South Africa’s mHealth to help prevent malaria
Malaria continues to be a global public health problem. Statistics from the Centre for Disease Control and Prevention (CDC) show that 3.2 billion people living in 106 countries and territories are at risk of malaria transmission. In 2015, approximately 214 million clinical episodes and 438, 000 malaria deaths were recorded according to the World Malaria Report 2015.
The World Bank has estimated that in Africa, half the population may be at risk, with 47% exposed to medium and high risk. To address the challenge, a report from the University of Pretoria says researchers at the Institute for Sustainable Malaria Control (UP ISMC) use satellite data to predict malaria outbreaks and mHealth to control and monitor the disease. The predicting techniques include Geographical Information Systems (GIS) and satellite imaging to detect environmental factors associated with emerging malaria risks. The team uses the data to improve the accuracy and reliability of predicted malaria outbreaks. The forecasts can look ahead by as much as three to six months. Predications have proven accurate, and shown to be 90% effective.
In 2015, UP ISMC in collaboration with French National Centre for Space Studies, the South African National Space Agency, South African Weather Service and other stakeholders initiated the Remote Sensing for Malaria Control in Africa Programme. It uses satellites to collect data on variables that associated with malaria, and carried out in the northern part of the Vhembe district, Limpopo province, across the border in Matabeleland South province and in Zimbabwe. It’s being extended to Maputo, Mozambique, particularly in Namaacha near the Swaziland, Mozambique and South African borders. This means that malaria outbreaks can be detected and early-warning systems triggered to aid in the fight against malaria.
An article in eHealthNews says UP ISMC uses mSpray and Malaria Buddy apps. Malaria Buddy, avails data on malaria risk, prevention and symptoms for travellers in areas where malaria’s endemic. mSpray focuses on malaria control data management for annual indoor residual spraying programmes, a chosen method for malaria control in locations at risk. Previously, during malaria seasons, spray workers would go into homes and spray walls manually. However, there was no clear database recording on the substances used and no centralised digital database to access to establish if spraying was effective and safe. The new malaria programme hopes to address many of these shortfalls.
iPhone was the biggest seller at more than 78m in Q4 2016
It seems the world isn’t losing its appetite for smartphones. Apple’s iPhone sales reached their highest volume of 78.29m in 2016’s fourth quarter. It provides about two thirds of Apple’s income. Samsung isn’t far behind with some 77.5m.
The news’s encouraging for Africa’s mHealth. More mobiles means more opportunities for mHealth. The challenge is for Africa’s health system to pick mHealth winners. It’s not easy. eHNA posted on research that found that some mHealth doesn’t help. It seems that more rigorous mHealth business cases and M&E are needed.
Do benchmarks offer better cyber-security for medical devices?
Our privacy, health and EHRs depend on secure and resilient cyber-security. An article previously on eHNA asked how safe are hospital devices? It’s clear that the increasing number of medical devices connected to the Internet increases cyber-security risks. They could be life threatening and have fatal consequences, so serious in the extreme. More healthcare providers are using connected medical devices to monitor and treat patients. It’s therefore imperative that these devices are secure.
The Center for Internet Security (CIS) is developing a set of benchmarks to protect medical devices, such as insulin pumps, pacemakers and defibrillators, from possible hacking or viral malware. In computing, benchmarking is running computer programs to assess the relative performance of an object by running numerous standard tests and trails against it. An article in MobiHealthNews says CIS has invited medical device makers to participate in the project to help to develop cyber-security control guidelines.
Protecting insulin infusion pumps is the first priority. The Washington Post has an article saying it’s one of the most used medical devices, so it’s likely to attract more attention from stakeholders and increase collaboration on increasing their cyber-security.
ABI Research has estimated that by 2020, more than 30 billion medical devices will be connected to the Internet of Things (IoT). Diabetes Mellitus and heart diseases are amongst the leading causes of death in South Africa. Although insulin pumps and pacemakers are not yet popular and easily accessible, demand’s growing rapidly. South Africa and other African countries can adapt the CIS cyber-security control guidelines initiative when manufacturing and using medical devices. The aim must be to ensure their safety.
