Members’ digital health interventions

By Alison McKinley, Senior Technical Advisor for the Innovation Programme, on behalf of the IPPF COVID-19 Taskforce

Dear Colleagues,

COVID-19 continues to present us all with many challenges, as both individuals and professionals. Despite, perhaps because of these challenges, we continue to find new ways to tackle the virus’ impact on our lives. Through dedication to ensure continued access to life-saving sexual and reproductive health (SRH) services, many members are going digital.

Innovation is taking two things that already exist and putting them together in a new way.’ (Tom Freston)

IPPF members, experts in the provision of quality SRH services, are increasingly combining this expertise with the multitude of digital platforms already enmeshed with our lives to ensure life-saving SRH service continuity through COVID-19 restrictions.

From modifying and scaling existing digital health interventions (DHI) to initiating new ones in response to reduced service access, the spectrum of DHIs ranges from straightforward information sharing on existing platforms, to clinical case management through digital platforms, with full access to commodities and medication.

This update provides a small snapshot of these initiatives, some key considerations for others looking to start a new DHI, and links to further resources.

What’s a digital health intervention?

DHIs comprise three components:  the health content (from general information to client-specific case management); the digital intervention (the digital way of sharing this information, may be short messages to individuals or groups; user or expert-generated content…); and the digital platform itself (the software or platform, eg SMS texts, websites, Facebook and so many others).

The World Health Organization classifies DHIs into four groups, depending on their target: clients, service providers, health systems and data services. Most pertinent to service continuity during COVID-19 are those aimed at clients and service providers.

How have Members used DHIs as part of their COVID response?

Telemedicine – ‘the delivery of healthcare services where patients and providers are separated by distance’ (WHO, 2018)

Pakistan – the Family Planning Association of Pakistan (RAHNUMA-FPAK) scaled up their existing hotline to great success. Run from the member’s hospitals, the toll-free number it is available 24 hours a day and has seen high uptake despite continued operation of normal clinical services, as people are wary of accessing face to face services. The service provides commodities to clients in their homes via community workers.

Sudan – following April’s national shutdown, the Sudanese Family Planning Association (SFPA) initiated a new call centre to increase access to services, including SGBV through counselling, referral and psychosocial support. They have found more men are engaging with SRHR through the call centre compared with face to face services, and that young women are able to talk more frankly about their reproductive rights. A challenge remains accessing commodities and making them available for clients.

Philippines – the Family Planning Organization of the Philippines’ (FPOP) clinics remain open but strict lockdown means client access is severely limited. FPOP launched ‘youRHotline’ to provide SRH information and counselling, referring to clinics as necessary and sending commodities, including HIV self-testing kits, via courier. YouRHotline is linked with the national call centre for ease of access for clients from different provinces. FPOP has also began co-moderating an existing women’s’ Facebook group for peer support and to increase visibility on SRHR during COVID-19.

Morocco – since the end of March, volunteer staff at the Moroccan Family Planning Association (AMPF) have initiated a new hotline which provides counselling and consultation, referring to specialist doctors where required. Commodities are available from clinics, although supply chain issues persist, and service providers follow up with clients by phone.

On demand information and services – ‘health information accessible to the general public triggered by the client that may inform decision making’ (WHO, 2018)

Chile – Associacion Chilena de Proteccion de la Familia’s (APROFA) tienesopciones website promotes SRHR through provision of secure, accessible and impartial information, alongside confidential counselling and guidance via secure web-based chat, so that clients can make free and fully informed decisions. Matilde – the page’s virtual counsellor – has a strong identity to instil confidence, while counsellors provide advice through Matilde’s persona, referring to face to face services where necessary.  The site ensured strong user-centric design to engage clients, and receives constant advice from service providers to ensure high clinical standards and quality of care. The platform is also in use in other Members in the region (eg Peru’s decidoyo).

Togo – Association Togolese pour le Bien-Etre Familiale’s (ATBEF) android app ‘InfoAdoJeunes’, was developed through youth-led design and provides comprehensive information from menstrual cycle tracking and contraceptive information to telemedicine and individual client chat to gamified SRH content to increase user engagement and learning. App downloads and use have increased during COVID restrictions, but ATBEF reflects that future iterations will include geolocation to support access to the nearest clinic.

Targeted client communication – ‘transmission of targeted health information in which separate audience segments benefit from a shared message’ (WHO, 2018)

Cameroon – the Cameroon National Planning Association for Family Welfare (CAMNAFAW) is using social media channels such as Facebook and WhatsApp to share information about SRHR and COVID-19, as well as links to available services. Their approach included training for key online influencers on how to use social media to promote good practices in SRHR and share accurate information about COVID-19 symptoms and what to do if clients suspect infection.

