Integrated digital health interventions in the first 1000 days

The evidence is clear about what health care is needed in “The First 1000 Days” from pregnancy to two-year-olds – but the “knowledge-do” gap is wide in low-resource settings. There are gaps in access, use, quality and equity of care. Many digital health interventions are effective in bridging such gaps, be it SMS reminders of appointments; checklists with decision-support for providers; or work-aids for reporting or managing clients. Yet, if such interventions are introduced in silos outside the health information ecosystem, they may be disruptive to services, and unsustainable at scale. Thus, WHO identifies digital health solutions integrated in individual client registries as a priority area of innovation. We spearheaded the scientific development of innovative eRegistries for women and children: integrating research-supported digital health interventions at the point-of-care – in the hands of care providers – embedded in the free and open-source health information system used in 68 low- and middle-income countries: DHIS2. Our eRegistries, co-designed with local users, are now operating in Palestine and Bangladesh. Challenges and enabling factors in implementing digital health interventions are well known. They relate to innovation; context; capabilities, opportunities and motivation of the users. Facilitation – how best to address them to facilitate the behavior change intended by the implementation, however, remains a significant research gap. We propose to provide: Evidence from randomized controlled trials that innovative eRegistries in support of evidence-based care for the first 1000 days, implemented at point-of-care and embedded in national health information systems, can successfully narrow the “knowledge-do” gap. Better understanding of how to effectively scale up sustainable eRegistries in different contexts, and what resources are needed, by studying implementation and facilitation in Bangladesh, Ghana, Palestine, and Uganda, using mixed methods.