MoH&FW releases guidance for addressing non-COVID health conditions through various telehealth platforms

mHealth was identified as one of the modes to minimise patient-provider contact

The World Health Organisation (WHO) published guidelines on digital interventions for strengthening health systems. The guidelines recognise mHealth as a significant component in the delivery and support of healthcare policy, guidelines and decision-making processes. In keeping with the same, the Ministry of Health & Family Welfare (MoH&FW), Government of India recently released a guidance note for addressing service delivery of non-COVID health conditions through the use of various telehealth platforms to maintain physical distancing. Mobile Health (mHealth) was identified as one of the modes to minimise patient-provider contact.

The document provides a summary of evidence from two systematic reviews 4,5 and the WHO guideline on digital health interventions. The qualitative systematic review by Odendaal et al forms the basis of this policy brief to help understand the barriers and enablers for successful implementation of mHealth technology from health workers’ perspectives and encourage them to use mHealth for delivering primary health services. The findings from this review are complemented by a quantitative systematic review findings and the WHO guidelines to formulate and contextualise key policy considerations. The systematic review by Odendaal et al explored the perceptions of various health workers when using mHealth technologies. 

Overall, the qualitative review reported 42 findings, with a high confidence in 13 findings, moderate confidence in 18, low confidence in six, very low confidence in five. The review reported four overarching themes. 

Theme 1 relates to the change in working styles and relationships between health workers (for example connecting lower-level health workers with higher-level health workers) through mHealth use. 

Theme 2 deals with the changes in delivery of care through mHealth use, and includes health workers’ views and experiences about issues, such as accessing information from the Internet, providing remote / distant care, and using treatment algorithms. 

Theme 3 describes the new forms of engagement and relationships with patients and communities through mHealth use, as it allows bidirectional communication between the health worker and the patient. Issues such as improved health worker status due to the use of modern technology and the need to protect patient information and privacy on their devices were also covered in this theme. 

Theme 4 relates to the health workers’ use and views of mHealth that are influenced by factors such as costs, the health worker, the technology, the health system and society. Issues such as the impact of poor network access and poor access to electricity were also covered in this theme.

Overall, the results showed that the use of mHealth applications was mostly limited to a few states and union territories such as Tamil Nadu, Karnataka, Delhi and Maharashtra. Health care professionals included in the studies were mostly physicians, with very few studies including other healthcare workers such as community health workers. Some of the key findings are reported below:

• Service delivery strengthening was the primary objective of majority of the included studies. Key activities covered in this domain included patient consultations, remote diagnosis, patient education, and follow-up through videoconferencing. Mobile phones were mainly used for treatment adherence reminders (text and Interactive Voice Response), appointment reminders, and behaviour change messaging. Technology- related perception of the end users, patient satisfaction, assessment of healthcare professional needs, and challenges related to health service delivery using IT were some of the issues that were explored in this domain.
• The most common health workforce strengthening activity included the establishment of a provider-to-provider communication through teleconsultations, remote trainings, and capacity building. A few studies reported on the development and utility of interventions for community health worker that facilitated task shifting for disease screening, referral, and health information dissemination.
• A few studies reported on the use of mHealth applications with a focus on medical products and technology and were mostly related to eye care (for example, use of remotely operated technological tools for disease diagnosis).
• Strengthening of the health information system, with focus on vital event tracking, disease surveillance, and case notification in rural areas was evaluated in a few studies.
• Due to constant new developments in mHealth applications, it becomes imperative that health workers become familiar with these applications and be supported with the technological know-how.

The WHO digital interventions guideline 1 highlight the role and value of digital health interventions (that are primarily available via mobile devices) in strengthening health systems and in closing health system gaps. Some of the key recommendations are:

• The WHO recommends the use of mobile devices for telemedicine, targeted patient-health worker communications, health worker decision support and digital tracking of health status and services.
• Telemedicine consultations between patient and health worker should be conducted in settings that ensure monitoring of patient safety, privacy, traceability, accountability and security.
• Digital targeted patient communication for behaviour change regarding sensitive content such as sexual, reproductive, maternal, newborn and child health, should ensure that patient confidentiality and data privacy are sufficiently addressed.
• Digital provision of training and educational content for health workers should be adopted and complement traditional methods of delivering continued health education and in-service training.