Skip Navigation

International Health

Advancing Digital Health Science and Practice

Johns Hopkins Global mHealth Initiative (JHU-GmI) produces three first-of-their kind publications

JHU-GmI coordinates with faculty and students from across the university to help mobilize the University’s digital health resources. Led by the Department’s Alain Labrique, an associate professor in the Global Disease Epidemiology and Control program, the Initiative’s overarching goal is to develop and test appropriate and effective digital health strategies, while strengthening the  evidence base. The absence of a shared vocabulary or common framework to describe clinical or health system innovations which use mobile technologies was a significant problem for researchers and policy makers interested in digital health.

Jessica Rothstein - MAPS
Jessica Rothstein, a doctoral student in International Health, worked with faculty and
alumni mentors to develop MAPS, now being digitized as a web-based tool by the WHO.
Photo credit: Yorghos Carabas

In 2013, Labrique and colleagues published one of the first mHealth frameworks. It laid out 12 common mHealth strategies used as “ingredients” in health systems-strengthening innovations across the reproductive health continuum. The framework helps individual projects describe their innovation and approach using a common framework to policymakers, donors and colleagues working in this space. In addition, it has been adopted by WHO and Unicef as a standard way of describing digital health investments recommended to governments. Published by Global Health: Science and Practice, the article is currently the journal’s most downloaded article, with over 30,000 downloads and 65 citations.

Over the last year, both faculty and students affiliated with GmI have produced new works that should also have wide-ranging and lasting impacts on the field. The new guidelines, toolkit and landscape review address mHealth programming from conception to implementation to evaluation. Labrique sums it up: 

We are thrilled that the work we’ve been doing in digital health with a range of partners, from WHO to ministries of health, has been appreciated for its rigor and innovation. Hopkins has a long history of bringing systematic thinking to the table, which we’re proud to bring to the digital health conversation. 

mHealth Evaluation, Reporting and Assessment (mERA) guidelines—First of their kind

Over the past decade, the global “mobile phone” revolution has inspired 1,000s of global health innovation projects. Clinicians and public health practitioners have been working with NGOs and governments to leverage the ubiquity of phones and connectivity across once-remote, rural populations as a way of overcoming barriers to scale-up programs and to resolve process bottlenecks. A major obstacle in the way of widespread adoption of these “mHealth” innovations, at scale, has been the absence of guidelines from normative bodies like WHO. This stems, partly, from the lack of quality reporting to provide an evidence-base of the mHealth work which is being done around the world.

The mHealth Evaluation, Reporting and Assessment (mERA) guidelines represents the FIRST step in this direction—as WHO commissioned a team, including researchers from Johns Hopkins Global mHealth Initiative and the WHO/HRP mHealth Technical Evidence Group (mTERG)—to develop standard criteria for reporting research and innovation findings.

Guidelines for reporting of health interventions using mobile phones: mobile health (mHealth) evidence reporting and assessment (mERA) checklist was written by Smisha Agarwal, Amnesty E LeFevre, Jaime Lee, Kelly L’Engle, Garrett Mehl, Chaitali Sinha, and Alain Labrique, with contributions from the WHO mHealth Technical Evidence Review Group. It was published in the March 19 issue of the British Medical Journal.

Mobile Technology in Support of Frontline Health Workers—A comprehensive overview of the landscape, knowledge gaps and future directions

A GmI team, led by International Health faculty Smisha Agarwal and Alain Labrique, with support of students and faculty across the University produced this report commissioned by the Bill & Melinda Gates Foundation. It summarizes global trends in the use of digital tools by frontline health workers in low- and middle-income countries around the world. Many developing countries have ramped up the adoption of mobile technologies, such as tablets and smartphones, as an important resource for frontline health workers. Although numerous projects have been deployed over the past decade, few have made it to national or regional scale—and the key “ingredients” for success are poorly understood. This report summarizes current data from over 140 projects, while describing emerging trends and best practices to help governments and implementing agencies consider various successes and failures, and weigh the benefits of different platforms and digital strategies. The Foundation and its partners plan to use this report and the comprehensive database created to support it to make strategic decisions in the coming months. Report authors: Smisha Agarwal, Leona Rosenblum, Tamara Goldschmidt, Michelle Carras, Neha Goel, and Alain B. Labrique.

Health Assessment and Planning for Scale (MAPS): Not your ordinary toolkit

One of the main criticisms of digital health in recent years has been the failure to scale many of the exciting pilot projects developed around the world. In response to this frustration, the World Health Organization, the United Nations Foundation and GmI worked together to develop a toolkit for program implementers and policymakers—designed to assess and plan digital projects for scale. The MAPS Toolkit is a comprehensive self-assessment and planning guide for projects seeking to scale up and achieve long-term sustainability of their mHealth solutions.

The Toolkit provides a series of six self-assessment scorecards, spanning domains considered to be essential to the scalability and growth potential of a digital health program. From the scientific groundwork and human resource capacity to financial health and technology architecture, the Toolkit is built to provide a quantitative "score" for project managers, identifying areas which may need strengthening to maximize the probability of scale. The criteria were developed based on extensive fieldwork and feedback from dozens of programs around the world.