Three Thoughts from Day 1 at the Global mHealth Forum

Greg Olson

Communications Senior Associate

Innovation overload. That is the only way to describe the Global mHealth Forum’s first day (day three of the broader mHealth Summit 2015).

Ready for questions at the Global mHealth Forum. (Photo: MSH Staff)

It seems like every week I am inundated by “innovations” in meetings, webinars, Twitter chats, blogs, and more; however, day one at the Gaylord National Resort and Convention Center takes the cake. Despite the flood of information, many of the advancements in connected digital health tools painted an inspired image of the future, and highlighted elements of the future that can already be seen today.

Here are my three key takeaways from the plenaries and panels that I attended: plan interoperability, design with the end-user in mind, and harness people power.

Plan Interoperability

Big developers and small do-it-yourselfers announce new digital health solutions every day. Unfortunately, many of these tools are built in silos, by individuals and organizations, within the sphere of the private health sector.

One gem that I mined from Janita Ferentinos during the National Scale: Perspectives of Sustainability from the Government, Health, and Mobile Sector panel, was to “collaborate, don’t compete.”

Collaborate broadly at all stages of design. Follow international and industry standards that allow others to build on what you have learned and designed; and engage governments and the public health sector early and often.

Although governments and public sector health institutions can be slow to adapt, they can provide a long-term foundation upon which to build stronger health systems.

Human-centered Design

Oftentimes, according to Paul Amendola–a Technical Advisor for Health Information at the International Rescue Committee, digital and mobile health tools are designed and implemented in a headquarters-down approach. The silver bullet has already been identified, and it just needs to be coded and disseminated.

However, this disjointed process often results in not only a sub-optimal product, but also a product that is not adopted by users (health workers, patients, managers, etc.). Instead, building mHealth tools through a human-centered design (HCD) approach helps ensure that tools address the needs and challenges that users face.

HCD means deliberately investing time and resources to research end-user wants, needs, and expectations. And that research does not stop after the initial discovery phase. Designers need to collaborate and engage users during every stage of development. Effective HCD processes reassess user experiences throughout. The end goal is a digital or mobile health tool that is tailored to its audience, and that users can easily adopt.

I think that Management Sciences for Health’s (MSH) Tao of Leadership offers some helpful guidance and poses a powerful argument in favor of HCD, specifically: “Go to the people, live with them, love them, learn from them, start with what they have, build on what they know.”

On the Leadership, Management, and Governance (LMG) Project, we have seen both ends of this spectrum. When the LMG Project first started supporting midwifery managers, our plans included an online community of practice, through MSH’s LeaderNet platform, that would connect midwives across borders; however, during implementation, online engagement was low. Instead, the midwives organized groups on WhatsApp, a mobile communication application, since they were already using it every day. Similarly, the LMG Project adopted some principles of HCD when designing our Youth Leadership eCourse, the LMG Project collaborated with the International Planned Parenthood Federation Africa Region’s Youth Action Movement to ensure that content was relevant, engaging, and tailored to the needs of aspiring young leaders. The feedback received prior to, and since, rolling out the eCourse has informed updates to the current course, and plans for future eCourses.

The strength of a HCD approach is reflected in the final product. Rather than investing money and resources in an array of digital tools that go unused, designing digital and mHealth tools with the end-user in mind leads to higher rates of engagement.

Harness People Power

Finally, from community health volunteers to community health workers (CHWs), people power was very much on display during the first day of the Global mHealth Forum. In communities around the world, the health workforce is driving health care both with and without digital health tools.

To steal another piece of wisdom from Paul Amendola, we need to stop thinking of mobile tools as innovations, and instead think of them as another possible tool in our kit.

Kristy Hackett, a PhD candidate at the University of Toronto, collaborated with the Supporting Systems to Improve Nutrition Maternal Newborn and Child Health (SUSTAIN-MNCH) Project in Tanzania to research links between the project’s smartphone-based decision support and counseling tool (SP+) for CHWs and MNCH outcomes, and to identify what the mechanism is for those impacts. Her research identified clear links that CHWs equipped with and trained on the SP+ application were motivated to visit pregnant mothers more often, and that pregnant mothers were more likely to give birth in health facilities after receiving multiple visits from CHWs.

Similarly, health workers already collect significant amounts of data on paper records, but equipping them with dashboards and smart registers can help them apply that information.

Dr. Anuraj Shankar, from the Harvard University T.H. Chan School of Public Health shared the example of the Open Smart Register Platform (OpenSRP) for local Anganwadi Workers in India. The workers collect and store health information on paper, but the benefits from shifting that data into a smart register goes beyond simply better information management. Using OpenSRP, the workers can apply information in a more effective way by customizing health services based on previous information or interventions that clients have received.

In Madagascar, the U.S. Agency for International Development-funded Mahefa Project led by John Snow Inc., recognized that the dashboards used to track drug supplies were plagued by user experience and data visibility challenges. The poor design placed a heavy burden on the CHWs who would submit inventory reports via SMS message. The Mahefa Project used HCD principles to work with CHWs to design a more effective dashboard and a less challenging reporting system. This shifted the supply chain management burden off of CHWs and onto the system, improving CHWs performance and reducing stock-outs.

Implementing mHealth at National Scale panel at the mHealth Summit 2015. (Photo: MSH Staff)

Digital health tools are shifting health services from standardization toward customization, and mHealth solutions further provide an opportunity to connect with clients, health workers, and organizations “where they are.” However, it remains essential to frame digital interventions, tools, and resources broadly, to avoid over-estimating or over-relying on their impact.

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