Innovations are bringing better health within reach
Photo: Direct Relief
Health systems in developing countries face huge challenges in providing high-quality, affordable services. Among them are geographic barriers, a shortage of skilled personnel, and poor data.
Increasingly, these countries are exploring the potential of eHealth (the use of Internet and communications technologies for health) and mHealth (the use of mobile technology for health) to deliver services.
Realizing this potential requires finding solutions, both technical and social, that work in specific environments. This was the goal of projects funded by IDRC in seven countries in Africa, Asia, Latin America, and the Middle East. The Strengthening Equity through Applied Research Capacity building in eHealth (SEARCH) initiative has shown that innovations must be grounded in local policy and social and cultural contexts to be sustainable and to have the potential for reaching greater numbers of people.
Overcoming distance and isolation
EHealth’s most touted benefit is the ability to breach long distances to bring timely, targeted services to underserved populations. How this is achieved, however, can vary greatly and may require both technological and social innovations.
In Burkina Faso, for example, researchers used open source software — software that can be freely modified for various purposes — to develop a mobile phone platform to enhance access to health information and care. An interactive messaging and voice system incorporating five major local languages was developed to overcome literacy barriers.
Researchers in Lebanon, in collaboration with experts at the Ministry of Public Health, created content and tools specifically designed for underserved refugee populations and the community health workers visiting them. The project delivered better quality care to women and men suffering from non-communicable diseases such as high blood pressure and diabetes, including to pregnant women experiencing gestational diabetes.
But technology alone is not enough. In Vietnam, health centres in remote mountainous areas were already computerized, but language barriers, low education, and limited access to information were major stumbling blocks to improve care for isolated ethnic minority women.
Identifying their needs and developing targeted text messages has led to better health for mothers and their babies.
Innovations can also overcome cultural barriers. When researchers in Burkina Faso encountered resistance from the husbands of women participating in the project, they developed a strategy to foster communication at all levels: in the home, between spouses, in villages, in health centres, and in community health associations.
Building a stronger health workforce
The shortage of health personnel is a major stumbling block to better health in many countries.
To fill the gap in Ethiopia, an eHealth platform was established to provide Health Extension Workers with the information and support they need to provide better maternal, child, and TB care to their communities. Through mobile phones, they can now access patients’ health profiles and feed data back to the health system. Their increased knowledge and stronger technological skills have increased their self-confidence, enhanced their leadership in the community, and boosted their reputation in the health system. This helps build more accountable and responsive health services.
Researchers in Burkina Faso recruited and trained women who are well-respected in their communities to act as intermediaries between the health system and local women. This solution emphasizes the community’s role in delivering treatment, monitoring patients, and helping to convey awareness-raising messages and reminders, tasks usually performed by health professionals.
In Lebanon, new tools offer health workers a way out of professional isolation and help them and their patients make better medical decisions. Among the new tools are online training materials to bring up-to-date information to care providers. Online platforms helped them share information and experiences and feel connected.
Enhancing data quality and accessibility
Accurate, up-to-date data is essential to assess the health needs of populations, plan and manage health interventions, and provide timely services. Unfortunately, health information systems in many countries are not up to the task.
In Bangladesh, researchers found that the management information system used by eHealth initiatives didn’t effectively share information, nor did national guidelines for information and data management address confidentiality. The framework they developed to solve these problems promotes system integration and confidentiality in future eHealth projects.
Researchers in Kenya found that many of the country’s eHealth implementers were reluctant to share information, leading to duplication and wasted resources. It also limited the Ministry of
Health’s ability to build on lessons and ensure that projects met national priorities. The ministry is now developing a framework to certify all eHealth innovations to reduce duplication and encourage the use of common platforms. To ensure data security, confidentiality, and ease of access, the ministry and the University of Nairobi are developing a common server to store data in-country.
Interoperability — the capacity of different information technology systems and software applications to communicate, exchange, and interpret the data — was a prime consideration in Peru. The WawaRed project’s success rested on the creation of an integrated data collection and analysis platform that links the country’s fragmented healthcare system. An integrated electronic health record for mothers and children ensures the correct information and advice can benefit the most vulnerable. Decision-makers were trained to use data, enabling them to better plan and allocate health services.
Smart solutions are key to success
As the SEARCH projects show, innovation is about finding smart solutions to challenges. These solutions need to be designed to meet identified health needs and priorities, be supported by an enabling environment, and ensure systems integration.
Effective partnerships between all stakeholders are also crucial. Community and government engagement, locally relevant content, and the involvement of the private sector (as in Burkina Faso and Peru) contribute to successful and scalable solutions. With the clever use of technology and strong relationships with leaders and the community, the potential for change is enormous.
Strong relationships are also crucial to research success. Although located in different time zones and speaking different languages, the seven SEARCH teams regularly shared lessons and learned from one another. Discussions about critical cross-cutting themes such as gender, research quality, and how to bring results to bear on policy and practice helped break down silos and enriched their collective knowledge.