• mHealth
  • 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.

  • 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. My next piece will unpack the third guideline chapter on stock notification and commodity.

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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.

  • Competitive telemedicine platform to help achieve UHC

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

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

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

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

  • Research2Guidance publishes its eHealth connectivity report

    Working within ecosystems is increasingly important for eHealth. Research2Guidance third report of its mHealth Economics 2017/2018 program deals with connectivity. It sees mobile apps as the core of eHealth connectivity hubs. These extend connectivity to wearables, tracking sensors, medical devices, tools, access to third party aggregated health data and EHRs.

    The report is an introduction to mHealth connectivity in mobile health. It discusses the connectivity landscape too. Contents are: 

    Tool usageConnecting to health data via APIsConnecting to sensors and wearablesConnecting to API aggregatorsConnecting to electronic health recordsOutlook on the future of connected devices. 

    These provide answers questions of:

    What eHealth connectivity options exist?To what extent are eHealth publishers connecting to sensors and wearables?Which tools are mHealth app developers using?Are mHealth app developers offering Application Programming Interfaces (API) for their apps?To what extent do they use aggregated health data through APIs?Which roles do EHRs play in eHealth?How will connectivity to sensors change in the near future?

    It’ll provide a wide range of stakeholders with insights needed for mHealth strategies, plans and initiatives. As Africa’s health systems keep building on their mHealth investments, the report is helpful in moving them on.

  • An eBook sets out six steps for clinical mHealth

    Clinical teams have increasing mHealth opportunities. mHealth strategies should provide the bases for decisions to use them. An eBook by Spectralink, a communications provider, available from Health IT Security, sets out six steps. The goal’s to invest in clinical smartphones for healthcare professionals to communicate, collaborate and co-ordinate patient care across wide arrays of teams and team members. 

    Six Steps to Developing a Successful Clinical Smartphone Strategy combines generic strategic concets, such as vision, with technical components. The six steps are:

    Define an overall vision for mHealth technology initiativesUnderstand information flows, application and technology requirementsEvaluate enterprise-class smartphone solutionsAssess ICT infrastructure and requirements, including Wi-FiImplement a proof of concept and pilot programmeAddress operational issues, including training and support requirements. 

    Creating successful clinical mHealth strategies need measured, forward-thinking. Improving patient care and outcomes, and accounting for future technology advancements  must be the focus. It should include people, processes and technology to maximise organisation’s benefits.

    The eBook extends from strategy to mHealth investment. Acfee would include a step for business cases to generate and compare options to identify and estimate:

    Strategic fitSocio- economic impact, including optionsManagement capacity to deliver and realise net benefitsFinance and affordabilityCommercial themes, such as contractual options.

    Completing this would be before and after step 5. Step 6 should also address benefits realisation issues. These lay foundations for M&E as step 7. 

    Africa’s health systems assign a high priority to mHealth. The eBook provides a process that they can adopt and ehance.

  • Nigeria uses mHealth to improve blood donations

    Blood shortages are common in many health systems. An initiative in Nigeria uses mHealth to create a community of voluntary blood donors, and connects hospitals with blood banks, and blood banks with donors. Life Bank, a Lagos start-up also provides a discovery platform on for hospitals to order blood

     LifeBank delivers requested blood in less than 45 minutes, in a WHO Blood Transfusion Safety compliant cold chain. An article in Disrupt Africa says it’ll add other medical products such as oxygen, vaccines and rare drugs to its services.

    Its founder, Giwa-Tubosun, began a non-profit service to encourage people to donate blood. She then moved on to address supply shortages and poor logistics. Two main goals are: 

    Increasing access to bloodReducing the number of Nigerian women who die from birth complications. 

    LifeBank’s resources include: 

    AIBlockchainCold chainmHealthMotorbikes.

    These combine to provide information about blood availability and avoid health workers’ wasted time and frustration seeking blood products. They also minimise ineffective blood transports that result in bacteria proliferation and consequences of health complications.

     Supporters include:

    Co-Creation Hub (CcHub) in 2016 that raised pre-seed fundingEchoVC Partners, a venture capitalistParticipation in Merck’s Lagos-based satellite accelerator this yearSelection for MIT Solv2018 that added grants and access to other resources.

    Its impact is considerable. To date, LifeBank’s delivered some 11,000 products for over 400 hospitals. Over 6,300 people are registered as voluntary blood donors, with over 20% donating blood in the last two years. The result: over 2,100 lives saved.

