Ethiopia is at a pivotal moment in its efforts to improve the health status of its people and move the country into a new phase of social and economic development. The country’s massive Health Extension Program (HEP) program has placed over 34,000 community health workers in 14,000 health posts in less than 8 years. Now, health authorities are exploring ways to improve the program with mobile solutions.

Sponsored by The Bill & Melinda Gates Foundation, Vital Wave Consulting authored the “mHealth in Ethiopia: Strategies for a new Framework” report for the Ethiopian Ministry of Health. The report offers a framework for addressing specific information, communication and inventory management issues with mHealth interventions.

Download the report by clicking the link below – and let us know what you think in the comments!

Indian Nurse Check Blood Pressure

Photo Credit: Anupam Nath / AP

In an ode to International Women’s Day, we wanted to review a few of the mobile health projects and programs directly focused on women’s health issues. mHealth has a great variance in the type of applications used to promote and assist in women’s health. This ranges from sending health information about pregnancy via basic text messaging to more advanced tools that allow community health workers to collect data, diagnosis diseases, and refer patients. As the need and ability to extend health information to women in developing countries increases, here is a diverse set of examples that have been used or are in current use.

 

MOTECH

Launched in Ghana, the Grameen Foundation’s Mobile Technology for Community Health (MoTECH) initiative has a duel focus – providing health information to pregnant women and arming community health workers with applications to track the services provide to women and children. This project was funded by the Gates Foundation and has worked in partnership with Columbia University’s Mailman School of Public Health and the Ghana Health Service. The “Mobile Midwife” application provides pregnant women with time-specific information about their pregnancy via text or voice messages. This includes reminders about seeking care, advice on how to deal with specific challenges during pregnancy, and knowledge about best practices and child development. The Nurses’ Application allows community health workers to register and track the care provided to patients in the region. By recording patient data in the MOTECH Java application and sending it to the MOTECH database, the system captures the data and can send automatic reminders to nurses for when and what type of follow up care to provide.  For more information about the MOTECH as well as the lessons learned, read the report from March 2011, “Mobile Technology for Community Health in Ghana: What It Is and What Grameen Foundation Has Learned So Far.”

 

MAMA

Launch in May 2011, MAMA (Mobile Alliance for Maternal Action) is a public-private partnership focused leveraging mobile connectivity to improve information and access to health care for pregnant and new mothers in developing countries. USAID and Johnson & Johnson are the founding partners, and the United Nations Foundation, the mHealth Alliance, and BabyCenter are supporting partners. This initial 3-year, $10 million investment from USAID and J&J is being used to build and expand global capacity of new and current mHelath programs in three countries – Bangladesh, South Africa, and India. The beauty of the MAMA Partnership is the focus on country ownership through these partners. And each country has a separate focus based on the specific needs and problems of the maternal health. In Bangladesh, the focus is to decrease maternal morbidity and mortality through stage-based health messages via mobile phones to low-income and at-risk mothers. The public-private partnership network in Bangladesh has already been established. Lead by D.Net, it includes technology developers (InSTEDD, SSD-Tech), corporate sponsors (BEXIMCO), outreach NGOs (Save the Children, BRAC), mobile operators (Airtel, Grameenphone, Banglalink), content providers (MCC Ltd), media (Unitrend Limited, Brand Forum), researchers (ICDDR, B), and government agencies (Ministry of Health and Family Welfare).  In India, MAMA is completing a landscape analysis to understand the complex cultural environment and see in what areas mobile phones can be utilized to improve maternal health throughout the country. Finally, in South Africa, MAMA has partnered with the Praekelt Foundation (lead partner), Wits Reproductive Health and HIV Institute, and Cell-life to provide messages to pregnant and new mothers about receiving earlier antenatal care, prevention mother-to-child HIV transmission, and exclusively breastfeeding.

