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International Health

October 12, 2018

Dr. Alain Labrique Leads Publication of New Series on Digital Health

Global Health Science and PracticeThe Johns Hopkins University Global mHealth Initiative and the WHO launched a special issue on the state-of-the-art in digital health and its place in future health systems in the journal Global Health Science and Practice at the Fifth Annual Global Symposium on Health Systems on Health Systems Research in Liverpool this week. The series of reviews, led by Alain Labrique, an associate professor of International Health at the Johns Hopkins Bloomberg School of Public Health, evaluates the ever-growing overlap between health systems and digital health. In each of the papers, authors present key research, policies, and funding priorities that will help guide digital health investments in low- and middle-income countries. The issue was supported by a grant to Labrique from the Aetna Foundation.

In May of this year, the WHO issued a resolution with all member states recognizing the importance of digital systems for facilitating health systems strengthening and achieving universal health coverage. The resolution identified that coordinated, systematic, and evidence-based approaches which WHO, with member states and partners, will need to prioritize to ensure that the full potential of digital health can be realized. This series of papers provides a much needed assessment of the current evidence available, as well as a foundation on which to continue advancing this new and quickly evolving global health domain.

The series is organized around WHO’s conceptualization of health systems, composed of six foundational areas, including information and research, governance, financing, workforce, and health services. Six teams, created by pairing experts from each of these areas with digital health experts, produced reviews of the existing body of evidence on how digital health is being leveraged to address health system barriers to coverage and services. In each of the papers, authors identify important roadblocks and reflect on key research, policies, and funding priorities. The issue also includes an editorial that provides a broad overview of this relatively new research field and highlights the growth it needs to realize its full potential. In addition to Labrique, other guest editors are Adjunct Professor Adnan Hyder, Bloomberg School associate and current Duke University faculty, Dr. Lavanya Vasudevan, alumnus Dr. Garrett Mehl of the WHO, and Ellen Rosskam, also with the WHO. 

Below are brief abstracts for each article, listed by the health systems area it covers. For more information and to read the open access supplement visit Global Health Science and Practice.

Information and research

Establishing Standards to Evaluate the Impact of Integrating Digital Health into Health Systems

Alain Labrique, Lavanya Vasudevan, William Weiss and Kate Wilson
Global Health: Science and Practice October 2018, 6(Supplement 1):S5-S17; 
The key milestones in the rise of digital health illustrate efforts to bridge gaps in the evidence base, a shifting focus to scale-up and sustainability, growing attention to the precise costing of these strategies, and an emergent implementation science agenda that better characterizes the ecosystem—the social, political, economic, legal, and ethical context that supports digital health implementation—necessary to take digital health approaches to scale.


What Does It Take to Be an Effective National Steward of Digital Health Integration for Health Systems Strengthening in Low- and Middle-Income Countries?
Michael J. Frost, Jacqueline B. Tran, Fatema Khatun, Ingrid K. Friberg and Daniela C. Rodríguez

Global Health: Science and Practice October 2018, 6(Supplement 1):S18-S28;
A purposeful literature review of peer-reviewed and gray literature identified 4 broad thematic areas of digital health stewardship—strategic direction, policies and procedures, roles and responsibilities, and health service delivery—that need further research and development in order for digital health to be better 


The Role of Digital Strategies in Financing Health Care for Universal Health Coverage in Low- and Middle-Income Countries
Bruno Meessen

Global Health: Science and Practice October 2018, 6(Supplement 1):S29-S40;
The development and adoption of effective digital health financing solutions that fit well in both coherent digital health information architectures and the universal health coverage agenda will require strong partnerships between entrepreneurs, developers, implementers, policy makers, and funders.


Digital Technologies for Health Workforce Development in Low- and Middle-Income Countries: A Scoping Review
Lesley-Anne Long, George Pariyo and Karin Kallander

Global Health: Science and Practice October 2018, 6(Supplement 1):S41-S48;
Digital health interventions have the potential to improve the health workforce by supporting training, supervision, and communication. More evidence is needed on the effectiveness of interventions implemented at scale, including the return on investment, the effect of government and donor policies on scale up, and the role of the private sector.

Health Services - Supply side 

Strengthening Delivery of Health Services Using Digital Devices
Maeghan Orton, Smisha Agarwal, Pierre Muhoza, Lavanya Vasudevan and Alexander Vu

Global Health: Science and Practice October 2018, 6(Supplement 1):S61-S71;
Delivery of high-quality efficient health services is a cornerstone of the global agenda to achieve universal health coverage. Digital health interventions for service delivery, such as digital health-enhanced referral coordination and mobile clinical decision support systems, demonstrate considerable potential to improve the quality and comprehensiveness of care received by patients but require greater standardization and engagement of health workers at different levels of the health system for effective scale up.

Health Services - Demand generation

The State of Digital Interventions for Demand Generation in Low- and Middle-Income Countries: Considerations, Emerging Approaches, and Research Gaps
Dustin G. Gibson, Tigest Tamrat and Garrett Mehl
Global Health: Science and Practice October 2018, 6(Supplement 1):S49-S60;
Despite advances in digital technology to generate demand for health services, considerable gaps remain in our understanding of which interventions are effective, which characteristics mediate their benefit for different target populations and health domains, and what is necessary to ensure effective deployment. Future research should examine the long-term effects of, equity in access to, and cost-effectiveness and efficiency of digital demand generation interventions.


Digital Health and Health Systems of the Future
Alain Labrique, Lavanya Vasudevan, Garrett Mehl, Ellen Rosskam and Adnan A. Hyder
Global Health: Science and Practice October 2018, 6(Supplement 1):S1-S4;

Digital strategies have been formally recognized as a critical health systems strengthening strategy to help meet the Sustainable Development Goals and universal health coverage targets. This landscaping collection reviews multiple possible approaches across health system pillars, from digital referrals to decision support systems, identifying key knowledge gaps across these domains and recognizing the growth needed in the field to realize its full potential.