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

2. 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.

3. 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

4. WHO Guideline Process

5. 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

6. 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

7. Basis for formulating PICOs: Classification of digital health interventions

8. Basis for formulating PICOs: Classification of outcomes

9. 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

10. 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

11. 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

12. 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

13. 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

14. Prioritization of questions underway
Add your voice and participate in survey to prioritize the digital health interventions for inclusion in the Guidelines review:
Read more and follow us through this process at:

15. 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!!