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.
A mobile health platform that connects refugees to life-saving preventative care including prenatal check-ups, childhood vaccinations, and other health services in Turkey.
Alysa St Charles
MEDAK, Field work and implementation
MEDAK, Field work and implementation
Grand Challenges Canada.
Mass Challenge Accelerator
Client, Health Care Provider, Health System Manager, Data Services Provider
Strategy and Investment, Services and Applications
Demand Generation, Service Delivery
The United Nations (UN) estimates that by 2050, 200 million people worldwide will be displaced from their homes in the wake of rising political conflicts and the acceleration of climate emergencies. Refugees face not only crises but a morbidity-mortality rate that is 60 times greater than more stable populations. Moreover, displaced women and children are at the highest risk of illness and death, and are also most likely to experience barriers to healthcare. 
HERA is named after the powerful Greek goddess and also stands for Health Recording App. It is a digital platform that exists to close healthcare gaps for displaced women and children, by connecting them to life-saving preventative care including prenatal check-ups and childhood vaccinations through their smartphones. Even as health services are available through relief agencies or host governments, demand-side barriers to accessing these services exist. These include language hurdles, xenophobia, and a lack of established medical records. Eliminating these demand-side barriers is crucial to increasing uptake of preventive services by refugee women and children. HERA works to diminish these barriers by providing health information in native languages, automatically calculating prenatal visit or vaccine schedules, and acting as a secure place to store individual medical data safely.
Data is self-reported by the user and supported with photos of their medical record. This is intentionally designed as an empowerment tool for the refugee end-user to capture and store their own personal health information (PHI).
There is no current integration into a clinic or hospital databases, but this may be considered for future pending data security navigation. Finally, data is stored locally, allowing for retrieval of medical records without access to the internet. (Image1)
HERA is an open-source mobile health (mHealth) platform designed by field experts, physicians, and refugees in Turkey. While specific Syrian refugee data in Turkey is challenging to obtain beyond market surveys, in a recent study with over 1,000 participants, 95.5 percent of Palestinian refugees in Jordan reported having a mobile phone.  Given the high projected levels of smartphone penetration, we concluded that mHealth approaches may be viably leveraged for refugee-directed interventions without physical provisions for smartphones at this time.  Appointment reminders are calculated after the app is downloaded and current health information is filled in. Refugees then receive push notifications about upcoming appointments regardless of connection to the internet.
HERA addresses additional challenges to refugees when needing health care, including offering health and medical information in their native language and locating emergency services or primary care clinics.  HERA advertises to target groups through direct service providers such as refugee health clinics and grassroots organizations , a strategy specific to the context of Turkey, where the majority of refugees are dispersed throughout the country in informal settlements rather than in refugee camps. HERA is also an agile app, meaning it is easily adjusted to respond to public and global health events, including pandemics.
HERA currently offers critical and up-to-date COVID-19 information to users in their native language, thereby eliminating language barriers between COVID-19 safety information and Turkey’s refugee populations. [5,6] HERA also has cost-effective capabilities to assuage financial concerns about refugee health. A return on investment projection for HERA suggests that, because HERA has an impact on vaccine and check-up compliance with implications for reduced morbidity and mortality from vaccine-preventable disease and pregnancy-related complications, HERA is both life-saving for refugees and a cost-effective tool for countries they migrate to.
HERA’s pilot study was completed in Turkey with the Syrian refugee population through an ethics review board-approved scientific study. This population was selected because Syrians make up approximately 3.8 million out of Turkey’s 4 million refugees. This study, centered on Syrian pregnant women and women with children under the age of two years as end-users, concluded it is highly feasible to implement a mHealth intervention for refugee groups.  The pilot study also concluded that automated reminders are a high-value alternative compared to other healthcare reminder methods. Above all, HERA found that refugee women have and are comfortable using smartphones and already use them to receive critical health information. Feedback was solicited from HERA users through interviews and focus groups.
HERA users were positive, with almost all stating that 1) HERA helped them with medical appointments; 2) HERA users were pleased they could keep their records digitally; and 3) supplementary health blogs within the app contributed to improved knowledge of current health issues, including the COVID-19 pandemic and any related government restrictions, information, and symptom descriptions. When evaluated by independent organizations such as Harvard Innovation Lab, Just One Giant Lab (JOGL), and Mass Challenge Accelerator, HERA scored highly among similar digital health interventions.
However, HERA’s unique differentiator is that it successfully provides users with regular reminders of prenatal and vaccination appointments for difficult to reach, vulnerable refugee populations. Overall, users and evaluators view HERA as an easy-to-use and valuable app for improving vaccines and prenatal care access.
Global health efforts must adapt to meet the realities of mobile, displaced populations, especially as refugee populations are expected to increase in upcoming decades. Mobile phones will also grow to be more important in health interventions and data collection as cell phones continue evolving into a necessity rather than a luxury. [2,5,7,8] HERA locates health disparities and confronts them by targeting vaccines and prenatal care by a preventive health approach. Vaccines, particularly for children, are essential to prevent disease in refugee camps and other close living conditions.
HERA makes accessing vaccines easy by both providing a vaccine schedule and locating nearby health clinics. The same goes for prenatal care: The earlier on in pregnancy, the mother’s health is monitored, the healthier the pregnancy, birth, and newborn period. Ultimately, mHealth interventions such as HERA are empowerment instruments that restore control over health to refugees themselves. 
With HERA, refugees maintain sovereignty over their health by carrying health records with them, communicating, and navigating the host country’s health system.