BLOG: Three Reasons for Harmonization in Digital Health

By Steve Ollis and Nadi Kaonga
BLOG: Three Reasons for Harmonization in Digital Health
A community health worker sits in the clinic and uploads results for patients via SMS technology Ngabu Clinic, Malawi, 2014 ©Schermbrucker

The field of digital health is at a crossroads. We know what interventions work, but are now left with the big two questions of: how do we scale those interventions, and how do we ensure they are sustainable?

Few digital health projects have “achieved scale,” but we can see what is possible from those that have. Examples such as MomConnect in South Africa and cStock in Malawi show us that we need to and can move away from “pilotitis” and take action to improve upon what exists and adapt successful innovations for the future. We have seen that such significant progress often hinges on one thing – harmonization. By this, we mean not only coordination across programs and existing work, but also collaboration and integration across technology systems, features, processes, and content.

Through the United Nations Commission on Life-Saving Commodities (“the Commission”), HealthEnabled, D-tree International, and the Diarrhea and Pneumonia Working Group worked together to identify a structured and routine way that governments and health implementing partners can address the challenges of scale and sustainability. The most difficult challenges include having the right type of leadership; understanding and identifying shared goals across key stakeholders and beneficiaries; and identifying, securing, and aligning the right type of resources.

With these top challenges in mind, we developed a framework for harmonization after conducting interviews with experts in digital health and child health, and analyzing the landscape of digital health initiatives supporting integrated community case management (m-iCCM) in Kenya, Malawi, Tanzania, and Uganda. Integrated Community Case Management (iCCM) is a strategy to extend case management of childhood illness beyond health facilities so that more children have access to lifesaving treatments. The iCCM package can differ based on particular contexts, but most commonly include diarrhea, pneumonia, and malaria for children under five years of age. While the framework focused on m-iCCM work, we developed it for application beyond digital health-supported child health initiatives. The framework was then validated by practitioners (representing government and implementing partners) and, separately, by researchers working on identifying areas of harmonization for national programs in sub-Saharan Africa.

The framework does not contain new information, but rather highlights clearly the key steps and considerations for how government, donors, and implementing partners can harmonize digital health interventions in a user-friendly format. Throughout the process of developing it, we came away with three key requirements for those seeking to harmonize in digital health:

1) Avoid re-inventing the wheel – leverage existing work. Far too often, digital health programs are duplicative. For example, sometimes you see that frontline health workers in one region have multiple mobile phones and are reporting the same information for different projects on unique applications each of those phones. There is no need for this duplication, especially when resources and time are scarce. We can, instead, use what works and build upon that knowledge to expand the existing work or use it in other settings. In addition, we can learn more readily from the challenges and successes of programs if we understand what is already taking place and what has been possible. This can be as simple as having open forums and discussions both remotely and in-person.

2) Adapt best practices from other health programs. In addition to avoiding replication, we should look for ways to avoid operating in siloes. Digital health programs may initially be designed for a particular health condition or area, but when thinking about scale, often innovations that work in one topic or content area can be adapted for others. Practitioners should consider and identify areas of overlap when conducting routine reviews of program content, technology systems, and service delivery across digital health implementations.

3) Increase transparency and knowledge sharing. If we take a more structured and routine approach to thinking about and taking steps towards the integration of systems, functions, features, processes, content and more, we can more readily identify mechanisms for scale-up and maintenance. In addition, we can improve upon what we have, coordinate resources, and share the lessons with others. At the foundation of all of these efforts is improving collaboration and increasing transparency. We must be more willing and active in sharing lessons and other information, as well as putting forward the effort needed for collaboration.

As we continue to think about scale and sustainability, harmonization should be at the forefront of the discussion. We hope this framework can inform not just harmonization across efforts in digital health, but also how practitioners across global development think about harmonization to ensure effectiveness and sustainability of their interventions. The framework can hopefully be used to take replicable actionable steps towards improving collaboration in, reach of, and scope of digital health for enhanced and sustained positive impact on lives.While it is not easy, such efforts can and will help us to tackle the challenges we face when it comes to achieving scale. Together, we can go further faster.


Steve Ollis is D-tree International’s Chief Operating Officer with over 20 years experience in management consulting, information technology and public health. Steve has worked extensively in Tanzania and has spent the last 6+ years designing, building and implementing digital health systems for frontline healthworkers in Africa and Asia.
Nadi Nina Kaonga, MHS MS, is currently serving as the interim deputy director for HealthEnabled. She has nearly a decade of experience in global health and has worked with organizations, including Columbia University, the United Nations Foundation, UNICEF and Merck for Mothers, on digital health strategies and implementations; she teaches for the Harvard Summer Program and is also completing her doctoral (MD) studies in clinical medicine. She enjoys working in her home country of Malawi and has extensive working experience in other countries throughout the African continent.

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