Health – Page 2 – Integra LLC

Using ICTs to Address HIV/AIDS in Humanitarian Emergencies

Responding to humanitarian emergencies poses a complex set of challenges that is exacerbated in areas where high rates of HIV/AIDS exist. The number of people living with HIV/AIDS hovers around 33 million and the vast majority live in sub-Saharan Africa, bringing to the forefront the complex interactions between HIV/AIDS, food security, livelihoods, and humanitarian action. This unique set of issues leads to the question of whether ICTs can be leveraged to address HIV/AIDS challenges in humanitarian crises, and if so, which groups are already doing so.

ICTs have been a used as a means for addressing HIV/AIDS issues in humanitarian situations by global aid agencies. The United Nations (UN) has recognized the impacts on HIV/AIDS on food security and is responding by integrating HIV into humanitarian responses. A priority for the UN Office for the Coordination of Humanitarian Affairs (OCHA) has been to “ensure a sustained flow of information and analysis on AIDS and [HIV] needs of populations in humanitarian situations” by producing reports, web specials, audio reports, fact files, etc. on the Integrated Regional Information Networks (IRIN) website. For example, IRIN radio produced a weekly 10-episode radio drama on HIV and AIDS for Somalis to listen to in the crisis country. The drama started on October 15^th and can be heard on the IRIN website.

FilmAid screening film at Kenyan refugee camp

Photo credit: FilmAid

Nongovernmental organizations are also using ICTs to address HIV/AIDS in humanitarian situations. FilmAid provides knowledge and empowerment to people suffering the effects of war, poverty, displacement or disaster through informational films. The organization works with communities to create films that are appropriate to the local context and relevant to community issues. One of the issue areas that FilmAid focuses on is Health & Safety, including HIV/AIDS. The organization has created various films relating to HIV/AIDS issues, such as a series of PEPFAR films that were shown in a Dadaab refugee camp in Kenya. The PEPFAR films were developed with the communities in Dadaab and promoted the prevention of mother-to-child HIV transmission, the uptake of voluntary counseling and testing (VCT), and abstinence.

The human rights organization WITNESS has created a video that tells the story of people living with HIV/AIDS in the war-torn Eastern region of the DRC, shown below. The film advocates for the provision of free testing, increased access to medical care, and prevention outreach in an area that desperately needs it.

These cases show that ICTs can be leveraged to address HIV/AIDS issues in humanitarian emergencies on many different levels, such as information flow, education, and advocacy. There is vast potential for increased ICT to more effectively and quickly address HIV/AIDS issues in humanitarian crises.

December 1, 2011/by actualize

Agriculture, Health, Health, HIV/AIDS, Originally posted on the GBI Portal

CrowdOutAIDS: Engaging Youth to Develop AIDS Policy

CrowdOutAIDS, the online crowdsourcing project that engages young people in developing a UNAIDS strategy on youth and HIV, has wrapped up its fifth week. The project launched in October 2011 and will run for two months, with the final crowdsourced strategy to be produced in January.

Crowdsourcing is a technique used to quickly engage large numbers of people to generate ideas and solve complex problems. CrowdOutAIDS’ target “crowd” is young people, 3,000 of whom become infected with HIV every day and 5 million of whom currently live with the virus.

The project’s approach is to follow a four-step model:

Connect young people online
Share knowledge and prioritize issues
Find solutions
Develop collective actions on HIV

Once the fourth step is completed, the UNAIDS Secretariat will put the youth strategy into action, and the strategy could become an advocacy platform in future UNAIDS work.

Currently the project is in the second stage of sharing knowledge. Youth from all over the world have been connected through eight regional Open Forums that are in Arabic, English, Spanish, French, Russian and Chinese. The moderator of each forum starts each day with a question (such as “What is your description of a healthy relationship?”) and participants respond and interact with one another.

The first week of the project revealed some of the major problems, in the eyes of youth participants, with UN agencies’ current approaches to working with youth. Participants expressed concerns that UN initiatives of working with youth in HIV response lack strategic vision and have no clear plan, and hinder young people from participating in decision-making.

It will be interesting to see what solutions are developed after the knowledge sharing step is completed, as well as what direction the UN youth and HIV strategy takes over the next six weeks. Be sure to check out the CrowdOutAIDS website and Twitter @CrowdOutAIDS for continuous updates.

