Bobby jefferson unite for sight apri 21 2pm l 2012

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global health innovation conference PMTCT mobile mhealth

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Bobby jefferson unite for sight apri 21 2pm l 2012

  1. 1. mHealth: Scale Up of Mobile in PMTCT Program technology isn’t the barrier to scale up• 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 1• Tanzania Orphans and Most Vulnerable Children (MVC) MIS
  2. 2. Outline• Description – Low Resource Environment• Approach – Low cost, appropriate technology• Solutions• Sharing Scale Up Lessons
  3. 3. Environment 423 ART Hospital Facilities 770 PMTCT - Antenatal Care (ANC)Low ResourceRural, remote, mission hospitals “serving poorest of poor” and Ministry ofHealth (MOH) facilities • Intermittent power, • Lack of trained IT staff, • Lack internet, • Sparse mobile coverage
  4. 4. Photo credits: Brian and Angie Savage
  5. 5. Low Resource EnvironmentNurses, Clinicians, Adherence Counselors, need health data, M&Eprogram 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
  6. 6. Off Grid Technology: Address Approach Intermittent Power How to Give Presentations or IT Training in Rural Clinics When Power or Generator is Offline ?to address power
  7. 7. Off Grid Technology: Address ApproachIntermittent Power Battery Operated Projector to address power
  8. 8. Off Grid Technology: Address ApproachIntermittent Power
  9. 9. Off Grid Technology: Address ApproachIntermittent Power
  10. 10. Off Grid Technology: Address ApproachIntermittent Power
  11. 11. Off Grid Technology: Address Approach Intermittent Power How to Print In Rural Clinic When Power or Generator is Offline ?to address power
  12. 12. Off Grid Technology: Address Approach Intermittent PowerZINK – Zero InkPortal Printers*use to QR code forPatient IDto address power
  13. 13. TechnologyApproach
  14. 14. Off Grid Technology: Address Approach Intermittent Power How to Power Netbook Computer in Rural Clinic When Power or Generator is Offline ?to address power
  15. 15. TechnologyApproach 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
  16. 16. 18
  17. 17. Photo credits: Brian and Angie Savage
  18. 18. Distance from Time spent toFacility Name District Facility to District Deliver PMTCT Bus Fare (Tsh) Tanzania (KM) Report (Hrs) MWANZA Region NYAMAGANA DISTRICTMwamashimba Health Centre Kwimba 50 1.30hrs 10000Malya Health Centre Kwimba 25 1hr 5000Kikubiji Dispensary Kwimba 102 4hrs 20000Kiliwi Dispensary Kwimba 100 4hrs 20000 KWIMBA DISTRICTNyakalilo Health Center Sengerema 46 2 HRS 8000Mwangika Health Centre Sengerema 98 4 HRS 10000Sengerema Health Centre Sengerema 10 20MIN 3000 SENGEREMA DISTRICTKharumwa Health Centre Geita 115 3HRS 20000Nzera Health Centre Geita 48 2HRS 8000Katoro Health Centre Geita 50 45MIN 6000Nkome Dispensary Geita 80 2HRS 6000Nyanghwale Health Center Geita 85 2HRS 7000Kasamwa Health Centre Geita 25 30MIN 4000Bukori Health Centre Geita 60 1:30HRS 6000
  19. 19. Tanzania Environment • staff Gender 89% female • 100% posses mobile phone • 71% used SMS on mobile phone • Predominately Swahili speakers and readers
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  21. 21. IQSMS – Free software  Report formatting  Data Type Validation  Data validation  Report Duplication CheckPMTCT MONTHLY REPORTJan-10 Paper Report SMSPMTCT Antenatal Clinic (ANC) Monthly SummaryForm LPTF 1All women attending ANC for thegiven report periodANC 01. New ANC clients this month 1188ANC 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 574ANC 07. Number of partners tested for HIV 16ANC 08. Tested HIV-Positive 4
  22. 22. IQSMS Reporting• IQSMS software, PMTCT Report Immediate Data Quality Alert Pass or Fail
  23. 23. PMTCT ReportData Quality Checks District Office
  24. 24. Reports and Analytics
  25. 25. Query Database Using SMS From Mobile PhoneBugando Clinic – Site 1How many new antenatal clients this month?How many were tested for HIV?How many tested Positive ?SMS Query: R1, M1, Site 1
  26. 26. Query Database Using SMS From Mobile PhoneSMS Query: 4679, 2561, 181
  27. 27. NUMBER OF CLIENT HAD HIV TEST AT ANC
  28. 28. BenefitsSubmission 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 trainingLow 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, levelsHealth facilities interested to know how their statistics compare with others in their districtsDistrict officers want to receive aggregate report via SMS, email andsend queries to IQSMS database
  29. 29. Distance from Time spent toFacility Name District Facility to District Deliver PMTCT Bus Fare (Tsh) Tanzania (KM) Report (Hrs) MWANZA Region NYAMAGANA DISTRICT 15 Min AvgMwamashimba 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  Nyanghwale Health Center Geita 85  
  30. 30. Number of PMTCT Sites Reporting Using Mobile IQSMS# ofSites # of Months
  31. 31. technology isn’t the barrier to scale up# ofSites # of Months
  32. 32. 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;
  33. 33. 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)
  34. 34.  Instruction on Any problems with Swahili critical to small buttons on the using IQSMS phone?  Response Freq % Response Freq %  No 6 17.14 No 30 85.71  Yes 29 82.86 Yes 5 14.29  Total 35 100 Total 35 100 • Reasons For Not Sending Monthly Report – Majority said they don’t understand English language – Need message understandable in Swahili language
  35. 35. IQSMS Instructions in Swahili
  36. 36.  Barriers to implementing • Anything that can be mobile phone reporting for improved on report submitting all four reports submission to make each month report to be on time  Mobile Network Problem/failure • Response Freq %  Server don’t respond on time • No 14 40.00  Report type is hard • Yes 21 60.00  It have been found that free • Total 35 100 Airtime is critical for scale up
  37. 37. technology isn’t the barrier to scale up# ofSites # of Months
  38. 38. 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 fordata quality audit (DQA) toverify the reported valuesagainst the register
  39. 39. 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
  40. 40. M&E Electronic Reporting System Solar Power Cell phones PDA device Ms Access Database Excel PMTCT MONTHLY REPORT PMTCT Antenatal Clinic (ANC) MonthlyExcel Only Summary Form Web Internet 118 Desktop ANC 01. New ANC clients this month 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
  41. 41. Thank youwe predict the trends that will affect acountry’s stability and growth. we seeconnections between disparate data pointsthat others miss— allowing us to uncoverthe real barriers to well-being and discoverinnovative solutions for a better world.

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