Tackling NCDs digitally

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“Innovation is embedding invention in routine systems that give it reach and impact.”

– Prof. Marc Ventresca, University of Oxford

US$ 7THealthcare costs & productivity losses 2011-2025

"We should all work to meet targets to reduce NCDs."

9MPremature deaths / year

Origins

6.8 BillionMobile cellular subscriptions

Background

2012BHBM founded as a joint programme between two UN agencies in response to the UN High-Level Declaration on NCDs in 2011 and the need for greater action and collaboration.

The initiative works on scaling up mHealth, promoting government ownership of national programmes, and fostering intersectoral collaboration.

2015• 8 official partner countries and requests from over 40 others to join

• Global toolkits on various disease and program management areas prepared for publication in 2016

• Live programs in 2 countries and launches of at least 4 others expected in 2016

• Partnerships with a broad range of multilateral, academic and private sector partners

"We should all work to meet targets to reduce NCDs."

Be He@lthy Be Mobile

Joint UN program between WHO and ITU*

Looks at SCALE: institutionalising successful mHealth tools within national health systems

*Aims to help embed innovation management for mHealth and digital health care within countries, bridging the gap

between small-scale trial and national service

The innovation is in the HOW and not the WHAT

A scale-up approach to mHealth

RESEARCH INTERVENTIONS

DEVELOP ‘TOOLKITS’

INSTITUTIONALISATION, KNOWLEDGE SHARING

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mHealth

KNOWLEDGE &INNOVATION HUBS

2013 – 2016: Be Healthy Be Mobile Programme Develop best practice for mHealth at scale

WHO-ITU build & trial reusable tools to be shared globally

SCALE or BUILD CAPACITY

IN COUNTRY

EVALUATE &REFINE

KNOWLEDGE

Beyond 2016Scale mHealth globally in a meaningful way

Develop light touch service models

Key operational areas

1. Toolkit Development

2. Country implementation

3. Partnerships

Key operational areas

1. Toolkit Development

2. Country implementation

3. Partnerships

mHealth toolkits

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mHEALTH ENABLES PUBLIC HEALTH SERVICES TO

"We should all work to meet

targets to reduce NCDs."

mDiabetes

mCessation

mHypertension

mCervicalCancer

mAgeing

mTB/Tobacco

Toolkit formation

Workshop/ expert

consultations

Drafting Group

Informal expert group

review

Internal, external and

Partners consultation

Executive Clearance and

Publishing

Reviews and updates

Each PID is tailored for country use during national workshops, to suit the specific needs of each country

Awareness

mDiabetes

High-risk populationHigh-risk population Diabetic patientDiabetic patient

Prevention Treatment

Education Monitoring and disease management

Increase awareness

Aimed at pre-diabetics

Focus on lifestyle interventions

Encourage healthy diet

Increase exercise

Regular foot checking

Appointment reminders

Track vital statistics: blood glucose and insulin levels

Medication reminders

Provide educational facts about diabetes

Encourage management of diet and exercise

Use of mobile technology to increase self-management of disease and reduce costs for the patient

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Example: the mDiabetes process

Receives daily reminders for measuring blood glucose and taking insulin

Receives regular advice on ways to manage diabetes through diet (e.g. replacement foods or help managing insulin levels)

Result: a happy, health diabetic with reduced A1c.

Numerous studies show that mobiles help diabetics to keep blood glucose stable and are acceptable to users.

The patient controls the disease

rather than the disease controlling the patient.

Individual replies to the SMS, enrolling them in the prevention programme.

Individual receives SMS-based advice on small changes they can make to reduce risk factors for diabetes – e.g. diet, exercise, information on diabetes development

Result: a happy, diabetic-free individual

Diabetic patient

Pre-diabetic individual

Self-registers for SMS disease management support (text code) or referred by doctor

Receives an initial outreach SMS engaging them in the programme.

Example: the mCessation process

Smoker is put into a message group based on criteria such as age, dependence, commitment to quit etc.

3. Smoker receives daily messages offering guidance on managing cravings, coping with withdrawal, etc.

5. Smoker receives gradually less messages as their tobacco-free time increases.

4. Smoker has code words to text if they need specific support at any moment.

6. After 6 months of support the smoker is no longer a smoker.

CRAVE

1. Smoker wants to quit but needs support. 2. Smoker self-enrols or is enrolled

by family/doctor.

