• eHealthAlive
  • eHealthALIVE 2016 The Report now available

    The exuberance and energy of eHealthALIVE still smoulders. It was a first and a success, bringing together a wide spectrum of stakeholders, who found good value in the unique opportunity to engage, challenge and debate the rapidly developing eHealth sector in Southern Africa.  

    The eHealth spectrum of the event in Johannesburg early September is captured in eHealthALIVE 2016 Southern Africa The Report. The African Centre for eHealth Excellence (Acfee) and eHealth News have now released it.

    Prof Peter Nyasulu, Acfee executive director is clear about why eHealth, is important. “Healthy Africans is eHealth’s most important goal in Africa. Achieving it needs eHealth to support health professionals to help them transform healthcare. Africans can be healthy and while we all know of the considerable challenges, eHealth is a powerful tool to help Africans be healthy.”

    This was a core focus of the event. I was struck by how comparable eHealth challenges were across African Countries and beyond. Presentations were drawn from eHealth initiatives and programmes from Namibia, South Africa, Sri Lanka, Swaziland, Uganda, Zambia, Zimbabwe and the East African Community. Master classes supplemented these, covering interoperability, a deep dive into MomConnect and presentation of multiple District Health Information System (DHIS) use cases. The spread reflects Acfee’s goal to help advance eHealth and eHealth capacity in African countries.

    The lessons learned at the event are set out in the report. It helped delegates to:

    1. Fix eHealth challenges and support extended data use, such as analytics and research, through Interoperability masterclasses
      1. Develop use cases for eHealth initiatives
        1. Design structured, formal eHealth capacity-building programmes for healthcare professionals
        2. Emphasise the need to expand eHealth’s role in direct and clinical benefits for patients and health workers
        3. Set an eHealth balance between managing reporting and data for patients and healthcare professionals
        4. Explore benchmarks for eHealth strategies and plans.

    eHealthALIVE 2016 brought them together. It was” a unique forum for stakeholders in health systems transformation to come together to engage on real-world practical issues and find opportunities to bring about tangible change - a platform for engagement we hope to continue to build year on year” according to Taryn Springhall, Editor at eHealth News.

    Planning is already underway for next year’s SA event; set to be a highlight on Southern Africa’s annual eHealth calendar. In parallel, planning is underway for an equivalent event with the East Africa Community (EAC). These help to lift eHealth’s profile and promote its value and benefits.


    eHealthALIVE was followed by the African eHealth Forum, a platform for strategic discussions between Acfee, its Advisory Board of eminent African health leaders, and representatives from the sector. Read about it here.



  • IOp for clinical data’s vital to eHealth success

    These days, healthcare professionals need reliable, available clinical data. At eHealth ALIVE’s masterclasses, Shelly Lipon, from the International Health Terminology Standards Development Organisation (IHTSDO) and the Systematized Nomenclature of Medicine–Clinical Terms (SNOMED-CT) initiative, unpacked Interoperability (IOp) and profiling terminologies.

    SNOMED-CT’s the world’s most comprehensive multilingual clinical terminology. It contains scientifically validated clinical content and maps to other international standards. In eHealth, it supports high quality clinical content in EHRs and has an increasing number of tools and implementations. It’s not surprising it’s used in more than 50 countries.

    Its clinical terms are comprehensive as a SNOMED concept. A comprehensive clinical scope reduces need for several coding systems, that also enables queries that span across numerous multiple disciplines and clinical areas, such as test results, diagnosis, medication, devices, procedures and organisms. It’s multilingual to, so can localise national, regional and dialect use. This’s matched by a facility that links different ways of saying the same thing by a common code.

    The common reference terminology facilitates integration of clinical data from many sources that use different code systems or free text. It means that it can provide consistent representations of meaning for retrieval, processing and communication. Computable definitions of meaning allows meaning-based retrieval of clinical relevant facts that help to define relationships, support powerful querying, reporting and linking knowledge.

    Using discharge summaries as an example, Shelly summarise the range of information needed. It includes diagnoses, procedures, medications, social circumstances and follow-up appointments. These are in a combined context of current problems, past medical histories and future contexts. The data can come from single or several systems.

    A data model for discharge summaries includes the data’s form, and the form it’s transferred in. Data’s recorded in text and clinical terminology codes. Terminologies used are classifications of data recorded as summaries of episodes of care, or data used for real-time recording. It’s transferred  as message structures that can include coded data only, original text only or a mixture of coded and original text. An example of SNOMED-CT’s codes is:

    Currently, SNOMED-CT isn’t used widely across Africa. Examples are in supporting HIV/AIDS services. As eHealth and IOp sophistication increases across the continent, it’ll become increasingly important in providing accessible, relevant information to clinicians and other health professionals to help manage and improve their clinical and working practices and integrate healthcare across organisational boundaries.

