May 18 - TNB Roundtable: Mobile Tech for Nonprofits, A Global Health Success Story

Mobile phones to improve quality at the point of care

Steve OllisD-tree International

sollis@d-tree.orgwww.d-tree.org

@DtreeInt

Get to Know D-tree

https://www.youtube.com/watch?v=B2s3WVx2Snw

Mobile Trends

Mobile phone penetration hasdrastically increased over the last decade especially in developing countries.

Global Health Challenges

Shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide, especiallyin low and middle income countries.

Obstacles to Good Healthcare- Limited number of healthcare providers- Heavy client load- Limited training - High burden of disease- Limited financial resources- Paperwork

Types of mHealth interventions

mHealth systems not apps!

• Provide mobile health systems for use by frontline health workers– Design, Test and Deploy applications– Partner with MOH and other health NGOs

• Focus areas:– Maternal and Child Health– Chronic Disease

What D-tree does

Health Worker

High quality care

Limited, infrequent access to data

System fragmentation

Mobile decision support application

Dashboards

Continuous engagement

Systems Approach

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS

The problem is the protocols are notused correctly• HW do not accurately

follow protocols• Expensive to change• HW embarrassed to use

a book in front of patients

Haitham M. Ahmed, Marc Mitchell, Bethany Hedt, National implementation of IMCI: Policy constraints and strategies, Health Policy (2010)

So what is the problem?

CCM Malawi

Patient historyHSA can review patient history

Sick child formHSA guided through sick child protocol

Counting breathsUses phone for time measurement

Absence of such measuring device had been major reason for referral

MedicationRecommends dose for age

Outcome of assessmentReferral Home Treatment

Vaccinations

Monthly ReportsVisible to both HSA and Supervisor within the application

C-stock IntegrationHSA reminded when monthly stock report is due

Entering new stock levels

Web Dashboard

Web Dashboard

mHealth for Safer Deliveries

> 50% of births are at home

when transfer to hospital is needed there are 3 delays:

•The decision to seek care•The transfer to a facility•Treatment at the facility

• Screening pregnant mothers to identify risks or danger signs

• Establishing community-based referral systems to transport women in labor

• Coordinating payment of transport to health facilities and hospitals using mobile banking

• Following up with the family within 2-5 days after delivery to ensure a continuum of care, including post-partum and post-natal care

mHealth for Safer Deliveries

Results: Facility delivery

• Over 78% facility delivery rate for 11,792 women who delivered (vs 30-40% DHS)

• For those where last delivery place was home, now 66% gave birth in a facility

• 88% attended postnatal care within one week after birth (vs DHS 36% in 41 days)

• Increased use of primary facilities, 34% compared to 4% (HMIS 2012)

“I can see that the instrument is good as it helps me to do IMCI both faster and with the proper procedures.”

“I liked it because it explains the situation of the child well and reminds you of things you can’t remember on the forms.”

“The thing I like most about using the phone is that it is simple to calculate dosage. A thing that I don’t like is that there are diagnoses that are not in the phone, such as UTI, HIV, that should be added, because there are now more childhood illnesses.”

“It simplifies work and provides direct results. It is different than paper, where you have to make the decisions. The phone makes its own decision, and will tell you if medicine is necessary and what the dosage is, so you can’t make a mistake in treating a child. The phone makes the parents interested and they see that the doctor is listening carefully. The [paper] forms are difficult to use but the phone is simple.”

translated from Swahili

What do providers say?

Mitchell M, Getchell M, Nkaka M, , van Esch J, Hedt B, Perceived improvement in Integrated Management of Childhood Illness (IMCI) implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania (Journal of Health Communication 17:1–10, 2012)

“In the past the doctor used to write prescriptions on a piece of paper without asking us questions, but today we were asked questions. That is what was different.”

“I was very happy with the new instrument. Previously we were not provided good services …the doctor used to ask what was wrong and then prescribe “chloroquin” and “panadol” for the child without even examining the child … He did not like to listen to me and would write the prescription before I could finish telling him the problem with my child.”

“What I liked the most was the way we were asked questions, the way my child was examined, and how they handled my child by touching some parts of his body to learn what the real problem is.”

“The service was like past services because my child was given “dawamseto” as usual, but this time we were asked some questions.”

translated from SwahiliMitchell M, Getchell M, Nkaka M, , van Esch J, Hedt B, Perceived improvement in Integrated Management of Childhood Illness (IMCI) implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania (Journal of Health Communication 17:1–10, 2012)

What do mothers say?

combinations grow exponentially

Does the child have a cold?

Fever?

Follow conditions

Review

Review and collaborate

Simulated sessions

Lessons learned

• Fast pace of technological change• Change Management essential • Encourage data driven management • Field refinement is critical• Users must feel application supports them• Don’t let technology push the program

– Sometimes a phone is just a phone – and that’s great!

Recommendations• Involvement with mHealth working

group in each country• Look for existing projects to leverage• Adapt each project around the in-country

m/eHealth ecosystem• Partner with MOH and consider the entire health

system • Plan for integration with HMIS from the start • Leverage mFinance, mAgriculture, other

e/mDevelopment initiatives

What’s next

• Improved integration of facility and community

• Integration of across domains• Improved dashboard analytics• Continued usage of mobile money• Exploration of integration with point of care

diagnostics / unique identifiers

mHealth/mEducation

more

Thank you!

For more information:

Steve Ollissollis@d-tree.orgwww.d-tree.org@DtreeInt