emHELP and supporting EGPAF Tanzania mHealth Working Group meeting, 15 August 2013 Peter Benjamin mHealth Alliance

emHELP and supporting EGPAF

TanzaniamHealth Working Group

meeting,15 August 2013

Peter BenjaminmHealth Alliance

Mhealth Alliance | 2

Outline

• emHELP – capacity building arm of mHealth Alliance

• Technical Assistance with EGPAF Tanzania

• Lessons learnt & next steps


Needs for building capacity in mHealth• Great and increasing

interest in mHealth• Lack of proven models of what works• Great potential• Also considerable

scepticism• Good experience in the many organisations• But difficult to access

expertise


Questions Body of knowledge Issues

1. FUNCTIONINGDoes the system function properly?

Technical design, Systems analysis. Software, hardware, network

Need to understand the medical problem being addressed.

Levels of Evidence for scale in health system


Technical design, Systems analysis. Software, hardware, network2. USABILITYWill people use it?





2. USABILITYWill people use it?Will people keep using after 6 months?

User-centred design,Soft systems design,marketing, training, workflow. Human-computer interface.Usability, literacy, language

Usability by end users (e.g. public, patients, health workers), people who use the data (e.g. health managers) - very relevant within the health system (failure in electronic system in police). For public-facing services, issues of advertising, marketing, retention.



Technical design, Systems analysis. Software, hardware, network2. USABILITYWill people use it?Will people keep using after 6 months?User-centred design,Soft systems design,marketing, training, workflow. Human-computer interface.





2. USABILITYWill people use it?Will people keep using after 6 months?

User-centred design,Soft systems design,marketing, training, workflow. Human-computer interface.Usability, literacy, language

Usability by end users (e.g. public, patients, health workers), people who use the data (e.g. health managers) - very relevant within the health system (failure in electronic system in police). For public-facing services, issues of advertising, marketing, retention.

3. IMPACTDoes it have any impact?

Measures of health systems efficiency or health impact. Epidemiology.Intervention studies

Studies to develop the evidence base, with ethical approval as required. Need for formal methods, beyond internal project monitoring.




4. SCALEWill it work at large scale?

Health systems at scale. Systems implementation science. Change management.Training /capacity building /supportIntegration with wider health systems (DHIS etc). Quality control.

For health systems, threshold of scale around 1,000 facilities or health workers; for public-facing mHealth 100,000 active users. By these measures, only scaled mHealth in SA are BabyInfo on MXit (750,000), Praekelt’s Young Africa Live (1.6 million); and Cell-Life’s Clinical Data Collection (984 facilities). Several others plan for scale in coming year.




4. SCALEWill it work at large scale?

Health systems at scale. Systems implementation science. Change management.Training /capacity building /supportIntegration with wider health systems (DHIS etc). Quality control.

For health systems, threshold of scale around 1,000 facilities or health workers; for public-facing mHealth 100,000 active users. By these measures, only scaled mHealth in SA are BabyInfo on MXit (750,000), Praekelt’s Young Africa Live (1.6 million); and Cell-Life’s Clinical Data Collection (984 facilities). Several others plan for scale in coming year.

5. ECONOMICIs it cost-effective?

Health economics. Measures of QALY (or equivalent). Business model. Value chain analysis.

Issues of ongoing sustainability (capacity, organisational, financial). Clarity on who the ultimate payer is, and how all parts of value-chain benefit.



emHELPeHealth & mHealth Expert Learning Network

The capacity building arm of mHealth Alliance

Network of advisers & consultants on mHealth (topic areas & in-country)

Question answering (free)

“How To” guides for main issues

Technical Assistance & consulting

University certified training

National engagements (currently)-Tanzania with EGPAF- South Africa policy

Obstacles to implementing mHealth from partner discussions

BASIC RESOURCES:FundingShort-term funding / sustainability issuesDifficulty scaling pilots

GOOD HUMAN RESOURCES:

Lack of competent workers with mH experienceTraining & Capacity building

AWARENESS:Awareness of doctors in using mHealthEducation of Govt and health organizations of mHealthPublic awareness & education about mHealth

INFRASTRUCTURE:

Reliability of cellular networksRecharging in rural areasCost of devices / SMS / mobile internet bandwidth

COLLABORATION:

Cooperation and local networks supporting mHealth

• Basic fact-finding• Establish groundwork

for Needs Assessment

• mHealth Recommendations

Exploratory

Mission

• Determine feasibility• Determine strategic

value• Prioritize

recommendations• Determine TA skills

and SoW• Collect baseline data• Identify workflows,

Info, flows and processes

• Obtain MoHSW. buy-in

• Prelim.. basic capacity-building

Needs Assessment

• Strengthen organizational mHealth capacity

• Operationalize prioritized recommendations

• Finalize Needs Assessment Tool

• Develop M&E framework to measure impact

Technical Support Consulta

ncy1) Increased

mHealth capacity of EGPAF

2) Increased program impact3) Prototype for

builidng org. mHealth capacity

Build the capacity of EGPAF Tanzania to strategize, implement, monitor and manage mHealth integration into EMTCT programs

Identify the needs & skills required to fill the needs• Understand the mHealth

ecosystem & stakeholders

• Understand the capacities

• Identify the skills needed to build capacity

Targeted TA to build organizational capacity to

integrate mHealth to improve program impact

Goal:

Objectives:

Review documents

• Exploratory Mission Report

• EGPAF Tanzania Progress Report

• Tanzania mHealth Public-Private Partnership Report -Finalize TA Action Plan

-Identify Baseline Data Indicators and M&E Plan

Develop Methodology Identify and Adapt Assessment Tool(s) and Questionnaires

Conduct Needs Assessment-Prepare Needs Assessment Report and Technical

Support SoW;-Revise Adaptable Tool

-Recommendations

Simple Process Flow for Needs Assessment

Criteria

• Implementation time in conjunction with the rollout of B+

• Compatibility & interoperability of existing systems

• Not “reinventing the wheel” – duplication of processes, systems

• Easy to support and maintain

• Potential for scalability and sustainability

• Not too technical or complex for existing & trained staff

Recommendations. The system will:

• provide decision-support for health workers to provide appropriate quality care in all patient encounters• will allow health workers at the health facilities to enter data on patients and health encounters, to retrieve individual patient record information and appropriate reports on patients for management of care (including contacting patients who are lost to follow-up)• send clinical care SMSs to the female patients to encourage attendance at the facility

Project partners• EGPAF: “Owner of the project”,

All implementation logistics• mHealth Alliance: Technical Assistance, needs

assessment, building capacity of EGPAF, M&E• D-tree International: Technical implementer

Electronic protocols, data collection, backend• University Computer Centre: Health systems links


Current status & next steps

• MOU & SOW late drafts, signing in August

• Develop and test electronic protocols & data collection in September

• Meetings with MoHSW & partners in September

• Implement from October in 10 sites Nzega (Option B+)

• M&E and track for 1 year


Lessons Learnt• Importance of strong partnerships

• Build on existing tools – many moving parts, try to simplify & take small steps

• Need Ministry involvement from the start

• Need to learn at each stage to continuously improve – quality control & feedback

Thank You! Dr Peter Benjamin

mHealth Alliance

eHealth & mHealth Expert Learning Program (emHELP) [email protected]+27 82 829 3353Skype: peterbenjamin

“These tools don’t get socially interesting until they are technologically boring”Clay Shirky, 2011

Documents

emHELP and supporting EGPAF Tanzania mHealth Working Group meeting, 15 August 2013 Peter Benjamin mHealth Alliance