IntraHealth

Are We at the “End of the Beginning” for Global Digital Health? And What’s Next?

cbales — Wed, 29 Nov 2023 18:53:44 +0000

Are We at the “End of the Beginning” for Global Digital Health? And What’s Next?

, Deputy director of data science

, Chief digital health officer

cbales November 29, 2023

November 29, 2023 12:00 PM

After decades of sustained focus by the digital health community, global bodies like the WHO, UNICEF, and the World Bank, and many country governments have embraced digital transformation as a key driver for achieving universal health coverage. But that may just be the end of the beginning for global digital health—to enable digital transformation that impacts health outcomes, we still have major challenges to address:

The proliferation of innovative, but not interoperable, digital tools has arguably left eHealth in eChaos.
The global health workforce is facing a shortage of 10 million workers by 2030 and many in post are leaving due to systemic burnout.
The open source data systems we rely on to make data available for high value Artificial Intelligence (AI) use cases suffer from under-investment and weak business models.

What opportunities exist to better leverage data and what long-term investments should be made to enable high value data use cases? Read on to learn how we’re taking on these challenges and opportunities at IntraHealth.

Connect with us at the Global Digital Health Forum, December 4-7, to discuss how we can partner to achieve the future we want.

Answering the most impactful business questions often requires more than one database.

Let’s face it, a lot of reporting systems in global health are built for donor reporting or national government monitoring rather than improving local program implementation. One can argue this came about out of necessity as the development sector grew and regulatory control is essential. But now we have an opportunity to shift our perspective and re-use data to answer some of our most critical business questions.

IntraHealth implemented the USAID Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) program from 2018-2023. We had a seemingly simple question: how many lay workers needed to be employed and could we dynamically redistribute their workload to improve retention? Our data science team had to merge four siloed databases to answer this question: data on the total staff by cadre at health facilities (PEPFAR HRH inventory), percent of those positions filled to proxy for workload (iHRIS), retention data and GPS locations of facilities (DHIS2), and the size of the cohort (DATIM High Frequency Reporting). We determined that if each lay worker had 50 clients they would have enough time to engage with them, helping to promote their long-term retention. Mapping the actual ratios let us see where we could redistribute workload. Since a lot of engagement is via phone, we could redistribute client lists without having to physically move any staff.

Having an internal data science team at IntraHealth has reduced the lead time from good ideas to great results. We have refined our approaches through several projects since 2019; you can read about our lessons learned from applying machine learning to messy, real-world data in LMICs here.

Generative AI can help cope with software developer and health worker shortages.

The world is not only facing a shortage of health workers. There is also a shortage of FHIR-literate software developers in global digital health—we don’t have estimates but anecdotally it is a lot.

At IntraHealth we’re excited about the opportunity created by large language models and generative AI like ChatGPT to support and upskill health workers and software developers who can help build FHIR-compliant global goods software. And the data from other industries is backing it up.

Early studies are showing that ChatGPT-like support for college-educated professionals and developers can help in two ways. When college-educated professionals were given a writing task and randomly assigned to use ChatGPT or not, those who used ChatGPT improved the quality of their work and reduced the time spent on the task. Interestingly, those with lower baseline scores improved their scores more while the benefit for more skilled professionals was to reduce time on the task and maintain high quality. Similarly at GitHub, their AI-based CoPilot boosted productivity of software developers by 55%!

What could this look like in a busy, understaffed inpatient nursing ward? We know that turnover among nurses is high due to systemic burnout caused by understaffing and lack of support. What if ChatGPT-style interventions could be that mentor providing support and advice for a young nurse who finds themselves alone in the inpatient ward before they’re ready? If she feels supported, maybe she’ll stay.

Come check out our presentation at GDHF where we’ll present the results of using ChatGPT to iterate on our iHRIS software. Monday, December 4, 1:30-2:45 pm in the Oakley Conference Room at the Bethesda North Marriot in Bethesda, MD. Full GDHF agenda is here.

The foundation of any AI use case is good data.

We’ve all heard the saying “garbage in, garbage out” to make the point that the data going into an AI model impacts the utility of the results you get out. Imagine you have a program delivering HIV care to clients in Uganda and you want to use electronic medical record (EMR) data to predict which clients are at risk for interrupting treatment.

How should you deal with inevitable missing data? If values are missing, it could be because the visit got cut short and the data didn’t get entered or some other reason that could be correlated to the outcome of missing an appointment. Some machine learning algorithms will automatically impute data but if the data is not missing at random, you should model the missingness and use it in the analysis (e.g., feature engineering).
How often should you update the model in production? When the results of the model can be pushed back to the EMR, this could be as easy as running the model at the beginning of each week. However, as you intervene with clients to reduce interruptions in treatment and those clients’ results go back into the model each week, the model’s accuracy can drift. Let’s say your intervention is successful and all 25-year-old males that got your intervention are less likely to interrupt. Is a 25-year-old male in your dataset now less likely to interrupt, or is the model learning from your intervention and becoming less accurate about typical 25-year-old males?
Can you make AI work in a paper-based world? EMRs may not be available during the visit for clinicians to check on the status of a client at risk for interruption in treatment and intervene. Can you create a paper-based tool that curates the model output into an assessment so that clinicians can evaluate clients sitting in front of them and provide support? Palindrome has had success doing that in South Africa.
Who ensures that global good open source software powering EMRs and other necessary tools is maintained? The EMRs we’re talking about are often open source software that is maintained at a loss by the original developers and without sufficient investment in security and maintenance, open source software can pose significant security risks. How can we ensure better coordination in the open source software space with sustainable business models?

