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 have 5 staff in US, 14 in Tanzania, 1 in Malawi and 1 in India

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

4. 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

5. Adolescent Life Skills + Health Antenatal Labor + Delivery Neonatal Infant Care Child Dev. + Nutrition Post Natal Parenting Skills Family Planning Continuum of Care D-tree Activites 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

6. Applications Community – Maternal and Child Health (Ante-natal, Post-natal, Neo-natal) – TB screening – Home based care – Orphans and Vulnerable Children – Family Planning Facility – IMCI – Maternal and Child Health (Ante-natal, Post-natal, Neo-natal) – Active Management of Third stage of labor – Immediate Newborn Assessment

7. Representative Clients

8. Software in the field

9. 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 in use by over 107 CHWs in the field. Plan to have over 200 CHWs users end of Nov 2010

10. Pathfinder… Focus group discussion

11. 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

12. JHPIEGO… Check for danger signs Treatment based on lab results Counseling messages

13. 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

14. UNICEF…

15. 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

16. PATH - Summary of data submissions Number of users (CHWs & DTHCs): 14 Total forms processed by 25 Oct: 1284 FormNumber ReceivedMost Recent Submission CHW- Diagnosis form12930/07/2010 CHW- Registration form20201/10/2010 CHW-Survey form52525/10/2010 CHW-TB screening form20106/09/2010 DTHC-closing facility form1817/10/2010 DTHC-facility registration form15522/10/2010 DTHC-TBHIV Data collection form3207/10/2010 DTHC-TBHIV Supervision form2207/10/2010

17. CARE-India Developed protocols for Individual Birth Planning and ANC, Active Management of 3 rd 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 ongoing and due for completion by January 2011

18. 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