 

CycleTel

Developed by the Institute for Reproductive Health (IRH) at Georgetown University, CycleTel is an innovative solution, combining a previously used family planning technique with mobile phones. In 2001, IRH created the Standard Days Method (SDM) as a low-cost alternative to family planning based on a women’s menstrual cycle. By avoiding intercourse on a woman’s most fertile days during her menstrual cycle, days 8 to 19, there is only a 5% chance of becoming pregnant. Having developed the system, IRH saw a natural fit with mobile phones. In the original set up, women would use Cyclebeads (multiple colored beads used to represent specific days of a menstrual cycle) to keep track of when they are more likely to become pregnant. Using the same idea, the CycleTel replaced the beads with a mobile phone. Each month on the first day of menses, a women text messages the system. Utilizing FrontlineSMS, it then responds by sending a message showing which days she could get pregnant. In 2009, IRH conducted a research study in the region of Uttar Pradesh, India. The pilot showed the need to tweak the system to fit the region context including the local languages and women’s past experience using mobile phones. But it also showed the willingness of women and men to pay for the service in order to avoid unwanted pregnancies. This program is being operated under to the Fertility Awareness-Based Methods (FAM) Project which is funded by USAID.

 

Dunia Wanita

Dunia Wanita, which means World of Women, was launched in February 2010 by Telkomsel, a MNO in Indonesia. It is a part of the MNO’s value-added services applications and is specifically for women to receive information on a number of different topics, including health. The subscription costs $0.12 per day. By dialing *468#, women have access to a “one stop info service.” By selecting “Cantik Sehat” (Health and Beautiful), women can receive health information and advice from famous Indonesian doctors. The voice messages include information about sexual health, pregnancy, and healthy living.

 

These are just a few examples of mobile health applications that are available to women in the developing world. The applications vary in information provided, media used, and business models utilized. This is a great illustration of how diverse mobile health can be in order to reach a targeted group within a country, based on infrastructure, location, health knowledge, and mobile usage/connectivity.

As you may have heard Women Deliver is celebrating the progress made on behalf of girls and women worldwide. Building on its 2011 competition, which featured inspiring people who have delivered for girls and women, this year they have chosen to spotlight top ideas and solutions in the following five categories:

•    Technologies and Innovations
•    Educational Initiatives
•    Health Modernization
•    Advocacy and Awareness Campaigns
•    Leadership and Empowerment Programs

Out of hundreds of submissions, a selection committee has chosen 25 per category. The top 125 have been posted here, where viewers can choose and vote on ten favorites per category. Several of the chosen innovations and solutions incorporate the use of mobile technologies for health, showing the increasing inclusion of this type of innovation for the advancement of women’s health. Finalists include the Mobile Alliance for Maternal Action (MAMA), Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) by M-PESA, and many, many others.

In addition, the mHealth Alliance’s Catalytic Grant Mechanism for Maternal, Newborn, and Child Health (MNCH) and mHealth has been chosen as one of the top 25 ideas and solutions in the health intervention category. The Innovation Working Group, part of the Every Woman Every Child initiative, Norad, and the mHealth Alliance have partnered in the creation of a competitive and catalytic grant mechanism with a special focus on growing programs with sustainable financing models and early indications of impact. The projects supported through this grant mechanism harness the reach and popularity of mobile phones to help women, their families, and their health care providers in low-income settings combat inequitable access to quality health services. Funding is awarded through annual competitions managed by the mHealth Alliance and allows winners to take mHealth pilot programs to scale. You can find out information on this year’s grantees here.

Please show your support for mobile innovations and vote. The top 50 winners will be announced on March 8th, International Women’s Day. Vote now!

 

This report draws on primary research (including questionnaires sent to key mobile stakeholders in Africa) as well as secondary research (reports and articles from AfricaNext, BizCommunity, Dataxis Intelligence, International Telecommunications Union, Africa Analysis, Voice of America, TMCNet, BizCommunity, Computerworld Zambia – see full list at end of report).

In 2008, imports of data enabled phones exceeded that of non-data enabled phones in many African markets. In 2009, the undersea cables hit East and Southern Africa in a big way. In 2010, mobile operators became serious about data availability and cost packaging for everyday Africans. 2011 is expected to bring a new type of data-enabled mobile user in Africa, and brings the mobile web to center stage.

McKinsey estimates Africa’s gross domestic product at about US $2.6 trillion, with US $1.4 in consumer spending. Africa’s population growth and urbanization rates are among the highest in the world.

