Is the desire for Innovation substituting the need for Evidence?
GETHealth: A Global Education & Health Technology Summit 2014 Dublin
Key Correspondent: Bianca van Bavel
‘We are living in an unprecedented time for technology and innovation ’, was a statement heard several times over the two day GETHealth Summit in Dublin, November 13th and 14th. And in true visionary fashion, the conference provided an extensive look at the global tech nexus across health and education in the context of development. Of particular emphasis, was the issue of having robust research and evidence-based practice, before we start hedging our bets and over-hyping the integration of unproven technological solutions, particularly in the field of global health and development. So why bother reconciling these tensions between the local need for supported evidence with the global pressure of technological innovation?
Because “the plural for anecdote is not data” –Bob Bollinger, John Hopkins Center for Global Health
Recently, Science published its first article on Global mHealth, highlighting the very need for a scientific approach to address the complexities at the root of health systems and policies. This is a step in the right direction to prioritize and operationalize the role of integrated mobile ICT strategies within health systems. That even amidst the emerging excitement and projected securities of technology, we still need to be careful about ‘claiming’ results without having enough substantial evidence to support them. Dr. Alain Labrique from the Johns Hopkins Global mHealth Initiative, also supported the need for evidence in lieu of anecdotal findings, and argued that it’s more ‘Hope’ than ‘Hype’ that is needed to effectively support the future of mHealth.
Because not all pilots and first phases are meant to be scaled up
In the opening plenary session of the conference, panelists reflected on the pressures and problems of the vast quantity of ongoing pilots in the field of mHealth and mEducation. Samara Hammond of AMREF Health Africa, questioned how we can narrow the scope and begin to see the forest for the trees of this seemingly unregulated ‘pilot-itis’. From the tens of thousands of ongoing pilots, there are several hundred randomized trials that are aimed to measure the efficacy of mHealth interventions. Many of these are still too narrow in the vertical approaches they take; addressing only a single problem within a particular context of a greater health system. Sometimes the very adoption of a ‘pilot’ intervention into the existing infrastructure can actually constrain the opportunity for innovation and certain types of scale.
Scaling is more than just replicating and extending the reach of previous piloted interventions. Targeted projects that leverage the ubiquity of cell phones in many low-and middle-income countries have become more common. Those interventions that are working to integrate the complexities of healthcare systems and apply a people-centered approach towards service provision and technology use are proving the most successful in uptake. We were reminded throughout the conference, that true sustainability and successful scalability cannot happen in isolation. Partnering with local communities and working through local governments to establish these initiatives will ensure the uptake and future feasibility of projects.
Because the natural process of evolution takes time and requires patience
From the evolution of e-Health, to m-Health, and towards potentially even digital d-Health; Health should be the operative word, with people being the main focus. It’s easy to get caught up in the solutions that ICT can provide. Particularly, given the current state of global health systems and policy, the potential for advancement is extraordinary. Nonetheless when it comes to improving the underlying structures, overall quality, and availability of resources within these global health systems, introducing technical innovation will not necessarily lead to an improvement in care.
Back at the conference, it was Patricia Mechael of mHelp, who echoed the‘need to reconcile the speed of our [technological] enthusiasm with the realities of human nature’. The world of public health evolves at a significantly slower rate than that of technology. Even with evidence based solutions, it still takes 10’s of years for successes to be adopted and failures rejected. Hard to imagine this as an improvement from the 100’s of years taken previously to complete an innovation cycle. This was the case with the uptake of dietary interventions like Vitamin A supplements into nutritional programs to prevent visual impairment and infectious disease in resource-poor settings; despite having been an integral part of many traditional diets and medical practices around the world for centuries. Given the realities of these evolutionary processes, rather than search for brand new unfounded solutions, it makes sense to contribute and build on what others are already doing in the field, be it on the digital, mobile, health or educational front.
Because cooperation rather than competition fuels more effective and collective progress
The beauty of innovation is that it is never what you intend it to be. A recent article in the New York Times, explores the inextricable link of technological innovation with failure. From the success of one innovation, comes the widespread failure of all its remaining competition across commercial markets and industries. In the field of public health however, at the global mHealth nexus of necessity and amenity, the dissemination of these failures will provide more useful lessons to inform future successes. Efforts are being made by donors to collate some of these operational lessons and develop a set of working Principles for Digital Development. However, it would be to a wider benefit and use of collective resources if we collaborated across sectors and disciplines to establish a systematic framework or standardized network that would enable the effective sharing of these experiences between ongoing projects. It is through this type of cooperation, rather than competition, where we will begin to see both the success and failure transformed into improved health outcomes and strengthened health systems.
Because regardless of the influence behind larger Political Powers, never underestimate the subtle power of p-values
We can accept that the field of mHealth and mEducation is still relatively new, however the transition towards evidence-based practice and operationalized research is both necessary and natural. The pressures of multi-lateral partnering, big donor spending and rapid technological advancement will continue to drive tensions between the desire to innovate and the duty to corroborate. As global practitioners, scientists, civilians, entrepreneurs, and technologists, we have the moral obligation to challenge these pressures and hold each other accountable. Working together will enable us to reach higher standards and operationalize expertise outside of our own individual abilities. If we agree to reconcile these tensions and bring together the politicians, tycoons and philanthropists with the activists, medics and academics, then we will be able to garner innovation through the promotion of evidence-based solutions.
Bianca van Bavel
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