Developing mHealth Systems to improve quality of care

Steve OllisD-tree International

sollis@d-tree.orgwww.d-tree.org

@DtreeInt

Mobile Trends

Mobile phone penetration hasdrastically increased over the last decade especially in developing countries.

Global Health Challenges

Shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide, especiallyin low and middle income countries.

Obstacles to Good Healthcare- Limited number of healthcare providers- Heavy client load- Limited training - High burden of disease- Limited financial resources- Paperwork

• Provide decision support tools for use by frontline health workers– Design, Test and Deploy systems– Partner with MOH and other health NGOs

• Focus areas:– Maternal and Child Health– Chronic Disease

What D-tree does

Types of mHealth interventions

mHealth systems not apps!

CCM Malawi

The challenge

• HSAs do not always follow guidelines– 56% asked about 3 danger signs– 37% assessed for 4 physical danger signs– 57% provided correct referrals and pre-referral

treatment – Major gap in identification of fast breathing

• Stock management• Data flows for monthly reporting

CCM in Malawi

• Phase 1 – cIMCI tool on Nokia phones

• Phase 2 – integrated CCM on Android• Vaccinations

• Commodity tracking/reporting

• Monthly reports

• Dashboard

• Supervisory application

• Phase 2a – modification to allow for mRDTs

• Phase 3 – integration with CBMNH

Patient historyHSA can review patient history

Sick child formHSA guided through sick child protocol

Counting breathsUses phone for time measurement

Absence of such measuring device had been major reason for referral

Outcome of assessmentReferral Home Treatment

Vaccinations

C-stock IntegrationHSA reminded when monthly stock report is due

Entering new stock levels

Web Dashboard

Lessons learned

• Fast pace of technological change• Change Management essential • Encourage data driven management • Field refinement is critical• Users must feel application supports them• Don’t let technology push the program

– Sometimes a phone is just a phone – and that’s great!

Recommendations• Involvement with mHealth working

group in each country• Look for existing projects to leverage• Adapt each project around the in-country

m/eHealth ecosystem• Partner with MOH and consider the entire health

system • Plan for integration with HMIS from the start • Leverage mFinance, mAgriculture, other

e/mDevelopment initiatives

What’s next

• Improved integration of facility and community

• Integration of across domains• Improved dashboard analytics• Continued usage of mobile money• Exploration of integration with point of care

diagnostics / unique identifiers

Thank you!

For more information:

Steve Ollissollis@d-tree.orgwww.d-tree.org@DtreeInt