Health Information Systems Analyst Mobile technology for community health Dominic Atweam K Health Information Systems Analyst Policy Planning Monitoring and Evaluation Division- Ghana Health Service

Overview What is MoTeCH? Pregnant Parents Application (MOBILE MIDWIFE) Tools for Community Health Workers(HIMS) General intro to presentation

What is MOTECH? Using mobile phones to increase the quantity and quality of maternal and child health services in Ghana Focus on frontline community health facilities (CHPS zone, Health Centre's) There are other similar programme running on different plat forms but performing the same functions as MOTCH GHS NMCSSP eREgister GHS - Sene Smart Phone Project

Overview What is MoTeCH? Pregnant Parents Application (Mobile Midwife) Tools for Community Health Workers (HIMS) Social Impact Assessment

Challenges in Communities ANC visits start late Incomplete ANC coverage Delay until newborns seen Unattended births Patchy immunization coverage Low IPT uptake Local myths When considering communities issues around Maternal and Child Health: pregnant women are often late to report to the CHPS compound, resulting in late uptake of ANC not all of our mothers are attending for at least 4 antenatal visits post natal care uptake for newborns is low vaccination schedules are not followed reliably IPT uptake is low and local myths sometimes encourage practices which are damaging to people’s health

MOTECH Component 1: Mobile Midwife Messages provide key MCH information for “pregnant parents” and reminders to seek timely care: Personal care during pregnancy Newborn care Recognition of danger signs Developmental milestones Nutrition and breastfeeding Malaria Immunization Postpartum family planning Diarrheal diseases Pneumonia MoTeCH aims to address some of the community-based issues by offering a mobile health information service for pregnant women, their husbands and families. The woman’s pregnancy is registered in the MoTeCH system along with her Estimated Due Date. MoTeCH then sends the patient’s mobile phone a message each week, containing information specific to that particular week of pregnancy. The information aims to give practical advice on how to deal with some of the challenges of pregnancy; physical, emotional and financial. It provides reminders about what healthcare women should be receiving, and gives users tips about where to deliver, how to breastfeed, how to care for the baby, and explains local myths. It is intended that this service encourages better health seeking behavior, leading to improved health outcomes. Provides weekly, relevant, actionable pregnancy care voice messages in local languages 3 messages a week , Tailored to stage of pregnancy, and first year of child’s life, Women use their own or , household/compound phones, Free service Provides maternal and child health information and encourages better and timely health-seeking behavior

Pregnant Parents’ Service Engage Both Parents Relevant, actionable and fun information by SMS and/or voice Encourage health seeking behavior Available in local languages Product Development Consultation with GHS stakeholders at all levels, midwives, lactating and expectant mothers, fathers, mothers- in-law, village chiefs. Field testing of messages to ascertain appropriate messaging, voice, accent, dialect. MoTeCH aims to address some of the community-based issues by offering a mobile health information service for pregnant women, their husbands and families. The woman’s pregnancy is registered in the MoTeCH system along with her Estimated Due Date. MoTeCH then sends the patient’s mobile phone a message each week, containing information specific to that particular week of pregnancy. The information aims to give practical advice on how to deal with some of the challenges of pregnancy; physical, emotional and financial. It provides reminders about what healthcare women should be receiving, and gives users tips about where to deliver, how to breastfeed, how to care for the baby, and explains local myths. It is intended that this service encourages better health seeking behavior, leading to improved health outcomes. The service has been developed in collaboration with GHS policy makers and Upper East management, midwives, pregnant women and other community members. The content aims to address user’s knowledge gaps and support the work of the CHPS workers. Early and constant consultation with real potential users has helped MoTeCH to ensure they are creating a useful service.

Why do we need injections for both mother & baby? What do we do about body swelling during pregnancy? Why do I need IPT? Why should we practice exclusive breast feeding? These are some of the questions that potential users have asked . It is these kinds of questions that we are able to answer through the service. Why should I attend clinic at first signs of pregnancy? Why do I vomit when I’m pregnant?

Overview What is MoTeCH? Pregnant Parents Application (mobile Midwife) Tools for Community Health Workers(HIMS) To address some of the challenges faced by nurses, MoTeCH has developed Simplified Registers and a mobile system to capture some patent data.

