Informational Briefing

Futures Group eHealth and mHealth

Bobby Jefferson, Senior Health Informatics Advisor, Futures Group Manage 36 Programmers India (10) , South Africa (10) , Kenya

(10), Tanzania (2), Nigeria (1), Guatemala (1) , Uganda (2)• U.S. Government President AIDS Relief Program $15 Billion –

10 Countries HIV, Prevention Mother to Child Transmission, TB, OVC

• Principal Investigator– National Health Informatics System (HMIS) Kenya Datawarehouse , National Electronic Medical Records 6,000 hospitals

• Lead IT Project Manager- Community Level Orphans and Vulnerable Children (OVC) electronic data system (World Vision, UNICEF, CRS, Africare) – Zambia, Tanzania

• Health IT Advisor - 5 Central Asia Republics (CAR) Consortium for AIDS Strategic Information in Central Asia (CASICA)

• Kazakhstan, Kyrgyz Republic, Tajikistan,• Turkmenistan, Uzbekistan

Implementing eHealth and mHealth for Implementing eHealth and mHealth for Low Resource Communities Low Resource Communities

502 Staff 30+ countries Multi-disciplinary Majority doctoral and masters-level

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Staff Profile

CHSS Geographic Focus

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Latin America and the Caribbean:GuatemalaGuyanaHaitiHonduras

Africa:KenyaLesotho*MozambiqueNigeriaRwandaTanzaniaSierra LeoneSouth AfricaSwazilandUgandaZambiaZimbabwe*

Asia and the Middle East:AfghanistanChina*IndiaPakistan*

Europe & EurasiaGeorgia*Ukraine

Informatics Solutions • IT Database related to Poverty Reduction

– Social Cash Transfer– Household base assistance, community

empowerment,

• Mobile Surveys • Monitoring and Evaluation system• PPP• Capacity Building, Knowledge Transfer,

– Site Capacity Assessment (SCA) tool

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We are working across 15 Countries, 1,033 Hospital Facilities + Satellites Clinics , Antenatal Care – 535 PMTCT sites

Rural, remote, hospitals “serving poorest of poor” and Ministry of Health (MOH) facilities, Rural health facilities serving BPL, marginalized and most vulnerable populations 

• Intermittent power, • Lack IT staff, • Lack internet, • Sparse mobile coverage

•Lack of referrals, or linkage between HIV, PMTCT, TB, •Cost effectiveness and sustainability -- no funds for proprietary licenses, or yearly maintenance fees

Low Resource Environment

Results

• Internet

• Internet

• Mobiles, SMS

Rural, Remote City

# of Facilities

• Sparse Mobile Coverage• No Internet

• Intermittent Power

Online Solutions

MobileSolutions

Offline, DisconnectedSolutions

• Smartphones

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

Use of freely available, reusable, tools, “coded in country” Creative commons approach

Reusable software and technology across countries and programs

Offline Solutions, Disconnected modelLocal programmers, all IT staff in country (India,

Kenya, South Africa)- Offer Programmer training SQL, Agile process, Virus Remediation

Low costs, Inexpensive $200-$350 Netbooks , Solar netbooks

Solar mobile phones, SMS instead of Smartphones

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Rajketu Singh

Amit Kumar

Naveen Sharma

Sanjay Rana

Piyush Khanna,

Jayanta Kr. Das:

Deepika Saini – no photo IT Team in India 2012

Paritosh MishraSeema Verma

Collaborators and Users

ICAP Columbia University 44 sitesIntra Health International 17 sitesElizabeth Glaser EGPAF 16 sitesFamily Health Inter FHI 45 sitesCatholic Relief Services 13 sites

Catholic Relief Services - 32Pathfinder InternationalGertrude Children HospitalDOD Walter Reed - 28 Mount Kenya UniversityMOH Kenya Sites

AIDSReliefJohn Snow InternationalRakai Health Services Vaccine Research

Intra Health International

Mennonite Christian CharitiesAIDSRElief 35 sites

PMTCT , ANC sites 535 sitesElizabeth Glaser EGPAF

Ministry of HealthMinistry of Education

Users

World VisionClinton FoundationColumbia UniversityUNICEFDFID

Health IT SolutionsHealth IT Solutions

Collectively referred to as IQSolutions

1. Electronic medical records

1. IQCare  

2. Independent Technical Evaluations Performed

WHO, USAID, CDC Atlanta, CDC in-country, Ministry of Health

2. Mobile Phone solution (IQSMS technology)

3. Visual Dashboards

4. Monitoring & Evaluation Electronic reporting

•  

Clinicians able to review individual patient Clinicians able to review individual patient historieshistories

