligence to understand how and where attacks are staged on the InternetInternally segmenting networks to contain a breachRestoring data from backupsEducating employees about security best practicesDeploying first line defences that stop opportunities for lateral movement of ransomware in networks, eliminate its propagation and reduce the time cyber-attacks have to operate in networks.

    Cisco’s eBook adds to Africa’s eHealth knowledge. It’s an essential document for its cyber-security library.

  • Predictive analytics needed for better infectious disease tracking

    When outbreaks of new diseases emerge, public health’s impact inevitably follows events. Eventually, it catches up. The US Government Accountability Office (GAO) report in May 2017, Emerging Infectious Diseases Actions Needed To Address the Challenges of Responding to Zika Virus Disease Outbreaks, found that the Zika virus case counts from the national disease surveillance system underestimate the total number infections because: 

    Infected people may not seek medical care because they have only mild or no symptoms, or other reasons,May not be diagnosed because of limitations in Zika virus diagnostic testingIncomplete surveillance reporting.                                                                                                                                   

    Better, prompt and accurate information’s still needed. Three Congress representatives have written to the GAO boss, the Comptroller General, suggesting a subsequent study into predictive models and systematically integrating modelling into outbreak responses. They think the US can respond more effectively bt learning if:

    Federal agencies use predictive modelling to inform planning for emerging infectious diseases?How federal agencies use models to inform regulatory decisions about infectious disease outbreaks?Do medical product sponsors use predictive modelling?What funding’s available for infectious disease predictive modelling?What challenges do predictive modellers face?If and how, federal agencies validate models’ predictions? 

    With predictive modelling and analytics expanding their potential, these seem like a good set of questions that all countries should ask. Answers can inform eHealth strategies and strengthen the role and impact of public health professionals.

  • Disaster and emergency preparedness may be needed for nine coastal African cities

    The Earth’s warming. There’s a consensus among Earth scientists that melting land ice contributes to Sea-Level Rise (SLR).  Research from the University Corporation for Atmospheric Research (UCAR) says future warming will exacerbate the risks to human civilization. Ice sheets, glaciers, and ice caps have melted during the 20th century leading to SLR. UCAR says it’s accelerating.

    A report from a team at the Jet Propulsion Laboratory, California Institute of Technology, Should coastal planners have concern over where land ice is melting? published in Science Magazine says the technique of Gradient Fingerprint Mapping (GFM) benefits long-term coastal planning. An appendix to the report identifies nine coastal African cities that could be affected. They’re:

    AlexandriaCasablancaDakarDarEsSalaamDjubutiDurbanLagosLuandaLuderitz

    While the report deals with cities, other coastal communities will be affected too. If measures to reduce global warming succeed, it may not happen. If they’re too late or don’t work, it seems that it will.

    One response is building sea defences. Another’s to relocate communities. Doing nothing could mean emergencies and unplanned population migration. All have consequences for health and healthcare. The results from the study need factoring into the nine countries’ longer term disaster and emergency response and eHealth strategies and plans. Africa’s other coastal countries may need to start planning too.

  • Does spambot Onliner have your email address?

    It’s described as the largest spambot. ZDNet has a report about the finding by Benkow, a cyber-security researcher in Paris, who discovered an open and accessible web server hosted in the Netherlands which stores dozens of text files. They contain a batch of 711 million email addresses, passwords server login information and 80 million email servers used to send spam. The credentials came from other data breaches, such as the LinkedIn and Badoo hacks.

    Malevolent goals are to send email spam through legitimate servers to defeat many spam filters. Onliner delivers Ursnif banking malware into inboxes globally. Ursnif is a Trojan. It steals data such as login details, passwords and credit card data. A spammer then sends a dropper file as normal-looking email attachments. When it’s opened, the malware downloads from a server and infects the machines. Spamming is still an effective way to deliver malware, but email filters are becoming smarter, with many spamming domains blacklisted. 

