1. D-Tree International
Who we are, what we do

2. D-Tree background
Vision - A world in which every person has access to high quality healthcare
Mission – To develop and support electronic clinical protocols that that enable health workers worldwide to deliver high quality care
Founded in 2004: Currently 5 staff in US, 14 in Tanzania, 1 in Malawi and 1 in India
29/03/2011
CRS ICT4D Conference

3. D-Tree background…
Health workers in clinics and community health workers are the front line of the health system, yet face high turnover and often have little training
Challenges also exist in collecting and reporting data
We build mobile applications to reinforce the training provided and to assist our partners in monitoring and managing the work that is done in remote locations
29/03/2011
CRS ICT4D Conference

4. What we do
Develop or adapt clinical protocols in a mobile, electronic format
Validate protocol effectiveness to ensure quality of care
Design open-source software to support scale up and correct use of protocols
Improve decision making through data and reports available across the continuum of care
29/03/2011
CRS ICT4D Conference

5. Continuum of Care develop / refine defined quality standards
Neonatal
Infant
Care
Child Dev.
+ Nutrition
Adolescent
Life Skills +
Health
Antenatal
Labor +
Delivery
Post
Natal
Parenting
Skills
Family
Planning
develop / refine defined quality standards
develop phone based delivery of standards to improve use
monitoring tools of standards use for supervision
patient data for quality improvement and links among providers
data links to HMIS/DHIS for supervisors + managers
D-tree
Activites

6. Training and Pilot prep
Our process
Design
Review of guidelines
Observe patient flow
Develop protocol
Develop prototype
Field Refinement
Train small group of workers
Weekly meetings to collect feedback
Incremental application refinement based on HCW feedback
Training and Pilot prep
Train larger group of workers
Complete central server set-up
Pilot
Monitor use of field applications
Regular meetings with HCWs
Validate reports
Assessment
Data analysis
Measure effectiveness of application and interventions
Lessons learned for larger scale-up
29/03/2011
CRS ICT4D Conference

7. TOSA Pilot Project - Bihar
Our work in Tanzania, Malawi, and India…
Chronic disease
HIV/AIDS
Diabetes
Hypertension TB
3. Preventive Care
Antenatal
Immunizations
Care and support
2. Child health
IMCI
Malaria
Newborn
HIV/AIDS
Nutrition
4. Reproductive Health
Family Planning
Labor & Delivery
Newborn
2/25/2019
TOSA Pilot Project - Bihar

8. Applications Community Facility
Maternal and Child Health (Ante-natal, Post-natal, Neo-natal)
TB screening
Home based care
Orphans and Vulnerable Children
Family Planning
Facility
IMCI
Active Management of Third stage of labor
Immediate Newborn Assessment
29/03/2011
CRS ICT4D Conference

9. Software in the field
29/03/2011
CRS ICT4D Conference

10. Who do we partner with
NGOs who are actively supporting the national and local government in their health programs
NGOs who are interested in improving the quality of care and data collection in the areas where they work
29/03/2011
CRS ICT4D Conference

11. Role of partner
Work closely with government partners at national, regional, district and facility level
Provide subject matter experts (SMEs) or access to SMEs in other organizations to assist in protocol development
Provide insight into local language and cultural practices, or access to those who can provide information
29/03/2011
CRS ICT4D Conference

12. Role of D-Tree
Develop protocols working with government partners and SMEs
Encode the protocols onto phones (java-enabled phones or smartphones)
Lead the field refinement process and train users
Adapt the software and protocol to incorporate the feedback received in the field
Set up server and reporting for use by government and partner organization
29/03/2011
CRS ICT4D Conference

13. Partners

14. Pathfinder
Developed mobile application to assist CHWs in the home visits for PLHA and Chronically ill patients
Guide management of patient schedule visits
Provide referral reminders for follow-ups all referred patients
Deployed and currently used by about 150 CHWs in the field.
29/03/2011
CRS ICT4D Conference

15. Pathfinder… Focus group discussion
Field Investigation
29/03/2011
CRS ICT4D Conference

16. JHPIEGO
Developed facility and community protocols for antenatal, neonatal and postnatal care in accordance with Tanzania MOH guidelines
Developed prototype applications ready for field refinement
29/03/2011
CRS ICT4D Conference

17. Treatment based on lab results
JHPIEGO…
Check for danger signs
Treatment based on lab results
Counseling messages
29/03/2011
CRS ICT4D Conference

18. UNICEF
Developed protocols to support outpatient treatment of severe acute malnutrition in Zanzibar
Developed application to support screening, registration, treatment and prescribing to be done at the health facility
Field refinement and pilot to be completed by June 2011
29/03/2011
CRS ICT4D Conference

19. UNICEF…
29/03/2011
CRS ICT4D Conference

20. PATH
Designed and Refinement of mobile app for District TB/HIV Coordinators (DTHCs) in Tanzania
Designed and Refinement of mobile application for Community Volunteers to do TB screening in the community
29/03/2011
CRS ICT4D Conference

21. CARE-India
Developed protocols for Individual Birth Planning and ANC, Active Management of 3rd Stage of Labor, Immediate Newborn Assessment and Postpartum follow-up for mother and child
Establishing server for integration of all patient data in OpenMRS
Application development and field refinement completed.
29/03/2011
CRS ICT4D Conference

22. CRS Malawi
Assisting with three mobile applications to improve the quality of life for orphans and vulnerable children and people living with HIV
Child Status Index
Supporting OVC committees
Community – IMCI
Supporting Health Surveillance Assistants
Mother-infant pair follow-up
Supporting Health Promoters
29/03/2011
CRS ICT4D Conference

23. What we have learned
Frontline workers quickly learn to use mobile phone based protocols
Mobile phones can significantly increase adherence to guidelines
Protocol development is a labor intensive, iterative process
Linking patient information across space and time can improve quality of care
29/03/2011
CRS ICT4D Conference

24. Keys to success
Willingness to try something new and listen to the field level workers
Active engagement in the protocol development and technology support by all parties involved
Incorporation of project into larger efforts so that this is not a stand alone “technology project”
Understanding that this is not “out of the box”, but an iterative process which will get us all to tools that can have a real impact
29/03/2011
CRS ICT4D Conference

25. What’s coming next
Linkage of community and facility based information and tools
Incorporation of media (pictures, videos, voice) into protocols
More in depth clinical protocols
Improved supervisory reporting
Reporting from OpenMRS
29/03/2011
CRS ICT4D Conference

26. Contact us http://www.d-tree.org
Offices in Boston, Tanzania and Malawi
Phone:
29/03/2011
CRS ICT4D Conference