Peter Nyasulu

eHNA Profile

  • mPowering frontline health workers’ launches WASH health domain on ORB

    Exhortations to people to wash their hands frequently have a long history. Continuous, accessible reminders are still essential.  Handwashing’s the single most cost-effective intervention to prevent pneumonia and diarrhoea in children. It reduces infections during pregnancy and childbirth too.

    In the eHealth age, there are more sophisticated ways of disseminating the advice than numerous signs with lots of slogans. mPowering Frontline Health Workers is launching a new domain using on Object Request Broker (ORB) for Water, Sanitations and Hygiene (WASH). It contains training materials for health workers. ORB’s middleware that allows program calls from one computer to another. It relies on a computer networks.

    The need’s clear. In 2013, WHO and The Partnership for Maternal, Newborn & Child Health (PMNCH)  identified the challenge of diarrhoea. Diarrhoeal disease is the second leading cause of death and a leading cause of malnutrition in children under five. It’s in children under five years old

     years old. It is both preventable and treatable. There’s an estimated 1.7 billion cases of diarrhoeal disease every year, leading to about 760,000 children under five dying. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.

    Another report says an estimated 10-15% of maternal deaths are due to two causes. One’s infections linked to unhygienic conditions during labour. The other’s poor hygiene practices during six weeks after birth. 

    ORB’s WASH materials provide training and information on waste management, urban water supplies, sanitation planning, environmental health. All content’s quality assured to ensure accuracy and relevance for health workers. It’s accessible from mobile devices. 

    mPowering Frontline Health Workers is an initiative of USAID and the mHealth Alliance. It has six goals:

    • Crowdsource innovative multi?media health content
    • Create an online library of downloadable digital health content for organisations in developing countries
    • Produce a digital dictionary to enable integration and standardised reporting across several mHealth applications
    • Accelerate the sustainable expansion of mHealth for frontline health workers in more than three developing countries
    • Rigorously evaluate partnership impact
    • Share experiences through a virtual global learning platform. 

    An estimate of 42% of global deaths from diarrhoea of children under five are in Africa. That’s about 320,000 children. mPowering Frontline Health Workers has an essential role.

  • A portal doesn’t improve US hospital outcomes

    As the internet and web have spread across healthcare, portals have been seen as an essential link between patients and clinical teams. It seems they don’t make any difference to hospital outcomes. A study at Mayo Clinic Hospital, Jacksonville, published in the Journal of the American Medical Informatics Association (JAMIA), found the 30-day re-admissions, inpatient mortality and 30-day mortality rates were virtually the same for hospital patients who used portals without prompting and those who didn’t have accounts to use them. The 30-day rates were adjusted for Lengths of Stay (LOS).

    Interpreting the results needs to incorporate the limitations of the portal. It has no specific features for communication between patients and healthcare teams. It only includes admission notes, operative notes, consultations and laboratory studies in real time. Daily progress notes can’t be viewed, and there’s a 72-hour delay in viewing radiology and pathology reports. There’s no educational material about patient-specific diseases and processes.

    Patients with portal accounts seem to drop their access on admission. About 44% of patients who had a portal account when they were admitted, but fewer than half, about 21%, accessed it when they were inpatients. Other studies have found similar results, such as 34% and 23%. For tertiary services, the rates were 25% and 16%.

     of registered users accessed their account.22 The lack of features designed specifically for inpatient use was previously emphasised in a systematic review.14 Consequently, several medical centres designed hospital-specific applications aimed at improving the use and usability of inpatient portals.23–25 In a realistic review, Roberts indicated that patient participation with inpatient health information technology (including patient portals) can be augmented by interactive learning focused on information sharing, self-assessment and feedback, tailored education, user-centred design, and user support. Outpatients with severe diseases use portals more frequently. 

    Patients who access portals have better outcomes for some chronic conditions such as: 

    ·             Diabetes, with lower haemoglobin (HbA1c) after 6 months

    ·             Hypertension, with improved blood pressure control at 12 months)

    ·             Depression management, with increased medication adherence

    ·             Preventative care, such as up-to-date immunisations and mammograms. 

    Portals can have benefits. African health systems need to be explicit about what their portals can achieve and ensure that these are maximised.