Africa’s social media for health looks strong - unpacking the 3rd Global Survey on eHealth
Africa is already using social media for health, and it is a foundation for more. Insights are in Chapter 7 of the WHO and Global Observatory for eHealth (GOe) publication Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable. WHO Global Survey 2015 is the data source.
The main theme is that social media provides an important means to convey messages for health organisations and receiving and sharing information for individuals and communities. A downside is that there’s still plenty to do to understand how its potential can support Universal Health Coverage (UHC).
Key findings include:
- Nearly 80% of countries say healthcare organisations use social media to promote health messages
- Nearly 80% say individuals and communities use it to learn about health issues
- In over 62%, individuals and communities use social media to run community health campaigns.
While, as usual, Africa lags behind the global position, its social media use is relatively high. Health organisations using it to promote health messages as a part of health promotion campaigns is not too far below global rates. Individuals and communities using it to learn about health issues is close to global rates too. Other uses tail off.
It reveals two goals for African countries; do more and find the best ways to use social media. eHNA finds, collects and posts on research and commentaries on social media. Some social media makes no difference to health, for some, it’s not clear what difference it makes, for others, it’s effective. All findings provide valuable lessons for Africa’s health systems’ endeavours to use social media for healthier Africans.
Rwanda benefits from VFAN’s eye care service
As a small charity with a big vision, Vision for a Nation (VFAN) thinks everyone should be able to access eye care and affordable glasses. It started its work in 2012, helping over 90% of its 10.5 million people who had no access to local, affordable eye care. Over a million only needed a simple pair of glasses to see clearly again. Many more could benefit from eye drops administered on-the-spot or a referral to a hospital for specialist treatment to prevent potentially blinding conditions.
The project has lessons for managing and succeeding with all-Africa’s health and eHealth projects. The management model is an essential component that runs across project and operational management and benefits realisation.
VFAN’s response was an innovative programme, building and integrating local primary eye care into Rwanda’s national health system. It’s planned for completion later in 2017.
The programme’s goals are ambitious. They include:
- Making primary eye care permanently available for services such as medication, reading glasses and innovative adjustable lens glasses and referrals for specialist treatment
- Through the country’s network of over 500 local health centres and with revenue generated from the sale of glasses at $1.50 each, but free for the poorest 20%, sustain the programme beyond 2017 when VFAN’s direct role has ended
- Nurturing local Rwandan talent, capacity and capability, extending from language skills to advanced degrees.
With over a million people already screened, VFAN’s this high impact approach enables it to screen an extra 1.5 million people by the end of 2017 and deal with the national backlog too. It’s succeeding because it thinks and operates like a successful business. It sees Return on Investment as critical, sets clear goals and measures outcomes against targets at every stage. Its founder, James Chen and major international institutions provide continuing support that enables financial flexibility and adaptability.
Rwanda’s Ministry of Health will assume full responsibility for new eye care services from January 2018. eHNA will be posting about the transformation and lessons from VFAN for other African projects and countries.
A checklist for EHRs can help
Like eHealth, there’s more than one definition of EHRs. Consequently, when it comes to procurement, it’s important to be specific about your definition and requirements. Dr Chrono has provided a checklist that can help Africa’s health systems with their eHealth strategies, plans and procure their EHRs. It has twelve components:
- Intelligent time-saving charting tools for operational efficiency, such as customisable medical templates, medical speech-to-text, dynamic photo charting and macros
- Customisation and flexibility, to tailor EHRs to practices and specialties
- Fully functional on mobile devices
- Integrated with laboratories so test and imaging requests, provide referrals and send prescriptions are seamless, minimise paperwork and streamline administrative tasks
- Real time eligibility verification and billing
- Patient portal that’s user-friendly
- Flexible and simple patient admissions and check-ins
- Sharable patient educational material
- Available training and support for EHRs
- Regulatory compliance
- Data flexibility and portability
- Application Programming Interface (API) and third party integrations.
For Africa’s health systems, sustainable affordability’s a vital matter. Other sustainability requirements, such as connectivity, are essential too. With all these in place, they can concentrate on mitigating investment risks and benefits realisation. There’s always more work to follow on with eHealth.
AI’s revolutionising healthcare
In 2016, supercomputer IBM Watson diagnosed a rare form of leukaemia in a patient at a hospital linked to Tokyo University. Using Artificial Intelligence (AI) and operating on the cloud, IBM Watson can cross reference and analyse data from millions of international oncology papers. From this data, it can extract information much faster than humans ever can. Evidence of its capabilities were reported by the University when IBM Watosn correctly diagnosed a Japanese woman in ten minutes.
