Depression for Naheed¹, a 26-year-old female, appeared suddenly and hit her like a ton of bricks. It started in March 2021 with jitteriness and loss of appetite and led to persistent irritability and elevated heart rate. She was low on energy, and a constant feeling of hopelessness and loneliness made it impossible for Naheed to enjoy any activities she had previously enjoyed.

Naheed reported these symptoms to her doctor at the Aga Khan Medical Centre Booni, 10 km away from her home in Charun, Upper Chitral, Pakistan. The doctor examined her through tests and assessments, in efforts to diagnose the causes of her symptoms. However, to her surprise, all tests confirmed that Naheed was in good physical health. She continued to feel tightness in her throat, severe headaches, and epigastric pain. Soon after, her complaints included sleeplessness and complete loss of appetite.

Using teleconsultation services offered through the AKDN Digital Health Programme, Dr Shazia Mir, a Psychologist at the Aga Khan Medical Centre, Booni decided to take a second opinion from Dr Adil Khan, who is a Consultant Psychiatrist at the Aga Khan Diagnostic Centre, Jutial. Dr Khan performed a thorough physical exam with the assistance of the medical team in Booni and took a detailed history of Naheed’s symptoms. Dr Khan, along with Naheed and her family, came to the conclusion that she was depressed with somatic complaints. He prescribed medication with regular follow-up teleconsultations over a course of nine months. Slowly, Naheed was able to recover with the help of teleconsultations and medication and she was finally able to manage her condition better.

Through teleconsultations, Naheed was able to consult a specialist, Dr Khan, 298 km away from her home, at the Aga Khan Diagnostic Centre in Jutial, Gilgit. In absence of the Programme, Naheed would have had to travel to Jutial to seek better health care service. The AKDN Digital Health Programme helped Naheed and her family save US $1220² , that would otherwise have been paid towards accommodation, meals and travel expenses from Charun, Upper Chitral to Jutial, Gilgit-Baltistan.

The AKDN Digital Health Programme allowed Naheed to receive quality health care services she needed through the live teleconsultation services, resulting in an accurate diagnosis and treatment.

Naheed has not recovered and is happily living her life at her home in Charun, Chitral.

Mental health issues can be chronic, with recovery taking longer than one would expect. They cause periods of stability along with difficult periods, which require a combination of medication and therapy. For anyone facing mental health challenges, early intervention and treatment is critical to recovery.

¹ The name of the patient has been changed to protect patient privacy.

²The amount is based on costs associated with accommodation, meals and travel for trips from Charun, Upper Chitral to Jutial, Gilgit-Baltistan.

Jamal Mohammad¹ was a playful and energetic five-year old boy, who lived with his parents in Bahar village in Ishkashim district in Afghanistan. It was February 2021, when he began losing his hair. He started noticing when other children began staring and pointing at him.

At first, his scalp had mild redness and itch; then some sparse patches appeared on his head and soon he lost a majority of his hair. Alarmed, his parents took him to several doctors in their village but no one was able diagnose his condition or offer a clear treatment plan.

Jamal’s parents reached the Community Health Centre (CHC), Ishkashim, 5 km away from their home, in hopes to find specialised care. The AKDN Digital Health Programme connects Ishkashim CHC to the Faizabad Provincial Hospital (FPH) for teleconsultation services. A live teleconsultation with Dr. Qutbuddin Fazli, Dermatologist, at the FPH was conducted.

Dr. Fazli diagnosed Jamal with Alopecia, an autoimmune condition that causes hair loss. He prescribed antibiotics and advised him to take precautions. As a result of the teleconsultation, Jamal was able to make a complete recovery.

Before Jamal’s parents learned about the AKDN Digital Health Programme, they made numerous visits to clinics and hospitals, but failed to receive a clear diagnosis. Through telemedicine services, Jamal received holistic treatment, without having to travel to Faizabad, saving his family a considerable amount of time and travel expenses.

¹ The name of the patient has been changed to protect patient privacy.

1. WHO Roundtable Discussion (May 2021):
   1. Leveraging digital health technologies to improve NCD outcomes in underserved, vulnerable populations
2. Health Systems Research Symposium (HSR) 2020 – presented on March 10, 2021.
   1. Topic: Hayat’s role in improving maternal health, gender equality and strengthening health systems
3. Africa Telehealth Conference (June 2021):
   1. AKDN Digital Health Programme and Sustainability through Public-Private Partnerships
4. Invitation to Deep Dive on Primary Health Care Innovation (September 2021)
   1. Hayat’s role in improving maternal health, gender equality and strengthening health systems
5. 11th Public Health Conference Contemporary Medicines, Health Technologies and Vaccines for Emerging Public Health Risks (September 2021):
   1. Health Systems Strengthening through Digital Health Technologies (Hayat & CIRP)
6. Canadian Conference on Global Health (November 2021):
   1. Hayat’s role in strengthening maternal, newborn, and child health provision in health systems of Pakistan and Afghanistan
   2. Environmental Health: Challenges and Solutions Identified through Partnerships
   3. Pandemic Resilience: COVID-19 Innovation Research Project

The COVID-Innovation Research Project (CIRP) aims to investigate the effectiveness of developing and scaling up three COVID-related digital health innovations in strengthening health systems and improving access to care in at-risk populations in select geographies in Afghanistan, Pakistan, Tajikistan, Kenya, Tanzania and for Arabic-speaking countries.