  • FSDoH’s eHealth implementation plan’s on the way

    While South Africa has a national eHealth strategy, provinces have different starting points. At this year’s eHealthALIVE conference, Ms Thato Lekhu set out the Free State’s eHealth status for its five municipalities.

    The Free State Department of Health (FSDoH) provides a diverse and interwoven healthcare programmes at different stages of maturity. These service areas start from basic healthcare, such as outreach teams, to specialised disciplines. Using eHealth to support these services should align with the complexities of each them is a core part of FSDoH’s eHealth strategy. A parallel goal’s to ensure that eHealth’s enabled with the bigger health and healthcare picture.

    High speed connectivity is seen as linking the front and back ends. Front end content includes:

    1. Care-based surveillance with patient-level data in EMRs
    2. Information, Monitoring and Evaluation (M&E)
    3. Management dashboards and routine data for policy and decision makers
    4. Graphical User Interfaces (GUI)
    5. Access security
    6. User-defined queries
    7. Management reports.

    The back end includes:

    1. Web-based application architecture
    2. Content management systems
    3. Central database, Structured Query Language (SQL)
    4. Cloud computing
    5. Data warehouse infrastructure
    6. Automated backup
    7. Data capture.

    The main systems for patient information and research include:

    1. District Health Information System 2 (DHISs) database
    2. ETR.net
    3. Tier.NET
    4. Patient admission and billing (PADS)
    5. MEDITECH
    6. Pharmacy and other database systems
    7. Mosiac for oncology
    8. Occupational Health and Safety Information System (OHASIS)
    9. Picture Archiving and Communication System (PACS).

    Current initiatives to enable the FSDoH eHealth strategy include:

    1. Connecting clinics using:
    • vSat
    • Microwaves
    • Distribution of 3Gs
    1. Some clinics have data initiatives with a minimum of 128k
    2. Tertiary, central and regional hospitals range from 512k to 2Mb.

    Ms Lekhu’s clear that all these initiatives aren’t enough to run all systems simultaneously. More investment’s needed to deal with practicalities such as:

    1. Scheduled backups and patches or updates to run at night
    2. Data being depleted before month ends, hampering services
    3. Delayed email deliveries, followed by  telephone call confirmations
    4. Connectivity strategies need expanding to roll out the Integrated Patient Information System (IPIS)
    5. An improved integration platform for information systems
    6. More people with ICT skills and programmers
    7. Need for a single patient information system
    8. Projects to implement the National eHealth and mHealth Strategy
    9. More capacity to import patient data, information and clinical notes into new databases
    10. Inadequate funding
    11. Enhanced in house skills of employees, including data capturers and healthcare practitioners.

    These are not exceptional just for FSDoH. Many health systems in many countries face equivalent challenges. The critical feature is dealing with them at pace that’s sustainable and successful. Ms Lekhu as three main recommendations to achieve them:

    1. A national driven eHealth implementation plan to guide provinces on when, where and how to invest
    2. A costed and funded business plan and conditional grant for implementing eHealth nationally
    3. Improved computer literacy for coalface officials.

    These will benefit the whole of South Africa’s health system. They also have a resonance with other countries’ eHealth strategies. Implementing eHealth strategies looks set to be a recurring eHealthALIVE theme.

  • Acfee to publish reviews of cyber-security and eHealth governance

    To priority topics to come out of the eHealthALIVE week in September were eHealth governance and cyber-security. Acfee’s taking action on both.

    At eHealthALIVE, several presenters said that successful larger-scale eHealth depends on effective eHealth governance. While there are generic components, such as accountability, there’s a need to develop and implement bespoke eHealth governance to fit each countries’ situation. An important aspect’s that it should fit the corporate and political governance arrangements. Consequently, Acfee’s eHealth governance document’s a basic guide for Africa’s health systems to build from. It’s not a recipe.

    After eHealthALIVE, Acfee’s African eHealth Forum met. It’s combination of Acfee’s advisory board members and selected, invited eHealth vendors. Cyber-security was identified as an essential eHealth component with minimal advice and commentaries for Africa’s health systems.

    eHNA monitors global cyber-security information, research and advice and Acfee is summarising some themes from its database of posts for Africa’s health systems. Cyber-threats are becoming more sophisticated, matched by new research, so the document’ll be followed with updates. These do not comprise cyber-security advice, but identifies actions from other continents for Africa’s health systems and eHealth leaders to consider as they develop their cyber-security policies, strategies and measures. 

