Rockefeller Foundation 2010 Annual Report

Contains president's letter; 2010 program highlights, including support for Africa's green revolution, sustainable and equitable transportation policy, and healthy communities; grants list; financial report; and lists of trustees and staff

The Contribution of Digital Technologies to Service Delivery: An Evidence Review

The explosion in digital connectivity, globalisation and the rapid growth in digital technologies over the last two decades has revolutionised the way that businesses perform and compete globally. Governments around the world have been put under strong pressure to transform themselves into electronic governments, in recognition of the efficiencies brought about by the appropriate use of information communication technologies (ICTs) in businesses and the need for development. The aim has been to maximise the state’s capacity to serve its stakeholders: namely citizens, business, employees and other government and non-government agencies. E-government or digital government has been a significant feature of public sector reform in recent years in both developed and developing countries with a substantial amount of resources dedicated to the development of necessary systems and infrastructure. Yet the transformational potential of digital for development risks not being replicated in the real world. Large-scale and sustainable use of ICTs for education is not yet being realised in developing countries, despite the fact that digital technologies have the potential to reduce costs and strengthen education systems. In the field of health care, mHealth systems are reaching significant scale in many developing countries but there is still a lack of concrete evidence with which to fully assess the economic impact of these technologies. This report explores and assesses the evidence for the impact and use of digital technologies in development, identifying cross-cutting themes that are important for use, implementation and scale-up. These include funding and infrastructure, policy commitments by government, skills and leadership.UK Department for International Developmen

Accountability in Health Systems and the Potential of mHealth

The rapid spread of information and communication technologies (ICTs) (and of mobile phones in particular) across low- and middle-income countries (LMICs) has generated considerable excitement in development circles regarding their potential to revolutionise service delivery in health systems. Broadly speaking, such innovations, widely referred to as mHealth, make possible new ways of collecting, collating and managing health and health service-related data, and novel means of communication between and among citizens, civil society, health service personnel and government actors. This can empower citizens to better understand, care and advocate for their own health; health workers to deliver improved services; and government actors to enforce or build health policies that uphold the health rights of all citizens, including poor and marginalised groups who are often systematically excluded from health systems. As mHealth is in its infancy, and most projects to date have been small in scale, this potential is still being tested. Furthermore, most research has focused on the extent to which mHealth has improved service delivery and/or health outcomes in the short term. There has been little explicit attention given to whether and how mHealth might improve accountability for public health services – that is, to what extent mHealth can enhance citizens’ abilities to demand improved services from providers and government in line with their rights, and/or augment the capacity and willingness of providers and government to respond to citizens’ needs and demands – both in the short and the long term. This Working Paper aims to begin to fill this gap by exploring literature on accountability in health systems and on mHealth and to build theoretical and empirical bridges between them. In so doing, we lay out a clearer understanding of the role that mHealth can play in accountability for public health services in LMICs, as well as its limitations. At the centre of this role is technology-facilitated information which, for instance, can help governments enforce and improve existing health policy, and which can assist citizens and civil society to communicate with each other to learn more about their rights, and to engage in data collection, monitoring and advocacy. Ultimately however, information, facilitated as it may be by mHealth, does not automatically lead to improved accountability. Different forms of health care come with different accountability challenges to which mHealth is only variably up to task. Furthermore, health systems, embedded as they are in diverse political, social and economic contexts, are extremely complex, and accountability requires far more than information. Thus, mHealth can serve as a tool for accountability, but is likely only able to make a difference in institutional systems that support accountability in other ways (both formal and informal) and in which political actors and health service providers are willing and able to change their behaviour.Future Health Systems Research Programme ConsortiumMaking All Voices CountUnited States Agency for International DevelopmentSwedish International Development Cooperation AgencyOmidyar NetworkUK Department for International DevelopmentEconomic and Social Research Counci

EXAMINING FACTORS INFLUENCING INTENTION TO USE M-HEALTH APPLICATIONS FOR PROMOTING HEALTHIER LIFE AMONG SMARTPHONE USERS IN TANZANIA

