Nº 6 2015 > Digital health technologies
Planning beyond the delivery of innovation
By Dr Ann Aerts, Head, Novartis Foundation
Commissioner, Broadband Commission for Sustainable Development
We are at a crucial point in global health where we see health systems in low- and middle-income countries (LMICs) still overburdened with managing infectious diseases and maternal and child health, while simultaneously struggling with an emerging crisis of non-communicable diseases (NCDs), expected to account for 65 per cent of all deaths in these countries in 2015.
At the same time we are seeing a rapid expansion of connectivity and use of technology in LMICs. The use of mobile technologies in sub-Saharan Africa alone is expected to have reached 85 per cent by the end of this year.
Connectivity and the use of digital health technologies allow for a significant expansion of patient reach and an opportunity to facilitate patient empowerment and compliance through targeted messaging and education. Another potential application of mobile technology is to centralize expertise and coach community health care workers in their patient care through telemedicine. Digital health tools also allow use of real-time data, making it possible for surveillance systems to be more action-oriented.
This makes it a very exciting time to be in the field of global health care as the use of digital health technologies provides opportunities previously not possible.
However, when we view technology as the end goal or the game changer in and of itself, there is the potential to end up with a highly fragmented landscape of digital solutions in target countries, putting a strain on local governance and control, capacity and sustainability. For example, the fixed costs of many digital health platforms are not considered in pilot projects, and this makes long-term sustainability challenging at best, and impractical in most cases.
We also face the reality that many digital health solutions are currently still in the pilot phase and, thus, there is limited evidence of their effectiveness, cost and impact on health outcomes.
While we may have a way to go until we have solid proof on how best to use technology to optimize patient outcomes, it is clear already that we must focus on innovation in healthcare delivery, not just the delivery of innovation.
Key factors to consider in any programme include:
- Build the programme based on the unmet need of patients, not the technology.
- Ensure the pilot is developed with local input, including local government, with an eye towards future scale and sustainability — including long-term costs and maintenance, and potential integration into the local healthcare system.
- Plan for resource constraints and barriers outside the technology. For example, some of the population may be illiterate, and if that is the case, then think more about interactive voice recording instead of SMS.
- Establish clear metrics on the programme and technology, assessing effectiveness, cost effectiveness and health outcomes, as well as the value of the technology in the service delivery.
- Be prepared to learn and adjust as necessary within the time-frame of the project and taking lessons learned to the next project.
An example from the Novartis Foundation of the use of enabling technology to help deliver health care in an innovative manner is our Community-based Hypertension Improvement Project (ComHIP) in Ghana. This project, launched in late 2014, will test an innovative model for screening and managing hypertension in an urban district in Ghana.
The World Health Organization (WHO) estimates that 27 per cent of adults in Ghana are living with hypertension, the number one risk factor for cardiovascular disease. And yet it is hardly known or discussed and most Ghanaians suffering from hypertension won’t even know they have it.
The intervention seeks to improve the control of hypertension by making services more accessible in the community and supporting self-management, thereby strengthening the primary health care system. The programme will include technological applications such as a patient-level cloud-based database, electronic guidelines and job aids for healthcare workers, and SMS/voice messaging systems for treatment adherence, reminders and healthy living tips.
The programme is being co-created, implemented and measured in partnership with FHI 360, the Ghana Health Service, the London School of Hygiene & Tropical Medicine, the School of Public Health at University of Ghana, and VOTO Mobile. The local partner organizations are also closely aligning with physician, nurse and pharmacy teams to ensure good cross-collaboration among members of the healthcare community.
We expect to begin screening by the end of 2015 and will closely follow and measure all aspects of the programme as it progresses.
Our focus for this project is on hypertension but our goal is not to create more vertical approaches to health care. Rather, we aim to build evidence on what type of delivery models and technology are effective, and then adapt and apply them to help manage the overall dual burden of infectious and non-communicable diseases that LMICs are still facing.
The potential value of technology to enable and to help realize improved quality of health services that are scalable and sustainable makes this a very exciting time to be in global health. Our ambitions can be much bigger and bolder than ever before.