eHealth: Lessons Learned


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  • The Millennium Villages Project (MVP), housed in CGHED at the Earth Institute, serves as a model to help and empower rural African communities out of extreme poverty and achieve the MDGs by 2015.  The initiative is community-led with support from an multi-disciplinary team of researchers and partnerships with Millennium Promise and UNDP who support operations and implementation of the program.  Projects are centered around five sectors: agriculture, health, education, enterprise and infrastructure with a strong focus on empowerment of women and girls.  As part of the health sector, science and technologies are being integrated into health systems in the context of the MVP sites. 
  • The Millennium Villages constitute fourteen sites in ten Sub-Saharan African countries with populations of between 5,000-50,000 people in Koraro, Ethiopia; Sauri, Kenya; Dertu, Kenya; Ruhiira, Uganda; Mayange, Rwanda; Mbola, Tanzania; Mwandama, Malawi; Gumulira, Malawi; Potou, Senegal; Tiby, Mali; Toya, Mali; Bonsaaso, Ghana; Pampaida, Nigeria; and Ikaram, Nigeria. There is potential for projects to scale-up beyond the MVP Sites.
  • The frontline for health service provision are community health workers (CHWs). CHWs, in MVP, are located within the villages and are responsible for 100-250 HHs each. CHWs conduct household visits and use paper forms (with a shift to mobile-based forms and reporting) to report information. CHWs report to senior CHWs who report to CHW Managers/Health Facilitators.Re: Health workers: “No other category of worker is so essential to the well-being of the population of every nation.” (Ethn Dis. 2009;19[Suppl 1]:S1-60–S1- 64)
  • Mobile Technology-related ActivitiesTo support increased access to health services and information and improved quality of care, MVP engages in the strategic design, testing, implementation and rigorous research and evaluation of eHealth tools (inclusive of mHealth tools) within MVP and beyond, while simultaneously working to advance an enabling environment for e- and mHealth, globally.  Collaboration between researchers at the Earth Institute and members of the Department of Biomedical Informatics at the Columbia College of Physicians and Surgeons, the Department of Epidemiology at the Mailman School of Public Health, the Department of Engineering and the Center for New Media Teaching and Learning at Columbia University. The Columbia International eHealth Laboratory (CIEL) links all of the institutions to help develop the eHealth program.At the core of the eHealth Program is the Millennium Villages Global Network (or MVG-Net). MVG-Net is an open source information and communication system and architecture.
  • These are initiatives that feed into mHealth activities within the eHealth Program at MVP with a focus on our mHealth activities. Drawing from our work and experiences, our priority has been to provide point of care support tools to health workers—both facility and community-based—in new and creative ways. [In part, this led to recognition of our CHW Program by the WHO’s Global Work Force Alliance—award of excellence.] This included the development of ChildCount+ (CC+), which is an SMS-based point of care support tool and data collection tool based off of the RapidSMS platform. CC+ allows for monitoring and evaluation of performance indicators of CHWs and health indicators of the community. Complementing CC+ are mobile phone closed user groups (that allow the health workers within their MVP community to call one another at no extra cost). This allows for mentoring, reporting emergencies and seeking transport and more. In Ghana, a call centre has been incorporated within the CUG. At this call centre, community-based health workers can reach a physician on-call at the nearby referral hospital to conduct teleconsultations or notify of referrals. Through this initiative, supervisors will be able to monitor the nature of the calls. The idea is that this monitoring system can then feed back into trainings and addressing knowledge gaps. Therefore, CHWs and other health staff receive learning opportunities and reinforcement through the trainings, interactions and supervisor reviews via CC+ and the Ghana Telemedicine Project. With that noted, we also looked into developing a more formal mLearning initiative. Through this mLearning Initiative, CHWs would be able to access content/topics covered during their trainings on their mobile phones.The data collected by the mHealth tools has been bridged with an open source electronic medical record (OpenMRS). OpenMRS is used at the facility-level, whereby facility-based staff use computers to create and update medical records of those within the MVP cluster. Recently, there has been an exploration to use a tablet to allow for the updating of these medical records through the ODK platform. This pilot initiative, called mClinic, will allow for nurses and midwives to access OpenMRS on android-based mobile phones. The platform links community- and facility-based data -- whereby alerts can be sent to CHWs based on mClinic interactions for follow-up and referrals. The pilot is underway in Ghana.
