How MSF is Supporting the Growth of Telehealth Services
An Inside View of Scaled Understanding for Real-Time Health Support in Humanitarian Settings
There are countless unknowns in the COVID-19 era, particularly in global health in humanitarian settings. Whether digital health solutions such as telehealth will maintain and grow their relevance in these health sectors is not one of those unknowns. Digital health is here to stay, what we now need to do, as global health actors, is to understand what elements are most useful in these settings and validate efficacy for varied patient populations.
Let’s Start with Why
The COVID-19 pandemic has severely restricted patients' ability to safely access healthcare and support and challenged MSF's ability to provide crucial healthcare services as of early 2020. Effectively addressing the needs of COVID-19 patients and maintaining routine life-saving care in over 70 countries, where health systems are often facing severe resource limitations, requires the support of new approaches. That's where real-time telehealth consultations come into play.
Catalysed by the current pandemic, two-way telehealth communication with patients is being increasingly recognized as one such support method to help expand access to, and delivery of, healthcare and health information. In September 2020, a rapid review of MSF activities as a part of the research for the MSF Telehealth Toolkit identified there were over 20 telehealth initiatives of different forms identified across the MSF movement. A number of these interventions were newly launched to directly guide patients through COVID-19 care, while others were intended to allow high-risk patients (e.g. those living with TB/HIV, non-communicable conditions and mental health needs) to engage in their care remotely.
As realization of the telehealth opportunity increased, so too did the awareness of the associated challenges and realities.
rapid telehealth deployments in field operations were not yet supported by best-practices or operational guidance, potentially threatening the safety and efficacy of telehealth interventions.
the deficit of an appropriate support and coordination structure to bring together insights from across the movement meant that field teams looking to launch their own telehealth intervention were left seeking hard-to-reach information on what had already worked or failed.
Based on this tangible need, the MSF Sweden Innovation Unit, Operation Centre Geneva and MSF Telemedicine Unit Canada generated the MSF Telehealth Toolkit to support field teams in better implementing and evaluating telehealth interventions. This report and toolkit were compiled based on secondary desk research of relevant literature and case studies in addition to primary insights obtained via interviews with a range of MSF stakeholders with telehealth experience. These interviews included interactions across multiple Operation Centres and involved consultations with clinical, data protection, legal, IT, health promotion, logistics, and communications specialists.
Main findings and conclusions from this Telehealth Toolkit research process include:
A need for increased multidisciplinary collaboration and exchange of insights as MSF further explores telehealth. Definition of the elements of telehealth and digital health were central to the generation and dissemination of this Toolkit.
A deficit of telehealth publications from low-resource settings compelling MSF to consider how telehealth efforts may contribute to addressing this gap with efficacy and best-practice insights
An increasing number of digital health and telehealth efforts in MSF demanding a more consolidated IT infrastructure.
An additional point worth noting from the interviews conducted is that telehealth interventions in MSF must be explored with equity and inclusion firmly integrated into the process. Telehealth penetration in high-income contexts has been significantly higher than that of low resource settings creating a 'digital divide'.
The MSF Telehealth Toolkit
The main body of the MSF Telehealth Toolkit is based around three main components: pre-launch planning, implementation and evaluation.
In the pre-launch section users are guided through some questions essential to telehealth project kick-off including:
Is a telehealth intervention suited to the challenge you have identified in the field?
If a telehealth intervention appears to be a promising solution for your challenge, what options are available and what form should the service take?
What stakeholders already exist that may be relevant partners for this MSF intervention and what stakeholders and services should we be cognisant of when establishing referral
Once these crucial pre-launch steps have been completed the implementation toolkit section supports users to navigate of elements including:
How to pilot your telehealth intervention at a small scale before full launch.
What protocols need to be in place for optimal training and support of telehealth intervention operators both in MSF and those who may be outsourced?
How to establish and maintain essential referral pathways for onward and inbound referrals?
Finally, Toolkit users are encouraged to investigate the monitoring and evaluation of their telehealth system:
How to best measure impact on patient outcomes and user satisfaction?
Setting an evaluation and iteration plan to prepare for potential scale up or scale down.
Preparing for a potential handover to National Health Authorities or another MSF team.
While this evaluation section is the last in the Toolkit this is something that should be considered from day-one of planning the services.
Next Steps
The teams are currently working on the digitization of the MSF Telehealth Toolkit. This new platform will make it easier for users in the field and Operational Centres to interact with the resource and allow teams to collaborate more effectively without important details getting lost in emails. If you are a part of the MSF movement you can access the full Telehealth Toolkit here. If you are interested in the Toolkit from outside the movement register to see a demo at the MSF Scientific Days here or email siu@stockholm.msf.org to learn more.