Overview of Global mhealth Initiatives & State of the mhealth Evidence Ecosystem Alain B. Labrique, PhD, MHS, MS Director, JHU Global mhealth Initiative & Associate Professor Program in Global Disease Epidemiology and Control Department of International Health & Department of Epidemiology Johns Hopkins Bloomberg School of Public Health & Johns Hopkins School of Nursing January 31, 2014 1
www.jhumhealth.org 129 mhealth Projects at JHU, as of January 30, 2014 2
The World is Rapidly Changing Euclidean map of 10 million of the 850 million Facebook users friend networks Paul Butler, FB Household Mobile Phone Ownership over time in rural Bangladesh, by Wealth Index (n=44,469) Ownership wnership.8 1 HH robability reporting of Mobile Phone Ow O.2.4.6 Proportion of H P 0 2008 2009 2010 2011 2012 Year Lowest Quartile WI (n=17,176) High Quartile WI (n=6,472) Low Quartile WI (n=19,789) Highest Quartile WI (n=1,032) Labrique, Tran et al, 2013 (in press) 3
2011 4
mhealth is an Emergent Field Source: PubMed Database, GSMA Literature Review of State of Evidence on mhealth 2011 mhealth doesn t work in a Vacuum 5
mhealth is a diverse research space: From enhanced data collection to improving timeliness of care provision and adherence to treatment regimens or standard care protocols. 6
Expectant women/ new mothers sign up for service Initiative Users receive 2 health-related messages weekly Global PPP Partner advertising and advocacy will drive subscription levels If you have any bleeding during this month, seek medical attention right away Your baby needs an immunization this week to stay healthy: Available free at all EPI clinics 7
Bridging the Gaps January 31, 2014 8
mcare: Community Health Worker System to improve delivery of ANC/PNC and increase client demand 9
The Gartner Hype Cycle Fenn J, Maskino M: When to Leap on the Hype Cycle. Gartner Group 2008. Why Evidence? 1. Two decades of Emphasis on EBD! 2. Health investments in global health are driven by more than market forces 3. Limited resources = Need for stringent, costeffectiveness based planning 4. Donors: Increased transparency / scrutiny 5. Population side demand for improved quality 6. e Health / ICT induced political fatigue 10
Healthy mskepticism The Bellagio ehealth Evaluation Declaration 2011 Rigorous evaluation of e & m Health is necessary to generate useful evidence and promote the appropriate integration of technologies to improve health and reduce inequalities. 11
If used improperly, ehealth may divert valuable resources and even cause harm implementation must be guided by evidence Bellagio Call to Action 2011 12
Need for Structure 13
mhealth Technical Evidence Review Group for RMNCH http://bit.ly/who-mterg Providing governments and implementing agencies objective, evidence-based guidance for the selection and scale of mhealth strategies across the reproductive, maternal, newborn and child health continuum The mhealth Alliance's Evidence Working Group (EWG) focused on the identification and promotion of research to generate credible evidence to support and identify if, how and to what extent mhealth and ehealth solutions can contribute and increase health impact, particularly in low and middle income countries (LMIC). 14
Evidence for whom? Is there evidence? Who is asking the question? Improving the Evidence for Mobile Health, 2011 15
Evidence of what? Evidence Across The mhealth Maturity Lifecycle Threshold of Information Amount of Information (R ED) OF WHAT? MEASURED HOW? Stability Functionality Useability Efficacy Effectiveness Maturity of the mhealth Project Systems Engineering Qualitative Quantitative Mixed Q/Q / M&E Methodology 16
