Tackling NCDs digitally
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“Innovation is embedding invention in routine systems that give it reach and impact.”
– Prof. Marc Ventresca, University of Oxford
US$ 7THealthcare costs & productivity losses 2011-2025
"We should all work to meet targets to reduce NCDs."
9MPremature deaths / year
Origins
6.8 BillionMobile cellular subscriptions
Background
2012BHBM founded as a joint programme between two UN agencies in response to the UN High-Level Declaration on NCDs in 2011 and the need for greater action and collaboration.
The initiative works on scaling up mHealth, promoting government ownership of national programmes, and fostering intersectoral collaboration.
2015• 8 official partner countries and requests from over 40 others to join
• Global toolkits on various disease and program management areas prepared for publication in 2016
• Live programs in 2 countries and launches of at least 4 others expected in 2016
• Partnerships with a broad range of multilateral, academic and private sector partners
"We should all work to meet targets to reduce NCDs."
Be He@lthy Be Mobile
Joint UN program between WHO and ITU*
Looks at SCALE: institutionalising successful mHealth tools within national health systems
*Aims to help embed innovation management for mHealth and digital health care within countries, bridging the gap
between small-scale trial and national service
The innovation is in the HOW and not the WHAT
A scale-up approach to mHealth
RESEARCH INTERVENTIONS
DEVELOP ‘TOOLKITS’
INSTITUTIONALISATION, KNOWLEDGE SHARING
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mHealth
KNOWLEDGE &INNOVATION HUBS
2013 – 2016: Be Healthy Be Mobile Programme Develop best practice for mHealth at scale
WHO-ITU build & trial reusable tools to be shared globally
SCALE or BUILD CAPACITY
IN COUNTRY
EVALUATE &REFINE
KNOWLEDGE
Beyond 2016Scale mHealth globally in a meaningful way
Develop light touch service models
Key operational areas
1. Toolkit Development
2. Country implementation
3. Partnerships
Key operational areas
1. Toolkit Development
2. Country implementation
3. Partnerships
mHealth toolkits
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mHEALTH ENABLES PUBLIC HEALTH SERVICES TO
"We should all work to meet
targets to reduce NCDs."
mDiabetes
mCessation
mHypertension
mCervicalCancer
mAgeing
mTB/Tobacco
Toolkit formation
Workshop/ expert
consultations
Drafting Group
Informal expert group
review
Internal, external and
Partners consultation
Executive Clearance and
Publishing
Reviews and updates
Each PID is tailored for country use during national workshops, to suit the specific needs of each country
Awareness
mDiabetes
High-risk populationHigh-risk population Diabetic patientDiabetic patient
Prevention Treatment
Education Monitoring and disease management
Increase awareness
Aimed at pre-diabetics
Focus on lifestyle interventions
Encourage healthy diet
Increase exercise
Regular foot checking
Appointment reminders
Track vital statistics: blood glucose and insulin levels
Medication reminders
Provide educational facts about diabetes
Encourage management of diet and exercise
Use of mobile technology to increase self-management of disease and reduce costs for the patient
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Example: the mDiabetes process
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.
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
Diabetic patient
Pre-diabetic individual
Self-registers for SMS disease management support (text code) or referred by doctor
Receives an initial outreach SMS engaging them in the programme.
Example: the mCessation process
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.
6. After 6 months of support the smoker is no longer a smoker.
CRAVE
1. Smoker wants to quit but needs support. 2. Smoker self-enrols or is enrolled
by family/doctor.
Key operational areas
1. Technical Process
2. Country implementation
3. Partnerships
Country programmes
Country Achievement
India National launch January 2016 to all states
Philippines Launch of mobile health in 2-3 cities by end of 2016
Senegal Multiple national mDiabetes campaigns for prevention, treatment support and health worker training
Costa Rica National platform set up, leading regional interest in the technology (Mexico, Nicaragua, Panama)
Tunisia National platform launch January 2016
United Kingdom Foundations laid for an mHypertension component in nation-wide health promotion campaign (2016)
Norway National replication of the BHBM structure for mCOPD (2016)
Zambia mCervicalCancer under preparation for launch in 2016
Egypt mDiabetes
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Countries
Brunei Mexico
Costa Rica India
Moldova Mauritius
Norway Panama
Egypt Philippines
Russian Federation United Kingdom
Senegal Zambia
Suriname
Tunisia
Argentina
Bahrain
Barbados
Brazil
Bolivia
Bulgaria
Comoros
Estonia
Ethiopia
Germany
Honduras
Indonesia
Israel
Jordan
Mali
Malta
Mexico
Pacific Islands (Fiji, British Samoa, American Samoa)
Saudi Arabia
Sri Lanka
Spain
Thailand
Tonga
Turkmenistan
Turkey
UAE
Viet Nam
Countries that have sent an Official Request (16)
Countries that have expressed interest in joining the initiative (45+) without outreach
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mDiabetes Awareness for Ramadan in Senegal
• Several modules of SMS sent to 4 different groups about Diabetes
• High visibility and engagement at the population level
• Currently more than 50,000 participants are enrolled in the program
• Multi-sectoral, multi-stakeholders model
Second phase
• Three tracks:
i. Prevention (general population risk awareness)
ii. Management for diabetics
iii. Health care worker training
India
• National services launched
• Unique feature: Missed Call for registration
• Live dashboard
• 160,000+ registered in the first week
• Part of Digital India movement
• Funding from within MoHFW and MoICT committed for first 2 years
• Integrated M&E plan from the onset
20-06-2014 mHealth Scale-Up Proposal 19
Key operational areas
1. Technical Process
2. Country implementation
3. Partnerships
Partnerships: cross-sectoral model
THE PROGRAM IS UNIQUE IN THAT IT ADOPTS A MULTI-SECTOR PARTNERSHIP STRUCTURE AND ENGAGES IN COUNTRY PARTNERS AND GOVERNMENTS TO MAXIMIZE SUCCESS.
Telecoms, Insurance ,
Pharma, Wellness, IT, Sporting
Industry, Other Private Sector
Government
NGOs , Civil Society
Philanthropies
Academia
UN
• 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
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• Best Practices
• Content
• Technology
• Deployment strategy
• M&E
Recent partnership activity (Jan-September 2015)
Jan 2015: mHypertensionworkshop
Jan 2015: mHypertensionworkshop
Feb 2015: Sanofi joins;
Agreement with European Respiratory Society
Feb 2015: Sanofi joins;
Agreement with European Respiratory Society
March 2015: World Conference on Tobacco Or
Health (public health)
March 2015: World Conference on Tobacco Or
Health (public health)
April 2015: GCM coordinating mechanism; annual report launched
April 2015: GCM coordinating mechanism; annual report launched
May 2015: Nomination for Guardian award
on innovative partnerships
May 2015: Nomination for Guardian award
on innovative partnerships
December 2015: global consultation on mHealth,
Geneva
December 2015: global consultation on mHealth,
Geneva
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. EtienneDirector,
Regional Office of the
World Health Organization for the Americas,
Washington, D.C., United States of America.
“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