Fighting the global health burden through new technology:

Transcription

1 Fighting the global health burden through new technology: WHO-ITU joint Program on mhealth for NCDs Sameer Pujari World Health Organization HQ Geneva

2 Non-Communicable Diseases(NCDs) and their causes Cancer Diabetes Cardiovascular Diseases Chronic Respiratory Diseases Other NCDs Physical inactivity Obesity Tobacco use Unhealthy diets Harmful use of alcohol Malnutrition

3 The socio-economic burden of NCDs US$ 170B is the overall cost for all developing countries to scale up action by implementing a set of "best buy" interventions, identified as priority actions by WHO US$ 7T is the cumulative lost output in developing countries associated with NCDs between million total deaths in 2008 of which 36 million were due to NCDs

4 Title "This is the second health issue ever to be addressed at a special meeting of the United Nations General Assembly. We should all work to meet targets to reduce NCDs. WHO's best buys serve as excellent guidance" Ban Ki-moon UN Secretary-General 19 September 2011 High-level Meeting on NCDs New-York

5 Connected Life.. Why is mhealth an important opportunity? Worldwide penetration ITU estimates, 2012 Mobile cellular subscriptions Number (millions) 6,835m Per 100 people 96.2% Fixed telephone lines Number (millions) 1,171m Per 100 people 16.5% Active mobile broadband subscriptions Number (millions) 2,096m Per 100 people 29.5% Fixed broadband subscriptions Number (millions) 696m per 100 people 9.8%

6 There are a number of challenges with mhealth Scattered pilots Govt Ownership No integration of systems Evidence Closed technology No evaluation/review Pilotitis Business model? Costs not analyzed Expensive technology

7 What is needed Political commitment Donor interest/ funding availability Evidence Pilots to health systems (toolkit) Standards and Guidelines NCD burden/ high burden of specific risk factor Mobile phone penetration

8 Tackling the challenges Evidence

9 Looking at evidence for NCDs (PREVENT, TREAT, ENFORCE) mawareness mdiabetes msocialnetworking, mgaming mwellness mtraining (Health workforce development) Prevention m Agriculture Treatment mphysicalactivity mcessation mdisease Management msurveillance Guidelines development mtaps msmokefree mgeomapping mwhistleblowers millicit Enforcement

10 Broad evidence in mhealth is increasing vidence-hub

11 AWARENESS & BEHAVIOUR CHANGE FOR NCDS Literature shows periodic prompts and reminders are an effective method to encourage and reinforce healthy behaviors including weight loss, treatment reminders, activity, sunscreen use, drug reminders etc Arogya in India targeted over a million people in a mass diabletes awareness programme 11% increase in those who exercised regularly 15% increase in those who had 2-3 servings of fruits a day 8% increase in those who had 2-3 servings of vegetables a day 14% increase in those who avoided fatty foods

12 TREATMENT: mcessation, disease management Number of successful SMS-based behavioural change programmes for smokers have been successful in the US, UK and New Zealand, Turkey, Hong Kong, Europe. Seen as being 2 to 5 times more effective. Diabetes Management: Proven clinical impact observed during early trials reported up to 1.9% A1c drop in participants

13 msurveillance Nationally representative household surveys in 31 countries 1M household level data & 350,000 household interviews WHO & CDC moved GATS onto handhelds in order to improve speed and quality More than 2,644 handheld computers were fielded and over 2,634 fieldworkers, supervisors and monitors were trained to use them Questionnaires were developed and programmed in 38 languages and scripts. 50 languages & dialects The global hardware failure rate was < 1% and data loss was almost 0%. OUTCOME : Better Data quality and faster data availability for policy and action EPIHANDY reduced data entry errors and improve cost-efficiency when compared with traditional paper surveys in Uganda

14 Crowd Sourcing and Geo Tagging Crowd sourcing and crowd crafting is being used very effectively for emergency and outbreak response Can be used to enforce laws and policies for NCDs

15 ENFORCEMENT: millicit Using mhealth technology developed for counterfeit malarias mpedigree decreased fake anti malarials in Ghana overnight! We can address big issues related to counterfeit cancer and other drugs Advanced tools such as barcodes and barcode readers can be also used by Customs officers and consumers to identify forfeit medicine

16 PREVENTION: mtraining mtraining : proven intervention in education sector and governance sector Used extensively in Maternal child health domain BBC world vision + DFID, a good example of mtraining efficacy

