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Publications

Filtering by Category: ICTs

Gender dynamics in digital health: Overcoming blind spots and biases to seize opportunities and responsibilities for transformative health systems

Future Health Systems

George, A, Morgan, R, Larson, E and LeFevre, A (2018) Gender dynamics in digital health: Overcoming blind spots and biases to seize opportunities and responsibilities for transformative health systems, Journal of Public Health, fdy180, DOI: 10.1093/pubmed/fdy180

Much remains to ensure that digital health affirms rather than retrenches inequality, including for gender. Drawing from literature and from the SEARCH projects in this supplement, this commentary highlights key gender dynamics in digital health, including blind spots and biases, as well as transformative opportunities and responsibilities. Women face structural and social barriers that inhibit their participation in digital health, but are also frequently positioned as beneficiaries without opportunities to shape such projects to better fit their needs. Furthermore, overlooking gender relations and focussing on women in isolation can reinforce, rather than address, women’s exclusions in digital health, and worsen negative unanticipated consequences. While digital health provides opportunities to transform gender relations, gender is an intimate and deeply structural form of social inequality that rarely changes due to a single initiative or short-term project. Sustained support over time, across health system stakeholders and levels is required to ensure that transformative change with one set of actors is replicated and reinforced elsewhere in the health system. There is no one size prescriptive formula or checklist. Incremental learning and reflection is required to nurture ownership and respond to unanticipated reactions over time when transforming gender and its multiple intersections with inequality.

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How can mobile phones be used to improve nutrition service delivery in rural Bangladesh?

Future Health Systems

Khan NU, Rasheed S, Sharmin T, Siddique AK, Dibley M and Alam A (2018) How can mobile phones be used to improve nutrition service delivery in rural Bangladesh?, BMC Health Services Research, 18(1):530, DOI: 10.1186/s12913-018-3351-z

Nutrition has been integrated within the health services in Bangladesh as it is an important issue for health and development. High penetration of mobile phones in the community and favourable policy and political commitment of the Government of Bangladesh has created possibilities of using Information Communication Technology such as mobile phones for nutrition programs. In this paper the implementation of nutrition services with a specific focus on infant and young child feeding was explored and the potential for using mobile phones to improve the quality and coverage of nutrition services was assessed.

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‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information

Future Health Systems

Waldman L, Ahmed T, Scott N, Akter S, Standing H and Rasheed S (2018) ‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information, Globalization and Health, 14:31, DOI: 10.1186/s12992-018-0349-6

Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers’ control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students’ usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this.

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ICT-Facilitated Accountability and Engagement in Health Systems: a Review of Making All Voices Count mHealth for Accountability Projects

Future Health Systems

Information and communication technologies (ICTs) and mHealth innovations hold great potential to improve health systems and health outcomes while at the same time enhancing citizen engagement and accountability. Yet there has been little assessment of the impact of mHealth innovations on the ground. 

This paper reviews the experiences of seven mHealth initiatives funded by the Making All Voices Count programme: OurHealth, eThekwini WACs and Thuthuzela Voices (all in South Africa), Mobile Mapping for Women’s Health (Tanzania), Text2Speak (Nigeria), SMS Gateway (Indonesia) and Citizen Journalism for Quality Governance of Universal Health Insurance Scheme (also Indonesia). It discusses the accountability model adopted by each project, and the challenges they faced. 

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Accountability in Health Systems and the Potential of mHealth

Future Health Systems

This Working Paper explores the literature on accountability in health systems and on mHealth and to build theoretical and empirical bridges between them. In so doing, the authors 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. 

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Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh

Future Health Systems

Khatun F, Heywood AE, Hanifi SM, Rahman MS, Ray PK, Liaw ST and Bhuiya A (2017) Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh, BMC health services research, 17:573, DOI: 10.1186/s12913-017-2523-6

Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.

