Be he@lthy, be mobile: fact pack

fact pacK What this fact pack is for This fact pack gives a broad overview of the Be He@lthy, Be Mobile initiative and how it fits into the 2030 Sustainable Development agenda WHO/NMH/PND/18.10 © World Health Organization and International Telecommunication Union, 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. Contents 1. NCDs: a global challenge 5 2. The rise of the mobile phone 13 3. NCDs and digital health at the UN 23 4. Be He@lthy Be Mobile 33 5. BHBM pillar one: handbooks 47 6. BHBM pillar two: countries 67 7. BHBM pillar three: partnerships 93 8. BHBM programme results 103 9. BHBM programme innovations 111 4 SeCtion one nCDS: a global Challenge 5 1. noncommunicable diseases: a global challenge 6 SeCtion one Noncommunicable diseases (NCDs) and their risk factors Risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol N on co m m un ic ab le di se as es Heart disease and stroke ✓ ✓ ✓ ✓ Diabetes ✓ ✓ ✓ ✓ Cancer ✓ ✓ ✓ ✓ Chronic lung disease ✓ nCDS: a global Challenge 7 • NCDs cause more deaths than all other causes combined • NCD deaths are projected to increase from 38 million in 2012 to 52 million by 2030 • Over 80% of NCD deaths happen in developing countries Source: WHO, Global status report on noncommunicable diseases 2014. Probability of dying from the four main noncommuni- cable diseases between the ages of 30 and 70 years, comparable estimates, 2012. WHO 2014, All rights reserved. Data Source: World Health Organization Map Production: Health Statistics and Information Systems (HSI) World Health Organization 0 850 1 ’700 3 ’400 kilometers The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Probability of dying from four main NCDs* (%) * Cardiovascular diseases, cancer, chronic respiratory diseases and diabetes <15 15–19 20–24 25 Data not available Not applicable 8 SeCtion one 9 global targets to be attained by 2025 A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases A 30% relative reduction in prevalence of current tobacco use Halt the rise in diabetes and obesity A 30% relative reduction in mean population intake of salt/sodium At least a 10% relative reduction in the harmful use of alcohol nCDS: a global Challenge 9 A 10% relative reduction in prevalence of insufficient physical activity An 80% availability of the affordable basic technologies and essential medicines, incl. generics, required to treat NCDs A 25% relative reduction in prevalence of raised blood pressure or contain the prevalence of raised blood pressure At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes 10 SeCtion one Cost of inaction US$ 7t The cumulative lost output in developing countries associated with NCDs between 2011-2025 Cost of action US$ 170b The overall cost for all low and middle income countries to scale up action by implementing a set of “best buy” interventions between 2011 and 2025, identified as priority actions by WHO Reports are available at www.who.int/ncd nCDS: a global Challenge 11 nCDs at the Un: 2011-2018 • For the second time in United Nations history, the UN hosted a high-level summit on a health issue • NCDs were acknowledged as an international health priority • Call for innovation and public-private partnerships 12 SeCtion tWo the riSe of the mobile phone 13 2. the rise of the mobile phone 14 SeCtion tWo raising your voice: 2002 There are over a billion mobile subscriptions, passing fixed-line users. 1978 First commercial cellular mobile services established. 1961 85 years later, fixed-line subscription reach 100 million. 1876 Alexander Graham Bell holds the first two-way telephone conversation. The number of mobile subscriptions will soon overtake the world’s population Fixed-line subscriptions Mobile subscriptions the riSe of the mobile phone 15 the development and progress of the telephone 16 SeCtion tWo • >7 billion mobile subscriptions globally • In 2015, 95% of the world had mobile network coverage the riSe of the mobile phone 17 What is mhealth? “Medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices” (Global Observatory for eHealth, 2011) 18 SeCtion tWo What is mhealth? 1. Client education & behaviour change communication (BCC). 2. Sensors & point-of-care diagnostics 3. Registries / vital events tracking 4. Data collection and reporting 5. Electronic health records 6. Electronic decision support Information, protocols, algorithms, checklists 7. Provider-to-provider communication User groups, consultation 8. Provider workplanning & scheduling 9. Provider training & education 10. Human resource management 11. Supply chain management 12. Financial transactions & incentives the riSe of the mobile phone 19 Why mhealth? Mobile phone subscriptions versus population: 7.194 billion subscriptions vs 7.5 billion people 20 SeCtion tWo Why mhealth? More people have access to mobile phone than clean water or toothbrushes the riSe of the mobile phone 21 Advances in mobile phone and wearable devices means we can record and use our own data for health and behaviour change 22 SeCtion three nCDS anD Digital health at the Un 23 3. nCDs and digital health at the