who$frameworkon$mheath$for$health$ system$strengthening
TRANSCRIPT
WHO Framework on mHeath for Health System Strengthening and the Digital Health Atlas mHealth Deployment Registry
Dr Garrett Mehl and Maeghan Orton
15 June 2016
Digital Innovations, Department of Reproductive Health and Research, World Health Organization, Switzerland
TECHNICAL CONCEPT
mHealth innovations as health system strengthening tools:12 common applications and a visual frameworkAlain B Labrique,a Lavanya Vasudevan,a Erica Kochi,b Robert Fabricant,c Garrett Mehld
This new framework lays out 12 common mHealth applications used as health systems strengtheninginnovations across the reproductive health continuum.
T he rapid proliferation of mHealth projects—albeitmainly pilot efforts—has generated considerable
enthusiasm among governments, donors, and imple-menters of health programs.1 In many instances, thesepilot projects have demonstrated conceptually howmHealth can alleviate specific health system con-straints that hinder effective coverage of healthinterventions.
Large-scale implementation or integration of thesemHealth innovations into health programs has beenlimited, however, by a shortage of empirical evidencesupporting their value in terms of cost, performance, andhealth outcomes.1–4 Governments in low- and middle-income countries face numerous challenges and com-peting priorities, impeding their ability to adopt innova-tions.2 Thus, they need robust, credible evidence aboutmHealth projects in order to consider mHealth alongsideessential health interventions, and guidance aboutwhich mHealth solutions they should consider toachieve broader health system goals.2 Their tolerancefor system instability or failure can be low, even whenthe status quo may be equally, or more, unreliable.
Current larger-scale effectiveness and implementa-tion research initiatives are working to address theevidence gaps and to demonstrate the impact of mHealthinvestments on health system targets.1 Other efforts areunderway to synthesize such findings.5
MHEALTH AS A HEALTH SYSTEMSSTRENGTHENING TOOL
Recent mHealth reviews have proposed that innovatorsfocus on the public health principles underlying
mHealth initiatives, rather than on specific mHealthtechnologies.6 International agencies and researchorganizations have also endeavored to frame mHealthinterventions within the broader context of healthsystem goals or health outcomes.2 The term ‘‘healthsystem’’ includes all activities in which the primarypurpose is to promote, restore, or maintain health.7
Some elements of a framework for evaluating healthsystems performance by relating the goals of the healthsystem to its essential functions have been proposedpreviously, which we believe can serve as a model forarticulating and justifying mHealth initiatives andinvestments.7
Applying a health systems lens to the evaluation ofmHealth initiatives requires different indicators andmethodologies, shifting the assessment from whetherthe mHealth initiative ‘‘works’’ to process evaluation orproxy indicators of the health outcome(s) of interest.This new way of thinking would facilitate selection ofmHealth tools that are appropriate for identifiedchallenges. In other words, it would drive people tofirst identify the key obstacles, or constraints, todelivering proven health interventions effectively, andto then apply appropriate mHealth strategies thatcould overcome these health system constraints.8
Presenting mHealth as a range of tools for over-coming known health system constraints, as a healthsystems ‘‘catalyst,’’ may also improve communicationbetween mHealth innovators and health programimplementers. Communicating mHealth technologiesas tools that can enhance delivery of life-savinginterventions through improvements in health systemsperformance, such as coverage, quality, equity, orefficiency, will resonate with health decision-makers.7
Hence, rather than being perceived as siloed, stand-alone solutions, mHealth strategies should be viewedas integrable systems that should fit into existinghealth system functions and complement the health
a Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAb United Nations Children’s Fund (UNICEF), New York City, NY, USAc frog Design, New York City, NY, USAd World Health Organization, Geneva, SwitzerlandCorrespondence to Garrett Mehl ([email protected]).
Global Health: Science and Practice 1
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1 A
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ished
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ust 6
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Ref: Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovaRons as health system strengthening tools: 12 common applicaRons and a visual framework. Global Health: Science and PracRce. 2013 Aug 15;1(2):160–71.
WHO & UNICEF Framework on mHeath for Health System Strengthening
mHealth is not Monolithic: Common Domains of mHealth
1Client(educa-on(&(behaviour(change(communica-on((BCC)
2 Sensors(&(point-of-care(diagnos3cs
3Registries)/)vital)events)tracking
4 Data%collec*on%and%repor*ng%%
Electronic*health*records5
Electronic*decision*support*(informa3on,*protocols,*algorithms,*checklists)
6
Provider(to(providercommunica0on((user(groups,(consulta0on)
7
Provider(workplanning(&(scheduling(
8
9 Provider)training)&)educa1on
Human&resource&management10
Supply&chain&management11
Financial'transac+ons'&'incen+ves12
TECHNICAL CONCEPT
mHealth innovations as health system strengthening tools:12 common applications and a visual frameworkAlain B Labrique,a Lavanya Vasudevan,a Erica Kochi,b Robert Fabricant,c Garrett Mehld
This new framework lays out 12 common mHealth applications used as health systems strengtheninginnovations across the reproductive health continuum.