November 28, 2011/by actualize

Agriculture, Health, Health, HIV/AIDS, Originally posted on the GBI Portal

Monitoring and Evaluation in mHealth: Opportunities and Challenges

Last week’s mHealth working group meeting laid out the opportunities, challenges, and potential of monitoring and evaluation (M&E) within the mHealth sector.

JhPiego circumcision promotion through texting service

Poster in Swahili promoting male circumcision through SMS service, part of Jhpiego program

Several experts in the field presented their experiences of monitoring and evaluating mHealth projects, emphasizing the considerable potential that mobile projects offer in generating robust and accurate data. Kelly L’Engle, a behavior scientist at FHI 360, discussed the need for M&E in order to gauge the impact of mHealth. She claimed that mHealth technology is not being fully leveraged and that the current mHealth research “doesn’t provide evidence on actual impacts…or answers to critical research questions…”

James BonTempo from Jhpiego presented on evaluating behavior change evidence from a text message project that promotes male circumcision (MC) for HIV prevention in Tanzania. He referred to this evidence extraction as “mining the data exhaust” – that is, the data generated as a byproduct of ICTs, the “trail of clicks” that ICT users leave behind.

The MC program offered a toll-free text-messaging/SMS service. With the service, individuals could request to receive information on the benefits of MC (using key word: TOHARA), where to find MC services (WAPI), as well as receive follow-up care information after undergoing the circumcision (BAADA). While the SMS platform was intended to capture requests to the three keywords and generate access logs for system performance monitoring, Jhpiego has analyzed this data in order to see if there was a relationship between requests for the MC data and actual utilization of MC services.

Jhpiego male circumcision project in Tanzania- behavior change evaluation

Potential link to behavior change in Jhpiego male circumcision project

The data set included 12,056 keyword requests sent by 4,954 users. After performing a Chi Square analysis on the data, the project team found that requests for information on the benefits of MC (TOHARA) was not strongly associated with going to receive the circumcision. However, it was found that those who requested where to find the data (WAPI) did have a statistically significant association with undergoing the circumcision. These results are consistent with pathway models of behavior change, indicating that those who simply wanted to know more about MC were not quite prepared to undergo the procedure, but those looking for service availability were ready to use the services.

The associations found in this particular project imply that providing text or voice messages that tell people where to get a particular service could be more effective in encouraging clients to utilize that service. M&E that finds results such as these could help project leaders design SMS services that generate more useful data.

Like most forms of M&E, there are limitations on findings that use mobile data. There is a lot of information that mobile devices do not provide, such as which phones belong to whom and who actually sends the text messages; this makes it difficult to link messages to specific individuals. In the MC case, data analysts found an association, but did not necessarily know the nature of the association. It can also be challenging to find the time or manpower to rake through the massive amount of data that is produced by mobile devices.

While M&E in mHealth has its limitations, it is difficult to find data that can be collected and analyzed as quickly, cheaply, or easily using other means. Paper, radio, and television simply do not offer the same kind of easily-mined data exhaust that mobile does.

October 25, 2011/by actualize

Agriculture, Health, Health, Health Systems, Originally posted on the GBI Portal

Will Nigeria Turn to mHealth to Achieve its Healthcare Goals?

Nigeria may be joining a number of African countries in prioritizing mHealth as a way to improve the country’s troubled healthcare system. At a recent mobile Health workshop in Nigeria that was put together by the African telecommunications company MTN, stakeholders voted for the nation to adopt a mobile healthcare system.

Omobola Johnson, Nigeria's Minister of Technology and Communications

According to some, Nigeria is among the countries leading the way in using mobile health services. Several mobile companies operate there, with MTN serving the largest population percentage followed by Globacom, Zain and Etisalat. The Nigerian Communications Commission estimates that around 105 million of the country’s 155 million people were subscribed to a mobile service provider in August 2011.

Nigeria faces many challenges in expanding its healthcare system, such as a lack of infrastructure, a shortage of trained healthcare professionals, high illiteracy rates and unreliable power sources. The nation’s government has made some efforts to address these challenges in order to meet the Millennium Development Goals. The National Primary Healthcare Development Agency operates under the Health Ministry to promote and support the development of a high quality primary healthcare system.

Photo credit: eHealth Nigeria

But is the Nigerian government prioritizing mHealth as a means to improve healthcare delivery? Omobola Johnson, Nigeria’s recently appointed Technology and Communications Minister, has been pushing toward nationwide mobile coverage as well as the implementation of emergency call centers and phone lines. However, when Johnson revealed the Ministry’s mandate at the end of August, the use of mobile devices for improved healthcare was not mentioned specifically.

