Hayat is an mHealth innovation, being implemented in select areas of Afghanistan and Pakistan, which aims to empower frontline health workers with digital health technologies in efforts to increase coverage of and access to routine immunisation maternal, newborn and child care (MNCH) and child illness and growth services.

Hayat has successfully been implemented in 56 health facilities and their catchment populations in select Afghanistan and Pakistan in collaboration with implementing partners, Aga Khan Health Service (AKHS) in Afghanistan and Pakistan; the government health departments of Khyber Pakhtunkhwa (KPK) and Gilgit-Baltistan in Pakistan and the Ministry of Public Health (MoPH), Afghanistan.

During the first year, Hayat has demonstrated immense potential in achieving higher utilizations of services by the population by improving the transparency and accountability mechanisms linked with health worker performance and creating a demand for services by generating awareness and interest through the awareness sessions. The close-to-real time monitoring through the digitised system, along with the comprehensive database, allows government stakeholders to identify gaps and challenges, enabling them to allocate resources appropriately in a timely manner. A key component of Hayat’s training sessions was the empowerment and capacity building of health workers, many of whom often lack digital literacy due to limited exposure in remote settings.

One of the main successes of Hayat were the interactive awareness sessions. Previously, a health worker would relay health education messages orally to a patient, but felt that this often lacked impact, as the participant would quickly lose interest. Under Hayat, the awareness sessions are met with great interest in the field, and other family members (such as the husband and mother-in-law, who are the primary decision makers in these settings) oftentimes participate, leading to a greater audience and impact. Awareness sessions are highly helpful in creating a change in their awareness, attitudes and ultimately, behaviors. Furthermore, with the usage of Hayat, the EPI and LHW Program health workers are now working with greater coherence. For example, a lady health worker is now informing a vaccinator about child births in their village through the Hayat application, helping reduce the number of zero dose children and tracking defaulters.

Saleem Sayani, Director of AKDN dHRC and AKU’s Technology Innovation Support Centre, was invited to join the World Health Organization’s (WHO) team of digital health experts in June 2019. WHO recently established a global, multidisciplinary Digital Health Department. The newly established department aims to harness the power of Information and Communication Technologies (ICTs) and innovative digital health technologies to steer development in efforts to attain the highest level of health of all people through the General Programme of Work (GPW13) triple billion goals and Sustainable Development Goal 3.

WHO established a roster of experts with experience in various areas of digital health, like implementation of strategic approaches, intervention and governance structures for regulations and adoption of digital health solutions and products. The digital health experts on the roster will provide extensive support and advise the global health body in establishing a digital health ecosystem.

WHO views digital technologies as a vital tool in achieving universal health coverage and has appointed a range of multidisciplinary innovators from around the world to its Digital Health Experts group. The group is part of WHO’s recently established Digital Health department that seeks to spur innovation in applications and interventions to help achieve targets under goal 3 of the sustainable development goals, Good Health and Wellbeing.

Nighedaasht presented at the Ninth French Medical Institute for Mothers and Children (FMIC) Annual International Scientific Conference

Nighedaasht was presented at the Ninth FMIC Annual International Scientific Conference in August 2019. The international conference is an annual event, which serves as a platform for scientists, researchers, physicians, nurses, allied health professionals, journalists, policy makers and officials from international public and/or private organizations across the globe.

Dr Momina Muzammil, Research Associate, delivered an online presentation titled, “Nighedaasht: Improving Maternal Health Outcomes through Digital Health Technology”. Nighedaasht, is an award-winning mobile health application, designed and developed by AKDN dHRC in collaboration with the Aga Khan Health Service, Pakistan with an aim to improve access to and provision of maternal, newborn, and child health (MNCH) services in the remote and rural areas of Pakistan.

Hayat Exhibited at the 5th All Pakistan DUHS-DICE Health Innovation Exhibition 2019
The Hayat mobile application was exhibited at the 5th All Pakistan DUHS-DICE Health Innovation Exhibition 2019 on October 16 and 17, 2019 at Expo Centre in Karachi, Pakistan. During the exhibition, members from AKDN dHRC discussed how Hayat addresses maternal, newborn, and child health (MNCH) care challenges in underserved communities in Afghanistan and Pakistan and its achievements in the first year of project implementation. Booth visitors were also given a walk-through of the Hayat mobile application.

Distinguish Innovation Collaboration & Entrepreneurship (DICE) foundation, a US-based non-profit in collaboration with the Dow University of Health Sciences (DUHS) organizes the DUHS-DICE Health Innovation Exhibition every year in efforts to promote innovation in health care in Pakistan.

Hayat showcased at the American Public Health Association (APHA) Annual Meeting and Expo 2019 in Philadelphia, USA
Hayat was presented at the American Public Health Association 2019 Annual Meeting and Expo on November 2019 in Philadelphia, Pennsylvania, USA. The abstract, titled “Using an mHealth Application for Improving Primary Care Delivery by Community Health Workers in Underserved Areas of Pakistan,” was included as part of Poster Session 5: Technology Enabled Health Outcomes. The conference theme was “Creating the Healthiest Nation: For science. For action. For health."

