July 18, 2023

Addressing digital health challenges and leveraging technology to reach the last mile: A conversation with grantees of the GHIG program

Innovations in Healthcare (IiH), a proud partner of the Pfizer Foundation's Global Health Innovation Grant (GHIG) program, hosted an exclusive peer learning and networking session for the latest cohort of grantees (GHIG7) at the IiH Annual Forum held on April 25, 2023 in Washington, DC. The seventh GHIG grant period runs from February 1, 2023 – January 31, 2024, with grant funding provided to 20 social enterprises that pilot and implement novel solutions to address critical health challenges particularly in the prevention, correct diagnosis, and appropriate treatment of infectious diseases for underserved populations in low-and middle-income countries. 

At the peer learning and networking session, grantees shared key challenges they are currently facing, as well as offered their strategies that have worked well in addressing them. Grantees noted that the most pressing challenges related to developing and deploying digital technology to provide better service delivery to patients and communities in the most remote areas. 

Below, we highlight the four key challenges that GHIG7 grantees discussed at the session: 

1. Technology developed in high-resource settings are often not economical, relevant, or user-friendly for marginalized populations. Most populations in underserved communities and geographies are not digitally literate and confident smartphone users. Furthermore, such populations are typically served by local community health workers who are also less likely to be digitally literate. Community health workers are also less likely to be trained clinical providers. Therefore, there is a great need to customize digital technology to make it fit-for-purpose for community health workers who provide last-mile healthcare in their communities, as well as patients in those communities. 

2. Lack of formal paper-based identity puts healthcare out of reach for large proportions of vulnerable populations. Particularly in underserved communities, a large proportion of the population lacks formal identification, significantly inhibiting their access to services from the formal healthcare. These populations are excluded from existing services because they are missing from existing counts of target populations. 

3. Even within countries, the public sector uses and operate vastly different technologies and systems. Organizations noted that part of the challenge in working with the public sector is that departments and units operate in silos with the result that digital technologies are often not interoperable, making it difficult to provide integrated solutions to address the needs of patients. 

4. Being able to sustain and scale digital solutions that have been shown to work effectively requires buy-in and funding from the public sector. Unfortunately, in many areas, the public sector faces constraints in supporting the sustainability and scale-up of digital innovations, including budget limitations and frequent political transitions. 

Five key strategies emerged from grantees’ discussion of the challenges they face, outlined below. 

1. Working closely with the government from the early stages of a project, such as identification of the problem and design of potential tools and technologies has been instrumental in getting their endorsement and support for scale-up and sustainability. For instance, Last Mile Health which has built long-lasting partnerships with ministries in several countries in Africa noted that their deep engagement with stakeholders begins right from the conception of any digital health intervention, and includes them throughout the design, development, and implementation stages. 

2. Grantees have built and strengthened partnerships with ministries of health through the development of free, open-source tools that are based on guidelines provided by multilateral organizations and customized to the specific context within each country. To maximize efficiency and interoperability, both Afya Research Africa and Last Mile Health standardize policies, training, hardware and software across units, partners, and donors. 

3. To ensure that health interventions are equitable in reaching vulnerable populations, grantees such as reach52 and Bive help the public sector both track populations in need and analyze the differentiated impact and unintended consequences of various interventions on different population segments through the capabilities in their digital technologies. Analysis of data captured by digital technologies coupled with feedback from trained community health workers helps in better targeting of resources to the people who need it the most, as well as in understanding the barriers to access that patients face. 

4. To identify and track vulnerable populations without a formal identity, Simprints deploys open-source biometric identification solutions to reach children and adults who might otherwise be missed without birth certificates or other forms of identity. This allows service delivery organizations to link patients to their records which is critical for providing routine healthcare, follow up care, and treatments. 

5. Being forced to pivot to a digital model of engagement at the start of the COVID-19 pandemic, mothers2mothers developed AI tools that would enable their mentor mothers to field questions on any health topic asked by their patients. This makes it easier for them to not have to remember details about all topics and aspects of care that each patient needs as well as to ensure treatment and follow up adherence among their patients.  

The in-person peer learning and networking event at the 2023 IiH Annual Forum provided a unique opportunity for the cohort of 20 grantees to come together, hear about common challenges across countries and regions, and learn about successful strategies from peers to address them. Over the duration of the grant period, Innovations in Healthcare will provide additional opportunities to connect grantees and provide learning and collaboration opportunities to leverage the strengths of this diverse set of organizations.