United nations 24 SeCtion three The SDGs represent an integrated set of goals that emphasizes cross-sectoral development. These SDGs are important for all UN agencies and determine a number of specific targets for each overall goal. nCDS anD Digital health at the Un 25 the changing face of global health Previous focus of global health – Communicable diseases – Vertical programs – Disease management Post-2015: the changing agenda – Move from vertical to comprehensive programs (holistic health) – Universal health coverage – Disease prevention, especially noncommunicable diseases 26 SeCtion three mhealth and the Sustainable Development goals Mobile technologies have the potential to play an important role in advancing universal health coverage and are well-positioned to contribute to the achievement of many of the Sustainable Development Goals (SDGs) nCDS anD Digital health at the Un 27 mHealth to support NCDs (SDG 3.4), Universal Health Coverage (3.8) and tobacco control (3a) through: • Behaviour change communication • Data collection • Health worker training • Reminders • Empowering women 28 SeCtion three Be He@lthy, Be Mobile is supporting SDG 9 by: • Encouraging ministries of health and technology to work together to deliver health services using ICT infrastructure • Fostering national innovation by supporting technology development, research and innovation in developing countries (SDG 9.b) nCDS anD Digital health at the Un 29 Be He@lthy, Be Mobile is supporting SDG 11 by: • Supporting mHealth programmes at the individual level, municipal level, and the national level 30 SeCtion three Be He@lthy, Be Mobile is promoting partnerships for sustainable development through: • A multisectoral partnership models for mHealth (SDG 17.17) • Horizontal collaboration between countries to share knowledge and expertise (SDG 17.6) nCDS anD Digital health at the Un 31 mhealth and nCDs at Who • WHO resolutions have recognized the centrality of NCDS and digital health to the core work of the organization • WHO declarations on NCDs and digital health from 2011-2018 include: – Resolution WHA 58.28 – Resolution WHA 64.11 – Resolution A/RES/66/2 – Resolution EB 139/8 – Resolution WHA 66.24 – Draft resolution for WHA 71 EXECUTIVE BOARD EB139/8 139th session 27 May 2016 Provisional agenda item 6.6 mHealth: use of mobile wireless technologies for public health Report by the Secretariat 1. Mobile technologies are becoming an important resource for health services delivery and public health due to their ease of use, broad reach and wide acceptance. According to a report prepared by ITU in 2015, there are more than 7 billion mobile telephone subscriptions across the world, over 70% of which are in low- or middle- income countries. In many places, people are more likely to have access to a mobile telephone than to clean water, a bank account or electricity.1 2. Mobile technologies have the potential to revolutionize how populations interact with national health services. Mobile wireless technologies for public health, referred to as “mHealth”, have been shown to increase access to health information, services and skills, as well as promote positive changes in health behaviours to prevent the onset of acute and chronic diseases. In order to realize these gains, Member States are seeking to identify standardized approaches for applying mHealth in health systems and services. 3. An increasing proportion of the population is accessing health information and services through mobile telephones, and a vast array of mobile-based solutions – from SMS to complex “smartphone” applications – have been developed to improve health access, knowledge and behaviours across a range of contexts and target groups.2 4. In spite of the potentially wide applicability of mHealth strategies and solutions to address the diversity of patients’ and, populations’ needs, however, Governments have found it challenging to assess, scale up, and integrate mHealth solutions. There are a number of contributing factors, including: • Multiplicity of pilot projects with no clear plan or process for scale; • Lack of interconnectedness between individual applications and of integration with existing national eHealth strategies and health information architectures; 1 The World Bank’s publication, Information and communications for development: maximizing mobile, is available at: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTINFORMATIONANDCOMMUNICATIONANDTECHNOL OGIES/0,,contentMDK:23242711~pagePK:210058~piPK:210062~theSitePK:282823,00.html (accessed 20 May 2016). 