Availing eLearning services and second opinions for surgical procedures in real-time directly from the operation theatre enable professionals in isolated and resource limited health facilities to perform high-quality surgeries in medically underserved locations. This eliminates the need for patients to travel long distances to avail surgical health care services and saves them unnecessary travel-related expenses. Furthermore, health professionals benefitting from eLearning services in telesurgery are able to build their capacity without having to leave their work places, which is beneficial in settings where there is already a shortage of health care workers.

During July 2019, telesurgery services for eLearning were implemented in East Africa at the Aga Khan Hospital, Dar es Salaam. This marks the first time telesurgery services have been implemented in East Africa through the AKDN Digital Health Programme. The set-up provides an immersive learning experience to health care professionals at the spoke site using virtual reality.

The Telesurgery 3D display provides surgeons located in different health facilities around the world with a shared, high-definition visual, facilitating collaboration amongst surgeons in real-time and helping improve surgical accuracy and reducing chances of errors. Telesurgery services not only help improve surgical patient care, but also act as an eLearning tool in medical education for surgical students and professionals, enabling profound real-time interaction among surgeons.

The 2010 Global Burden of Disease data estimates about 3.87 million premature deaths by 2025 as a result of cardiovascular diseases. Pakistan faces a similar situation with many of its 210+ million people suffering from hypertension, dyslipidemia, cardiovascular diseases (CVDs) and diabetes mellitus, such that an estimated 2000 people die from a serious cardiovascular event each day.

In efforts to reduce the burden of cardiovascular diseases in Pakistan, AKDN dHRC in collaboration with the Department of Medicine at the Aga Khan University designed and developed the Meri Shifa application.

Meri Shifa, meaning ‘my health’ in the local Urdu language, is a mobile application and web portal, which assists in the early detection and management of CVDs in individuals at risk through screening, referrals, treatment and lifestyle modification. The app facilitates convenient, real-time management of patients at risk of CVDs and generates reports instantaneously. The app functions in both online and offline modes, allowing access around the clock.

The mobile-based application contains several questionnaires to assess the risk factors, including: Indian Diabetes Risk Score (IDRS); International Short Physical Activity Questionnaire; Global Adult Tobacco Survey; Food Frequency Questionnaire; Questionnaire to Verify Stroke Free Status; Rose Angina screening; and direct questions to detect hypertension. Based on the answers the integrated Artificial Intelligence (AI) categorizes each participant as low, moderate or high risk. Moderate to high risk individuals undergo further clinical investigations and avail teleconsultation services through the app.

Lifestyle modification messages are sent to all participants to ensure on-going support. During the clinical investigation, a healthcare provider records all findings on the Meri Shifa web portal.

The Meri Shifa app is a component of a pilot study, funded by The George Institute for Global Health. The study is currently being conducted in the Union Council of Malir Town in Karachi. Robocalls and SMS have been used to enroll participants in the study.

Capitalizing on an existing infrastructure of 270 laboratories and 16 integrated medical centres across Pakistan, the pilot study aims to demonstrate feasibility of mHealth to provide an early, preventive health care plan with potential outcomes to inform national policy and practice.

AKDN dHRC’s publications and reports play a critical role in fulfilling its mandate to drive improvements in access, quality, cost, efficiency and safety of health care. They help identify gaps in the health services delivery that can be addressed through innovative use of Information and Communication Technologies (ICTs) and provide vehicles for AKDN dHRC to engage in policy discourse and influence decision-making.

Between July to December 2019, AKDN dHRC authored and co-authored two publications in digital health and was featured in a policy note published by Organisation for Economic Co-operation and Development (OECD) Development Centre.

• Addressing Cost and Time Barriers in Chronic Disease Management through Telemedicine: An Exploratory Research in Select Low- and Middle-Income Countries
  In December 2019, the AKDN dHRC in collaboration with the World Bank published a study on economic benefits of telemedicine in low- and middle-income countries. The study, through an analysis of data covering a period of five years of the AKDN Digital Health Programme across, emphasized how telemedicine is a game changer in improving chronic disease outcomes, improving access and increasing uptake of services by reducing socioeconomic barriers related to cost and accessibility, thereby enabling early intervention and long-term management.

• Bridging the Gap in Training and Clinical Practice in Sub-Saharan Africa
  In September 2019, AKDN dHRC co-authored a study, which sheds light on the growing gap in medical advancements in LMICs and high-income countries (HICs). The article highlights that innovative technology and sharing of knowledge by committed individuals along with public private partnerships (PPP) can help bridge the gap.

• Health and Philanthropy, Harnessing Novel Approaches for Improved Access to Quality Healthcare OECD Development Centre, Paris (Page 34-35)
  The “Health and Philanthropy, Harnessing Novel Approaches for Improved Access to Quality Healthcare OECD Development Centre” policy note discusses how AKDN dHRC has been championing eLearning and telemedicine in LMICs. The document also discusses AKU’s award winning innovative mHealth solution, Teeko.