IntraHealth is among a small group of companies working to develop AI models that can predict which HIV clients are going to interrupt in treatment before they do. You can read more about these efforts here and here.

Check out IntraHealth’s presentation at the GDHF to hear how we addressed these issues in the USAID-funded HIV Care & Treatment Project in Central America. Wednesday, December 6, 1-2 pm in the Forest Glen Conference Room at the Bethesda North Marriot in Bethesda, MD. Full GDHF agenda is here.

How do we solve some of these challenges?

1. Create a data use architecture plan for how data is going to be used

Any data scientist worth their salt will tell you that data science isn’t magic, it’s driven by good questions and good data. Projects can start today by assessing their monitoring and evaluation (M&E) data used for reporting (i.e., telling stakeholders what’s been done) and figuring out how to turn it into strategic information (i.e., telling program managers what to do next). Donors can work with implementers to reduce the burden of M&E reporting.

At IntraHealth, we call our overall approach to data use READI: Rapid, Efficient, and Data-Driven Implementation. READI’s guiding principles are real-time, granular, automated data; re-use of donor reporting and secondary data for implementation where possible; and working with governments to review their data and make decisions through a Data to Action (D2A) process.

In READI, we re-use as much donor reporting M&E data as possible for implementation. When the data we need isn’t an M&E indicator, we leverage free, publicly available secondary data (e.g., hyper-local 1x1 km estimates of socioeconomic and population indicators) to help increase the efficiency of our programs. We also engage with communities of practice to re-envision M&E data to support program implementation and have developed a standard set of indicators our projects can choose from for family planning, maternal and child health + nutrition, and non-communicable disease implementation.

2. Invest in open source software

You may have seen various versions of this image around the web. While many open source communities have created great enhancements to software over the years, the complexity and needs of the global goods community are often beyond what can be managed and maintained by volunteers. Better investment is needed in global goods to ensure that the software being provided is being maintained, incorporates standards, is secure, and evolves with advances in technology. This is particularly essential where reasonably priced, commercial alternatives do not exist.

3. Create markets for health information system (HIS) components

A fully functional HIS supports innovation and entrepreneurship by reducing transaction costs so that innovators can build technology able to leapfrog physical infrastructure barriers (like telemedicine apps) with APIs to high-quality health worker and facility lists maintained by a single, public entity. In a perfect world, governments would be able to implement a fully interoperable HIS already using existing architecture specifications like OpenHIE, and digital health sandboxes would allow entrepreneurs to easily introduce new innovations to the ecosystem. However, there are markets that are decades away from this model and there are transitional approaches that might be easier to achieve in the short-term. Markets could benefit today from middleware business to government (B2G), government to business (G2B), or business to business (B2B) models to build, maintain, and license the registries needed to build telemedicine apps to innovators rather than each innovator building and verifying their own. What other opportunities are there for B2G, G2B, or B2B use cases that can support public health? And what non-traditional funders (e.g., health tech investors) might be interested in starting up middleware companies to create the market needed to make health tech profitable? Read more in our blog.

Digital Health Global Digital Health Forum

In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs

cbales — Mon, 20 Nov 2023 16:19:57 +0000

In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs cbales November 20, 2023

November 20, 2023

IntraHealth is partnering with Takeda Pharmaceutical Company Limited to improve maternal and child health in Mali, Senegal, and Niger by sustainably increasing the number of skilled nurses and midwives ready to serve rural communities.

Through the Classroom to Care (C2C) project, funded by Takeda's Global Corporate Social Responsibility (CSR) Program, IntraHealth International is improving access to high-quality maternal and child health care in Mali, Niger, and Senegal by strengthening the preservice training of nurses and midwives in 12 private health schools. Now at the end of the second year of the project, more than 3,000 nursing and midwifery students—75% of whom are women—are benefiting from updated curricula adapted to local clinical practice.

The project is responding to several pressing issues. There is a critical shortage of health workers (nurses, midwives, and doctors) available in the three countries, with only 6.1 health workers in Mali, 3.9 health workers in Niger, and 4.3 health workers in Senegal for every 10,000 people. The shortage is even more acute in rural areas. Currently, traditional preservice education curricula have not prepared health workers for real-life work conditions, and many health training institutions are inadequately equipped and unaccredited. Furthermore, women are disproportionally disadvantaged when it comes to enrollment and graduation due to a variety of factors, such as family responsibilities. Discrimination against women and gender inequalities directly impede development of the health workforce to provide equitable and accessible health services.

Meanwhile the maternal mortality rate remains very high in the three countries, with 315 deaths per 100,000 live births in Senegal, and more than 500 deaths per 100,000 live births in Mali and Niger. And in Mali and Niger, approximately 10% of children die before their fifth birthday.

Competency-Based Approach

Competency-focused preservice education is critical for the provision of high-quality maternal and child health services that meet local needs. Since 2006, the West African Health Organization (WAHO) has pushed to harmonize training curricula for nurses and midwives in the Economic Community of West African States (ECOWAS) region that addresses current disease patterns as well as intra-regional migration. The curricula use a competency-based approach (CBA) that considers population and student needs to replace classic training. Many health schools in the region, however, have still not started the process of implementing the WAHO standardized curricula or been able to train a critical mass of teachers on CBA.

From 2017-2020, the USAID/Mali Human Resources for Health Strengthening Activity, led by IntraHealth, supported the use of competency-based curricula in 10 schools and strengthened policies and practices related to recruitment and retention of students, leading to improved performance of health workers.

