As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
An electronic health record for antenatal care built on the DHIS2 and localized with national reproductive health facilities, services, and care guidelines.
Tracker Product Manager
HISP UiO - software development, implementation support, training material development, global project coordination
HISP West and Central Africa - implementation support, training, regional project coordination
HISP Vietnam - implementation support, training, app development, regional project coordination
HISP Uganda - implementation support, training, app development, regional project coordination
HISP Sri Lanka - implementation support, training, app development, regional project coordination
HISP Tazania - implementation support, training, app development, regional project coordination
HISP South Africa - implementation support, training, app development, regional project coordination
HISP Saudigitus - implementation support, training, app development, regional project coordination
HISP Rwanda - implementation support, training, app development, regional project coordination
HISP Nigeria - implementation support, training
HISP Malawi - implementation support, training
HISP India - implementation support, training, app development, regional project coordination
HISP Indonesia - implementation support, training, app development
HISP Ethiopia - implementation support, training
HISP Colombia - implementation support, training, regional project coordination
HISP Bangladesh - implementation support, training
Norwegian Institute of Public Health
Palestinian Institute of Public Health
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
King's College London
National MoH (various) - implementation, maintenance, training
Other organizations (NGOs, etc.) - role depends on project
The Norwegian Agency for Development Cooperation (Norad),
The Bill and Melinda Gates Foundation
The Global Fund
The U.S. Centers for Disease Control and Prevention
Gavi, the Vaccine Alliance
The World Health Organization
Unicef, the University of Oslo
62 Countries including; Afghanistan, Angola, Bangladesh, Benin, Bhutan, Botswana, Burkina Faso, Burundi, Cambodia, Cameroon, Chad, Colombia, Dem. Rep. Congo, East Timor, Eritrea, Eswatini, Ethiopia, Ghana, Goa, Guatemala, Guinea, Haiti, Honduras, India, Indonesia, Ivory Coast, Kenya, Laos, Lebanon, Lesotho, Liberia, Madagascar, Malawi, Mali, Mozambique, Myanmar, Namibia, Nepal, Niger, Nigeria, Norway, Pakistan, Palestine, Republic of the Congo, Rwanda, Sao Tome, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Sri Lanka, Sudan, Tanzania, The Gambia, Togo, Uganda, Vietnam, Yemen, Zambia, Zanzibar, Zimbabwe
Client, Health Care Provider, Health System Manager, Data Services Provider
Legislation, Policy, and Compliance, Services and Applications, Infrastructure, Workforce
Demand Generation, Service Delivery, Supply Chain Management, Policy and Enabling Environment
Maternal and child health forms an important part of the healthcare system in Palestine. There are approximately 60,000 live births in the West Bank annually, and 99 percent are reported to be delivered in hospitals. Therefore, the public health system plays a major role in screening for pregnancy complications: gestational anemia, hypertensive disorders of pregnancy, gestational diabetes mellitus, and fetal growth restriction are identified as priority conditions for prevention. However, approximately 43 percent of pregnant women attend public antenatal care (ANC) services, and just 13 percent according to the recommended national schedule, which results in inadequate coverage of clinical interventions.
In 2016, the Maternal and Child Health (MCH) e-Registry, a custom application built on the DHIS2 Tracker platform, was introduced to Palestine’s public ANC system to improve the delivery of quality healthcare during pregnancy. Through the e-Registry, care providers capture essential patient data at the point of care and respond to real-time clinical decision support notifications. Complimentary digital health interventions have since been layered on top of this client management system. For example, targeted client communication is sent via SMS before each scheduled ANC visit, and critical quality improvement indicators are monitored by clinician-facing dashboards. In addition to this specific project, DHIS2 Tracker is used in RMNCAH and related programs (such as HIV prevention) in many countries. However, this case study provides detail on only one implementation country. More information on other DHIS2 projects and use cases can be found at dhis2.org.
In 2014, the Palestinian National Institute of Public Health (PNIPH) assessed the MCH register in Palestine. As a result of this assessment, and based on an agreement with the Ministry of Health (MoH), PNIPH partnered with the Norwegian Institute of Public Health (NIPH) and University of Oslo (UiO) to introduce the MCH e-Registry in Palestine. The main goal of the e-Registry is to automate client-level data collection, relieving care providers of reporting burden while transferring data to the national level to support evidence-based decision-making.
The e-Registry is an electronic health record for ANC built on the DHIS2 Tracker data model and localized with Palestine’s reproductive health facilities, services, and care guidelines. Algorithms for screening and treatment based on gestational age were embedded within the client record through pop-up alerts, skip logics, and suggested referrals to lab tests or high-risk clinics. Before each appointment is scheduled through the e-Registry, a client receives automated SMS to nudge healthy behaviors based on her record (for example, improving diet if hypertensive). Clinicians review their adherence to guidelines for screening and treatment of hypertension, anemia, and diabetes through a custom quality improvement dashboard.
The MCH e-Registry was planned and implemented through a consensus-driven process with MCH stakeholders across Palestine. As part of the e-Registry design process, national antenatal and postnatal care guidelines were updated. Additionally, a governance structure was developed to provide privacy and confidentiality, alongside an appropriate message library for SMS to clients.
During a phased roll-out, 1,500 health care providers were trained on using the e-Registry in the West Bank and Gaza Strip. As of the end of 2020, 360 of 427 governmental clinics are using the system.
The first of two cluster-randomized controlled trials of the e-Registry, the eRegQual study (2018), assessed the comparative effectiveness of e-Registry’s interactive checklists with clinical decision support and the existing paper-based recording routines. The trial evaluated 60 facility clusters using e-Registry and 60 clusters using paper records, enrolling 6,367 pregnancies in total. Results showed that screening dramatically improved for diabetes and anemia. Proper management of hypertensive disorders also improved (49 percent vs 19 percent).
The trial included a sub-study called “eRegTime”, observing the effect of the e-Registry on time spent by the care providers on client care, documentation, and reporting at 24 clinics. Compared to paper records, care providers using the e-Registry took 33 percent less time on health information management (9.9 minutes per client with paper compared to 6.6), and marginally more time spent on client care (4.9 minutes vs. 5 minutes). The second trial,eRegCom, began in autumn 2019.
The eRegCom study is a 2×2 RCT design with arms comparing layers of two e-Registry interventions during the phased introduction, including targeted client communication via SMS, quality improvement dashboard, both interventions, or decision support only. Preliminary results show that clients in the arm with both SMS and dashboards were more likely to attend four timely ANC visits than women in clinics with just one. Another sub-study, a survey of SMS recipients, showed that the targeted SMS did not increase pregnancy-related worries among recipients and there was no difference in women’s satisfaction with the ANC services between intervention and control arms.
The success of this e-Registry has led the Ministry of Health to adopt DHIS2 for routine reporting and disease surveillance in other areas, including COVID-19 surveillance in 2020. After the trials, PNIPH and Palestine’s MOH have built on and maintained the MCH e-Registry across public ANC clinics. Plans include linking a number of other DHIS2 Tracker programs across primary care with the MCH e-Registry, which would support better monitoring and continuity of care. Meanwhile, results from the trials, as well as experiences with the point-of-care use case in Palestine, have informed the development of the next generation of DHIS2 Tracker features, including referral management, analytics, and clinical decision support thereby enabling similar use cases in other contexts.