    There’s been over 100,000 unique infections up to the end of August 2017. Cyber-attackers need large lists of Simple Mail Transfer or Transport Protocol (SMTP) credentials that authenticate them to send bogus legitimate emails that by-pass spam filters. The more servers they find, the bigger the campaign. 

    When bogus emails are opened, they send back to the cyber-crookss the IP address and user-agent information used to identify the type of computer, operating system and other information about the devices. Cyber-attackers use this to identify who to target with Ursnif. They specifically target Windows computers. iPhone or Android users aren't affected by the malware.

    Focused hacking instead of scatter bombing reduces the malevolent campaign’s cyber-noise. It can help to slow down responses from law enforcement agencies. 

    Benkow’s discovery re-emphasises the need for Africa’s eHealth programmes to train, then train again and again, health workers in cyber-security. It’s an essential components in the constant cyber-security response. 

  • Managing high risk populations’ health needs better information

    Successful population health management need health organisations to learn and know how to manage risks, outcomes, utilisation and well-being of high and increasing risk communities. Components Necessary for Managing High-Risk Population, a report from Cerner, available from EHR Intelligence, sets out ways that organisations can use information to manage people’s care as part of health risks cohorts and identify opportunities to reduce avoidable costs.

    The report says about 5% of the population are high risk. Another 20% are grouped as rising risk. Globally, these health risks are increasing. In a report, on global health risks, WHO says “Health risks are in transition: populations are ageing owing to successes against infectious diseases; at the same time, patterns of physical activity and food, alcohol and tobacco consumption are changing. Low- and middle-income countries now face a double burden of increasing chronic, non-communicable conditions, as well as the communicable diseases that traditionally affect the poor. Understanding the role of these risk factors is important for developing clear and effective strategies for improving global health.”

    Cerner’s report focuses on care management requirements and patients. The principles apply to health promotion and illness prevention too. Selecting the right people for care management plans is essential to improve their health and enable healthcare to cost outcomes. Cerner proposes three components:

    Risk stratification strategiesHealth IT needs for managing high-risk populationsChoosing the right care management approach.

    These are supported by six eHealth requirements.

    Longitudinal healthcare recordsChronic condition and wellness registries for patient cohortsCare management and co-ordination systemsLongitudinal plansData analytics and modellingReferral management system. 

    Linked to information on social determinants of health, some of this approach can support health interventions in high risk communities in low and middle income countries. It could include local data and predictive analytics to identify changes communities’ behaviour, and needs and demands for healthcare and related services such as education and social care.

  • Mobicure wins World Expo grant

    A Nigerian eHealth start-up Mobicure has won an Expo Live grant. An article in Disrupt Africa says it

    OMOMI application, which helps expectant mothers and parents of under-five-year-olds monitor the wellbeing of their children from home. The award’s up to US$100,000, made available incrementally depending on progress and results. 

    OMOMI’s a mobile platform. At the touch of a button, mothers can easily monitor their children’s health, access life-saving maternal and child health information and medical expertise. It was launched in Benin City in 2015 and now has 31,000 users with over 4,000 active monthly users. In the last nine months, it’s seen a 450% rise in users. The Expo Live grant will help it achieve three more goals. One’s an expanded reach to more families. Another’s adding more features and health information. The third’s promoting OMOMI to more parents in Sub-Saharan Africa.

    Emirates is delighted to host the next World Expo, in Dubai in 2020. Will another African eHealth start-up succeed there?

  • Burkina Faso’s MOS@N muestra el valor de compromiso

    Para alcanzar la Cobertura Universal de Salud (UHC)  se necesita que el acceso a la atención médica sea mas amplio. En Burkina Faso, MOS@N, un proyecto de mHealth está ayudando a las poblaciones vulnerables del distrito de Nouna a mejorar su acceso y lograr una mejor salud. Tambien, al superar los prejuicios de género, ha mejorado el estatus de las trabajadoras de la salud. 

    Las altas tasas de mortalidad materna son un importante desafío de la salud pública para Burkina Faso. Nouna tiene 341 muertes maternas por cada 100.000 nacidos vivos. Solo el 70% de las mujeres recibe atención prenatal y el 34% da a luz en el hogar. Las tasas de VIH / SIDA siguen siendo altas, con alrededor del 30% de las personas infectadas que no siguen el tratamiento requerido. 