Many individuals, private companies, civil society organizations, and aid agencies feel that Nigeria should embrace mHealth as a mechanism for repositioning the country’s healthcare system. Through fuller adoption of mHealth into the healthcare delivery system, many more people could be reached. But the government will need to place mHealth at the top of the agenda and support mHealth initiatives should the emerging field succeed in improving Nigeria’s healthcare.

October 19, 2011/by actualize

Agriculture, Health, Health, Maternal & Child Health, Originally posted on the GBI Portal

How to Disseminate Maternal Health Information to Rural Women

There are numerous ICT projects that focus on maternal health, many designed to reach women in rural areas where there is a severe lack of healthcare services. Mhealth in particular – the use of mobile phones to improve health – has taken off as a tool for providing critical information to pregnant and new mothers. In USAID’s MAMA project, for example, pregnant women in Bangladesh receive weekly information updates via text or voice message.

Photo credit: Open Ideo

But what is the best method for disseminating health information to rural women? How can the women learn and interpret the information in a way in which they can understand its value, making certain behavior changes if needed? Vikram Parmar, a professor at the Delft University of Technology in the Netherlands, attempted to find this out through research conducted in India with 120 women from seven different rural villages. Parmar wanted to know how to motivate users of a Primary Health Information System (PHIS) to adopt positive health practices through designing and developing a Health Information System that maximized information dissemination.

Parmar wanted to explore how to improve information dissemination where health ICT projects had fallen short in three areas. First, he was concerned with the limited impact of Health Information Systems in educating rural users, as well as ICT-based health interventions such as film showings and radio program broadcasts that had not improved the health practices of rural target audiences. Secondly, the typical content and design of Health Information Systems did not encourage regular use due to the “non-persuasive setting of health interventions,” resulting in an information gap between rural women and primary health information. Finally, HIS deployed to rural users were based on content developed for urban users, resulting in a mismatch between the information given to rural women and the information they actually needed. In particular, maternal health and other personal women’s health issues had not been addressed.

Parmar proposed addressing these problems by employing a user-centered design framework to develop ICT interventions (see framework in full below). He tested this framework in the context of the PHIS. The results of his exploratory research indicated that the rural women’s knowledge had improved after interacting with the PHIS, signifying the importance of understanding user needs, taking into account existing social beliefs and practices related to health issues. Using this framework could improve information dissemination, resulting in positive change in rural women’s health-related practices.

October 14, 2011/by actualize

Agriculture, Health, Health, Maternal & Child Health, Originally posted on the GBI Portal

Marketing “Mobile Midwife” in Ghana

Can information delivered on a mobile phone affect the outcome of a pregnancy in a developing country? Can communities and healthcare workers use mobile phones to save the lives of newborns? These are some of the questions that the Mobile Technology for Community Health (MOTECH) program in Ghana is trying to address. Grameen Foundation is working with Ghana Health Service and Columbia University in one of the poorest rural districts of Ghana to try to improve the health outcomes for mothers and their newborns using mobile phones. But once a service has been created, how do you generate awareness for it and ensure there is adequate participation?

In July 2010, we launched a service called “Mobile Midwife,” which enablespregnant women and their families to receive SMS or pre-recorded voice messages on personal mobile phones. The messages are tied to the estimated due-date for the woman so the information is time-specific and delivered weekly in their own language. Nurses also use mobile phones to record when a pregnant woman has received prenatal care. If critical care is missed, both the mother and the nurse receive a reminder message on their mobile phones. To date, over 7,000 pregnant women and children under five have been registered in the system. More detail about the program can be found online in our “Lessons Learned in Ghana” report.

One of the challenges we faced in the development of this system was how to generate awareness for the “Mobile Midwife” service in the first place. Unless people register for the service, they cannot receive the important information we are able to provide about pregnancy. As we talked to people in the rural villages where “Mobile Midwife” would be available, it quickly became clear that communities in Ghana, and particularly the Upper East Region, had been inundated with cartoon-like health message campaigns from myriad NGOs and government agencies. People told us that if campaigns were seen as “too slick,” people would not think the messages were relevant to them. The MOTECH team decided to pursue an approach that sought to provide “aspirational” images that were differentiated from the typical “NGO cartoon” campaign, but still were relevant to the UER population. This included using real photographs instead of drawings, and ensuring that the people in the photographs were wearing clothes in the style of those worn in the rural areas where we worked. Part of the aspirational message was dressing the models in new, clean clothing, which proved to be effective. When field testing the marketing styles, many people said they “liked the lady in the pictures and it made them feel good as one day they would like to be dressed well too.” The team also decided to create some messaging that was targeted specifically to men, in an effort to respect their roles as decision makers in the family, get them to listen to the messages with their partners, and be a part of making positive health choices throughout pregnancy, birth and early childhood. As the program evolves, we expect to experiment with broader reach marketing vehicles such as radio and community mobilization.

