Mother Infant Pair Mobile Application Mobile Services that Empower Vulnerable Communities Mother Infant Pair Mobile Application Malawi Lyness Kanada M & E Specialist March 20, 2013 ICT4D Conference Accra, Ghana

Acknowledgements: IMPACT consortium partners CHIKWAWA DIOCESE

IMPACT Background USAID/PEPFAR-funded GDA serving 100,000 OVC and PLHIV, July 2010 - June 2014 Designed to complement WALA Program in 9 districts in central and southern regions Collaboration with Government of Malawi through MoGCSW, MoH, NAC & OPC/DNHA and US Peace Corps Improve wellbeing of OVC and increase access to treatment and care for PLHIV SO1: Improved wellbeing of 60,000 OVC SO2: Access to treatment and care for 40,000 PLHIV enhanced IMPACT is a four year program and has two strategic objectives, SO1 and SO2 WALA - Wellness & Agriculture for Life Advancement is USAID funded program that aims to promote food security for vulnerable households MOGCSW- Ministry of Gender, Children and Social Welfare NAC – National AIDS Commission MoH- Ministry of Health OPC/DNHA – Office of President and Cabinet / Department of Nutrition and HIV and AIDS Currently the program has reached to over 80,000 individuals

IMPACT Background - IMPACT Consortium Members Opportunity International Bank of Malawi TNM D-Tree International National Assoc of People Living with HIV and AIDS in Malawi Dedza Catholic Health Commission (CHC) Lilongwe CHC Zomba CHC Africare Chikwawa Diocese Emmanuel International PCI Save the Children World Vision WALA partners Faith based partners Private sector partners Tech Asst partners

MIP application Mother Infant Pair protocol: guidelines on following up infected women and their exposed infants during antenatal, post-partum and postnatal home visits until child is aged two Application guides HSAs through content on each home visit Application developed on CommCare platform, running on Nokia 2700c phones 21 HSAs trained -46 more to be trained by May 2013 MIP Application was designed as per government CBMNC guidelines CBMNC: Community Based Maternal and neonatal care – government developed guidelines on community care for pregnant women from antenatal period through postnatal period until child is two years old. Application developed with guidance from D-Tree International All HSAs were first trained on CBMNC guidelines and had to put the work in practice before being trained on the Mobile application

MIP Application Design Main Menu Application has main menu from which you select the form you want to use. A list of all registered MIPs appears on each form according to the stage at which the pair is currently at. i.e. at antenatal, post-partum or post natal At antenatal visit, first the visit number is selected; visit 1(first trimester), visit 2(second trimester), visit 3 (third trimester) The phone then takes you through all the questions/advices to be asked/provided to the client Registration Antenatal Visit

MIP Application Design Cont’ In post-partum and postnatal forms, the visits are automatically selected according to the child age(if its at registration) and the last visit conducted. The phone takes you through in assessing both the child and the mother Post-partum visit Postnatal visit

Key Successes Application has helped HSAs understand CBMNC guidelines better Adherence to protocol has improved Clients have been more open to HSAs during follow-up visits as compared to before using the phone - application has improved relationship between HSAs and clients Continued counseling on drug adherence for both mother and child at each visit to avoid defaulting Referrals are being made during home visits Capacity built within CRS on mobile applications At each visit, the application prompts the HSAs to ask the mother if both herself and the child are taking the drugs correctly and if the child has gone through required tests according to the child’s age. i.e DNA/PCR test and HIV Rapid test HSA-Health Surveillance Assistant IMPACT in collaboration with D-Tree International has also developed two other mobile applications (Child Status Index and Community Case Management) and was building capacity within CRS so that future management and development of other application can be done within CRS. This is the first application that CRS has taken a lead in developing.

Key Issues / Challenges Testing all sections of the application - time from pregnancy until child is two Using application on MIP households may compromise on confidentiality issues - CBMNC application Some MIPs don’t disclose their status to their spouses – becomes difficult for HSAs to conduct home visits Looking at the remaining time for the project to phase out and the time to test the application from pregnant woman until the child is two years was a challenge. As such HSAs that were involved during the testing period had clients at different stages. So we had clients at antanatal, postpartum and postnatal period to make sure that all sections of the applications were tested. Users complained that using the phone application at MIP households only might bring stigma and discrimination in the communities as HSAs do also visit non MIP households. As such we have decided to redesign the application so it can also be used at non MIP households as well, hence the CBMNC application

Lessons Learned Application can help improve PMTCT as exposed women are fully followed up and each visit done correctly as per protocol Need to add component to the application to be used on non MIPs as well Relevant DHO staff under MoH are oriented on the application - to take over when IMPACT finishes Application uses GPRS data transmission at $0.00003/Kb (compared to $0.03/Kb for a single SMS) The application helps the HSAs not to miss out anything to be discussed with the client at each visit as per CBMNC MoH-Ministry of Health DHO-District Health Office Data is send to a cloud server and can be downloaded through the internet GPRS: General Packet Radio Service Average size of submitted forms 3-5Kb

Conclusion MIP Mobile Application Improving quality of service offered to HIV infected women and their exposed infants!!

Mobile Services that Empower Vulnerable Communities Questions!