2 The Economist article, “Things are looking app”, 12 March 2016, see http://www.economist.com/news/business/ 21694523-mobile-health-apps-are-becoming-more-capable-and-potentially-rather-useful-things-are-looking (accessed 11 May 2016). EB139/8 3 7. For more than a decade, WHO has recognized the value that information and communication technologies bring to health systems and services. Evidence of the priority placed on such technologies is seen in the many resolutions on eHealth adopted by the World Health Assembly and by the Regional Committees.1 8. The WHO Global Observatory for eHealth survey of Member States in 2015 documented the surge in adoption of eHealth in countries. Today there are 121 countries that have national eHealth strategies, representing the beginning of a shift from an unsustainable project-based approach towards a systematic, integrated approach designed for cost-effective investment and alignment of partners.2 In this context, there is potential for mHealth programmes to become more systematically implemented, with increasing interest in sharing lessons learned and adopting enabling policies. 9. In collaboration with ITU, the Secretariat is working to raise awareness, record trends, build capacity, establish guidance, and generate and document evidence on eHealth, including mHealth, as a tool to promote person-centred, integrat d service delivery. 10. Significant technical engag ment by th Secretariat towa ds the development and implementation of mHealth programmes, include: • the joint initiative with ITU “Be He@lthy Be Mobile” for the prevention and management of noncommunicable diseases; • the development of uida ce for mHealth applications in the area of reproductive health through the mHealth Technical and Evidence Review Group for reproductive, maternal and child health; • building on digital solutions to help tuberculosis patients. 11. New priorities for WHO in the area of mHealth include: • to support and strengthen ongoing efforts to build evidence-based guidance on the use of mHealth in order to advance integrated person-centred health services and universal health coverage; • to provide guidance on mHealth adoption, management and evaluation in order to aid good governance and investment decisions. These could include guidance to inform the development of national programmes and strategies, and the development of standard operating procedures; • to work with Member States and partners to build platforms for sharing evidence, experience and good practices in mHealth implementation as a way to achieving the Sustainable 1 Relevant resolutions include resolution WHA58.28 on eHealth (2005), resolution WHA66.24 on eHealth standardization and interoperability (2013), and various resolutions of the Regional Committees, including resolution EM/RC53/R.10 (2006), resolution AFR/RC56/R8 (2006), resolution AFR/RC60/R3(2010), resolution CD51.R5 (2011), and resolution AFR/RC63/R5 (2013). 2 For more information, see the Global Observatory for eHealth website, at http://www.who.int/goe/policies/en (accessed 20 May 2016). 32 SeCtion foUr be he@lthy be mobile 33 4. be he@lthy, be mobile 34 SeCtion foUr mhealth challenges • Suffering from “pilotitis” – many small-scale mHealth pilot and research studies • Programs not designed for sustainability or SCALE • Leads to fragmented evidence base be he@lthy be mobile 35 • Be He@lthy, Be Mobile was created in 2012 to address these challenges and opportunities and help countries scale up national mHealth programs for NCD prevention and management 36 SeCtion foUr bhbm objectives Mission: Save lives and improve the world’s health through digital. 1. Help committed countries build, scale, sustain digital health programmes. 2. Develop content that works 3. Enter into meaningful partnerships 4. Explore and expand innovations be he@lthy be mobile 37 Who mission “The attainment by all peoples of the highest possible level of health.” Who Strategic priorities • Health coverage – 1 billion more people covered • Health emergencies – 1 billion more people safe • Health priorities – 1 billion lives improved bhbm contribution to strategic priorities Digital platforms, digital content, digital programmes to reach these 3 billion people 38 SeCtion foUr our impact is more than just numbers ŝŐŝƚĂůWƌŽŐƌĂŵŵĞĨŽƌEƐ ŝŐŝƚĂůƉůĂƚĨŽƌŵƐ ĨŽƌ EƐ ,D ,ĂŶĚŬƐ ΘŽŶƚĞŶƚ KƵƌŝŵƉĂĐƚŝƐŵŽƌĞƚŚĂŶũƵƐƚŶƵŵďĞƌƐ džĂŵƉůĞ͗ĞƌǀŝĐĂůĂŶĐĞƌƐĐƌĞĞŶŝŶŐƐ͍ WƌŽŐƌĂŵ WůĂŶŶŝŶŐ dĞĐŚŶŽůŽŐLJ ^ŽůƵƚŝŽŶƐ ŝŐŝƚĂů,ĞĂůƚŚ EĂƚŝŽŶĂů ,ĞĂůƚŚ EĂƚŝŽŶĂůEƉƌĞǀĞŶƚŝŽŶ ΘŵĂŶĂŐĞŵĞŶƚƐƵƉƉŽƌƚ ,ĞĂůƚŚƐLJƐƚĞŵƌĞŝŶĨŽƌĐĞĚ ĂŶĚƐƚƌĞŶŐƚŚĞŶĞĚ ,ĞĂůƚŚ ^LJƐƚĞŵ ,ĂƉƉLJĂŶĚŚĞĂůƚŚLJ ĐŝƚŝnjĞŶƐ’ ůŝǀĞƐ ƐĂǀĞĚ /ŶĚŝǀŝĚƵĂů ĐŝƚŝnjĞŶƐ Country’s ĐŽŶŽŵLJ /ŵƉƌŽǀĞĚ 'WŽĨĐŽƵŶƚƌLJ be he@lthy be mobile 39 ŝŐŝƚĂůWƌŽŐƌĂŵŵĞĨŽƌEƐ ŝŐŝƚĂůƉůĂƚĨŽƌŵƐ ĨŽƌ EƐ ,D ,ĂŶĚŬƐ ΘŽŶƚĞŶƚ KƵƌŝŵƉĂĐƚŝƐŵŽƌĞƚŚĂŶũƵƐƚŶƵŵďĞƌƐ džĂŵƉůĞ͗ĞƌǀŝĐĂůĂŶĐĞƌƐĐƌĞĞŶŝŶŐƐ͍ WƌŽŐƌĂŵ WůĂŶŶŝŶŐ dĞĐŚŶŽůŽŐLJ ^ŽůƵƚŝŽŶƐ ŝŐŝƚĂů,ĞĂůƚŚ EĂƚŝŽŶĂů ,ĞĂůƚŚ EĂƚŝŽŶĂůEƉƌĞǀĞŶƚŝŽŶ ΘŵĂŶĂŐĞŵĞŶƚƐƵƉƉŽƌƚ ,ĞĂůƚŚƐLJƐƚĞŵƌĞŝŶĨŽƌĐĞĚ ĂŶĚƐƚƌĞŶŐƚŚĞŶĞĚ ,ĞĂůƚŚ ^LJƐƚĞŵ ,ĂƉƉLJĂŶĚŚĞĂůƚŚLJ ĐŝƚŝnjĞŶƐ’ ůŝǀĞƐ ƐĂǀĞĚ /ŶĚŝǀŝĚƵĂů ĐŝƚŝnjĞŶƐ Country’s ĐŽŶŽŵLJ /ŵƉƌŽǀĞĚ 'WŽĨĐŽƵŶƚƌLJ ŝŐŝƚĂůWƌŽŐƌĂŵŵĞĨŽƌEƐ ŝŐŝƚĂůƉůĂƚĨŽƌŵƐ ĨŽƌ EƐ ,D ,ĂŶĚď ŽŬƐ ΘŽŶƚĞŶƚ KƵƌŝ ƉĂĐƚŝƐ ŽƌĞƚŚĂŶũƵƐƚŶƵ ďĞƌƐ džĂŵƉůĞ͗ĞƌǀŝĐĂůĂŶĐĞƌƐĐƌ ĞŶŝŶŐƐ͍ WƌŽŐƌĂŵ WůĂ ŶŝŶŐ dĞĐŚŶŽůŽŐLJ ^ŽůƵƚŝŽŶƐ ŝŐŝƚĂů,ĞĂůƚŚ EĂƚŝŽŶĂů ,ĞĂůƚŚ EĂƚŝŽŶĂůEƉƌĞǀĞŶƚŝŽŶ ΘŵĂŶĂŐĞŵĞŶƚƐƵ ƉŽƌƚ ,ĞĂůƚŚƐLJƐƚĞŵƌĞŝŶĨŽƌĐĞĚ ĂŶĚƐƚƌĞŶŐƚŚĞŶĞĚ ,ĞĂůƚŚ ^LJƐƚĞŵ ,Ă ƉLJĂŶĚŚĞĂůƚŚLJ ĐŝƚŝnjĞŶƐ’ ůŝǀĞƐ ƐĂǀĞĚ /ŶĚŝǀŝĚƵĂů ĐŝƚŝnjĞŶƐ Country’s ĐŽŶŽŵLJ /ŵƉƌŽǀĞĚ 'WŽĨĐŽƵŶƚƌLJ 40 SeCtion foUr • Joint UN program between WHO and ITU • Looks at SCALE: institutionalising mHealth tools • Inter-UN, multisectoral structure