Key operational areas

1. Technical Process

2. Country implementation

3. Partnerships

Country programmes

Country Achievement

India National launch January 2016 to all states

Philippines Launch of mobile health in 2-3 cities by end of 2016

Senegal Multiple national mDiabetes campaigns for prevention, treatment support and health worker training

Costa Rica National platform set up, leading regional interest in the technology (Mexico, Nicaragua, Panama)

Tunisia National platform launch January 2016

United Kingdom Foundations laid for an mHypertension component in nation-wide health promotion campaign (2016)

Norway National replication of the BHBM structure for mCOPD (2016)

Zambia mCervicalCancer under preparation for launch in 2016

Egypt mDiabetes

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Countries

Brunei Mexico

Costa Rica India

Moldova Mauritius

Norway Panama

Egypt Philippines

Russian Federation United Kingdom

Senegal Zambia

Suriname

Tunisia

Argentina

Bahrain

Barbados

Brazil

Bolivia

Bulgaria

Comoros

Estonia

Ethiopia

Germany

Honduras

Indonesia

Israel

Jordan

Mali

Malta

Mexico

Pacific Islands (Fiji, British Samoa, American Samoa)

Saudi Arabia

Sri Lanka

Spain

Thailand

Tonga

Turkmenistan

Turkey

UAE

Viet Nam

Countries that have sent an Official Request (16)

Countries that have expressed interest in joining the initiative (45+) without outreach

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mDiabetes Awareness for Ramadan in Senegal

• Several modules of SMS sent to 4 different groups about Diabetes

• High visibility and engagement at the population level

• Currently more than 50,000 participants are enrolled in the program

• Multi-sectoral, multi-stakeholders model

Second phase

• Three tracks:

i. Prevention (general population risk awareness)

ii. Management for diabetics

iii. Health care worker training

India

• National services launched

• Unique feature: Missed Call for registration

• Live dashboard

• 160,000+ registered in the first week

• Part of Digital India movement

• Funding from within MoHFW and MoICT committed for first 2 years

• Integrated M&E plan from the onset

20-06-2014 mHealth Scale-Up Proposal 19

Key operational areas

1. Technical Process

2. Country implementation

3. Partnerships

Partnerships: cross-sectoral model

THE PROGRAM IS UNIQUE IN THAT IT ADOPTS A MULTI-SECTOR PARTNERSHIP STRUCTURE AND ENGAGES IN COUNTRY PARTNERS AND GOVERNMENTS TO MAXIMIZE SUCCESS.

Telecoms, Insurance ,

Pharma, Wellness, IT, Sporting

Industry, Other Private Sector

Government

NGOs , Civil Society

Philanthropies

Academia

UN

• Best Practices

• Content

• Deployment strategy

• M&E

• Best Practices

• Content

• Technology

• Deployment strategy

• Policies

• M&E

• Best Practices

• Content

• Technology

• Deployment strategy

• Policies

• M&E

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• Best Practices

• Content

• Technology

• Deployment strategy

• M&E

Recent partnership activity (Jan-September 2015)

Jan 2015: mHypertensionworkshop

Jan 2015: mHypertensionworkshop

Feb 2015: Sanofi joins;

Agreement with European Respiratory Society

Feb 2015: Sanofi joins;

Agreement with European Respiratory Society

March 2015: World Conference on Tobacco Or

Health (public health)

March 2015: World Conference on Tobacco Or

Health (public health)

April 2015: GCM coordinating mechanism; annual report launched

April 2015: GCM coordinating mechanism; annual report launched

May 2015: Nomination for Guardian award

on innovative partnerships

May 2015: Nomination for Guardian award

on innovative partnerships

December 2015: global consultation on mHealth,

Geneva

December 2015: global consultation on mHealth,

Geneva

eHealth: Harnessing

technology on the road towards universal health coverage …

An example is the initiative “Be He@lthy Be Mobile”, which promotes the use of mobile technology to help Member States combat the growing burden of noncommunicable diseases

Carissa F. EtienneDirector,

Regional Office of the

World Health Organization for the Americas,

Washington, D.C., United States of America.

“The WHO ITU joint initiative on mHealth for NCDs is a promising innovative intervention to see how to use new technologies to better health outcome"

Helen Clark • UNDP Administrator • 31 January 2013 • Harvard School Public Health• Boston, Massachusetts

THANK YOUpujaris@who.int hasvoldp@who.int