Reaching Beyond the Grid: K4Health Malawi Demonstration Project CORE Group Presentation by Liz McLean, MSH May 2012
K4Health MalawiChallenge How can we support Community Based Distribution Agents to deliver effective FP/RH services at the community level though they are in remote locations, receive limited training and have limited access to resources available at the district and national level?
K4Health MalawiSMS Goal Goal: Increase CHW’s access to FP/RH information through mobile telephone networking using FrontlineSMS in Salima and Nkohtakota Districts Desired Result: Timely and accurate Family Planning and Reproductive Health services provided to men and women in hard to reach areas, reducing incidences of maternal and neonatal mortality
K4Health MalawiKey Interventions Formation of a national Knowledge Management Taskforce to manage and disseminate technical information on FP/RH and HIV/AIDS. Establishment of two District Learning Centers (DLCs) at hospitals in Nkhotakota and Salima to support information flows from and to the national, district, and community levels. Creation of an SMS-based mobile phone network to improve communication and information sharing among community health workers.
K4Health MalawiProject Timeline and M&E Tools LDP for KM Final LDP Launch (Feb) Workshop Formal Dissemination Mid Term (Dec) Capacity Some project Workshop & KM Toolkit Survey (Nov) Taskforce Building to funding ends Development MOH established (April) (June ) (December) (April) LDP Coaching 2009 2010 2011 Support to mHealth End Line MOHNeeds Baseline mHealth RH Toolkits Scale up (400 Assessment & sustainedAssessment Net launch published additional Net Mapping (July-Dec)(June-Sept) Mapping (June) (Aug) phones) (Feb) (2) (May) (March)
K4Health MalawiDesign of the mHealth projectResources: $25 mobile phones and $7 solarchargers for 663 CHWsPartnership: Medic Mobile (FrontlineSMS);MOH; BASICS; and other SMS projectsSMS system: • SMS alert system (i.e. notification of community vaccination dates, trainings, etc) • Peer-to-peer SMS network (ongoing support for CHWs) • On-demand automated FP/RH info and tips (immediate info on dosages or other automated responses to FAQ)
K4Health MalawimHealth Project Step 1: Client/CHW has a question In a remote area, a Community Health Worker (CHW) or client has a question. Step 5: CHW takes action The CHW can now make a more informed decision and provide case specific guidance to clients. Step 2: CHW sends Step 4: CHW receives SMS System question via SMS answer via SMS Average time required to The CHW sends a SMS to The CHW receives an answer to their contact and receive feedback the HUB at district hospital, question via SMS from HUB, District from the person providing using a direct line or key Coordinator, or another CHW. technical support: word messaging, or to other CHWs in district. 9 minutes HUB Step 3: District responds District Coordinators/Supervisors receive the SMS message and respond at the HUB, from their personal phones if key word messaging was used, or another CHW responds directly.
K4Health MalawiResults• Faster feedback from supervisors; with the phones the average time to receive feedback was 9 minutes as opposed to over 1 day• Improved reporting and communication as the CHWs were able to submit reports over their phones and talk with their supervisors immediately• Cheaper access to information as SMS only cost 11 Kwacha (MK) whereas the same information would have cost 464 MK if the CHW needed public transportation to discuss with a technical expert• More reliable clinical information as CHWs could connect directly with technical experts at the District Hospitals
K4Health MalawiResults• Increased CHW self-confidence and client trust as the CHWs were able to quickly secure the technical information they needed• Improved detection and prevention of stock- outs as the SMS allowed for constant updating• More efficient referrals as CHWs could check to see if a service was available before referring a patient• Widened service coverage as the CHWs were able to provide faster services, allowing them more time to reach new clients• Prompt responses to outbreaks; the average time went from 523 minutes to 3 minutes
K4Health MalawiJune 2011 National Level MapHIV Testing InformationFamily Planning Information
K4Health MalawiWhy Net-Mapping to support our M&E? Satisfies both research interest and immediate project management needs Is low-tech, low-cost, intuitive, and inter-culturally applicable Makes implicit knowledge explicit Is flexible for use in different contexts By visualizing the network in which we were working, we could analyze, improve, and influence that network
K4Health MalawiWhat is Net-Mapping and how does it work?It’s a 5 step process:Step 1: Identify a core question: Whoinfluences X in a certain context?Step 2: Name stakeholders: Ask participantsto identify all the stakeholders involved intheir network.Step 3: Generate the links: Ask them to drawlines to reflect the relationships they have withone another.Step 4: Determine influence: How influentialis each actor?Step 5: Discuss and validate with participants
K4Health Malawi Core Question: What are the critical information flows for Malawi in improving healthcare for HIV/AIDS and Reproductive Health?Links:- Who provides technical information on HIV testing?- Who provides technical information on family planning?
K4Health MalawiBefore and After Map Comparisons at District Level Salima District Map in 2010
K4Health MalawiBefore and After Map Comparisons at District Level Salima District Map in 2011
K4Health MalawiEvaluation Activities: Social Network AnalysisSalima 2011 mobile phone impacton communication
K4Health MalawiEvaluation Activities: Social Network Analysis ‘’At first it was taking usSalima 2011 mobile phone impact weeks without having theon communication supplies whenever we had stock outs, but with the coming in of this project we are able to get all the supplies that we want in time, because now it’s just a matter of sending an SMS to the supervisor.” CBDA in Nkhotakota