The five-year C2C project builds on this work and supports four private schools in each country to strengthen preservice education of nurses and midwives through enhanced competency-based curricula; train teachers and others in the CBA, achieve the appropriate accreditations; and promote diversity, equity, and inclusion (DEI) to increase the number of nursing and midwifery graduates, particularly women from marginalized communities and vulnerable groups.

C2C partners with a diverse set of stakeholders, including WAHO, government bodies including the ministries of health and education in each country, government units such as the Human Resources Division and the Division for Mother and Child Health, private school associations, health professional associations, and Empower School of Health.

Preliminary results

C2C conducted an in-depth needs assessment to identify the baseline for each school, then developed capacity-building plans for all 12 schools to address gaps in national accreditation standards, purchased essential teaching equipment for competency labs, and digitized eLearning modules harmonized with the WAHO curricula.

At the end of Year 2, the project has:

Supported the development and validation of CBA teacher training documents at the national level, including a reference manual, trainer’s guide, and participant workbook.
Through updated CBA training programs, improved the skills and knowledge of 3,721 students, teachers, and school management staff:
- 398 teachers acquired skills and knowledge in adult teaching techniques.
- 250 teachers and clinical supervisors received training on competency-based curricula.
- 3,073 students (2,361 women) benefited from updated curriculum content with tools adapted to clinical practice.
Developed an Accreditation and Quality Assurance Roadmap for all three countries, established internal quality assurance and accreditation units in each school, and oriented 62 educational advisors on quality assurance—laying the groundwork for the accreditation process.
Digitized 33 maternal and child health teaching modules and developed an eLearning platform in collaboration with Empower School of Health. This platform is a comprehensive learning management system tailored to each country, and the modules cover topics such as pediatrics, anatomy, community health, and obstetrics. The eLearning platform incorporates DEI considerations in its design, audio and visual features, and mobile and offline options.
Established inter-ministerial technical working groups in the three countries and initiated a regional private sector community of peers and a community of practice on medical sciences training.

What’s next

C2C is currently conducting DEI situational analyses in all three countries, and in the next year will use them to develop school-specific DEI plans that apply DEI best practices, such as providing nurseries and lactation rooms, to make partner schools more inclusive for women students and boost well-being and academic performance.

C2C will launch the eLearning platform and over the next three years will expand the platform to also include management and leadership courses and solidify it as the standard in health care education across West Africa. C2C will ensure each partner school receives the necessary equipment and technical support to set up competency and computer laboratories. C2C will deepen engagement with stakeholders, from government bodies to local communities, ensuring that the project's impact is sustainable and far-reaching.

The project will also continue its Private Sector Community of Practice, strengthen public-private partnerships through the technical working groups, and oversee implementation of action plans in each school.

By the end of the project, C2C aims to have 580 teachers trained on the CBA, 9,720 students benefiting from quality training, and all 12 private health schools accredited.

Learn more about the Classroom to Care project in three short videos produced by IntraHealth’s Mali team for a virtual visit this month with Takeda.

Want to Unleash Pent Up Health Tech Innovation in Africa? Invest in Health Worker and Facility Registries

cbales — Wed, 04 Oct 2023 14:43:00 +0000

Want to Unleash Pent Up Health Tech Innovation in Africa? Invest in Health Worker and Facility Registries

, Deputy director of data science

, Chief digital health officer

cbales October 04, 2023

October 04, 2023 12:00 PM

Earlier this year, IntraHealth International connected with a company that’s using artificial intelligence (AI) and machine learning to dynamically redistribute the health workforce in Liberia. We quickly got into the weeds—how are you setting it up and how much does it cost? No surprise, it’s like any data science project—80% of the work is wrangling the data. In this case, the firm had to create a list of all the health facilities and the providers working at those facilities and their training and skillset—using available, messy data and at times visiting health facilities to collect data from scratch—before they could even begin to use AI.

Registries are an essential building block of a health information system.

It wasn’t long before we realized the startup had created their own custom health worker and facility registry. What’s a registry? Registries are an essential building block of a health information system. Simply put, they are lists of entities that have been verified with some criteria. However, registries don’t get the attention they deserve. Let’s see how integral they are to the health tech ecosystem in Africa.

Health tech investing in Africa has reached over half a billion dollars in the last 18 months according to a 2023 report from Briter Bridges. Telemedicine companies are leading the pack—and registries are critical to a telemedicine startup in the same way they were critical to the AI company redistributing health workers in Liberia. When a client connects with a health worker virtually, they may need a referral to another provider or to a pharmacy nearby to pick up a prescription. Behind the scenes is a registry of health care providers, pharmacies, and in stock medicines, and if it’s a repeat customer a client registry can help identify existing prescriptions and any interactions.

Just like that, telemedicine has leapfrogged infrastructure barriers to health care access in Africa—but not without registries.

A customized registry could cost between $100-300k.

Like any startup, a telemedicine startup needs to generate revenue quickly with limited funding runways and most startups never get past the early stages if they cannot generate revenue. If there is no national registry, having to create a customized registry could cost between $100-300k and require ongoing maintenance of between $10-40k per month, depending on the scope and scale. If a startup dies, its custom-built registry dies with it.

Established national registries not only reduce the startup costs and barriers to entry but can accelerate the time from startup to revenue generation when companies can pour money into reducing customer acquisition costs (CAC) rather than recreating and updating registries for their own use. A market with an up-to-date and well-maintained health worker, facility, and client registry can lower startup costs and potentially attract new investors to fund innovation in these markets.

Open source global good software is on the shelf and ready to be implemented.