Yunkap Kwankam and Ntomambang Ningo, authors of the paper titled “Information Technology in Africa: A Proactive Approach,” maintain that African countries can bypass several stages in the use of ICTs.

On the technology front, Africans can accelerate development by skipping less efficient technologies and moving directly to more advanced ones. The telecommunications sector continues to attract a flurry of public and private investment.

Alex Twinomugisha in Nairobi, manager at Global e-Schools and Communities Initiative, says telecom investment in sub-Saharan Africa is coming not only from foreign sources but also local banks. But the investment should be in software and services as well, not just cabling infrastructure.

To learn more about the state of mobile in Africa, download the entire report here.

Arthur Zang - Photo Credit: http://www.rnw.nl/africa

A 24 year-old Cameroonian has invented a touch screen medical tablet that enables heart examinations such as the electrocardiogram (ECG) to be performed at remote, rural locations while the results of the test are transferred remotely to specialists for interpretation.

The touch screen tablet – Cardiopad was invented by Arthur Zang, a young computer engineer born and trained in Cameroon at the Ecole Nationale Supérieure Polytechnique (ENSP) in Yaounde.

According to Zang, the Cardiopad is “the first fully touch screen medical tablet made in Cameroon and in Africa.” He believes it is an invention that could save numerous human lives, and says the reliability of the pad device is as high as 97.5%. Zang says he invented the device in order to facilitate the treatment of patients with heart disease across Cameroon and the rest of Africa. So far, several medical tests have been carried out with the Cardiopad which have been validated by the Cameroonian scientific community.

“The tablet is used as a classical electrocardiograph device: electrodes are placed on the patient and connected to a module that, in turn, connects to the tablet. When a medical examination is performed on a patient in a remote village, for example, the results are transmitted from the nurse’s tablet to that of the doctor who then interprets them, says Radio Netherlands.”

While doing his academic internship at the General Hospital of Yaounde, in 2010, Arthur Zang became aware of the difficulties faced by Cameroonians in accessing care related to the heart. The Central African country has an approximately 40 cardiologists for about 20 million population with almost all these cardiologists located in the two large cities of Yaounde and Douala.

Access to cardiologist by patients especially those living in remote cities is therefore a huge challenge. This severe deficit of medical personnel means that patients with heart ailments usually have to travel long distances to undergo heart examinations and consult with doctors. Even at that, it is still not easy. On some occasions, patients must make appointments months in advance, and some even die in the process of waiting for their appointment.

The Cardiopad

Photo Credit: Cardiopad

This is how the technology works. Both the cardiologist (in the city) and the nurse (in the remote community) need to have the Cardiopad. A patient in the remote community is connected to electrodes placed on his heart. These electrodes are connected to a module called Cardiopad Acquisition Mobile (CAM) via a Bluetooth interface, which transmits the heart signal to the Cardiopad after the signal has been digitized. The nurse can then read the heart beats, heart rate, and the intervals between each beat displayed on the Cardiopad, etc. All these data are then stored in a file and sent to the cardiologist’s Cardiopad via a mobile telecommunication network.

The Cardiopad is already generating a lot of interest in African tech and medical circles. Zang believes his invention will cut down the cost of heart examinations and he is currently looking for venture capital to commercially produce the device. Visit here for detailed information on the Cardiopad and its inventor.

Mobile Phone and Cash

Photo Credit: OpenIDEO

According to article released this week by Uganda Online, hospitals in Uganda are now accepting mobile money to pay for health expenses. While there are eight mobile providers in Uganda, four are providing mobile money services to their customers – MTN’s MobileMoney, Airtel’s ZAP, UTL’s M-Sente and Warid Pesa – with Orange Uganda planning on releasing their version of the service soon. In the article, a picture clearly shows that the hospital (Case Clinic) allows for mobile payments from MTN and Airtel. Other companies in Uganda are allowing for mobile payments – DStv (satellite TV provider), NWSC (water and sewerage) and Umeme (energy provider).

