A series of three perspectives from the Patient Pathways and Pandemics Community of Practice on the ‘NCD Care’ app with PharmAccess in Ghana.
Click below to view the other articles:

1. Pivoting COVID-19 innovations to UHC: Is 2022 a year digital health moves up a gear?
2. Could digital platforms enhance clinicians’ health coaching skills? Reflections on technology-powered NCD services following the COVID-19 pandemic
3. A world of possibilities: How should digital health companies partner with healthcare payers to support scale-up?

For all the damage caused to health systems around the world by COVID-19, the pandemic also spurred a huge amount of innovation across low, middle and high income countries alike. Digital health tools in particular saw a breakthrough in uptake, whether through established technologies such as the use of telephone for consultation and triage, or newer ones such as AI-powered triage and primary care. Emerging economies were responsible for some of the most advanced and impressive digital tools for COVID-19, such as the Indonesian government’s partnership to implement its Covid testing and vaccination program through integration with popular digital health and ride hailing apps.

While few of these tools were completely new when the pandemic struck, the scale of their adoption, especially by governments and universal health systems – often working in partnership with private sector developers – was unprecedented. What remains to be seen is whether health systems will ‘revert to type’ as the pandemic subsides, or whether a permanent step change – a new baseline – will have been established in the use of digital health tools for the achievement of quality healthcare for all.

There are already signs that some of the innovations rolled out for COVID-19 are being applied to an older, but equally global, health crisis among Joint Learning Network (JLN) member countries: non-communicable diseases (NCDs). Most emerging economies face a daunting challenge of expanding access and quality of health services for NCDs, which show a seemingly inexorable year-on-year rise, using healthcare resources that are growing at a far slower rate. Digital health tools are one way in which some are hoping to bridge this gap.

An early example of one such Covid-to-NCD ‘pivot’ is the CovidConnect app, launched by PharmAccess in July 2020 in partnership with the Ministries of Health of Nigeria, Ghana and Kenya. This system supported an integrated blend of COVID-19 risk monitoring, self-care content, e-consultations, patient triage to counseling, testing, and acute care, and disease trend analytics. Largely due to none of the three countries experiencing a major COVID-19 peak at that time, take-up of the app was low, yet rather than scrap the app, the Ghana team are now working to refocus it towards hypertension and diabetes.

The pivoted remote care solution, NCD Care, has much the same functionalities, structure and technology backbone as CovidConnect – patients are onboarded (this time through their own healthcare provider rather than ‘direct to consumer’), then monitor and report relevant vital signs into an app. The data from these readings can be viewed by the patient themselves, and are monitored by a back-end team of nurses who can provide supportive advice either directly or via a chatbot. If a patient’s readings suggest they may be at increased risk, automated alerts are triggered, or the nurses can themselves refer them to a specialist. From August to November 2021 a Community of Practice of JLN representatives from six member countries met to support the early development of this initiative.

This is just one example of a pattern that many JLN member countries are witnessing of the long-lasting legacy that innovations from the COVID-19 era are likely to have. Other high-potential areas where the JLN Community of Practice participants mentioned a ‘new normal’ potentially being established in their countries include:

• Improving pre-arrival patient information available to providers before a patient visit.
• Use of voice, text, video and group calls for patient consultation, triage and education – especially where this allows doctors in one part of a country to treat those in another.
• Targeted health messaging sent direct to patients’ phones.
• Digital education and supervision of clinicians to improve quality of care.
• Closer interaction and interoperability between healthcare providers and pharmacy chains.
• Home monitoring requiring patients to make use of simple equipment like a pulse oximeter / glucometer.
• Extension of supply chain management tools not just to pharmacies but to the patient’s door.
• Ability of private providers to be linked into publicly-funded systems and provide subsidized care.
• Large hospital systems moving into the home care market and away from episodic outpatient models.
• Strengthening of foundational IT systems within providers (e.g. EHRs, portable records).
• Changing employment opportunities for healthcare workers, who can now choose to work from home or remote locations.

Yet the biggest shift that participants reported COVID-19 having left on their health system was not the specific tools available, but ways in which governments and providers have learned to engage with digital health differently – no longer as a ‘nice to have’ but a necessity in the race to improve access and quality for issues like NCDs. In the next two blogs in this three-part series we will explore two of these issues considered in more depth by the JLN Community of Practice: (i) new partnership forms between healthcare payers and digital health developers, and (ii) how the use of digital health tools, far from creating an additional barrier between clinicians and patients, can in fact support the development of health coaching and clinical soft skills.

With thanks to Jonty Roland, Niti Pall, Colette Van Montfort, Alex Attachey, GV Ramana Rao, Dharmesh Lal, Javan Waita, Kasarachi Omitiran, Jake Mendales, Esteban Bermudez