The study undertakes a multi-pronged applied research approach on the following three digital health innovations:

1. CoronaCheck: an AI-based mobile application, which aims to contribute to early detection of COVID-19 and positively influences health-seeking behaviour among at-risk populations;
2. VirtualDoc: a mobile-based teleconsultation application, which aims to improve access to care for hard-to-reach populations; and
3. Protective Personal Equipment (PPE): an educational mobile app equipped with best-practice PPE guidelines for health workers in light of the COVID-19 pandemic.

Objectives of CIRP

Overall, the study focuses on the extent of which these three digital health innovations are effective, feasible, usable and sustainable within health systems in target geographies. The project is underpinned by the integration of these innovations in health systems through public-private partnerships (PPPs) with local and national health authorities.

During 2021, as part of project activities, CIRP was selected to be showcased at the 11th Annual Public Health Conference: Contemporary Medicines, Health Technologies and Vaccines for Emerging Public Health Risks September and the Canadian Conference on Global Health (CCGH) in November.

CIRP is a two-year research project, led by AKDN dHRC in 2020, with research funding from the Government of Canada through the International Development Research Centre (IDRC) and the Aga Khan Foundation (AKF).

Hayat aims to test the effectiveness of a mobile application, which helps to empower health workers with technologies to improve coverage of and access to Reproductive, Maternal, Newborn and Child Health (RMNCH) services, immunisation and child growth services, by digitalizing health worker operations. The Hayat application has successfully been implemented in select regions of Afghanistan and Northern Pakistan and is being used by 665 health workers.

Previous Next

Hayat is designed to primarily benefit children under 2 years of age and women of reproductive age in catchment populations of select areas of Gilgit-Baltistan and Chitral and in Bamyan and Badakhshan in Afghanistan.

Hayat uses a quasi-experimental study to evaluate the effectiveness of the use of the Hayat application in the existing health system in improving utilization of essential RMNCH services provided by frontline health workers. Antenatal care (ANC), postnatal care (PNC), family planning and childhood immunization were assessed using baseline and endline cross sectional surveys in intervention and control areas. The difference-indifference (DID) was calculated to see the effect of intervention.

The assessment in the pilot and transition-to-scale phases has demonstrated that Hayat has exhibited adequate levels of feasibility, interoperability, usability, and efficacy in the research areas.¹

Qualitative Findings

The study findings demonstrate that use of smart phone-based Hayat application has high acceptability among the health care providers in both Afghanistan and Pakistan. has benefitted the existing health system functioning but providing reliable data and transparency, and better monitoring methods of the frontline workers and the clients.

This is better than the manual procedure and no doubt, the timely information [it provides] is very helpful.

Vaccinator, Phandar, Gilgit-Baltistan, Pakistan

The study revealed high usability of Hayat app both by the end users and stakeholders at district level. Overall, the app helped in improving quality and timeliness of data, improved immunization coverage and maternal care through supportive supervision and monitoring of CHWs and LHWs both in Pakistan and Afghanistan. Data validity improved and health managers were confident of the reliability of data collected through the app.

The data sharing process is improved specially the data of the LHW program. There are less chances of manipulation in the digitized system and it will be much better if the whole data is digitized.

EPI Coordinator, Gilgit-Baltistan, Pakistan

According to most of the vaccinators this application resulted in better coordination with the supervisors and all the features of the app are relevant to their work and provide ease in their routine immunization process. The app was well taken and appreciated by all the vaccinators and CHWs. In comparison, younger CHWs and vaccinators were more satisfied with the use and understanding of app features as compared to senior staff, who faced difficulty in adopting the technology in the initial phase.

In the opinion of the managers the vaccinators were now better organized and over the time they have noted improved efficiency in their work. The problem of absenteeism has also been resolved to some extent.

The attendance has improved, because, before, it was difficult to [keep track of] the attendance, even if a vaccinator is not on duty for a whole month. Now, we call the vaccinators on the phone and they tell us that they are busy with the outreach vaccination [activities].

CHS, Shebar, Afghanistan

¹Zaidi S, Kazi AM, Riaz A, Ali A, Najmi R, Jabeen R, Khudadad U, Sayani S Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community .