CONSULTANCY ON DIGITAL HEALTH IN EYE CARE PROGRAMS

1. INTRODUCTION

The Fred Hollows Foundation (The Foundation) is a secular non-profit public health organization based in Australia, founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems and the treatment and prevention of avoidable blindness. Operating in more than 25 countries across Australia, the Pacific, South and Southeast Asia, and Africa, The Foundation has recently intensified its efforts to leverage digital health tools to enhance access to high-quality eye care.

The digital transformation of healthcare has been slower than in other industries but is inevitable. Recent years have seen an acceleration in this transformation, driven partly by the COVID-19 pandemic and increased access to digital tools and communications infrastructure. The adoption of the WHO Global Strategy on Digital Health by the World Health Assembly in 2020 underscores the critical role of digital health technologies in advancing health-related Sustainable Development Goals. This strategy highlights the essential contributions of the private sector, civil society, and technical communities in the widespread, effective, and equitable adoption of technology in healthcare.

To address the growing global need for eye care, widespread adoption of digital health tools, alongside systemic reforms, is essential. These tools have the potential to significantly increase access to high-quality eye care, though they come with associated costs and risks that will not be experienced equally. The Foundation is committed to a proactive yet considered approach to piloting and leveraging opportunities to improve coverage, accessibility, quality, efficiency, and affordability, ensuring these benefits are equitably distributed.

The Foundation is also aware that digital health technologies is already a crowded landscape however there in often a lack of traction in a low to middle income country setting, with digital health companies not investing in this area.

Recognizing the need for strategic investment in digital health, The Foundation aims to amplify its impact and contribute to the health sector’s efforts to provide quality, integrated eye care services to those most in need. A SWOT analysis of The Foundation’s current approach and investment in digital health revealed:

• The Foundation has some experience in developing and implementing digital health solutions, but its engagement has been ad-hoc and responsive to contextual demands and opportunities. (Examples of past work will be provided as background reading.)
• To deliver on the transformational ambition of The Foundation’s new strategy and to align with major partner and funder expectations, The Foundation needs to scale up its focus and investment in digital health. As a late adopter, we need to be open to innovative partnerships to help us significantly lift are capability and capacity in this area.
• There is a compelling need to expand efforts, which would require clarifying The Foundation’s focus and role ensuring a clear value proposition, developing clear programming guidance, and securing dedicated resources (both technical and financial).
• The Foundation’s global footprint, operating model, and commitment to development principles and reducing inequities suggest a partner-based approach is necessary.

Initial desk research indicates that NGOs are engaged in various areas of digital health, including:

