• mHealth
  • 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.

  • Will the mHealth app market expand by 2020?

    Despite the hype around mHealth apps, the global mHealth app market is still niche. A report, mHealth App Market Sizing 2015 – 2020, by Research2Guidance believes it’ll change drastically over the next two years or so as mHealth app publishers refine their business models. Traditional apps store revenue sources like paid downloads, in-app purchase and in-app advertisement won’t be big enough to support the growing number of mHealth app publishers.

    The report focuses mainly on rich high-income clients, such as those in China, USA and France, all of which are in the top ten major country markets. Not surprisingly, no African country ranks in the top ten. This doesn’t mean that it’s not relevant for African countries.

    The report has five main parts:

    1.     Current market size, with  current mHealth market sizing in terms of app numbers, app downloads and app store revenues for all mHealth apps or by app category and identifying key app segments according to their current reach

    2.     Country mHealth markets, reviewing  the mHealth app markets of 56 countries. profiling ten countries which currently offer the best market potential for mHealth app publishers and information about the country mHealth app market characteristics, such as which platform leads in the country and required download numbers to enter a top five ranking position

    3.     Seventeen mHealth business models, describing of mHealth app publishers’ performance, their different monetisation strategies and the most commonly used business models for mHealth apps and  examples of best practice

    4.     Top mHealth app publishers, with their background and performance for the Health&Fitness and Medical app section and lists and descriptions of current, most successful Health&Fitness and Medical app publishers,  analysing their product portfolios and performance

    5.     mHealth market forecasts, with estimated market size and revenue until 2020, with  a detailed outlook on the demand and supply side of the mHealth app market, forecasting the number of mHealth app users, their platform preference and the number of downloads.

    Analysts, mHealth decision makers, mHealth app publishers and investors can all benefit from the insights in the report. It looks at important trends that African countries implementing mHealth solutions should be aware of. 

  • Kenya’s mHealth standards set out governance and policy rules

    Leadership’s seen as an underpinning component of mHealth governance and policy. Kenya Standards and Guidelines for mHealth Systems sets out the Ministry of Health approach to framework of strategies, plans, budgets, governance and policy.

    Kenya already has a governance framework. It integrates three stakeholder types, policy, suppliers and users. It fits into its institutional governance framework described in Kenya National eHealth Policy 2016 to 2030. Its mHealth governance arrangements fit within its three main policy stakeholder parts of policy, suppliers and users. Each one sets out stakeholders’ roles and responsibilities.

    Its regulation standards extend across:

    A certification frameworkProtection of privacy and confidentialityManaging disclosures of health informationSource code and application ownership.

    Governance has four main parts:

    SecurityValidationAccountabilityOwnership.

    These are huge steps forward for all Africa’s eHealth. A possible trajectory for eHealth governance may be towards the standards released by the American Health Information Management Association (AHIMA). An eHNA post summarised these. COBIT 5 is an international for ICT governance in all economic sectors. Published by ISACA, It’s been adopted by AeHIN. As an extremely sophisticated governance model, it shows a possible destination of Africa’s eHealth governance.

  • Pocket mHealth's patient-centric and advances IOp

    Combining the synergy of patients, their mobiles and healthcare’s a growing ambition. Pocket mHealth likes the idea. It’s an app that brings EHRs to smartphones. The group is part of Atos Research & Innovation based in Atos Spain. It can fit Africa’s programmes for mHealth and EHRs.

    Validated by medical professionals, Pocket mHealth aims drives the paradigm shift needed for person-centric medical care. It provides access to EHRs so users can improve the way they take care of their health. An emphasis on Interoperability (IOp) and eHealth standards enabling integration of clinical data from heterogeneous Hospital Information Systems (HIS), it supports benefits such as better clinical efficiency, fewer medical errors and lower costs.

    Pocket mHealth’s underlying philosophies are:

    Clinical data belongs to appropriate citizensUsers supervised by corresponding, responsible health professionals.

    These are achieved by Pocket mHealth’s validation by medical professionals. Other features include:

    Improved diagnosesSuppressing unneeded paper or DVD reportsAvoiding duplicate and redundant testsEHRs are continuously updated and complete, enabling better health and quality of life decisionsSupporting patient mobility with accessible clinical data that enables better healthcare in rural or holidays locationsCyber-security mechanisms that guarantee the privacy and data security.