Deaths related with Non-Communicable Diseases (NCDs) have recently increases, similarly, development of mobile technologies have paved a way in which Smartphone users can use m-health applications to address high level of sedentary behaviours that relates to negative health consequences. Therefore, this study was conducted to examine factors which may influence generation Y who are Smartphone users to adopt m-health applications in controlling NCDs in Tanzania. TAM theory was extended with awareness, trust and perceived cost to develop a research conceptual model of this study. Google form was used to developed online questionnaire which was distributed through social media platforms to respondents. Furthermore, other questionnaires were physically administered using snowball sampling through Drop-off / Pick-up method. A total of 396 valid and reliable questionnaires were received and used for data analysis. IBM-SPSS software was used to analyze the hypothesized relationships. Findings show that trust, perceived usefulness and perceived ease-of-use have significant influences on behaviour intention to adopt m-health applications in controlling NCDs. Nevertheless, awareness and perceived cost were found to have no significant effects on behaviour intention to adopt m-health applications. The study has provided theoretical and practical implications for researchers, m-health application owners and developer

eRegistries: Electronic registries for maternal and child health

Background: The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women’s, Children’s and Adolescent’s Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. Methods: In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middleincome countries, and a systematic search of literature from 2005–2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. Results: eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paperbased data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. Conclusions: Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children

The Impact of the Digital Health Interventions in Curbing COVID-19 in Zimbabwe

Amid ongoing research about, Digital Health Interventions (DHI) in Zimbabwe, is the largely overlooked impact of DHI to mitigate the spread of COVID-19. To contribute towards filling this knowledge gap, the study seeks to examine the DHI strategies that have been adopted to curb the inimical effects of COVID-19 in Zimbabwe. DHI such as telemedicine, use of social media, Electronic Medical Records (EMRs), Mobile Health (mHealth), and Healthcare Information Systems (HIS) have been disposed to curtail the spread of COVID-19. The limitations and hurdles crippling DHI are discussed extensively. This study adopts a qualitative research design, comprising personal and targeted interviews and documentary review. Preliminary findings are that DHIs are effectively working for employing routine and innovative forms of Information and Communications Technology (ICT) to address health needs. However, the research noted that various factors such as corruption lack of funding, shortage of qualified workforce and medical expertise, and weak healthcare infrastructure are militating against robust deployment of DHIs. This study includes measures that can be adopted to address these challenges

Transforming Health Systems Initiative: Midterm Evaluation

The Rockefeller Foundation is currently in the midst of a five year, $100Million initiative called "Transforming Health Systems" – which aims to helpdeveloping world countries improve health services and financial protection(from the cost of health services) for their overall populations.At the halfway point, the foundation embarked on an independent evaluation,led by consultant Arnon Mishkin, to record the progress that has been made,examine the strategy and impact to date to identify opportunities for midcoursecorrections, as needed

Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: a literature scoping review and framework for designing chronic services

BACKGROUND: Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis and treatment in underserved communities. In this scoping review, we catalogued, described, and appraised community-based care models for aHT in sub-Saharan Africa, considering their acceptability, engagement in care and clinical outcomes. Additionally, we developed a framework to design and describe service delivery models for long-term aHT care. METHODS: We searched relevant references in Embase Elsevier, MEDLINE Ovid, CINAHL EBSCOhost and Scopus. Included studies described models where substantial care occurred outside a formal health facility and reported on acceptability, blood pressure (BP) control, engagement in care, or end-organ damage. We summarized the interventions' characteristics, effectiveness, and evaluated the quality of included studies. Considering the common integrating elements of aHT care services, we conceptualized a general framework to guide the design of service models for aHT. RESULTS: We identified 18,695 records, screened 4,954 and included twelve studies. Four types of aHT care models were identified: services provided at community pharmacies, out-of-facility, household services, and aHT treatment groups. Two studies reported on acceptability, eleven on BP control, ten on engagement in care and one on end-organ damage. Most studies reported significant reductions in BP values and improved access to comprehensive CVDs services through task-sharing. Major reported shortcomings included high attrition rates and their nature as parallel, non-integrated models of care. The overall quality of the studies was low, with high risk of bias, and most of the studies did not include comparisons with routine facility-based care. CONCLUSIONS: The overall quality of available evidence on community-based aHT care is low. Published models of care are very heterogeneous and available evidence is insufficient to recommend or refute further scale up in sub-Sahara Africa. We propose that future projects and studies implementing and assessing community-based models for aHT care are designed and described according to six building blocks: providers, target groups, components, location, time of service delivery, and their use of information systems

Pocantico II: The Global Challenge of Health Systems, 2007

Summarizes discussions among global health leaders at a September 2007 meeting on public health monitoring, professional competencies, access to technologies and innovations, improving systems with information technology, and leveraging private sectors

What’s Past Is Prologue: A Scoping Review of Recent Public Health and Global Health Informatics Literature

Objective: To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014. Methods: We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups. Results: A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we observed a small but growing set of articles that measure the impact of ICT on clinical outcomes. Discussion: There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles. Conclusion: While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in eHealth by governmental health agencies