The great thing about registries is that the global health community has produced guidelines for developing and maintaining facility, health worker, and client registries, and open source global good software is on the shelf and ready to be implemented. IntraHealth has developed and maintains three canonical, open source, and standards-based registry tools. iHRIS is a health worker registry that stores information on health workers across a health system, including their demographics, training, and certifications; GOFR, the Global Open Facility Registry, is a tool that allows facility reconciliation and the creation of a master list of facilities; and OpenCR is a privacy preserving client registry tool. At scale, registries built on such open source tools could power tomorrow’s health tech growth in Africa but not without further investment and governance.

Why not develop and maintain registries through a B2B, business-to-business, model? Venture capitalists could consider funding an NGO, or a social enterprise based in a low- or middle-income country, to enter the market and maintain an application programming interface (API) to an up-to-date and well-maintained health worker and facility registry. Startups could pay a fee to the company rather than recreating the list each time, customers could be assured that they are getting referrals to the most qualified individuals, and the government could have access to the data for free.

With national health worker and facility registries, promising health tech innovations we haven’t even thought of yet could have a running start at revenue generation.

Digital Health

Three Ways to Support and Engage the Full Health Workforce Needed to Deliver on UNGA’s Health Agenda

cbales — Mon, 02 Oct 2023 14:21:01 +0000

Three Ways to Support and Engage the Full Health Workforce Needed to Deliver on UNGA’s Health Agenda

, Vice President, Resilient Health Systems, Abt Associates

cbales October 02, 2023

October 02, 2023 12:00 PM

This post was originally published on the Frontline Health Workers Coalition Blog during the UN General Assembly in September 2023.

As global health leaders convene in New York for three separate high-level UN meetings—on the fight against tuberculosis (TB); universal health coverage (UHC); and pandemic preparedness, prevention, and response—there is one critical element required to complete all these agendas, and that is a robust and resilient health workforce. Without sufficient, well-protected, well-trained, and supported health workers in the right places to respond to the health needs of vulnerable populations, the TB epidemic will rage on, UHC will remain an elusive goal, and countries will be unprepared to respond to the next epidemic or climate-related catastrophe.

There is enormous return on investment in the health workforce, but the critical role of allied health professionals is often left out of this conversation. While clinical health workers remain the backbone of high-quality services, equally important to the fight against TB are the logisticians, who ensure supply chains effectively distribute medicines and supplies where they are needed, and laboratory professionals, who ensure rapid and correct diagnosis of TB and other diseases. Universal health coverage cannot be achieved without economists and financial management professionals who ensure budgets are allocated to priority needs, especially those at the primary health care level. And early warning systems are not effective without trained epidemiologists to review data and note anomalies that need response.

Allied professionals across the system enable the critical work of clinical professionals, as do clear-eyed managers and supervisors who constantly adapt and adjust systems and resources to support staff at every level and function within the health system. And there are countless other professionals who provide social support to families, assist people with disabilities, and otherwise support a people-centered and inclusive health system.

The siloed approach to global health... treats health professionals as a commodity to be used by a program—not as people who are part of a community and want to see better health for their countries overall.

Each of these professionals needs to be recognized for their role in achieving global health and broader Sustainable Development Goals; they need the structure and resources to fulfill their roles according to the context in which they work and the space to innovate and generate solutions uniquely calibrated to their local context. This means understanding that their roles and functions are not specific to one disease or one outcome and that truly supporting health workers means supporting their roles in the system to create more effective outcomes for all. The siloed approach to global health that assumes achieving specific outcomes requires a direct link between actions and outcomes treats health professionals as a commodity to be used by a program—not as people who are part of a community and want to see better health for their countries overall.

Here's how to engage and support the full health workforce needed to achieve the objectives of UNGA’s high-level meetings:

1. Really embrace localization.

Lately, localization is a constant topic in international development and global health, with much focus on the transfer of funds directly to local organizations. Truly embracing localization, though, means putting local actors, such as allied health professionals and others responsible for the full functioning of critical health systems, in the lead. While the international community has generated research and evidence around what needs to be done to achieve UHC, TB, and pandemic preparedness objectives, we have to recognize that externally-imposed ideas of how to implement evidence-based approaches often fall short.

2. Have some humility.

To truly let the local health workforce lead, the global development community needs to have the humility to trust local solutions. International actors should take a step back and view their role as largely focused on “what” works in terms of evidence-based technical solutions—while giving local actors the space to iterate on how best to implement these in local contexts.

3. Recognize the power of collaboration and partnership.

For the global health community, having the humility to recognize the value of locally-generated solutions creates more collaboration and partnership among programs. Rather than each program fearing its issue will be diluted if not solely controlled within their community, they should enter global discussions with a clear-eyed understanding of each program's unique contributions. They should look to understand how these unique contributions can complement, or be complemented, by those of other programs—without competing for resources or “leadership” within the space. That might just pave the way for enhanced results through genuine collaboration.

UN General Assembly Health Workforce & Systems

How Can Nurses Support Digital Health and Vice Versa?

cbales — Wed, 13 Sep 2023 17:08:25 +0000

How Can Nurses Support Digital Health and Vice Versa?

, Strategic communications manager

, Chief digital health officer

cbales September 13, 2023

September 13, 2023 12:00 PM

Digital health is key for achieving universal health coverage and equitably responding to pandemics—both on the agenda for the UN General Assembly this month.

I sat down with Olivia Vélez, IntraHealth International’s chief digital health officer and part of our delegation heading to UNGA. She’s a registered nurse and holds a PhD in nursing informatics, in addition to master's degrees in information systems and public health. She shared how digital health can support nurses and other health workers, and how as a nurse she’s advancing digital health innovation.