T he rapid proliferation of mHealth projects—albeitmainly pilot efforts—has generated considerable
enthusiasm among governments, donors, and imple-menters of health programs.1 In many instances, thesepilot projects have demonstrated conceptually howmHealth can alleviate specific health system con-straints that hinder effective coverage of healthinterventions.
Large-scale implementation or integration of thesemHealth innovations into health programs has beenlimited, however, by a shortage of empirical evidencesupporting their value in terms of cost, performance, andhealth outcomes.1–4 Governments in low- and middle-income countries face numerous challenges and com-peting priorities, impeding their ability to adopt innova-tions.2 Thus, they need robust, credible evidence aboutmHealth projects in order to consider mHealth alongsideessential health interventions, and guidance aboutwhich mHealth solutions they should consider toachieve broader health system goals.2 Their tolerancefor system instability or failure can be low, even whenthe status quo may be equally, or more, unreliable.
Current larger-scale effectiveness and implementa-tion research initiatives are working to address theevidence gaps and to demonstrate the impact of mHealthinvestments on health system targets.1 Other efforts areunderway to synthesize such findings.5
MHEALTH AS A HEALTH SYSTEMSSTRENGTHENING TOOL
Recent mHealth reviews have proposed that innovatorsfocus on the public health principles underlying
mHealth initiatives, rather than on specific mHealthtechnologies.6 International agencies and researchorganizations have also endeavored to frame mHealthinterventions within the broader context of healthsystem goals or health outcomes.2 The term ‘‘healthsystem’’ includes all activities in which the primarypurpose is to promote, restore, or maintain health.7
Some elements of a framework for evaluating healthsystems performance by relating the goals of the healthsystem to its essential functions have been proposedpreviously, which we believe can serve as a model forarticulating and justifying mHealth initiatives andinvestments.7
Applying a health systems lens to the evaluation ofmHealth initiatives requires different indicators andmethodologies, shifting the assessment from whetherthe mHealth initiative ‘‘works’’ to process evaluation orproxy indicators of the health outcome(s) of interest.This new way of thinking would facilitate selection ofmHealth tools that are appropriate for identifiedchallenges. In other words, it would drive people tofirst identify the key obstacles, or constraints, todelivering proven health interventions effectively, andto then apply appropriate mHealth strategies thatcould overcome these health system constraints.8
Presenting mHealth as a range of tools for over-coming known health system constraints, as a healthsystems ‘‘catalyst,’’ may also improve communicationbetween mHealth innovators and health programimplementers. Communicating mHealth technologiesas tools that can enhance delivery of life-savinginterventions through improvements in health systemsperformance, such as coverage, quality, equity, orefficiency, will resonate with health decision-makers.7
Hence, rather than being perceived as siloed, stand-alone solutions, mHealth strategies should be viewedas integrable systems that should fit into existinghealth system functions and complement the health
a Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAb United Nations Children’s Fund (UNICEF), New York City, NY, USAc frog Design, New York City, NY, USAd World Health Organization, Geneva, SwitzerlandCorrespondence to Garrett Mehl ([email protected]).
Global Health: Science and Practice 1
10.9
745/
GH
SP-D
-13-
0003
1 A
dvan
ce A
cces
s Arti
cle
publ
ished
on
Aug
ust 6
, 201
3 as
doi
: G
lob
Hea
lth S
ci P
ract
Ref: Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovaRons as health system strengthening tools: 12 common applicaRons and a visual framework. Global Health: Science and PracRce. 2013 Aug 15;1(2):160–71.