    El acceso a la atención materna enfrenta numerosos obstáculos. Incluyendo las distancias a los centros de salud, la escasez de personal de salud calificado, la falta de información sobre la salud sexual y reproductiva y los altos costos del tratamiento médico. La información de salud para mujeres embarazadas y proveedores de servicios de salud a menudo no se entrega en el momento adecuado y podria estar desactualizada. Los valores sociales paternalistas profundamente arraigados pueden llevar a que muchos hombres prohíban a sus esposas asistir a los centros de salud en lugar de trabajar en los campos. 

    Lanzado en 2013, el nombre de MOS@N se deriva de móvil y santé. Su objetivo es mejorar el acceso de la atención de calidad para madres, niños y personas con VIH / SIDA. Al principio, los investigadores del Centro de Investigación en Salud de Nouna, un instituto de investigación del Ministerio de Salud, se dispusieron a determinar si las TIC y los teléfonos móviles podrían mejorar la administración de la salud para un acceso más equitativo a la asistencia sanitaria. Financiado por el Centro Internacional de Investigaciones para el Desarrollo (IDRC) y llevado a cabo en colaboración con la Universidad de Montreal, MOS@N se desplegó en centros de salud que prestaban servicios en 26 aldeas.

    El estudio, Posicionamiento de la Salud Movil: un estudio cualitativo de las expectativas de mHealth en el distrito de salud rural de Nouna, Burkina Faso, publicado en Springer, confirmó el éxito de MOS@N en el fortalecimiento del sistema de salud y la mejora del acceso. A fines de 2016, 2.161 mujeres embarazadas habían recibido atención prenatal. Los partos asistidos aumentaron en un 50% a más del 97%. Los trabajadores de la salud pudieron rastrear a casi 260 pacientes que viven con el VIH y lograron una baja tasa de abandono de solo el 1.6% de los casos. 

    MOS@N también aumentó la equidad y la participación en la administración de la salud. Las mujeres fueron fundamentales para la implementación del proyecto y ayudaron a determinar los servicios de salud materno e infantil ofrecidos. Unos contactos directos más fuertes con los centros de salud y un fácil acceso a la información les ayudará a mantener los logros alcanzados. 

    Un artículo del IDRC en la web de Relief dice que “marraines”, madrinas, que usan teléfonos móviles, se han convertido en actores centrales en la educación y movilización de la salud, roles que anteriormente desempeñaban los trabajadores de la salud de la comunidad masculina. Elegidos por los líderes de las aldeas para acompañar a las mujeres durante el embarazo y el parto, las “marraines” son intermediarias entre su comunidad y los trabajadores de la salud.

    MOS@N enfatiza el papel de la comunidad en la entrega de tratamiento, el seguimiento de pacientes y la entrega de mensajes y recordatorios de concientización. Integra los roles de los centros de atención primaria de salud local, trabajadores de salud, técnicos de TIC, “marraines”, líderes comunitarios e investigadores de salud pública. 

    Se desarrolló localmente utilizando software de código abierto y permite el acceso a la información sobre atención médica materno e infantil y la vida con VIH. Los sistemas de mensajes de texto e interactivos brindan mensajes en cinco idiomas locales, personalizados para satisfacer sus necesidades específicas, que incluyen recordatorios de citas para madres, asegurando la inclusión y una mayor accesibilidad. Todo el contenido cumple con las pautas nacionales para una amplia gama de atención médica. Incluye atención pre y posnatal, parto asistido, vacunación contra la polio y el tétanos, prevención del paludismo y seguimiento de pacientes. Otras características son un sistema central de información de salud desarrollado e integrado en las instalaciones de salud del distrito para recopilar los datos necesarios para el seguimiento y toma de decisiones.

    MOS@N y los hallazgos del estudio ayudarán a guiar las iniciativas de mHealth. El diseño y la implementación que satisfagan las necesidades específicas de los usuarios optimizarán las posibilidades de éxito. Proporciona lecciones para mHealth de África.

