Garrett Mehl, Tigest Tamrat, Maeghan Orton WHO Guidelines on Digital Health Interventions for RMNCAH and Health Systems Strengthening Garrett Mehl, Tigest Tamrat, Maeghan Orton

Background—Why Guidelines Official request from member states on Guidelines regarding the selection and prioritization of digital strategies of value for the SDGs. Global financing mechanisms and governments increasingly recognize potential value of digital health interventions, but lack evidence-base guidance to direct planning and investments. Does digital health work?: Unresolved debates on effectiveness and comparative value of digital health interventions to support health system goals. Will be revising bullet #2These include the UN Sustainable Development Goals (UN SDGs), the Global Measurement and Accountability Roadmap, the Global Strategy for Women’s, Children’s and Adolescents’ Health, as well as the Global Financing Facility for RMNCAH highlight the critical need for.

Guideline objectives Provide evidence-based recommendations to ministries on the effectiveness of digital health interventions to inform decisions and country investment plans Identify evidence and knowledge gaps for further research to inform member states Define essential packages of evidence-based digital health strategies for RMNCAH and overall health system strengthening

WHO Guideline Process

What are PICOs Population Intervention Comparator Outcome Population group—could be clients, providers, or health system Intervention Digital health strategy under question Comparator Non-digital alternative Standard practice Outcome Health system constraint to addressed, service delivery improvements sought

How PICOs become Recommendations PICO question Does the insertion and removal of IUDs (I) by lay health workers (P) improve the uptake of contraception (O)…? Evidence syntheses Multi-stakeholder review Where we want to go: Recommendation

Basis for formulating PICOs: Classification of digital health interventions

Basis for formulating PICOs: Classification of outcomes

Public feedback, iterations, refinement Consultations with advisory group (still under development) Internal consultation with WHO technical units Public survey with over 340 respondents, across all WHO regions

Interventions under consideration Currently have 19 PICO questions under consideration, focusing on a variety of digital health interventions: Digital communication to clients (e.g. health promotion messaging, appointment/medication reminders) Digital delivery of formal training materials for healthcare providers Electronic decision support Electronic service records (e.g. digitized versions of health service registers) Birth notification Health workforce monitoring and performance feedback Management of commodities Data reporting, management and visualisation Citizen-based reporting Provider to provider communication Remote client to provider communication

Outcome categories [INFORMATION] improve knowledge of behavior [UTILIZATION] improve coverage of [RMNCH/SRH] services [UTILIZATION] improve utilization of [RMNCH/SRH] services [CONTINUOUS UTILIZATION] improve adherence to ART; retention in [RMNCH/SRH] services [EFFICIENCY] reduce time for initiation of treatment/service [QUALITY] improve provider adherence to diagnostic, treatment, and counseling protocols for services [ACCEPTABILITY] improve client satisfaction when receiving services

What digital interventions do people want guidance on? Most prioritized interventions* Least prioritized interventions* Targeted messaging and reminders On-demand information services Electronic decision-support Closed-provider communication groups Remote client to provider consultations Digital supply chain tracking/management Digital work planning and scheduling * interventions receiving at least an average score of 7 out of 9 Mobile payments to clients Mobile payments to health workers Digital strategies for counterfeit drugs Non-targeted messaging *interventions receiving less than an average score of 7 out of 9

What outcomes do people want included in the recommendations? Most prioritized outcomes* Least prioritized outcomes** Utilization of services Knowledge of RMNCH/SRH behaviours Treatment adherence Reduced discontinuation of services Availability of supplies Timeliness of care *outcomes receiving at least an average score of 7 out of 9 Client satisfaction Provider motivation and self-efficacy **outcomes receiving less than an average score of 7 out of 9

Prioritization of questions underway Add your voice and participate in survey to prioritize the digital health interventions for inclusion in the Guidelines review: http://bit.ly/Digital_Guideline Read more and follow us through this process at: http://tinyurl.com/DigitalHealthGuidelines

Next steps and timeframe Activity 2016 2017 June July Aug Sept Oct. Nov Dec Jan Feb Mar Apr May Draft PICO questions, in-person consultations with technical units   Circulate PICO questions for feedback Advisory meeting to scope and finalize PICO questions Feedback, revisions, prioritization Planning systematic reviews Evidence synthesis Meeting of the advisory group to review findings and finalize recommendations Cycles of review Launch Guidelines!!