    Both the vision and type of solution fit Africa’s needs. Its strategies and programmes for EHRs can incorporate secure IOp links to citizens’ smartphones. 

  • eVisits create more visits

    Long before eHealth, the 18th century Scottish poet and farmer, Robert Burns, alerted us to the risks of projects having a mind of their own. His poem to a Mouse, a field mouse to be precise, gave us a permanent truth that "The best laid schemes o' mice an' men / Gang aft agley.” Since then, management and academic gurus have encapsulated it in more prosaic theories.

    Another human condition inspired by his field mouse was “I backward cast my e'e, On prospects drear!” A big advantage of retrospective evaluations is identifying unintended consequences. These can be extra benefits or extra costs. At an extreme, they can make a problem worse, such as Black Swan events, Nassim Nicholas Taleb’s concept, or unmitigated large-scale risks. Robert King Merton, a US sociologist awarded the National Medal of Science, promoted the concept. It’s important for eHealth strategists, planners and developers know if and when they’ve created any. Then, they need to fix any that are adverse, not rationalise them.

    A study published by Social Science Research Network (SSRN) found two unintended consequences arising from eVisits, a secure messaging service  between patients and providers. Generic goals are to improve healthcare quality and increase providers’ capacity. The team from Wisconsin University and Wharton School at Pennsylvania University found that eVisits create about 6% extra office visits by patients to their doctors. It also found mixed results on phone visits and patients’ health.

    The increased demand reduced capacity. It redeployed time allocated to phone visits, and 15% fewer new patients were accepted by doctors each month following their eVisits implementation. These results are from almost 100,000 patients over five years from 2008 to 2013, a period that includes eVisits’ rollout and diffusion.

    Taken together, the two findings may be good value for the 6% who may be accessing healthcare they need, but they might have delayed or foregone. It’s not good for the 15% who may have given up on healthcare they need.

    The adverse effect was more pronounced for healthcare organisations already at or near capacity. These seem like high priorities for eVisits’ potential. The study also reveals the difference between eHealth’s potential and its probable net benefits. Rarely, if ever, does eHealth operate at its full potential. A probable performance below this can create viable net benefits. Falling well short creates negative results.

    Africa’s health systems can test these unintended scenarios using effective business case methodologies. Risk adjustments that convert an ostensibly attractive project into a negative can reveal the scope for unintended consequences to come into play. It provides decision-takers an opportunity to deal with them prior to the event.  While another of Burns’ lines was sceptical about estimating. He thought “Foresight may be vain.”

    Maybe, but it’s better to model and test an unwelcome future than stumble into it.

  • Discover Africa’s plethora of eHealth opportunities at eHealthAFRO 2017 Use-case Bazaar

    Industry stakeholders are realising the opportunity for eHealth to help expand access to healthcare resources, improve patient outcomes, and increase efficiency of healthcare services. The eHealth space in Africa is experiencing an explosion of new ideas and technologies, which the eHealthAFRO 2017 conference will showcase. It takes place at Emperors Palace from 2-4 October 2017.

    Afternoon use-case bazaars on Tuesday and Wednesday will allow conference participants to explore 48 new ideas and technologies. These sessions will feature compelling eHealth solutions and implementations. The use-case bazaar themes extend from the conference theme: eHealth for Universal Health Care (eH4UHC) and includes mobile apps and devices, eHealth systems and architecture, and eHealth use-cases demonstrating on-the-ground successes.

    Participating organizations include HISP-SA, UCT's CIDER, Jembi Health Systems, SANAC's Focus for Impact project, the AitaHealth assisted community outreach project, HPCSA’s new eLogbook for interns and many more.

    See the expanding list on the eHealthAFRO website. Don’t miss this opportunity to engage with industry leaders, share your ideas and keep abreast of eHealth developments in Southern Africa.

    If you or your organization have an interesting eHealth solution or project, let it be shown where Africa meets for eHealth. There are still a few open slots for organizations that would like the opportunity to showcase their eHealth idea or technology. For more on this opportunity, contact the eHealthAFRO organizing committee here.