  • Kenya’s eHealth prioritises healthcare access in remote communities

    A report on relief web from the International Development Research Centre (IDRC) says the high mobile penetration has spawned an mHealth boom, the KEMRI-Wellcome Trust Research Programme reveals that it hasn’t improved healthcare accessible.

    A map identifying Kenya’s eHealth projects  shows 70 initiatives clustered in and around Nairobi, Kisumu, and Mombasa. Few are in the arid and semi-arid regions, home to people most in need of services. The lack of a well-defined national eHealth strategy and standards, now being addressed, contributes to an inequitable service distribution and duplication and waste of resources. These comprise a set of clear benefits for mHealth’s next generation.

    IDRC funding in 2013 enabled researchers to determine if and how eHealth fosters health equity and improve health system governance. Questions were, are affordable and timely health services available to people who needed them, and health decisions made transparently and with all stakeholders’ participation? 

    Despite good intentions and the launch of a series of government initiatives to address health system challenges, the team found that more work remains to achieve quality healthcare for all. This is a challenge facing all Africa’s countries. 

    Most of Kenya’s eHealth projects have a strong mHealth emphasis. Nearly 70% rely on mHealth. Most projects were developed by donor-funded NGOs, with an inevitable consequence of isolated data silos and no Ministry of Health approval. Consequently, few were aligned with national needs or priorities and a lack of government engagement and funding led to many abandoned projects after pilot phases.

    Stakeholder engagement and consultation at design stages were limited too. Projects didn’t reflect their needs, a deficiency researches say could’ve been overcome by better accountability, governance and ownership. 

    Only eight projects had been systematically evaluated, with only one evaluated using cost-effectiveness analysis. Little’s known about their impact and there are few lessons about success factors or failures.

    Kenya’s has moved on since the report. eHNA has reported on its excellent work on mHealth standards, a model for all countries. This, and the IDRC findings can benefit all Africa’s eHealth programmes and help to achieve long-term health benefits for all Africans.

  • How to construct the perfect password

    Passwords are personal, secret, vital and too complicated to be guessed. That’s the theory. It seems that expert advice hasn’t complied with the complicated part. A report from the US Joint Task Force Transformation Initiative Appendix A set out password practices. In an article in the Wall Street Journal (WSJ), the author, Bill Burr, a former National Institute of Standards and Technology (NIST) manager, says his advice wasn’t right. 

    The original report in 2003 was NIST Special Publication 800-53 Revision 4 Security and Privacy Controls for Federal Information Systems and Organizations. It’s been updated regularly, and proposed password management should include:

     Changing passwords every 90 days Adding capital letters, numbers and symbols to words, such as password being Pa55?w0rd.

    He now says passwords shouldn’t be changed frequently because people often make only small modifications, such as Pa55?w0rd to Pa55!w0rd. These changes weaken passwords when the intention’s to strengthen them.

    A report by the BBC says a better method’s a random string of words, such as "pig coffee wandered black." It takes malware longer to break this code than using random guesses to find Pa55!w0rd.

    Africa’s eHealth programmes and users can adopt this updated advice. They should also follow research on cyber-security practices. Complying with evidence-based actions is always best.

  • Machine learning use cases for health points to the future

    Machine learning (ML) and artificial intelligence (AI) have quickly rocketed to the top of the industry’s buzzword list, driven partly by heightened interest in big data analytics amongst healthcare providers and vendors

    The allure of intelligent algorithms to mine masses of structured and unstructured data for innovative insights get’s health planners pretty excited. However, a fragmented health ICT landscape and sluggish analytics development have thus far kept that Holy Grail beyond reach.

    Regardless, ML is already making a difference.  Here are some examples;

    Imaging analytics and pathology

    ML can supplement the skills of human radiologists by identifying subtler changes in imaging scans more quickly and potentially leading to earlier and more accurate diagnoses.  At Stanford University, ML tools performed better than human pathologists when distinguishing between two types of lung cancer.  The computer also bested its human counterparts at predicting patient survival times.