Is your mhealth the same as my mhealth? ARTICULATING mhealth STRATEGIES AS HEALTH SYSTEMS INNOVATION Patient Knowledge and Self Efficacy Provider Competency and Accountability Health System Adequacy INFORMATION DEMAND CREATION SUPPORT SYSTEMS WORK MANAGEMENT DECISION SUPPORT ENUMERATION SURVEILLANCE SUPPLY CHAIN STAFF AND FACILITY PERFORMANCE MONITORING REFERRAL SUPPORT 17
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mhealth Strategy Intermediate Outcome Outcome / Impact CLIENT PRO OVIDER HEA ALTH SYSTEM Real-time Data Access / PHR Vital Statistics Reporting Disease Surveillance Logistics monitoring and tracking Financing (Banking, Insurance) Client reporting of quality / performance Electronic Medical Records Workflow Management Systems Decision Support Systems On-Demand Training / Assessment Point-of-care of Diagnostics Remote Monitoring Remote Consultation Enhanced Counseling Appointment Scheduling Client Education On-demand Information / Helplines Improved Dem. / Hlth. Data Appropriate Resource Alloc. Policy Adjustments Supply Chain Integrity Accuracy of Information Continuity of Care Affordability of Care Provider Competence, Accountability, Effectiveness. Client Knowledge and Self-Efficacy Responsive Health System Improved Efficiency / Coverage Improved Quality of Care Improved Health Behaviors Improved Population Health Improved Health Outcomes A Taxonomy for mhealth 19
What is the problem we re trying to solve? INFORMATION AVAILABILITY QUALITY ACCEPTABILITY UTILIZATION EFFICIENCY COST 4.1.1 Lack of population enumeration 4.2.1 Supply of commodities 4.3.1 Quality of care 4.4.1 Alignment with local norms 4.5.1 Demand for services 4.6.1 Workflow management 4.7.1 Expenses related to commodity production 4.1.2 Delayed reporting of events 4.2.2 Supply of services 4.3.2 Health worker competence 4.4.2 Addressing individual beliefs and practices 4.5.2 Geographic inaccessibility 4.6.2 Effective resource allocation 4.7.2 Expenses related to commodity supply 4.1.3 Quality/ unreliability of data 4.2.3 Supply of equipment 4.3.3 Quality of Commodity 4.4.3 Stigma 4.5.3 Low adherence to treatments 4.6.3 Unnecessary referrals/ transportation 4.7.3 Expenses related to commodity disbursement 414 4.1.4 Communication roadblocks 424Di 4.2.4 Diversity i of treatment options 434Health 4.3.4 worker motivation 4.5.4 Loss to follow up 4.6.4 Planning and coordination 4.7.4 4Expenses related to service delivery 4.1.5 Access to information or data 4.3.5 Continuity of care 4.6.5 Timeliness of care 4.7.5 Client-side expenses 4.3.6 Supportive supervision Preventive and Curative Public Health Interventions of known efficacy exist and are well described 20
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mhealth: A Health Systems Catalyst EFFECTIVE COVERAGE Shift focus from Does mhealth work? to Does mhealth optimize what we know works? INTERVENTION OF KNOWN EFFICACY Jo Y, Labrique AB et al. In Press 2013 22
12 Common Applications of mhealth RMNCH Continuum: Known Interventions mhealth Strategy: overcoming these constraints: Touching these actors in the system: Labrique, Mehl, Vasudevan et al. 2013 (MS in Review) 23
Labrique, Mehl, Vasudevan et al. 2013 (MS in Review) Value of a shared framework and taxonomy: Communicate within the field Communicate to non-mhealth actors Curate Evidence and Information Identify areas of focal activity Identify gaps and opportunities for action Avoid / minimize redundancy / duplication Identify opportunities for collaboration / integration Focus on the HEALTH SYSTEM not the TECHNOLOGY 24
mhealthevidence.org Helping to Consolidate efforts Globally MREGISTRY.ORG A Global mhealth Registry And other partners 25
Pilotitis mterg Criteria for Grading mhealth Information Quality 26
Benjamin, I just want to say one word to you Plastics. -Mr. McGuire The Graduate, 1967 27
EVIDENCE INTEGRATION ENTERPRISE SCALE From this 28
To this? THANK YOU. 29