NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Though there are more than 2,000 pilot electronic health (eHealth) and mobile health (mHealth) projects in low- and middle-income countries, there is still much confusion about how best to realize the potential of these technologies to transform health systems. In 2014, we heard the same sentiment from the departments of health in multiple African countries: “We know there is something interesting happening with mHealth, and we know we don’t know how to do it ourselves, but the only people we can talk to about this are all salesmen!”

Realizing the potential of digital health tools is extremely challenging – out of those thousands of mHealth pilots around the world, only a handful have gone to scale. While examples of coherent national policies, sustainable programs and effective use of m- and eHealth products and programs exist, a “know-do” gap persists. Policies are often not well aligned and projects are frequently fragmented in “silos,” weakening efforts to establish integrated digital health systems at scale and compromising the potential for sizable investments that can create large-scale impact.

To create national integrated health systems that improve health care quality, coverage and efficiency, three interlinking elements must be in place:

• National policy that leads to informed decision making

• Sustainable programs that are designed, operationalized and built for scale

• Effective public good digital health tools that meet the user’s needs

Many organizations are already incorporating these elements and doing incredible work in the spaces of mHealth, eHealth, health informatics and all other names for ICTs-in-health (information and communications technology). These include JHU Global Health Initiative, D-tree International, mHealth Kenya, mPowering Frontline Health Workers, Jembi, Dimagi, Text-To-Change, the Praekelt Foundation and ThoughtWorks.

But if the interventions these organizations focus on – from mass communications systems like MAMA’s messages to pregnant women, to health worker support tools like those from Dimagi and D-tree – are to truly take root and improve health outcomes for millions of people, more connections must be made. Digital health experts need to connect with national governments to align national policies with sustainable programs and the effective use of technology for health products and programs.

Making nationally integrated health systems a reality will require:

• Stronger government capacity and national policies around digital health

A strong foundation is essential to enabling national governments to plan and budget for coherent digital health programs. This includes aligning health and ICT policy, linking government programs with telecommunications regulation, building a framework for data protection and privacy, guiding interconnection and open standards, considering data security and building coalitions. These coalitions might include government, other health implementers, technology providers, mobile network operators and others. Initiatives such as MomConnect in South Africa and Saving One Million Lives in Nigeria are currently playing this role.

• Health implementers empowered to use digital health tools effectively

Whether they are in government or other large health programs, health implementers need to develop capacity through participating in training courses, learning from international best practice, or harnessing organizational development to make use of the potential that new technologies bring (this is sometimes referred to as “business process reengineering” in the private sector). For example, mothers2mothers in South Africa, EGPAF in Tanzania and the UN Commission on Life-Saving Commodities are currently building their organizational capacity to more effectively run their health programs by using digital health tools in their interventions.

• A higher bar for national health standards and performance

To improve the overall level of digital health in a country, a national scorecard can be developed on eHealth and mHealth, measured against international best practices. Prizes, implementation certification and practitioner accreditation may also help raise the bar. Doing so will help the digital health community more easily share knowledge to drive improved standards and performance of programs that can create large-scale impact.

• Experts, implementers, academics, policymakers and users that are working together

To avoid “siloing” of efforts, these parties need to communicate through regional knowledge hubs and information dissemination points. Cross-cutting communities of practice are currently in development in South Africa, Kenya, francophone West Africa and on an Africa-wide scale.

We believe that by 2020, these four points can come together to make national integrated digital health systems a reality. But it will not be easy and no single party can do it alone. In an effort to bridge that main obstacle – the “know-do” gap – we recently launched a collective action initiative called HealthEnabled that seeks to improve health outcomes by aligning national policies, sustainable programs and user needs to activate the effective and widespread use of integrated digital health tools in low- and middle- income countries.

We’re starting with a few key countries in Africa, and expanding as funding allows. Throughout our efforts, we are working with the individuals and organizations who have the most experience and expertise in their fields and can apply their in-depth insight to the challenges and opportunities of each unique country context. We look forward to collaborating with like-minded organizations, facilitating the use of digital health tools to improve health, and supporting universal health coverage in the years to come.

Peter Benjamin is the director of HealthEnabled, formerly the mHealth Expert Learning Program (mHELP).