HEALTH INTERVENTION
Health intervenLons of known efficacy exist and are well
described for each level of system
Health intervenLons of known efficacy exist and are well
described for each level of system
Package of Essential
Noncommunicable (PEN) Disease
Interventions for
Primary Health Care
in Low-Resource Settings
CANCER
HEART
DISEASE
& STROKE
DIABETES
CHRONIC
RESPIRATORY
DISEASE
Health intervenLons of known efficacy exist and are well
described for each level of system
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
Digital strategies as catalysts for valid health intervenLons
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
poor$
demand
for$services
Digital strategies as catalysts for valid health intervenLons
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
poor$
demand
for$services
failure(to(
follow(guidelines(
Digital strategies as catalysts for valid health intervenLons
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
commodi&es)stockout)
insufficient)workforce)
inaccessibility)of)facili&es
poor$
demand
for$services
failure(to(
follow(guidelines(
Digital strategies as catalysts for valid health intervenLons
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
commodi&es)stockout)
insufficient)workforce)
inaccessibility)of)facili&es
poor$
demand
for$services
failure(to(
follow(guidelines(
Digital strategies as catalysts for valid health intervenLons
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
commodi&es)stockout)
insufficient)workforce)
inaccessibility)of)facili&es
poor$
demand
for$services
failure(to(
follow(guidelines(
Digital strategies as catalysts for valid health intervenLons
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
commodi&es)stockout)
insufficient)workforce)
inaccessibility)of)facili&es
poor$
demand
for$services
failure(to(
follow(guidelines(
Digital strategies as catalysts for valid health intervenLons
Constraints
Digital Strategies
INTERVENTIONOF)KNOWNEFFICACY
QUALITY)&COVERAGEOF)HEALTH
INTERVENTION
commodi&es)stockout)
insufficient)workforce)
inaccessibility)of)facili&es
poor$
demand
for$services
failure(to(
follow(guidelines(
Digital strategies as catalysts for valid health intervenLons
Problems in Achieving EffecLve Coverage
Taxonomy of Problems
AVAILABILITY
4.2.1 Insufficient supply of
commodities
4.2.2 Insufficient supply of services
4.2.3 Insufficient supply of
equipment
INFORMATION
4.1.1 Lack of population
denominator
4.1.2 Delayed reporting of events
4.1.3 Lack of quality/reliable
data
4.1.4 Communication
roadblocks
4.1.5 Lack of access to
information or data
COST
4.7.1 High cost of manual
processes
4.7.3 Client-side expenses
UTILIZATION
4.5.4 Loss to follow up
4.5.1 Low demand for services
4.5.2 Geographic inaccessibility
4.5.3 Low adherence to treatments
ACCEPTABILITY
4.4.1 Lack of alignment with
local norms
4.4.2 Programs which do not
address individual beliefs and practices
EFFICIENCY
4.6.1 Inadequate workflow
management
4.7.2 Lack of effective resource
allocation
4.6.4 Delayed provision of care
4.6.2 Lack of or Inappropriate
referrals
4.6.3 Poor planning and coordination
QUALITY
4.3.1 Poor patient experience
4.3.3 Low quality health commodities
4.3.4 Low Health worker motivation
4.3.2 Insufficient health worker competence
4.3.6 Inadequate supportive supervision
4.3.5 Insufficient continuity of care
HEALTH SYSTEM CHALLENGES
Accountability
4.8.1 Lack of patient
engagement
4.8.2 Unaware of service
entitlement
4.8.3 Absence of community feedback
mechanisms
4.1.6 Insufficient utilization of data and information
V.8.09.07.16
4.3.7 Poor adherence to
guidelines
4.6.5 Inadequate access to
transportation
4.8.4 Lack of transparency in
commodity exchange
4.8.5 Poor accountability
between the levels of the health sector
4.8.6 Low knowledge of the characteristics population to which you are responsible
4.1.7 Lack of unique identifier
4.7.4 Lack of coordinated
payer mechanism
4.2.4 Insufficient supply of qualified
health workers
IllustraLve Challenges Related to TB/HIV Care ConLnuum
Adapted: G.S Bloomfield et al. (2014) doi:10.1186/1744-‐8603-‐10-‐49 [email protected]
Health worker motivation
15.2Health Promotion and Prevention
15.3Detection and
Diagnosis
15.5 Management and Quality of
Care
15.6Follow up and Retention to
care
15.7 Reporting and
Planning
15.4Linkage to Care & Coordination
15.1Identify Target
Populations
Demand for services
