Bobby jefferson unite for sight apri 21 2pm l 2012
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Transcript of Bobby jefferson unite for sight apri 21 2pm l 2012
mHealth: Scale Up of Mobile in PMTCT Program
1
• Bobby Jefferson, Director Health Informatics, Futures Group • Principal Investigator – Health Information Systems Grant Kenya
• Partners in AIDS Care and Treatment, University of Maryland Institute of Human Virology
• Tanzania HIV AIDS Relief Program
• Tanzania Orphans and Most Vulnerable Children (MVC) MIS
technology isn’t the barrier to scale up
• Description
– Low Resource Environment
• Approach
– Low cost, appropriate technology
• Solutions
• Sharing Scale Up Lessons
Outline
423 ART Hospital Facilities
770 PMTCT - Antenatal Care (ANC)
Low Resource
Rural, remote, mission hospitals “serving poorest of poor” and Ministry of
Health (MOH) facilities
• Intermittent power,
• Lack of trained IT staff,
• Lack internet,
• Sparse mobile coverage
Environment
Photo credits: Brian and Angie Savage
Nurses, Clinicians, Adherence Counselors, need health data, M&E
program data 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
Low Resource Environment
Approach
How to Give Presentations or
IT Training
in
Rural Clinics When
Power or Generator is Offline
? to address power
Off Grid Technology: Address
Intermittent Power
Approach
Off Grid Technology: Address
Intermittent Power
Battery Operated
Projector
to address power
Approach
Off Grid Technology: Address
Intermittent Power
Approach
Off Grid Technology: Address
Intermittent Power
Approach
Off Grid Technology: Address
Intermittent Power
Approach
How to Print In Rural Clinic When
Power or Generator is Offline
? to address power
Off Grid Technology: Address
Intermittent Power
Approach
ZINK – Zero Ink
Portal Printers
*use to QR code for
Patient ID
to address power
Off Grid Technology: Address
Intermittent Power
Approach
Technology
Approach
How to Power Netbook Computer
in Rural Clinic When
Power or Generator is Offline
? to address power
Off Grid Technology: Address
Intermittent Power
Approach
Samsung Solar
Netbook PC - NC215 Intel Atom N570 Processor 1.3 GHz
1 GB DDR3 Memory Module
10’ LED Backlit LCD Screen
250GB 5400 rpm Sata Hard Disk
802.11bg/n Wi-Fi
10/100 Ethernet Port
0.3 Mega Pixel Web Camera
802.11 b/g/n Wireless LAN
Bluetooth V3.0
Headphone Jack,
4-in-1 (SD, SDHC, SDXC, MMC) Multi
Card Reader
3 USB 2.0 Ports & VGA Port out
3 W Stereo Speaker (1.5 W x 2)
Dimensions : 10.20″ (W) x 7.07″ (D)
x 0.85″ ~ 1.33″ (H)
Warranty : 1 Year Warranty
Technology
18
Photo credits: Brian and Angie Savage
Facility Name District
Distance from
Facility to District
(KM)
Time spent to
Deliver PMTCT
Report (Hrs)
Bus Fare (Tsh)
MWANZA Region
NYAMAGANA DISTRICT
Mwamashimba Health Centre Kwimba 50 1.30hrs 10000
Malya Health Centre Kwimba 25 1hr 5000
Kikubiji Dispensary Kwimba 102 4hrs 20000
Kiliwi Dispensary Kwimba 100 4hrs 20000
KWIMBA DISTRICT Nyakalilo Health Center Sengerema 46 2 HRS 8000
Mwangika Health Centre Sengerema 98 4 HRS 10000
Sengerema Health Centre Sengerema 10 20MIN 3000
SENGEREMA DISTRICT Kharumwa Health Centre Geita 115 3HRS 20000
Nzera Health Centre Geita 48 2HRS 8000
Katoro Health Centre Geita 50 45MIN 6000
Nkome Dispensary Geita 80 2HRS 6000
Nyang'hwale Health Center Geita 85 2HRS 7000
Kasamwa Health Centre Geita 25 30MIN 4000
Bukori Health Centre Geita 60 1:30HRS 6000
Tanzania
• staff Gender 89% female
• 100% posses mobile phone
• 71% used SMS on mobile phone
• Predominately Swahili speakers and readers
Tanzania Environment
28
IQSMS – Free software Report formatting
Data validation
PMTCT MONTHLY REPORT
Jan-10
PMTCT Antenatal Clinic (ANC) Monthly Summary
Form
All women attending ANC for the
given report period L
PT
F 1
ANC 01. New ANC clients this month 1188
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
Paper Report SMS
Data Type Validation
Report Duplication
Check
• IQSMS software,
IQSMS Reporting
Immediate Data Quality Alert
Pass or Fail
PMTCT Report
PMTCT Report
District Office
Data Quality Checks
Reports and Analytics
Query Database Using SMS From Mobile Phone
Bugando Clinic – Site 1
How many new antenatal clients this month?
