The Peek Practice-based Evidence Framework

Health system strengthening, as endorsed by the WHO’s global action plan for universal eye health, facilitated a 25% reduction in global visual impairment between 1990 and 2015. New mobile health technologies have potential to greatly enhance systems strengthening, driving further revolutionary improvements in eye care. Currently, lack of detail in health system data and delayed information flows results in sporadic health systems’ improvement rarely founded on locally derived evidence. Testing single changes typically requires classical research studies, often taking years to produce results, by which time the environment may have changed, causing study data not informing change in practice. In the commercial software sector, a variety of testing methodologies are employed to develop and optimise web-based systems. Learning from these, we propose developing a hypothesis-driven, agile health service improvement approach enabling responsive changes to eye care service systems (our specific field) in low- and middle-income countries. This will use techniques including A/B testing and data-driven perpetual optimisation. These hypothesis-driven methodologies will allow quicker testing, analysis and implementation of service improvements with greater potential for translation to other settings. Used by local health system leaders, the tools could lead to a paradigm change in health system strengthening, improving health for millions.