  • Technology’s healthcare transformation is core

    As their name implies, the two fictional robot clans of transformers were good at it. For healthcare, it’s a constant, striving ambition. A health policy statement from the American College of Cardiology (ACC) sees it as relying on successful adoption of technological innovations in big data analytics, precision medicine and eHealth. Published in the Journal of the American College of Cardiology, 2017 Roadmap for Innovation—ACC Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health puts healthcare transformation as a product of a shared vision of a broad range of stakeholders. It has to establish healthcare delivery’s future and develop new patient-centred, evidence-driven models that reward value over volume.

    It sets out six steps that Africa’s health systems can adopt and adapt:

    • Continuously engage a multidisciplinary group of stakeholders in an innovation collaborative to foster an understanding of how patient care guides the development and integration of new technologies
    • Drive patient-centric innovation by broadening patient access to health information, consumer empowerment and clinician activation
    • Support research into new innovations, including national and international academic activities, and incorporate rural and underserved populations in phases of device and precision-based clinical trials
    • Develop a compact for human-centred design and a commitment to measuring the impact of new innovations on health, access, equity, costs, and outcomes through evidence generation and development of best practice models
    • Harness the principles of evaluation, integration, patient and clinician engagement and measures of care efficiency as innovation platforms in an inclusive and iterative model to advance new technology development centred around factors important to patients, clinicians, and healthcare institutions
    • Identify mile markers for innovation success, including new innovation groups to guide activities that represent types of clinician and professionals in training.

    These are rigorous activities. They can help Africa’s health systems move their eHealth services into a new phase with a firm strategic foundation.



  • mHealth helps diabetes management

    As diabetes spreads across Africa, an encouraging study reported in Diabetes Care found the mHealth helps deal with it. A team from Cardiff University in Wales investigated 14 mHealth services used in glycaemic control,  HbA1c in diabetes 2 self-management by 1,360 users.

    Results are encouraging for Africa’s mHealth initiatives. The mean reduction in HbA1c of mHealth users was 0.49% compared with control groups. Sub-group analyses indicated that younger patients were more likely to benefit from mHealth for their diabetes. Benefits increased when health professional provided feedback, indicating that mHealth plus health professionals can be a better healthcare model that mHealth alone.

    Two other findings are, mHealth for diabetes can be effective for populations, and mHealth’s functionality and use need standardising. The latter highlights the need for Africa’s health systems to enhance their overall eHealth regulation that can lead to appropriate mHealth policies and guidance.

  • Do smokeless stoves help UNICEF’s fresh air goals?

    Fresh, clean air’s better for health than polluted air. Nothing controversial about that, so UNICEF’s fresh air initiative, summarised in an eHNA post, seems straightforward, but it might not be. The Cooking and Pneumonia Study (CAPS) in Malawi, reported  in The Lancet, was expected to show children are less likely to die of pneumonia if they live in a home where food’s cooked on smokeless stoves instead of open fires. They didn’t. A report from the UK’s Medical Research Council (MRC) says it seems smokeless stoves make no difference. It doesn’t make a difference to children’s illness either.

    The study was financed by the MRC, Wellcome and the UK Department for International Development (DfID). If there’s no evidence that cleaner burning biomass-fuelled stoves reduce the risk of pneumonia in young children in rural Malawi, what are their health benefits and what other, evidence-based interventions are need to reduce risks?

    Such a counter-intuitive research finding’s important for eHealth projects aiming to help deal with pollution. The limited evidence for eHealth might obscure an equivalent conundrum. Africa’s health systems need to scrutinise these rigorously. The implications are enormous.

  • Derek Kunaka leads health systems strengthening for SDGs

    Africa’s eHealth goals are extensively drive by Sustainable Development Goals (SDGs). MEASURE Evaluation Strategic Information for South Africa (MEval-SIFSA) supports strengthening health systems, especially through eHealth, so African countries can make good progress.

    MEval-SIFSA’s a key eHealthALIVE2016 partner. The two-day conference in Sandton is on the 6 and 7 September 2016. It brings together healthcare stakeholders to explore eHealth leadership, strategy, lessons and eHealth’s impact on the lives and health of Africans. Tickets are on sale now, with four weeks to go.

    Derek Kunaka has worked in public health since 2004 on projects to strengthen health information systems, build strategies for data collection how healthcare organisations manage data to improve health outcomes.

    MEval-SIFSA works closely with South Africa’s National Department of Health (NDoH) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to improve strategic information for evidence?based HIV management and related health programmes. MEval-SIFSA provides technical support to the NDoH to assess processes for data collection, the people who collect it and who responds and uses it.