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Beyond pilotitis: taking digital health interventions to the national level in China and Uganda

Future Health Systems

Huang F, Blaschke S and Lucas H (2017) Beyond pilotitis: taking digital health interventions to the national level in China and Uganda, Globalization and Health, 13:49, doi: 10.1186/s12992-017-0275-z

Innovation theory has focused on the adoption of new products or services by individuals and their market-driven diffusion to the population at large. However, major health sector innovations typically emerge from negotiations between diverse stakeholders who compete to impose or at least prioritise their preferred version of that innovation. Thus, while many digital health interventions have succeeded in terms of adoption by a substantial number of providers and patients, they have generally failed to gain the level of acceptance required for their integration into national health systems that would promote sustainability and population-wide application. The area of innovation considered here relates to a growing number of success stories that have created considerable enthusiasm among donors, international agencies, and governments for the potential role of ICTs in transforming weak national health information systems in middle and low income countries. This article uses a case study approach to consider the assumptions, institutional as well as technical, underlying this enthusiasm and explores possible ways in which outcomes might be improved.

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ICTs and the challenge of health system transition in low and middle-income countries

Future Health Systems

Bloom G, Berdou E, Standing H, Guo Z and Labrique A (2017) ICTs and the challenge of health system transition in low and middle-income countries, Globalization and Health, 13:56, doi: 10.1186/s12992-017-0276-y

The aim of this paper is to contribute to debates about how governments and other stakeholders can influence the application of ICTs to increase access to safe, effective and affordable treatment of common illnesses, especially by the poor. First, it argues that the health sector is best conceptualized as a ‘knowledge economy’. This supports a broadened view of health service provision that includes formal and informal arrangements for the provision of medical advice and drugs. This is particularly important in countries with a pluralistic health system, with relatively underdeveloped institutional arrangements. It then argues that reframing the health sector as a knowledge economy allows us to circumvent the blind spots associated with donor-driven ICT-interventions and consider more broadly the forces that are driving e-health innovations. It draws on small case studies in Bangladesh and China to illustrate new types of organization and new kinds of relationship between organizations that are emerging. It argues that several factors have impeded the rapid diffusion of ICT innovations at scale including: the limited capacity of innovations to meet health service needs, the time it takes to build new kinds of partnership between public and private actors and participants in the health and communications sectors and the lack of a supportive regulatory environment. It emphasises the need to understand the political economy of the digital health knowledge economy and the new regulatory challenges likely to emerge. It concludes that governments will need to play a more active role to facilitate the diffusion of beneficial ICT innovations at scale and ensure that the overall pattern of health system development meets the needs of the population, including the poor.

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New Digital Ways of Delivering Sex Education: A Practice Perspective

Future Health Systems

Waldman L and Amazon-Brown I (2017) New Digital Ways of Delivering Sex Education: A Practice Perspective, IDS Bulletin, Institute of Development Studies, DOI: 10.19088/1968-2017.104

This article explores new, under-researched genres of sex education for adolescents in sub-Saharan Africa resulting from access to the internet through mobile phones. It examines the history of developing online health information platforms tailored for youth through the experiences of digital developers and the reflections of users.

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Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration

Future Health Systems

Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw S-T (2016) Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration, International Journal of Medical Informatics, Volume 93, pp 49–56, DOI: 10.1016/j.ijmedinf.2016.05.010

There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.

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Determinants of readiness to adopt mHealth in a rural community of Bangladesh

Future Health Systems

 

Khatuna F, Heywood AE, Ray PK, SMA Hanifi, Bhuiya A, Liaw ST (2015) Determinants of readiness to adopt mHealth in a rural community of Bangladesh, International Journal of Medical Informatics, Volume 84, Issue 10, Pages 847–856, http://dx.doi.org/10.1016/j.ijmedinf.2015.06.008

Evidence in favour of mHealth for healthcare delivery in settings where trained health workforce is limited or unavailable is accumulating. With rapid growth in access to mobile phones and an acute shortage of health workforce in Bangladesh, mHealth initiatives are increasing with more than 20 current initiatives in place. “Readiness” is a crucial prerequisite to the successful implementation of telehealth programs. However, systematic assessment of the community readiness for mHealth-based services in the country is lacking. This article reports on a recent study describing the influence of community readiness for mHealth of a rural Bangladesh community.

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Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh

Future Health Systems

Khan NUZ, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, Hanifi SMA, Hoque S, Iqbal M and Bhuiya A (2015) Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh, BMC Medical Informatics and Decision Making, 15:62, doi:10.1186/s12911-015-0188-9

Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. This study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention.

