Digital health solution characteristics |
Perceived value | The solution responds to the needs of various actors. Example:FLHW data capture and decision-support solutions streamline data collection systems and improve the timeliness, quality, accessibility and use of data. Direct to FLHW solutions affordable, standardised and logistically simple mechanism to refresh face to face training and fill in knowledge gaps.
| Institutionalises support, supervision, and performance monitoring. For FLHW data capture and decision-support tools, the solution should move beyond data capture for report generation to use of data at multiple levels of the health system to improve provider performance and quality of service delivery.
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Adaptability | Configurable software is seen as a more scalable approach which can accommodate differences in state-level health programmes and priorities. Extensibility is driven by infrastructure and telecommunications connectivity choices.
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Data storage and governance | Use of high-quality cloud-based data storage (eg, Mobile Academy). Features of data governance, including data privacy, access, consent, not considered to be a key enabler of scale. Failure to prioritise data governance features have likely had adverse consequences on consent capture at the front lines.
| Data governance largely not considered, but understood by some as concerning. Evolving data protection legislation is likely to have impact on data capture, procedural access controls, and consent processes.
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Actor roles and relationships |
Government champions | | Sustained engagement from influential government actors critical. The movement (due to transfer, retirement, other) of these champions is a significant barrier to sustainability. NDHM would also be a factor in enabling sustainability—so not an individual champion but a government champion if you will.
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Stakeholder networks | Important to scaling digital tools for FLHWs Example: A government champion pushing CAS forward to approve decision to scale. | Argued as key to longevity of digital tools for FLHWs Example: For Mobile Academy, importance of cultivating deeper relationships going down to all implementers/FLHWs and broader buy-in to ensure the programme continues when there is turnover of key individuals. Or the NCD one that allows for adding other services. |
FLHW engagement | FLHWs are supported to use technologies | Continuous FLHW engagement and feedback is integral to the longevity of the digital tool Example: FLHWs value and demand the tool, and want it fixed if it breaks or crashes. |
Implementation processes |
Investing in evidence | Formative research used to design solutions Example: Some cases underwent extensive user testing and embedded development (MA, NCD app, TECHO+), while others were first developed by technology partners with specifications/data capture features stipulated, and then adjusted when implemented (ANMOL). | |
Operationalisation | Programme roll-out fosters FLHW engagement and ensures digital tool addresses FLHW needs Varied perspectives on whether to discontinue use of paper records immediately, or in phases. Procurement processes are initiated at the outset of the programme versus at the point of transition to government.
| Programme roll-out fosters FLHW engagement and ensures digital tool addresses FLHW needs Procurement processes are initiated at the outset of the programme versus at the point of transition to government.
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Evolving stakeholder roles and relationships | | Concerns about government capacity to ensure handovers. Government funding is important but not necessarily sufficient for sustainability, as even with government funding, programmes could still be cancelled.
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Context |
National-state dynamics | Standardised model for national-level to state-level scaling up does not exist. Several notable examples of state-level solutions which have scaled. National government leadership in establishing standards for interoperability.
| Requires more robust data governance in long term Example: The national government could create an ecosystem and standards within which states can innovate. If this standardisation is in place, each state can have its own system using a common API and all the systems can speak to each other and state level data can be fed into a central database. |
Interoperability | Intersectoral collaboration between government ministries required to reach agreement on common architecture and standards for interoperability. | Intersectoral collaboration between government ministries required to reach agreement on common architecture and standards for interoperability. Need to mandate adherence to standards once agreed on Example: It is important to ensure that all digital platforms built by all Ministries are interoperable with each other to eradicate siloed approaches to the delivery of healthcare, nutrition and other social services.
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