Scaling Up Digital Health In Conflict Countries

Multiple pathways to scaling up and sustainability: An exploration of digital health solutions in South Africa

10.21203/rs.3.rs-80041/v1 ◽

2020 ◽

Author(s):

Alison Swartz ◽

Amnesty E LeFevre ◽

Shehani Perera ◽

Mary V. Kinney ◽

Asha S George

Keyword(s):

South Africa ◽

Digital Health ◽

National Level ◽

Scale Up ◽

Monitoring And Evaluation ◽

Scaling Up ◽

Value Proposition ◽

Problem Identification ◽

Human Resource Capacity ◽

Organisational Context

Abstract Background With an aim to support further understanding of scaling up and sustaining digital health, we explore digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem Identification Programme and Child Healthcare Problem Identification Programme (mortality audit reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service) and CommCare (a community health worker data capture and decision-support application). Results A framework integrating complexity and scaling up processes was used to conceptually orient the study. Findings are presented by case through four domains: value proposition, actors, technology and organisational context. The scale and use of PPIP and Child PIP were driven by ‘champions’; clinicians who developed technically simple tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect, supported by ongoing financial and technical support from donors and technical partners. Donor preferences played a significant role in the selection of CommCare as the platform to digitise CHW service information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and advocates for the value of the digital health solution. The technology need not be complex but must navigate the complexity of operating within an overburdened and fragmented South African health system, where adequate and sustained investment from donors and government overall, and in particular in its human resource capacity and in robust monitoring and evaluation continue to threaten the sustainability of digital health solutions. Conclusions There is no single pathway to achieving scale up or sustainability, and there will be successes and challenges regardless of the configuration of the domains of value proposition, technology, actors and organisational context. While scaling and sustaining digital solutions has its technological challenges, perhaps more complex are the idiosyncratic factors and nature of the relationships between actors involved. Scaling up and sustaining digital solutions need to account for the interplay of the various technical and social dimensions involved in supporting digital solutions to succeed, particularly in health systems that are themselves social and political dynamic systems.

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The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective

BMC Health Services Research ◽

10.1186/s12913-021-06285-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carmen Sant Fruchtman ◽

Selemani Mbuyita ◽

Mary Mwanyika-Sando ◽

Marcel Braun ◽

Don de Savigny ◽

...

Keyword(s):

Health System ◽

Health Systems ◽

Large Scale ◽

Digital Health ◽

Health Sector ◽

Building Blocks ◽

Scaling Up ◽

Stock Management ◽

Study Approach

Abstract Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

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The Complexity of Scaling Up an mHealth Intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective

10.21203/rs.3.rs-77432/v1 ◽

2020 ◽

Author(s):

Carmen Sant Fruchtman ◽

Selemani Mbuyita ◽

Mary Mwanyika-Sando ◽

Marcel Braun ◽

Don de Savigny ◽

...

Keyword(s):

Health System ◽

Large Scale ◽

Digital Health ◽

Scaling Up ◽

Stock Management ◽

Study Approach ◽

Mhealth Intervention ◽

Future Technologies ◽

Document Review

Abstract BackgroundThe objective of this study was to apply systems thinking to examine the opportunities and challenges of scaling up and integrating a new electronic health technology into a complex health system. We used the implementation cycle of the supply chain management solution (SMS for Life 1.0) in Tanzania as a case study. SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. It aimed to bring visibility to antimalarial stock-outs through the use of SMS technology.MethodsA qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework, we carried out a joint thematic analysis and identified the key reasons for the discontinuation of the programme.ResultsSMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after four years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers.Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system.ConclusionThis study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

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Scaling-Up Digital Innovations in Healthcare: Expert Commentary on Success Factors and Barriers (Preprint)

10.2196/preprints.24582 ◽

2020 ◽

Author(s):

Hannes Schlieter ◽

Lisa A. Marsch ◽

Diane Whitehouse ◽

Lena Otto ◽

Ana Rita Londral ◽

...

Keyword(s):

Health Care Providers ◽

Success Factors ◽

Digital Health ◽

Scale Up ◽

Healthcare Delivery ◽

Rapid Change ◽

Well Being ◽

Scaling Up ◽

Care Providers ◽

Wide Range

UNSTRUCTURED Healthcare delivery is undergoing a rapid change from traditional processes towards the use of digital health interventions and personalized medicine. Hospitals and health care providers are introducing hospital information systems, electronic health records, and telemedicine solutions to create more efficient workflows in and beyond institutions. Patients are choosing among a wide range of digital health tools provided by wearables and mobile phone applications to support their self-management, health and well-being. The question of how sustainable digital health scale-up can be successfully achieved is not yet sufficiently resolved. This paper identifies and discusses success factors and barriers for scaling-up digital health innovations. The results discussed in this paper were gathered by 13 scientists and representatives of public bodies and patient organizations during the 1st International Workshop on Best Practices for Scaling-Up Digital Innovations in Healthcare – Scale-IT-up!, co-located with the BIOSTEC 2020 conference held in Valletta, Malta. The resulting success factors and barriers are explored in the context of prior research and implications for future work.