Initiative:

Maternal Newborn mHealth

Order:

October 5, 2011/by actualize

Agriculture, Health, Health, Maternal & Child Health, Originally posted on the GBI Portal

USAID MAMA initiative leading the way in mobile for maternal health projects

The USAID-initiated MAMA (Mobile Alliance for Maternal Action) project that utilizes cell phones to improve maternal health in developing countries gave an in-depth update at the latest mHealth Working Group meeting.

The pilot initiative, announced in May by Secretary of State Hillary Clinton and co-sponsored by Johnson & Johnson, has begun work in Bangladesh. MAMA seeks to achieve “scale, sustainability and impact” by creating a replicable model of reaching low-income mothers and household decision-makers (husbands, mothers-in-law) through increasing the impact of current mHealth programs, providing technical assistance to new mHealth models, and improving methods of applying mobile technology to improving maternal health.

At the working group meeting, Sandhya Rao of USAID and Pamela Riley of USAID’s SHOPS (Strengthening Health Outcomes through the Private Sector) program discussed the status of Aponjon, the MAMA project in Bangladesh. Aponjon provides vital health information through mobile phones two times a week to expecting and new mothers, reminding them of when to receive checkups and how to stay healthy during the pregnancy. Bangladesh was chosen to pilot the project because the country’s government has been a leader in promoting and expanding access to ICTs and is very active in mHealth.

Photo credit: Council on Foreign Relations

In order to bring it to a national scale, the burgeoning MAMA initiative has established private, public, and NGO partnerships to help implement its activities, and is carefully monitoring its methods and practices to ensure that the project is reaching its target goals. For example, Aponjon is constantly tweaking the content of its phone messages so that mothers and decision-makers understand, retain and relate to the information given.

Photo credit: Highmark Medicare Services

Another aspect of the project that MAMA will be monitoring is its business models to determine which are the most sustainable and effective. Currently, customers pay service providers to retrieve the phone messages. Text messaging is the cheapest method for remitting information in most developing countries, but many of the poorest clients are unable to read the texts. The alternative is interactive voice response (IVR) through which customers can hear recorded messages at a much lower cost than call centers but more than texting. MAMA and its partners are experimenting with different pay schemes, such as subsidizing rates, working with service providers to offer low rates or donate funds to the project, and charging fees based on usage.

It will take the new initiative years before sustainable, reliable, and replicable models are in place. What is clear is that the potential for improving maternal and newborn health through the use of mobile phones is being tapped.

September 29, 2011/by actualize

Agriculture, Health, Health, Non-communicable Diseases, Originally posted on the GBI Portal

Arogya World announces diabetes prevention mHealth program in India

Arogya World, a US based NGO, in association with Nokia, will be launching a large-scale diabetes prevention mHealth program in India. The diabetes awareness program aims to reach one million people over the course of the next two years through the use of text messages, which will be translated in multiple languages, catering to the diverse population in India.

The announcement was made at the 2011 Clinton Global Initiative (CGI) Annual Meeting in New York City.

For more information, read the official press release here.

September 26, 2011/by actualize

Agriculture, Health, Health, HIV/AIDS, Maternal & Child Health, Originally posted on the GBI Portal

Scalable and Replicable: ICT4Health is Chosen Theme for UN South-South Awards

Digital Health 4 Digital Development was the theme of choice for the 2011 South-South awards that took place earlier this week. The United Nations-supported awards ceremony, held September 19th, honors governments, organizations and individuals accelerating progress toward the Millennium Development Goals (MDGs), and this year awards were given for utilizing ICTs for the advancement of the MDG health goals.

Prime Minister of Bangladesh receives South South award from

Photo Credit: thefinancialexpress-bd.com

The awards were organized by South South News, a digital media platform launched by the United Nations General Assembly High-level Committee in 2010. The platform disseminates development news and allows countries in the global South to share best practices in advancing implementation of the MDGs. As health remains a high priority within the international development field, with three of the eight MDGs calling for health improvements by 2015, this year South South chose the “catalytic and unifying force of ‘digital health’” as its focus.

