Contents

Global Digital Health Forum 2018

When: December 10 - 11th 2018

Where: Washington DC

Attendees: Rebecca Alban (Unlicensed), Vidya Sampath, Swetha Srinath (Unlicensed) and Mary Jo Kochendorfer (Deactivated)

The following is a joint trip report. Please note that the session notes are quite detailed and some are rough notes. Feel free to leave questions and comments for the authors.

Overview

Team spoke on two panels (Mary Jo and Vidya), presented two posters (Swetha and Rebecca), attended lots of sessions, and crammed in lots of meetings in two very full days. Some photos and table of Contents with LINKS below!

Rebecca presented a poster on OpenLMIS.

Agenda

Here

Follow up

Follow up for OpenLMIS Stewards


Presentations

Here

Session Notes 

Facilitating Collaboration to Accelerate Scale and Improve Digital Health Global Goods

Attendee: Rebecca and Vidya

Presenter (panel): Mary Jo Kochendorfer (Deactivated)Matt Berg (Unlicensed), Amanda BenDor (Unlicensed), Chris Seebregts (Jembi), Steven Macharia (Bahmni) 

DescriptionDigital Square, an innovative co-investment global program led by PATH aims to serve as a convener in the digital health community, bringing together practitioners to share their work, lessons learned, and future needs. This helps organizations to work together to implement digital health tools that are adaptable to different countries and contexts, also known as Global Goods. To foster transparency, collaboration and synergy, Digital Square uses an open application platform including community feedback to align investments in digital health systems. The open application process provides a unique opportunity for practitioners to learn key details about, and comment on, each other’s tools and implementation plans. This session will describe the innovative open application process and feature global goods awarded through Digital Square including the OpenLMIS, Community of Practice, OpenCRVS, OpenSRP, and Bahmni.

Digital Square- lives at PATH but is a consortium of donors. They are a funding mechanism, and coordinate digital health investments

Open Proposal process- community feedback from peer review committee and governing board, comments, and create coalitions. Transparent process

Bahmni-open source Hospital Information System (HIS) and EMR; does not require custom software development; about 50 implementation

Jembi- OpenCRVS (civil registration and vital statistics); register children, deaths, big unmet need; works with FHIR 7, HopenHIE, and DHIS2. Supports OpenHIE architecture; can interoperate with low demand service like civil registry, with a low demand service like vaccination

OpenSRP- focus in care at facility and community level. Integrates with national health systems like DHIS2. Does Client ID, client management. OpenSRP community   Canopy reporting stack is result of DigitalSquare investment

?What are challenges with Digital Square open proposal process?


Impact of electronic systems on health service delivery in Zambia

Presenters: Wendy Bomett (JSI Zambia), Chris Opit (Unlicensed) (JSI Zambia)

Attendee: Mary Jo Kochendorfer

Zambia is looking to automate down to the community level.


Opening Plenary- How funders are operationalizing digital health principles

Attendees: Rebecca, Swetha, Mary Jo

Strengthening primary health care through digital tools

Attendee: Swetha Srinath (Unlicensed)

Speakers: Maryanne Mureithi; Jamil Zaman (Bangladesh), Ephrem Lemango

Moderator: Uju Aderemi

  1. Medic Mobile [Ethiopia]
  1. Mobile Job Aid for H.E.Ws [Ethiopia]


  1. eMIS (Save the Children Bangladesh)
  1. Questions

WHO's 1st ever Guidelines for Digital Health Interventions for HSS

Attendee: Vidya

Panelists: Garret Mehl, Tigest Tamrat, and Smisha Agarwal

Notes:

PATH, as the support org to WHO, convened a session with the WHO team that has put together the very first WHO Guidelines on Digital Health Interventions for HSS.

Team consists of Garret Mehl, Tigest Tamrat, and Maeghan Orton (latter two involved with early CCPF work)

The guidelines for formally approved by WHO board this week and will be made publically available early next year. PATH is helping put together an interactive website to accompany the print publication. The guidelines will also have helpful language/visuals to show how these interventions map to Universal Health Coverage (UHC) goals.

This work is part of the larger Digital Health Atlas compendium that this team is also leading (a WHO global technology registry platform).

The team first developed "Classification of  Digital Health Interventions" and the Guidelines map to this classification.

The third deliverable is a "Planning and Costing Guide for Digital Health Interventions" which is set for release next Spring.