Health advances initially seen as futuristic, like virtual avatars and chatbots, are quickly becoming a reality. An article in The Irish Times, says these technologies apply AI to match discussions with people, connect to the Internet and perform tasks that normally require human intelligence.
Sensley’s an example. It’s a mobile triage mHealth app currently being tested by the UK’s NHS. Sensley has an AI nurse that guides patients through their personal healthcare needs. It’s available all day, every day. Dressed in blue NHS scrubs, Seneley collects information by listening and asking questions similar to interactions between a clinicians and patients. Richard Corbridge, the developer and chief executive of eHealth Ireland says “Things are moving so fast that technologies we would have regarded as sci-fi last year, will become a reality this year. Over the last couple of years, Ireland has made some really big strides in digital healthcare.”
Corbridge believes that by 2019, all Irish maternity hospitals will be using advanced monitoring technology for newborns. Every newborn will have three devices in their cot, monitoring respiration, temperature and heart rate. Information will transfer automatically to their EHRs. In Healthcare Dive Corbridge says instead of constantly checking these levels individually, nurses will have a tablet to monitor the vital information and requests for tests, scans and results.“It’s an amazing leap for Ireland in a short space of time,” says Corbridge.
Will Africa’s health systems use AI soon too? Their eHealth strategies should now include a section on medium term plans for adopting AI.
WFPHA says PHA’s need to do more on eHealth
Opportunities for eHealth to improve public health need developing and promoting by Public Health Associations (PHA). These are the conclusions of an article in the Journal of Public Health Policy, Digital technologies for population health and health equity gains: the perspective of public health associations, by an international team. How did it reach them?
The World Federation of Public Health Associations (WFPHA) conducted a semi-structured interview with its national PHA members about their eHealth use, their eHealth challenges, and their experiences and thoughts on how to assess its impact. There were 17 responses, with more detailed discussions with ten PHAs, including Cameroon and Uganda.
A survey of the relative public health priorities showed:
This led onto three questions:
- How does eHealth facilitate the capacity of a PHA to achieve its mandate?
- How do PHAs use eHealth as a core element in their programmatic and advocacy activities?
- How do PHAs assess eHealth’s impact on population health and health equity?
How they use eHealth is:
These fulfil three main roles:
- Communicate with members
- Disseminate information about public health issues, best practices, and policies to members, stakeholders, and the general public
- Advocate, primarily to government representatives, policies and programmes to improve their country’s health system and have a positive impact on the public’s health.
Examples of PHAs eHealth use are:
- Policy and advocacy
- Mobilising partnerships
- Identifying and solving health problems
- Informing, educating, and empowering people about health issues
- Analysing and investigating health problems and hazards
- Contributing to create and maintain a competent public health workforce
- Improving effectiveness, accessibility and quality of public health services.
Alongside these initiatives, advancing PHA’s eHealth has to address a long list of challenges and constraints that limit their capacity:
- Lack of qualified people to design and manage websites
- Lack of internal ICT competency in PHAs
- Internal human resource ICT capacity in PHAs is limited
- Using volunteers to design and manage their websites helps, but it’s insufficient
- Lack of resources, including donor funding, to support core operational costs
- While external funding can provide funds to start eHealth, it doesn’t extend to operating costs
- Some eHealth initiatives are specific to other projects and operate as long as funding is available
- Several projects share similar aims but use incompatible apps that can’t be scaled to national systems
- Lack of an explicit communications strategy that includes eHealth
- Need for leadership that encourages and supports change management to overcome internal resistance, experiments with new technologies, and improving effectiveness
- For PHAs in low income countries, problems with local infrastructure, Internet connectivity, low bandwidth capacity, interruptions in electricity supply, high costs of hardware and software maintenance, and inadequate real-time videoconferencing capability.
For Africa’s PHAs these are insurmountable on a significant scale in the short, and probably medium, term. Health systems also endure these constraints for their eHealth programmes.