Stigma
Geographic inaccessibility
Unnecessary referrals/
transportation
Timeliness of care
Client-side expenses
Feasible & Accurate
Diagnostic Methods
Health worker competence
Delayed reporting of
events
Client knowledge and capacity to
act
Quality/unreliability of
data
Access to information or
data
Utilization of data and
information
Lack of population
enumeration
Provider Performance
Continuity of Care
Supply of commodities
Continuity of care
Loss to follow up
Referrals
Adherence to Medication Regimen
Client-side expenses
Delayed reporting of
events
Supportive supervision
Integrated data at different levels
of Care
Utilization of data and
information
Access to information or
data
Quality/unreliability of
data
Planning and coordination
Adapted: G.S Bloomfield et al. (2014) doi:10.1186/1744-‐8603-‐10-‐49 [email protected]
Health worker motivation
15.2Health Promotion and Prevention
15.3Detection and
Diagnosis
15.5 Management and Quality of
Care
15.6Follow up and Retention to
care
15.7 Reporting and
Planning
15.4Linkage to Care & Coordination
15.1Identify Target
Populations
Demand for services
Stigma
Geographic inaccessibility
Unnecessary referrals/
transportation
Timeliness of care
Client-side expenses
Feasible & Accurate
Diagnostic Methods
Health worker competence
Delayed reporting of
events
Client knowledge and capacity to
act
Quality/unreliability of
data
Access to information or
data
Utilization of data and
information
Lack of population
enumeration
Provider Performance
Continuity of Care
Supply of commodities
Continuity of care
Loss to follow up
Referrals
Adherence to Medication Regimen
Client-side expenses
Delayed reporting of
events
Supportive supervision
Integrated data at different levels
of Care
Utilization of data and
information
Access to information or
data
Quality/unreliability of
data
Planning and coordination
IllustraLve Challenges Related to TB/HIV Care ConLnuum
Technology technology(ies) (operaRng system + code + funcRons)
WHO mTERG ClassificaLons
RapidPro
Technology technology(ies) (operaRng system + code + funcRons)
Digital IntervenLon Strategy
funcRon, use, purpose (to address specified problems)
Text messages to improve informaLon and demand for ANC
visits
WHO mTERG ClassificaLons
RapidPro
Technology technology(ies) (operaRng system + code + funcRons)
Digital IntervenLon Strategy
funcRon, use, purpose (to address specified problems)
Text messages to improve informaLon and demand for ANC
visits
mHealth Project strategy + geo + technology Ananya (BBC)
WHO mTERG ClassificaLons
RapidPro
Technology technology(ies) (operaRng system + code + funcRons)
Digital IntervenLon Strategy
funcRon, use, purpose (to address specified problems)
Text messages to improve informaLon and demand for ANC
visits
mHealth Project strategy + geo + technology Ananya (BBC)
Health IntervenLon
Specific Health intervenRon targeted for enhanced effect 4 ANC visits
WHO mTERG ClassificaLons
RapidPro
Text-‐it
What is the effect of strategy on health intervenLon quality and coverage?
WHO Priority for Evidence Synthesis
mHealth Technology
technology(ies) (operaRng system + code + funcRons) Text-‐it
What is the effect of strategy on health intervenLon quality and coverage?
WHO Priority for Evidence Synthesis
mHealth Technology
technology(ies) (operaRng system + code + funcRons)
Digital IntervenLon Strategy
funcRon, use, purpose (to address constraints)
Text messages to improve informaLon and demand for ANC
visits
Text-‐it
What is the effect of strategy on health intervenLon quality and coverage?
WHO Priority for Evidence Synthesis
mHealth Technology
technology(ies) (operaRng system + code + funcRons)
Digital IntervenLon Strategy
funcRon, use, purpose (to address constraints)
Text messages to improve informaLon and demand for ANC
visits
mHealth Project strategy + geo + technology MAMA
Text-‐it
What is the effect of strategy on health intervenLon quality and coverage?
WHO Priority for Evidence Synthesis
mHealth Technology
technology(ies) (operaRng system + code + funcRons)
Digital IntervenLon Strategy
funcRon, use, purpose (to address constraints)
Text messages to improve informaLon and demand for ANC
visits
mHealth Project strategy + geo + technology MAMA
Health IntervenLon
Specific Health intervenRon targeted for enhanced effect 4 ANC visits
Text-‐it
What is the effect of strategy on health intervenLon quality and coverage?