    Interoperability’s (IOP) essential to reaching South Africa’s eHealth goals by the 2030 deadline. It’s linked to the target to eliminate duplication of effort and improve the way information systems talk to each other.

    Derek sees measurement and accountability as important underlying eHealth themes. For South Africa, they can help to support the NDOH to meets it targets.

    Come to eHealth ALIVE to learn more about eHealth in Southern Africa and how it can support countries to achieve their SDGs. It’s easy to buy your ticket now. 

  • eHealth can help Africa’s elderly

    If Africans reach 60, their average life expectancy’s about 17 years. People aged over 64 are about 4% Africa’s population, roughly similar to the percentage of the African population with diabetes. As a demographic group, the elderly have their some specific health and healthcare needs. A study in BioMed Central looked at the how eHealth, including mHealth, can help.

    It starts from the proposition that both, communicable and Non-communicable Diseases (NCD) affect how ageing populations in developing countries access healthcare.  eHealth’s supporting role’s inhibited because older adults lag behind younger adults in using new technologies in their everyday life.

    Features of people seeking health information online are set out as:

    1. Widespread access to health information in remote areas and vulnerable communities.
    2. Equity in access to health information
    3. Interactivity facilitates interpersonal interaction.
    4. Tailoring information for increased personalised services where users can select sites, links and specific messages based on knowledge, educational or language level, need and preferences
    5. Older adults with a higher socioeconomic status are more likely to use the Internet for information
    6. People’s Internet use can increase if they have a chronic medical condition.

    There’s a wide range of eHealth that can meet some of elderly populations’ needs. They include:

    1. EHRs
    2. e-Prescribing
    3. Telemedicine
    4. Consumer health informatics
    5. Health knowledge management
    6. mHealth
    7. Healthcare information systems
    8. Social media.

    There comprise valuable tools for elderly people in developing countries. It’s especially so for those with limited resources to access to medical care, and in poor rural areas where hospital resources and health workers are scarce and overstretched. Elderly people in poor areas may also have limited literacy that decreases eHealth access.

    eHealth solutions need a range of initiatives. They could include eHealth training of older people, reliance on visual information, free WiFi, reliable connectivity, social networks and technical support. These aren’t readily available, but should be part of Africa’s eHealth strategies so the elderly can enjoy their extra 17 years or so.

  • How can mHealth improve populations’ health?

    It seems that mHealth has a long way to go before it makes a big difference to populations’ health. Aetna Foundations, Aetna’s charitable entity, is setting up two mHealth fellowships to find out. Dr Garth Graham, the Foundation’s boss said to mHealth Intelligence that his organisation’s undertaking a serious review of mHealth platforms and their contribution to population health, especially in underserved markets.

    One’s the Aetna Foundation Health Equity Innovation Fellowship at Yale University. It’ll review challenges affecting low-income communities. The other’s the Aetna Foundation Fellowship in Healthcare Innovation at Massachusetts General Hospital, supporting direct experiences that encourage students to use mHealth solutions for sustainable healthcare improvements. Both have the goal of seeking innovative ways to improve public health and transforming lives.

    mHealth’s seen as an opportunity. It’s well known that people in underserved communities are more likely to endure chronic diseases and are high adopters of mobile technology, but there are challenges. Developing preventative health tools in mHealth and incorporating them into people’s daily activities are two. Educating communities is needed too so people can use mHealth to help them take their important health decisions. The biggest priority in tackling chronic disease is prevention.

    eHNA has posted that some professionals see mHealth data as not reliable enough. It’s a barrier to progress. Aetna Foundations two programmes aim to improve integration and confidence, so empower physicians to use mHealth in treatment, care management, information gathering, diagnosis and prevention plans.

    There are two other goals:

    • Support mHealth that’s developed, tested and optimised in real clinical and non-clinical settings to determine the best use
    • Disseminate research findings so people are more awareness of available mHealth and its information.

    Findings from the two programmes are directly relevant for Africa’s mHealth initiatives and plans. Adopting rigorous good practices are vital in ensuring mHealth’s net benefit, both for people and setting the trajectory for continuous mHealth investment.

  • Emergent strategy offers Africa's eHealth a refresh

    Africa’s health systems must address big challenges for its countries eHealth to catch up. At Acfee’s African eHealth Forum (AeF) in July 2015, senior eHealth leaders from several countries identified more than 60 long-standing eHealth challenges that need fixing before eHealth can make a big impact. The list, described in Advancing eHealth in Africa, was longer, and more demanding than most people expected.