  • SNOMED and IHE were at eHealthALIVE

    Interoperability (IOp) was a core theme at eHealth ALIVE’s masterclasses. Charles Parisot of GE and Integrating the Healthcare Enterprise (IHE) set out the standards approach of IHE. IHE Is the most comprehensive set of open profile specifications. It’s based on widely adopted standards such as Health Level 7 (HL7), Digital Imaging and Communications in Medicine (DICOM), Internet Engineering Task Force (IETF) and the Organization for the Advancement of Structured Information Standards (OASIS). Standards in IHE’s technical frameworks extend across Health Information Exchange (HIE) transport, security, privacy, directories, workflow management, records sharing services, clinical data and data content

    It’s a resource with support for testing implementations in Connectathons organised on several continents, and has robust open source test tools, especially its Gazelle platform. There’s also a support services for users. 

    IHE profiles are already deployed by eHealth national programmes in many countries. They support health records sharing for hundreds of millions of patients in Canada, the European Union, Japan, Switzerland, USA and Uruguay. There are regional projects in China, Denmark, Germany, Italy and Slovenia.

    When IHE’s implemented in software applications, it can be tested for conformity through the internationally recognized, IHE Conformity Assessment of products based on ISO/IEC 17025 accredited laboratories. It’s ubiquity can ensure that IOp’s delivered by a large number of vendor products and open source implementations.

    Shelly Lipon from SNOMED outlined the services of Systematized Nomenclature of Medicine–Clinical Terms (SNOMED-CT). It’s the most comprehensive, multilingual, clinical healthcare terminology in the world, and comprises a resource with comprehensive, scientifically validated clinical content. This enables consistent, processable representations of clinical content in EHRs. Other international standards such as HL7, DICOM, IHE map onto it. This sophistication has resulted in more than fifty countries using it.

    When it’s implemented in software applications, it represents clinically relevant information consistently, reliably and comprehensively as an integral part of eHealth. SNOMED-CT’s features support the development of comprehensive high-quality clinical content in EHRs and standardises the representation of clinical phrases captured by clinicians. This enables their automatic interpretation. An important advantage is its clinically validated, semantically rich, controlled vocabulary facilitates that provide evolutionary growth to meet emerging requirements.

    These combine into benefits for individual patients and clinicians, and communities and whole populations. It also offers direct support for evidence-based healthcare, an essential component of eHealth benefits.

    Africa’s health systems are on the brink of needing IOp standards. IHE and SNOMED-CT should be part of their assessment.

  • Using data’s an important theme at eHealthALIVE 2016

    eHealth’s not much use if its data isn’t used to good effect, and this was a recurring theme at this year’s eHealthALIVE conference. Dr Vincent Shaw, Director of Health Information Systems Program South Africa (HISP SA), outlined three features of useful data for decisions, what’s new and what’s coming. His main message was:

    1. The world in which we collect health data is changing and the pressure to change’s from two large pushes:
    2. First, the  ICT industry’s creating opportunities:
    • Mobile services are changing how we do things in the future
    • Internet access is becoming more available
    • Both will elicit new opportunities for how data’s shared and used
    1. Second, there are increasing pressures to pay more attention to data collected about healthcare provided to individual patients, including:
    • A push for Universal Health Coverage (UHC), and in South Africa, the National Health Insurance initiative
    • Care for TB and HIV/AIDS patients and integrated health care processes
    • Expanded ward-based outreach and community-based health worker programmes
    • Information demands from clinicians and academics.

    It’s vital that we prepare ourselves for these changes and taking the opportunities they create. As eHealth continues to expand, this will be a constant endeavour.

    The global ICT Development Index (IDI) rankings, where Korea is top, show some important trends that are shaping eHealth’s future. They include:

    1. Access sub-index shows growth in:
    • Mobile subscriptions per 100 inhabitants
    • Percentage households with a computer
    1. Use sub-index shows growth in:
    • Percentage of individuals using the Internet,
    • Wireless broadband subscriptions per 100 inhabitants
    1. Skills sub-index, shows growth in:
    • Adult literacy rates
    • Enrolment ratio at the secondary level.