be he@lthy be mobile 41 • Builds country capacity for innovation management in mHealth and digital health care • Develops validated content 42 SeCtion foUr 2013 – 2016 Be He@lthy, Be Mobile Programme • Develop best practices for mHealth at scale in 9 countries • WHO-ITU build & trial technical guidance to be shared globally • Cross-sectoral partnership model • Sustainability models in countries DEVELOP ‘TOOLKITS’RESEARCH INTERVENTIONS SCALE OR BUILD CAPACITY IN COUNTRY be he@lthy be mobile 43 2017 – 2020 • Share experience quickly through knowledge and innovation hubs • Explore apps, wearables for NCDs • Explore cities and workplaces for NCDs EVALUATE & REFINE KNOWLEDGE INSTITUTIONALISATION, KNOWLEDGE SHARING 44 SeCtion foUr the three pillars of be he@lthy, be mobile 1. Handbook development be he@lthy be mobile 45 3. Partnerships 2. Country implementation 46 SeCtion five bhbm pillar one: hanDbookS 47 5. pillar one: handbook Development 48 SeCtion five The end-user is the starting point in the handbook development process Be He@lthy, Be Mobile has borrowed from the tech industry, implementing an innovative process is which end-user needs, limitations and context are given extensive attention at each stage of the product- development process. bhbm pillar one: hanDbookS 49 What is an mhealth handbook? Be He@lthy, Be Mobile mHealth handbooks: • Present all information necessary to implement an mHealth program in the form of ready-to-use options • Are developed for each Be He@lthy, Be Mobile intervention by an informal expert group in collaboration with WHO, ITU, and other relevant stakeholders • Are based on the best available evidence from the literature and experience 50 SeCtion five the evidence base: bhbm handbook foundation • WHO has reviewed numerous studies and clinical trials where mHealth has been used successfully in the prevention and management of NCDs. • The results of this systematic review of evidence are the basis for the BHBM handbooks. bhbm pillar one: hanDbookS 51 Steps in designing a text messaging intervention Conduct formative research for insights into target audience and target health behaviours Design the text message programme • Review functional outcomes and incorporate country- specific findings from needs assessment (list examples) • Review and adapt communication objectives (such as beliefs, attitudes, knowledge) and behavioural techniques (such as actions) • Review and adapt the framework or algorithm for the programme (timing and frequency of messages) • Adapt the message library Pre-test the text messaging programme concept and messages Revise the text message programme STEP 1 STEP 2 STEP 3 STEP 4 52 SeCtion five mhealth handbook development process Each Handbook is tailored for country use during national workshops, to suit the specific needs of each country. Workshop / expert consultations Drafting Group Internal, external and Partners consultation 1 2 Reviews and updates bhbm pillar one: hanDbookS 53 Informal expert group and WHO/ITU expert review Executive Clearance and Publishing 3 4 54 SeCtion five the 5 core handbook content areas Handbook annexes also include content libraries and algorithms, templates, literature, and additional resources FIVE AREAS OF THE mAGEING PROGRAMM Operations management Content development and adaptation 1 2 3 bhbm pillar one: hanDbookS 55 mAGEING PROGRAMME Promotion and recruitment Technology specifications Monitoring and evaluation 4 5 56 SeCtion five The handbook content is technology agnostic and can be delivered via numerous platforms ALGORITHMS ALGORITHMS ALGORITHMS bhbm pillar one: hanDbookS 57 mhealth handbooks mDiabetes mTobacco Cessation mCervical Cancer mTB-Tobacco mBreatheFreely mAgeing mHypertension mActive mSmartLife 58 SeCtion five mHealth handbooks by type of prevention Prevention Type Primary (Wellness) Secondary (Diagnostics) Tertiary (self-care) What is it? Primary prevention avoids the development of disease Secondary prevention activities are aimed at early disease detection and treatment Tertiary prevention reduces the negative impact of an already established disease Key drivers collect data, identify patients, increase awareness, calculate risk, effective promotion, improve enrolment and change Stratify risk, target at risk groups, change attitudes, increase uptake and streamline follow-up Help patients take charge of managing their condi- tion through improved un- derstanding, recording/ monitoring, adherence to treatment, sharing of information Be He@lthy Be Mobile handbooks mTobacco- Cessation mDiabetes mSmartLife mActive mHyper- tension mCervical Cancer mDiabetes mHyper- tension mBreathe- Freely mDiabetes mTB-Tobacco mAgeing mBreathe- Freely bhbm pillar one: hanDbookS 59 Country implementation of a handbook: a learning cycle 1. Handbook developed 2. Country requests 6. Country shares results 3. Country adapts 5. Country implements 4. Experts review 60 SeCtion five mhealth for tobacco Cessation • • • • bhbm pillar one: hanDbookS 61 • • 62 SeCtion five mhealth for Diabetes • • bhbm pillar one: hanDbookS 63 64 SeCtion five Digital Service