11h05 jessica grameen

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  • MoTeCH is Mobile Technology for Community Health. It is a project which aims to use mobile phones to increase the quantity and quality of antenatal care in rural Ghana. It is being piloted in the Upper East Region, with intention to scale nationally if successful. MoTeCH is a partnership between Ghana Health Service, Grameen Foundation and Columbia University, using a grant from the Bill and Melinda Gates Foundation.
  • Despite the success of CHPS, like any other healthcare system, it has it’s challenges. These challenges stem from issues in the communities that we serve, as well as the CHPS system itself
  • For the CHPS nurses there are challenges in the reporting systems which rely on cumbersome paper forms, which take 4 - 6 days per month to complete, detracting from the time the nurses are spending with their patients. Information which nurses record in their registers does not flow back to the nurse in a way that is useful for reporting or service provision.
  • MoTeCH aims to address some of the community-based issues by offering a mobile health information service for pregnant women, their husbands and families. The woman’s pregnancy is registered in the MoTeCH system along with her Estimated Due Date. MoTeCH then sends the patient’s mobile phone a message each week, containing information specific to that particular week of pregnancy. The information aims to give practical advice on how to deal with some of the challenges of pregnancy; physical, emotional and financial. It provides reminders about what healthcare women should be receiving, and gives users tips about where to deliver, how to breastfeed, how to care for the baby, and explains local myths. It is intended that this service encourages better health seeking behavior, leading to improved health outcomes.The service has been developed in collaboration with GHS policy makers and Upper East management, midwives, pregnant women and other community members. The content aims to address user’s knowledge gaps and support the work of the CHPS workers. Early and constant consultation with real potential users has helped MoTeCH to ensure they are creating a useful service.
  • MoTeCH aims to address some of the community-based issues by offering a mobile health information service for pregnant women, their husbands and families. The woman’s pregnancy is registered in the MoTeCH system along with her Estimated Due Date. MoTeCH then sends the patient’s mobile phone a message each week, containing information specific to that particular week of pregnancy. The information aims to give practical advice on how to deal with some of the challenges of pregnancy; physical, emotional and financial. It provides reminders about what healthcare women should be receiving, and gives users tips about where to deliver, how to breastfeed, how to care for the baby, and explains local myths. It is intended that this service encourages better health seeking behavior, leading to improved health outcomes.The service has been developed in collaboration with GHS policy makers and Upper East management, midwives, pregnant women and other community members. The content aims to address user’s knowledge gaps and support the work of the CHPS workers. Early and constant consultation with real potential users has helped MoTeCH to ensure they are creating a useful service.
  • MoTeCH is enabling nurses to enter some of the information on the simplified registers on to a mobile phone. Doing this enables us to automatically generate some of the nurses’ monthly reporting. It is hoped that this will reduce the amount of time that nurses spend on administrative tasks. By capturing patient data on the mobile phone MoTeCH is also able to send the nurses reminders about patients who are due or overdue for care. For instance we can send nurses’ lists of all antenatal defaulters. It is hoped that this will make it easier for nurses to follow up on patients, resulting in better coverage of care. The phones are simple, low cost handsets which will be provided by MoTeCH. The simplified registers and mobile phone service together aims to reduce the burden of reporting and patient tracking for the nurse – reducing the many different registers that are currently in existence….
  • MoTeCH is enabling nurses to enter some of the information on the simplified registers on to a mobile phone. Doing this enables us to automatically generate some of the nurses’ monthly reporting. It is hoped that this will reduce the amount of time that nurses spend on administrative tasks. By capturing patient data on the mobile phone MoTeCH is also able to send the nurses reminders about patients who are due or overdue for care. For instance we can send nurses’ lists of all antenatal defaulters. It is hoped that this will make it easier for nurses to follow up on patients, resulting in better coverage of care. The phones are simple, low cost handsets which will be provided by MoTeCH. The simplified registers and mobile phone service together aims to reduce the burden of reporting and patient tracking for the nurse – reducing the many different registers that are currently in existence….
  • MoTeCH will be launched in 2 districts in the Upper East Region in June 2010. The effectiveness of the program will be evaluated on three counts. A Time Use Study will be conducted in order to assess if MoTeCH is actually reducing the nurses’ administrative burdenThe quality and use of aggregated data will be analyzed to determine whether MoTeCH is increasing data accuracyPopulation-based surveys will detect MoTeCH’s impact on coverage of essential interventions, such as: - increased ANC 4+ attendance - increased skilled births - increased postnatal care for both mother and baby - improved vaccination coverage
  • MoTeCH will be launched in 2 districts in the Upper East Region in June 2010. The effectiveness of the program will be evaluated on three counts. A Time Use Study will be conducted in order to assess if MoTeCH is actually reducing the nurses’ administrative burdenThe quality and use of aggregated data will be analyzed to determine whether MoTeCH is increasing data accuracyPopulation-based surveys will detect MoTeCH’s impact on coverage of essential interventions, such as: - increased ANC 4+ attendance - increased skilled births - increased postnatal care for both mother and baby - improved vaccination coverage
  • MoTeCH will be launched in 2 districts in the Upper East Region in June 2010. The effectiveness of the program will be evaluated on three counts. A Time Use Study will be conducted in order to assess if MoTeCH is actually reducing the nurses’ administrative burdenThe quality and use of aggregated data will be analyzed to determine whether MoTeCH is increasing data accuracyPopulation-based surveys will detect MoTeCH’s impact on coverage of essential interventions, such as: - increased ANC 4+ attendance - increased skilled births - increased postnatal care for both mother and baby - improved vaccination coverage
  • 11h05 jessica grameen

