The Millennium Global Village-Net: Status and Lessons Learned Andrew S. Kanter, MD MPH a,b,c ; Jonathan Dick d ; Frederick Bukachi, MD PhD a,b,f ; Edward Johnson a,e ; Colin Borland b ; Schadrack Dusabe b ; James Wariero b , Sonia Ehrlich Sachs b a International Partnership for Health, NFP, Chicago, IL b Millennium Villages Project, Earth Institute, Columbia University, NY c Department of Biomedical Informatics, Columbia University d University of Chicago Medical School e Wolfson Collage, Cambridge University f Dept. of Physiology, University of Nairobi

Millennium Villages Project Partnership between Earth Institute at Columbia University, UNDP, Millennium Promise and national governments. Operates in 10 countries in 13 agro-ecological zones Integrated development at $120 pc/y Covers about 500,000 people Each cluster of villages has around 40,000 people and 3-6 clinics

Partnership between Earth Institute at Columbia University, UNDP, Millennium Promise and national governments.

Operates in 10 countries in 13 agro-ecological zones

Integrated development at $120 pc/y

Covers about 500,000 people

Each cluster of villages has around 40,000 people and 3-6 clinics

Millennium Villages Koraro, Ethiopia Bonsaaso, Ghana Dertu, Kenya Sauri, Kenya Kokoyah, Liberia Mwandama, Malawi Tiby, Mali Timbuktu, Mali Ikaram, Nigeria Pampaida, Nigeria Mayange, Rwanda Potou, Senegal Mbola, Tanzania Ruhiira, Uganda

Koraro, Ethiopia

Bonsaaso, Ghana

Dertu, Kenya

Sauri, Kenya

Kokoyah, Liberia

Mwandama, Malawi

Tiby, Mali

Timbuktu, Mali

Ikaram, Nigeria

Pampaida, Nigeria

Mayange, Rwanda

Potou, Senegal

Mbola, Tanzania

Ruhiira, Uganda

Vision: MGV-Net Information System All MVP sites Common Dictionary Integrated Locally Automate Reporting De-identified Data warehouse Connect CHWs/ Community mHealth Increase IT capacity

All MVP sites

Common Dictionary

Integrated Locally

Automate Reporting

De-identified Data warehouse

Connect CHWs/ Community mHealth

Increase IT capacity

MGV-Net Information System

Comparable and Timely Data Month Year Cases Treated Smears Neg Smears Neg Smears Tx'd (%) 11 2008 308 408 481 455 292 (64.1758) 12 2008 248 251 428 393 176 (44.7837) 1 2009 644 789 514 457 183 (40.0438) 2 2009 541 561 816 728 142 (19.5055) 3 2009 292 343 443 406 79 (19.4581) 11 2008 115 159 175 168 118 (70.2381) 12 2008 97 111 152 136 77 (56.6176) 1 2009 99 108 142 123 56 (45.5285) 2 2009 64 68 161 143 36 (25.1748) 3 2009 43 38 123 115 26 (22.6087)

Status of Implementations (Sauri) Single Laptop as server, 1 additional laptop for data entry As of end of March, 2009: 7,097 patients 11,833 encounters Forms (fields entered/form): Adult (~17), Peds (~12), Antenatal (~14)

Single Laptop as server, 1 additional laptop for data entry

As of end of March, 2009:

7,097 patients

11,833 encounters

Forms (fields entered/form):

Adult (~17), Peds (~12), Antenatal (~14)

Status of Implementations (Mayange) WAN with 1 server and 6 workstations As of end of February, 2009: 4,257 patients 5,026 encounters Mostly adults entered New peds forms required by gov’t No pharmacy yet

WAN with 1 server and 6 workstations

As of end of February, 2009:

4,257 patients

5,026 encounters

Mostly adults entered

New peds forms required by gov’t

No pharmacy yet

Status of Implementations (Others) Bonsasso, Ghana; Tiby, Mali and Potou, Senegal have OpenMRS on a server Bonsasso doing vital statistics entry Plan full encounter form rollout to Bonsasso, Nigeria and Mbola (Tanzania) this year

Bonsasso, Ghana; Tiby, Mali and Potou, Senegal have OpenMRS on a server

Bonsasso doing vital statistics entry

Plan full encounter form rollout to Bonsasso, Nigeria and Mbola (Tanzania) this year

Terminology Service Bureau

Status of Terminology Service Bureau Centralized concept dictionary for all sites, with translations of concepts and User Interface messages Crossmaps to SNOMED CT, RxNORM and ICD-10. Runs on PHP and needs conversion to OpenMRS module Needs subsetting

Centralized concept dictionary for all sites, with translations of concepts and User Interface messages

Crossmaps to SNOMED CT, RxNORM and ICD-10.

Runs on PHP and needs conversion to OpenMRS module

Needs subsetting

Status of Implementation in Ruhiira WAN across cluster of 6 clinics including one hospital. As of April 30, 2009: 20,000 patients 29,783 encounters Typical Month/Clinic (# of encounters): Adults (736), Peds (570), Antenatal (105)

WAN across cluster of 6 clinics including one hospital.

As of April 30, 2009:

20,000 patients

29,783 encounters

Typical Month/Clinic (# of encounters):

Adults (736), Peds (570), Antenatal (105)

Challenges and Lessons Learned Human Capacity Clinician Engagement Reliable electricity Computers Connectivity Gov’t Policies

Human Capacity

Clinician Engagement

Reliable electricity

Computers

Connectivity

Gov’t Policies

Way Forward IDRC helping to fund eHealth Specialists and additional data entry clerks More training Better coordination with infrastructure rollout and management of power Coordinate with HMN and others to define policies which support eHealth

IDRC helping to fund eHealth Specialists and additional data entry clerks

More training

Better coordination with infrastructure rollout and management of power

Coordinate with HMN and others to define policies which support eHealth