A very encouraging consensus emerged from the survey. PHAs should include evaluation of eHealth impact on population health and health equity gains in their strategies’ communications components. This requires PHAs to use eHealth to identify all determinants that affect health and to explore how to exploit eHealth fully. Acfee’s working on frameworks and methodologies the help PHAs and health ministries to do this. It’s a welcome finding from the WFPHA.
The study suggests that PHAs should:
- Examine their eHealth’s impact
- Incorporate eHealth and allocate and reallocate resources for adoption and management into strategic and business plans and plans to assess eHealth’s impact the PHAs’ mandates and health and health equity
- Where PHAs have experiences using and assessing eHealth, mentor other PHAs and provide financial and technical assistance to help build eHealth capacity
- Put into place a programme to help PHAs, especially in middle and lower income countries, develop their capacity to use and assess eHealth
- Work with PHA members to develop an eHealth evaluation framework
- Customise and adapt methodologies and metrics to the needs of PHAs, including assessing inter-sectoral eHealth impact on health and building relationships with software developers
Host a session during the 15th World Congress on Public Health, bringing together PHAs, multilateral organisations, Canada’s International Development Research Centre (IDRC), and organisations outside of the health sector with experience in using and assessing eHealth impact, laying the groundwork for a global action plan on eHealth use and assessment of population health and health equity.
It’s a set of ambitious initiatives. As eHealth expands, these activities will have to expand with it.
Barkly sets out three ransomware predictions
- An extra threat of doxxing, public disclosure of private records, either a file at a time or as a catastrophic dump to increase the chances of victims paying the ransom
- Ransomware infections will spread more quickly and easily
- Fileless ransomware will increase rapidly.
A Barkly survey reports only 5% of US organisations say they paid ransoms. Better back-ups and easier data recovery have reduced ransom attack’s effectiveness. Cyber-criminals are shifting their attacks to businesses instead of consumers to demand more. It means they’re increasing the potential damage and disruption of not paying. Other countries are seen as softer targets too. It’s a warning for Africa’s eHealth and healthcare.
Ransomware attacks will also increasingly bypasses scanners and signature-based anti-virus security. It raises the chances of infection for less sophisticated organisations. These’ll add to the more common technique of phishing emails with malicious attachments. Fileless attacks aren’t easy to identify using conventional endpoint security tools.
The lessons for Africa’s eHealth are stark. Two main themes are:
- Stepping up basic cyber-security measures rapidly, and not just to deal with ransomware
- Adopt more sophisticated cyber-security to deal with emerging new threats, especially ransomware threats.
Health systems will need investment in new cyber-security skills and solutions. They’ll need new eHealth strategies too.
There are plenty of eHealth startups to watch out for in 2017
Technology and startups keep growing across Africa as more people search for unique solutions to everyday problems. Disrupt Africa monitors technology startups on the continent and recently published a report identifying South Africa, Nigeria and Kenya as the top three destinations for technology investors in 2016, both in terms of numbers of deals and total funding.
A Disrupt Africa list now sets out the top technology start-ups for 2017, ITNEWS Africa selected ten start-ups it predicts will influence the market this year. Of the ten innovations, three are in healthcare. They are:
Flare, a Kenyan start-up. Its app aggregates available ambulances onto a single system and allows patients or hospitals to request emergency help using a smartphone. Flare underwent testing with ambulances throughout 2016 ahead of the release of an Uber-style consumer-facing app.
Jumaii. a Tanzanian company. Its app provides a mobile micro-health insurance product for low income and informal sectors. It’s built a mobile policy management platform that performs all the administrative activities of an insurer and allows users to access cheap insurance. Jamii won the Tanzania Seedstar World competition and is set to launch in Kenya, Uganda, Ghana, Nigeria and South Africa in 2017.
Dr CADx, a Zimbabwean start-up founded in 2016. It’s developing a computer-aided diagnostic system to help doctors diagnose medical images more accurately and provide pervasive radiology diagnostics in regions that don’t have radiologists. The solution’s designed to be used by medical professionals on existing computers and tablets. Dr CADx is able to diagnose most diseases but the start-up’s initial focus is on lung diseases such as tuberculosis, pneumonia and lung cancer, as well as head injuries and breast cancer. Dr CADx was named winner of the Zimbabwean edition of Seedstars World.
All the best to the startups. We’re looking forward to reporting on your successes on eHNA soon.