In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone, and an online image portal for storing and annotating images. A smartphone app is used to control the mobile colposcope, and upload pictures to the image portal. In this paper, a new app feature that documents clinical decisions using an integrated job aid was deployed in a cervical cancer screening camp in Kenya. Six organizations conducting VIA used the EVA System to screen 824 patients over the course of a week, and providers recorded their diagnoses and treatments in the application. Real-time aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by “smart” diagnostic medical devices holds promise for broader use in screening programs in low-resource settings.

BackgroundIsrael hosts approximately 50,000 asylum seekers, most of them from Eritrea. Exclusive policies restrict their access to healthcare. In 2013, local activists partnered with Eritrean asylum seekers to assess health needs as well as willingness to pay for health insurance among the Eritrean communities. This initiative was meant as a step towards jointly advocating access to Israel’s public healthcare system and towards strengthening collective efficacy among the asylum-seeking communities, as well as a first attempt to apply a community-based participatory research (CBPR) approach to migrant health research in Israel.MethodsApplying a CBPR approach, a 22-item survey was developed by a team of activists, academics and community members. It was administered by community members in four different cities. Cell weighting was applied to align sample estimates with the population distribution. The results were analyzed by means of a Generalized Linear Model. Six follow-up interviews and two focus group discussions helped interpret the quantitative findings and provided additional information.ResultsThe results from 445 questionnaires show that most (95%) asylum seekers are interested in purchasing health insurance. To this end, more than half of the respondents are willing to invest up to 300 NIS monthly, which represents a significant part (5–7.5%) of their median monthly income. Willingness to pay for health coverage was independent from employment and income; it was significantly associated with city of residence – which translates into current healthcare options - understanding of health insurance, and health seeking motives. The study further highlights the role of labor policies in shaping not only asylum seekers’ access to care but also psychosocial wellbeing.ConclusionsThe study provides initial evidence for asylum seekers’ willingness to pay monthly contributions into a public health insurance scheme, in spite of economic hardship, and it points to understanding of and trust in the healthcare system as a central factor influencing willingness to pay. The outcomes of this initiative further offer some support for the potential of CBPR to enhance research into the health of marginalized populations and, moreover, to counter their social exclusion through capacity building and strengthening of collective efficacy.Electronic supplementary materialThe online version of this article (10.1186/s13584-017-0185-9) contains supplementary material, which is available to authorized users.

A persistent challenge facing global health actors is ensuring that time-bound interventions are ultimately adopted and integrated into local health systems for long term health system strengthening and capacity building. This level of sustainability is rarely achieved with current models of global health intervention that rely on continuous injection of resources or persistent external presence on the ground. Presented here is a case study of a flipped approach to creating capacity and adoption through an engagement strategy centered around an innovative mHealth device and connected service. Through an impact-oriented business model, this mHealth solution engages stakeholders in a cohesive and interdependent network by appealing to the pain points for each actor throughout the health system. This particular intervention centers around the MobileODT, Inc. Enhanced Visual Assessment (EVA) System for enhanced visualization. While focused on challenges to cervical cancer screening and treatment services, the lessons learned are offered as a model for lateral translation into adjacent health condition verticals.

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