mhealth in Developing Countries: understanding the contributions in sub-saharan Africa

Transcription

1 mhealth in Developing Countries: understanding the contributions in sub-saharan Africa Daniel Opoku, MScPH 1

2 World Bank: countries in the bottom 2/3 of gross national income (GNI) GNI measures are useful for social indicators United Nations: 159 nations but no official definition IMF: advanced and emerging market economies ehealth GrundlagenGastvorlesung 2

3 there is so much heterogeneity success of development efforts varies (e.g. infant mortality) Malaysia is more like the US than Malawi (Umar Serajuddin) different income groups (China, Bolivia and Eritrea) shift from MDGs to SDGs development is universal (Tim Fernholz, 2016) ehealth GrundlagenGastvorlesung 3

4 Background-history, policy strategies, aims and objectives, partners ehealth in SSA-examples, uses, advantages, limitations mhealth in disease management: What works? For whom? In what circumstances? and How? Conclusion and discussion Outline ehealth GrundlagenGastvorlesung 4

5 Background SSA: UN classification (except Sudan) WHO, Africa region: 47 countries ehealth GrundlagenGastvorlesung 5

6 Cont Universal health coverage: a powerful concept in public health and one of the key areas of progress in health in the African Region o equity in access everyone who needs health services should get them, and not simply those who can pay for them o quality of health services good enough to improve the health of those receiving the services o financial-risk protection ensuring that the cost of health care does not put people at risk of financial hardship (The African Health Monitor, 2015) ehealth GrundlagenGastvorlesung 6

7 Cont Primary Health Care: aims at comprehensive and continuous health care services to all manner of persons o Person-centered care over time (buiding long term relationship between patients and HWs) o Integrated care o Quality health care delivery and access (especially in remote communities) (WHO, 2003, 2008; Starfield et. al, 2005) ehealth GrundlagenGastvorlesung 7

8 Cont Burden of Disease: increasing co-existence of infectious diseases and NCDs e.g: o Men (15-60yrs) high risk of dying from NCDs o Women high risk of dying from infectious diseases o Women (15-60yrs) 15% more likely to die from NCDs than women in high-income countries o Upsurge stroke, hypertensive heart disease, diabetes and chronic kidney disease o Vital priorities Malaria, maternal and child health Gastvorlesung 8

9 Trends in under-five mortality per 1000 live births Trends in maternal mortality ratio, per live births (WHO, 2012) ehealth GrundlagenGastvorlesung 9

10 a model strategy and cost-effective intervention facilitate access and service delivery in primary care self care and management provide quality and efficient healthcare minimize number of unnecessary referrals improve quality of care in deprived communities reduce long distance travels disease surveillance health promotion and education support for healthcare workers improve professional education Department of Health Care Management mhealth in SSA ehealth GrundlagenGastvorlesung 10

11 Cell-Life project in South Africa Coaching women through medical abortion process Family planning info Self-assessment of abortion completion (de Tolly and Constant, 2014) ehealth Grundlagen-Gastvorlesung 11

12 (Mechael et. al, 2010 cited in Vélez O, 2011) ehealth Grundlagen-Gastvorlesung 12

13 MVP-teleconsultation in Ghana ehealth Grundlagen-Gastvorlesung 13

14 Case 1: convulsion Department of Health Care Management A child was brought with convulsion. I inserted suppository first and then I was not sure whether I should add diazepam or not. I called them and they said I should add the diazepam for the child to be stabilized for a while and when I added that one, the child slept for a while and after that the convulsion just left her and I started treating for malaria. (CHN) (Opoku et. al, 2015) ehealth Grundlagen-Gastvorlesung 14

15 Case 2: Postpartum Hemorrhage I was called to manage PPH-postpartum hemorrhage. The uterus wasn t well contracted. She didn t check because she wasn t a midwife and then I asked her to expel some clots and then examine if there are perineal tears. But there were no perineal tears but just that the uterus was not well contracted. So she gave Oxytocin 20 Units: 10IM and 10 was the infusion. She was massaging the uterus. So the bleeding subsided and I asked her to pad. Later on she removed it and then she called to tell me that the bleeding has stopped. (TCC midwife) (Opoku et. al, 2015) ehealth Grundlagen-Gastvorlesung 15

16 What makes it work and why? Is it the technology itself and the design? Is it about User experience? NB: Outcomes are the result of choices made by individuals whose interactions are influenced by the intervention and by the context of implementation ehealth Grundlagen-Gastvorlesung 16

17 What works for whom in disease management? (Opoku et. al, 2017) ehealth GrundlagenGast-vorlesung 17

18 Conclusions mhealth interventions in SSA are mainly to facilitate (remote) access to previously unavailable and often specialized services A successful mhealth intervention in SSA is as a result of the perceptions that the technology involved is useful and easy to use among patients and healthcare providers according to their predisposing characteristics and needs as well as the availability of certain enabling resources in their community ehealth GrundlagenGast-vorlesung 18

19 Key mechanisms Predisposing mechanism: the propensity to utilize and/or implement mhealth interventions based on a set of personal characteristics - Age, language, Enthusiasm, cultural and social acceptance Enabling mechanism: certain available resources to enable usage/implementation Access to phones, infrastructure, volunteerism, partnerships Need mechanism: the imperative factors and proficient evaluations accounting for the need for the intervention Upsurge of NCD epidemic, severity of perceived threat appraisal of disease Ease of Use: how (potential) users find mobile phone technologies easy to use Easy portability, ease of operability, asynchronous services, very basic services, simple and suitable for persons with low/no education Usefulness: how useful are the interventions Value propositions and competitive advantage ehealth GrundlagenGastvorlesung 19