  • Implementing across ten different countries in fourteen different sites. With such a large-scale implementation in different contexts, it was important for us to have innovation, collaboration, transparency, independence and customization be incorporated into the design, implementation and maintenance of the system.The use of open source tools has allowed us to be innovative and fostered collaboration not only within MVP but also within the various development communities whose tools we have adapted for use in MVP (such as OpenMRS). We also do not depend on one programmer or organization to adapt and maintain our tools--we are able to do that in-house.Realising that not all sites have the same data needs (i.e. government reports vary), the data model was expandable but had reference standards (ICD-10, SNOMED CT, RxNORM, LOINC, CVX) that made sure there were central concepts to allow for understanding, compatibility and comparisons across all sites.In addition to the above, key lessons we have learned is that adequate HR needed--the work is intensive and one needs to be realistic in terms of what resources are needed in order to design and maintain the systems and allow for the system to grow and/or change with the users; buy-in and feedback from users important (participatory design), resources still required if going open source—especially if looking to link two systems; while software development and implementation support can over lap, software development requires its own resources and implementation support requires separate resources.
  • Applicable to Egypt in that implementation done in SSA context. Use cases show can be used by health workers – from community-based to physicians. Some key take aways include considering open source tools for customisable platforms (if one has the resources); consider external stakeholders – namely, government and reporting requirements therein--selecting an appropriate data model that attempts to adhere to international and national data standards and requirements; make sure to include the end-users in the design process and gather their feedback (consider if and how their workflow is being improved); implement at a smaller-scale, fine tune, and then expand; have adequate human resources; having regular training or reinforcement of material is important. In addition, costing analyses and health outcomes research are important.
  • Collaboration includes mHealth Alliance, ministries/governments, private sector (i.e. telecom operators), WHO, Open Mobile Consortium, other organisations
  • eHealth: Lessons Learned

    1. 1. eHealth in MVP: Lessons Learned from Implementation Across Sub-Saharan Africa Nadi Nina Kaonga Dr Andrew S. Kanter Health IT Conference in Cairo, Egypt 18-19 April 2012 Earth Institute, Columbia University, New York, USA Columbia International eHealth Laboratory (CIEL)Department of Biomedical Informatics, Columbia University, New York, NY, USA
    2. 2. Presentation Overview About the Millennium Villages Project Overview of MVG-Net Lessons Learned via Implementation of MVG-Net Relevance to Egypt and Other Settings
    3. 3. About the Millennium VillagesProject
    4. 4. Scope Pampaida, Tiby, Mali Toya, Mali Koraro, Ethiopia Nigeria (Pop. 55,000) (Pop. 5,000) (Pop. 55,000) (Pop. 15,000) Sauri, Kenya Potou, Senegal (Pop. 55,000) (Pop. 31,000) Dertu, Kenya Bonsaaso, Ghana (Pop. 5,000) (Pop. 30,000) Ruhiira, Uganda Ikaram, Nigeria Gumulira, Malawi (Pop. 40,000) (Pop. 20,000) (Pop. 5,000) Mayange, Rwanda Mwandama, Malawi (Pop. 20,000) (Pop. 35,000) Mbola, Tanzania (Pop. 30,000)
    5. 5. Reaching Underserved Populations
    6. 6. Overview of MVG-Net
    7. 7. Activities Toll-free Handsets for Voice/Mobile CHWs and Phone Closed Clinics User Groups Mobile Applications: ChildCount+ mLearning Mobile [Java/Android- Telemedicine based Data Collection and Support Tools] MGV-Net •OpenMRS •DHIS2 •Enterprise eHealth Research and Evaluation Architecture The primary aim of mHealth activities within the eHealth Program in MVP is to use mobile technologies to accelerate the achievement of the health-related MDGs. mHealth and eHealth initiatives of MVP are developed and implemented together within a broader Columbia Global eHealth Program through the Columbia International eHealth Laboratory.
    8. 8. Lessons Learned via Implementation ofMVG-Net Open source platforms Expandable data model Reference standards and centralised concept dictionary Translation of content/concepts into locally accepted terminology User feedback and perceptions
    9. 9. Relevance to Egypt and OtherSettings
    10. 10. Sustainability and Scale-Up MVP Scale-up Initiatives Enterprise Architecture/Standards Development Collaborations Research, Metrics and Evaluation
    11. 11. Thank youFor more information, please feelfree to send an email