• mHealth
  • eHealth Africa pilots AVADAR to track Toward Polio Eradication progress

    In response to the reported cases of wild poliovirus in Nigeria, eHealth Africa (eHA) partnered with Bill & Melinda Gates Foundation, the  WHO, and Novel-T to pilot a mobile surveillance app for Acute Flaccid Paralysis (AFP) in children. It’s a condition of a rapid onset of weakness of people’s extremities, and includes Guillain-Barré syndrome.  AFP often causes weakness of respiration and swallowing muscles, progressing to maximum severity within one to ten days. 

    WHO defines AFP surveillance as six goals:

    Track wild poliovirus circulationUse data to classify cases as confirmed, polio-compatible or discardedMonitor routine coverage and surveillance performance using standard indicators in all geographical areas and focus efforts in ones that are low-performingMonitor seasonality to determine low season of poliovirus transmissions to help to plan National Immunisation Days (NID)Identify high-risk areas to plan mop-up immunisation campaignsProvide evidence to certification commissions of interruptions of wild poliovirus circulation. 

    Standard indicators are: 

    >90% of expected monthly reports>1/1000,000 annualised non-polio AFP rate per 100,000 children under 15>80% of AFP cases investigated within 48 hours>80% of AFP cases with two adequate stool specimens collected 24-48 hours apart and less than 14 days after onset>80% of specimens arriving at laboratories in good condition>80% of specimens arriving at a WHO-accredited laboratories within three days of despatch>80% of specimens for which laboratories’ results sent within 28 day turn round. 

    AFP surveillance’s one of four cornerstone strategies of polio eradication. The objective’s to identify all cases of polio through a system that targets any case of AFP as a potential case of polio.  AVADAR’s a surveillance tool on android mobile devices provided to health workers and community informants. It aids AFP detection and reporting both in health facilities and local communities.

  • mHealth keeps expanding, but Africa and South America are trailing

    The mHealth market’s been growing steadily, and will keep it up. In its report mHealth App Economics 2017 Current Status and Future Trends in Mobile HealthResearch2Guidance (R2G), a strategy advisory and market research company, assesses how digital intruders are taking over the healthcare market. 

    This year, there are 325,000 health and fitness apps available from all major app stores. It’s 78,000 more than last year.

    Most eHealth practitioners come from Europe, 47%, and 36% from the US, a combined 83%. Asia-Pacific accounts for 11%. South America and Africa trail at 4% and 2% respectively, confirming the need for increased human capacity development.

    Other findings include:

    Android’s overtaking Apple in health app numbers84,000 health app publishers release appsWidening demand and supply gap, with high number of developers and low downloads growth ratesUS$5.4bn investment in eHealth start-ups fuelling the marketUsers will download an estimated 3.6bn apps in 201718% are not developing health apps because of uncertain regulations53% of eHealth practitioners expect health insurances to be  the future distribution channel with best market potentialAn estimated 28% pure eHealth market players in the eHealth industry.

    Two app types may have a big healthcare impact. Artificial Intelligence (AI) is seen as the most disruptive technology.  It’s seen as combining with remote monitoring to be the technologies that will disrupt healthcare most. The profile’s:

    AI 61%Remote monitoring and assistance 43%Wearables 34%IoT 30%Virtual reality and intelligence 27%3D printing 22%Blockchain 18%5G 8%Other 5%. 

    It seem that there’s an opportunity for Africa’ health systems to support and expand their local health app supply side. An integrated demand and supply strategy could do it.


  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • England’s mHealth has successes and challenges for African initiatives to learn from

    Strategies and plans for mHealth and mobile working stretch across most of Africa. A service from Digital Health can help the continent’s health systems to compare their performance with some of England’s NHS mHealth initiatives. Its Advisory Series, August 2017 deals with mobile and modern working. It has two perspectives, projects for clinical staff working in communities and mHealth that improves hospital care and to help non-clinical staff to be efficient.

    For mental health services, a goal’s to extend mobile access to EHRs for staff working mainly outside hospital. It includes logistics data such as patients’ locations and travel plans between them. mHealth benefits inpatient services too, where there are many routine tasks, such as therapeutic observations, and not similar to some community services that can involve complicated conversations that need recording. An mHealth solution from an in-house development enables health workers to use a range of phones or tablets that provide process-driven interfaces about patient care. mHealth can also replace traditional paper ward diaries with eLogistic  systems.

    Clinical audit and research can benefit from mHealth. An app can capture data about interactions with patients and match these against clinical guideline milestones. Instead of writing activities, doctors can tick boxes and data can be analysed and practices reviewed. Time saving and better quality healthcare are the results.

    South Gloucestershire Clinical Commissioning Group is another organisation which has found increased efficiency through greater use of mobile – simply by introducing the sort of electronic diary management abilities most take for granted in their private lives.

    Bring Your Own Device (BYOD) isn’t seen as viable for some NHS organisations. The extra complexities it brings can disrupt and a number of cultural changes to clinical and working practices are needed to realise mHealth’s benefits. These are the most challenging components of mHealth projects. They’re more significant than affordability challenges of devices, software, licences, connectivity and cyber-security. Mind-set changes and clinical leadership are essential for success. Clinical informatics champions, currently a small cadre, are helping to increase mHealth adoption.

    Africa’s mHealth programmes will have encountered many of these themes. There’s strong case for their leaders to share their experiences too.