How many were tested for HIV?
How many tested Positive ?
SMS Query: R1, M1, Site 1
Query Database Using SMS From Mobile Phone
SMS Query: 4679, 2561, 181
NUMBER OF CLIENT HAD HIV TEST AT ANC
Benefits
Submission via low cost mobile phones in the field
IQSMS project takes advantage of mobile phones already owned by health worker. By using a
familiar device, training requirements are similar to paper based training
Low cost of SMS submission ($0.04 per SMS)
Fuel and Transport cost savings in staff travel and reliable data submission
Health Care Workers no longer required physically to transport paper reports or fax PMTCT
reports to central project offices.
PMTCT Data can be made accessible to a wider audience (local, district, region, levels
Health facilities interested to know how their statistics compare with others in their districts
District officers want to receive aggregate report via SMS, email and
send queries to IQSMS database
Facility Name District
Distance from
Facility to District
(KM)
Time spent to
Deliver PMTCT
Report (Hrs)
Bus Fare (Tsh)
MWANZA Region
NYAMAGANA DISTRICT 15 Min Avg
Mwamashimba Health Centre Kwimba 50
Malya Health Centre Kwimba 25
Kikubiji Dispensary Kwimba 102
Kiliwi Dispensary Kwimba 100
KWIMBA DISTRICT
Nyakalilo Health Center Sengerema 46
Mwangika Health Centre Sengerema 98
Sengerema Health Centre Sengerema 10
SENGEREMA DISTRICT
Kharumwa Health Centre Geita 115
Nzera Health Centre Geita 48
Katoro Health Centre Geita 50
Nkome Dispensary Geita 80
Nyang'hwale Health Center Geita 85
Kasamwa Health Centre Geita 25
Bukori Health Centre Geita 60
Tanzania
# of Months
# of
Sites
Number of PMTCT Sites Reporting Using Mobile IQSMS
# of Months
# of
Sites
technology isn’t the barrier to scale up
• After early adopters, health care workers not keen sending message
unless they have free airtime and toll free number available from their
mobile telecom provider ; we increase use by 50% when toll free is
available
• They wanted direct feedback from district coordinator verifying he
received their monthly report
• The older staff have more difficulty
using mobile for messaging and
reporting;
technology isn’t the barrier to scale up
• Staff in rural areas want their SMS messages in Swahili or local
language; Detailed instructions in Swahili to how to do reporting and
use phones for reporting
• Worker receive per diem for transports costs to bring their list and
reports district offices, losing out in reimbursement was not issue
• (25% share phone vs. Own)
technology isn’t the barrier to scale up
Any problems with small buttons on the phone?
Response Freq %
No 30 85.71
Yes 5 14.29
Total 35 100
Instruction on Swahili critical to using IQSMS
Response Freq %
No 6 17.14
Yes 29 82.86
Total 35 100
• Reasons For Not Sending Monthly Report
– Majority said they don’t understand English language
– Need message understandable in Swahili language
IQSMS Instructions in Swahili
• Anything that can be improved on report submission to make report to be on time
• Response Freq %
• No 14 40.00
• Yes 21 60.00
• Total 35 100
Barriers to implementing mobile phone reporting for submitting all four reports each month Mobile Network Problem/failure
Server don’t respond on time
Report type is hard
It have been found that free Airtime is critical for scale up
# of Months
# of
Sites
technology isn’t the barrier to scale up
• When PMTCT staff submits SMS report that fails validation more than three (3) times; there is likely an issue with understanding the indicators;
• We use data to target training on indicators to specific staff
• We still travel for
data quality audit (DQA) to
verify the reported values
against the register
technology isn’t the barrier to scale up
• Delay in Reporting times for PMTCT reports to district level office went from 1-2 months to 30 minutes
• It takes on average only 15 minutes a month to submit all four reports
technology isn’t the barrier to scale up
Excel
PMTCT MONTHLY REPORT PMTCT Antenatal Clinic (ANC) Monthly
Summary Form
ANC 01. New ANC clients this month
118
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
Ms Access Database
PDA device
Web Internet Desktop
Excel Only
M&E Electronic Reporting System Solar Power Cell phones
Thank you
we predict the trends that will affect a
country’s stability and growth. we see
connections between disparate data points
that others miss— allowing us to uncover
the real barriers to well-being and discover
innovative solutions for a better world.