COVID-19 Response - Challenges and Opportunities for Digital Health

Conducted by CORE Group in collaboration with the Digital Health and Innovations Working group of the Child Health Task Force, this COVID-19 Coordination Call, part of a weekly series organised by CORE Group (see Related Summaries, below), is designed to share experiences with and learn from participants in two key areas: maintaining the quality of care, and monitoring health service disruption during COVID-19 waves and inter-wave periods.

Each session offers opportunities, such as polls and chatrooms, for participants to give input on their priorities, concerns, and solutions. The outcome is the sharing of a selection of tech-based tools and digital solutions, according to Julie Dargis, Senior Advisor, Global COVID-19 Response, CORE Group, who introduced the presenters and concluded the meeting; Steve Ollis, Senior Digital Health Advisor, John Snow, Inc. (JSI), moderated and opened it.

The two presentations and feedback sessions were:

1. Presentation: Challenges and Creative Solutions for Quality of Care
By: Jeanne Koepsell, Community Case Management Advisor, Save the Children
Summary: Keopsell presents some of the challenges to quality of care and discusses responses to those challenges. In particular, she identifies how to ensure that quality of service remains high, even as opportunities for supervision and other in-person connection with the health services are eliminated. She highlights the following areas that affect quality of care during COVID-19:

• Competing priorities
• Community Case Management (CCM)-specific behaviours, including: counting respiratory rates, rapid diagnostic tests (RDTs), and stock management
• COVID-19-specific behaviours, including: knowing the current list of signs/symptoms, recognising those signs/symptoms, and understanding the appropriateness of home treatment versus referral
• Data quality
• Counselling
• Referral gaps

In terms of solutions, she explores, with input from the participants, some of the digital tools that are currently being used. To mention just a few examples, to deal with competing priorities (where community health workers are dealing with multiple health issues such as malaria and tuberculosis (TB) in addition to COVID-19), e-learning and e-updates are potential solutions to offering them guidance on what to prioritise. Equally, when it comes to COVID-19-specific behaviours (e.g., keeping up to date with the latest information on signs and symptoms, and knowing when to refer patients for hospital care), potential solutions include updates on computer home screens, algorithms, e-learning, and videos on specific skills. For challenges around community counselling, videos/flipcharts on a phone/tablet or e-learning are being used as potential solutions. Meeting participants were asked to share some of the digital solutions and apps they are using; links are accessible in the chat function of the recording.

2. Presentation: Mitigation Strategies for Service Disruption
By: Darlene Irby, Director of Digital Health and Health Information at Jhpiego
Summary: The objective of this presentation is to present examples and tools that can collect service disruption data in order to better inform health service support and mobilise resources. It also seeks to discuss the bottlenecks and challenges with service disruption data collection and data quality during COVID 19, as well as to consider how partners are mitigating the effects of service disruption, using digital health. The presentation highlights three different categories of tools that can be used:

1. Tools that present modelling of service disruption - in particular, the Lives Saved Tool (LiST), which is being used to model the impact of service interruption on maternal and child mortality;
2. The newly launched Global Fund COVID-19 Country Monitoring Tools, which is a survey-based tool to assess levels of disruption to HIV, TB, and malaria services; and
3. Use of national health information systems, such as District Health Information Software 2 (DHIS2) and other registries, that can monitor the use of health services and reported health issues.

Irby discusses the opportunities and challenges for these three tools, making the point that there are still challenges in the collection and quality of data and that it is still not always possible to determine where and who the pandemic will impact most or where to strengthen health workers and target support. In the absence of targeted data collection objectives, the rapidly changing pandemic also leaves decision-makers with a lot of unknowns to weigh.

The presentation and discussion on service disruption point to the importance of indicators and touch on the issue of data reliability, especially in resource-poor settings. Irby highlights the importance of considering the country context and building on existing data collection tools when making decisions around which tools to use in a particular country. Should any new tool be developed, her advice is to design with the user, such as community health workers, in mind. Lessons from Ebola also show that it is not a good idea to bring on board a new digital tool in the midst of an epidemic; it is preferable to use existing tools that are familiar to people.

On February 6 2020, CORE Group began a series of weekly calls (see Related Summaries, below) to convene members and partners to discuss their institutional positions around a range of topics related to COVID-19 in an effort to coordinate and support the global pandemic response. During each call, people who signed up for the discussion have the opportunity to ask questions and give input, and these discussions are also included in the recording. To receive updates and coordination call announcements, subscribe to CORE Group's One Health Interest Group listserv or email the listserv using: onehealth@lists.coregroup.org.