    Africa’s health systems are all below average on the IDI. Nine countries, about 17%, are ahead of the rest. They’re Algeria, Botswana, Ethiopia, Ghana, Kenya, Morocco, Namibia, Tunisia and South Africa. All face the challenge of moving up the IDI rankings. An example of how Africa’s growth may be slower than the global rate’s shown by comparing Ghana’s Nigeria’s, South Africa’s, and Uganda’s position in 2010 with its 2015 performance. The spider’s web diagram shows a modest change, with some features unchanged over the period.

    A global trajectory may be:

    1. Global population covered by mobile cellular networks heading for 95%
    2. Broadband connections using mobiles up from 40% in 2014 to 70% by 2020
    3. Connections using smartphones could be 60%
    4. Additional smartphone connections by 2020 of about 2.9 billion, mostly from developing countries
    5. Data traffic to increase by ten time by 2020, with 3G coverage reaching 86% of the global population by 2020.

    For Africa, it seems that the medium-term future may be:

    1. Expansion of Internet access through mobile broadband services
    2. Services likely to be 3G or 4G based
    3. Smartphones are rapidly becoming ubiquitous
    4. Mobile services are expanding faster than fixed line services
    5. Mobile services will play a big role in data transmission in the future
    6. Telecomms companies will have an increasing role in eHealth and its mHealth component.

    In these contexts, successful eHealth needs to overcome several challenges. They include:

    1. Strengthening governance
    2. Multiplicity of mHealth initiatives
    3. Data ownership
    4. Data security
    5. Strengthened regulatory environment
    6. Wholesale market regulation
    7. Price regulation
    8. Secure data transmission standards
    9. Privacy standards
    10. Reducing data transmission costs
    11. Data storage, exchange and management protocols need improving
    12. Costs of equipment and services are the third most frequent barrier to internet access
    13. Other barriers include low user capability, and weak infrastructural capacity
    14. Creating shared health records and communicate patient data across systems

    Interoperability’s (IOp) at the core of the solution. A framework needs several functions around Health Information Exchange (HIE). They include shared clinical repositories, shared registers, health analytics, security and auditing services and standards-based health data and information systems and points of care. When these are in place, they’ll help to track individual patients. To reach this position, are needed on the:

    1. Complexity of data standards needed for IOp
    2. Complexity of systems and the use and role of registries
    3. Use of OpenHIE standards compared to direct data exchange
    4. Unique identifiers as a key for data exchange
    5. One national universal ID or a health UID as one of many UIDs and how should this be structured
    6. The use of open source software
    7. Increased availability of Open Source Software (OSS)  such as DHIS, OpenHIE, OpenMRS, LibreOffice
    8. Capacity Building for multi-disciplinary teams:
    9. Availability of staff skilled in all aspects of eHealth, not just ICT
    10. Management of Infrastructure and software
    11. How data can be analysed, interpreted and information used.

    A culture will be needed where maturity models are key and NDOH governance and leadership are central. These will help to manage the balancing act between:

    1. Information demands in terms of data volume
    2. Infrastructure availability
    3. Skills and resource availability
    4. Creating opportunities for innovation within a structured environment.

    Dr Shaw’s view’s that developing solutions is best located in a well-defined, information architecture and enabling environment created in a context of strong eHealth governance and leadership. On their own, they’re not sufficient. In-country capacity building is critical to these initiatives too.

  • South Africa’s IOp’s moving on

    As Interoperability (IOp) becomes more important for South Africa’s eHealth strategy, Mbulelo Cabuk, Director of South Africa’s National Health Information System at the National Department of Health (NDoH) describes what happens next in the country’s eHealth programme. At eHealthALIVE2016 in Johannesburg, he said he sees IOp in healthcare not only to the extent to which systems and devices can exchange data, but as interpreting the data and displaying it in a user-friendly way for users. This range of goals is vital for users to realise eHealth’s value.

    Three IOp levels are:

    1. Foundational interoperability for data, such as clinical image files exchanged from one ICT system to another
    2. Structural interoperability for exchanging data from one system so the next can be interpreted at the data field level and preserved or unaltered, ideally creating a uniform movement of healthcare data remaining unchanged in its operational and clinical forms
    3. Semantic interoperability to make codified data clear because systems use the same vocabulary with no discrepancies between EMRs.

    Standards that support these IOp requirements provide a common IOp framework. Numerous types of standards are needed, including data exchange, semantic, security, safety, privacy, pharmacy and architecture. These are set out in the National Health Normative Standards Framework for Interoperability in eHealth in South Africa (HNSF).