1. What drove you to study and pursue both nursing and tech?

In undergrad I double majored in computer science and neuroscience. After I graduated, all my jobs as a software developer or database developer were in the health sector, at community health centers or health insurance companies.

One day I was working with nurses, developing a mobile tool for them to do quality assurance audits, and I thought I'd do a better job at this if I was a nurse and I really understood what they needed. So I decided to go to nursing school, with the idea that I would focus on nursing informatics and community health.

2: How are you using your background in nursing in your current role as chief digital health officer at IntraHealth?

I understand what nursing challenges are, and I bring that view and wisdom to how we design our digital health tools and how we implement them. I also understand what it’s like to be a new nurse and feel alone on your first shift, or during your first month of working. In a lot of the countries we work in, nurses are assigned to rural clinics where they're working by themselves without a lot of supervision, and there’s a shortage of nurse mentors and more experienced nurses because of brain drain and the overall health workforce shortage.

I understand what it’s like to be a new nurse and feel alone .

So I bring my nursing experience to the forefront and think, how can we help nurses move along the path from being a novice nurse to being an expert? How can we build their confidence and ensure they stay in the field?

My knowledge applies to other kinds of health workers too. I know that stress when you don't have the resources or the support you need. So I always look for solutions with technology and even what we can do with artificial intelligence (AI) to support mentorship, development, and growth.

3. What do you think is unique about IntraHealth's approach to digital health? What are you working on that you are excited about?

IntraHealth has primarily focused on digital health tools that are supportive infrastructure for health systems at the national level. iHRIS tracks all health workers in the country, and Open Client Registry (Open CR) safely links patient information between different databases for continuity of care. Facility Match helps ministries, as well as donors and implementing partners, create and maintain master lists of all the health facilities in the country, and eliminate duplication.

We focus a lot on interoperability, so different information systems can share important information. And, if local entrepreneurs build mobile health tools, for example, they can be integrated. We also focus on making sure our software is safe and secure.

I'm personally really excited about the work we're doing with machine learning and predictive analytics, like how we're using iHRIS for health workforce planning—from day-to-day to redistribution of health workers to respond to an emergency or pandemic. And also our thought leadership around building a culture of data use. When we implement our tools we think, you're collecting all this data, what are you actually going to do with it? How is it going to help decision-makers improve health workforce planning or access to quality health services?

4: Nursing is a woman-dominated field, and digital health is dominated by men. Have you had to overcome any gender-related challenges in your career?

The general challenge a lot of women face in this field is the constant need to prove our technical expertise. Because most people know I'm a nurse, they don't realize I worked as a software developer for ten years, so I don't need the technical side dumbed down for me. Other women I’ve talked to have faced that as well, even if they have engineering degrees, etc.

It's important to have gender representation in the design and development of tools.

To address this, we created and held a Women in Global Digital Health Leadership Workshop last December before the Global Digital Health Forum [Vélez is cochair of the Global Digital Health Network, which hosts the forum]. We talked about the common challenges we face and formed a network of women to continue to discuss these issues and find solutions. Because it's important to have gender representation in the design and development of tools, and we want to make sure that tools are implemented with a gender equity lens. There's still a big gap in the digital divide, and diversity is important. We're planning to host another workshop this December to follow up on last year's success.

5: What advice would you give to other women, particularly nurses in low- and middle-income countries, interested in digital health?

Digital health is a broad field with a lot of different specialties. You could be a solutions architect, a software engineer, a data scientist. So number one is to explore which aspect of digital health interests you. There are a lot of free Google or Microsoft online courses that can help you learn more about a particular area. If you’re interested in privacy and security, Google has a whole privacy and security track that you could take and get a good understanding.

The International Council of Nurses has competencies for nurses interested in nursing informatics. In a few years the World Health Organization will release a digital health competency framework for health workers. Many people from IntraHealth have participated in the early stages of the development of those competencies, with low- and middle-income countries in mind. Africa CDC has a flagship initiative that we're also participating in to build digital health capacity within the African Union. And along with that we can expect to see programs and courses coming out to help nurses gain the skills they need.

6: What suggestions do you have for donors or policymakers to advance digital health?

Donors and policymakers should invest in building digital health capacity for health workers. As more health workers have skills in digital health, they can better contribute to the design of tools, as an end user in the user-centered design process, or in leading the design and implementation of tools.

Invest in building digital health capacity for health workers.

They should also continue to invest in open source tools, like iHRIS, so there's funding to continue core development, and to use the best technology possible, while still keeping the implementation and the total cost of ownership low for countries.

7: You’ll be attending the UN General Assembly next week. What are you listening for that could impact digital health?

I'm looking forward to the discussions on health data governance led by Transform Health. That's a big deal this year especially. IntraHealth signed on to several statements around the health data governance principles. It’s really important to make sure the health workers and patients we are including in digital health systems around the world are protected and afforded the same rights with regard to the privacy of and use of their data. We are responsible for making sure that the digital health tools we implement, and the data that goes in them, are used to improve quality of care and achieve universal health coverage.

Follow Olivia Vélez:

At UNGA, Olivia Vélez will speak at a roundtable, Accelerating equitable digital innovations for women's reproductive health, on September 19 hosted by Dalberg and Resolve Global Health.
In October, Vélez will join the 2023 Class of Fellows of the American Academy of Nursing. She’ll be recognized for her outstanding impact on health and health care at the Academy’s annual Health Policy Conference on October 5-7 in Washington, DC.
Connect with her on Linked In at https://www.linkedin.com/in/oliviavelez/.

