Digital Health for Systems: Strengthening Family Planning Systems Through Time and Resource Efficiencies

This brief summarises the experience and evidence for the most commonly used digital health technologies aimed at supporting health systems and service delivery for family planning around the world. Digital health has been identified as a high-impact practices in family planning (HIP) enhancement by the HIP technical advisory group of international experts. (A HIP enhancement is a practice that can be implemented in conjunction with HIPs to further intensify the impact of the HIPs.)

Digital health applications, such as mobile phones, tablets, and computers, for health systems and providers can support implementation of HIPs by offering:

• Better data for decision making with virtually real-time reporting of services and commodities through a health management information system (HMIS) and logistics management information system (LMIS)
  • Digital applications can be used to manage logistics and reduce contraceptive stock-outs. For example, in Bangladesh, an electronic LMIS collects data on consumption and availability of family planning commodities, sends SMS (short message service, or text), and email alerts for reporting reminders, tracks reports against set timelines, and sends warnings of potential stock imbalances for contraceptive commodities. Participant districts nearly eliminated stock-outs; for instance, facilities reporting stock-out rates for Implanon implants dropped from 69% to 1% among facilities using the digital system.
  • Digital national health management information systems allow for timely analysis, data visualisuation, and reporting. Many countries are investing in large digital HMISs, such as the District Health Information Systems 2 (DHIS 2), and in digital human resource information systems such as Health Workforce Information Solutions (iHRIS) (see Table 2). Although DHIS 2 and iHRIS can and should include family planning indicators and data, not all countries are currently fully leveraging these platforms to capture this information. These indicators should be incorporated into new and existing digital health and logistics management information systems.
• Improved provider capacity through continuous learning, digital provider tools, and mobile supervision. For example, digital health is commonly used to enhance client-provider interactions and adherence to recommended protocols, particularly among community health workers (CHWs). For example, in Benin, a mobile application enables CHWs to register women as family planning clients, provide family planning counseling and advice using a combination of images and audio messages in the local language, register clients' chosen contraceptive method, share information on possible side effects of the method chosen, and record any family planning products distributed. CHWs in India reported that similar tools increased their confidence in performing their job. More research is needed about when and how digital applications for provider support are most effective, efficient, and scalable.
• Increased transparency, efficiency, and accountability through digital financial service (bobile money and electronic financial transactions).

Table 1 provides some illustrative examples of how digital technologies can be used to support implementation of HIPs.

Tips from implementation experience include:

• Gather information about and from the intended users of the digital interventions. This includes questions related to how stakeholders currently understand and use technology (including the types of technology they use and prefer and how they pay for technology use), as well as the barriers they face that a digital solution might address.
• Understand the overall technology landscape, including available infrastructure, existing programmes, opportunities for interoperability, and potential technology partners.
• Determine the potential scale for the project and the resources necessary for its long-term operation. Successful projects have engaged local stakeholders from the beginning in a deliberate, systematic, and continuous process.
• Consider realistic options for sustainable financing; digital health interventions need to be developed in a way that is appropriate to the local context while at the same time considering cost implications should the project be scaled nationally.
• Monitor the implementation and performance of a digital health service. What is unique to digital health technologies is the ability to rapidly collect monitoring and evaluation data through various techniques, including through routine system data as well as through other quantitative and qualitative approaches such as surveys deployed via the digital platform. The ability to garner near real time process monitoring information enables rapid design and implementation improvements.

The following research questions, reviewed by the HIP technical advisory group, reflect the prioritised gaps in the evidence base specific to the topics reviewed in this brief and focus on the HIP criteria: In what circumstances is the use of digital health interventions in family planning most cost-effective for offering training, training follow-up, or continuing education to providers? In what circumstances are digital health interventions most cost-effective for use in contraceptive counseling and screening? In what circumstances are digital health interventions in family planning cost-effective compared with non-digital interventions? Do digital applications that support family planning systems contribute to client-level outcomes such as the modern contraceptive prevalence rate?

To conclude the brief, links to resources for further learning are provided.