1. mUbuzima/mHealth Dr Richard Gakuba National e-Health Coordinator Rwanda

2. Dispersed population and hilly terrain make access to health facilities difficult

3. Governance E-Health Strategic Plan E-Health Unit in MoH E-Health steering committee MoH institutions Other Government stakeholders MINICT/RDB-IT Local Government NID Development partners

4. E-Health systems

5. mHealth in Rwanda First mHealth application: 2004 HIV/AIDS monitoring system (TRACnet) Used by over 400 facilities that offer HIV services (over 80% of total facilities) Community Health information system (SISCOM) 2010 mUbuzima and RapidSMS In Pipeline: health insurance authentication

6. Community based applications mUbuzima MDG indicator monthly reporting Localizing MDGs mEducation RapidSMS Maternal Health tracking Pregnancy Risk events Delivery Post natal mEducation

7. Sustainability challenges CHWs organization Not full time, have to take care of their families Cost of handsets Cost for 45k handsets Lost phones, phone lifespan Communication cost Cost of calls/SMS Technology: eg: SMS vs IVR Negotiation with telecoms: 84% cost reduction for voice and SMS Infrastructure Electricity Software development and support In-country development/support MoH programmers and Local company support

8. Sustainability challenges Phone use penetration Per capita affordability Network footprint Cost effectiveness/Impact on health care Proof that outcome is worth the health outcomes How many lives per $ is cost effective? mHealth as part of an Enterprise (Health) Architecture mHealth applications not stand alones Interoperability and standards with other applications Ownership Part of a Government program; planning, funding Should make CHW’s work easier

9. SISCom data used for PBF payments

10. SIScom database and eHealth Enterprise Architecture Selected eHealth Registries Facility Registry National Indicator data warehouse Provider Registry Interoperability layer SISCom Health facility PBF EMR HMIS RapidSMS mUbuzima Some of the related eHealth Applications

11. Scalability

12. Lessons learned The enormous scale of the roll-out of the system requires careful planning and considerable resources that were not initially anticipated Substantial savings can be made by combining training schedules with the delivery of other content (data management + PBF, MCH monitoring, etc..), rather than doing them all in parallel. Opportunity for public-private partnership with 45,000 new cell phone users. The MOH was able to negotiate deep discounts for SMS and voice messaging with the mobile-phone operators (bringing costs of air time down 82% from $600k to $116k). By combining PBF incentives within the SISCom , reporting compliance risen quickly to 97%

13. Thank you/Merci/Murakoze