‘Technology is an amazing tool but it is not magical. It can and will break. One needs to test as much as possible’

For a decade, the World Health Organization (WHO) has been constantly emphasising on the grave difficulties that exist in safeguarding women and children’s health all over the world. With rising attention to maternal and child health issues, a number of countries have made considerable progress in recent years1.

However, the world’s largest and second largest continents—Asia and Africa despite of numerous emerging preventive health initiatives—face challenges to improve the health of women and children in their region. These barriers in the system are making it difficult to meet the aspirational Sustainable Development Goals (SDGs).

Steve Ollis, senior digital health advisor at the Maternal Child Survival Program and John Snow Inc., shares his observations on the current developments in these continents. Excerpts.

Q.      You have worked intensely with frontline health workers in Africa and Asia. How does the public health system functions in these regions? Are they any different from each other?

Steve: Of course, there are many differences, from country to country. But one of the key differences is in the use of community health workers (CHWs). In Asia, there seems to be more paid models which are managed by the local non-profit organisations (NGOs), whereas in Africa, CHWs are serving majorly on voluntary basis. However, both the systems face similar challenges. Some of them being, low pay, uncertain supply chains, little adherence to quality standards, burden of heavy reporting and hardly any use of statistics for decision-making.

Q.      Could you briefly tell us more about the status of healthcare services in Tanzania? Has it evolved over last 10 years, especially with the easy accessibility to the information and communication technologies (ICT)?

Steve: Tanzania has evolved considerably in the last 10 years, becoming one of the hotbeds of digital health innovation. This has happened by nationally scaling up programmes in supply chain, mass messaging, DHIS2 (a web-based open-source information system used for national health data management and analysis, IDSR (The Integrated Disease Surveillance and Response, a framework that makes surveillance and laboratory data more usable for public health managers), among other things.

There has been a considerable use of mobile money in support of health programmes as well as decision support applications deployed to support both community as well as facility-based health workers. Most critically, in support of all of this, there is a robust digital health community of practice and eHealth steering committee. Their conjunction with strong leadership from the Ministry of Health have furthered the development of an eHealth strategy which now is being put in place to ensure harmonisation and interoperability of the healthcare systems.

Q.      According to you, what are the best practices for effective digital communication to raise crowdfunding for maternal and child health programmes?

Steve: This is an interesting question and the one I don’t claim to have a perfect answer to. One of the key things is to look at the market and analyse: Does it make sense to try to reach out to 10,000 new people who might give $10 each or try to reach out to four new wealthy individuals or small foundations that might provide $25,000 each?

My suspicion is that it makes sense to go after the smaller group. In either of the cases, one requires the ability to inspire ordinary people as well as the aptitude to stimulate confidence in the organisational leadership. To accomplish this, conscious efforts should be made by being present at significant health and development events, recording short videos and also through active use of social media or a variety of such networking platforms.

Q.      You provide technical leadership to support the integration of effective digital health solutions in the MCSP-supported countries. While designing and implementing ICT solutions, how do we maintain a balance between quality control and expanding outreach?

Steve: This is again an excellent question and one that many groups struggle with. The key to this is to build in check-points at each level in the system or during organisational expansion and assess what may need to be reworked—whether it is technology or the processes.

It may be tempting to scale up quickly after achieving some initial success but it is also possible to dilute the effectiveness of any programme, which is not well-supported or experiences significant system downtimes, thereby causing health workers and beneficiaries to lose faith in the programme. The need for quality control is paramount and needs to be thought of as everyone’s job, not just that of a system developer’s. The key is to understand that technology is an amazing tool but it is not magical, it can and will break and one needs to test as much as possible under a variety of settings. It is safe to institute the ongoing timely monitoring efforts and develop the ability to quickly respond to any system challenges.

Source: 1 World Health Statistics 2016

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