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Inside Industry

Asia-Pacific Biotech News ◽

10.1142/s0219030320000348 ◽

2020 ◽

Vol 24 (05) ◽

pp. 54-61 ◽

Cited By ~ 1

Keyword(s):

Research Collaboration ◽

Digital Health ◽

Antiviral Treatment ◽

Cohort Analysis ◽

Scaling Up ◽

Healthcare Systems ◽

Hybrid Cloud ◽

Healthcare Organizations ◽

Cloud Adoption ◽

Management Platform

The following topics are under this section: Scaling Up the Digital Health Ecosystem Cohort Analysis of Remdesivir as Antiviral Treatment for COVID-19 Pharmaceutical Giants Join Forces in Fight against COVID-19 Reinventing Healthcare in Asia Accelerating Efforts to Combat the Global COVID-19 Pandemic Evaluation of Stem Cell Therapy as Potential Treatment for COVID-19 Pneumonia Factors that Influence Hybrid Cloud Adoption in Healthcare Organizations Commencing Sale of Nutraceuticals in China Research Collaboration to Develop Novel Therapies Easing Strain on Healthcare Systems with COVID-19 Patient Management Platform

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Multiple pathways to scaling up and sustainability: an exploration of digital health solutions in South Africa

Globalization and Health ◽

10.1186/s12992-021-00716-1 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Alison Swartz ◽

Amnesty E. LeFevre ◽

Shehani Perera ◽

Mary V. Kinney ◽

Asha S. George

Keyword(s):

South Africa ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Digital Health ◽

National Level ◽

Scaling Up ◽

Value Proposition ◽

Problem Identification ◽

Organisational Context

Abstract Background With the aim to support further understanding of scaling up and sustaining digital health, we explore digital health solutions that have or are anticipated to reach national scale in South Africa: the Perinatal Problem Identification Programme (PPIP) and Child Healthcare Problem Identification Programme (Child PIP) (mortality audit reporting and visualisation tools), MomConnect (a direct to consumer maternal messaging and feedback service) and CommCare (a community health worker data capture and decision-support application). Results A framework integrating complexity and scaling up processes was used to conceptually orient the study. Findings are presented by case in four domains: value proposition, actors, technology and organisational context. The scale and use of PPIP and Child PIP were driven by ‘champions’; clinicians who developed technically simple tools to digitise clinical audit data. Top-down political will at the national level drove the scaling of MomConnect, supported by ongoing financial and technical support from donors and technical partners. Donor preferences played a significant role in the selection of CommCare as the platform to digitise community health worker service information, with a focus on HIV and TB. A key driver of scale across cases is leadership that recognises and advocates for the value of the digital health solution. The technology need not be complex but must navigate the complexity of operating within an overburdened and fragmented South African health system. Inadequate and unsustained investment from donors and government, particularly in human resource capacity and robust monitioring and evaluation, continue to threaten the sustainability of digital health solutions. Conclusions There is no single pathway to achieving scale up or sustainability, and there will be successes and challenges regardless of the configuration of the domains of value proposition, technology, actors and organisational context. While scaling and sustaining digital solutions has its technological challenges, perhaps more complex are the idiosyncratic factors and nature of the relationships between actors involved. Scaling up and sustaining digital solutions need to account for the interplay of the various technical and social dimensions involved in supporting digital solutions to succeed, particularly in health systems that are themselves social and political dynamic systems.

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17.C. Workshop: I-Care Lab: Puglia scaling up in integrated care for the future of digital health and social system

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.835 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

Keyword(s):

Integrated Care ◽

Digital Health ◽

Chronically Ill ◽

Scaling Up ◽

Healthcare Services ◽

Added Value ◽

Good Practices ◽

Health And Social Care ◽

Care Systems ◽

Sustainable Health

Abstract Background Healthcare systems around the world are under great pressure to drive forward transformation in order to meet the evolving needs of their populations. Ageing and chronicity are the main challenges to be tackled. In many countries care is too often fragmented and has clear deficiencies in quality, inducing low responsiveness of the healthcare system and low satisfaction with healthcare services. To address these challenges, the transformation towards integrated care has the potential to address deficiencies in order to obtain accessible, quality, effective and sustainable health care. Objectives The objectives of this workshop are to present 3 innovative projects undertaken by Puglia Region, by means of its Strategic Regional Agency for Health and Social Care AReSS, within the framework of the I-CARE LAB, a think tank and beta site for integrated care focused on the production of evidence-based knowledge and systematic approaches to exploitation and scaling up of good practices. The workshop will present the results of the research that has taken place around the above-mentioned projects and to gather feedback from the participants on their opinions and perspectives about integrate care models, policies, tools and practices. Results The featured projects are based on the collaboration with national and international partners interested in developing tools and approaches to stimulate changes towards more sustainable health and care systems, and in supporting scalability and transferability of good practices in Europe. The knowledge transfer among these institutions represents the added value that can establish a common language and framework of integrated care. The showcased projects focus on vulnerable populations for which integrated care might be most beneficial, e.g., chronically ill, frail elderly, and multi-morbid persons; the projects have identified and described an impressive number of promising practices; there are several plans to evaluate these in the coming years, and other plans to facilitate the wider-spread implementation and scaling up of such programs. During this session, 3 of such projects will present their findings, approaches and connections: SCIROCCO Exchange (assessment of integrated care interventions), FooDia-NET (patient engagement and literacy), EURIPHI (innovation procurement). Conclusions The workshop will be a 90-minute session with 3 presentations with ample time for audience interaction (30-minutes). Three individual members of the above-mentioned projects will be responsible for conducting the workshop (the chair, and 3 people making 3 presentations). The session will be chaired by the AReSS Puglia CEO, who will introduce the workshop. A set of presentations will follow, covering the different session topics corresponded to the 3 projects of the Puglia I-Care Lab. Participants will be asked to actively join in the discussion on the further projects enhancement. Key messages The first impact of the proposed workshop consists of stimulating knowledge and discussion about emerging tools and approaches in Europe towards more sustainable health and care systems. The second expected impact is to create awareness and to support scalability and transferability of good practices in Europe and abroad.

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