Monitoring and Evaluation of existing digital health interventions:

The team highlighted the usefulness of the mERA checklist which has been around for a couple of years now. For impact evaluations, they recommend the following study designs:

Controlled before and after;

Stepped wedge RCT;

Interrupted time series studies

More information on mERA here:

https://www.bmj.com/content/352/bmj.i1174 (paper summary)

https://www.researchgate.net/profile/Amnesty_Lefevre/publication/311738723_Monitoring_and_evaluating_digital_health_interventions_a_practical_guide_to_conducting_research_and_assessment/links/5858cdf908ae64cb3d47f7d3/Monitoring-and-evaluating-digital-health-interventions-a-practical-guide-to-conducting-research-and-assessment.pdf (detailed assessment guide including the checklist)

Takeaways:

Putting the Patient in Charge- new tools to help clients manage their own health data

Attendee: Rebecca

Online self-administered screening tool for improving TB detection among students in Ethiopia (MSH)

Online screening to be the first layer of assessment (rather than needing a HCW to examine each individual)

Maternal Health in Liberia(D-Tree)

Tuberculosis in Thailand (D-Tree)

-->NFC token stores the client’s information. It can be a card, sticker, bracelet, etc. Client can keep that card and bring it with them. Its low cost (10x less expensive than biometrics).

DOT Fertility App- to help manage fertility (Cycle Technologies)

70% of the world will own a cell phone by 2020

DOT fertility app uses user info and machine learning to track her cycles; help prevent or plan pregnancy

Ways to think about our own technology (OpenLMIS)


Challenges of Innovation at Scale

Presenters: Wayan Vota (Digital Health Director, IntraHealth International) Jonathan Jackson (Dimagi), Dr. Iniobong Ekong, Clayton (Dimagi), Carmen Sant

Attendee: Mary Jo


Dimagi, Jonathan Jackson - the Digital health principles work for scoping (not at scale). Scope and scale are very different. Scope/pilot is what you get done on a certain budget for a certain set of users. Scale is really hard and procurement, training, data use, etc.

We didn’t have the initial challenging conversations at the beginning. We don’t have good frame-of-reference for those conversations.

For example, 130,000 scale was slowed due to procurement of hardware. Gave time for the conversation to happen because scope was deployed for 18 months before scaling.


Dr Iniobong Ekong - Nigeria (FCT eHealth Project).

ICT + Health systems = universal access.

Bought notebooks for doctors to support doctors in servicing rural. Access increased by 247%. All things going great.

Big challenge, had to still complete the manual forms and electronic systems in parallel.

Need to make sure the ART reporting is integrated into the EMR. Clear requirements and standards need to be in place. Now now new EMR can be rolled out without a clear ART module meeting the standards.

Top down doesn’t work. Standards are needed. Continuous evaluation of systems.


Clayton CTO - Talked about the Bihar scale up

130,000 CHW using CommCare.

5 years of working on the app before we scale.

Goal was to have non technical teams design and build the app.

242 servers to host the system right now.

What they had to focus on from 2017 was about tools for deployment. Not the actually application.


Carmen Sant (Research Assistant)

Health systems perspective. SMS for Life. 2009 over 5000 health facilities in TZ. Monitoring the stock outs. Ran for 4 years collecting the weekly data and then it was cancelled.

We thought it was really good from a technical perspective. Focusing on anti-malaria.

Surveillance without a response will not bring you to where you want to go. There wasn’t a plan for how to respond to the ‘stock outs’.  Who was responsible for the stock outs?

Perhaps the program didn’t involve all the stakeholders who needed to be there to realize this gap.

Pilot tech was inexpensive.

Costs at scale supposed a large burden for the government was quite large.

She overlayed the timeline from both the SMS for life and the government efforts.  There were parallel efforts and the SMS for life app didn’t change or wasn’t considered.

Focus of visibility, wasn’t enough. What about the action? A costing exercise would have been useful. Agile technology, program design, and project management would have been useful to allow for pivots.


Key Takeaways and Discussion

Making the most out of all that data: leveraging existing small and big data to improve health outcomes (9:00 AM - 10:15 AM)

Attendees: Swetha and Mary Jo (late)

Presenters: Asif (Living Goods), Gabriel Krieshok (Abt), Gina Assaf (SoukTel), Jacques de Vos (Mezzanine Vodafone), Vidya Mahadevan (BlueSquare)  




























Digital Solutions and Medical Vendors-Improving Health Outcomes through Market-based interventions

Attendees: Rebecca & Swetha

Presenters: Richard Wright (Unilever), Abi Gleek (Every1Mobile), Ting Shih (ClickMedix)

Key Takeaways:


What is Unilever’s interest in medical vendors? Funding from DFID to support social enterprises’ Unilever has shopkeepers and other ‘assets’ to support social businesses. They don’t do big health program interventions. This is NOT CSR. They help the businesses/grantees create proof of concept, and for Unilever its about growing their markets and getting people to use their products (more people washing hands=more clients)


Naijacare- enabling Medical vendors to strengthen delivery of primary healthcare services (PPMVs)

ClickMedix- mobile platform to scale healthcare services

Partnerships with private sector: DFID & Unilever- Unilever structured the partnership to include others who can supplement expertise that they done have (Vodofone, Mastercard, etc.). Organizations can join at a project level or program level (for general interest).