    Natural language processing and free text data

    Using natural language processing (NLP), ML algorithms can turn images of text into editable documents, extract semantic meaning from those documents, or process search queries written in plain text to return accurate results.  Anne Arundel Medical Center is using a natural language interface, similar to any of the widely known internet search engines, to allow users to access data and receive trustworthy results.

    Clinical decision support and predictive analytics

    Identifying and addressing risks quickly can significantly improve outcomes for patients with any number of serious conditions, both clinical and behavioral. The University of California San Francisco’s Center for Digital Health Innovation (CDHI) and GE Healthcare are creating a library of predictive analytics algorithms for trauma patients in an attempt to speed up the delivery of critical care.

    Cybersecurity and ransomware

    At the end of 2016, IBM Watson launched its Cyber Security Program.  Watson’s ML and cognitive computing skills are used to flag cyber threats and check for suspicious activity against known malware or cyber crime campaigns.  This helps IT staff take better decisions based on known characteristics of malware.

    ML and AI are the keys to addressing health care inadequacies.  These technologies can help predict and control disease, expand and augment service delivery, and address several persistent social inequities. Ubiquitous health tech is by no means inevitable.  Successful rollout will entail an immense amount of concerted effort, capital, labor, and partnership.

  • Are WAFs part of your cyber-security toolkit?

    As websites’ role in health and healthcare expand across Africa, the need for cyber-security increases too. Web Application Firewalls (WAF) services are part of the solution. WAFs are deployed in front of web servers to protect web applications against cyber-attacks, monitor and control access to web applications and collect access logs for compliance, audits and analytics. Gartner has assessed and classified suppliers in its report Magic Quadrant for Web Application Firewalls. 

    The matrix measures ability to execute and vision completeness. It classifies suppliers into challengers or leaders and niche players or visionaries. Three suppliers are in the leader segment. Imperva is the most visionary. F5 scores top ratings for ability to execute. Akamai is behind these two.

    Vision and execution are important for WAF suppliers as the demand side trends towards cloud-based WAF service platforms that can protect from Content Delivery Networks (CDN), Distributed Denial of Services (DDoS) and bots. Its use is expected to be up from 20% to 50% by 2020 and are in the same quadrant.

    Suppliers were assessed against a wide range of criteria. They provide a basis for Africa’s health systems to evaluate suppliers in their procurements. They are:

    WAF’s capabilities in:

    Maximising detection and catch rate for known and unknown threatsMinimising false positives and alertsAdapting to evolving web applicationsEnsuring broad adoption through ease of use and minimal performance impactAutomating incident response workflows for cyber-security analystsProtecting public and internal facing web applications and Application Program Interfaces (API)Features and innovations to improve web application security beyond conventional network firewalls and Intrusion Prevention Systems (IPS)

    Gartner’s provided its research results for enterprise cyber-security teams to use as part of their evaluation of WAFs’ benefits can improve cyber-security. It offers Africa’s health systems a valuable template for their cyber-security endeavours.

  • Burkina Faso’s MOS@N to improve access to quality care for mothers, children and people with HIV/AIDS

    Achieving Universal Health Coverage (UHC) needs expanded healthcare access. In Burkina Faso, MOS@N, an mHealth project’s helping vulnerable populations in the Nouna district improve their access and achieve better health. By overcoming gender biases, it’s enhanced women health workers’ status too.

    High maternal mortality rates are a major public health challenge for Burkina Faso. Nouna has 341 maternal deaths per 100,000 live births. Only 70% of women receive prenatal care and 34% give birth at home. HIV/AIDS rates remain high, with about 30% of people infected not following up required treatment.

    Accessing maternal care confronts numerous obstacles. They include distances to health centres, shortages of skilled health staff, lack of information on sexual and reproductive health and high medical treatment costs. Health information for pregnant women and health providers is often not delivered at the right time and can be out-of-date. Deep-rooted paternalistic social values can lead many men forbidding their wives attend health centres instead of working in the fields. 