    Since then, WHO’s 2015 eHealth Survey, reported in eHNA, found that out of 33 African countries, only one’s started to deal with Big Data. Other missing initiatives include investment in predictive analytics, both for surveillance and in clinical services, and the Internet of Things (IoT). Do these point to the need for countries to refresh their eHealth strategies and plans?

    Expanded eHealth leadership, and eHealth capacity for skills and knowledge in the health workforce, were important challenges. These we identified in 2009 by the Commonwealth Secretariat in its support programme for eHealth strategies. In a series of workshops, African countries working on their eHealth strategies showed that they needed to develop and achieve new organisational contexts to pursue their eHealth goals effectively. Without them, the important eHealth technicalities such as interoperability, architecture, standard and connectivity would not realise their benefits fully. There still much more to do. 

    eHNA’s reported that five-year eHealth strategies have a timescale that’s too short. eHealth needs a continuous process that stretches well beyond this horizon and allows for regular updates to address emerging issues.

    A first step for African countries to refresh their eHealth strategies is to recognise that it’s a long, slow road with no end. Health workers need new eHealth skills and knowledge that go beyond the health ICT technical skills of health informaticians. Acfee is developing programmes with African universities to deal with part of this journey.

    The expanding range of eHealth opportunities makes eHealth choices and affordability more challenging too. A segmented strategy and a combination of planned, deliberate and agile, emergent initiatives are needed. Henry Mintzberg’s credited with devising emergent strategy concepts. He sets out the deliberate, emergent choices on You Tube.

  • Engaging patients needs ten actions

    “Answers to our challenges in healthcare relies (sic) in engaging and empowering the individual.” This’s a solution put forward by Elizabeth Homes, the founder and owner of Theranos, a USA blood testing company with some “deficiencies“ recently identified by US inspectors, as reported in Wall Street Journal. If that’s where the answers are, finding them’s important for Africa.

    Lenovo’s come up with a checklist of ten actions needed to engage patients. It’s emphasis is on health systems with well-developed connectivity and eHealth and more health workers per head, but the lessons still provide a foundation for African countries to adopt and develop. The ten are:

    1. Show patients and tell them about their health and healthcare, use mobile devices in health facilities to display diagnostic images to describe injuries and illnesses to patients and their families to promote informed decision-making and higher patient satisfaction
    2. Brighten up the bedside with ICT tablets or virtual clients to take advantage of opportunities to enhance patient experience and provide patients with access to health data, educational materials, discharge instructions and order meals
    3. Go where they go and streamline on-demand access to health data and providers anywhere, anytime so it’s easier for patients to view data securely, ask questions, express concerns and share updates, because they’ll then take more responsibility for their own care
    4. Stay connected to make it easy for patients to communicate with their care teams using texts, email, Skype, FaceTime, and other digital channels, so they can interact with health in the same way they do other organisations, but it requires improved responsiveness and stronger patient-physician relationships by keeping in touch through email, secure two-way messaging, video chats or virtual visits
    5. Present the big picture to patients, which includes access to comprehensive data, and ensuring that physicians, laboratories, pharmacies and other healthcare teams can securely share up-to-date data from integrated patient-provided information from wearable fitness devices and health and wellness apps to supports better collaboration
    6. Do your home-work and follow-up by remotely monitoring patients’ progress and health after discharges using wearable sensors. Telehealth, smartphones, ICT tablets or desktops with the aim to reduce readmissions, improve outcomes, and empower patients to engage in healthier, safer behaviours
    7. Put some zip in your patient portal by creating an indispensable, interactive go-to tool that enables patients to:
      1. Schedule appointments
      2. Have repeat prescriptions
      3. Request a referral
      4. Access records, test results, and doctors’ notes and communicate with care providers
      5. Submit information for preregistering for an examination and updating health data
    8. Remember that portals work both ways, so provide post-visit care summaries, post-discharge care management instructions, and educational materials patients available from a secure portal, and automated SMSs and personalised emails for appointments, immunisation, medication reminders and news about new material
    9. Broadcast engagement options so patients know about your patient portal and ensure health workers emphasise the portal’s benefits and educate patients in how to use it
    10. Seek feedback from users and implement the findings.

    Africa’s health systems can start the journey. It’s long and important.