Universal health coverage is one of the key targets within Sustainable Development Goal 3 on ensuring healthy lives and well-being for all ages, with estimates that achieving UHC could help prevent 8.6 million deaths annually.
“We actually found that the barriers were a lot fewer than the opportunities.”— Jessica Heinzelman, vice president of growth, Nivi
However, evidence suggests that any increased access to care driven by UHC may not result in better health outcomes if the care provided is not of high quality. The use of smartphones and new mobile and portable devices is helping to improve the quality of care, but ensuring coverage for all means combining this with understanding the needs of marginalized voices, including women.
Bernardo Mariano, CIO and director of WHO’s department of digital health and innovation, says there are two branches to WHO's digital health work.
So how do we design quality care interventions that truly serve the needs of all women? How can technology be used not only to enable women to more easily access care, but also to drive and inform the quality of care they receive? And how can such tools be used to amplify the voices of women and girls, and inform policy to help drive better health outcomes for all?
A variety of ways to answer these critical questions were discussed at Devex’s Prescription for Progress: Bringing health solutions to scale conference in San Francisco on Feb. 20. At a special, interactive workshop session hosted by Devex and MSD for Mothers, titled “Moving beyond access: Using digital to integrate the voices of women to improve quality of care,” attendees discussed how women can be empowered through technology, placed at the center of shaping their own care and accessing health services, and helped to overcome the restraints of systems that are often designed top-down on the path to UHC.
These are the five key takeaways from the workshop.
1. Digital tools have real potential to increase access to health care for women and elevate and integrate their experiences
There is significant potential for mobile and portable technology tools to rapidly scale up access to health care services and information for women. Identifying such options is crucial, given that lack of access to care-related information contributes to preventable deaths.
Services such as Nivi provide a conversational platform that enables users to ask questions around family planning, receive personalized information, and connect to nearby health services.
There is still a long way to go to ensure access to quality health services for women everywhere, but attendees at the event pointed out that such digital tools can allow segments of society such as young girls and adolescents to speak more freely away from the constraints imposed by cultural and political norms.
Digital tools also aid the dissemination of much-needed information on pregnancy and contraception. In South Africa, MomConnect, an initiative by the country’s National Department of Health, sends regular free mobile-based messages in 11 different languages to pregnant women and enables interactive feedback.
“We need to ensure digital tools reach women at the last mile, because we already see examples of how marginalized voices are using these platforms to drive change,” said Dr. Mary-Ann Etiebet, lead and executive director at MSD for Mothers.
“People may feel safe there, it’s anonymous, and the connections with other people who are facing the same challenges, create a sense of community and momentum for mobilization and action,” Etiebet said.
2. Countries need access to the wide variety of health data collected from digital tools for use in adapting their health strategies while safeguarding user privacy
Health data collected from the use of digital resources can offer hugely valuable insights if harnessed by national health authorities, said attendees. But when data is managed by third parties such as NGOs or the private sector, it may not end up incorporated into national systems — posing the risk that learnings will be overlooked.
That requires solutions for gathering this information. Attendees at the workshop called for the establishment of community data centers to act as central points for managing data, allowing critical information to be stored in one place.
Though this data has the potential to be valuable in informing health strategies and national action plans, concerns remain around privacy and fears of government accessing data, so methods must be in place to ensure data is properly protected and anonymized in a way that people can trust.
3. The internet expands opportunities to self-educate on health, but a strong presence is still needed from health workers to further educate and eliminate misinformation
As internet connectivity continues to grow worldwide and smartphones come down in price, the number of people using online resources to self-educate on health is rising.
“Smartphones are now coming in progressively and it’s a world where they’re almost as cheap as [earlier generation] feature phones, so you can have more two-way communication, more hand-holding of families with respect to the conditions that they have risk factors for,” said Dr. Aparna Hegde, founder and managing trustee at the nonprofit ARMANN, which creates scalable programs using technology to impact maternal and child health.
Attendees highlighted that many issues at a community level stem from a lack of awareness about many health issues, meaning wider accessibility is a positive development.
Yet to avoid the spread of misinformation on these platforms, technology should not be over-relied upon at the expense of direct human communication, said attendees.
“We need to think about intermediaries and where we can have the kind of face-to-face that can either pull community conversations into digital or vice versa,” Etiebet said. “We can’t think that [technology] is the be-all and end-all. Not everyone is connected and there [can be] unintended consequences.”
There is still a need for community health workers to provide support by conveying health messages to inform and educate users, and answering their questions — especially as some communities still lack access to smartphones and data is often expensive.
4. Self-diagnostic health tools and online information hold promise if there is robust back-up from physicians to minimize unintended risks.
The rise in connectivity also means more tools for self-diagnosis — from smartphone-based microscopes for analyzing blood to mobile ultrasound devices. Interest in using these tools, which have the potential to further expand access, is gaining significant traction in communities.
At the same time, they carry clear risks. Self-diagnosis is difficult without medical expertise and people may reach the wrong conclusions rather than getting the professional help they need.
It is therefore important to again find methods to link back to support from local and national health systems, and follow up with providers; self-diagnosis tools are only one component of a full continuum of care for women and families. This is challenging given the lack of access to health practitioners, with the World Health Organization predicting a shortfall of 18 million health workers by 2030, but is again aided by the increasing ubiquity of mobile devices and the possibility of methods such as teleconferencing.
Community health workers have a part to play here too; for endemic diseases such as malaria, one option is to give them a focal point for aiding self-diagnosis. “You could have some simple diagnostic tools in the hands of community health workers, who can then be the ones facilitating diagnosis in the village,” Hegde said.
5. Women must be involved in the creation of new technologies to make sure they are addressing their needs
There are other key challenges to keep in mind with technology too. For one, when designing a service, it is important to ensure that the economics for scaling up make sense, as a tool’s success depends on financial sustainability.
There are also technology barriers for those who can’t read or lack access to a smartphone. One option being harnessed is the use of automated interactive voice calls as a push service for information, as well as conference calls.
Attendees also highlighted that not enough women were being involved in actually creating new health tools — something that needs to happen to fully address their needs. And ultimately, there was a feeling that it is important to use technology as an enabler and not a standalone method.
Yet if the challenges can be overcome, digital tools have significant potential to aid with giving women and other marginalized groups a voice.
“We actually found that the barriers were a lot fewer than the opportunities,” said Jessica Heinzelman, vice president of growth at Nivi. “Digital helps us reach the specific audience that we want to talk to at scale … while also overcoming taboos and stigma through the use of private messaging channels.”
The Funding the Future series is supported by funding from MSD, through its MSD for Mothers program and is the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.