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Drugs by drone and mother mentors: how health services across the globe are being transformed

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In the mountainous region of Kintobo, in Rwanda’s remote Western Province, it used to take medical staff more than three hours each way to drive to the capital city of Kigali to restock the health centre. Now, a drone can deliver blood and medical products within the hour, after they send the order via WhatsApp message.

It’s all thanks to a Silicon Valley drone delivery company, Zipline, which began working with the Rwandan government in 2016. Since then, it has completed around 22,000 flights – sometimes up to 60 a day – and serves health facilities throughout the whole of the country from its two distribution centres, in addition to responding to requests from Ghana too.

Israel Bimpe, who works in global operations for the company, says they’ve already seen the impact that timely deliveries of blood products can have. “The ministry of health recently did an analysis of their efforts to address maternal mortality,” he says. “And three hospitals were the first to have zero maternal mortality in a period as long as seven months. One of the key factors the ministry and hospital administrators pointed out was that they were now receiving deliveries from Zipline.”

It’s just one example of how digital health initiatives are striving to improve the access and quality of healthcare in countries around the world, particularly when it comes to driving universal healthcare coverage (UHC). A 2018 study published in the Lancet found there were 15.6 million excess deaths that occurred in low and middle income countries in 2016 – 8.6 million of which could be avoided if the “expansion of service coverage is accompanied by investments into high-quality health systems”, the authors concluded.

That’s the goal of Be He@lthy, Be Mobile (BHBM), an initiative launched in 2013 by the World Health Organization (WHO), in partnership with the UN agency the International Telecommunication Union (ITU). The BHBM programme makes use of existing mobile infrastructure to tackle the causes of noncommunicable diseases (NCDs), such as diabetes, cardiovascular disease, and cancer, which account for 71% of all deaths each year.

So far, more than 3 million people have received SMS messages to encourage them to make healthier nutritional choices, attend screening appointments, and/or to give up smoking, across 11 countries, including India, Senegal and Egypt. 

Preparing a  Zipline drone for launch. Photograph: Zipline

“The ubiquity of mobile phones means that information and services [can] reach nearly everyone in the world,” says Virginia Arnold, project officer at WHO, about the success of using mobile technology. 

In Ghana, the Novartis Foundation, has also seen positive results. Its telemedicine programme connects remote community health workers with medical professionals in dedicated reference centres, and has found 70% of issues can be solved by phone, Skype or WhatsApp, preventing unnecessary journeys to health facilities. In 2016, the government funded seven reference centres to cover the whole country and formally adopted the scheme.

Facilitating that sort of local support is also the ethos behind the mothers2mothersinitiative in Africa, developed in partnership with Johnson & Johnson. It aims to reduce mother-to-child HIV transmission, by providing education and support via mentor mothers who are also HIV positive. Through counselling sessions and a mobile app to keep track of appointments, the scheme has reported increased retention in HIV care for patients, better adherence to drug regimes, more effective data collection and support delivered.

Novartis is also working with partners on the SMS for Life programme, which helps primary health facilities maintain their supplies of medicine in sub-Saharan Africa by reporting their stock levels and disease surveillance data to district medical officers. The platform – which uses mobile phones, SMS text message and tablet computers – means that issues can be resolved in two to three days, rather than the one or two months previously needed, and it facilitates better disease management on a country-wide level. Since launching in 2009, the platform has been rolled out across more than 10,000 public health facilities in Tanzania, Kenya, Ghana, the Democratic Republic of Congo and Cameroon. Programmes like these can be found on the Global Health Progress website, a knowledge hub of the biopharmaceutical industry’s various initiatives to support the attainment of sustainable development goals across the globe.

There are challenges to making digital health solutions a reality. Finding the necessary funding, keeping up with the high pace of digital change, and ensuring collaboration between innovators, investors and governments, all play a part in whether or not an initiative can achieve real change. “Many of the most cutting-edge technologies are designed for communities that have fast internet connections, high levels of technological literacy and strong health infrastructure,” says Dykki Settle, chief digital officer of the non-profit organisation PATH. “Applying these technologies to low-resource communities is more complex than simply downloading a piece of software to a computer, or an app to a smartphone.”

In 2017, PATH launched the Digital Square initiative to encourage the development of digital health tools. The organisation runs open funding cycles for donors of all sizes, where software developers can find money “to improve, expand or develop their software, service or content”, says Settle. To date, he states, Digital Square has provided more than $13m to 20 digital health initiatives, and is used in more than 70 countries around the world. Digital Square also strengthens the capacity of national and regional digital health leaders and technology experts to develop, use and manage strong in-country digital health systems and strategies.

Ann Aerts, head of the Novartis Foundation, agrees that collaboration and coordination with a country’s health authorities is essential, and that building digital solutions is only one part of the story when it comes to achieving UHC. Governments need to invest in building well-functioning health systems. And local policymakers need to be in the driver’s seat, defining the health priorities to be addressed with the help of digital technology, right from the beginning. “We cannot address all the global health challenges with the currently existing health systems,” Aerts says. “Health systems in low-income settings are often overburdened and face shortages of skilled healthcare professionals.”

At the 2019 World Health Summit in Berlin, Marie-Josée Hébert, vice-rector of research, discovery, creation and innovation at the University of Montreal, highlighted how far behind the healthcare sector is when it comes to the adoption of digital innovation, compared with other industries such as autonomous vehicles and energy. But, during a panel discussion on digital technology, she also flagged the opportunity developing countries have to leapfrog others that are struggling to update legacy systems. “We don’t have a decade in front of us,” she said. “We need to make sure that not only do we prepare, but we’re ready to start running … [So that] we will be [able] to change the rules of the game as we go, based on outcomes, based on data and reassessment of what we’re doing collectively, together.”

Source: The Guardian

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