    Launched in 2013, MOS@N’s name’s derived from mobile and santé. Its goal’s to improve access to quality care for mothers, children and people with HIV/AIDS. At the outset, researchers at the Centre de Recherche en Santé de Nouna, a Ministry of Health research institute, set out to determine if ICT and mobile phones, could improve health governance and more equitable healthcare access. Funded by the International Development Research Centre (IDRC) and carried out in collaboration with the University of Montreal, MOS@N was deployed in health centres serving 26 villages. 

    The study, Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso,published in Springer, confirmed MOS@N’s success in strengthening the health system and improving access. By the end of 2016, 2,161 pregnant women had received prenatal care. Assisted childbirths increased by 50% to over 97%. Health workers were able to track almost 260 patients living with HIV and achieve a low drop-out rate of only 1.6% of cases. 

    MOS@N also increased equity and participation in health governance. Women were central to the project’s implementation and helped determine the maternal and child health services offered. Stronger direct contacts with the health centres and ready access to information will help them maintain the gains made 

    An article by IDRC in Relief web says marraines, godmothers, using mobiles, have become central players in health education and mobilisation, roles previously played by male community health workers. Chosen by village leaders to accompany women through their pregnancy and childbirth, marraines are intermediaries between their community and health workers.

    MOS@N emphasises the community’s role in delivering treatment, monitoring patients and delivering awareness-raising messages and reminders. It integrates the roles of local primary healthcare centres, health workers, ICT technicians, marraines, community leaders and public health researchers.

    It was developed locally using open source software, and enables access to information about maternal and child healthcare and living with HIV. Text and interactive voice messaging systems provide messages in five local languages, customised to meet their specific needs, including appointment reminders for mothers, ensuring inclusiveness and greater accessibility. All content complies with national guidelines for a wide range of healthcare. It includes pre and postnatal care, assisted delivery, vaccination against polio and tetanus, malaria prevention, and patient follow-up.

    Other features are a core health information system developed and integrated in district health facilities to collect data needed for follow-up and decision-making.

    MOS@N and findings from the study will help guide mHealth initiatives. Design and implementation that meets users’ specific needs will optimise the chances of success. It provides lessons for Africa’s mHealth.

  • BYOD’s statistics provide a snapshot of the future

    As smartphones become smarter, healthcare’s eHealth has to keep up with doctors’ and nurses’ eHealth ingenuity. They rely extensively on their own mobiles to access and share clinical data. Bring Your Own Devices (BYOD), is now an essential and more convenient part of eHealth. A study by Imperial College, London (UCL), published BMJ Innovations, found:

    99% of doctors own a smartphone, 74% own a tablet device96% of nurses own a smartphone, 65% own a tablet device93% of doctors found their smartphones ‘very useful’ or ‘useful’ for their clinical duties93% of nurses found their smartphone ‘very useful’ or ‘useful’ for their clinical duties90% of doctors use their medical apps as part of their clinical practice67% of nurses use their medical apps as part of their clinical practice46% of doctors used picture messaging to send patients' clinical information to their colleagues7% of nurses used picture messaging to send patient-related clinical information to their colleagues72% of doctors want a secure means of accessing data37% of nurses want a secure means of accessing data.

    The health professionals’ perceptions of using smartphones in clinical practice are positive. From a list of adjectives, they chose positive terms such as helpful, brilliant and essential more frequently than negative terms such as unnecessary, complicated and terrible. It reveals that many of them see BYOD as a constructive solution, not just as practical means of overcoming eHealth’s limitations.

    For Africa’s health systems, BYOD’s an invaluable contribution to eHealth costs. It seems a reasonable assumption that these BYOD practices will increase, so an eHealth challenge is ensuring effective eHealth regulation and cyber-security to embed them constructively into clinical and working practices.

  • Three ways gamification helps people stay healthy

    If you measure your daily step count or chase after Pokemons, you’ve already succumbed to the charms of gamification and its habit-creating powers. Expect to see more. Gamified apps, devices, and therapies will appear in every field of healthcare, making behaviour change easier and more fun.

