CommCare for WV BHAMC Child Survival Project Dennis Cherian, MS, MHA, BHMS Director of Operations | Health and Hope |  Res...
WV BHAMC Child Survival Project <ul><li>Better Health for Afghan Mothers and Children </li></ul><ul><li>Herat Province- fo...
Why Afghanistan? <ul><li>2 nd   worst maternal mortality rate and the highest infant mortality rate </li></ul><ul><li>Only...
Mobile Health in Afghanistan <ul><li>Rural Healthcare systems suffer greatly because of distance </li></ul><ul><ul><li>Nea...
Operations Research Objective <ul><li>To test if the use of CommCare can: </li></ul><ul><ul><li>Increase uptake of Healthy...
Key OR Components  <ul><li>Safe pregnancy </li></ul><ul><li>Newborns </li></ul><ul><li>Emergency tele-medicine </li></ul>
Decision Making Framework
Expected Outcomes <ul><li>Utilization - Increased percentage of  Healthy Actions taken by pregnant women </li></ul><ul><li...
Operational challenges <ul><li>CHW literacy  </li></ul><ul><li>Security in the province </li></ul><ul><li>Cultural accepta...
Implementation Supervision Tools Training Life-saving  intervention
<ul><li>Client lists </li></ul>CHW CLIENT Reminders Checklists Decision Support
CHW FIELD  SUPERVISOR,  LOCAL CLINIC CLIENT PROGRAM MANAGERS SMS Alerts Activity reports Health stats  Coordination CommCa...
<ul><li>Improve adherence to protocol. </li></ul><ul><li>Better, faster data. </li></ul><ul><li>Improve supervision. </li>...
e-IMCI (preliminary) results Clinical Step Current practice adherence e-IMCI adherence p-value Vomiting 66.7% (n=24) 86% (...
Design Under the Mango Tree
<ul><li>ict4chw  discussion (groups.google.com/group/ict4chw) </li></ul><ul><li>JavaROSA codebase (EpiSurveyor, GATHER, Ce...
Summary <ul><li>Afghanistan is a difficult and important area to test mHealth tools. </li></ul><ul><li>CommCare automates ...
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CommCare for WV BHAMC Child Survival Project

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CommCare for WV BHAMC Child Survival Project

Dennis Cherian, World Vision

CORE Group Spring Meeting, April 30, 2010

Published in: Health & Medicine
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  • ICT has been shown to improve the healthcare system in Developing Nations. The use of cell phones in healthcare settings can potentially deliver important benefits, because of their ability to provide and improve access to communication and information resources. ICTs such as mobile phones enhance access to medical expertise and enable remote consultation. The latter provides rural healthcare workers with quick and convenient access to expert advice from healthcare experts based in urban surroundings with essential medical infrastructure. ICTs improve the links outside of the formal health infrastructure by connecting communities with healthcare providers (Kaplan, 2006). ICTs also improve access to medical and health information, often in digital journals. The use of cell phones in healthcare settings can potentially deliver important benefits, because of their ability to provide and improve access to communication and information resources. This can occur both within the healthcare system and with external resources, and with beneficiaries, such as the community.
  • Improve pregnancy and newborn outcomes in remote villages of Herat province through improved routine care and practice of pregnancy, and better access to higher-trained health workers
  • TALK TALK TALK
  • Referral and follow up services - Continue to be poor with out ICT OR Identification of danger signs during pregnancy and intervention of skilled health personnel – remains a challenge Emergency care during pregnancy- in the absence of an ambulance Post natal visits – continue to be a challenge Basic information of newborn care and breastfeeding issues
  • CommCare for WV BHAMC Child Survival Project