Awardees were recognized for policies, programs and projects that address global health using ICTs as a mechanism for “scalability and replicability of the broad development agenda.” Awards were given on health categories such as Women and Children’s Health and HIV/AIDS, TB and Malaria with special consideration given to achievements in the fields of mobile, broadband, Internet, medical, and pharmaceutical applications.

Among the winners was Bangladesh’s prime minister Sheikh Hasina who received recognition for the use of ICTs in addressing women and children’s healthcare. The government of Bangladesh has made increasing the use and availability of ICTs a priority over the past decade, declaring IT a “thrust” sector and implementing a national ICT policy in 2002. The prime minister has been a catalyst for ICT development in Bangladesh, launching the Digital Bangladesh 2021 program, reducing taxes to make computers and other electronics more affordable, and giving free internet services to schools. This is not the first time she has been recognized for her ICT work in the country. The PM noted during the ceremony that most of Bangladesh’s 11,000 community health clinics have been digitized, allowing for free treatment of diseases like malaria and AIDS and reducing maternal and infant mortality rates.

Use of PDA by the nurses at ICDDRB hospital in Dhaka, Bangladesh

Photo credit: Bytesforall "ICT4Health" Network

Other development agencies and UN-affiliated organizations are also choosing to give awards to those using ICTs to advance public health initiatives. The Elena Pinchuk ANTIAIDS Foundation, rising from the work of UNAIDS High Level Commission on HIV Prevention, has launched a competition to find innovative start up projects that use social media and mobile phones for HIV prevention. The competition is taking applications until October 1^st and the winners will receive up to $10,000 to implement one-year projects.

As global health becomes a pressing priority, it is essential to utilize, innovate, and increase access to ICTs within the healthcare sector. The South South awards have set a precedent by recognizing the success of ICT4Health in accelerating the Millennium Development Goals and could encourage Global South countries to follow in the footsteps of nations like Bangladesh.

September 22, 2011/by actualize

Agriculture, Health, Health, Non-communicable Diseases, Originally posted on the GBI Portal

Beyond “an App for that”: Using mHealth to fight NCDs

As the global health community gears up for the upcoming United Nations High-Level Summit on non-communicable disease (NCDs), I thought it would be useful to explore the ways in which mobile technology can play a role in the efforts to reduce the burden of NCDs globally. NCDs include cardio-vascular disease, diabetes, cancer, and chronic respiratory diseases. The combined impact of these diseases contributes substantially to global poverty rates and places strain on healthcare systems worldwide.

With a growing urban population and lifestyle changes, particularly in diets where fast foods have become a greater part of the local diet, obesity and diabetes rates tend to grow rapidly. NCD rates are frequently driven by the combination of lifestyle changes and environmental shifts and require more innovative thinking around behavioral change and social movements in order to make long-term changes.

mHealth applications for NCDs are already quite common in parts of the world where diabetes rates, in particular, are high. This can be found in personalize-able mobile applications such as Glucose Buddy, or in social media campaigns such as TuAnalyze, which uses Twitter to drive higher compliance rates for hemoglobin A1c testing (a bit of a gold-standard when it comes to diabetes care).

Beyond diabetes, there are NCD prevention applications, such as the anti-smoking Text2Quit, demonstrating the potential to find interventions with the capacity to scale into national campaigns. On the respiratory disease front, Asthmapolis, is an innovative approach that combines sensors with mapping to track the contexts in which people with asthma use their inhalers and furthers our public health understanding of asthma and the environment. Tracking programs that enable dieters to monitor food intake and exercise can be effective tools for fighting obesity and cardio-vascular disease.

In order to realize the full potential of mobiles, however, we should take a few cues from the recent mass mobilizations and social movements in the Middle East where Facebook and Twitter were utilized to facilitate social change movements in Egypt and Tunisia.

Similarly, long-term efforts at prevention in public health have rarely succeeded without complementary sustained social movements that reduce the social barriers to behavioral change and create stronger enabling environments for personal lifestyle changes to succeed. This could include more walkable cities, better access to health foods, and changing environmental drivers that affect cardiovascular diseases and respiratory health outcomes.

We’ll likely need to move beyond the “app for that” ethos to engaging with social networks and technology in ways that can promote both well-being and the underlying social transformations required to sustain behavioral change in a health landscape that must navigate a long-term global financial crisis where resources are in short supply.

September 20, 2011/by actualize

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