Tuberculosis (TB)

Frequently asked questions on Global Task Force on digital health for TB and its work

What is e-/mHealth?

WHO

eHealth (or “electronic health”) is defined by WHO as the cost-effective and secure use of information and communication technologies (ICTs) for health and health-related fields. mHealth (or “mobile health”) is a component of eHealth, and involves the provision of health services and information via mobile technologies, such as mobile phones, tablet computers and Personal Digital Assistants (PDAs). The collective term "digital health" encompasses both of these concepts.

Why is e-/mHealth (digital health) so important for TB prevention and care?

The application of ICT to health care is a fast developing phenomenon. As the coverage of internet and portable telephony advance at a rapid pace, new perspectives open up to help patients in their quest for health and the health professionals to carry out their work. eHealth and mHealth (known collectively as "digital health") could provide new solutions and avenues for action on various aspects of TB prevention, care and control.

The factsheet eHealth in the TB Response identifies some of these applications, grouped under 4 functions, namely patient care; surveillance and monitoring ; programmatic management and eLearning. The potential for ICT to combat TB remains under-exploited. Nonetheless, a number of initiatives have already been put in place to improve or study the effect on work processes.

For instance TB patients and health care workers alike can use mobile devices to report notifications, encounters, or adverse drug reactions to centralised registers. Cash can be transferred via mBanking to reward patient adherence to treatment. Care-givers can receive alerts on test results via a short message or email. Mobile applications and webpages can be developed to update health care worker knowledge.

What is the WHO Global Task Force on e-/mHealth and TB and what is its mandate?

The Global Task Force was established in February 2015 and includes experts in different fields of TB care and control, representatives from major technical and financial partners, experts in information and communication technology (ICT), and representatives from countries on the forefront of the response to the TB epidemic.

The End TB Strategy approved by the World Health Assembly in 2014, as well as other WHA resolutions and efforts to promote the application by countries of ICT for health (“e/mHealth”) by WHO, define the functions and mandate of the Task Force. In carrying out its work the Task Force upholds the principles of patient-centred care, and ensures that the scope of interventions reach also to health concerns beyond the TB process itself.

What is the Task Force doing to fulfill its mandate?

In the short term (2015-2017), the Task Force will focus its efforts on two priority areas of work, namely:

1. Target product profiles (TPPs) for digital health products

The characteristics of the desirable ICT products will be defined and specifications will be developed to guide decision-makers on what type of products to have in order to address the challenges posed to health care providers, patients and their families

2. Case studies on scalability

Country-level or setting-specific projects will be supported to improve the uptake of e/mHealth at large scale

What is the vision of the Task Force concerning the target product profiles (TPPs)?

One of the main objectives of the consultation of 25-26 February 2015 was to develop specifications for e/mHealth products considered to be priority solutions for programmatic challenges. These specifications would be formulated in a standardised manner and following a particular methodology within each workstream. The end result would be a strategic document known as a target product profile (TPP).

A TPP helps to shape the creation and evolution of the intended product, aligning the needs of end-users with the work that the system developers need to follow in order to satisfy these demands; it provides a possible starting point for the detailed discussions that the various stakeholders need to have in order to bring the product to a successful implementation within a country.

Developers require TPPs early on within the production pathway. As a minimum, the TPPs should indicate the purpose of the functionality or system being developed, the goal/s to be met, who are the target end-users and the beneficiaries of the product, and what is the expected impact. The product should also achieve all the “minimal” and most of the “optimal” criteria which are set for each TPP.

A TPP should be considered a “living document” which evolves as the project matures. The Task Force is now committed to take forward the work started in the working groups of the consultation and to prepare a first version of the TPPs by mid-2015. Following the production of the first drafts of the TPPs the process will require a broad input from multiple stakeholders.

Who is paying for the work of the Task Force?

The Global Task Force is composed of experts in their own right who work pro bono. Most of these experts belong to institutions and international agencies which support the objects of the task force and thus provide funding in kind. The European Respiratory Society has financed the technical consultation which led to the creation of the task force and is also providing further support to the group and its activities.

The secretariat of the Task Force is provided by the Global TB Programme of the World Health Organization, which is supported by USAID. At country level, most eHealth activities are expected to be funded either from domestic sources or else through external funding, such as the Global Fund to Fight AIDS, TB and Malaria and USAID.

Research on the effectiveness of mHealth for TB and other health care delivery is being conducted by institutions such as the London School of Hygiene and Tropical Medicine, the University of Geneva, and the University of British Columbia. The aim of the secretariat and the Task Force is to engage more technical and financing partners to contribute to digital health efforts for TB.

How will the Task Force support countries to strengthen digital health efforts?

The second priority area of work for the Task Force consists of providing support to countries that have already embarked upon digital health initiatives for TB and which envisage a broader scale-up of these efforts. Projects will be chosen if they are already producing results or for which there are good grounds to expect an effective outcome, based on evidence from trials, from experience in the country or best practices elsewhere.

In the first years the projects would need to inform one of the TPPs being developed. The intention of the Task Force is not to run “pilots” but to provide and rally project funding and to furnish technical assistance in implementation and evaluation.

I want to introduce an electronic system for TB. Can you recommend me one, or will the Task Force be creating one for all programmes?

There is no simple answer to this question. Electronic systems may refer to different things and no two system requirements will look exactly the same, given that they often reflect different expectations, worker preferences, needs, infrastructural possibilities and so on. It is therefore not the objective of this website or the Task Force to develop one, common electronic system to generate the TB programme indicators.

The successful adoption of electronic recording and reporting does not start and end at software installation: much of it is also about changing how people work. In 2012, WHO and its partners developed a manual (see below) to guide users on how to assess the gaps and develop specifications focused on the recording and reporting of tuberculosis. If your programme is committed to create a system it is useful to approach the problem in a systematic manner, and you can follow the steps in this manual to develop detailed specifications. The TPP framework described above can be used to organize the different characteristics of the electronic system you aspire to.

It is useful to consult widely on such a TPP and ensure that the health care workers who will be using it have a realistic expectation and the right determination to see it through. They should also envision a system that will lighten and improve their work. The end-users' perspective is crucial but at times neglected.

Where can I find more information on the work of the Task Force and how can I get involved in its work?

These pages will be updated with information relevant for different users: you can find these on the homepage of "Digital health in TB care and control" , particularly under the "Resources & documents" and under the “Events” sections. You may also wish to visit the links to the websites of our technical partners: a number of them have some very useful documents with practical knowledge on implementation, assessment, latest news and so on.

Some sites like PubMed also list research work published in the scientific literature relating to the application of digital health and some leading peer-reviewed journals are now focused on this dimension of health care delivery. You can also contact the secretariat of the Task Force at falzond(at)who.int