    South Africa already has several eHealth programmes. District Health Information System (DHIS), is used for most routine healthcare information in eight of the nine Provincial DoHs. Western Cape DoH uses Sinjani. These are primary sources for most routine data and indicators for Monitoring and Evaluation (M&E). Both DHIS and Sinjani have expanded over the years to include many extra modules, such as data for hospitals, school health, ward-based outreach teams, emergency medical care data, environmental health data, national core standards, and client satisfaction surveys.

    Patient-based surveillance systems implemented nationally include ETR.Net for TB and the Tier.Net for the lifelong management of HIV clients. eHealth in provinces include:

    Building from the current position needs nine challenges addressing. These are common to many countries, and are:

    1. Clinicians expected to maintain too many registers
    2. Patient files managed in many places, with inconsistent numbering schemes in clinics, leading to duplicate records and files
    3. These two result in poor case management
    4. Manual calculations generate inaccuracies, such as adding data from tick registers used by clinicians to produce a monthly summary sheets
    5. Heavy maintenance, with many import-export processes at district and provincial levels
    6. Many disparate patient repositories, such as Tier.net, MomConnect and Health Patient Registration System (HPRS)
    7. Many disparate data repositories in districts and provinces
    8. Gaps between data collection and use
    9. Poor data quality, usually improved where data’s used.

    A transition from routine surveillance Information systems to patient and case-based Information systems is the planned solution. It will also deal with the complications of four health system tiers of national, provincial, district and facility that need addressing. It has four parts:

    1. Efficient manual systems
    2. Digitising selected data
    3. Automated operations by implementing patient-based information systems
    4. Shared EHRs.

    Progress towards electronic patient-based information systems includes seven initiatives:

    1. HNSF and standards-based exchange
    2. HNSF pilots and reference implementation to exchange identifier and demographic patient data with Tier.net completed successfully
    3. Improved HPRS
    4. Health Provider Registration System
    5. Public health facility unique identifiers
    6. Assessment of Primary Health Care Systems (PHCS) and Hospital Information Systems (HIS)
    7. Development and rollout of National Health Information Repository and Datawarehouse (NHIRD).

    HPRS is a vital component of these initiatives. It includes:

    1. Barcode scanning of ID books and drivers’ licences and biometric data
    2. Patient look-up facilities
    3. Generating patient file numbers
    4. Maintaining patient details
    5. Linking patients to Primary Healthcare (PHC) facilities
    6. Visit records, including dates, times and purposes
    7. Management information.

    These are supported by a range of actions. For patient-based information:

    1. Integration and IOp as the key to derive value for patients and providers and patients and successful implementation
    2. Complete integrating Tier.net and ETR.net already underway, for better case management and linking patients in care and retention of patient on care
    3. Adapting district health management information systems policies
    4. Streamlining workflow at health facilities using information systems and developing the information management roles of district, provincial and national offices
    5. Integrating patient administration and clinical systems where there is stable patient administration
    6. Shifting culture to improve filing systems, patient admin system, clinical record keeping – training clinical providers and administrative, data capture staff

    For surveillance systems and data use, initiatives are:

    1. Enhancing monitoring of data submission rates to timeliness and completeness, and building on timeliness improvements already achieved
    2. Strengthening feedback between workers who generate information and management at all levels of the health system
    3. Making information widely accessible
    4. Addressing the demand and supply continuum.

    These combine into a considerable and demanding programme. The new Ministerial Advisory Committee on eHealth, a think tank, will help to steer the course. A remaining challenge’s the ubiquitous African challenge of providing the budgets to support the considerable and sustained finance for the eHealth programme. It’s a vital step in what’s next.

  • Frere Hospital improves patient morbidity

    A previous eHNA post described Frere Hospital’s use of information to improve mothers’ and children’s mortality, Dr Rolene Wagner, Frere’s CEO, presented its approach to morbidity eHealthALIVE 2016 for hospital acquired infections, bed sores and general patient information.

    Since 2014, Hospital Acquired Infection (HAI) rates have fallen from about 3.8 to some 2.0, with a peak of about 5.8. Most of the peaks seem due to HAI in ICU and the burns unit. When these excluded, the HAI rate’s about 0.8 down to about 0.4. While the information reports have achieved a reduction, they also reveal their use to support the constant clinical and managerial vigilance needed to sustain the improvement and respond to the quarterly variations.