platform for hypertension bhbm pillar one: hanDbookS 65 66 SeCtion Six bhbm pillar tWo: CoUntrieS 67 6. pillar two: Countries 68 SeCtion Six be he@lthy be mobile programmes 2012-2018 bhbm pillar tWo: CoUntrieS 69 Be He@lthy Be Mobile is currently working in 10 countries, and has received requests for support from more than 90 more… • Burkina-Faso • Costa Rica • Egypt • India • Norway • Philippines • Senegal • Tunisia • United Kingdom • Zambia 70 SeCtion Six Country Selected mHealth programme and achievements India mTobaccoCessation has ~2.1 million users as of Q1, 2018. Full scale program evaluation (May 2017) showed 6 month quit rate at ~ 7%. Program to introduce new languages and IVRS. MoH added mDiabetes program within 6 months of launch of the mCessation program. Will introduce mAging and mTB/ Tobacco program in 2018. Philippines Launch of mTobaccoCessation and tobacco quitline took place in June 2017. Senegal mRamadan 2017 had ~ 117,834 diabetic patients and ~5000 health care providers. The program has consistently seen an increase in subscriber base since its launch in 2014. Results from biometric evaluation indicate that SMSs have positively influenced control of diabetes in the intervention group. Zambia mCervicalCancer national program launched in October 2016 by the First Lady. 600,000 clients received text messages on cervical cancer on the launch day. Since Feb 2017, SMS have been sent to 500,000 men and women in Lusaka province. Program being developed as a continumm of care model for cervical cancer. Egypt mRamadan program (April 2016) reached out to to 50,000 people with diabetes. 2017 edition reached out to 180,000 diabetics. mTB-Tobacco program to be launched in 2018. bhbm pillar tWo: CoUntrieS 71 Costa Rica National platform set up and sharing experiences with regional counterparts Tunisia mTobaccoCessation service launched nationally in December, 2017 and has more than 65000 users as of Q1, 2018. mDiabetes under design. UK Looking at digital hypertension and the process for scaling digital health in government systems. Norway BHBM activities are linked to the national program on Continued Chronic Healthcare (CCH), a broad program including services for COPD. Four different COPD systems are being trialled to show remote support can be helpful. Burkina Faso Setting up a program for mTobaccoCessation and mCervicalCancer 72 SeCtion Six WHO, ITU, and informal expert group Group of ageing and mHealth experts to assist in drafting the handbook and advising on implementation National operations, content, promotion, technology, and monitoring and evaluation project leaders (subset of the TAG) Management of overall programme operations, including needs assessment, work- plan, budget and legal aspects Management of recruitment, communications, marketing and dissemination Management of technical aspects of programme development and implementation Management of the development and implementation of monitoring and evaluation plans Development and adaptation of the content of the intervention International mAgeing steering committee With representatives from the ministries of health and telecommunications and national and international representatives of WHO and ITU, to decide the overall direction and agreements National technical advisory group Government sectors (including health, telecommunications, business, media, treasury and planning) to set up the legal, technical and nancial framework for a sustainable programme. This group will network with a large group of potential partners such as the telecommunications and software industry, local telcoms and mobile network providers, non- governmental organizations, health professionals, academic and research organizations, health insurance groups, health service providers, civil society groups, opinion leaders, the media and others as appropriate Operations Content Promotion Monitoring and Evaluation Technology - example of a country mhealth management team bhbm pillar tWo: CoUntrieS 73 estimated timeline to implement an mhealth program Task Year 1 Year 2 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 TAG formation x Stakeholder engagement x Needs assessment x x Resource assessment x x Creation of target population database x Refinement of SMS content and delivery algorithm x mHealth program pilot testing x x Refinement of target population and intervention x Implementation of mHealth intervention x x x Monitoring and evaluation x x x 74 SeCtion Six logic model to evaluate an mhealth program PERSON CENTERED DOMAIN PROGRAM CENTERED DOMAIN Outgoing messages Incoming messages Surveys, Interviews INPUT Governance Policy data Resources (Finance, Human resources, ICT architecture Content development Outreach and promotion Data from “Person centered domain” INPUT Reach and registration Information about the user population Ease of understanding messages OUTPUT Coverage of intervention Intervention quality Interoperability OUTPUT Improved literacy/ knowledge/ outreach Behavior change Return on investment Technology performance OUTCOME Integration with health systems