*Clinicians review patient histories, prescribed drugs, ordered tests and results, and progress on care and treatment during the exam

demodemo

http://173.203.65.108/iqcare/frmLogin.aspxUsername: user1Password: 1Facility/Satellite: 001-01-01-Demo Site

Mobile Phone Reporting by Remote Workers

PMTCT Currently consists of 4 types of monthly reports

1. PMTCT Antenatal Clinic (ANC) Monthly Summary Form2. PMTCT Care Register Monthly Summary Form3. PMTCT Maternity (L&D) Monthly Summary Form4. PMTCT Mother - Child followup SummarForm

IQSMS PMTCT ReportsIQSMS PMTCT Reports

Monthly and Quarterly Reports

PMTCT Report

Must Pass All Data Quality Rules,District Office

Data Quality Checks

NUMBER OF CLIENT HAD HIV TEST AT ANC

Excel PMTCT MONTHLY REPORT   PMTCT Antenatal Clinic (ANC) Monthly Summary Form    

ANC 01. New ANC clients this month  

1188

ANC 02. Previously known to be HIV positive   17ANC 03. Total number tasted   574ANC 04. Number of new client had HIV test at ANC   277ANC 05. Tested HIV-Positive   37ANC 06. Post-test counseled for positive and negative   574

ANC 07. Number of partners tested for HIV   16ANC 08. Tested HIV-Positive   4

Orphans Vulnerable Children (OVC), Most At Risk Population (MARPS), Maternal Child Health (MNH)

Ms Access Database

PDA device

Web Internet Desktop

Excel Only

M&E Electronic Reporting SystemSolar Power Cell phones

UNICEF Social Cash Transfer Application

Futures Group International

STEPS OVC

• STEPS OVC = Sustainability Through Economic Strengthening, Prevention and Support for Orphans and Vulnerable Children

• Program provides – Support for HIV prevention and behavior

change initiatives– Reducing HIV transmission– Support for OVC, at-risk youth and adults, and

other vulnerable populations

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STEPS OVC Login

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STEPS OVC Beneficiary Search

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ICT for Development – Best PC Security Practices

District Health Training - Mobile Phone Survey using SMS

Held Training of 600 District Health Officers in KenyaOn New District Health Reporting Tool Ministry of Health NASCOP SMS 1:Have you entered /Imported data into the new tool ? Yes or No  SMS 2:Have you run reports using the new district tools ? Yes or No  SMS 3:Have you discussed the new district tools and reports with other members of the district health team ? Yes or No

 SMS 4:In what district do you work?

Your answers are confidential and a Ksh 20 refund will be given for each valid reply

Mobile Phone Survey Architecture

Assessment Database

(Excel)

Assessment Database

(Excel)

Valid?

SMS Provider service

(Zain/Safaricom)

survey data

sent

via fro

ntline S

MS

SMS archived in

frontlinesms application DB

Survey responses/corrections via SMS

FrontlineSMS

Assessment

Application

Assessment

Application

Survey questions and acknowledgement via SMS

Get SMS data

SaveYes

No

Acknowledge

(Reimburse airtime)

Request for correction

Con

vert

SM

S

cont

ent t

o D

B d

ata

8 provinces involved in the survey, a total of 388 interviewees sent some reply; 101 interviewees completed the survey

Graph 1: N Participated = 165; N completed = 101

Percentage participation/completion in the DHPT text message survey by province

Table 5: Time in minutes to complete the survey

Province N = 131

Minimum

25th Percenti

le

Median 75th Percentile

Maximum Mean

Central 12 11.00 22.00 27.00 59.00 5861.00 999.33

Coast 12 5.00 9.00 27.00 54.50 969.00 106.75

Eastern North 5 15.00 17.00 25.00 30.00 31.00 23.60

Eastern South 20 3.00 9.00 18.00 480.00 9703.00 1202.10

North Rift 17 15.00 34.00 50.00 262.00 17561.00 2512.06

Nyanza 22 9.00 19.00 27.00 152.00 17534.00 1722.05

South Rift 19 2.00 15.00 35.00 1623.00 27553.00 3162.63

Western 24 4.00 768.00 1372.50 19012.50 30063.00 9424.38

Response duration and times

Graph 2: N: 131 interviewees who responded to at least 2 questions

Median times (in minutes) participants used to complete the SMS survey

Response duration and times

• Most of the respondents attended to the SMS after 5pm

• Sending multiple questions drastically reduces the response rate

• Re-sending an answered question does not guarantee a response

• Contact (physical, by mail or otherwise) significantly increases the  response rate

• The longer the duration between a response and the next question the lower the chances of getting the next response

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