1. Marc Mitchell, M.D., S.M Harvard School of Public Health and D-tree International Providing Decision Support to Health Workers

2. “[There is] an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide. The shortage is most severe in the poorest countries, especially in sub-Saharan Africa, where health workers are most needed. “ The Problem

3. BUT  less basic education  less training  limited supervision  monitoring difficult Using less trained health workers to provide health care in clinics and the community. Task Shifting The Solution

4. What is Needed End to End solution 1. task identification 2. skills taught 3. reinforce knowledge 4. monitor performance

5. Task Identification: assessing child with cough

6. Task Identification: treating child with cough

7. 1.How to measure respiratory rate 2.How to detect indrawing, stridor 3.How to classify 4.How to treat; what dose? Teaching Specific Skills

8. Reinforcement: at point of care

9. How sick? very □ mild □ well □ Emergency? unconscious □ bleeding □ seizure □ other □ next  fever □ cough □ diarrhea □ abd. pain □ rash □ Symptoms next  Bringing evidence-based medicine to frontline health workers worldwide next  ampicillin 500 mg + paracetemol 1 tab Treat Pneumonia next  getting sicker □ Respir.Rate >40 □ indrawing □ stridor □ wheezing □ no source found □ Symptoms next  REFER URGENTLY Reinforcement: at point of care

10. patient database Performance Report patients lost to f/u 1. ali samuel 2. ben hasan 3. etc. growth monitoring immunizations lab tests pregnancy registration referral tracking Enable continuum of care Clinical Protocol Monitor performance in real time

11. SMS alerts for missed clients Monitor performance in real time

12. eIMCI

13. Nutrition      Link CHW and clinic HW

14. Support to CHW Support to clinic staff providing a continuum of care across space and time Antenatal care newborn care Link CHW and clinic HW

15. Can we reduce the 3 delays of Home Births through: 1.phone based protocols 2.mPesa to pay transportation and fees 3.cell numbers of vehicles for hire in emergency 4.recorded permissions for emergency transfer 5.SMS or phone call to receiving hospital Obstetric Plan B Support community midwives Grand Challenges

16. 1.Develop or adapt clinical protocols that enable task shifting 2.Validate protocol effectiveness to ensure quality of care 3.Design open-source software to support scale up and correct use of protocols 4.Improve decision making by making data available at and across points of care What we do

17. End to End solution to support HW throughout the system client (basic phone) information alerts reminders CHW (java phone) pt. registration pt. record protocols scheduling training alerts reminders msg to clinic supervisor (phone or netbook) messaging exception rules for supervision surveillance learning notifications alerts clinic (smart phone) pt. registration pt record protocols scheduling training alerts reminders telemedicine manager (laptop) exception rules for supervision surveillance learning data queries

18. Marc Mitchell, M.D., S.M Harvard School of Public Health and D-tree International Providing Decision Support to Health Workers