mHMtaani – Mobile Health for our Communities

Marion McNabb, Senior Technical Advisor mHealth

CORE Group Meeting, October 16, 2014

ENHANCING SERVICE DELIVERY AND QUALITY IMPROVEMENT

THROUGH MOBILE TECHNOLOGY

GLOBAL MOBILE PHONE OWNERSHIP 2005-2014• In developing countries, mobile-cellular penetration will reach 90%

by the end of 2014, compared with 121% in developed countries

• Africa will reach 69% and Asia and the Pacific will reach 89% mobile-cellular penetration by the end of 2014.

Source: International Telecommunications Union, 2014 Accessed August 2014

Mobile Phone Ownership Among Women• Women are 21% less likely to own a phone compared to men, this

increases to 23% if she lives in Africa and 37% if she lives in South Asia

• Women represent 2/3 of the untapped market for mobile growth. • 93% of women feel safer with a phone; 85% of women feel more

independent because of their mobile phone

Source: Women and Mobile: Global Opportunity; GSMA and Vial Wave, 2013

PATHFINDER mHEALTH AND MOBILE MONEY PROGRAMS

Community Health Worker Mobile

Applications and Mobile Money

Behavior Change using SMS

Mozambique – mCenas! - Youth Focused SMS for FP and SRH

Ethiopia – m4Youth - Youth Focused SMS for FP and SRH

Tanzania – EngageTB – TB Client Self Screening and Referral

Kenya - MNCH and OVC Application, Pay for Performance

Nigeria - MNCH Application, Mobile Conditional Cash Transfer

Haiti – Integrated CHW application, Stipends with mMoney

Tanzania – MNCH, FP, HIV and Client Feedback mobile money for maternal emergencies

Vietnam – NIH RCT – SMS for Continuing Medical Education

Pathfinder’s Approach

HEALTH SYSTEM STRENGTHENING AND mHEALTH

KENYA mHMTAANI (MOBILE HEALTH FOR OUR COMMUNITIES)• CORE group, Dimagi Award with support from USAID in 2012• Visa Funding in 2013 to introduce “Pay for Performance” (P4P)• MCH and orphans and vulnerable children mobile application

(on CommCare platform) for community health workers • End Game Goal is to create a comprehensive community level

care application (but not there – YET!) to promote integrated community service delivery (FP, MCH, HIV, WASH Etc) built off the Kenya Essential Package of Health– Leverage lessons learned from USAID Funded

Pathfinder/SSQH Haiti and Dimagi partnership and mHealth program for CHWs

mHMTAANI, CONT.

• Decentralized community health workforce, absorbing pay into government, currently CHWs paid by NGOs/APHIA+

• Community health worker (community) and community health extension worker (clinic) – improved supervision (tablets + phones)

• Clear need to connect community and facility – integrated systems strengthening focused on the community level

• What’s the motivation to use the phone? For the CHW and clients?

WHAT IS THE MOTIVATOR?

• Money (Yes…and?)• Professional motivation (learning, advancement, praise, etc)• Ability to move up in the org chart, better supervision?• Viewing performance compared to peers – self motivation?• Professional advancement – career ladder?• Need for sustainable investments – where and how?

We are starting with money in this project, but thinking about other drivers – any ideas?

DIGITAL DATA COLLECTION AND PAYMENT

• mPesa (mobile money) is our standard of payment/administration

• Phased out cash in 2010 – mandate from CFO• Since then, 622,053 people have been paid using mPesa• US $5,655,035.84 has been sent through mPesa• Around 3,300 CHWs paid monthly stipends using mPesa • Through this project, we are moving from operational use to

program use of mPesa payments and taking lessons to other countries (Nigeria, Tanzania, Haiti)

THE STATE OF THE PROJECT IN PATHFINDER KENYA

• 260+ CHWs using MCH and OVC CommCare app• Implementing in Kilifi, Coast Province Kenya – 6 Community Units

• Targets and Indicators negotiated with District MOH • P4P incentive model based on proxy indicators to maternal

and child/orphan health outcomes • LESSON LEARNED! Integrate Community level MOH reporting

forms to collect government indicators• Coordination with other partners also working on MCH for

CHWs with mobile solutions

PERFORMANCE METRICS

• Level 1: (submission qualifies base payment)– Submission of MOH514 (community level HMIS Register)

• Level 2: (any of the following qualifies additional incentive)– Referral completion (at least 15 referrals of any kind) – Referral or follow up of 5 new OVCs– Refer or follow up on at least 2 pregnant women for

deliveries.

PRELIMINARY RESULTS

• Since June 2014, mothers tracked increased by 26% and OVCs by 18%

• Current analysis of program data for presentation at the Global mHealth Forum (mHealth Summit in December)

CHALLENGES

• Government bureaucracy and approvals to implement pay for performance

• Staffing and expertise• Analytics and tools to help process data automatically• CommCare integration with mPesa – PPPs, APIs, acronym

soup!• Sustainability and integration into national plans and budgets• How can pay for performance be sustainable?• What are other performance motivators?

OPPORTUNITIES AND NEXT STEPS FOR PAY FOR PERFORMANCE (P4P)• Analyze project results and data for presentation at Global

mHealth Forum in December• Continued collaboration with Dimagi on other performance

improvement approaches (non-monetary) that can be delivered through mobile enhanced interventions

• Extend the model to other Pathfinder mHealth programs – P4P Launching in D-Tree/Pathfinder Tanzania Partnership

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For more information contact Marion McNabb - mmcnabb@pathfinder.org