Futures Group eHealth briefing Feb 2012


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Futures Group eHealth briefing Feb 2012

  1. 1. Informational BriefingFutures Group eHealth and mHealth
  2. 2. Implementing eHealth and mHealth for Low Resource CommunitiesBobby Jefferson, Senior Health Informatics Advisor, Futures GroupManage 36 Programmers India (10) , South Africa (10) , Kenya (10), Tanzania (2), Nigeria (1), Guatemala (1) , Uganda (2)• U.S. Government President AIDS Relief Program $15 Billion – 10 Countries HIV, Prevention Mother to Child Transmission, TB, OVC• Principal Investigator– National Health Informatics System (HMIS) Kenya Datawarehouse , National Electronic Medical Records 6,000 hospitals• Lead IT Project Manager- Community Level Orphans and Vulnerable Children (OVC) electronic data system (World Vision, UNICEF, CRS, Africare) – Zambia, Tanzania• Health IT Advisor - 5 Central Asia Republics (CAR) Consortium for AIDS Strategic Information in Central Asia (CASICA)• Kazakhstan, Kyrgyz Republic, Tajikistan,• Turkmenistan, Uzbekistan
  3. 3. Staff Profile 502 Staff 30+ countries Multi-disciplinary Majority doctoral and masters-level 3
  4. 4. CHSS Geographic Focus Europe & Eurasia Georgia* Ukraine Asia and the Africa: Middle East: Kenya AfghanistanLatin America and Lesotho* China*the Caribbean: Mozambique IndiaGuatemala Nigeria Pakistan*Guyana RwandaHaiti TanzaniaHonduras Sierra Leone South Africa Swaziland Uganda Zambia Zimbabwe* 4
  5. 5. Informatics Solutions• IT Database related to Poverty Reduction – Social Cash Transfer – Household base assistance, community empowerment,• Mobile Surveys• Monitoring and Evaluation system• PPP• Capacity Building, Knowledge Transfer, – Site Capacity Assessment (SCA) tool
  6. 6. 6
  7. 7. Low Resource EnvironmentWe are working across 15 Countries, 1,033 Hospital Facilities + Satellites Clinics ,Antenatal Care – 535 PMTCT sitesRural, remote, hospitals “serving poorest of poor” and Ministry of Health (MOH)facilities, Rural health facilities serving BPL, marginalized and most vulnerablepopulations • Intermittent power, • Lack IT staff, • Lack internet, • Sparse mobile coverage• Lack of referrals, or linkage between HIV, PMTCT, TB,• Cost effectiveness and sustainability -- no funds for proprietary licenses, or yearly maintenance fees
  8. 8. Results# of Facilities • No Internet • Sparse Mobile Coverage • Intermittent Power • Mobiles, SMS • Smartphones • Internet Rural, Remote City Online Mobile Offline, Disconnected Solutions Solutions Solutions
  9. 9. Low Resource EnvironmentNurses, Clinicians, Adherence Counselors, need health data, M&E programdata 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
  10. 10. Approach Use of freely available, reusable, tools, “coded in country” Creative commons approachReusable software and technology across countries and programsOffline Solutions, Disconnected modelLocal programmers, all IT staff in country (India, Kenya, South Africa) - Offer Programmer training SQL, Agile process, Virus RemediationLow costs, Inexpensive $200-$350 Netbooks , Solar netbooksSolar mobile phones, SMS instead of Smartphones-
  11. 11. Naveen Jayanta Piyush Sharma Sanjay . Das: Khanna Rana Ajay Sharma Rajketu Santosh , Singh GhandiArchana Mahawar Deepika Sain, Kanchan Verma Meetu Rahul Futures IT Team in India
  12. 12. Collaborators and Users Users Intra Health International ICAP Columbia University 44 sitesWorld Vision Intra Health International 17 sitesClinton Foundation Elizabeth Glaser EGPAF 16 sitesColumbia University Catholic Relief Services - 32 Family Health Inter FHI 45 sitesUNICEF Pathfinder International Catholic Relief Services 13 sitesDFID Gertrude Children Hospital DOD Walter Reed - 28 Mount Kenya University MOH Kenya Sites Mennonite Christian Charities AIDSRElief 35 sitesMinistry of Health AIDSReliefMinistry of Education John Snow International Rakai Health Services Vaccine Research PMTCT , ANC sites 535 sites Elizabeth Glaser EGPAF
  13. 13. Health IT Solutions Collectively referred to as IQSolutions 1. Electronic medical records 1. IQCare 2. Independent Technical Evaluations Performed WHO, USAID, CDC Atlanta, CDC in-country, Ministry of Health 2. Mobile Phone solution (IQSMS technology) 3. Visual Dashboards 4. Monitoring & Evaluation Electronic reporting•