Utilizing mobile money in the health sector is nothing new. M-PESA in Tanzania has been used by the CCBRT Hospital to pay for patients’ bus ticket from rural areas to the hospital’s location in Dar es Salaam (the capital city). In Kenya, Changamka allows individuals to save and pay for health services by combining a medial smart card with M-PESA. In the Philippines, Smart Communications has partner with PhilHealth, a national insurance provider, to allow customers to pay their premiums via mobile money. This list continues as money mobile is being further employed in the health sector which includes insurance, vouchers program, and conditional cash transfers. The ability to save and pay via mobile money for health issues creates insurance for individuals and families that do not have access to typical insurance products. Mobile money has also been leveraged to pay nurses and community health workers serving in rural areas which helps with worker retention and decreases tardiness.

In the mHealth sector, this is a clear sign that innovative solutions can be shaped around current mobile products and services. Once mobile money has been established in countries, this opens doors for new businesses to be developed around the mobile money platform. The examples above show the need and desire for products that create the ability to both save and pay for health service. While the Ugandan example is not a revolutionary app (or killer app), it provides a necessary product so individuals and families can receive curial medical services. In this case, the ‘killerness’ of the service to using mobile money in the health care system is that it fits both the needs and infrastructure of Uganda, include accepting payments from multiple mobile providers.

Logo from the SHOPS project

Photo Credit: Abt Associates

SMS-based messages can improve training retention for health workers, according to the results of a mobile learning and performance support pilot in Uganda released in November. The goal of USAID’s pilot project, called Mobiles for Quality Improvement (m4QI), was to test the use of mHealth applications in the reinforcement of in-person training provided to health workers.

The outcome from the pilot showed that texts messages are a viable alternative for the continued education of health workers located in rural regions. This is a low-cost option that allows workers to learn in the field and does not interrupt their service to clients.  By utilizing an open source product (FrontlineSMS:Learn), the platform can be used for free and is customizable specifically to needs and challenges in new regions. As a part of USAID’s SHOPS (Strengthening Health Outcomes through the Private Sector), the next steps of m4QI project are to seek out other markets to leverage the mobile learning platform in order to further develop the software as well increase scale. The goals of future projects include improving implementation and identifying best practices.

In using the FrontlineSMS: Learn software platform, Appfrica, a software developer company based in Uganda, created a replicable program that sent messages to health workers to support and test their knowledge retention. The platform allowed for the use of basic mobile phones in order to match the phones commonly owned by the health workers. It provided supervisors data to assess which areas of knowledge were not being properly retained by workers. The project ran from September 2010 through August 2011. The intervention was provided to 34 family planning workers on the Marie Stopes Uganda (MSU) staff in six different service delivery sites. The workers’ jobs ranged from receptionists, lab technicians, service providers, doctors, drivers, housekeepers, and managers. By reviewing the behavior of the staff, four indicators were identified as areas of improvement: hand-washing, sharps disposal, instrument decontamination, and pain management techniques. Four messages were created for each indicator in which two were reinforcing, tips, reminders, or encouragement and the other two were review questions in order to test staff knowledge of past training. In order for each of the four messages to be sent twice to the participants, each worker received one message a day, four days a week, for eight weeks.

While it was initially an eight week pilot, it was expanded until August as there were multiple technical problems which caused the delivery of messages to fail. In total, 3,449 messages were sent, and there was an 86.5% success rate of receipt. In response to the assessment questions, there was a 19% response rate. Participants indicated after the pilot that they were motivated by the reminders for hand-washing rules, utilized their training manuals when they received a question about treatment protocols, were able to re-learn steps to properly sterilize instruments, and applied the information they received about pain management during patient interaction. The interviews also revealed that the messages increased the interaction between co-workers about the topics of the messages.

The pilot also provided lessons for future projects. Those include the need for technical support in the field, a greater understanding by project stakeholders to the purpose and role of the mobile application, a more organized orientation and training for participants, and pre-paid airtime for participants to increase involvement.

The SHOPS project is funded by USAID and is led by Abt Associates and includes partnerships with Banyan Global, Jhpiego, Marie Stopes International, Monitor Group, and O’Hanlon Health Consulting. The focus of the project is to use private sector health in order to improve the quality and availability of family planning and reproductive health, maternal and child health, and HIV/AIDS treatment. Within the mobile health arena, the partnership’s goal is to identify mHealth applications and their best practices in implementation and scale.

