Digital tools to strengthen healthcare and improve access for vulnerable populations

This century has seen waves of crises in the form of natural disasters, conflicts and widespread infectious disease. All of these highlight the need to strengthen health system approaches for preparedness and response, locally and globally.  

The COVID-19 pandemic demonstrated that now, more than ever, low- and middle-income countries have a pressing need for resilient health systems that are equipped with adequate measures to respond effectively and efficiently while minimizing impacts on vulnerable populations, including women, girls and refugees, and internally displaced populations. 

Research has repeatedly proven that digital health solutions play a promising role in optimizing levels of care by increasing the availability and accessibility of health services and enhancing data quality, while reducing the burden on health systems. Using the current pandemic as a learning mechanism to identify existing gaps in preparedness and response of health systems, the COVID-19 Innovation and Research Project (CIRP) proposed to investigate the effectiveness of developing and scaling up three digital health innovations to strengthen health systems and improve access to care in at-risk populations in select geographies of Pakistan, Tajikistan, Syria, Kenya and Tanzania. The project is a two-year initiative led by the Aga Khan Development Network’s Digital Health Resource Centre and funded by IDRC. 

The project is integrating the innovations in health systems by forging and maintaining partnerships with local and national health authorities. It uses a multi-pronged applied research approach, which examines the following questions:  

• How effective are the features of artificial intelligence (AI) in contributing to early detection of illness and positively influencing health-seeking behaviours among at-risk populations across the target geographies? 
• To what extent is a teleconsultation-based mobile application effective in improving access to healthcare for hard-to-reach populations in the geographies? 
• How can a solution-based mobile application help change the awareness and behaviour of healthcare providers? 
• Will the proposed digital health innovations be effective, feasible, usable and sustainable within health systems in the geographies?  

Important highlights of this research project include the following: 

• The Personal Protective Equipment Mobile Application (PPEMA) has been used as an eLearning platform to provide evidence-based content on the use of PPE by healthcare workers across low- and middle-income countries. In total, 82 percent of participants reported a change in their knowledge of PPE practices due to the app. Similarly, 82 percent reported that the app influenced a change in their behaviour. These findings were significant across all genders and workplace settings, with the highest improvement among healthcare workers employed in informal settings. 
• VirtualDoc (Elaj Asan) has been used as a telemedicine app offering non-urgent teleconsultations to ensure the provision of services to people — such as the elderly, those with physical disabilities, and women and girls in remote and rural areas — who experience barriers to accessing health services. In total, 98 percent of participants found the app easy to use and 99 percent were satisfied with the platform’s ability to provide remote care, with the highest improvements in satisfaction found among populations living in rural settings. 
• CoronaCheck has been used to provide AI-based risk assessments and reduce the burden on health facilities, disseminate evidence-based material, combat misinformation and provide supportive resources for survivors of gender-based violence. Over 90 percent of users reported that the app resulted in an improvement in their knowledge and behaviour related to COVID-19 prevention and management, and 99 percent reported that they were likely to use the app again. 
• Another important result of this project is the partnerships established with health system stakeholders in different countries, and the ability to leverage these relationships to understand the unique context, challenges and opportunities for technology in each health system. 
• An in-depth gender strategy guided the project’s implementation, monitoring and evaluation, as well as the design of the mobile apps developed during the project. Following this strategy ensured the availability of the platforms to the most vulnerable populations, including women and girls, and addressed key barriers faced by these populations. 

The project is making many contributions: 

• It contributes to the field of study in several ways. There are often concerns that the use of technology can contribute to greater health inequalities, with certain populations benefiting most. However, the results from this multi-country study suggest that when a platform reflects end-users’ needs and capacities, populations residing and working in remote and informal settlements derive the most benefit. 

  At the same time, the nature of the study’s design and financial constraints did not permit a more in-depth evaluation of the related inequalities. Therefore, these results might be prone to social desirability bias (as participants may rate themselves higher for improvements in knowledge and behaviour). Efforts were made to ensure that participants knew that the project did not maintain any information that could identify them. Regardless, the results of these studies do provide the foundation for more in-depth research on how technology can be used to empower populations living in resource-constrained areas — particularly development projects aligned with SDG 3: Good health and well-being, SDG 9: Industry, innovation and infrastructure and SDG 10: Reduced inequalities.

• CoronaCheck: An unexpected outcome was high vaccine hesitancy due to misinformation surrounding COVID-19 vaccines. To mitigate this reality and reduce vaccine hesitancy as vaccines were rolled out across these countries, the team expanded the scope of CoronaCheck to disseminate evidence-based information regarding vaccine safety and efficacy, which eventually proved to be a valuable addition to the app.  
• VirtualDoc: VirtualDoc was customized for each country’s health system and offered as a service-delivery tool that can be integrated within the Hospital Management Information System (HIMS) at Aga Khan Health Services, Tanzania. In addition to its teleconsultation features, the app also offered e-pharmacy options in Pakistan.  
• PPEMA: There was a scarcity of PPE in low-resource settings at the initial stages of the pandemic, along with an influx of grey literature regarding its use. This literature was analyzed in a systematic review. As the pandemic progressed, evidence regarding alternative methods was established and the World Health Organization published clear guidelines on the type of PPE to be used and its correct usage. To ensure PPEMA provides evidence-based awareness, content regarding alternative methods was omitted from the app’s scope. However, to remain dynamic, the team worked to incorporate any content in support of alternative methods, if there was credible evidence in its favour.  
• Mobilize global alliances to support more sustainable and inclusive societies: Governments’ buy-in and feedback helped to increase the use and sustainability of applications beyond the project’s lifetime. Partnerships with local and global entities were also developed and strengthened for future projects and collaboration. 

Learn more about the project. 

Contributors: Avery Carter, Programs and Partnerships Manager, Health, Aga Khan Foundation Canada; Saleem Sayani, Director of the Aga Khan Development Network (AKDN) Digital Health Resource Centre (dHRC); and Momina Muzzamil, Research Specialist, AKDN dHRC