bobby jefferson unite for sight apri 21 2pm l 2012

mHealth: Scale Up of Mobile in PMTCT Program

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• Bobby Jefferson, Director Health Informatics, Futures Group • Principal Investigator – Health Information Systems Grant Kenya

• Partners in AIDS Care and Treatment, University of Maryland Institute of Human Virology

• Tanzania HIV AIDS Relief Program

• Tanzania Orphans and Most Vulnerable Children (MVC) MIS

technology isn’t the barrier to scale up

• Description

– Low Resource Environment

• Approach

– Low cost, appropriate technology

• Solutions

• Sharing Scale Up Lessons

Outline

423 ART Hospital Facilities

770 PMTCT - Antenatal Care (ANC)

Low Resource

Rural, remote, mission hospitals “serving poorest of poor” and Ministry of

Health (MOH) facilities

• Intermittent power,

• Lack of trained IT staff,

• Lack internet,

• Sparse mobile coverage

Environment

Photo credits: Brian and Angie Savage

Nurses, Clinicians, Adherence Counselors, need health data, M&E

program data in knowledge repository

• Lack of referrals, or linkage between HIV, PMTCT, TB, or to existing

technology systems

• Cost effectiveness and sustainability -- no funds for proprietary

licenses, or yearly maintenance fees

Low Resource Environment

Approach

How to Give Presentations or

IT Training

in

Rural Clinics When

Power or Generator is Offline

? to address power

Off Grid Technology: Address

Intermittent Power

Approach

Off Grid Technology: Address

Intermittent Power

Battery Operated

Projector

to address power

Approach

Off Grid Technology: Address

Intermittent Power

Approach

Off Grid Technology: Address

Intermittent Power

Approach

Off Grid Technology: Address

Intermittent Power

Approach

How to Print In Rural Clinic When

Power or Generator is Offline

? to address power

Off Grid Technology: Address

Intermittent Power

Approach

ZINK – Zero Ink

Portal Printers

*use to QR code for

Patient ID

to address power

Off Grid Technology: Address

Intermittent Power

Approach

Technology

Approach

How to Power Netbook Computer

in Rural Clinic When

Power or Generator is Offline

? to address power

Off Grid Technology: Address

Intermittent Power

Approach

Samsung Solar

Netbook PC - NC215 Intel Atom N570 Processor 1.3 GHz

1 GB DDR3 Memory Module

10’ LED Backlit LCD Screen

250GB 5400 rpm Sata Hard Disk

802.11bg/n Wi-Fi

10/100 Ethernet Port

0.3 Mega Pixel Web Camera

802.11 b/g/n Wireless LAN

Bluetooth V3.0

Headphone Jack,

4-in-1 (SD, SDHC, SDXC, MMC) Multi

Card Reader

3 USB 2.0 Ports & VGA Port out

3 W Stereo Speaker (1.5 W x 2)

Dimensions : 10.20″ (W) x 7.07″ (D)

x 0.85″ ~ 1.33″ (H)

Warranty : 1 Year Warranty

Technology

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Photo credits: Brian and Angie Savage

Facility Name District

Distance from

Facility to District

(KM)

Time spent to

Deliver PMTCT

Report (Hrs)

Bus Fare (Tsh)

MWANZA Region

NYAMAGANA DISTRICT

Mwamashimba Health Centre Kwimba 50 1.30hrs 10000

Malya Health Centre Kwimba 25 1hr 5000

Kikubiji Dispensary Kwimba 102 4hrs 20000

Kiliwi Dispensary Kwimba 100 4hrs 20000

KWIMBA DISTRICT Nyakalilo Health Center Sengerema 46 2 HRS 8000

Mwangika Health Centre Sengerema 98 4 HRS 10000

Sengerema Health Centre Sengerema 10 20MIN 3000

SENGEREMA DISTRICT Kharumwa Health Centre Geita 115 3HRS 20000

Nzera Health Centre Geita 48 2HRS 8000

Katoro Health Centre Geita 50 45MIN 6000

Nkome Dispensary Geita 80 2HRS 6000

Nyang'hwale Health Center Geita 85 2HRS 7000

Kasamwa Health Centre Geita 25 30MIN 4000

Bukori Health Centre Geita 60 1:30HRS 6000

Tanzania

• staff Gender 89% female

• 100% posses mobile phone

• 71% used SMS on mobile phone

• Predominately Swahili speakers and readers

Tanzania Environment

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IQSMS – Free software Report formatting

Data validation

PMTCT MONTHLY REPORT

Jan-10

PMTCT Antenatal Clinic (ANC) Monthly Summary

Form

All women attending ANC for the

given report period L

PT

F 1

ANC 01. New ANC clients this month 1188

ANC 02. Previously known to be HIV positive 17

ANC 03. Total number tasted 574

ANC 04. Number of new client had HIV test at ANC 277

ANC 05. Tested HIV-Positive 37

ANC 06. Post-test counseled for positive and negative 574

ANC 07. Number of partners tested for HIV 16

ANC 08. Tested HIV-Positive 4

Paper Report SMS

Data Type Validation

Report Duplication

Check

• IQSMS software,

IQSMS Reporting

Immediate Data Quality Alert

Pass or Fail

PMTCT Report

PMTCT Report

District Office

Data Quality Checks

Reports and Analytics

Query Database Using SMS From Mobile Phone

Bugando Clinic – Site 1

How many new antenatal clients this month?

