• Public Health
  • There’s not enough eHealth for healthy living

    An important theme in Acfee’s goal of healthy Africans is eHealth that supports healthy lifestyles and discourages unhealthy behaviours. Few eHealth initiatives are available for this public health strategy. In an article in KQED Science, Stephen Downs, chief technology and strategy officer the Robert Wood Johnson Foundation (RWJF), attributes the paucity to two main causes. One’s the growing proliferation of chronic diseases, especially diabetes, cancer and heart ailments. The other’s a huge growth in wearables that monitor the consequences of sedentary lifestyles, such as mHealth apps that count steps to show that people don’t naturally incorporate the time and space to walk.

    Down’s solution is for innovators to stop treating symptoms and start remedying the problem’s roots. This needs much more than eHealth. It needs unhealthy systems to be re-engineered to remedy the effects of unhealthy environments by engineers and designers in all industries and for them to identify their products’ effects people’s health.

    An example is the Changing Places group at the Massachusetts Institute of Technology (MIT) Media Lab. It’s attempting to create solutions that change human behaviour fundamentally. One initiative’s designing ways to feed people healthier diets through urban farms that make use of city spaces. If it succeeds it could benefit millions of Africans living in Africa’s huge cities. A project is the MIT CityFARM that aims to eliminate the large water volumes used by agriculture and avoid unnecessary fertilizers and pesticides.

    Another’s the Blue Apron delivery services. It provides boxes of fresh food to doorsteps, with all the ingredients and spices needed to cook meals at home. It replaces fast food with faster food and better nutrition.

    ColaLife’s an equivalent and expanding initiative in Africa. eHNA’s previously posted about its activities and successes.

    With eHealth’s existing, huge emphasis in healthcare, it seems it’ll be sometime before eHealth for health will start to catch up. Links needed with other activities make it a complex endeavour. Africa’s health systems could take a leading role.

  • How quickly can Africa’s public health fill the social media space?

    Social media seems to dominate some people’s every waking minute. It may have a big role in some people’s sleep too. A report in the Journal of Public Health Policy, Social media, knowledge translation, and action on the social determinants of health and health equity: A survey of public health practices, sees this as “Opportunities for public health to increase its influence and impact on the social determinants of health and health equity.”

    It found that public health agencies use social media for knowledge translation, relationship building, and specific public health roles to advance health equity. Its penetration leaves plenty of room for expansion into activities such as navigating, creating and evaluating content to support action on Social Determinants of Health (SDH), health equity, enhance research evidence and mobilising knowledge, informing, educating, and empowering people about health issues, assessing public perception, increasing rapid access to public health messaging during emergencies and other times, mobilising community partnerships and action, and collecting surveillance data. There’s a wide range of uses to aim at.

    Facebook and Twitter are the main media channels identified by the survey. On a scale of daily, weekly, monthly, infrequently and never across several public health SDH and health equity activities, never had the highest score, between 32% and 44%. Infrequently was second, between 29% and 33%.

    These give a range of rates for regular social media use of between 14% and 38%. Expanding from this low base is an opportunity because about 75% respondents said online engagement afforded opportunities for networking and relationship building. Nearly 70% said it’s good for collaboration. Over half are motivated by the chance to share their work on SDH and health equity.

    The challenge’s converting the motivation into capacity utilisation. How quickly can Africa’s public health utilise social media’s spare capacity?

  • IHE release new quality, research and public health white paper

    Access to secondary data and using it effectively’s essential for initiatives to improve health and healthcare quality, research, implementation, surveillance and M&E. The Quality, Research and Public Health  (QRPH) Technical Committee of Integrating the Healthcare Enterprise (IHE) has published a new white paper, Using IHE Profiles for Healthcare - Secondary Data Access. It’s the fourth in a series of white papers. The other three are:

    1. Knowledge Representation in Chronic Care Management: Example of Diabetes Care Management
    2. Newborn Screening (NBS)
    3. Performance Measure Data Element Structured for EHR Extraction.

    The new white paper describes how to allow secondary data communities to have standard, reliable and secure data access from another health community, especially clinical. It also provides guidance on respecting patients’ privacy and access to data if a secondary data community isn’t allowed to know patients’ identifiers used by the other community.

    Before using the white paper, it’s important to have a working knowledge of five IHE standards:

    1. Cross-Enterprise Document Sharing (XDS)
    2. Patient Identifier Cross-Referencing (PIX)
    3. Cross-Community Access (XCA)
    4. Patient Demographic Query (PDQ)
    5. Cross-Community Document Reliable Interchange (XCDR)
    6. Query for Existing Data (QED).

    Other relevant standards are:

    1. Redaction Services (RSP)
    2. Data Element Exchange (DEX)
    3. Clinical Research Process Content (CRPC)
    4. Retrieve Protocol for Execution (RPE)
    5. Aggregate Data Exchange (ADX).

    There are two use cases:

    1. Epidemiology, with data available from research to the clinical community
    2. Case Report Forms (CRF) retrieval for clinical purposes, with data available in both directions between research and clinical communities.

    IHE has a standing invitation to public health professionals to join its collaborative efforts between the public health and HIT vendor communities. It guides the development of IHE Integration Profiles for Interoperability (IOp) among and between EHR and Public Health Systems (PHS). The profiles facilitate the linkages, standardisation and integration of health data between clinical care and public health to create robust, overarching Health Information Exchanges (HIE). These are becoming increasingly important for Africa’s eHealth.

