There is growing consensus in the global health community about the potential of digital models and tech-enabled care to accelerate progress across the health-related Sustainable Development Goals (SDGs), including achieving universal health coverage and protecting communities from epidemics and pandemics.
Creating digital technologies that can serve as digital public goods (DPGs) is one way that the Johnson & Johnson Center for Health Worker Innovation supports global health equity efforts to provide quality, affordable and equitable care. Defined as “open-source software, open data, open AI models, open standards and open content that adhere to privacy and other applicable laws and best practices, do no harm, and help attain the SDGs,” digital public goods are designed to be adaptable in different countries and contexts to help address key health system challenges.
The promise of emerging technologies and the proliferation of organizations tackling health inequity challenges using tech-based solutions brings both opportunity and the increased risk of digital fragmentation. Historically, a lack of coordination in digital health initiatives have led to vertical or stand-alone technology solutions that, although well-intended, have resulted in information fragmentation and, consequently, poor delivery of services.
“Digital public goods are about tackling the fragmentation that exists within the health system,” says Sarah Mullane, Director, Health Technology for Johnson & Johnson Global Community Impact. “From the architecture to the code that created them, DPGs are designed to be picked up, translated and contextualized elsewhere. It’s really about considering the digital ecosystem and strengthening it over the long-term rather than seeking one-off solutions. Opening up the technology globally is really where the magic happens.”
Supporting the development of digital health initiatives in the hardest-to-reach areas
Medic’s Community Health Toolkit (CHT) is a digital public good that provides resources to help partners design and deploy digital tools for care teams with the support of an active community of collaborators. Digital health tools built with the CHT are supporting health workers across the world to deliver better, faster and more equitable healthcare. The Johnson & Johnson Foundation has enabled Medic to support 57 projects across Africa and Asia.
In Nepal, for example, health workers equipped with digital tools are providing better primary care for pregnant women—and local governments, seeing the value of the tools, are increasingly allocating resources toward expanding these digital health programs.
"After using Medic's tool in several districts, we realized the need to scale-up. This tool will help us build a health system that is accountable to the people. We from the Ministry facilitate an enabling ecosystem for mHealth, the local government allocates financial resources for implementation, and Medic provides the technology. These elements together form a successful partnership model with potential to overcome the challenges of mHealth implementation." - Shival Lal Sharma, Statistical Officer at Public Health Administration, Monitoring and Evaluation Division, Ministry of Health and Population.
The Medic-led mHealth program in Nepal has been scaling consistently year-over-year, and has achieved a 70/30 cost-sharing model, where local governments currently fund an average of 70% of programmatic costs and is steadily transitioning toward 100% government ownership.
In Côte d'Ivoire, Medic, in collaboration with Muso Health, leveraging open-source technology to create community health worker (CHW) supervisor tools for the Ministry of Health and increase efficiency and effectiveness of CHW's providing doorstep care in their respective communities. This app was built upon Medic’s collaboration with Muso in Mali, demonstrating that open-source tools in one context or country can be re-thought, re-tooled, and launched in a new context successfully.
The tools have been well received by CHWs and their supervisors.
"The application is very easy to use and serves as a guide on how to treat patients during home visits. When it is time to go on home visits, the application orients me to which household I should go to, based on the last time I visited a household or on a patient that may need to be monitored more frequently due to their illness." - Brigitte, CHW
"The application makes my work very straightforward because it allows me to schedule my visits and sort through documents related to supervision. The questionnaire and protocol are already laid out and easy to navigate. The training I completed on the use of the app was also extremely useful -- everything is detailed and this allows for efficient supervision." - Rostand, CHW Supervisor
As Côte d'Ivoire’s Ministry of Health explores expansion toward a national electronic community health information system, Medic and the CHT are primed to support this national health system revolution.
Using data science to empower health workers and improve global health outcomes
CHWs provide critical services and care around the world where other health infrastructure is often lacking. Through the use of digital health tools and mobile applications, millions of patient interactions are logged every year and yield large volumes of data that could potentially drive more effective national health policies, help CHWs optimize their care delivery, and improve program management and evaluation for better global health outcomes. Robust data and analysis are also critically needed to reveal systemic inequities that put certain populations disproportionately at risk. However, data collected at the front lines of care are still considered unreliable for data-driven decision making.
Support from the Johnson & Johnson Foundation was critical to the creation of DataKind’s Data Observation Toolkit (DOT), an open-source, community-informed tool capable of automated monitoring and detection of inconsistent or problematic data. DOT is highly configurable and can be used to monitor data in any relational database, making it amenable to scaling across platforms and domains. Through DataKind’s partnership with Medic, DOT integration is already available on the Community Health Toolkit, that is being used to support tens of thousands of CHWs across 16 countries, and is recognized as a digital public good.
“DataKind and Medic working together to optimize data, to figure out what's working for whom and when, under what circumstances, is a wonderful example of how we are able to support the development of digital public goods to support health workers and their patients,” adds Mullane.
Scaling up tech-enabled models for strong community-driven primary healthcare delivery ecosystems and resilient health workers
The E-Heza Data Solution from TIP Global Health is Rwanda’s first point-of-care digital data collection system designed to improve primary healthcare delivery by providing frontline health workers with immediate insights to help personalize information and care for families. This digital app designed by and for the frontline health worker can be used on a smartphone or tablet, and the data collected is automatically linked to the Ministry of Health database, providing timely and accurate data reports for better public health policy decision making.
E-Heza is registered as a digital public good and aims to facilitate high quality and efficient primary healthcare in a way that minimizes burnout of frontline health workers, promotes quality of care and maximizes engagement in care. The Johnson & Johnson Foundation has been supporting TIP Global Health’s efforts to develop the E-Heza model for effective primary care, including formative research to ensure that the health worker’s voice and the patient voice are embedded within the system evolution and development.
In response to a high demand for E-Heza across Sub-Saharan Africa, TIP Global Health is working with the Africa Africa Centres for Disease Control to establish criteria for prioritizing country expansion with the goal of reaching at least four countries by 2025.
Task shifting away from the health worker
Innovative use of digital models will be an essential enabling factor towards achieving health for all. At the Johnson & Johnson Center for Health Worker Innovation, we are working with partners to ensure that this enablement is sustainable and designed with the needs of those at the heart of care—health workers.
WHO estimates a projected shortfall of 10 million health workers by 2030, mostly in low- and lower-middle income countries, to achieve the SDG targets and other global health aspirations. We are committed to leveraging and scaling digital public goods that task shift away rather than toward health workers, extending the reach and capacity of the health workers we have to focus on where they can have the best and highest value.