How many were tested for HIV?

How many tested Positive ?

SMS Query: R1, M1, Site 1

Query Database Using SMS From Mobile Phone

SMS Query: 4679, 2561, 181

NUMBER OF CLIENT HAD HIV TEST AT ANC

Benefits

Submission via low cost mobile phones in the field

IQSMS project takes advantage of mobile phones already owned by health worker. By using a

familiar device, training requirements are similar to paper based training

Low cost of SMS submission ($0.04 per SMS)

Fuel and Transport cost savings in staff travel and reliable data submission

Health Care Workers no longer required physically to transport paper reports or fax PMTCT

reports to central project offices.

PMTCT Data can be made accessible to a wider audience (local, district, region, levels

Health facilities interested to know how their statistics compare with others in their districts

District officers want to receive aggregate report via SMS, email and

send queries to IQSMS database

Facility Name District

Distance from

Facility to District

(KM)

Time spent to

Deliver PMTCT

Report (Hrs)

Bus Fare (Tsh)

MWANZA Region

NYAMAGANA DISTRICT 15 Min Avg

Mwamashimba Health Centre Kwimba 50

Malya Health Centre Kwimba 25

Kikubiji Dispensary Kwimba 102

Kiliwi Dispensary Kwimba 100

KWIMBA DISTRICT

Nyakalilo Health Center Sengerema 46

Mwangika Health Centre Sengerema 98

Sengerema Health Centre Sengerema 10

SENGEREMA DISTRICT

Kharumwa Health Centre Geita 115

Nzera Health Centre Geita 48

Katoro Health Centre Geita 50

Nkome Dispensary Geita 80

Nyang'hwale Health Center Geita 85

Kasamwa Health Centre Geita 25

Bukori Health Centre Geita 60

Tanzania

# of Months

# of

Sites

Number of PMTCT Sites Reporting Using Mobile IQSMS

# of Months

# of

Sites

technology isn’t the barrier to scale up

• After early adopters, health care workers not keen sending message

unless they have free airtime and toll free number available from their

mobile telecom provider ; we increase use by 50% when toll free is

available

• They wanted direct feedback from district coordinator verifying he

received their monthly report

• The older staff have more difficulty

using mobile for messaging and

reporting;

technology isn’t the barrier to scale up

• Staff in rural areas want their SMS messages in Swahili or local

language; Detailed instructions in Swahili to how to do reporting and

use phones for reporting

• Worker receive per diem for transports costs to bring their list and

reports district offices, losing out in reimbursement was not issue

• (25% share phone vs. Own)

technology isn’t the barrier to scale up

Any problems with small buttons on the phone?

Response Freq %

No 30 85.71

Yes 5 14.29

Total 35 100

Instruction on Swahili critical to using IQSMS

Response Freq %

No 6 17.14

Yes 29 82.86

Total 35 100

• Reasons For Not Sending Monthly Report

– Majority said they don’t understand English language

– Need message understandable in Swahili language

IQSMS Instructions in Swahili

• Anything that can be improved on report submission to make report to be on time

• Response Freq %

• No 14 40.00

• Yes 21 60.00

• Total 35 100

Barriers to implementing mobile phone reporting for submitting all four reports each month Mobile Network Problem/failure

Server don’t respond on time

Report type is hard

It have been found that free Airtime is critical for scale up

# of Months

# of

Sites

technology isn’t the barrier to scale up

• When PMTCT staff submits SMS report that fails validation more than three (3) times; there is likely an issue with understanding the indicators;

• We use data to target training on indicators to specific staff

• We still travel for

data quality audit (DQA) to

verify the reported values

against the register

technology isn’t the barrier to scale up

• Delay in Reporting times for PMTCT reports to district level office went from 1-2 months to 30 minutes

• It takes on average only 15 minutes a month to submit all four reports

technology isn’t the barrier to scale up

Excel

PMTCT MONTHLY REPORT PMTCT Antenatal Clinic (ANC) Monthly

Summary Form

ANC 01. New ANC clients this month

118

8 ANC 02. Previously known to be HIV

positive 17

ANC 03. Total number tasted 574 ANC 04. Number of new client had HIV test

at ANC 277

ANC 05. Tested HIV-Positive 37 ANC 06. Post-test counseled for positive

and negative 574

ANC 07. Number of partners tested for HIV 16

ANC 08. Tested HIV-Positive 4

Ms Access Database

PDA device

Web Internet Desktop

Excel Only

M&E Electronic Reporting System Solar Power Cell phones

Thank you

we predict the trends that will affect a

country’s stability and growth. we see

connections between disparate data points

that others miss— allowing us to uncover

the real barriers to well-being and discover

innovative solutions for a better world.