WHO Priority for Evidence Synthesis
9.1Client education and
behavior change communication
9.1.1 Personalized IEC
Content
9.1.2.1 On Demand
information service
9.1.3 Mass messaging campaigns
9.2Point of Care diagnostics
9.2.1 in-Device
Diagnostics
9.2.2 Sensors & wearables
9.4 Data Collection and Reporting
9.4.1Data Collection & Management
9.4.1.1Household
surveys
9.4.3 Surveillance
9.4.4 Report
Generation
9.5Service Delivery
9.5.1 Electronic
decision support
9.5.3 Remote client-to-
provider consultations (Telemedicine)
9.5.2 Provider-to-provider
communication
9.7 Human
resource management
9.7.1Supportive supervision
9.8Supply
management
9.8.1Cold chain
management
9.8.2 Commodity tracking /
replenishment
9.8.3Counterfeit prevention
9.8.4 Maintenance of
equipment
9.9Financial
transactions and incentives
9.6Provider
training and education
9.3Client
Information Systems
9.3.2 Registries
9.3.3 Vital events notification
9.3.1 Electronic health
records
9.3.4 Enumeration
Detailed Digital
Strategies
9.1.1.1 Reminders
9.1.2Multimedia
content
9.6.2Curriculum-
based training materials9.2.3
Medical devices
9.4.4.1 Service delivery
statistics
9.7.2 Human resource registry
& capabillity
9.5.4Provider work planning and scheduling
9.4.5Citizen-based accountability
reporting
9.6.1Assessment of capacity needs
9.9.1 Mobile payment for
Services
9.9.1.1Conditional
cash transfers
9.9.2 Savings
Accounts
9.9.3Insurance
9.9.1.3 Performance-
based incentives
V.4.09.14.16
DIGITAL INTERVENTION STRATEGY DOMAIN
TAXONOMY
9.1Client education and
behavior change communication
9.1.1 Personalized IEC
Content
9.1.2.1 On Demand
information service
9.1.3 Mass messaging campaigns
9.2Point of Care diagnostics
9.2.1 in-Device
Diagnostics
9.2.2 Sensors & wearables
9.4 Data Collection and Reporting
9.4.1Data Collection & Management
9.4.1.1Household
surveys
9.4.3 Surveillance
9.4.4 Report
Generation
9.5Service Delivery
9.5.1 Electronic
decision support
9.5.3 Remote client-to-
provider consultations (Telemedicine)
9.5.2 Provider-to-provider
communication
9.7 Human
resource management
9.7.1Supportive supervision
9.8Supply
management
9.8.1Cold chain
management
9.8.2 Commodity tracking /
replenishment
9.8.3Counterfeit prevention
9.8.4 Maintenance of
equipment
9.9Financial
transactions and incentives
9.6Provider
training and education
9.3Client
Information Systems
9.3.2 Registries
9.3.3 Vital events notification
9.3.1 Electronic health
records
9.3.4 Enumeration
Detailed Digital
Strategies
9.1.1.1 Reminders
9.1.2Multimedia
content
9.6.2Curriculum-
based training materials9.2.3
Medical devices
9.4.4.1 Service delivery
statistics
9.7.2 Human resource registry
& capabillity
9.5.4Provider work planning and scheduling
9.4.5Citizen-based accountability
reporting
9.6.1Assessment of capacity needs
9.9.1 Mobile payment for
Services
9.9.1.1Conditional
cash transfers
9.9.2 Savings
Accounts
9.9.3Insurance
9.9.1.3 Performance-
based incentives
V.4.09.14.16
WHO mHealth and ICT framework for RMNCH
TECHNICAL CONCEPT
mHealth innovations as health system strengthening tools:12 common applications and a visual frameworkAlain B Labrique,a Lavanya Vasudevan,a Erica Kochi,b Robert Fabricant,c Garrett Mehld
This new framework lays out 12 common mHealth applications used as health systems strengtheninginnovations across the reproductive health continuum.
T he rapid proliferation of mHealth projects—albeitmainly pilot efforts—has generated considerable
enthusiasm among governments, donors, and imple-menters of health programs.1 In many instances, thesepilot projects have demonstrated conceptually howmHealth can alleviate specific health system con-straints that hinder effective coverage of healthinterventions.
Large-scale implementation or integration of thesemHealth innovations into health programs has beenlimited, however, by a shortage of empirical evidencesupporting their value in terms of cost, performance, andhealth outcomes.1–4 Governments in low- and middle-income countries face numerous challenges and com-peting priorities, impeding their ability to adopt innova-tions.2 Thus, they need robust, credible evidence aboutmHealth projects in order to consider mHealth alongsideessential health interventions, and guidance aboutwhich mHealth solutions they should consider toachieve broader health system goals.2 Their tolerancefor system instability or failure can be low, even whenthe status quo may be equally, or more, unreliable.
