A Perspective on the TB Digital Landscape

Workshop on Digital Health Technologies for a World Free of TBJuly 24, 2018New Delhi, IndiaKaiser Shen | USAID/Washington

WHERE ARE WE?

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Projected TB incidence decline to target levels

Optimize current tools, pursue universal health coverage and social 

protection

Introduce new vaccine, new prophylaxis

Average ‐10%/year

‐5%/year

Current global trend: ‐2%/year

Average‐17%/year

• Only 1 in 10 MDR‐TB cases are successfully treated

• MDR‐TB is currently the largest share of AMR deaths

Unchecked, by 2050: • MDR‐TB will account for 75 million deaths• MDR‐TB will cost the world economy $17 trillionin lost growth

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MDR‐TB Burden: Public Health Crisis

*All Party Parliamentary Group on Global TB. The price of a pandemic: counting the cost of MDR‐TB; 2015

Barriers and Gaps in the Continuum

USG APPROACH

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A World Free of TB

Reduce TB incidence rate by 90% by 2035Reduce TB mortality rate by 95% by 2035

IMPACT

Long term outcomes

During 2015-2019: Reduce TB incidence rate by 25%

Maintain treatment success rate > 90%Successfully treat 13 million patients

Initiate treatment for 360,000 DR-TB patientsProvide ART for 100% of TB/HIV patients

Medium term

outcomes

Improved access to

high quality, TB services

Prevention of transmission and disease progression

Strengthened TB platforms

Accelerated research

Objectives

USG TB Strategy

MDRTB NAP target to initiate

additional 200,000 DR patients on treatment

• Comply with International Standards

• Support National Strategic Plans

• Rapidly introduce and scale up proven interventions and innovation

• Target the local epidemic with country-specific strategies

• Encourage inclusive and locally owned programs

• Support successful implementation of Global Fund grants

• Build sustainable national TB procurement systems

• Utilize clear and comprehensive Monitoring and Evaluation Plans

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USG TB Guiding Principles For Technical Interventions

• Bangladesh

– ConnecTB, mHealth app for DOT providers

• India

– Social Media leverage

– Operation OSHA Biometric (DIV)

• Indonesia

– Notification app for providers

– GxAlert

– e-TB manager

• Kenya

– KEHEALA USSD Technology (DIV)

• Global Development Lab

– Development Innovation Ventures (DIV)

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Examples of USAID-supported TB Digital Health Interventions

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TB patient pathway: digital health interventions

Estimated $130M+ spend in digital ICTs to support health over 4 years in:

*Figure does not include investments made through USAID country offices.

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USAID Global Health: Leveraging Digital Health

ProofofConceptPIloting

BuildOutofLargerSystemsandPrograms

NationalandRegionalScalingofSystemsandDigitally‐SupportedPrograms

NationalDigitalHealthStrategies&Platforms

2002‐2007 2007‐2012 2012‐2017 NOW

EvolutionofDigitalHealthInvestments

Digital health tools, systems, and data historically have been funded independently by different health verticals, creating data silos.

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Fragmentation of digital tools, systems, data

• Funding is independent (financial inefficiencies)

• Data is not comparable (impedes decision-making)

• Lifespan of solutions are based on lifespan of project (pilotitis)

Digital H

ealth Application

Digital H

ealth Application

Digital H

ealth Application

Digital H

ealth Application

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Explosion of mHealth pilots: Uganda example

Map of mHealth pilots in Uganda (Sean Blaschke, UNICEF Uganda, 2010)

The Rwandan MoH issues it’s first eHealth Strategy

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NATIONAL & REGIONAL PLANS

2006

2010

2016

The Ugandan MoH issues a moratorium on new ICT systems.

The Tanzanian MOH institutes a costed investment plan for digital health.

NOW The EAC develops a regional shared vision, roadmap and architecture.

WHERE ARE WE GOING?

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GLOBAL CONSENSUS

At the country level, cross-cutting digital health platforms should be interoperable and yet adaptable to local requirements and sovereigntyNational Academies of Science, Engineering, and Medicine, May 2017

As a first step toward national digital health implementation, leaders can develop a national digital health vision and strategy. Strong leadership and governance can prevent duplication of effort and harmonize standards for digital technology.

Broadband Commission Report on Digital Health, February 2017

Ecosystem collaboration is needed to address current fragmentation and create a holistic digital health model

GSMA – Scaling Digital Health in Developing Markets, June 2017

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VISION

Established country and regional collaborative processes led by government which yields national and regional plans, enterprise architecture, supported by a strong enabling environment, including, interoperability and use of global goods.

To overcome challenges of fragmentation and duplication of digital health systems around the world, greater coordination is needed, including among public and private funders. Recommendations include:

• First, that countries create and support the implementation of a digital health strategy reflecting priorities identified in the countries national health strategies;

• Second, financiers align their efforts on digital health with national digital health strategies. Where country-focused digital health strategies do not yet exist, their development should be prioritized;

• Third, that countries strengthen a digital health-enabling environmentincluding support for capacity building and governance with a focus on privacy, accessibility, use of data and data systems;

• Fourth, that investments align with a country’s progression along the digital health continuum--starting with moving from paper to digital, culminating with a country’s transition to independent management of digital health technologies; [...]

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USG Digital Health Position

Digital Investment Principles

http://digitalinvestmentprinciples.org/

http://digitalinvestmentprinciples.org/

• Growing foundational literature• U.S. government consensus position• WHO classification of Digital Health Interventions• WHO Digital Health Resolution• Digital Investment Principles

A Way Forward

● WHO Digital Health Resolution (May 2018)○ Calls for Member States to develop and

implement digital health strategies

○ Calls for WHO to develop its own digital health strategy, provide guidance/support

● Regional Digital Health Efforts (2018)○ Digital Regional East African Community Health

Initiative (Digital REACH)○ USAID Regional Action through Data

(RAD) mechanism

● Regional, peer-to-peer learning ○ AeHIN○ African Alliance 23

Trends: Global & regional

● LMIC Ministers of Health calling for sea change○ Calling for donors to cease investing in

duplicative and fragmented technologies○ Requesting technical assistance from

WHO-ITU, with support from donors● Countries developing national digital

health strategies○ Country-led strategies & investment plans○ Enterprise architecture and governance○ Foundational components of architecture

■ Health Metrics Network Framework■ OpenHIE Framework common guide

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Trends: Country

● Principles for Digital Development (2013)○ Cross-sector○ Nine areas of best practice ○ Derived from learning from common failures○ Speaks primarily to implementers○ 100+ endorsers including USAID, DFID,

NORAD● Donor Principles for Digital Investment (2018)

○ Specific to the global health sector○ A call to action laid out in ten recommendations○ A response to LMIC gov calls for donor reform○ Addresses donors in particular○ Endorsers include USAID, NORAD, BMGF,

BMZ25

Trends: Donor

When we have arrived at the question, the answer is already near.

-Ralph Waldo Emerson

HOW DO WE GET THERE TOGETHER?

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Acknowledgements

USAID/W- Center for Digital Development

Krissy CelentanoMerrick SchaeferAdele Waugaman