 

Nigerians using smartphone

Photo Credit: Leah Ekbladh

Using smartphones to collect tuberculosis (TB) data within the health sector of Nigeria has eliminated the use of printed forms; minimized human error in data entry; reduced the lag time of availability of data for policymakers and managers; and helped pinpoint ways to improve delivery of TB care, reported Leah Ekbladh.

Ekbladh, who is a Senior Associate at Abt Associates was giving a talk hosted by the Global Health Council on the topic “Quality TB Care: Using Smartphone Technology for Data-driven Improvements in Nigeria” as part of the Health Systems 20/20 presentation series on Tuesday January 10. Her talk focused on TB quality improvement activity in Nigeria, the Abt Associates’ approach to quality improvement (QI), the before and after picture of supportive supervision (SS) system, next steps, and lessons learned.

TB Situation in Nigeria and the Health System

According to Leah, with Nigeria ranking 10th among the 22 high TB burden countries in the world, the country’s TB situation could be improved. Before the HS2020 and the National TB Program’s joint intervention, the TB supervision system was largely paper-based. Results of data collected from health facilities were not available immediately for feedback and quality improvement; each state had its own paper-based system with different design of the forms and different items; data were compiled quarterly at State levels; and data entry and analysis was time consuming and prone to a lot of human error.

With support through Health Systems 20/20, the USAID flagship project for strengthening health systems worldwide, the need to strengthen the Supportive Supervision (SS) system to improve performance and treatment outcomes with Nigeria’s health sector was identified. The activity by Abt Associates aimed to shift away from the long paper-based checklists that do not support timely QI at the health facilities, towards supervision that concentrates on performance of clinical tasks, resolution of problems experienced by the health workers, and increased feedback from supervisors.

Nigerians using smartphone

Photo Credit: Leah Ekbladh

The Activity: The Role of Information and Communication Tools

The project believes that when the new information and communication technologies (ICTs) are smartly and strategically integrated into existing development processes, they can help streamline, transform and improve services. And with the strong in-country leadership support from Nigeria to explore new and innovative ways of improving quality through SS system, the activity took off smoothly with a pilot in 4 local government areas (LGA) in 4 states.

Tools Used: Beginning with what was available at the time, and also based on the usability of the features, Personal Digital Assistants (PDAs) were used in combination with Pendragon software to help in creating forms, connecting the forms to the users, distributing the forms, and uploading the forms to a database. After a year of piloting, it was realized that the market for the PALM PDAs was declining with the increasing use of smartphones in Nigeria. Also, EpiSurveyor software from Datadyne was recommended due to its ease of use and its ability to calculate and populate the forms for data collection.

Outputs

Rapid Results Indicators (RRI): RRI form was created with the most critical items that sum up the key elements that are needed for quality data collection, analysis, use and QI for supervision. This was done through repeated iteration resulting in a consolidated checklist that streamlines and integrates the numerous checklist that exists on the paper-based system. The checklist (RRI) loaded into the smartphones, are programmed to do automatic calculations of critical indicators by reducing human error.

Training and Capacity Building: Thirty (30) out of 50 supervisors have been trained on the use of the smartphone technologies and data managers are also trained on the use and improvement of the database. (It should be noted that these people are the existing public servants of the ministry of health in Nigeria). Six rounds of data collection have been done with one using smartphones and five with PDAs.

Database: Through the system, a web-based database to house the data collected and to more easily aggregate and report information to the national level has been developed and launched. The database provides online data aggregation for analysis and dissemination, and quality control system of the data including online government approval data being published and used.

When data is uploaded, supervisors gets notified or alerted for review either on their phone through SMS or email. Updates are communicated back to the officer for review and publication.

Impact of the Activity

With the pilot activity, supervisors have reported the ease of use of the tool in data collection as well as for review and editing of submitted data. Some reported a reduction of working hours from 3 hours with paper-based system to 30-45minutes with the smartphone technology. Supervisors have indicated that the system is enabling them to monitor and assess performance of the TB health delivery system, identify problems and opportunities, and many cases take immediate action for improvement. For example, the rate of drug stock-outs has significantly decreased, and external quality control is easily obtained for quality service with far less delay.