Current larger-scale effectiveness and implementa-tion research initiatives are working to address theevidence gaps and to demonstrate the impact of mHealthinvestments on health system targets.1 Other efforts areunderway to synthesize such findings.5
MHEALTH AS A HEALTH SYSTEMSSTRENGTHENING TOOL
Recent mHealth reviews have proposed that innovatorsfocus on the public health principles underlying
mHealth initiatives, rather than on specific mHealthtechnologies.6 International agencies and researchorganizations have also endeavored to frame mHealthinterventions within the broader context of healthsystem goals or health outcomes.2 The term ‘‘healthsystem’’ includes all activities in which the primarypurpose is to promote, restore, or maintain health.7
Some elements of a framework for evaluating healthsystems performance by relating the goals of the healthsystem to its essential functions have been proposedpreviously, which we believe can serve as a model forarticulating and justifying mHealth initiatives andinvestments.7
Applying a health systems lens to the evaluation ofmHealth initiatives requires different indicators andmethodologies, shifting the assessment from whetherthe mHealth initiative ‘‘works’’ to process evaluation orproxy indicators of the health outcome(s) of interest.This new way of thinking would facilitate selection ofmHealth tools that are appropriate for identifiedchallenges. In other words, it would drive people tofirst identify the key obstacles, or constraints, todelivering proven health interventions effectively, andto then apply appropriate mHealth strategies thatcould overcome these health system constraints.8
Presenting mHealth as a range of tools for over-coming known health system constraints, as a healthsystems ‘‘catalyst,’’ may also improve communicationbetween mHealth innovators and health programimplementers. Communicating mHealth technologiesas tools that can enhance delivery of life-savinginterventions through improvements in health systemsperformance, such as coverage, quality, equity, orefficiency, will resonate with health decision-makers.7
Hence, rather than being perceived as siloed, stand-alone solutions, mHealth strategies should be viewedas integrable systems that should fit into existinghealth system functions and complement the health
a Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAb United Nations Children’s Fund (UNICEF), New York City, NY, USAc frog Design, New York City, NY, USAd World Health Organization, Geneva, SwitzerlandCorrespondence to Garrett Mehl ([email protected]).
Global Health: Science and Practice 1
10.9
745/
GH
SP-D
-13-
0003
1 A
dvan
ce A
cces
s Arti
cle
publ
ished
on
Aug
ust 6
, 201
3 as
doi
: G
lob
Hea
lth S
ci P
ract
DIGITAL INTERVENTION STRATEGY DETAILS
WHO mHealth and ICT framework for RMNCHWHO Digital IntervenLons for Health System
Strengthening Framework -‐ RMNCAH Lifecourse
WHO Digital IntervenLons for Health System Strengthening Framework -‐ Care ConLnuum
WHO Framework on mHealth for Health Systems
Stregthening
14.2Health
Promotion and
Prevention
14.3Detection
and Diagnosis
14.5 Management and Quality
of Care
14.6Follow up
and Retention to
care
14.7Reporting
and Planning
14.4Linkage to
Care & Coordination
14.1Identify Target
Populations
Validated Health Interventions
WHO Framework on mHealth for Health Systems
Stregthening
14.2Health
Promotion and
Prevention
14.3Detection
and Diagnosis
14.5 Management and Quality
of Care
14.6Follow up
and Retention to
care
14.7Reporting
and Planning
14.4Linkage to
Care & Coordination
14.1Identify Target
Populations
Validated Health Interventions
Questions Illustrative Options Reference Visual
How is mHealth applied (technology function, use, purpose)?
Which health constraint(s) are being overcome?
What Health Interventions are being enhanced?
When is mHealth applied along the care continuum?
Where does mHealth implementation engage actors (facilities, providers, clients)?
Example Visual on Framework
Protection, Health promotion/disease
prevention, detection, referral, disease
management
Health Promotion and Prevention
Diet, physical activity, tobacco cessation,
reduced sugar intake
Reduced salt intake
Motivation, geographic inaccessibility, poor demand for services, client-side expenses
Low Demand for Services
Client education and behavior change,
sensors and point of care diagnostics
SMS reminder messages about
upcoming treatment
Home, PHC, district facility, client, provider,
laboratory, national health information
system
SMS reminder message about upcoming
appointment is sent to client's phone
mHealth Framework for Health System Strengthening -‐ Details
WHO Framework on mHealth for Health Systems
Stregthening
14.2Health
Promotion and
Prevention
14.3Detection
and Diagnosis
14.5 Management and Quality
of Care
14.6Follow up
and Retention to
care
14.7Reporting
and Planning
14.4Linkage to
Care & Coordination
14.1Identify Target
Populations
Validated Health Interventions
Questions Illustrative Options Reference Visual
How is mHealth applied (technology function, use, purpose)?
Which health constraint(s) are being overcome?
What Health Interventions are being enhanced?
When is mHealth applied along the care continuum?
Where does mHealth implementation engage actors (facilities, providers, clients)?