Learning as we go: Adaptive Management for digital health

Attendee: Mary Jo


USAID Accelerate (Siobhan Green): attempting to integrate the USAID mission portfolio to be focused on behavior change across the silos. Key challenge is around collecting data to understand if the behavior changes are happening or not. Are the investments making the desired impact.


Amy Green:


Kelsey (JHU): mCare was a shift from directly controlling the delivery. mCare was using the public health delivery systems. mCARE-II (using OpenSRP) which is doing a lot of support around the life-cycle of care. Both supply and demand intervention.

Some key learnings


Question: donor and MOH buyin?


Question on CLA (collaborate, learn, adapt) and Adaptive Management principles alignment.


Merrick: Key thing is that there is intention behind the desire to be adaptive.

Siobhan: making adaptive concrete into making better outcomes.

Kelsey: flexibility are very important and will need to throw things out of the window.

Amy: focus and open-minded. Focus on what matters while not throwing things out the window.


Real time decision-making

Attendee: Swetha

Speakers: Jacqueline Edwards, Sherri Haas, Natalie Tibbels, Chancy Mauluka
Moderator: Emily Nicholson



Overview






Precision Health and Service Delivery

Attendees: Vidya & Rebecca

Panelists: Matt Berg (moderator), Benjamin Winters, Kelsey (?), Guy Vernat

Key takeaways:

This session seemed to define (intentional or not) precision public health to be exacting use of GIS mapping for health service delivery

Examples included using GIS mapping and check-ins to establish a more accurate denominator (Akros and Jivita/Ona examples from Zambia and B’desh); leveraging ubiquitos biometric tools to create more transparency in service delivery, etc


Guy Vernat, Foundation Merieux USA

I-Lab: Connecting clinical Labs to Infectious Diseases Surveillance Systems in West Africa

Over a period of 12 months, I-LAb mapped all the lab sites in Senegal using WHO lab assessment tool, including location as well as devices available and types of diagnostics possible

-DHIS2 used to share reporting and analysis of data, but was not used for labs. I-Lab project implemented DHIS2 for electronic disease surveillance

-captured data re: lab locations, lab capabilities and created country’s first “Lab Book”

ACTION: any interest from AmosTaxi to connect?


Benjamin Winters, Akros

Zambia based company focused on developing surveillance processes and other health interventions and DHIS2 trainings

Worked closely on Macepa project with PATH and used “reactive case detection” with DHIS2 to map areas

Process management of campaigns (vaccinations, IRS, etc.). Looking for better M&E models, process improvement

Indoor Residual Spray- found more accurate way to measure/calculate coverage. ‘Denominator challenge’--Akros & Ona worked together to  identify structures and guide field teams. mSpray takes maps, puts them into a device, and helps teams know where they need to go to spray and record data. Creates breadcrumb dataset. Using mSpray caused teams to find more structures and spray more. This instance was a success, but what we want is overall govt improved performance

-learned that the mSpray concept had applicability across many types of campaigns

Call to action: if we want our solutions to stick over time, more investment into the data culture that funds these innovations is needed


Kelsey (?) standing in for Alain Labrique

Geo-spacial Innovations to Improve Equity and Measure True Coverage

JaVitA Study Area- households are mapped, women have ID number.

-Tech has advanced faster than government structures have to support them.*this issue was raised in earlier governance session today as well*

-How can we leverage the private sector?

-What will next couple of years bring?


Impact of Digital Health Interventions on Data Use and Health Outcomes - Immunization Focus

Attendee: Vidya

Session objectives

ToCs state that there is an impact of digital health interventions on data use and health -- save/improve quality of life, save time, save money BUT the actual evidence lacks the rigor/stds to actually state their usefulness as fact

Today's session presents some of that better research

Garrett Mehl - present 2 reviews

Have contacted him for the presentation deck of his two reviews because actual talk was super choppy, hard to follow and full of tech issues

Jessica Shearer -- Dir, Health Systems Analytics and Technical Lead on IDEA

IDEA report now available on www.findyourfinding.org

They conducted a realist review of what works to improve the use of routine data in immunization decision-making with evidence from peer and grey literature of work done in LMICs. (Realist reviews look at whether something worked, why they worked and dig into mechanisms/contexts where they worked in order to scale up) This analysis resulted in an evidence gap map -- mostly greys (grey lit) and few blues (peer reviewed). They categorized the evidence as "high certainty of evidence, some certainty of evidence, low certainty" but a major limitation is that they did not use the same set of outcome or impact measures for all the evidence they reviewed, instead using the publication's own interpretation of success in their classification.

Takeaways:

Nargis Rahimi, Shifo Foundation

Conducted scoping review, did not put a time period barrier, looked at all peer-reviewed publications looking at what factors contribute to poor data versus good data, and facilitations of what interventions work to improve quality.

Identified 1000+ articles on the topic but only 25 made the cut!

Takeaways:

Country Experience with Strategy and Governance (10:30 - 11:45am)

Attendee: Rebecca

Key takeaways