Improved health literacy Access to intervention OUTCOME Improved health outcome Improved use of resources IMPACT Improved health outcomes (SDG 3) Improved digital capacity (SDG 9) Efficiency & efficacy IMPACT bhbm pillar tWo: CoUntrieS 75 Case study: mtobacco Cessation in india • About Half of the tobacco users in India want to quit (GATS). • Limited face to face counselling facilities. • High interest and commitment in the under Digital India initiative. PERSON CENTERED DOMAIN PROGRAM CENTERED DOMAIN Outgoing messages Incoming messages Surveys, Interviews INPUT Governance Policy data Resources (Finance, Human resources, ICT architecture Content development Outreach and promotion Data from “Person centered domain” INPUT Reach and registration Information about the user population Ease of understanding messages OUTPUT Coverage of intervention Intervention quality Interoperability OUTPUT Improved literacy/ knowledge/ outreach Behavior change Return on investment Technology performance OUTCOME Integration with health systems Improved health literacy Access to intervention OUTCOME Improved health outcome Improved use of resources IMPACT Improved health outcomes (SDG 3) Improved digital capacity (SDG 9) Efficiency & efficacy IMPACT 76 SeCtion Six mtobacco Cessation in india: current status • National services launched in Jan 2016 as part of Prime Ministers Digital India Initiative • Innovative registration method • •Real time data dashboard • 2.2 Million users registered as of Nov. 2017 • The initiative is listed in the top 100 innovations of the Prime Minister's Office • mDiabetes launched within 6 months, using same platform • mAgeing and mTB-Tobacco expected in 2018 Full-scale program evaluation completed in May 2017 showed the effective 6 month quit rate at 7.2% (7.2 % of users who subscribed to the program were able to quit tobacco use at 6 months). bhbm pillar tWo: CoUntrieS 77 Example mTobacco Cessation messages Day 1 Welcome to the programme! Congratulations on your decision to quit smoking. To opt out at any time, text STOP to this phone number. Day 10 It has been 9 days since you quit smoking. Congratulations! How are you feeling today? Text back: GOOD, OK, or BAD Day 15 (1) You are on the right track! Quitting smoking is hard but stay confident. You can do this. Day 15 (2) Your kids can get sick from secondhand smoke. It sinks into lungs, eyes, and skin. Think again before you smoke. Trigger words e.g CRAVE We know how you are feeling. Think about what you are gaining and why you want to quit smoking. Stay focused. It will get easier. 78 SeCtion Six mtobacco Cessation user journey bhbm pillar tWo: CoUntrieS 79 80 SeCtion Six Case Study: mhealth in Senegal First phase • SMS messages sent during Ramadan to help diabetics manage their diabetes • High visibility and engagement at the population level Second phase • Three tracks: – Prevention (general population risk awareness) – Management for diabetics – Health care worker training bhbm pillar tWo: CoUntrieS 81 adapting mDiabetes for ebola • Senegal used mDiabetes partnerships and platform to encourage people to alert health authorities of anyone showing signs of a fever and bleeding by calling a toll-free number. Messages were shared ahead of large-scale public events, including football matches and rallies. • Senegal’s SMS Ebola campaign was rolled out at top speed thanks to the existing collaboration among stakeholders created by the mDiabetes platform. • As part of a massive public awareness effort, Senegal’s Ministry of Health sent 4 million SMS messages to the general public warning of the dangers of Ebola and how to prevent it 82 SeCtion Six Case Study: mDiabetes in egypt • Egypt used the mDiabetes handbook and experience from Senegal’s mDiabetes program to launch their initiative • The mDiabetes program in Egypt was launched in November, 2015 as a national application of the global mHealth initiative. BE HE@LTHY BE MOBILE A handbook on how to implement mDiabetesInternational Telecommunication Union Place des Nations CH-1211 Geneva 20 Switzerland website: mhealth4ncd.itu.int website: www.who.int e-mail: mhealth@itu.int Printed in Switzerland Geneva, 2016 Photo credit: Shutterstock ISBN: 978-92-61-21481-4 9 7 8 9 2 6 1 2 1 4 8 1 4 bhbm pillar tWo: CoUntrieS 83 Example mDiabetes messages Day 1 Walking is the best physical activity for good health. Day 2 Healthy diet, regular exercise and regular medication are the 3 main pillars of blood sugar control Day 3 Soft drinks contain lots of sugar; avoid them! Day 4 30 mins a day and 5 days in a week of walking or cycling or any activity which increase your breathing is healthy for a person Day 5 To find out more about any of these messages, visit [govt website] 84 SeCtion Six mDiabetes user journey (customised for user groups) bhbm pillar tWo: CoUntrieS 85 86 SeCtion Six Case Study: mCervical Cancer in Zambia • National launch by the First Lady of Zambia took place in October 2016 • The objective of the initial phase of mCervicalcancer program is to increase awareness on cervical cancer prevention via the use of