  14. 14. Clinicians able to review individual patient histories*Clinicians review patient histories, prescribed drugs, ordered tests and results, and progress on care and treatment during the exam
  15. 15. demohttp:// Username: user1 Password: 1 Facility/Satellite: 001-01-01-Demo Site
  16. 16. Mobile Phone Reporting by Remote Workers
  17. 17. IQSMS PMTCT ReportsPMTCT Currently consists of 4 types of monthly reports1. PMTCT Antenatal Clinic (ANC) Monthly Summary Form2. PMTCT Care Register Monthly Summary Form3. PMTCT Maternity (L&D) Monthly Summary Form4. PMTCT Mother - Child followup SummarForm
  18. 18. PMTCT Report Data Quality ChecksMust Pass All Data Quality Rules, District Office Monthly and Quarterly Reports
  20. 20. M&E Electronic Reporting System Solar Power Cell phonesOrphans Vulnerable Children PDA device(OVC), Most At RiskPopulation (MARPS),Maternal Child Health (MNH) Ms Access Database Excel PMTCT MONTHLY REPORT PMTCT Antenatal Clinic (ANC) Monthly Excel 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
  21. 21. UNICEF Social Cash Transfer Application Futures Group International
  22. 22. STEPS OVC• STEPS OVC = Sustainability Through Economic Strengthening, Prevention and Support for Orphans and Vulnerable Children• Program provides – Support for HIV prevention and behavior change initiatives – Reducing HIV transmission – Support for OVC, at-risk youth and adults, and other vulnerable populations 28
  23. 23. STEPS OVC Login 30
  24. 24. STEPS OVC Beneficiary Search 31
  25. 25. STEPS OVC Beneficiary - OVC 32
  26. 26. STEPS OVC Reports 33
  27. 27. ICT for Development – Best PC Security Practices
  28. 28. District Health Training - MobilePhone Survey using SMS
  29. 29. Held Training of 600 District Health Officers in KenyaOn New District Health Reporting ToolMinistry of Health NASCOPSMS 1:Have you entered /Imported data into the new tool ? Yes or NoSMS 2:Have you run reports using the new district tools ? Yes or NoSMS 3:Have you discussed the new district tools and reports with other members of thedistrict health team ? Yes or No SMS 4:In what district do you work?Your answers are confidential and a Ksh 20 refund will be given for each valid reply
  30. 30. Mobile Phone Survey Architecture Survey questions and acknowledgement via SMS SMS Provider service Survey responses/corrections via SMS (Zain/Safaricom) SMS archived in Get SMS data Assessment frontlinesms application DB FrontlineSMS Application content to DB data Convert SMS Request for correction No Acknowledge Assessment Yes (Reimburse airtime) Database Save Valid? (Excel)
  31. 31. Graph 1: N Participated = 165; N completed = 101 Percentage participation/completion in the DHPT text message survey by province8 provinces involved in the survey, a total of 388 interviewees sentsome reply; 101 interviewees completed the survey
  32. 32. Response duration and timesTable 5: Time in minutes to complete the surveyProvince N= Minimu 25th Median 75th Maximum Mean 131 m Percentil Percentile eCentral 12 11.00 22.00 27.00 59.00 5861.00 999.33Coast 12 5.00 9.00 27.00 54.50 969.00 106.75Eastern North 5 15.00 17.00 25.00 30.00 31.00 23.60Eastern South 20 3.00 9.00 18.00 480.00 9703.00 1202.10North Rift 17 15.00 34.00 50.00 262.00 17561.00 2512.06Nyanza 22 9.00 19.00 27.00 152.00 17534.00 1722.05South Rift 19 2.00 15.00 35.00 1623.00 27553.00 3162.63Western 24 4.00 768.00 1372.50 19012.50 30063.00 9424.38 Graph 2: N: 131 interviewees who responded to at least 2 questions Median times (in minutes) participants used to complete the SMS survey
  33. 33. Response duration and times• Most of the respondents attended to the SMS after 5pm• Sending multiple questions drastically reduces the response rate• Re-sending an answered question does not guarantee a response• Contact (physical, by mail or otherwise) significantly increases the response rate• The longer the duration between a response and the next question the lower the chances of getting the next response
  34. 34. www.futuresgroup.comwww.facebook.com/FuturesGroupwww.twitter.com/FuturesGroupGbl 46