1. Telemedicine: NGOs are implementing telemedicine platforms to provide remote consultations, particularly in rural and underserved regions. This can involve mobile-based video calls or SMS-based services for areas with low connectivity.
   o Mobile Health (mHealth): Mobile apps and SMS-based health information services are used to educate communities, monitor diseases, and provide support for chronic illness management (e.g., diabetes, HIV).
2. Data-Driven Healthcare:
   o Health Data Analytics: NGOs are using advanced analytics, artificial intelligence (AI), and machine learning to analyze large sets of health data (collected from clinics, field workers, etc.) for predictive health trends, tracking disease outbreaks, and improving decision-making in public health programs.
   o Electronic Health Records (EHRs): Implementing interoperable EHR systems in regions with limited healthcare infrastructure helps ensure continuity of care across various touchpoints and healthcare providers.
   o Digital Training and Capacity Building.
   o E-learning Platforms: NGOs are investing in digital platforms that train healthcare workers remotely through virtual simulations, online courses, and video tutorials. This improves healthcare workers’ skills, particularly in remote areas.
   o Augmented and Virtual Reality (AR/VR): Some cutting-edge NGOs are experimenting with AR/VR technologies to offer immersive training environments for field workers, allowing them to practice emergency procedures or patient care in virtual settings.
3. AI and Chatbots for Health Education and Support
   o AI-Powered Health Chatbots: Automated chatbots offer 24/7 assistance for patient inquiries, guide individuals on health resources, remind patients of medication schedules, or assist in monitoring symptoms and triaging care.
   o Digital Health Assistants: AI-driven platforms help track disease outbreaks, manage large vaccination campaigns, and optimize the allocation of resources.
4. Blockchain for Health Records and Supply Chain Management.
   o Blockchain for Secure Health Records: NGOs are exploring blockchain technology for securing health records and ensuring data privacy in regions where cybersecurity is a concern.
   o Supply Chain Transparency: Blockchain is used to track the supply chain for medicines, vaccines, and medical equipment, helping prevent counterfeit products from entering the market and ensuring accountability.
5. IoT and Wearables
   o Remote Monitoring via IoT: IoT (Internet of Things) devices, such as wearable health trackers and remote patient monitoring systems, are being used by NGOs to gather real-time data on patients in remote areas, allowing continuous monitoring of vital signs or medication adherence.
   o Connected Health Kits: NGOs may distribute connected health devices (e.g., blood pressure monitors, glucose meters) to allow for regular health monitoring without frequent clinic visits.
6. Health Information Systems and Open Data Initiatives.
   o Open Health Data Platforms: NGOs are creating or collaborating on open-source health information systems to increase transparency and interoperability. These platforms can track health outcomes, disease prevalence, and treatment patterns globally, while ensuring community involvement in data governance.
   o GIS and Spatial Data for Disease Mapping: Geographic Information Systems (GIS) are used for mapping disease outbreaks, monitoring environmental health risks, and targeting resources to areas in need more effectively.
7. Collaborative Digital Partnerships
   o Cross-Sector Collaborations: NGOs are increasingly partnering with technology companies, governments, and research institutions to co-develop digital solutions. Partnerships with telecommunication companies, for example, provide the infrastructure for remote health services in remote regions.
8. Cloud-Based Platforms for Health Management
   o Cloud Computing: Cloud platforms enable NGOs to store, access, and analyze vast amounts of health data in real-time. These systems improve the scalability and coordination of health services, particularly during crises like pandemics or natural disasters.
9. Ethical AI and Digital Inclusion
   o Addressing Bias in AI: As NGOs adopt AI for health interventions, there’s a growing focus on ensuring that AI algorithms are free from bias, particularly regarding gender, race, and socio-economic factors.
   o Digital Equity and Accessibility: Ensuring that digital health solutions are accessible to everyone, including people with disabilities, older adults, and populations in areas with low internet connectivity, is a key part of an inclusive digital health strategy.

See summary overview of digital health from major eye health competitors.

The Foundation’ Operating model:
At the Foundation, we align closely with WHO guidelines in our collaborative work with partners. We have conducted a comprehensive review of WHO guidelines on digital health (see appendix for details).

Our operating model involves partnering with various entities, primarily government organizations, to implement eye health services. This model not only allows us to deliver essential services but also enables us to contribute to the global knowledge base in the eye care sector.

Our organizational strategy emphasizes being bold, transformative, and impactful, with a focus on scaling our efforts. Digital health solutions can enhance system performance (e.g., workforce strengthening, commodities management), decentralize care delivery (e.g., improving care delivery effectiveness), and improve accountability and agency (e.g., IoT, digital inclusion, consumer awareness). Each of these pathways requires different scaling strategies and investment needs.

Therefore, we seek advice on the most promising areas to focus on, both programmatically and in terms of funding opportunities.

Details as follows:

1. PURPOSE OF THE PROJECT

The Fred Hollows Foundation (FHF) is commissioning a project to support a scoping review focused on digital health solutions to enhance the delivery of eye care within the FHF operating model. This project aims to enhance the delivery of quality eye care through the introduction of digital health and technology solutions, including AI.

Goal: Scope and identify digital health technologies and approaches (including AI tools) to address key eye care challenges such as workforce shortages, service integration and coordination, and community engagement in developing country. The focus will be on the key areas mentioned above, providing recommendations on which areas make the most sense for FHF to focus its plans on, both from a programmatic and funding perspective.

