The Aga Khan Development Network Digital Health Resource Centre established an Innovation Lab in 2014 to foster innovative digital health device development. Since then, it has been involved in conducting cutting-edge research to ideate, design, develop, test and launch cost-effective innovative solutions that respond to health care delivery challenges in low-resource settings.

As a result of the multidisciplinary research, AKDN dHRC in collaboration with faculty members from the Aga Khan University, has been able to file three international patents. These patents include a multipurpose scope; a surgical tray and an ambu bag.

The Multipurpose Scope is an adapter for smartphones, which converts the phone into a diagnostic device with three interchangeable modules that can function as otoscope, ophthalmoscope, oral scope, dental scope and derma scope to help examine and capture clinically important images of the parts of a human body, such as skin, ear, nose, throat, eye, teeth and mouth. When attached to a microscope, the device can also capture pathological images. The Multipurpose Scope has been launched at multiple AKDN health sites in East Africa and South Asia to improve access to quality health services in low-resource settings.

The Surgical Tray provides a solution to difficulties experienced by health care professionals in the operation room. It comprises of an application and a surgical tray and through Augmented Reality (AR), imaging and physical parameters, it keeps track of surgical instruments that are placed on the tray before and after a surgical procedure. The solution aims to lowers costs by reducing rework and improve accuracy of surgeries.

The Ambu Bag (Automated Resuscitation Device) is a device, which automates resuscitation of patients in emergency rooms. The device is particularly useful in low-resource settings, where there is often a dearth of mechanical ventilators and manual resuscitation is carried out manually by available hospital staff. Due to shortages, patients who require artificial ventilation are conventionally resuscitated using an ambu bag manually by available staff or family members. Though effective, the process of manual resuscitation is tiresome and liable to human error. AKDN eHRC in collaboration with the Breathhack team, a group of clinicians and researchers, has designed the Automated Resuscitation Device, wherein a motor is attached to an ambu bag, automating the resuscitation process. The device aims to reduce casualties arising out of shortage of ventilators and staff in the emergency room. The device was the winner of the CCIT Hack 2016, Aga Khan University’s first medical hackathon hosted by the Aga Khan University Critical Creative Innovative Thinking (CCIT) team.

Teeko, an mHealth application and web portal, designed and developed by the Aga Khan Development Network Digital Health Resource Centre (AKDN dHRC) in collaboration with the Division of Women and Child Health and the Expanded Programme on Immunization (EPI), Sind was selected as the winner of the Innovation in Preventive Care category at the Innovating Care Asia Pacific (ICAP) Awards 2017. The Awards were held in Kuala Lumpur on 30th September 2017.

Teeko was competing against two other Finalists in the Innovation in Preventive Care category. There were a total of nine finalists among the four categories, including Most Innovative Ageing Programme; Excellence in Disruptive Innovation; Innovation in Preventive Care; Best Patient Experience.

During 2017, Teeko was nominated as a finalist for three different award competitions: the Second Commonwealth Digital Health Award under the Child Health category; mBillionth Awards Gala 2017 under the Health and Wellbeing category and the ICAP Awards 2017.

The ICAP Awards recognize best practices across the continuum of care in care monitoring and delivery in the Asia-Pacific region. Practices which significantly increase and improve the quality of care while addressing challenges of accessibility, cost and scarcity of resources are recognized. New approaches to care as well as innovations in existing ideas, systems or processes for improved patient experiences and outcomes are also highlighted.

Teeko, an innovative Android-based mobile application and web portal, was developed by AKDN dHRC to assist with vaccinator and immunization tracking and monitoring. Teeko has helped monitor 26 vaccinators and 400 lady health workers in Tando Mohammad Khan district in the southern part of Sindh province in Pakistan, where the research project was being carried out. Through the app, 33,616 children were immunized while 147,627 vaccinations were administered.

Teeko was part of a research project titled, “Improving Routine Immunization Coverage through Health Systems Strengthening” implemented by AKU in collaboration with the government’s EPI, Sindh. AKDN dHRC designed, developed and provided technical assistance for Teeko.