AKDN dHRC developed an mHealth application, PurUmeed Aghaaz to assess the effectiveness of web-based mHealth coaching in improving the nutrition and use of supplements (folic acid, iron and Vitamin D) during pregnancy compared to the standard counseling.

The pregnancy-support application is developed as a component of a research project led by Dr. Rozina Nuruddin, Assistant Professor Department of Community Health Sciences, Aga Khan University, Karachi in collaboration with AKDN dHRC and Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, Rotterdam. The research project is based on the Barker’s hypothesis of the fetal origin of adult disease. The Barker hypothesis suggests that poor nutrition during the antenatal period will not only affect pregnancy outcomes but may also disturb epigenetic programming.

PurUmeed Aghaaz, a web-based mobile application was developed to advice and counsel women during pregnancy. The application also collects data on food and supplements consumed by pregnant women over the period of one week before each antenatal visit, using questionnaires. The questionnaire is auto-filled with the help of food log maintained though integrated Artificial Intelligence (AI). The application also allows pregnant women to log lifestyle habits, including physical activity.

Through the data provided, the app generates a score and provides customised recommendations. Scores generated from the six food groups are a combination of qualitative and quantitative score, in which a healthy diet results in a lower score. Each participant receives customized push notifications or advice three times a week. The recommendations enable women to improve the dietary intake and use of supplements and habits. Women with a lower score and adequate exercise receives motivational notification to keep up with the compliance.

Saleem Sayani, Director, AKDN dHRC and Digital Health Expert, World Health Organization, was invited to participate on a panel of innovators during a session at the Grand Challenges 2019 Annual Meeting in Addis Ababa, Ethiopia.

The plenary session’s focus was on bold innovations and panelists experiences with governments in facilitating the innovators to bring change in underserved areas. Saleem spoke about how he worked with the Ministry of Public Health in Afghanistan and Departments of Health in Khyber Pakhtunkhwa and Gilgit-Baltistan in Pakistan to scale Hayat, an innovative mobile application for use by health workers to improve access to and coverage of maternal, newborn and child health services in select areas of Afghanistan and Northern Pakistan. Hayat is part of a CAD 2 million transition-to-scale grant funded by Grand Challenges Canada and the Aga Khan Foundation Canada.

Saleem emphasized on the role of governments in acting as an enabler to help innovators implement new technologies and efficient ways of health service delivery in remote regions and how these programs can be integrated into the national/provincial health delivery systems for long-term sustainability.

The Grand Challenges Annual Meeting 2019 was a four-day event, which brought together key leaders from across the globe to share best practices, foster collaboration and seek solutions for development challenges through bold innovations.

The conference, held between October 28-31, 2019, was co-hosted by the African Union; Ethiopia's Ministry of Health; Grand Challenges Canada; the United States Agency for International Development and the Bill & Melinda Gates Foundation. The theme of the conference was Saving Lives at Birth: A Grand Challenge for Development.

In collaboration with AKUH, K, AKDN dHRC designed and developed the Sales and Service Outreach mobile application to enable outreach staff to conveniently manage their workload and report progress. The application is Android based-tablet application with a web portal, allowing outreach staff to manage day-to-day activities, track and report trips. Supervisors, through the app, are able to digitally manage all tasks performed by the outreach team, including meeting requests, training information, time traveled, etc. in real-time. For each of the coordinators, who monitor multiple clusters in the nine regions of Pakistan, the application helps keep track of the administrative, sales and marketing tasks; maintain records of Continuing Medical Education (CME); and record daily travel journeys.

Sehatmandi is a three-year project administered by the World Bank through the Afghanistan Reconstruction Trust Fund (ARTF) and implemented by Afghanistan’s Ministry of Public Health (MoPH), aiming to increase the utilization and quality of health, nutrition, and family planning services.

Through the project, contracts to national and international non-government organizations are issued in efforts to support the guidelines of the MoPH for the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS). The Aga Khan Health Service, Afghanistan (AKHS, A) was issued a year-long contract, which allocated the management of 189 government- and AKDN-owned health facilities across the region of Bamyan and Badakhshan.

For the project, AKHS, A and AKDN dHRC collaborated to develop a robust, digital health tool to aid with the performance monitoring of the allocated 189 health facilities. AKDN dHRC developed Sehatmandi, a tablet-based application to digitise the manual assessment and monitoring process for health facilities. The application enables health care administrators to record real-time data through a digital questionnaire to enable indicator monitoring in real-time. The questionnaire helps monitor health facilities focusing on defined indicators for tuberculosis and maternal and child health services provided.

The application is a user-friendly and time-saving tool, which ensures seamless access to data of select health facilities. It is not dependent on internet connectivity and operates in offline mode, allowing data to be synchronized with the central server via SMS technology in case connectivity is not available.

During 2019, the app was successfully implemented in 74 and 115 health facilities in Bamyan and Badakhshan, respectively, and is being used by health care administrators to assist with the monthly performance monitoring and reporting in various clinical and administrative areas.