Example Visual on Framework
Protection, Health promotion/disease
prevention, detection, referral, disease
management
Health Promotion and Prevention
Diet, physical activity, tobacco cessation,
reduced sugar intake
Reduced salt intake
Motivation, geographic inaccessibility, poor demand for services, client-side expenses
Low Demand for Services
Client education and behavior change,
sensors and point of care diagnostics
SMS reminder messages about
upcoming treatment
Home, PHC, district facility, client, provider,
laboratory, national health information
system
SMS reminder message about upcoming
appointment is sent to client's phone
mHealth Framework for Health System Strengthening -‐ Details
WHO Framework on mHealth for Health Systems
Stregthening
14.2Health
Promotion and
Prevention
14.3Detection
and Diagnosis
14.5 Management and Quality
of Care
14.6Follow up
and Retention to
care
14.7Reporting
and Planning
14.4Linkage to
Care & Coordination
14.1Identify Target
Populations
Validated Health Interventions
Questions Illustrative Options Reference Visual
How is mHealth applied (technology function, use, purpose)?
Which health constraint(s) are being overcome?
What Health Interventions are being enhanced?
When is mHealth applied along the care continuum?
Where does mHealth implementation engage actors (facilities, providers, clients)?
Example Visual on Framework
Protection, Health promotion/disease
prevention, detection, referral, disease
management
Health Promotion and Prevention
Diet, physical activity, tobacco cessation,
reduced sugar intake
Reduced salt intake
Motivation, geographic inaccessibility, poor demand for services, client-side expenses
Low Demand for Services
Client education and behavior change,
sensors and point of care diagnostics
SMS reminder messages about
upcoming treatment
Home, PHC, district facility, client, provider,
laboratory, national health information
system
SMS reminder message about upcoming
appointment is sent to client's phone
mHealth Framework for Health System Strengthening -‐ Details
WHO Framework on mHealth for Health Systems
Stregthening
14.2Health
Promotion and
Prevention
14.3Detection
and Diagnosis
14.5 Management and Quality
of Care
14.6Follow up
and Retention to
care
14.7Reporting
and Planning
14.4Linkage to
Care & Coordination
14.1Identify Target
Populations
Validated Health Interventions
Questions Illustrative Options Reference Visual
How is mHealth applied (technology function, use, purpose)?
Which health constraint(s) are being overcome?
What Health Interventions are being enhanced?
When is mHealth applied along the care continuum?
Where does mHealth implementation engage actors (facilities, providers, clients)?
Example Visual on Framework
Protection, Health promotion/disease
prevention, detection, referral, disease
management
Health Promotion and Prevention
Diet, physical activity, tobacco cessation,
reduced sugar intake
Reduced salt intake
Motivation, geographic inaccessibility, poor demand for services, client-side expenses
Low Demand for Services
Client education and behavior change,
sensors and point of care diagnostics
SMS reminder messages about
upcoming treatment
Home, PHC, district facility, client, provider,
laboratory, national health information
system
SMS reminder message about upcoming
appointment is sent to client's phone
mHealth Framework for Health System Strengthening -‐ Details
WHO Framework on mHealth for Health Systems
Stregthening
14.2Health
Promotion and
Prevention
14.3Detection
and Diagnosis
14.5 Management and Quality
of Care
14.6Follow up
and Retention to
care
14.7Reporting
and Planning
14.4Linkage to
Care & Coordination
14.1Identify Target
Populations
Validated Health Interventions
Questions Illustrative Options Reference Visual
How is mHealth applied (technology function, use, purpose)?
Which health constraint(s) are being overcome?
What Health Interventions are being enhanced?
When is mHealth applied along the care continuum?
Where does mHealth implementation engage actors (facilities, providers, clients)?
Example Visual on Framework
Protection, Health promotion/disease
prevention, detection, referral, disease
management
Health Promotion and Prevention
Diet, physical activity, tobacco cessation,
reduced sugar intake
Reduced salt intake
Motivation, geographic inaccessibility, poor demand for services, client-side expenses
Low Demand for Services
Client education and behavior change,
sensors and point of care diagnostics
SMS reminder messages about
upcoming treatment
Home, PHC, district facility, client, provider,
laboratory, national health information
system
SMS reminder message about upcoming
appointment is sent to client's phone
mHealth Framework for Health System Strengthening -‐ Details
WHO Framework on mHealth for Health Systems
Stregthening
14.2Health
Promotion and
Prevention
14.3Detection
and Diagnosis
14.5 Management and Quality
of Care
14.6Follow up
and Retention to
care
14.7Reporting
and Planning
14.4Linkage to
Care & Coordination
14.1Identify Target
Populations
Validated Health Interventions
Questions Illustrative Options Reference Visual
How is mHealth applied (technology function, use, purpose)?