    A challenge is convincing blood bank partners to use LifeBank. As this is  overcome, it’s it easy to envisage LifeBank eventually operating across Africa.

  • AI, blockchain, cold chain and motorbikes improve blood donations and save lives in Nigeria

    Blood shortages are common in many health systems. An initiative in Nigeria uses mHealth to create a community of voluntary blood donors, and connects hospitals with blood banks, and blood banks with donors. Life Bank, a Lagos start-up also provides a discovery platform on for hospitals to order blood

    LifeBank delivers requested blood in less than 45 minutes, in a WHO Blood Transfusion Safety compliant cold chain. An article in Disrupt Africa says it’ll add other medical products such as oxygen, vaccines and rare drugs to its services.

    Its founder, Giwa-Tubosun, began a non-profit service to encourage people to donate blood. She then moved on to address supply shortages and poor logistics. Two main goals are:

    Increasing access to bloodReducing the number of Nigerian women who die from birth complications.

    LifeBank’s resources include:

    AIBlockchainCold chainmHealthMotorbikes.

    These combine to provide information about blood availability and avoid health workers’ wasted time and frustration seeking blood products. They also minimise ineffective blood transports that result in bacteria proliferation and consequences of health complications.

    Supporters include:

    Co-Creation Hub (CcHub) in 2016 that raised pre-seed fundingEchoVC Partners, a venture capitalistParticipation in Merck’s Lagos-based satellite accelerator this yearSelection for MIT Solv2018 that added grants and access to other resources.

    Its impact is considerable. To date, LifeBank’s delivered some 11,000 products for over 400 hospitals. Over 6,300 people are registered as voluntary blood donors, with over 20% donating blood in the last two years. The result: over 2,100 lives saved.

    A challenge is convincing blood bank partners to use LifeBank. As this is  overcome, it’s it easy to envisage LifeBank eventually operating across Africa.

  • How do Africa’s mHealth strategies match the modern profile?

    With mHealth a standard component of Africa’s eHealth strategies, what’s a good benchmark to test them against? Spok, a US communications firm, as a profile of mHealth strategies that can help. Its eighth annual survey shows some marked priorities.

    Mobile Strategies in Healthcare Results Revealed says mHealth that reflects overall clinical goals for the health system or hospital are most successful. It also underpins larger eHealth strategies to deliver more efficient, higher quality care and increase satisfaction for patients, carers and health workers.

    mHealth strategies extend across a wide range of information and areas. The top two are:

    mHealth management and security, for 56% of respondents Device selection, at 52%.

    The bottom two are mobile, and business development and reporting strategies. 

    The full profile’s:

    Management and security 56%Device selection 52%EHR integration 48%Infrastructure assessment 45%Clinical workflow evaluation 43%Device ownership, including BYOD 34%Mobile app strategy 29%Mobile app catalogue 16%Mobile strategy governance 14%Business development and reporting strategy 12% 

    The third item, EHR integration, matches findings from another Spok survey of hospital CIOs. They said integrating with the EHR was their top priority for respondents. Clinical workflow evaluation’s high score on is seen as revealing. It’s an indication that doctors, nurses, and other health workers in direct patient care roles use mHealth to define safe, efficient and effectively managed workflows.

  • Medical apps need better UX and UI

    With the ubiquitous use of smartphones today, mobile users have great expectations from their apps: fast loading time, intuitive workflows, ease of use and aesthetic appeal. Digital health and mHealth organisations hoping to compete successfully in this vivid ecosystem, can no longer ignore user experience(UX) and user interface (UI) design as an essential component of their product strategy.

    So, what is UX and UI? 

    UX is the process of researching, developing, and refining all aspects of a user’s interaction with a product to ensure that it is meeting the user’s needs. UI is more cosmetic and takes into consideration the visual interaction with a product, including the colour schemes, the size and colour of a button, the consistency of a theme and so on.  

    Simply put, UX makes apps useful, while UI makes apps beautiful. Together these aspects play an important role in highlighting the value of your product and creating a lasting connection with your users.  They also have a positive impact on the bottom line, by reducing development time, increasing sales and improving customer retention. 

    With over 318,000 health apps across the most popular app stores, the difference between a successful and unsuccessful mHealth app will lie in the quality of its UX and UI.  The importance of good UX and UI cannot be overemphasized.