    1. 1. Mobile Technology for Community Health<br />Aim: Use mobile phones to increase the quantity and quality of antenatal and postnatal care in Ghana.<br />Funded by Bill & Melinda Gates Foundation<br />
    2. 2. Maternal & Child Healthcare Challenges<br />In Communities<br />Myths & Traditional Practices<br /><ul><li>The Evil Eye
    3. 3. Hot compresses used to deliberately mold the baby’s skull to give them a ‘special’ shape
    4. 4. Colostrum is dirty
    5. 5. Eating eggs or meat during pregnancy will make the child a thief
    6. 6. Giving the “welcome drink” (water) to introduce baby to the world
    7. 7. Eating clay helps with morning sickness</li></ul>Knowledge Gaps<br /><ul><li>Dietary requirements
    8. 8. Health-seeking and sanitation practices for pregnant women and children</li></li></ul><li>Maternal & Child Healthcare Challenges<br />ForNurses<br /><ul><li>Volume of paper: up to 20 different patient registers for each facility
    9. 9. Onerous data reporting: nurses spend 4-6 days per month aggregating data
    10. 10. Little information flows back to the nurse: difficult to identify defaulters or high risk patients
    11. 11. Nurse attitudes sometimes discourage clients from seeking health information</li></li></ul><li>Application 1. MOTECH Mobile Midwife<br /><ul><li>Provides weekly, relevant, actionable and fun pregnancy care information through SMS or voice messages
    12. 12. Available in local languages
    13. 13. Engages both parents
    14. 14. Sends messages to remind clients when care is due or overdue
    15. 15. Encourages health seeking behavior
    16. 16. Can be accessed by those without a phone by flashing / calling a toll free number</li></li></ul><li>Application 1: Content Development<br /><ul><li>Consultation with Ghana Health Service stakeholders at national, regional, district and facility levels
    17. 17. Consultation with international and local NGOs: UNICEF, WHO, Afrikids
    18. 18. Consultation with pregnant women, mothers, fathers, mothers-in-law, village chiefs
    19. 19. Field testing of messages to ascertain appropriate messaging, voice, accent, dialect</li></ul>Above: Content creation workshop<br />
    20. 20. Application 2: Nurses’ Data Management Tool<br /><ul><li>Rural health clinics given $40 phones.
    21. 21. Nurses record patient encounters using MOTECH app. More efficient patient data collection and aggregation.
    22. 22. In-built data validation ensures high data integrity. Increases data accuracy for decision-makers.
    23. 23. Nurses upload data via GPRS (approx 5 GHC per month/facility).</li></li></ul><li>Application 2: Functionality Enabled<br /><ul><li>Medical records system on back end to maintain patient data for accurate District Health Information System reports and operational reports.
    24. 24. Monthly reports automatically generated for GHS Health Information Management System.
    25. 25. Reminders sent to nurses when care is overdue / deliveries happen so they can easily identify defaulters.</li></li></ul><li>How is MOTECH doing?<br />Pilot and Replication<br />Project piloted in one district in Upper East Region for 1 year. About to replicate in second district.<br />Social Impact Assessment <br />Columbia University conducting randomized control trial to determine the health impacts of MOTECH.<br />Reporting<br />Of 11 CHPS, involved in the pilot, 9 are ready to switch to MOTECH-only generated reports for antenatal, child welfare and outpatient records. <br />
    26. 26. Mobile Midwife Pilot: Huge Demand<br /><ul><li>70% of all estimated pregnant women in current catchment area enrolled using only below the line marketing in health facilities. No other marketing conducted.
    27. 27. Extremely high demand among non-pregnant women & men. 150% as many of these registrants as pregnant women.</li></li></ul><li>Mobile Midwife: Client Feedback<br />“I liked the messages especially on the nutrition as I was able to share with my husband so he could hear it and now I am allowed to get these things such as beans, vegetables, small ground fish for the soup and sometimes meat”<br />“Now with MOTECH I don’t feel alone during my pregnancy, it makes me feel that there are people that care for me and are concerned about me while I am pregnant. ”<br />“MOTECH helps a lot with the preparation for birth and I felt like I had a good idea of what would happen and how to prepare practically and financially. I went to Paga Health facility and had a safe delivery. ”<br />
    28. 28. MOTECH Nurse Feedback<br />“I used to get two or three, but last month I had ten deliveries [at the facility] because the clients get the messages and they come. For postnatal they come. Even if they deliver at home they get the messages [from MOTECH] which make them come for postnatal.”<br />“MOTECH has been good because it helps us with our reports. Sometimes our tallying gives us incorrect data. With the phones we know the data that we get at the end of the month is correct. <br />CHPS Nurse<br />CHPS Nurse<br />Midwife<br />“With MOTECH we get our clients easily because we get messages listing our defaulters. Some of them also because MOTECH sends them messages telling them to come. We get people coming here telling us that MOTECH has told them to come to the facility.”<br />“When we see our clients for a child welfare clinic we gather them in a big group to educate them but often these meetings are big and noisy so not everyone picks up what you've said. That's why MOTECH is good because it provides 1:1 info to patients along with personalized reminder messages.”<br />CHPS Nurse<br />
    29. 29. Implementation Successes<br /><ul><li>Failure!
    30. 30. Exposing other binding constraints in health delivery system
    31. 31. Maintenance of internal organizational learnings
    32. 32. Demand – building open source platform.
    33. 33. Partnerships: government, telco, service delivery.
    34. 34. Listening to client needs – highly customizable (language, time to receive message), flashing, accessibility for those without own phones.
    35. 35. Biggest upcoming challenge: development of business model, involving yet deeper partnerships and collaborations with telcos and tapping into a different demographic.</li>

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