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Sexual and reproductive health and rights and mHealth in policy and practice in South Africa

Future Health Systems

Waldman, L. and Stevens, M. (2015) Sexual and reproductive health and rights and mHealth in policy and practice in South Africa, Reproductive Health Matters, Vol 23, Issue 45, PP 93 - 102, doi:10.1016/j.rhm.2015.06.009

Information and Communications Technology (ICT) offers enormous opportunity and innovation to improve public health and health systems.This paper explores the intersections between mHealth and sexual and reproductive health and rights in both policy and practice. It is a qualitative study, informed by policy review and key informant interviews. Three case studies provide evidence of what is happening on the ground in relation to ICTs and reproductive health and rights.

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Understanding Health Information Seeking from an Actor-Centric Perspective

Future Health Systems

This paper presents a conceptual approach for discussing health information seeking among poor households in Africa and Asia. This approach is part of a larger research endeavor aimed at understanding how health systems are adapting; with possibilities and constraints emerging. These health systems can be found in a context of the changing relationships between states, markets and civil society in low and middle income countries. The paper starts from an understanding of the health sector as a “health knowledge economy”, organized to provide people with access to knowledge and advice. The use of the term “health knowledge economy” draws attention to the ways the health sector is part of a broader knowledge economy changing the way individuals and households obtain and use specialist information. The paper integrates an actor centric approach with the theory of planned behavior. It seeks to identify the actors engaged in the health knowledge economy as a precursor to longer term studies on the uptake of innovations integrating health services with mobile phones, commonly designated as mHealth, contributing to an understanding of the potential vulnerabilities of poor people, and highlighting possible dangers if providers of health information and advice are strongly influenced by interest groups.

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Accelerating learning for pro-poor health markets

Future Health Systems

Given the rapid evolution of health markets, learning is key to promoting the identification and uptake of health market policies and practices that better serve the needs of the poor. However there are significant challenges to learning about health markets. We discuss the different forms that learning takes, from the development of codified scientific knowledge, through to experience-based learning, all in relationship to health markets.

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FHS Bangladesh Research Brief 6: Knowledge of, Attitude towards, and Use of mHealth Services in Chakaria, Bangladesh

Future Health Systems

Bangladesh has a serious shortage of physicians, paramedics, nurses, and midwives. The available qualified care providers are centred in urban areas, resulting in an inequitable access of the rural and disadvantaged sections of the population to healthcare. Under these circumstances, the use of mHealth meaning provision of healthcare services through mobile devices provides a new opportunity to ensure access to quality healthcare services for the population in general, and for people from poorer sections and hard-to-reach areas in particular. There are currently around 20 mHealth service initiatives in the country which are mostly telephone hotlines for consulting physicians and/or obtaining healthcare information. Effectiveness of these services depends on the evidence-informed development of appropriate programmes designed around people’s perceptions of mHealth and user feedback. To that end, FHS Bangladesh partner, ICDDR,B recently conducted a survey on mHealth in Chakaria, a rural area in the southeast coastal area of Bangladesh. This brief presents the findings from this survey.

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Future Health Markets: A meeting statement from Bellagio

Future Health Systems

Policy-makers, entrepreneurs, academics and funders convened at the Rockefeller Foundation Bellagio Center from 10th-14th December 2012 to discuss the changing face of health markets, and in particular to consider future trends in such markets. Their aim was to promote a greater shared understanding and analysis of health market systems, and to consider how markets can better serve the needs of the poor in low- and middle-income countries (LMICs). This report is an attempt to capture the rich discussions held during the meeting, which reviewed the evolution of health markets, identified key drivers of and gaps resulting from their rapid development, and highlighted critical issues that must be tackled to ensure the poorest have access to safe, affordable, effective and equitable health services. The report concludes with recommendations for shaping future health markets as agreed during the meeting.
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WP7 - Provider performance and information and communication technologies

Future Health Systems

There has been much discussion of the role that recent advances in information and communication technologies (ICTs) can play in improving health provider performance, though as yet there seems to be little reliable, independently verified evidence to support the claims of those who initially viewed the new ICTs as offering ―a revolution in global healthcare management‖ (Séror 2001, p. 1). In particular, limited systematic attention has been given to the application of ICTs by private providers in developing countries, with most of the international agencies concerned with these issues tending to focus on large-scale public sector innovations (e.g., Chetley 2006; WHO 2006).
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