Nigerians using smarphone

Photo Credit: Leah Ekbadh

Lessons Learned and Steps Forward

It was discovered that careful selection of technologies (information communication technologies) for international development activities is key for success; suitable technologies in combination with human resources (socio-technical) is critical; and steps must be taken to roll-out projects incrementally and then plan for scale-up.

In terms of scaling, a total coverage of Lagos and Abia is expected soon with the training of additional 50 supervisors and full integration of the database on schedule. The project also expects to leverage other funding sources to expand further and also involve the private sector in Nigeria.

Visit Abt Associates international health programs for more information on their activities and the Health Systems 20/20 presentation series site for information on the upcoming events and also access the audio recording of the talk.

BY: Raj Shah, U.S. Agency for International Development (USAID) Administrator 

This Post originally appeared on ABCNews.

Raj Shah holds up his hads, with the words 1 million moms written on his palmsEnsuring the safety of a mother and her newborn is not only one of the greatest development challenges we face, it is also one of the most heartbreaking.

Earlier this year, I visited South Sudan, where I met school children studying in a classroom—some of them for the very first time. Although I was optimistic about their future, I was also concerned, because I knew that for every girl I met, she was statistically more likely to die in childbirth than complete a secondary education.

This reality is simply unacceptable.

There is an incredible need to ensure the safety of mothers and infants in the critical period of 48 hours surrounding birth.  To help spur progress in maternal and child health, we launched our first Grand Challenge for Development  – Saving Lives at Birth – in partnership with the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada and The World Bank.

Saving Lives at Birth calls for groundbreaking prevention and treatment approaches for pregnant women and newborns in rural settings during this perilous time around childbirth.  We received more than 600 proposals to our Grand Challenge, more than a quarter of which arrived from the developing world.  Last week we announced our three transition-to-scale grant nominees.  These nominees have proven that their ideas can deliver real results in local communities and are ready to test them on a much larger scale.  While we expect our first round of grants to yield exciting innovations with the potential for significant change, we will encourage our community of innovators to push boundaries and find new ways to shape collective action.

Similarly, the Million Moms Challenge is inspiring American families to help mothers and children around the world. I am proud to accept this Challenge and will continue my commitment to this important cause.

I hope you will too.

A recently released paper looking at systematic approaches to program adaptation of evidence-based health promotion programs focused on the computer-based sexuality education program, The World Starts With Me (WSWM), for a case study.

WSWM, introduced in 2003 by the World Population Foundation, was developed for a priority population in Uganda and adapted for use in Indonesia this year. The program’s target population includes both school-going young people and early school leavers, generally ages 12-19, and is complemented with teacher-led activities. It utilizes a comprehensive approach that includes building IT-skills and creative expression, aiming to contribute to sexual and reproductive health as well as social and economic development.

Student using The World Starts With Me program

Photo Credit: The World Starts With Me

The program provides introductory computer skills lessons as well as 14 lessons on adolescent development, decision making and sexual and reproductive health and rights. The lessons employ effective sex education methods, including practical applications to increase knowledge, develop attitudes, and help youth recognize and cope with social influences.

The paper’s authors, all public health professionals and academics, chose WSWM as their case study because of its proven success. In 2004, the program received the Golden Nica Award by Prix Ars Electronica in the digital communities category, and UNESCO used WSWM’s digital curriculum as a guideline for implementing effective sexuality education.

A meta-analysis revealed that computer technology-based programs like WSWM have similar results to traditional human-delivered interventions in terms of HIV/AIDS prevention behavior adoption. In particular, they proved to have positive results in increased condom use and reduced sexual activity, numbers of sex partners and sexually transmitted infections (STIs). Computer-based assignments also allow programs like WSWM to be student-driven, which means teachers are less burdened to talk about sensitive sexuality issues which may be uncomfortable for students. According to the meta-analysis, given computer-based programs’ “low cost to deliver, ability to customize intervention content, and flexible dissemination channels, they hold much promise for the future of HIV prevention.”

From the world starts with me website

http://www.theworldstarts.org/

This research paper reveals that ICT-based HIV-prevention programs like WSWM can be effectively adapted in other contexts, which could lead to widespread reduction in HIV rates among young people.

 

 

 

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