Table 1.
Summary of WHO Guideline: recommendations on digital interventions for health system strengthening.
| Interventiona | Health conditions | Recommendation | Effectb | Certainty of effect rangec | |
|---|---|---|---|---|---|
| 1 | Birth notification via mobile devices | N/A | RECOMMENDED ONLY IN SPECIFIC CONTEXTS OR CONDITIONSa: | No effect | Very low |
| In settings where the notifications provide individual-level data to the health system and/or a civil registration and vital statistics (CRVS) system, and the health system and/or CRVS system has the capacity to respond to the notifications. | |||||
| 2 | Death notification via mobile devices | N/A | RECOMMENDED ONLY IN THE CONTEXT OF RIGOROUS RESEARCHa: | No studies identified | Very low |
| In settings where: the notifications provide individual-level data to the health system and/or CRVS system, and the health system and/or CRVS system has the capacity to respond to the notifications. | |||||
| 3 | Stock notification and commodity management via mobile devices | All | RECOMMENDED ONLY IN SPECIFIC CONTEXTS OR CONDITIONSa: | No effect | Very low |
| Where supply chain management systems have the capacity to respond in a timely and appropriate manner to the stock notifications. | |||||
| 4 | Client-to-provider telemedicine | All | RECOMMENDED ONLY IN SPECIFIC CONTEXTS OR CONDITIONSa: | No effect, + effect | Very low to moderate |
| To complement, rather than replace, the delivery of health services and in settings where patient safety, privacy, traceability, accountability, and security can be monitored. | |||||
| 5 | Provider-to-provider telemedicine | All | RECOMMENDED ONLY IN SPECIFIC CONTEXTS OR CONDITIONSa: | No effect, + effect | Very low to low |
| Where: patient safety, privacy, traceability, accountability, and security can be monitored. | |||||
| 6 | Targeted client communication (TCC) across five population groups | Sexual, reproductive, newborn, child, and adolescent health | RECOMMENDED ONLY IN SPECIFIC CONTEXTS OR CONDITIONSa: |
Adolescents: No effect, + effect; Adult users: No effect, + effect, − effectd; Pregnant/post-partum women: No effect, + effect; Pregnant/post-partum women with HIV: No effect, + effect; Parents of children <5 years of age: No effect, + effect |
Adolescents: Very low to low; Adult users: Very low to low; Pregnant/post-partum women: Very low to moderate; Pregnant/post-partum women with HIV: Very low to moderatee; Parents of children <5 years of age: Very low to moderate |
| Under the condition that potential concerns about sensitive content and data privacy can be addressed. | |||||
| 7 | Health worker decision support via mobile devices (CDSS) | All | RECOMMENDED ONLY IN SPECIFIC CONTEXTS OR CONDITIONSa: | No effect, + effect | Very low to moderate |
| For tasks that are already defined within the scope of practice for the health worker. | |||||
| 8 | Digital tracking of patients’/clients’ health status and services via mobile devices | All | RECOMMENDED ONLY IN SPECIFIC CONTEXTS OR CONDITIONSa: |
Tracking+TCC: No identified data; Tracking+CDSS: No effect, + effect; Tracking+CDSS+TCC: No effect |
Tracking+TCC: N/A; Tracking+CDSS: Very low to moderate; Tracking+CDSS+TCC: Very low |
|
Where the health system can support the implementation of these intervention components in an integrated manner; For tasks that are already defined as within the scope of practice for the health worker; and Where potential concerns about data privacy and transmitting sensitive content to clients can be addressed. | |||||
| 9 | Provision of training to health workers via mobile devices (mLearning) | All | RECOMMENDEDa: | No effect, + effect | Very low to low |
| To complement, rather than replace, traditional methods of delivering continued health education and post-certification training. |
aRecommended: the intervention/option should be implemented; recommended only in specific contexts or conditions: the intervention is applicable only to the condition, setting or population specified in the recommendation, and should only be implemented in these contexts; recommended only in the context of rigorous research: Given the uncertainties in the intervention/option, implementation should be undertaken in the form of research to address unanswered questions.
bPertains to positive, no effect, or harmful effect on a range of outcomes assessed, including:
Client Interventions (4,6): unintended consequences, resource use, satisfaction/acceptability, utilization of health services, health behavior, status, and well-being.
Health worker interventions (5,7,8,9): unintended consequences, resource use, satisfaction/acceptability, health worker performance, health worker skills/attitudes, health worker knowledge, clients’ utilization of health services, clients health behavior, status, and well-being.
Health systems interventions (1,2,3): unintended consequences, resource use, satisfaction/acceptability, coverage of birth/death registration (1,2), timeliness of birth/death notifications (1,2), coverage of newborn or child health services (1,2), timeliness of newborn or child health services (1,2), availability of commodities (3), quality and timeliness of stock management (3).
cCertainty of effect pertains to very low, low, moderate, and high certainty evidence based on grading of the evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)7.
dFor a study on TCC among adult users conducted in a community setting in Bangladesh, it was determined that the digital intervention may increase the number of women who experience physical violence12.
eThe only evidence graded to be of moderate quality suggested little to no difference of the intervention on the number of pregnant women adhering to prenatal anti-retroviral medication.