17 In October 2012 we launched the WHO-ITU Joint Initiative on mhealth with clear objectives NCD Problem WHO ITU mhealth program on NCDs Supporting framework 36 m deaths / year 9 m premature deaths / year $7 tr health-care costs & productivity losses Resource Mapping: identify who is doing what in mhealth for NCD space Coordinate: technical groups & partners Validate: NCD content and solutions Evaluate: cost effectiveness & health outcomes Promote: results and best practices Build capacity: where gaps exist Mobilize countries: to implement Mobilize Resources: governments & partners Health systems Global Platform Evidence challenges To enable Provide To overcome Capacity building Partnerships Scaling challenge

18 Tackling the challenges Encouraging Government ownership through a UN convening platform

19 There is changing political will and extreme interest

20 The WHO ITU joint initiative on mhealth for NCDs is a promising innovative intervention to see how to use new technologies to better health outcome" Helen Clark UNDP Administrator 31 January 2013 Harvard School Public Health Boston, Massachusetts

21 mhealth for NCDs Business case NCD control GOOD BUYS FOR GOVERNMENTS Mobile health mhealth is a great mechanism to use the mobile infrastructure for out-reach and save significant funds in the health sector.

22 Tackling the challenges Tools being developed

23 mhealth for NCDs Toolkit

24 Diabetic patient mdiabetes Pre-diabetic individual Self-registers for SMS disease management support (text code) or referred by doctor Receives an initial outreach SMS engaging them in the programme. Receives daily reminders for measuring blood glucose and taking insulin Receives regular advice on ways to manage diabetes through diet (e.g. replacement foods or help managing insulin levels) The patient controls the disease rather than the disease controlling the patient. Individual replies to the SMS, enrolling them in the prevention programme. Individual receives SMS-based advice on small changes they can make to reduce risk factors for diabetes e.g. diet, exercise, information on diabetes development Result: a happy, health diabetic with reduced A1c. Numerous studies show that mobiles help diabetics to keep blood glucose stable and are acceptable to users. Result: a happy, diabetic-free individual

25 1. Smoker wants to quit but needs support. mcessation 2. Smoker self-enrols or is enrolled by family/doctor. 3. Smoker receives daily messages offering guidance on managing cravings, coping with withdrawal, etc. Smoker is put into a message group based on criteria such as age, dependence, commitment to quit etc. 4. Smoker has code words to text if they need specific support at any moment. CRAVE 5. Smoker receives gradually less messages as their tobacco-free time increases. 6. After 6 months of support the smoker is no longer a smoker.

26 We are also looking at mwellness mtraining menforcement mscreening etc Interventions

27 M&E Impact assessment framework WHO-ITU mhealth impact assessment model

28 Tackling the challenges From Pilotitis to Health systems approach

29 Cross sectoral partnership model Best Practices Content Technology Deployment strategy M&E Telecoms, Insurance, Pharma, Wellness, IT, Sporting Industry, Other Private Sector Government Best Practices Content Technology Deployment strategy Policies M&E UN NGOs and Academia Best Practices Content Technology Deployment strategy Policies M&E Best Practices Content Deployment strategy M&E

30 Our Core Partner Strategy combines inclusiveness and focus Focus on five key partnership sectors: 1. Governments and development agencies; 2. Telecoms and technology; 3. Pharmaceutical companies; 4. Health insurance providers; and 5. Wellness groups 30

31 Costa Rica : Champion example Commitment from the President s office from day 1. 1 million dollars committed by the Government Strong leadership from the MoH High end coordination between MoH, MoICT, egovernance group

32 Partners already signed on/late stage negotiations Associations Strategic partners 32

33 The step ahead Evidence Political commitment NCD burden/ high burden of specific risk factor Donor interest/ funding availability From Pilots to health systems (toolkit) Mobile phone penetration Standards and Guidelines

34 Why should you join hands Leadership benefits Play a LEADERSHIP role in a highprofile global health initiative Help create opportunities for Health and technology entrepreneurs within your country Develop a Global coordination and delivery model for tech based health systems Programme benefits Quick profiling and better outcome relationship with citizens Get more for less by leveraging transparent systems that provide real time impact at low cost Strengthen prevention and early, effective treatment to improve population health

35 Main Value proposition For Health - opportunity for local innovation, and a platform for targeting a global health market, help use technology to deal with domestic NCD problem. For trade - opportunity for various sectors within country(such as academia, pharmaceuticals, telecoms, and IT) to benefit from a guiding role in the Initiative, to learn and work with other countries. The German and local companies can contribute (and benefit) plus then use the initiative to source back to the German innovations from across the world. For south south collaboration- given GIZ growing leadership in technology and development, this initiative can provide the legacy for a true collaboration model between countries through and effective, also provides a mechanism for evidence based innovation in health. 35

36 Contact: Sameer Pujari THANK YOU!