The evolving role of IT in public health

The benefits of health IT and mHealth are increasingly acknowledged by Ministries of Health in Sub-Saharan Africa, but how do governments sustainably integrate technology into their strategy for reaching health goals?

Health systems in Sub-Saharan Africa and throughout the world are faced with a double burden of disease. Both infectious and non-communicable (chronic and non-transmittable) diseases (NCDs) are prevalent. At the same time, with limited resources it can be a challenge to develop efficient and effective disease prevention, treatment and care models. Currently, there is a great emphasis on the United Nations’ Millennium Development Goals (MDG) and a post MDG environment, focusing on maternal and child health priorities. NCDs are getting more attention in African countries each year, but programs to combat them are still often underfunded. Health ministry budgets often face the competing needs of the population with lean budgets. In such cases, technology can offer many innovative and cost-effective opportunities to enable health program objectives.

However, governments seeking to use innovative technologies are often confronted with a confusing landscape of vendors and solutions of varying effectiveness, with insufficient evidence to support them on a large scale. Mobile phone usage is increasing dramatically in rural and urban areas alike, and there is potential to reach citizens in new and impactful ways. Health ministries are currently considering a wide range of technology solutions from electronic health data aggregation and analytics to text messages to promote healthy behaviors to decision support tools on basic phones for community health workers working in rural communities. However, even in these areas, finding the best technological solutions to support national health priorities while meeting economic and geographic constraints is challenging. Many systems and apps are available, yet only a few have been used on a national scale.

Governments looking to get the most for their resources in the health sector should seek platforms that are nimble enough to support priorities across a range of infectious and non-communicable diseases. For solutions focused on specific diseases, governments should ensure there is evidence that the solution’s impact is measurable, and where that information is not available, help facilitate the necessary evaluation of such innovations. For innovations showing promise, it is important that evaluations move quickly from small-scale pilots to larger scale assessments.

A one-size-fits-all approach to mHealth technology innovations may not be viable or even recommended in many situations for governments. Telecommunications infrastructure is not uniformly available in both urban and rural areas, though it is improving rapidly in most African countries. SMS driven technologies designed to reach populations nationwide are a commonly accepted approach but smartphone usage is growing rapidly. From an innovation perspective, while SMS is ubiquitous, increasingly tech savvy mobile phone users may be underwhelmed by purely SMS driven innovations, and these solutions may have limited functionality and longevity compared to smartphone solutions. Moreover, evolving SMS regulation has cost and liability implications for groups innovating on SMS technologies. While cloud-based models can reduce costs from a hosting and maintenance perspective, they have limitations when employed on a large scale because of intermittent internet connectivity nationally, even as telecommunications and wireless infrastructure continually improve.

Therefore, remaining relevant today while building for the future will continue to be a balancing act for technology vendors. Similarly, at this stage of the market, governments may have a hard time finding turnkey solutions that meet their current and evolving needs without significant customization, which can be expensive.

While the solution landscape is in flux, some solutions are getting significant traction with Ministries of Health across Africa. DHIS2, an open source data aggregation and analytics solution, is being adopted by many African nations. DHIS2 allows Ministries of Health to manage, analyze and visualize aggregate data. Ministries of Health across East Africa – Kenya, Rwanda, Tanzania and Uganda – have all completed national implementations of DHIS2. DHIS2 reports major improvements: in Kenya, national reporting rates have been above 90 per cent for major monthly forms; in Tanzania, outbreaks and weekly summary data are collected from public, private and faith-based health facilities and allow for disease surveillance and response; and Uganda has been using new patient tracking capabilities including a pilot to track mothers and children. DHIS2 help governments make data-driven decisions related to health planning and resource allocation across many competing needs.

In summary, as much as we see a proliferation of health IT and mHealth innovations across Africa, we are still in the early stages of an exciting space. There is a lot of room for innovation, and the public sector can benefit from insisting on evidence-based models as the sector matures and partnering to study such opportunities when aligned with national health priorities.

(The writer is the CEO and Founder, access.mobile)

(This article has been reproduced from the May’15 edition of CIO East Africa magazine)