In an effort to standardize data collection of deliveries across Aga Khan Development Network (AKDN) health facilities, a standard electronic data collection tool, the AKDN Delivery Tool, was developed and implemented by the Aga Khan Development Network Digital Health Resource Centre (AKDN dHRC) after consultation with various stakeholders.

The tool, a web portal and mobile application, is being used by physicians and nurses and has successfully been implemented in phases across AKDN health facilities in Bamyan, Faizabad and Kabul in Afghanistan; Gilgit and Booni in Pakistan; Mombasa in Kenya; and Dar es Salaam in Tanzania. Plans are to implement the application in Karachi and Hyderabad in Pakistan; Nairobi in Kenya; and Mwanza in Tanzania by the end 2019.

The AKDN Delivery Tool was developed by customizing and digitizing the CEmONC tool, developed by the World Health Organization and the Royal College of Obstetricians and Gynaecologists. Currently, it is being used by health care professionals. Essentially, the tool is a web-based portal with a mobile application that provides a single platform to record and report data of deliveries that take place across AKDN health facilities. It operates in both online and offline modes, allowing synchronization of data with the server as and when internet connectivity is available. From December 2017 to August 2018, the tool has helped record 3248 maternal admissions.

With an estimated 42,000 network-wide deliveries each year, this delivery tool brings uniformity in the data collection process and aims to bring access to aggregated data on deliveries, which can be used for implementation research and collaboration with policy makers, in efforts to improve maternal and newborn outcomes in underserved regions.

Pakistan has the third highest burden of maternal, fetal and child mortality in the world. Gaps in both health service delivery and policy levels have led to deteriorating Maternal, Newborn and Child Health (MNCH) outcomes, especially in remote and rural areas.

In 2018, AKDN dHRC in collaboration with the Aga Khan Health Service, Pakistan (AKHS, P) developed and launched an mHealth app, Nighedaasht, in remote, rural areas of Gilgit-Baltistan and Chitral, Pakistan in efforts to improve MNCH outcomes. The app is used by community midwives (CMWs) during community visits and physicians in health facilities. It aims to improve the quality, coverage and access to MNCH services by digitizing antenatal care, the delivery process and postnatal care; strengthening the referral system between community midwives (CMWs) and gynaecologists; and building capacity of CMWs through educational videos.

From January to September 2018, Nighedaasht has helped serve 513 mothers; supported CMWs with 158 deliveries, 399 initial antenatal, and 162 follow up antenatal visits; and tracked 47 referrals. Currently, the app is being used by 31 CMWs and eight physicians in eight health facilities of Gilgit-Baltistan and Chitral in Pakistan.

Nighedaasht ensures pregnant women and new mothers are able to receive the care they need during pregnancy, delivery and after birth, aiming to curb maternal and neonatal mortality and morbidity rates. The app was developed for the AQCESS Project, funded by the Aga Khan Foundation Canada and Global Affairs Canada. Plans are to expand functionality of the app to include family planning and tracking of child growth, illnesses, treatment and immunisations.

In efforts to streamline preparations at the Aga Khan University Hospital (AKUH) in Karachi for the renewal of Joint Commission International (JCI) accreditation that occurs every three years, AKDN dHRC recently developed and launched the AKUH – JCIA App.

The AKUH – JCIA App is a comprehensive guide to assist employees of AKUH with preparations for the renewal of JCI accreditation. It contains essential information and guidance regarding JCI accreditation standards and their implementation at AKUH. The main features of the app include a JCIA Pocket Guide, providing a guide on compliance requirements; JCIA Flyers, released internally for AKUH staff; and a JCIA Checklist to ensure completion of all preparations.

The mobile app is now publically available on the Google Play Store and the Aga Khan University App Store for download and has achieved over a 1000 downloads till date.