Digital Health Health workforce development Policy & Advocacy UN General Assembly Nurses

At UNGA, Civil Society Must Mobilize Global Solidarity for Universal Health Coverage

cbales — Tue, 12 Sep 2023 12:08:31 +0000

At UNGA, Civil Society Must Mobilize Global Solidarity for Universal Health Coverage

, Founding Executive Director, African Center for Global Health and Social Transformation

cbales September 12, 2023

September 12, 2023 12:00 PM

As world leaders prepare for the United Nations General Assembly (UNGA) in New York, it’s important for those of us in civil society to prepare ourselves ideologically to engage, especially for pushing leaders to make commitments during the UN High-Level Meeting on Universal Health Coverage (UHC) on September 21. The theme for this important gathering is Universal health coverage: expanding our ambition for health and well-being in a post-COVID world.

We all have a right to life and to health.

We need to remind ourselves of the basics, namely that health of the people is a precondition for productive lives. The right to life and to health, articles 3 and 5 of the Universal Declaration of Human Rights adopted by the UNGA in 1948, is also a right to responsive health systems.

As we know, quality of life varies between regions and within countries. In some cases, there is unacceptable poverty and lack of social justice and equity—including in access to quality health care. In fact, at least half of people around the world still lack access to essential health services, including maternal care, HIV treatment, family planning, and vaccines. This is in a world that is connected, interdependent, and globalized with knowledge and resources to achieve UHC but sadly lacks the will and organizational capacity needed to expand and achieve our ambition enshrined in the Sustainable Development Goals (SDGs).

Our response to the existential threat from climate change is also constrained by our inability to mobilise for collective action, hence the Climate Ambition Summit planned for September 20.

To reach UHC we need PHC.

There are admirable achievements we can build on, such as negotiation of the SDGs; rolling out global health initiatives such as GAVI and the Global Fund for AIDS, TB and Malaria; and UN agencies like the World Health Organization (WHO) and UNICEF. But the ability of these initiatives and agencies to achieve UHC that truly leaves no one behind cannot be realized until people are reached and engaged through primary health care (PHC) that is owned and driven by communities, and people participate as a duty and a right using the currently available resources. According to the WHO, scaling up PHC in low- and middle-income countries could save 60 million lives, and increase life expectancy by 3.7 years, by 2030.

Achieving UHC is challenged by the quality of partnerships between countries in implementing PHC and reaching communities. Some countries and their institutions are donors while others are recipients of aid for health. Many conferences have been held on aid effectiveness and there are good practice guidelines, such as promoting country leadership and capacity building, which are not generally followed. In my experience, if aid receiving countries take the leadership and are clear about what results they aim to achieve with the aid, donors are likely to follow. The implementing individuals from both sides need to be prepared for their roles and be personally committed to improving health.

There are also commercial determinants of health which are private sector activities and products that are detrimental or promotive of population health. Country health systems and corporate, national, and global institutions need to be awake to these and guide their populations accordingly, including during negotiation of contracts and trade deals.

All countries need strong health systems.

The health of the people cannot be left to the market. The COVID-19 pandemic has demonstrated the centrality of strong and resilient health systems in all countries. The COVID-19 experience provides all countries with an opportunity to rethink the priority of health systems in their national plans.

The pressures for resources in every economy are many but keeping the heath agenda visible and funded is popular with the people who value their health highly. Population health should be a visible issue over which elections are won and lost in all countries.

I recently attended the WHO African Regional Health Ministers conference in Gaborone, Botswana. What has struck me is there are African countries that are high performers in achieving health goals and at the same time there are countries where health indices are depressing. The difference between the two appears to be the level of political commitment to population health and political and social stability.

We must address the global health workforce shortage and other challenges.

This discussion cannot be complete without referring to human resources for health who are responsible for implementing health plans and running health systems. There is a global health workforce crisis that was recognized over 20 years ago and is characterized by widespread shortages, maldistribution of health workers, and poor working conditions.

I served in the past as the executive director of the Global Health Workforce Alliance at the WHO and continue to follow this subject closely. I am disappointed to note that global health workforce strengthening is severely underfunded.

We’re facing a shortage of at least 10 million health workers by 2030, with the global gap growing and Africa bearing nearly half of the shortage. Health worker migration from poor to rich countries is rampant and out of control, partly fueled by push factors of poor working conditions, low pay, and unemployment in low-income countries. The WHO Code on the International Recruitment of Health Personnel adopted by the World Health Assembly in 2010 is available to guide health worker migration. This Code provides for the training of a global pool of health workers to be shared, but this is not happening and poses a threat to our ability to achieve UHC and global health security.

Civil society must engage.

It is my prayer that this UNGA will address the above issues and become an effective vehicle for mobilizing the right climate of opinion, global solidarity, and harmony for expanding our ambition for health and well-being in a post-COVID world.

The role of civil society organizations and academic institutions in mobilizing for UHC is critical. We can hold governments and duty bearers to account and create a climate of opinion among communities, countries, regions, and globally, that enables the adoption and implementation of health promoting policies.

During UNGA we can build expectations for heads of state to make strong commitments to strengthen the global health workforce at the High-Level Meetings on health and in the Political Declaration on UHC. After UNGA we can monitor their commitments and press our leaders to live up to them.

Also see the Frontline Health Workers Coalition’s Top Policy Recommendations to Invest in Health Workers.

This op-ed was originally published on the Frontline Health Workers Coalition Blog.

