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mHealth: Revolutionizing Healthcare Worldwide Roshani KothariCommunications & Development Director
Internet Capacity Building for Social GoodFebruary 12, 2016
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Mobile Trends
Mobile phone penetration hasdrastically increased over the last decade especially in developing countries.
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Mobile Trends
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Mobile Features
Send and receive voice dataSend and receive alphanumeric
data (text msgs)Run programs using processingStore data and voice Listen to music Take & Store photos & videos Location and Navigation (GPS) Use diagnostics
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mHealth Components
mHealth Systems not Apps!
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mHealth Overview
PatientDatabase
growth monitoringimmunizationslab testspregnancy registrationreferral tracking
Continuum of careClinical
Protocols
19
69
56
72
16
65
13
29
0
20
40
60
80
y g
who completed 12 months of ARVs
78 %90 %VL undetectable75 %87 %CD4 > 20083 (19 %)13 (2 %)Lost to follow-up58 (13 %)99 (17 %)Deaths289 (68 %)483 (81 %)Still on ARVs430595PatientsHOSPITALCLINICS
78 %90 %VL undetectable75 %87 %CD4 > 20083 (19 %)13 (2 %)Lost to follow-up58 (13 %)99 (17 %)Deaths289 (68 %)483 (81 %)Still on ARVs430595PatientsHOSPITALCLINICS
patients lost to f/u
1. ali samuel2. ben hasan3. etc.
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• Provide decision support tools for use by frontline health workers- Design, test and deploy applications- Partner with Ministry of Health and other health NGOs
• Focus areas- Maternal and Child Health- Chronic Disease
D-tree > Decision tree
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1. Develop clinical protocols that enable better quality care
2. Design software that can scale up and uses of protocols correctly
3. Create Electronic Patient Record to improve care and provide information
What We Do
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Challenges
Shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide, especiallyin developing countries.
Obstacles to Good Healthcare- Limited number of healthcare providers- Heavy client load- Limited training - High burden of disease- Limited financial resources- Paperwork
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Community Case Management, Malawi
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Key Challenges
• Health Survellaince Assistants (HSAs) do not always follow guidelines- 56% asked about 3 danger signs- 37% assessed for 4 physical danger signs- 57% provided correct referrals and pre-referral treatment - Major gap in identification of fast breathing
• Medicine stock management
• Data flows for monthly reporting
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Patient History
Health Surveillance Agent can review patient history
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Sick Child Form
HSA is guided through sick child protocol.
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Counting BreathsUse phone for time measurement
Absence of such measuring device had been major reason for referral
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Assessment Outcomes
Referral Home Treatment
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Vaccinations
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Monthly ReportsVisible to both HSA and Supervisor within the application.
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C-stock IntegrationHSA reminded when monthly stock report is due. They can enter stock levels.
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Web Dashboard
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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!
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Recommendations
• Get involved 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 Ministry of Health and consider the entire health system• Plan for integration with HMIS from the start• Leverage mFinance, mAgriculture, other e/mDevelopment initiatives
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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.
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Saving Mothers Lives, Zanzibar
> 50% of births are at home
When a transfer to hospital is needed there are 3 delays:
• The decision to seek care• The transfer to a facility• Treatment at the facility
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Community Health Workers
• Screen pregnant mothers to identify risks or danger signs.
• Establish community-based referral systems to transport women in labor.
• Coordinate payment of transport to health facilities and hospitals using mobile banking.
• Follow up with the family within 2-5 days after delivery to ensure a continuum of care, including post-partum and post-natal care.
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Results: Facility Deliveries
0.010.020.030.040.050.060.070.080.090.0
100.0
Pemba North Pemba South Unguja North
Facility deliveries among project participants compared to demographic and health survey
Project DHS
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Results
• Dramatic increase in facility delivery rates.
• 82% of women had identified conditions for which delivery in a higher level facility is recommended.
• Facility delivery rate increased from approx. 50% to 75%.
• Average cost per delivery $22.
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Lessons Learned
• Fast paced (technology)Change Management essential at all levels.
• Field refinement is critical.
• Partner with MOH and consider entire health system.
• Users must feel application supports them.
• Phones can improve prestige and self-esteem of HWs
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Opportunities & Threats
Opportunities• Low cost smartphones• Telcom partnerships possible on global scale• Point of care diagnostics• Content libraries being developed for
applications • Integration with other applications
Threats• Lack of intermediate funding• Lack of power sources in hard to reach areas
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Our Partners
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Connect with Us
Roshani [email protected]