Comprehensive Sexuality Education – 

It is difficult to provide comprehensive sexuality education during COVID-19 where remote mechanisms for this were not already in place. Indeed necessarily rapid responses to provide essential, but perhaps less comprehensive, education during COVID lockdown might be referred to simply as ‘sexuality education’. However, digital platforms do present new opportunities for sexuality education and the recent member survey suggests a huge increase to almost 50% of respondents now doing so.

Options include both synchronous (real-time) learning sessions, such as those provided by the Estonian MA, as well as asynchronous teaching whereby materials are provided online for young people to access and work through in their own time (such as in the Netherlands).

An example of a readily available asynchronous resource which members could use during COVD-19 is AMAZE (already used within WHR, ARO and EN), which provides medically accurate, age-appropriate, affirming and honest sex education that can be accessed directly online. The resources are free (although translation may be required) and can be uploaded on to other websites and incorporated into members’ existing CSE resources.

Should I begin a new DHI at this time?

Firstly, do not reinvent the wheel! Consider both the health content you need to share, and the digital channels you already have.  Where possible, modify or expand these. For example, use client contact numbers you already have to push information about available services during lockdown.

If this cannot meet new needs presented by COVID-19, look for collaborations or share the existing DHIs of others. For example, share verified SRH information or links to available services on existing public health platforms such as government websites or health apps, or advocate for and train staff on SRH service provision through existing national helplines.

New DHIs can be resource-intensive and are not always a silver-bullet, but if other options cannot support service continuity during COVID-19, you might be considering a new DHI.

The choice of options can be overwhelming but this tool can help to navigate which may best suit your needs. Remember also that, at a minimum, DHIs should be available on a mobile device to maximise impact.

Where to start…

Key principles:  Do no harm:  Consider that shared phones and reduced freedom of movement in lockdown can have profound implications for privacy and confidentiality and there is evidence that DHIs can increase intimate partner violence.

Sustainability: during COVID-19, consider sustainability of services, and not necessarily longevity of the DHI. In many cases a longer-term business case will exist (such as for CSE or self-care interventions) but DHIs are largely recommended to complement, not replace, face to face services, and their efficacy and cost-effectiveness in comparison to face to face services hasn’t been established. Monitoring of key performance indicators and ensuring a handover plan back to face to face services as appropriate is essential.

Ensuring impact: User-engagement is consistently shown to be the key factor in successful DHIs. Although it may be difficult to directly engage with users during lockdown, there are secondary sources which can inform DHI design, for example this WHO resource has an ‘acceptability’ section summarizing evidence on how users feel about interacting with different DHIs for SRHR.

In all cases, consider the potential for DHIs to collect data to support decisions about longer-term investment after COVID-19, for example equity of access, clinical QoC outcomes, user acceptability and cost.  Finally, where clinical services are provided digitally, consider the ability to link these to client medical records and service statistics reporting.

For more information on specific steps to take to develop a DHI, this UNICEF resource is a good starting point, providing a very detailed ‘how to’ guide which itself includes many other good references from defining the challenge, designing and testing ideas and taking DHIs to scale.

The IPPF COVID-19 Taskforce is setting a new benchmark of collective decision making and actions to contribute to the vision of a Unified Secretariat. Its Microsite and Slack channel have been invaluable to share news throughout the Federation.

Please do continue to engage with each other and the Taskforce through them.  In particular, the #innovation and #services Slack channels are a great place to share members experience and enable peer support where other members would like to replicate DHIs.

And you can stay up to date on the work of the Taskforce through the actions and decisions page here: Actions and decisions from the COVID-19 Taskforce

Links to other resources

IPPF resource: Digital Health Interventions for SRHR during COVID-19

IPPF webinar (English): Digital Health Interventions for SRHR during COVID-19 (password 6Z#iH$hP)

IPPF webinar (French): Interventions Numériques en Matière de Santé (mot cle 1B*k=521)

FP2020 webinar (English): Exploring Digital Platforms for Family Planning During COVID-19

FP2020 webinar (French): Explorer les plateformes numériques pour la planification familiale pendant COVID-19

WHO Classification of Digital Health Interventions

UNICEF Designing Digital Interventions for Lasting Impact

WHO Recommendations on Digital Interventions for Health System Strengthening

In Solidarity,

Alison McKinley,

Senior Technical Advisor for the Innovation Programme

Posted in All Updates, C19-Responsive SRH Services, CSE, Innovation, Taskforce Updates

Leave a Reply

Your email address will not be published.