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mHealth and Community Health Workers


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With a worldwide penetration rate of over 85%, the mobile phone has become one of the most transformative tools in human history. As mobile communication technologies become less expensive, faster, and more accessible, the ability of people, communities and institutions to share information and knowledge will continue to skyrocket. Specifically for Global Health, the use of mobile communication and network technologies for delivery of health care (mHealth) holds great promise for the future. In low resource settings, community health workers (CHWs) provide a backbone for the delivery of health care services. Often isolated and without significant formal education or training, CHWs can be seen as key connectors between their communities and the formal health care system. In the hands of CHWs, mHealth tools may facilitate effective task shifting; by expanding the pool of human resources, increasing the productivity of health systems, and lowering the cost of services. The reported experience with mHealth suggest a wide range of opportunities exist to improve ease, speed, completeness and accuracy of the work of CHWs. The outcomes associated with these sort of new capabilities can be expected to result in ongoing improvements in performance on key national health indicators. The presentation will examine the state of the art and science-- by describing a systematic review of the literature and citing examples in action -- and provide recommendations focused on the design and development of mHealth tools for use by CHWs to strengthen Global Health interventions.

Speaker Bio:
Dennis M. Israelski, M.D

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mHealth and Community Health Workers

  1. 1. Enhancing Community Health Dennis M. Israelski, MD President and CEO, InSTEDDWorkers Performance WithMobile Technology Innovative Support to from PEPfAR with support Emergencies Diseases and Disasters
  2. 2. Source: Wall Street, 20th Century Fox, Written by Stanley Weiser and Oliver Stone, Directed by Oliver Stone, Produced by Edward Pressman, 1987
  3. 3. source: Motorola, 1973
  4. 4. 4b Mobile phone subscriptions (billions) developing countries developed countries* 3b 2b 1b 2000 ‘01 ’02 ’03 ’04 ’05 ’06 ’07 ’08source: World Bank, 2011 *OECD members
  5. 5. Global Cell Phone Usage Cell Phones Per Person Over 1.20 .901 - 1.20 .601 - .900 .301 - 600 Under .300source: World Bank, 2011
  6. 6. 87% of the global population is a mobile phone user Cell Phones Per Person Over 1.20 .901 - 1.20 .601 - .900 .301 - 600 Under .300source: World Bank, 2011
  7. 7. 87% of the global population is a mobile phone user 4.5 billionsource: CIA World Fact book 20010-11 users in the developing world
  8. 8. A kid in Africa with a smartphone today has access to more information than the President of the United States had just 15 years ago. Ray Kurswell quote: kid in africa has more info than the pres 15 yrs agosource: Quote from Futurist, Ray Kurzweil, Time Magazine, March 26, 2012
  9. 9. “ This device has become part of the fabric of society, whether a teenage girl taking a Blackberry to bed with her, or a farmer in an African village trying to find out the latest crop prices. ”source: Quote from Ben Wood, mobile phone analysis at CCS Insight, 2010,
  10. 10. “ The mobile phone just may be the most prolific consumer device ” on the planet.source: Quote from Ben Wood, mobile phone analysis at CCS Insight, 2010,
  11. 11. <30 years
  12. 12. <20 yearssource: Nokia, 2007
  13. 13. small lightweight portable connected inexpensive simple convenient intuitive+ accessibleopportunity
  14. 14. 57 countries havesevere shortagesof health workers
  15. 15. 36 are in sub-Saharan Africa
  16. 16. Countries with a Critical Shortage of Health Service Providers (doctors, nurses and midwives) countries with critical shortage countries without critical shortagesource: WHO, Global Atlas of Health Workforce (
  17. 17. 53% of the population of Africa owns a mobile phonesource: World Bank, 2011
  18. 18. 53% 74% of the population of Asia owns a mobile phone of the population of Africa owns a mobile phonesource: World Bank, 2011
  19. 19. mHealth: at the intersection of mobile communication technologies and health + health issues mobile + service delivery communications mHealth + decision support technologies + supervision + moresource: USAID Community Health Worker Evidence Summit Concept Note, 2012
  20. 20. The Community Health Worker at the Intersection of Two Dynamic Systemsgraphic: Mobile Tech and Community Case Management , UNICEF & frog design
  21. 21. mHealth:the delivery of health care servicesvia mobile communication devices
  22. 22. Systematic Review of the Literature initial search strategy n = 5,868 duplicate citations identified & excluded n = 1,201 unique citations n = 4,667 mHealth exclusions based on title, abstract & author key words relevant mHealth n = 2,064 literature obtained n = 2,603 CHW exclusions based on title, abstract & key wordsrelevant CHW & mHealth n = 2,031 literature obtained n = 35 CHW & mHealth inclusions based on citations full text of potentially n=4relevant literature obtained n = 37 studies excused post full-text review literature included in n = 11 analysis n = 26 Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR
  23. 23. medical engineering mHealth research areas global publicdevelopment health databases Catalani, C et. al.
  24. 24. Systematic Review of the Literature Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR
  25. 25. Systematic Review of the Literature Catalani, C et. al. ( Manuscript Submitted) supported by HIPPP, PEPfAR
  26. 26. - errors- data loss- lack of real-time QA- lack of CHW supervision- lack of rapid response- travel expenses
  27. 27. africa asian=9 n=5 mHealth research locations south northamerica america n=2 n=1 Catalani, C et. al.
  28. 28. provide address decentralizedhealth issues services mHealth research use cases provision of professional medical support & services supervision Catalani, C et. al.
  29. 29. Colombia | multimedia mHealth technologiesA simulated experimental study in + significantly decreased errorsColombia used mobile multimedia + increased compliance with care protocolsdevices to facilitate point-of-care + combination of text, audio, images and video improve patient careclinical decisions among CHW. Florez-Arango JF, Iyengar MS, Dunn K, Zhang J. Performance factors of mobile rich media job aids for community health workers. Journal of the American Medical Informatics Association  : JAMIA. 2011 Mar 1;18(2):131-7.
  30. 30. Tanzania | CommCare maternal mHealth technologiesCommCare is a CHW focused automated + improved time managementquality improvement system operating + improved data reportingthrough mobile phones. + helpful decision support Svoronos T, Mjungu D, Dhadialla P, Luk R, Zue C. CommCare  : Automated Quality Improvement To Strengthen Community-Based Health The Need for Quality Improvement for CHWs. New York City: 2010.
  31. 31. + health + human systemresources productivity mHealth effective support for task shifting - costs - errors Catalani, C et. al.
  32. 32. + fewer errors+ less data loss+ real-time review of quality+ close CHW supervision+ rapid response capabilities+ cost effective
  33. 33. mHealth technologies Verboice is a customizable application thatempowers users to build their own interactive voiceresponse systems.
  34. 34. mHealth technologies Baby Monitor is anunconventional approach to service delivery along the birth continuum in remote locations by creating an interactive voice response application for mobile phones that is designed for mothers as end-users.
  35. 35. mHealth technologies Reporting Wheel is a non-electric device thatsimplified data reporting for the most remote workers, including the illiterate.
  36. 36. mHealth technologiesResource Mapping helpspeople to collaboratively track their work, resources and results geographically and through SMS.
  37. 37. mHealth technologies GeoChat is enables self- organizing group communications by allowing users to link the field, headquarters, and the local community in a real-time, interactive conversationvisualized on the surface of a map. GeoChat is a tool forgroup communications based on SMS, email, and Twitter.
  38. 38. mHealth technologies GeoChat is a flexible open source group communications technology that lets team members interact to maintain sharedgeospatial awareness of who is doing what where — over any device, on any platform, over any network.
  39. 39. mHealth technologies Nuntium is a set of services and clients that allow anyone to build SMS-based applicationswith uses that range from simple modem-based needs to countrywide deployments integrated with wireless operators.
  40. 40. mHealth technologies Nuntium is used every day in mission-critical applications includingministries of health or in crises such as in Haiti.
  41. 41. Research & Evaluation
  42. 42. project project A project H B small scaleproject independent project exploratory G non-collaborative C project project F project D E
  43. 43. project project A project H B PILOTITIS small scaleproject independent project exploratory G non-collaborative C project project F project D E
  44. 44. project project A project H B interoperabilityproject reusability project scalability G sustainability C project project F project D E
  45. 45. Recommendations for the Future + country leadership & ownership* + human-centered design + engaged end users + capacity development* + strategic reuse* + interoperability + open source accessibility* + coordinating, harmonizing & sharing* + research & evaluation* + implementation science agenda for M&E, operations research, economic assessment & impact evaluation *Greentree Principles
  46. 46. Innovative Support to Emergencies Diseases and
  47. 47. Enhancing Community HealthWorkers Performance WithMobile Technology Innovative Support to Emergencies Diseases and Disasters (manuscript in preparation)
  48. 48. Health Informatics Public Private Partnership Management TeamPaul Biondich, Regenstrief Institute Mike Gehron, OGACDennis Israelski, InSTEDD John Novak, USAIDChris Seebregts, Jembi, South Africa Xen Santas, CDC Chris Bailey, WHO* A Central OGAC Initiative *former member
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