Which health constraint(s) are being overcome?
What Health Interventions are being enhanced?
When is mHealth applied along the care continuum?
Where does mHealth implementation engage actors (facilities, providers, clients)?
Example Visual on Framework
Protection, Health promotion/disease
prevention, detection, referral, disease
management
Health Promotion and Prevention
Diet, physical activity, tobacco cessation,
reduced sugar intake
Reduced salt intake
Motivation, geographic inaccessibility, poor demand for services, client-side expenses
Low Demand for Services
Client education and behavior change,
sensors and point of care diagnostics
SMS reminder messages about
upcoming treatment
Home, PHC, district facility, client, provider,
laboratory, national health information
system
SMS reminder message about upcoming
appointment is sent to client's phone
mHealth Framework for Health System Strengthening -‐ Details
Routine immunizations
MHEALTH & ICT FRAMEWORK FOR RMNCH
RMNCH ESSENTIAL INTERVENTIONS
COMMON MHEALTH & ICT APPLICATIONS
MOTHER ADOLESCENCE PREGNANCY BIRTHBEFORE PREGNANCY
POSTPARTUMMOTHER
MATERNAL HEALTH
CHILD POSTNATALNEWBORN
INFANCY CHILDHOOD
2 Sensors & point-of-care diagnostics
1 Client education & behaviour change communication (BCC)
6 Electronic decision supportInformation, protocols, algorithms, checklists
7 Provider-to-provider communicationUser groups, consultation
3 Registries / vital events tracking
4 Data collection and reporting
5 Electronic health records
8
9 Provider training & education
10 Human resource management
11 Supply chain management
12 Financial transactions & incentives
Provider workplanning & scheduling
HEALTH SYSTEM CONSTRAINTS
design byPART A
IMPLEMENTATION STRATEGY = FUNCTION + PURPOSE
Routine immunizations
PROJECT PARTNERS
PROJECT SCALE
INTERACTIVE ALERTS
1
5
Low demand for servicesLoss to follow up
Quality/unreliability of dataContinuity of care
Educational pamphlets to encourage vaccinationsSMS to remind clients about upcoming vaccinations
Electronic records to track vaccinations
Lottery-based cash prize to incentivize on-time vaccinations 12 Health worker motivationClient-side expenses
INTERACTIVE RESEARCH AND DEVELOPMENT (IRD)/ PAKISTAN
12,000 infants being actively tracked using the electronic vaccine registry in Sindh province (Landhi and Korangi townships) as of July 2013.
4 RFID-mediated updates ro record vaccinations
3 Electronic registry of new births for enumeration Lack of population enumeration
Access to information or data
Web dashboard to monitor facility-level vaccination coverage statistics
10 Supportive supervision
Interagency web-‐plahorm to curate digital health implementaRons, supporRng the global community of technology implementers, governments, and financial investors to map, monitor, foster growth and coordinate digital health investments.
Digital Health AtlasDigital Health Atlas
• Poor digital health coordinaRon, documentaRon, and planning
• Country and implementer unfamiliarity with other technologies that are already being used locally, which could be adapted and reused
• Orphaned and abandoned technology investments when projects end or funding stops
• Lack of appropriate assessment frameworks and tools to assess interoperability, and guide investments and strategic planning
• Limited country capacity for evaluaRng technologies and developing hands-‐on soluRons for interoperability challenges
Digital Health Atlas
• The DH Atlas Supports: governments, technologists, implementers, as well as donors to manage informaRon about digital soluRon investments in a structured way
• Each mHealth/eHealth “digital” deployment that is registered receives a unique ID
• The web-‐plahorm facilitates reuse, co-‐investment and collaboraRon, support interoperability and technology standards, and discourage re-‐invenRon and siloed investments into technologies.
Digital Health AtlasDigital Health Atlas
The Digital Health Atlas Leverages the mHealth
Framework and WHO MAPS tool
mHealth Assessment and Planning for Scale (MAPS) toolkit for Maturity Assessment
• MAPS provides actionable information to improve mHealth projects’ capacity to scale up
• Informed by WHO, UN IWG Catalytic Grant Mechanism for mHealth projects
• MAPS has two main goals: 1. Assess Maturity
2. Plan
Axes of scale with corresponding domains
MAPS Tool Performance
• The Digital Health Atlas was recently launched
• AddiRonal funcRonality being developed in Q4 2016 will focus on cataloguing data elements, indicators, interoperability, and data exchange standards
• Country-‐level training on the Digital Health Atlas for Ministries of Health and ImplemenRng Partners will commence in late 2016
Digital Health AtlasDigital Health Atlas
