Digital health tools slowing COVID – and will help long after pandemic subside

Over the past 18 months, tech and health leaders around the world have collaborated on a range of smart digital tools that are not only helping countries detect COVID and deliver care during the pandemic, but also have the potential to transform health care long after the pandemic subsides.

The development and launch of dozens of new smartphone apps are demonstrating the power of digital tools, and expediting their uptake and reliance in low- and middle-income countries. In helping frontline health workers deliver and improve care in remote communities, close gaps in access to care, and strengthen health systems, these apps provide a potential pathway to improving health outcomes for decades to come.

“COVID is presenting us a once-in-a-generation opportunity to help health systems leapfrog to mobile platforms that can dramatically improve access and outcomes for patients, lower costs for providers, and detect and respond to outbreaks earlier and better than ever,” said Chuck Slaughter, managing director of The Goldsmith Foundation and founder of Living Goods.

During one of the most severe COVID-19 outbreaks on the African continent, for example, South Africa and its partner Praekelt.org launched a suite of new digital health tools called HealthConnect. They have now adapted these tools, as the pandemic has shifted, to address changing needs – including those beyond COVID.

“What started out as a tool to deliver timely pandemic related information at scale has expanded and evolved into a digital front door to the health system,” said Debbie Rogers, CEO of Praekelt.org. “COVID drove home the need for real-time data. Normally, it takes two or three years to get national data. But with our digital tools, we are collecting data 24 hours a day and can analyze data daily, and the National Department of Health and National Institute for Communicable Diseases can use that up-to-date information to inform a variety of decisions, such as where CHWs might best be employed.”

“The pandemic,” added Rogers, “has thrust health into a new digital age.”

South Africa’s Department of Health and Praekelt.org took an iterative approach in developing and launching HealthConnect. First came an app called HealthAlert, which provides free, trusted information on COVID via a simple menu. This tool was developed in under two weeks and reached more than four million families within its first 60 days. Next, they created another tool on the same platform called HealthCheck, that helped users better determine if they were showing potential COVID symptoms and if they needed testing. Schools and health facilities are using this tool to conduct daily screening of students and front-line health workers, track the outbreak and ensure anyone with symptoms does not go to work or school.

By the end of 2020, HealthConnect had reached over eight million users – about 25 percent of the country's population. Given that many phones are shared by families in South Africa, the actual reach and impact may be as much as half the country. HealthConnect is accessed by smart phones via WhatsApp, or feature phones via USSD, and is free, with no data rates applying.

In May, the partners expanded the digital tool again to help South Africans register and schedule vaccinations. So far, 4.3 million South Africans have done so through the platform – including 2,140 people who are over 99 years old – demonstrating its ease of use or perhaps that the tool is being used collectively by multi-generational families.

Lastly, the partners have developed and included in the suite of tools a survey function. Thus far, more than 270,000 South Africans have participated by sharing their thoughts and concerns about COVID-19 vaccinations and more than 900,000 South Africans have opted in to receive weekly or timely alerts via WhatsApp. The ongoing polling has allowed health leaders to both adjust messaging and media campaigns as needed and to share targeted messaging tailored to specific concerns.

“Someone who, for example, might have religious concerns about the vaccine might be sent a message with a link to a video of a religious leader endorsing the vaccine,” said Rogers. “We know it is going to take a lot of effort to get hesitant people vaccinated. We need to start by not just communicating with these people but understanding them.”

These digital tools are poised to outlast the pandemic.

Already, South Africa has expanded use of the tools beyond COVID to address tuberculosis. And the WHO has partnered with Praekelt.org to produce a similar digital engagement tool to support anti-tobacco efforts.

Within a week of Vietnam’s first reported case of COVID-19, the government began work on the NCOVI app which helps patients self-diagnose and report COVID, helping health leaders quickly identify potential hotspots. As of March 2021, NCOVI had been downloaded by 20 percent of the population. Data from NCOVI and Bluezone, a contact tracing app, feed directly into a large database managed by the Ministry of Health and are playing a vital role in bolstering and targeting the country’s COVID response, experts say.

Health leaders in Uganda and Kenya, with support from Living Goods, quickly modified their Smart Health App, which is used by 10,000 community health workers (CHWs) who serve more than eight million people, to help them adapt to the challenge of COVID. The app automates diagnoses, follow-ups, and reports illnesses in real time to health leaders at all levels of government. Health leaders quickly modified it to support COVID-safe low-touch assessments, remote supervision, and patient calls for help. They also used their SMS communication platform to quickly train CHWs on COVID basics as well as patient education to prevent COVID transmission. A review of government data in Kenya and Uganda found that during the pandemic, demand for care in locations where CHWs were not equipped with the Smart Health app declined (in some cases as much as 35 percent), while demand for malaria, pneumonia, vaccinations, and prenatal care in the areas where CHWs had Smart Health app increased, in some cases by as much as 50 percent.

Each of these digital tools share a few key traits. They focus on empowering patients and use mobile tools to radically expand access to vital information and care. They emphasize simplicity and access as a path to rapid scale and impact. They are all built on effective pre-existing public-private partnerships between forward thinking government leaders and capable technology-driven partners. And, importantly, they provide critical support to frontline health workers to maximize their impact during this pandemic and beyond.

For those with more interest in digital tools for health, the WHO's Classification of Digital Health Interventions provides an overview of digital technologies and how they can help address specific challenges in health systems.