SMS, thereby increasing demand and uptake of screening services among women in Zambia. bhbm pillar tWo: CoUntrieS 87 “Women should not die from highly preventable diseases such as cervical cancer due to lack of access to information. We are excited that Zambia will be launching the mCervicalCancer program, the first in the world. mCervicalCancer will enable women in hard to reach areas of Zambia have access to life-saving information…” Her Excellency, Mrs Esther Lungu, First Lady of the Republic of Zambia 88 SeCtion Six bhbm pillar tWo: CoUntrieS 89 Example mCervicalCancer messages Monday Health Fact! Did you know that Cervical Cancer is the most common cancer in Zambia? Women 25 years and above should come for screening at your nearest clinic. Thursday Health Fact! Human Papillomavirus is the main cause of early changes on the cervix that lead to cervical cancer if left untreated. Get screened! Sunday Health Fact! Healthy looking women may have changes on the womb without knowing. These changes are treatable. Get screened for Cervical Cancer! 90 SeCtion Six mCervicalCancer user journey Woman aged between 25-29 receives SMS inviting her to join the program She self-enrols by sending an SMS to the number The screening finds she has very early symptoms and treats her for them She is around for her children and her children’s children bhbm pillar tWo: CoUntrieS 91 She receives SMS every day for 2 weeks with different information on how a cervical cancer screening could save her life and inviting her to a free screening At least one of the SMS makes her think of her family and friends and how they need her She goes to a nearby clinic for screening 92 SeCtion Seven bhbm pillar three: partnerShipS 93 7. pillar three: partnerships 94 SeCtion Seven • Be He@lthy, Be Mobile’s multi-sectoral partnership approach is designed to engage partners whose skill sets match the needs of the global initiative or country-level work in technology, health, governance and innovations management. • By approaching mHealth from an ecosystems perspective, the aim is for programs to be more sustainable as they are less vulnerable to shifts in the broader mHealth landscape. bhbm pillar three: partnerShipS 95 the mhealth ecosystem New care provision New engagement platforms New funding models New sustainability frameworks PHARMA ELECTRONICS & DEVICES TELECOMS HEALTH INSURANCE OTHERS TECHNOLOGY HEALTH CARE PROVIDERS DIGITAL GENOMICS AI & DATA STARTUPS ACCELERATORS GLOBAL ECOMMERCE PLATFORMS EMPLOYEE ENGAGEMENT PLATFORMS GLOBAL EDUCATIONAL PLATFORMS CORPORATE WELLNESS PLATFORMS GLOBAL DEVELOPMENT FUNDS BANKING FOUNDATIONS DIGITAL HEALTH VC FUNDS GLOBAL DIGITAL CONSULTANCY SMART CITIES & INFRASTRUCT. 96 SeCtion Seven Private Sector: Telecoms, Insurance, Pharma, Wellness, IT Government NGOs , Civil Society, Philanthropies Academia UN •Content •Communication & advocacy • Best practices • Knowledge •Convening •Policies •Funding •Communication & promotion •Governance •Policy & strategy •Technology •M&E •Funding •Intellectual property •Technology •Recruitment •Marketing • Knowledge •Running programmes • Knowledge •Content Be He@lthy, Be Mobile is a unique initiative in that it adopts a multi-sector partnership structure and engages country partners and governments to maximize success. bhbm pillar three: partnerShipS 97 Private Sector Country governments NGOs, Civil Society, Academia, Philanthropies be he@lthy be mobile partners 98 SeCtion Seven Knowledge and data sharing Funding support Public relations, communications and advocacy Country-specific support UN Private Sector: Telecoms, Insurance, Pharma, Wellness, IT Why partners are so important bhbm pillar three: partnerShipS 99 Co-creation of new tools and programs Provision of products and services Global advocacy and leadership Technical Expertise Government NGOs , Civil Society, Philanthropies Academia 100 SeCtion Seven bhbm is an opportunity for learning and innovation • Egypt is learning from Senegal • Zambia is utilizing existing screening capacity • India is adapting content and adding services on their national digital platform • Senegal used their infrastructure and network with telecoms to send messages to rural areas during Ebola crisis • BHBM informal expert groups and partners are learning from country experiences bhbm pillar three: partnerShipS 101 2015 Global Consultation on Lessons Learned 102 SeCtion eight bhbm programme reSUltS 103 8. be he@lthy, be mobile programme results 104 SeCtion eight phase 1 achievements (2013-2016) • Nomination for a sustainable business award (May 2015) • WHO DG Award for Excellence (March 2016) • Programmes in 10 countries • 3 toolkits published (mTobaccoCessation, mDiabetes, mCervicalCancer) and 4 under development • Partnerships/collaborations with 10 countries and over 18 international organizations bhbm programme reSUltS 105 106 SeCtion eight be he@lthy, be mobile 2017-2018 country results INDIA, mTobacco Cessation: Effective 6 month quit rate ~ 7%* *respondents who after 6 months of being enrolled in the program reported that they did not use tobacco in the last 30 