    Game play focuses and controls our attention, helping us tap into our innate strengths.  It compels us attain more powerful and effective skills. That’s why many believe it is perfect for behavior change that’s good for our health.

    A game is more than automated collection of vital signs and notifications. Gamified services engage us, keep us motivated and help us achieve change. It’s the combination of a great friend and a considerate parent. That’s why gamified solutions will spread like silent epidemics for better health. 

    Here are three ways gamified solutions are already helping large numbers of people stay healthy:

    Physical Fitness - Fitbit has been one of the most popular gamified devices in helping people attain their physical fitness and wellness goals.  Users may set up challenges on the Fitbit community interface and compete with one another to motivate better gym performance and step counts.  Medical aid schemes, such as  Discovery, further encourage fitness and wellness by providing points for step counts.  These points accrue to rewards and savings on selective lifestyle purchases for achieving members.Medication and chronic disease management - Mango Health developed a smartphone application designed to motivate patients to take their medications on time. Users set the times when medications should be taken, and the app reminds them. It also provides information about the medications and warns about drug interactions and side effects. By taking the medications properly, users earn points towards gift cards or charitable donations in raffles held weekly.Physical therapy and rehabilitation - GestureTek Health is a Canadian company that develops applications specific to health, disability, and rehabilitation. Its virtual reality exercise programs enable patients to have fun while stretching their physical and cognitive capabilities. MindMaze created devices, which use virtual reality, brain imaging and gaming technologies to retrain the brain in stroke victims. It also works on solutions for spinal cord injury and amputee patients. If you’re making healthy choices without thinking about it, and an App is helping to make those choices easier and more fun, you’re already doing it.  Us Africans want health to be fun and look forward to seeing much more gamification in the African health innovation landscape soon. 

  • 3D printing lends a hand to prostheses

    3D printing first appeared in the late 1980s, initially for use in industrial prototyping and manufacturing processes. With recent advances, the technology is being applied across many industries, including health, where it is reducing the cost and production time of a range of body parts, from hips to hearts.

    Now, a team of engineering students from the University of Witwatersrand have made a prosthetic hand prototype that will cost around R2,000 (about US$140). They hope that it will make this type of prosthesis more accessible to South Africans who find conventional prosthetic limbs, which can cost more than 50 times the prototype’s price, unaffordable.

    Abdul-Khaaliq Mohamed, a lecturer and PhD candidate in the School of Electrical and Information Engineering at Wits said, “We’re trying to create a hand that’s relatively cheap but has sufficient functionality that allows users to do basic daily movements”.   

    Development is iterative. Last year the group perfected a tripod pinch, the grip used to hold a pen. Next, bicep and triceps were hooked up to the hand and as the person moves the muscles, the hand closes or opens. Sensors were then added to the fingertips to enable the hand to sense force. This year the group has focused on integrating the sensors with vibrational feedback to provide an indication of how strong the hand’s grasp is.

    This promising work expands the range of 3D printing applications. It also brings many patients a big step closer to having a functional prosthesis. What will be 3D printed next?

  • Drones and mHealth help to combat global diseases

    As drones expand their role in healthcare, they’re starting to help in dealing with global diseases. Their impact’s combined with the mobiles’ role. An article from the London School of Hygiene and Tropical Medicine describes some of the initiatives and benefits.

    Drones can be seen as a subset of robots. They’re being used in Malaysian Borneo to map deforestation after a surge in human cases of ‘monkey malaria’, a strain of the disease caused by the parasite Plasmodium knowlesi that normally only affects macaques.  It’s commonly misdiagnosed as P. malariae, a mild form of malaria because it looks similar under the microscope. The monkey form is severe in humans and has a high fatality rate.

    Research has found that people in villages with significant deforestation around them are more likely to be infected with P. knowlesi. To measure changes, drones with cameras picture and map changing forest landscapes. They track monkeys’ movements through GPS collars placed on the animals to identify how they moving in response to deforestation, and especially if they approaching houses and settlements.

