Background and rationale
Private sector health service delivery is an important component of many health systems across the globe as it is often the first consult and the primary source of care, especially for children under the age of five. This trend is consistent across multiple health conditions including fever, diarrhea, acute respiratory infection or symptoms of severe illness with up to 60% of patients first seeking care from private medicine retailers. Private medicine retailers are a diverse group of for-profit providers and includes any facility, pharmacy, drug shop, or individual that provides health services, yet is not managed by a government. The WHO has acknowledged the role of private medicine retailers in achieving universal health coverage because of the need for timely provision of health services and the increasing demand for health services through the private sector.
Studies have demonstrated significant gaps in quality of care delivered through private medicine retailers, stemming partly from limited exposure to or limited use of current treatment and diagnostic guidelines, poor access to or uptake of quality-assured commodities, and demand-driven interactions with clients. These gaps contribute to low adherence to appropriate clinical algorithms and widespread use of sub-standard medicines, jeopardizing public health targets for disease control and prevention.
Digital technologies provide an opportunity to address health system challenges, and thereby offer the potential to enhance the coverage and quality of health practices and services. Leveraging digital technologies in private medicine retailers has the potential to create operational efficiencies, improve the quality and quantity of products and services offered, generate needed case management data, and create impact at scale. While recognizing the innovative role digital tools can play in strengthening the health system, there is an equally important need to evaluate their contributing effect to ensure that investments are adequately balanced between digital tools and non-digital approaches.
The range of digital health interventions is broad and continues to evolve. This landscaping exercise aimed to identify which digital tools are being used to address gaps in quality of care and understand the extent to which digital tools support achievement of desired outcomes along the continuum of care i.e., recognition of symptoms, access to commodities, provision of appropriate treatment and reporting of results.
Approach
CHAI conducted a desk review of publications and journal articles, country-specific private sector strategy documents, and relevant donor reports. Additionally, we reviewed data collected by periodic surveys including Demographic Health Surveys and Malaria Indicator Surveys as well as data captured through CHAI projects (e.g., from the Essential Medicines; Maternal, Newborn, and Child Health; and Malaria teams). We also conducted interviews with key informants, including CHAI country and regional teams who engaged in private sector focused work, and technology organizations to understand and assess digital tools used to support of community-level health interventions (including those with a focus on community health workers and private medicine retailers).
Findings
Our landscape identified a number of digital platforms (those specific to malaria and with broader remits like diarrhea management and family planning) developed by technology companies and implemented by NGOs that may improve quality of care provided in private medicine retailers. A summary of the outcomes, interventions, and digital tools explored is provided in Table 1.
We found that although these digital tools have the potential to integrate, scale, and speak to private medicine retailer motives, there is limited available evidence on the effectiveness and impact of many of the digital tools we identified. However, in many cases these tools are feasible to implement, show national scalability potential, and demonstrate acceptability by end users.
For that reason, the WHO recommends any of the approaches and types of tools outlined in Table 1 with the caveat that they should be implemented only if certain conditions are present. End user considerations include a sufficient network connectivity perception of value-add, ease of use, affordability, integration with existing workflows and data security. For governments, projects should consider resource mobilization, horizontal disease program integration, and the regulatory environment for private medicine retailers and digital tools. As with any new approach, digital interventions require changes in behavior and transitions to new practices for the project to be sustained long-term. Deploying tools into a favorable environment will ensure digital tools complement and enhance health system functions and lead to impact.
Table 1: Summary of private sector focused interventions and digital tools
| Desired Outcome | Intervention | Digital component | Digital Tool examples |
| Private medicine retailers comply with national regulations and guidelines | Pursue regulatory reform | Digital accreditation process | Unable to identify existing digital tools |
| Digital registration process | |||
| Private medicine retailers recognize symptoms of disease | Design and implement training programs geared towards private medicine retailers that are patient facing | Digital questionnaires evaluate compliance to national guidance in private medicine retailers | HNQIS tool by PSI |
| Remote training program or training materials accessed ad hoc | IA Watch by Immunization Academy Leap by Amref Viamo |
||
| Build system for private medicine retailers to maintain their case management skills | Remote supportive supervision | Mobile Kunji by BBC Media Action | |
| Continuing medical education digital platform | SwipeRx by mClinica | ||
| Private medicine retailers are equipped with appropriate commodities at affordable prices | Ensure access to quality commodities and proper management of commodities at retail level | Inventory management system | Shelf Life by Field Intel mSupply |
| Digital point of sale platform | Maisha Meds | ||
| Digital marketplace | Healthy Entrepreneurs DrugStoc Kasha |
||
| Establish/ reinforce access to finances for private medicine retailers to purchase quality assured commodities | Digital platform for microlending/ credit for quality assured health commodities | Kionect by Mastercard KopoKopo |
|
| Private medicine retailers provide appropriate care or refer | Provide guidelines and workflow support to private medicine retailers | Electronic SOPs/ job aids | MEDSINC by ThinkMD TBSTARR by SHOPS Plus |
| RDT Reader mobile apps | HealthPulse by Audere | ||
| Provide access to in-person clinical support networks | Electronically accessed peer networks | mHero by Intrahealth | |
| Referral linkages facilitated by digital communications | Afya Tek by D-Tree International | ||
| Provision of incentives for proper case management/ quality care | Electronically dispersed conditional subsidies | PharmAccess Maisha Meds TESTsmART by CHAI |
|
| Non-monetary incentives for testing and reporting | QualityRx by mPharma | ||
| Private medicine retailers document and report test and treatment results | Establish reporting system to track patient diagnosis and treatment and/or shop commodities | Electronic reporting tools | mTrac by UNICEF Other various applications |
| Dashboards/ feedback reports directly to retail shops | Bloom by mPharma | ||
| Patients/caregivers are aware and informed on malaria diagnosis and treatment | Financial support to patients for testing services at retail shops | Mobile wallets/money | Helium Health |
| Digital insurance platform | CarePay Connected Care by Discovery |
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| Product information (i.e., dosing, quality assured commodities, etc.) dissemination to patients/caregivers | Packaging QR codes with drug information | Sproxil | |
| Digital behavior change communication/ community messages | Viamo TriggerRise Keheala |
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| Mobile information resource or electronic medical records | askNivi Red Bird PROMPTS by Jacaranda Health |
Moving forward
Since the landscaping, CHAI has established relationships with some of the technology partners listed in Table 1 and is keeping track of long-term trends in the expanded use cases, functionalities, and impact of various digital tools. Furthermore, this landscaping led to a partnership between CHAI and Audere. Together we are co-designing a project in Nigeria using their RDT Reader software among patent and proprietary medicine vendors (PPMVs) to increase testing with RDTs for fever patients and encourage appropriate treatment to positive malaria cases.