    Information for Hospital Acquired Pressure Ulcers (HAPU) shows an equivalent performance. After a steady decline from 2013 and a sustained low rate of about 15, the trend took a steep step up to over 25. This triggered a clinical and managerial action to bring the trend back into line.

    1. The main causes are
    2. Increase high-risk patient load
    3. Increase in temperature due to heatwave
    4. Insufficient ripple mattresses for at risk patients per ward
    5. Centralisation of procurement resulted in delays of orders
    6. Increased absenteeism amongst nurses in certain wards
    7. Possible abuse suspected.

    These are good examples of the power of information to improve quality in hospitals services. How can other hospitals develop their approaches?

  • HealthEnabled describes MomConnect at eHealthALIVE

    As health challenges go, Africa’s HIV/AIDS is big. At 12%, it’s the biggest cause of deaths. Prevention of Mother-To-Child Transmission (PMTCT) is one initiative aiming to help. Peter Benjamin for HealthEnabled explained MomConnect’s role to eHealth ALIVE.

    Messages about HIV supplement the main MomConnect content. They’re for HIV positive pregnant women and mothers to try to keep their babies HIV negative. Its aim’s to strengthen the National Department of Health’s (NDOH) strategy on PMTCT by supporting adherence to approved protocols and greater linkage of women to healthcare. There are 95 messages, covering pregnancy, delivery, up to the baby’s first birthday and a final reminder for 18 month tests. Pregnant women or mothers of infants living with HIV in South Africa, and caregivers for HIV positive infants benefit by opting into the system.

    Patients know about MomConnect’s PMTCT service from their health workers advise HIV positive pregnant women and mothers of infants to up on their own mobile phones. They can do this at any stage, first stage Anti-Natal Care (ANC), late diagnosis or after delivery. Health workers can give women business cards as reminders. Posters also provide information, such as “Are you HIV positive and Pregnant? Ask the health worker.”

    Signing in’s easy, with simple questions, steps and guides, and using keys 1 and 2 for responses. Opting out’s simple too.

    The PMTCT helpdesk coordinator at NDOH Pretoria can answer SMS questions on HIV, pregnancy, PMTCT and related issues. It’s in parallel to calls out to HIV positive pregnant women and mothers. High-risk patients are a special priority for this service. These include women under 18 years old and the first ANC’s after 20 weeks. The helpdesk asks if they’re ‘Stable on Antiretroviral (ARV) drugs?’ and ‘Disclosed status?’ in research. They’re supported by links with local PMTCT services such as Mother2mothers. Western Cape offers follow-ups by Community Health Workers (CHW) for high-risk patients during pregnancy. There’s a National MomConnect link to local care too.

    The initial pilot in five districts ends in December 2016. They’re Gauteng: Johannesburg and City of Ekurhuleni, KwaZulu-Natal (KZN): Ethekwini and Umgungundlovu and Western Cape: Cape Town, Khayelitsha, Mitchells Plain and Southern. It’s already decided to retain the pilot in these five districts until September 2017. Research with Wits Reproductive Health Institute (WRHI) will determine implementation in all districts as a national rollout, so more news to come.

  • eHealthALIVE asked, why mHealth?

    As Africa’s mHealth expands, Debbie Rogers from Praekelt asked this year’s eHealthALIVE conference, why would we use mobile phones to improve people’s health? It’s a timely reminder that mHealth must achieve benefits for health and healthcare.

    Praekelt’s experience’s that evidence shows a wide range of health benefits, including:

    1. Reduce loss to follow up healthcare
    2. Improved knowledge of healthy practices
    3. Improved coverage of four anti-natal care visits
    4. Smoking cessation.

    Two considerable challenges are scaling up mHealth and proving its impact to show it’s worth its investment. The USAID report mHealth Compendium Special Edition 2016 Reaching Scale provides several case studies of good examples. They’re outlined in an eHNA post. A common theme’s that successful scaled mHealth provides users with personal, relevant and empowering information leading to Universal Health Coverage (UHC).

    Achieving these depends on effective stakeholders’ engagement, collaboration and participation. This helps to integrate mHealth into the contexts of users’ daily lives. mHealth developers can’t do it on their own, but success needs developers to offer two attributes, leadership and humility. These combine into listening to ensure they provide better access to data for decision making.

    From this position, proving success means bridging the gap between impact evaluations and real time access to information. This needs to show that mHealth benefits exceed its costs over time, so it’s worth it. This can help to justify subsequent stages such as machine learning and bespoke, tailored nudges. These are demanding requirements, but mHealth always has to prove it. For Africa, the stakes are too high not to.