Suggested Approach: Facilitate a problem and opportunity analysis. This analysis should include an assessment of the competitor landscape, including the digital health focus of the sector, and both public and private sectors, to assess FHF’s value add.
Assess the major public and private sector partners in this area to help The Foundation to identify potential partnership and collaboration opportunities.
Provide an assessment of digital health strategies aligned to the major barriers to eye health in the developing countries in which we work so The Foundation can assess options that will have the most impact.
Assess the major funding drivers so we can ascertain where major institutional, philanthropic funding and impact investing is being directed in digital health.
Develop and conduct early testing of a set of investment options.
Provide guidance on the scalability of the opportunity analysis.

Out of Scope: Testing the clinical efficacy of digital equipment and/or software. The Fred Hollows Foundation is commissioning a project to support it in undertaking a scoping review focused on digital health solutions to enhance the delivery of eye care within the FHF operating model.

Noting: Approach and milestones are open to discussion with the successful consultants.

1. MILESTONES, DELIVERABLES AND TIMELINE

The project is expected to start in October 2024 for an estimated duration of 25 days. The proposed timeline and the review milestones and deliverables are listed below:

Deliverables, Milestones and Timing:

Milestone 1: Initiation meeting to discuss and finalise project scope, objectives, inputs, approach and deliverables.

Milestone 2: Finalisation of contract
Following initial meeting, timing dependent on respective contracting timelines and process.

Milestone 3: Establish a draft prioritisation/decision making matrix/ framework to scope possible options including considerations of relevant factors such as geographic, local vs global, resources, risk appetite etc.

Milestones 4: Review of documents, problem statement (root cause) and opportunity analysis & interviews with stakeholders completed.

Milestone 5: Check in meeting – Review consultation and adjustment of prioritisation framework.

Milestone 6: Research to scope potential digital health and technology options including those that are attracting public and private funding.

Milestone 6: Report on findings and recommendations.

Milestone 7: Check-in meeting / workshop
Discuss findings and possible recommendations for piloting/testing.

Milestone 8: Final report submitted.

1. REVIEW TEAM & QUALIFICATIONS

The Foundation seeks to engage the services of an independent registered organisation or consultant, who have following experiences and expertise.

Qualifications:
The consultant or team lead must:

• Be registered as a business.
• Hold a university degree or equivalent in Public Health degree.

Experience:

• Extensive experience in supporting the use of digital tools in health care settings.
• 5 years’ experience in digital health technologies and services, international aid and development, and research/evaluation.
• Demonstrated experience working in low- and middle-income country settings.
• Demonstrated experienced working with NGOs.
• Demonstrated experience planning and implementing research and evaluations.

Skills:

• Research and evaluation design.
• Qualitative analysis of documents.
• Training program development.
• Guidelines development.
• Interviewing for research and evaluation projects.
• Excellent written and English skills required or excellent analytical, writing and presentation skills.
• Strong interpersonal and communication skills.

1. CONFIDENTIALITY
   The consultant/s agree to not divulge confidential information to any person for any reason during or after completion of this contract with The Foundation. Upon completion or termination of this contract, the evaluator/s undertake to return to The Foundation any materials, files or property in their possession that relate to the business affairs of The Foundation.
2. INTELLECTUAL PROPERTY
   All intellectual property and/or copyright material produced by the evaluator/s whilst under contract to The Foundation remain the property of The Foundation and will not be shared with third parties without the express permission of The Foundation. The evaluator/s are required to surrender any copyright material created during the term of the contract to The Foundation upon completion or termination of the contract.
3. INSURANCE
   Any consultants involved in this project will be required to have in place insurance arrangements appropriate to provision of the requirements in this Terms of Reference including travel insurance.
4. OTHER
   The consultant/s are expected to maintain high professional and ethical standards and comply with The Foundation’s Research Ethics and Data Management Policy. The Foundation is committed to ensuring a safe environment and culture for all people, including children, with whom we come in contact during the course of our work. All members of the evaluation team will be required to comply with The Foundation’s Safeguarding People Policy including Code of Conduct and sign the Safeguarding Code of Conduct.