    1. 1. CommCare for WV BHAMC Child Survival Project Dennis Cherian, MS, MHA, BHMS Director of Operations | Health and Hope | Resource Development and Management International Programs Group [email_address] Neal Lesh, PhD, MPH D-tree International Dimagi, Inc email: [email_address]
    2. 2. WV BHAMC Child Survival Project <ul><li>Better Health for Afghan Mothers and Children </li></ul><ul><li>Herat Province- four districts </li></ul><ul><li>Innovation category </li></ul><ul><li>September 15, 2008 – September 14, 2012 </li></ul><ul><li>Funded by USAID CSHGP </li></ul>
    3. 3. Why Afghanistan? <ul><li>2 nd worst maternal mortality rate and the highest infant mortality rate </li></ul><ul><li>Only 24.3% of mothers receive skilled delivery assistance during delivery </li></ul><ul><li>Only 20.8% mothers received post natal check by skilled health personnel after three days of delivery </li></ul><ul><li>Almost half of all deaths of women in reproductive age result from complications of pregnancy and childbirth. </li></ul>
    4. 4. Mobile Health in Afghanistan <ul><li>Rural Healthcare systems suffer greatly because of distance </li></ul><ul><ul><li>Nearly 40-45% of the population cut off from health facilities during winter season </li></ul></ul><ul><li>There are only 15 nurses in the project area </li></ul><ul><ul><li>1 nurse to 17,500 people </li></ul></ul><ul><li>Only 313 CHWs </li></ul><ul><ul><li>1 CHW to 832 people </li></ul></ul><ul><li>Successful experience using mobile phones in Indonesia - TEA Midwifery assistance program </li></ul>
    5. 5. Operations Research Objective <ul><li>To test if the use of CommCare can: </li></ul><ul><ul><li>Increase uptake of Healthy Actions </li></ul></ul><ul><ul><li>Increase knowledge of Important Information points </li></ul></ul><ul><ul><li>Improve communication and coordination by CHWs with higher-trained health workers. </li></ul></ul><ul><li>Improve pregnancy and newborn outcomes in remote villages of Herat province through improved routine care </li></ul><ul><li>Document the socio-cultural, gender and other community factors influencing the effective use of phone-based applications. </li></ul>
    6. 6. Key OR Components <ul><li>Safe pregnancy </li></ul><ul><li>Newborns </li></ul><ul><li>Emergency tele-medicine </li></ul>
    7. 7. Decision Making Framework
    8. 8. Expected Outcomes <ul><li>Utilization - Increased percentage of Healthy Actions taken by pregnant women </li></ul><ul><li>Knowledge - Increased knowledge by pregnant women of the Important Information points. </li></ul><ul><li>Access - Increased use of midwives and expert services via phone calls. </li></ul>
    9. 9. Operational challenges <ul><li>CHW literacy </li></ul><ul><li>Security in the province </li></ul><ul><li>Cultural acceptability of using mobile phones to health issues </li></ul><ul><li>Understanding and use of the research tool by CHWs </li></ul><ul><li>Healthcare worker capacity and knowledge </li></ul><ul><li>Community access and use of health facilities </li></ul>
    10. 10. Implementation Supervision Tools Training Life-saving intervention
    11. 11. <ul><li>Client lists </li></ul>CHW CLIENT Reminders Checklists Decision Support
    12. 12. CHW FIELD SUPERVISOR, LOCAL CLINIC CLIENT PROGRAM MANAGERS SMS Alerts Activity reports Health stats Coordination CommCareHQ
    13. 13. <ul><li>Improve adherence to protocol. </li></ul><ul><li>Better, faster data. </li></ul><ul><li>Improve supervision. </li></ul><ul><li>Easier to update. </li></ul><ul><li>More sophisticated protocols. </li></ul>Why automate algorithms?
    14. 14. e-IMCI (preliminary) results Clinical Step Current practice adherence e-IMCI adherence p-value Vomiting 66.7% (n=24) 86% (n=28) - Chest indrawing 75% (n=20) 94% (n=18) - Blood in stool 71% (n=7) 100% (n=3) - Measles in the last 3 months 56% (n=9) 95% (n=21) < 0.05 Tender ear 0% (n=1) 100% (n=5) - All 61% (n=299) 85% (n=359) < 0.01
    15. 15. Design Under the Mango Tree
    16. 16. <ul><li>ict4chw discussion (groups.google.com/group/ict4chw) </li></ul><ul><li>JavaROSA codebase (EpiSurveyor, GATHER, Cell Life..) </li></ul><ul><li>OpenROSA consortium </li></ul><ul><ul><li>4 th meeting in Dar, TZ in July 2009 </li></ul></ul>Collaboration
    17. 17. Summary <ul><li>Afghanistan is a difficult and important area to test mHealth tools. </li></ul><ul><li>CommCare automates protocols & checklists for CHWs </li></ul><ul><li>We will assess clients served by CHWs using CommCare vs. those not using it. </li></ul><ul><li>Field refinement of tools is important </li></ul><ul><li>Open standards are important. </li></ul>

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