    The next step’s to develop risk maps to find places and people that are more likely to have P. knowlesi. Forecasts and prediction of the disease will inform malaria control programmes.

    In Cambodia, basic mobile phones help women stay free of STIs and use effective contraception after abortions. MObile Technology for Improved Family Planning (MOTIF) has found that sending voice messages reminding women about the importance of continuing with contraception after abortions and offering telephone counselling helped maintain compliance. As mobile phone technology has developed since the trial, the project uses instant messaging, such as WhatsApp, so users can respond at times convenient to them. It’s expected to improve effectiveness.

    Africa’s developing mHealth programmes can expect equivalent benefits for patients, communities and their health systems. It’d be valuable to share and learn from their experiences with each other.

  • Mapping South Africans to achieve SDGs

    People’s addresses are essential for delivering some health services such as community services and appointment letters. Effective data’s needed to achieve the Sustainable Development Goals (SDG). In Africa’s rural, remote and informal communities, it’s not so simple to achieve.

    South Africa’s Gateway Health Institute (GHI), a health and human rights organisation, has joined What3Words and Digitata for a project to bring addresses to South Africa’s informal settlements and rural areas in. The challenge to providing verifiable home addresses for South Africans was revealed during the Tlokwe by-election crisis described in the report by the Election Commission (IEC). A Constitutional Court ruling required the IEC to ensure all voters have a verifiable address within an 18 month deadline.

    People’s precise and unique locations are a big challenge to providing them with health services and products. Patients and other citizens living in informal settlements and rural areas particularly limited, especially where they have significant health needs and service delivery is poor due to a lack of information about home addresses.

    Having a home address will help improve healthcare’s outreach. It’ll contribute to SDG targets too. The project could be a model for all Africa.

  • Kenya’s mHealth standards are clear on compliance

    mHealth standards and guidelines are essential, but have to be applied. Like all regulations, effective compliance’s essential. Kenya Standards and Guidelines for mHealth Systems sets three main part of the Ministry of Health approach. They’re:

    Commitment at a senior level is a requirement for stakeholders, including an accountable resource either as an officer or managerImplementation that identifies the resources, including a person, needed for the design, development, implementation and monitoring stages and documenting compliance levels Audit, with a person assigned to provide an objective review of documentation and the compliance process to provide feedback and recommendations directly to management, especially for corrective action needed where compliance is weak or missing. 

    There’s a big stick too. Fines and penalties are part of a range of measures to encourage compliance. Building on Kenya National eHealth Policy 2016-2030, the mHealth standards are a huge step forward for eHealth regulation, not just for Kenya, but across Africa too.

  • An EU regulation and cyber-security checklist can help Africa’s eHealth

    The EU’s noted for its long documents. At over 200 pages, the General Data Privacy Regulation (GDPR) (EU) 2016/679, will apply from May of 2018. It consolidates and replaces existing data protection regulations, and may change the way businesses handle and store data. A core goal’s to strengthen security and privacy protection for individuals. A white paper from Alien Vault  sets out a nine point checklist. GDPR Compliance Checklist: A 9 step Guide can help Africa’s cyber-security and regulations too. 

    The nine steps are:

     Implement a Security Information and Event Management (SIEM) tool with log management capabilities that adhere to compliance requirements.Create an inventory of all critical assets that store or process sensitive data to allow for more stringent controls to be appliedUndertake vulnerability scanning to identify where weaknesses exist that could be exploitedConduct risk assessments and apply threat models relevant to your businessRegularly test to gain assurance that security controls are working as designedPut in place threat detection controls to reliably inform you in a timely manner when a breach has occurredMonitor network and user behaviour to identify and investigate security incidents rapidlyHave a documented and practiced incident response planHave a communication plan in place to notify relevant parties.

    Each of these has a schedule of activities. With cyber-security a prominent feature and priority at eHealthAFRO 2017, Alien Vault’s checklist offers a constructive approach for Africa’s eHealth. It’s a prime example of Africa learning from other countries’ experiences and initiatives.