Francis Omaswa is the founding executive director of the African Centre for Global Health and Social Transformation, an initiative incorporated in Uganda and promoted by a network of African and international leaders in health and development. Until May 2008, he was special adviser to the WHO director general and founding executive director of the Global Health Workforce Alliance. Before joining GHWA, he was the director general for health services in the Ministry of Health in Uganda, where he was responsible for coordinating and implementing major reforms in the health sector, including quality assurance and decentralization. Among Dr. Omaswa’s many accomplishments and leadership roles in the global health community, he was founding chair, and later served as vice chairman, of the global Stop TB partnership; was one of the architects of the Global Fund to Fight AIDS, TB and Malaria; and served as chair of the portfolio and procurement committee of the Global Fund board; was a member of the steering committee of the High Level Forum on health-related MDGs; and participated in the drafting the Paris Declaration on Aid Effectiveness.

Dr. Omaswa is a graduate of Makerere Medical School, Kampala, Uganda, a fellow of the Royal College of Surgeons of Edinburgh, founding president of the College of Surgeons of East, Central and Southern Africa, and is a senior associate at the Johns Hopkins Bloomberg School of Public Health and an overseas member of the National Academy of Medicine in the United States.

UN General Assembly Health Workers

Maqsoda Maqsodi Appointed Permanent President & CEO of IntraHealth

cbales — Tue, 29 Aug 2023 12:15:03 +0000

Maqsoda Maqsodi Appointed Permanent President & CEO of IntraHealth cbales August 29, 2023

August 29, 2023

Chapel Hill, NC

IntraHealth International’s board of directors has voted unanimously to appoint Maqsoda Maqsodi as president and CEO of IntraHealth, effective immediately. Maqsodi has served as interim president and CEO since February 2023, and has led the organization on a transformation agenda that has strengthened our program delivery and localization efforts around the world.

“Maqsoda is hands-down the right person to lead IntraHealth into this exciting new era,” says Mary Karen Wills, chair of IntraHealth’s board of directors. “From day one of her interim role, she began developing and leading an agenda that will grow IntraHealth’s presence in key regions around the world and work toward more sustainable, region-based leadership of its global health programs.”

Maqsodi joined IntraHealth in 2021 as chief program officer, serving in that role and as chief of growth and operations before she was appointed interim president and CEO this year. She has 20 years of experience in the private and nonprofit sectors, including leading and implementing large, complex, donor-funded projects globally.

“I am so humbled and grateful for this opportunity to continue leading IntraHealth,” Maqsodi says. “I would like to thank the incredible IntraHealth staff for their support and belief in me and the board for their collaboration and mentorship. I am so excited to lead the organization on this new journey and contribute to a future of inclusive, locally led development, which is an urgent challenge and priority for our field.”

Prior to joining IntraHealth, Maqsodi served as senior director for the Middle East and North Africa Business Unit at Chemonics and as acting senior vice president, project director, and operations director in the Global Health Division at Chemonics. She also served as the interim chief of party and project director on the $64 million USAID-funded SIKA-West project, which was designed to increase citizen confidence and promote stability in key areas of western Afghanistan.

”We could not ask for a more dynamic, groundbreaking candidate to steer IntraHealth into the future of global health,” says Pape Gaye, founder and president of the Baobab Institute. (Gaye served as president and CEO of IntraHealth during 2004–2020 and now serves on IntraHealth’s board of directors.) “I am thrilled to continue working with Maqsoda as IntraHealth evolves and leads the way toward a future of more effective, more equitable development.”

The board has also voted to appoint Philippe Guinot as permanent chief technical and operating officer. Guinot has served as the chief technical officer and as interim chief operating officer since February. He brings 30 years of experience from the nonprofit and private sectors and has extensive expertise in strategy, partnership development, country programming, portfolio management, finance and operations, and business planning. Since joining IntraHealth this year, Guinot has helped develop and operationalize a new strategic direction for the organization, expanded IntraHealth’s impact on noncommunicable diseases through the Novartis Foundation-funded CARDIO4Cities Accelerator, and integrated IntraHealth's technical expertise into its new business efforts.

For press inquiries, please contact David Nelson, director of communications at IntraHealth.

IntraHealth International is a global health nonprofit that has worked in over 100 countries since 1979. We partner with governments and local collaborators to improve the performance of health workers and strengthen the systems in which they work so that everyone everywhere has the health care they need to thrive.

USAID and IntraHealth to Expand Locally Led Development in Zambia

cbales — Tue, 08 Aug 2023 16:07:29 +0000

USAID and IntraHealth to Expand Locally Led Development in Zambia cbales August 08, 2023

August 08, 2023

Through a new contract from the US Agency for International Development (USAID), IntraHealth International will implement the Zambia Leading Organizational Capacity and Localization Development (LOCAL) Activity. This project will build on IntraHealth’s 24-year history in Zambia, and our successful local capacity-strengthening work, to enable local implementing partners (LIPs) to independently secure, manage, and monitor USAID programs to carry out the country’s development agenda and deliver results for the Zambian people.

Locally led development is the best path toward sustained improvements in health and development outcomes around the world. In Zambia, USAID has made tremendous progress in establishing direct awards with local organizations to lead HIV programs. Yet gaps in local partners’ organizational capacity must be addressed to strengthen their operations and ensure sustainability.

Since 2019, IntraHealth has worked with 101 local implementing partners in 18 countries.

As implementer of the USAID Accelerating Support to Advanced Local Partners (ASAP) and ASAP II contracts in sub-Saharan Africa, IntraHealth brings extensive expertise in rapidly preparing local organizations and government entities to develop the capabilities and resources to serve as prime partners for USAID programming. Since 2019, IntraHealth has worked with 101 LIPs in 18 countries, including Zambia, with 98% of LIPs documenting capacity improvements.