HIMS Challenges For Nurses Volume of paper: up to 20 different patient registers for each facility Onerous data reporting: nurses spend 4-6 days per month aggregating data Little information flows back to the nurse: difficult to identify defaulters or high risk patients Nurse attitudes sometimes discourage clients from seeking health information For the CHPS nurses there are challenges in the reporting systems which rely on cumbersome paper forms, which take 4 - 6 days per month to complete, detracting from the time the nurses are spending with their patients. Information which nurses record in their registers does not flow back to the nurse in a way that is useful for reporting or service provision.

PROBLEM: SOLUTION: Too much paper, too little useful information SOLUTION: Using the mobile phone for data entry and management MoTeCH is enabling nurses to enter some of the information on the simplified registers on to a mobile phone. Doing this enables us to automatically generate some of the nurses’ monthly reporting. It is hoped that this will reduce the amount of time that nurses spend on administrative tasks. By capturing patient data on the mobile phone MoTeCH is also able to send the nurses reminders about patients who are due or overdue for care. For instance we can send nurses’ lists of all antenatal defaulters. It is hoped that this will make it easier for nurses to follow up on patients, resulting in better coverage of care. The phones are simple, low cost handsets which will be provided by MoTeCH. The simplified registers and mobile phone service together aims to reduce the burden of reporting and patient tracking for the nurse – reducing the many different registers that are currently in existence….

MOTECH Component #2: Nurses’ Application Data collection & Reporting Simplified paper registers Nurses record patient data onto mForms Upload data to central database Data validation ensures high data integrity Generates monthly reports for nurses and district officials Alerts & Reminders Sends alerts and reminders to nurses and clients about patient care We started with Nokia 1680 and migrated to Nokia 2330 and subsequently to Nokia C1. Currently the program is using Nokia ASHA 200.

Phone-based health education Phone based alerts and reminders System effect MOBILIZE SUPPLY Simplified Register Capture and store data more efficiently + Health worker focused mobile intervention information to support service delivery and continuity of care Improved supervision and feedback Increase quantity and improve quality of interactions between clients and health system Improve work routine and time for service delivery MOBILIZE DEMAND Phone-based health education to pregnant women and new mothers to increase knowledge and awareness Phone based alerts and reminders at “critical” times to promote and encourage utilization of essential health services

MOTECH Pilot-to-Scale & Transition to GHS Aug 2010: Pilot in KNW District, Upper East Region Sept 2011: Replication in Awutu Senya District, Central Region March 2012: Phase II: Scale & Transition To date Full implementation in 2 districts in 2 regions – Upper East, Central Began expansion to 3 new districts in 2 new regions – Volta, Greater Accra Approximately 23,783 clients currently enrolled (2 districts) ` 100 facilities reporting (automated or enroute to automation) 469 nurses trained and using MOTECH (automated or enroute to automation)

(Sustainable) Scale-up Status National steering committee formed and chaired by Director General of GHS, similar platforms at Regional & District level actively leading the program Proposed joint initiative to scale to an entire Region, led by GHS with TA from Grameen Possible MTN partnership: fee-based Mobile Midwife service that will cross- subsidize the free service for those who cannot aford. There are other similar programme running on different plat forms performing the HIMS COMPONENTS of MOTECH GHS community eRegister GHS - Sene Smart Phone Project The Pregnant Parent Components(messaging ) to be integrated into the GHS Community eRegister

Challenges Ahead Need for full implementation of national ehealth strategy to: ensure alignment and interoperability between MOTECH and other mhealth/ICT solutions in Ghana integration of the Nurses Application into DHIMS2 and GHS community eRegister systems Costing/packaging MOTECH model for full integration into GHS workplans and budgets Cost of airtime remains high, need for negotiation with Telcos to bring rates down and increase network coverage Securing mobile phones in high volumes at low prices for nurses GHS resource availability to support roll out – health sector budget already strained, Need to demonstrate the cost-efficiency of MOTECH vs. non- mhealth approaches for frontline data management/reporting and getting health information to women

GHS HIMS STRATEGY DHIMS2 Integration Tools Clinical Information Systems Community eRegister/Motech messaging Other Systems Data Warehousing and Reporting Data Integration Transactional Data

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