In efforts to improve health outcomes for rural and marginalized communities, AKDN dHRC commits itself to research and contributing to the existing body of knowledge in digital health. Recently, AKDN dHRC has co-authored multiple publications in digital health, on various topics such as improving community health outcomes, non-communicable diseases and palliative care. Publications include:

• Clinician-Targeted Mobile Apps in Palliative Care: A Systematic Review in Journal of Palliative Care
• Feasibility of mHealth intervention to improve uptake of antenatal and postnatal care services in peri-urban areas of Karachi: a qualitative exploratory study in Journal of Hospital Management and Healthcare Policy
• Mobile Health (mHealth) Technology for the Management of Hypertension and Hyperlipidemia: Slow Start but Loads of Potential in Current Atherosclerosis Reports
• Using Mobile Health (mHealth) Technology in the Management of Diabetes Mellitus, Physical Inactivity, and Smoking in Current Atherosclerosis Reports

Through continuous research, AKDN dHRC aims to drive improvements in access, quality, cost, efficiency and safety of health care; identify gaps in the health services delivery that can be addressed by implementation of innovative Information and Communication Technologies; and provide evidence-based and comprehensive information to stakeholders i.e. governments, health organizations, funding agencies and foundations.

With an aim to align with the current global trend and terminology, AKDN eHRC is pleased to announce that the official name of the AKDN eHRC is being revised to AKDN Digital Health Resource Centre (AKDN dHRC).

The work in the global eHealth space has expanded beyond electronic means, growing into wearables, augmented reality and 3D printing, focused more on digital technologies. It comes with opportunities for new, digitally-based models of care, the use of mobile, digital health communities, consumer health devices, gamification, etc.

AKDN eHRC has also evolved to in terms of vision, focusing more on digital innovations and mobile technologies, and therefore, considers it necessary to revise its name.

With this, AKDN dHRC has also redesigned its logo to reflect the official name change.

In July 2018, the AKDN dHRC team visited Kenya to implement and initiate digital health services at four sites. The Aga Khan Hospital (AKH), Mombasa was connected as a hub site to three spoke sites, Kilifi Health Centre, Akunda Health Centre and Aga Khan Academy in Mombasa for teleconsultation services in various specialties. Connecting AKH, Mombasa with the Aga Khan Academy for family medicine services marks the first connection established between Aga Khan Health Services and Aga Khan Academies.

During implementation, activities conducted at each site include digital health services’ room identification; training of physicians; and installation of LCD screens. A digital stethoscope and a multipurpose scope was also provided to each of the spoke sites to aid with diagnosis during teleconsultations.

Digital health services have been initiated in East Africa as a component of an ambitious expansion strategy that the Aga Khan Health Services, East Africa (AKHS, EA) has rolled out. In terms of the digital health network to be created in East Africa, AKHS, EA in collaboration with AKDN dHRC plans to implement digital health services in five clusters, Mombasa, Kisumu, Nairobi in Kenya and Dar es Salaam and Mwanza in Tanzania.

Plans are to implement and initiate telemedicine services at the Voi Outreach Centre in Kenya in late-2018.

In September 2017, the Aga Khan Development Network Digital Health Resource Centre (AKDN dHRC) organized an eHealth workshop, titled eHealth Innovations, at the Kalyon Hotel in Istanbul, Turkey. The workshop was an extension of another workshop, Telemedicine & mHealth Innovations – Exploring Possibilities, offered by AKDN dHRC earlier in 2017.

The aim of the workshop was to cultivate bold ideas in eHealth and help develop potential digital health solutions for implementation in the field. The workshop was designed to help health care professionals, programme coordinators and managers identify and address existing challenges in the domain of eHealth by promoting innovative ideas and approaches utilizing Information and Communication Technologies (ICTs).

The three-day workshop was systematically designed, where the first day was designated to presentations and discussions on digital health and integrated innovations, while during the remaining two days, participants were assigned to country teams, each of which worked to identify eHealth service delivery challenges currently faced in their local healthcare settings and ideate innovative solutions to address those challenges.

The workshop was funded and supported by the Central Asia Health Systems Strengthening (CAHSS) project. Thirty participants from Afghanistan, Kyrgyz Republic, Pakistan and Tajikistan attended the workshop.