Through the five-year Zambia LOCAL activity, IntraHealth and partners SustainAbility Solutions and Ku-Atenga Media will provide LIPs the support they need for success in operations, income generation, and advocacy, building on lessons learned from ASAP and other local partner capacity-strengthening initiatives. Specifically the project will:

increase LIPs’ capacity for risk identification, mitigation, and compliance to financial and operational best practices
enhance LIPs’ resource mobilization and funding diversification capacity for the purpose of organizational sustainability
increase networking opportunities; improve communication, monitoring, evaluation, and learning capacities; and enhance understanding of integrated programming.

The activity will initially focus on health-related LIPs that are expected to greatly expand in scope and implement development programs at national and provincial levels. It will also support LIPs that implement non-health-related program activities.

Zambia LOCAL will incorporate local voices into all aspects of its work—a key for successful localization—and create space for local leadership and for local communities.

Annie Banda, a Zambian global public health professional, will serve as chief of party. Banda has significant experience assessing and strengthening the capacity of local organizations. She will manage a pool of Zambian experts and technical advisors to provide technical assistance that meets LIPs’ needs.

"I am so grateful and excited for the opportunity that IntraHealth has given me to lead and champion USAID Zambia's agenda of empowering local organizations to sustainably deliver health services to targeted communities," says Banda.

"IntraHealth is a longstanding partner of USAID in Zambia," says Maqsoda Maqsodi, president and CEO of IntraHealth. "Since 1999, we've partnered with the Zambian government and others. Together we've strengthened the Zambian health workforce and improved health services for Zambian communities. Now we're honored to be helping local organizations prepare to lead USAID programs and drive the country's development agenda."

Also read: Toward Sustainable Locally Led Development, IntraHealth's 2022 annual report

IntraHealth partnered with 6,616 local entities worldwide in 2022, including health facilities, governments, civil society groups, religious leaders, youth advocates, and more.

In South Sudan, Antiretroviral Therapy Gives Man a Second Chance to Live

cbales — Tue, 01 Aug 2023 13:24:41 +0000

In South Sudan, Antiretroviral Therapy Gives Man a Second Chance to Live

, Communications Officer

cbales August 01, 2023

August 01, 2023 12:00 PM

Twenty-five-year-old John thinks he may have lived with HIV for over three years before taking a blood test in December 2021. After several failed over-the-counter malaria treatments, John’s older brother Ojok took him to Munuki Primary Health Center in Juba, where he tested HIV positive.

Although health workers immediately enrolled John on antiretroviral therapy (ART), he refused medication and lived in denial for another year.

John’s health deteriorated and in December 2022, Ojok returned him to Munuki Primary Health Center. After health workers at the center performed another positive HIV test, and provided a radiological tuberculosis (TB) diagnosis, he began receiving HIV and TB treatment.

Munuki is one of 14 health centers supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International providing comprehensive HIV services—including Pre-Exposure Prophylaxis (PrEP), an HIV prevention method—and free ART to 11,345 people living with HIV in South Sudan. By partnering with local health facilities and organizations, the South Sudanese government, and local communities, AHEC helps train health workers to provide HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

This time, AHEC attached John to Agnes, one of 161 community outreach volunteers the activity trained to help HIV clients adhere to treatment. Agnes visits John twice a month to assess and understand the challenges he is facing, suggest appropriate recommendations, provide psychological support, and, when needed, accompany him to the health facility for ART refills or counseling.

HIV & AIDS Health Workers Community Health Workers

Community Advocacy Leads to New Maternity Unit at Rwanda Health Center

cbales — Tue, 11 Jul 2023 14:21:08 +0000

Community Advocacy Leads to New Maternity Unit at Rwanda Health Center

, Community health engagement specialist

cbales July 11, 2023

July 11, 2023 12:00 PM

For years, maternity services at Gashaki Health Center in Rwanda’s Muzanze District were hindered by poor infrastructure, congestion, and a lack of community participation.

“We had such a small delivery room that we couldn't accommodate more than two women at the same time,” says Sylvain Ndagiwenimana, the health center manager. “This lack of space contributed to an increase in home deliveries.”

Now clients and community members have a say in the type and quality of services they receive.

Lack of space contributed to an increase in home deliveries.

The USAID-funded Ingobyi Activity, led by IntraHealth International, used a Patient Voice Program–Citizen Voice and Action (PVP-CVA) approach to enhance service quality at the health center. PVP-CVA gives health facity leadership and districts insights into how the community views the services they provide and offers community members the opportunity to participate in efforts to improve service delivery.

After a January 2019 data review and analysis showed the health center was consistently under-performing in most indicators related to reproductive, maternal, newborn, and child health (RMNCH) and malaria, Ingobyi targeted Gashaki Health Center with the PVP-CVA intervention.

In May 2019, Ingobyi organized a “scorecard meeting” with community members, health workers from the health center, and some of the district leaders. Community members listed services they received at the health center and ranked their quality. One of the issues that stood out was the old maternity unit, which didn’t provide a comfortable place for delivery or postpartum stay.

Women are now happy to deliver in the new maternity unit.

The meeting participants agreed the facility needed a new maternity unit and formally advocated to district leaders to provide the funds for a new building. In December 2019, district leaders promised to allocate funds in the next fiscal year budget to build a new, modern maternity unit at the health center.

Construction began in November 2021 and the new maternity unit opened its doors in August 2022. Since completion, 330 women have delivered their babies in the new maternity ward.

“The new maternity unit offers much space and ensures privacy to our clients,” Ndagiwenimana says. “Women are well received and are happy to deliver in this new unit. The average quality score for maternity services has increased from 81% in 2021 to 100% in 2023.”

Maternal, Newborn, & Child Health Policy & Advocacy Quality of Care