days and had read the mCessation messages INDIA, mDiabetes: Full scale evaluation of the program indicated that mobile technology has the potential to positively change behaviour in the context of diabetes, and serve as an enabler to reach a large number of people in a short time with minimum effort and cost bhbm programme reSUltS 107 ZAMBIA, mCervical Cancer: ~ 6% increase in first time screens* *attributable to the mCervical Cancer program; preliminary data collated from 12 out of 19 clinics in Lusaka province between the period of Feb- July 2017 SeNeGAL, mDiabetes: Results of a biometric evaluation indicate that sending SMS was associated with an improvement in glycaemic control in people with type 2 diabetes 108 SeCtion eight BMJ Innovations special edition on digital health and innovation • First international interdisciplinary journal focused on innovations • BHBM special issue on digital health and innovation, including country results • Publication date in mid 2018 bhbm programme reSUltS 109 Staying in touch: monthly postcards 110 SeCtion nine bhbm programme innovationS 111 9. be he@lthy, be mobile programme innovations 112 SeCtion nine talking book • Partnership between Literacy Bridge BHBM, ARM • Provides health messaging orally • Funded for pilot testing in Gabon Features: • Speaker for group listening • Speakers the local language • Updated and monitored over USB • Mic for user feedback • Embossed for use in the dark or when blind bhbm programme innovationS 113 robust tablet for health care workers in lmiCs • Partnership between WHO, DFID, ARM • Currently in development 114 SeCtion nine mhealth knowledge & innovation hub (2017-2020) Objective of hub • Scale-up mHealth services • Compile best practices • Focus innovation around key needs and gaps Structure • Jointly managed by WHO, ITU & EC • Three-year project with: – Hub selection – Set-up – Scale-up • National and international experiences solicited bhbm programme innovationS 115 Core functions Operational research Train and educate Identify standards, regulatory and policy gaps Implementation support and consulting HUB 116 SeCtion nine mhealth knowledge and innovation hub – eU project • Four year project funded by the Horizon 2020 Program (2016-2017 Work Programme) – 1st March 2017 – 28th February 2021 • ITU and WHO are Partners bhbm programme innovationS 117 • Objectives: – Establish an EU mHealth Hub for collecting and disseminating research and experience relating to large-scale implementations of mHealth programs – Build capacity for the Hub to be able to support Member States in implementing national mHealth programs 118 SeCtion nine european Community ex- pected impact of the project 1.Creating evidence on health outcomes, quality of life and care efficiency gains in the NCD management by using mHealth solutions. 2.Enabling mHealth to be deployed in national and regional level health services and to deliver large- scale benefits, first of the selected entities, and later in the rest of Europe. 3.Becoming the focal point for expertise on mHealth in the EU and identifying and highlighting trends and gaps in policies, standards, regulations, etc. and best practices and barriers to the creation of consistent mHealth infrastructure and strategy. 4.Unique platform to support innovation in and up-scaling of mHealth by convening cross sector stakeholders (young entrepreneurs, start-ups, governments, technical officers etc.). 5.Creating synergies with the existing EU platforms of stakeholders such as eHealth network of Member States and also the EU EIP on Active and Healthy Ageing (requirement, scope, impact). bhbm programme innovationS 119 beyond the eU project • Use as a model for regional mHealth Hubs • Strengthen regional/local context for mHealth • Network of Hubs • Strengthen Be He@lthy Be Mobile outreach and knowledge base • Will have to balance local role and relationship to other regional mHealth stakeholders with relationship to network of Hubs and relationship with ITU and WHO • Avoid becoming another project and pilots operator 120 SeCtion nine “eHealth: Harnessing technology on the road towards universal health coverage … An example is the initiative Be He@lthy Be Mobile, which promotes the use of mobile technology to help Member States combat the growing burden of noncommunicable diseases” Carissa F. Etienne Director, Regional Office of the World Health Organization for the Americas, Washington, D.C., United States of America. bhbm programme innovationS 121 “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 • Former UNDP Administrator • 31 January 2013 • Harvard School Public Health• Boston, Massachusetts 122 SeCtion nine “I firmly believe that technology has a pivotal role to play in helping the world achieve Universal Health Coverage”—@DrTedros to #ITUWTDC. “WHO and ITU are successfully using eHealth to address non-communicable diseases and risk factors via their mobile phones”—@DrTedros @Broadband commission UNGA. Dr Tedros at the ITU WTDC and Broadband commission For more information, please contact: alipiazzaz@who.int or arnoldv@who.int