Fwd: [SAmHealth] WHO digital health recommendations and SA

19 April, 2019

Dear HIFA colleagues,

I am forwarding (with permission) a thoughtful message below by Peter Benjamin, originally sent on the South Africa mHealth forum (SAmHealth). Do Peter's comments resonate with your experience in your country?

The WHO guideling on digital health, on which Peter's comments are based, is freely available here: https://www.who.int/reproductivehealth/publications/digital-intervention...

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Dear friends and colleagues in digital health,

The launch of the WHO Digital Health Recommendations went well yesterday. See the document here. It is as thorough as WHO Recommendations usually are and is 150 pages long. If that is intimidating, the summary is in a simple table only 2.5 pages long (pages xiv – xxi).

Such documents are critical reviews of all the available good quality evidence. They comprise what the WHO, the authoritative body on health issues, believes has been proven sufficiently for it to make recommendations for implementation and investment by Ministries of Health and others around the world. As such, this is a big step forward for the digital health sector. As the document says, 'The key aim of this guideline is to present recommendations based on a critical evaluation of the evidence on emerging digital health interventions that are contributing to health system improvements, based on an assessment of the benefits, harms, acceptability, feasibility, resource use and equity considerations.' (page xi). The guidelines are for 'prioritized digital health interventions accessible via mobile devices', what we used to call 'mHealth'.

To put it bluntly, the WHO says for certain functions these things work.

Well, it actually is more nuanced than that. There are many caveats that digital health systems are an enabler of, rather than a substitute for, functioning health systems, and that non-digital services are appropriate in many cases. For each topic the report says that these digital health systems are only recommended in specific contexts and conditions, which are explained at length in the document.

The recommendations are on 10 topics:

- Birth notification via mobile devices

- Death notification via mobile devices

- Stock notification and commodity management via mobile devices

- Client-to-provider telemedicine

- Provider-to-provider telemedicine

- Targeted client communication via mobile devices (particularly for maternal & child health)

- Digital tracking of patients'/clients' health status and services via mobile devices

- Health worker decision support via mobile devices

- Combination of digital tracking, decision support and targeted communications

- Provision of training and educational content to health workers via mobile devices (mobile learning, mLearning)

Recommendation 6 on targeted client communications is only for sexual, reproductive, maternal, newborn, child and adolescent health. The other 8 recommendations cover all health areas. These aren't the only areas where digital health could be useful, but these ten are the only topics that the WHO has found sufficiently high-quality evidence to base official recommendations on. In the future, as evidence increases, further recommendations on digital health will be made. In the launch event, the WHO said they were now working on other topics for recommendations, such as content services for Non-Communicable Diseases (NCDs). The WHO are also working on Artificial Intelligence, Big Data and Machine Learning, but isn't ready to make recommendations here yet (there was a laugh in the room as this is a complex and contested area).

Of the ten, South Africa is active in some but not all. The following is my personal assessment of progress in these 10 areas in SA. This is NOT definitive, more an initial suggestion to start discussion.

WHO digital health recommendations

(Personal view of)

SA usage of digital health in these area

1. Birth notification

No, I don't think this is done via mobile tech in SA.

2. Death notification

No, I don't think this is done via mobile tech in SA.

3. Stock notification and commodity management

Yes. The Stock Visibility Systems (SVS) of Mezzanine is working widely in health facilities.

4. Client-to-provider telemedicine

Not really. Other than a few isolated and limited services (e.g. Hello Doctor), this isn't being done at scale in SA, unlike other countries. A major challenge here is the ruling of the HPCSA against this.

5. Provider-to-provider telemedicine

Some examples of this, particularly in the private sector, but not at scale throughout the health system.

6. Targeted client communication

Absolutely! Here SA is a world-leader. The MomConnect programme of the NDOH has subscribed over 2.7 million pregnant women and mothers for text messaging over the last 5 years. This is one of the largest and most embedded in the health system in the world. There are many other smaller targeted communication projects in SA health as well (HIV, TB, other RMNCH).

7. Digital tracking of patients'/clients' health status and services

Some services in the private sector (e.g. Discovery), much less in the public sector beyond a few small pilots.

8. Health worker decision support

We are very active here, particularly with Community Health Worker (CHW, also known as Ward Based Outreach Teams WBOT in SA). There are many mHealth for CHW systems in SA by companies such as Dimagi, Mezzanine, Mobenzi, HISP, Qode, Virtual Purple and others. The NDOH is very active in building large-scale systems.

9. Combination of digital tracking, decision support and targeted communications

This isn't being done in SA yet.

10. Provision of training and educational content to health workers (mLearning)

Partial. There are some projects, but not fully used. NurseConnect, which sends text messages to 27,000 nurses and other MNCH staff, is part of MomConnect, but is not a full education and training project. Prof Dave Woods is working to move excellent paper materials for health workers to electronic formats, and there are other small initiatives.

NB: These are my personal views and understandings and are not official at all. Please correct this where I am mistaken or ignorant of other initiatives.

Please give your opinion, contribution, suggestion, question or even disagreement.

What do you think these WHO Recommendations on digital health mean for South Africa?

Best wishes,

Peter

[Note from HIFA moderator. I attach below Peter's HIFA profile:

HIFA profile: Peter Benjamin is the coordinator for Capacity Building for the mHealth Alliance, and is currently based in Cape Town. Previously he was managing director of Cell-Life ( www.cell-life.org), South Africa. Professional interests: Using mobile technology to provide access to health information and services for the majority. In countries like South Africa, 90% of youth and adults have a cellphone. However, this is not well used as a channel to access healthcare. Mobile tech can become a way to get healthcare information that allows people to manage their own health (and their families). Mobile can also be the first point of contact with the health system – for health promotion & disease prevention; general health information and queries; triage services when there is a problem; linking & referral to health facilities; self-managed care for chronic conditions; maternal & child support; community monitoring of the health system. He is a member of the mHIFA working group.

http://www.hifa.org/support/members/peter

http://www.hifa.org/projects/mobile-hifa-mhifa

peter@healthenabled.org ]

Best wishes, Neil

Neil Pakenham-Walsh (HIFA moderator)