fighting the global health burden through new technology...
TRANSCRIPT
Fighting the global health burden through new
technology:
WHO-ITU joint Program on mHealth for NCDs
Sameer Pujari
World Health Organization HQ Geneva
Non-Communicable Diseases(NCDs) and their causes
Chronic
Respiratory Diseases
Cardiovascular Diseases
Diabetes
Cancer
Physical inactivity
Obesity
Unhealthy diets
Tobacco use
Harmful use of alcohol
Malnutrition
Other NCDs
The socio-economic burden of NCDs
US$ 170B
US$ 7T 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
is the cumulative lost output in developing countries associated with NCDs between 2011-2025
57 million total deaths in 2008 of which 36 million were due to NCDs
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
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%
There are a number of challenges with mHealth
Scattered pilots
Evidence Closed technology
Govt Ownership
Pilotitis
No evaluation/review
No integration of systems
Business model?
Expensive technology
Costs not analyzed
Political commitment
Donor interest/ funding
availability
NCD burden/ high burden of specific risk factor
Mobile phone penetration
What is needed
Pilots to health systems (toolkit) Evidence Standards and
Guidelines
Tackling the challenges
Evidence
Preven
tion
Enfo
rcemen
t
Treatmen
t
mSocialnetworking, mGaming
mIllicit
mCessation
mTraining (Health workforce
development)
mGeoMapping
mWellness m Agriculture
Guidelines development
mWhistleblowers
mAwareness
mDiabetes
mSmokeFree
mSurveillance mPhysicalActivity mTAPS
mDisease Management
Looking at evidence for NCDs (PREVENT, TREAT, ENFORCE)
Broad evidence in mHealth is increasing
• http://www.mhealthevidence.org/
• http://www.healthunbound.org/packaged/mevidence-hub
• http://www.ipihd.org/innovations/ipihd-innovators/ipihd-innovator-profiles-and-case-studies
• http://healthmarketinnovations.org/programs
Arogya in India targeted over a million people in a mass diabletes awareness programme
AWARENESS & BEHAVIOUR CHANGE FOR NCDS
• 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
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
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.
TREATMENT: mCessation, disease management
Diabetes Management: Proven clinical impact observed during early trials reported up to 1.9% A1c drop in participants
• 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
mSurveillance
EPIHANDY reduced data entry errors and improve cost-efficiency when compared with traditional paper surveys in Uganda
•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
Crowd Sourcing and Geo Tagging
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
ENFORCEMENT: mIllicit
• 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
PREVENTION: mTraining
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NCD Problem WHO ITU mHealth program on NCDs Supporting framework
Partnerships
Capacity building
Scaling challenge
Global Platform
Health systems
Evidence challenges
Provide…
To enable…
To overcome…
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
36 m deaths /
year
9 m premature
deaths / year
$7 tr health-care
costs & productivity losses 2011-
2025
In October 2012 we launched the WHO-ITU Joint Initiative on mHealth with clear objectives
Tackling the challenges
Encouraging Government ownership
– through a UN convening platform
There is changing political will and extreme interest…
“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
mHealth for NCDs Business case
GOOD BUYS
FOR GOVERNMENTS
Mobile health NCD control
•mHealth is a great mechanism to use the mobile infrastructure for out-reach and save significant funds in the health sector.
Tackling the challenges
Tools being developed
mHealth for NCDs Toolkit
Diabetic patient
Pre-diabetic individual
Self-registers for SMS disease management support (text code) or referred by doctor
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)
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.
The patient controls the disease
rather than the disease controlling the patient.
Receives an initial outreach SMS engaging them in the programme.
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, diabetic-free individual
mDiabetes
1. Smoker wants to quit but needs support. 2. Smoker self-enrols or is enrolled
by family/doctor.
Smoker is put into a message group based on criteria such as age, dependence, commitment to quit etc.
3. Smoker receives daily messages offering guidance on managing cravings, coping with withdrawal, etc.
5. Smoker receives gradually less messages as their tobacco-free time increases.
4. Smoker has code words to text if they need specific support at any moment.
CRAVE
6. After 6 months of support the smoker is no longer a smoker.
mCessation
Interventions
• We are also looking at
– mWellness
– mTraining
– mEnforcement
– mScreening etc…
M&E Impact assessment framework
WHO-ITU mHealth impact assessment model
Tackling the challenges
From Pilotitis to Health systems approach
Cross sectoral partnership model
•Best Practices
•Content
•Deployment strategy
•M&E
•Best Practices
•Content
•Technology
•Deployment strategy
•Policies
•M&E
•Best Practices
•Content
•Technology
•Deployment strategy
•Policies
•M&E
•Best Practices
•Content
•Technology
•Deployment strategy
•M&E Telecoms,
Insurance , Pharma,
Wellness, IT, Sporting
Industry, Other Private Sector
Government
NGOs and
Academia UN
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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
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
Associations Strategic partners
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Partners already signed on/late stage negotiations
Political commitment
Donor interest/ funding
availability
NCD burden/ high burden of specific risk factor
Mobile phone penetration
The step ahead…
From Pilots to health systems (toolkit) Evidence Standards
and Guidelines
Why should you join hands
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
Leadership benefits Play a LEADERSHIP role in a high-
profile 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
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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.
Main Value proposition
