ICTworks

We all know the dangers of “pilotitis” in the ICT4D and mHealth space. The potential for new ideas and innovations is seemingly limitless, but challenges arise when we try to make these ideas lead to long-lasting impact. Each of us is seeking the magic formula for sustainability, and the Principles for Digital Development go a long way to providing guidance for this. But what does this look like in real life?

PATH, an international nonprofit organization working to save lives and improve health, has recently beaten pilotitis with two successful digital health innovations in Vietnam that have transitioned into government-led national systems within just a few years. A closer look at the key elements of project design and implementation may hold answers ripe for replication in scaling up similar programs.

ImmReg Digital Immunization Registry

The first innovation was ImmReg; a digital immunization registry introduced in 2012. ImmReg allows vaccination records to be stored electronically, reducing human error and allowing health staff to allocate more time to patient care instead of paperwork.

Leveraging the knowledge that nearly all Vietnamese adults now have a mobile phone, ImmReg also sends appointment reminders via SMS. An evaluation in 2015 found that ImmReg had significantly increased the number of children achieving timely full vaccination coverage.

In 2015, in southeastern Vietnam’s Ba Ria-Vung Tau province, PATH devised a similar method to tackle the rising challenge of multidrug-resistant tuberculosis (TB). Using the combined system of patient-tracking software and SMS reminders, patients are automatically reminded to take medication and attend appointments—increasing adherence to treatment and reducing the risk of drug resistance.

In 2017, the Vietnam Ministry of Health (MOH) and the National TB Program decided to roll out ImmReg (as part of the National Immunization Information System [NIIS]) and the mHealth TB adherence tool nationwide with their own resources.

This fantastic result is not only because ImmReg and the TB mHealth tool are effective innovations in their own right, but because of four ways that the two pilots were devised and implemented.

1. Designing for scale

As well as working closely with local health authorities to ensure each intervention met the needs of day-to-day users, PATH planned for scale-up from the outset by engaging high-level government advocates from the very beginning.

By keeping Vietnam’s National Expanded Immunization Program (NEPI) and the National Tuberculosis Control Program (NTP) involved, justifying the efficacy of each innovation was simple, as Vietnamese health authorities had witnessed the evolution of each initiative throughout.

In the case of the mHealth TB adherence tool, PATH ensured that the system was integrated with the pre-existing digital database, the Vietnam TB Information Management Electronic System (VITIMES), from the outset, allowing for a smooth transition from pilot to national system.

2. Building for sustainability

Digitizing health records and systems is often accompanied by a daunting upfront price tag. Demonstrating return on investment is therefore critical to whether a pilot program can be viable on a larger, more permanent scale. ImmReg conducted a cost-benefit analysis, which showed that an estimated US$673,000 would be saved each year by switching from paper-based vaccination reminders to SMS reminders.

3. Being data driven

Equally important to gathering pilot cost data is producing measurable data on impact. Thorough data collection and evaluations of health impact were conducted for both innovations in collaboration with local partners. The results were then disseminated among national-level advocates. Combining measurable health outcome data with cost-benefit analysis enabled the MOH to assess the cost-benefit ratio and feasibility for national scale-up.

In the case of the mHealth TB tool, PATH and the NTP’s evaluation was included in official instructions distributed to provincial-level authorities nationwide as justification for the introduction of the system.

4. Design with the (future) user

Both ImmReg and the TB mHealth adherence tool were designed for the public health system, and engaged local public health workers in the design, testing, and development of the tool. However, Vietnam is witnessing rapid growth of private and fee-based health services. PATH, the MOH, and telecommunications partner Viettel have recognized this and are already designing the NIIS to link with and serve this sector, so as not to enable a segmented public versus private record system.

An NIIS digital information portal currently in development will enable citizens to use smartphones or computers to access their own immunization records and schedule fee-based vaccination appointments online in both public and private clinics.

Our End Result: Scaling Up

Pushing a pilot out of its fledgling stages is never easy, but PATH has achieved this in Vietnam by looking at what end-users needed, analyzing current trends in technology use, and facilitating scale-up through early and continual inclusion of the national government. PATH also gathered the necessary data to demonstrate improved health outcomes and cost-effective strategies.

These real-world examples of the Principles for Digital Development contribute to a catalogue of best practices and lessons learned which can support others in the development of sustainable digital health innovations.

By Parysa Oskouipour a freelance communications consultant and Louise Cotrel-Gibbons, the Mekong Regional Communications Officer for PATH.