  • mHealth improves public healthcare in South Africa

    42 million South Africans rely on an under-resourced public health care sector. Inadequate access to health care perpetuate the inequalities that exist. The country faces infectious diseases which kill thousands of people every year namely HIV/AIDs and TB, as well as non-communicable diseases, such as diabetes and cardiovascular diseases, high levels of violence and injury, as well as a relatively high maternal and child mortality rate. These factors make for a dire healthcare situation in the county.

    IT-ONLINE says that healthcare in South Africa is increasingly hospital-centred, disease focused and specialized. This model has led to significant advances in medicine, has helped to improved access to health care and proven profitable, but excludes large segments of the population as it cannot provide universal access.

    The Department of Family Medicine at the University of Pretoria has created a community-orientated primary care (COPC) model for the country. “COPC is a geographically-based, collaborative approach to health that begins with individuals, and families in their homes,” explains research lead Professor Jannie Hugo.

    “COPC is an established concept, but our solution is novel in that it blends academic rigour, public health focus, clinical care and technological innovation and a transformative platform for improved society-wide health outcomes,” says Prof Hugo. The value of the model rests in its comprehensive care that integrates the home, clinics, GPs and hospitals to improve individuals’ ability to manage their health consistently. The system has the potential to revolutionise health care in South Africa.

    AitaHealth is a smartphone app which supports the newest COPC model used by community healthcare workers. Modules in the app collect patient information, guides responses and plans treatment and future visits. “The app guides community health workers through the process, and the information entered guides action, such as treatment or testing,” explains Prof Hugo.

    The backend of the app has a web-enabled platform so all information and interventions captured is available to managers to plan service and delivery. It also allows managers to  support their teams in the field in real-time. AitaHealth is linked to a patient record system using Synaxon to provide continuity of information and care by connecting people in their homes to professionals in clinics and hospitals.

    Continuous learning is another key feature of the app  and is critical in healthcare, and COPC in particular. “To equip healthcare workers and professionals with the knowledge and skills required to carry out the complex tasks of COPC, is necessary for success and sustainable development,” says Prof Hugo.

    Continuous work integrated learning is built into the implementation plan and is supported by curricula, face-to-face training and specifically developed learning materials. Through workplace learning, health workers transition to higher qualifications and professional development to empower and upskill community members.

    The collection of information also provides robust data on the real health situation and services in communities. This kind of information means teams can tailor health care to individuals in specific areas, and can be used in basic and applied research.

    As a result of this work, the National Research Fund is funding 14 masters and 12 doctorate students who are working on various aspects of learning in community health to improve the model, quality of care and the general level of capability in health, including health research.

    The project is already supporting the health of communities around Tshwane and is replicable and scalable. Because the approach is sustainable and affordable community-based health care system, millions more can benefit from this new approach.

  • Malawi’s Moyo ndi Mpamba shares public health information

    Malawi has developed an innovative interactive communications campaign to solve its public health challenges. The Moyo ndi Mpamba! initiative (Life is Precious!) is a radio drama programme which encourages listeners to interact with the show using SMS and social media, on key health issues, says an article in BIZTECH Africa.

    The initiative came about when the Ministry realized the public was missing out on some basic fundamental health insights. One such example was the Ministry of Health’s attempt to prevent malaria by distributing insecticide-treated nets. What they found is that even though the nets were reaching those in need, some communities misused the nets due to a lack of understanding about their purpose.

    Consequently, the Ministry developed the Moyo ndi Mpamba to help tackle these problems and promote better behaviour. The programme combines the power of entertainment with education to address key issues such as malaria, family and maternal planning, neonatal and child health, HIV and AIDS, water and sanitation. In each 30 minute programme, audiences hear about the twists and turns of community life as the characters learn to cope with challenges that reflect the real-life problems of people in Malawi. Listeners are encouraged to respond via SMS or Facebook and a subsequent feedback programme highlighting the audience’s reaction is then aired. The interactive aspect of the show is dynamic and has proved very successful with many people claiming to have made personal changes in their lives as a result of the show.

    On an individual level, there have been stories of people seeking medical help within 24 hours of the onset of fever, using mosquito nets and attending antenatal classes for the required four visits. On a community level, more public toilets have been built, hand-washing facilities in communities have been installed and home births are less frequent. This simple initiative is having a real life impact on Malawians. 

  • Sharing public health data has challenges

    Data sharing in the eHealth age is seen as a standard benefit. A report from an international team, and published on Biomed Central (BMC), says that the opportunities offered by public health data collection, and leading to better global health cooperation, scientific discovery, and effective disease control programmes, are not matched by efforts to use the data efficiently. It says that a “Global process will be essential for a more effective use of known solutions and to build consensus for new solutions to harness the potential of data towards a 21st century population health.”

    The delay is due to twenty barriers in six groups. These are:

    • Technical

    o   Data not collected

    o   Data not preserved

    o   Data not found

    o   Language differences

    o   Restrictive data formats

    o   No technical solutions available

    o   No metadata and standards

    • Motivational

    o   No incentives

    o   Opportunity cost

    o   Exposure to criticism

    o   Disagreements on data uses

    • Economic

    o   Possible economic damage

    o   Lack of resources

    • Political

    o   Lack of trust

    o   Restrictive policies

    o   No guidelines

    • Legal

    o   Ownership and copyright constraints

    o   Privacy protection

    • Ethical

    o   Lack of proportionality

    o   No reciprocity.

    It’s a crushing list, and confirms the need for African countries to emphasize public health and population health management in their eHealth strategies. Converting it into action is more important, and isn’t easy. The report says that “Most technical, motivational, and economic barriers are deeply embedded in much larger challenges of health information system capacity, particularly in low- and middle income countries.” eHealth’s components of people, ICT and change will need to combine to make improvements from a long-term endeavour.