CRS ICT4D mHealth Expo

Bobby Jefferson, Senior Health Informatics Advisor, Futures Group • Principal Investigator CDC HMIS Grant Kenya• Senior HMIS Advisor - AIDSReliefAbby Clay, Senior Business Development Associate, Futures Group

Global Organizational Structure

Futures Group Global, LLC

Chris LeGrand, MSChief Executive Officer

Futures Group Global, LLC

Chris LeGrand, MSChief Executive Officer

Center for Policy & Advocacy

Sarah Clark, PhDVice President

Center for Health Systems & Solutions

Shannon Hader, MD, MPHVice President

Finance & Administration

Timothy SchurChief Financial Officer

Finance & Administration

Timothy SchurChief Financial Officer

Technical

Farley R. Cleghorn, MD, MPHSenior Vice President & Chief Technical Officer

Human Resources Human Resources

Operations

Ed Abel, MPASenior Vice President & Chief Operating Officer

Operations

Ed Abel, MPASenior Vice President & Chief Operating Officer Organizational Dev

BenefitsRecruitingEmployee Relations

• Founded in 1971

• Headquartered in Washington, DC USA

• 467 staff worldwide

• Operating in 30+ countries

• Largest country presence,

USAIndiaAfghanistanKenyaSouth AfricaTanzania

Nigeria, Kenya, Uganda, Tanzania, Rwanda, Zambia, South Africa, Haiti

Guyana, Ethiopia , 10 Countries, 244 Hospital Facilities + 112 Satellites Clinics , 535 Antenatal Care - PMTCT sites

Supporting rural, remote, faith based mission hospitals “serving poorest of poor”

Lack power, intermittent power, No IT staff, No internet, Sparse mobile coverage

Nurses, Health workers need to report health indicators, M&E program data on monthly basis

Cost effectiveness and sustainability -- no funds for proprietary licenses, or yearly maintenance fees

mHealth Informatics Challenge

Health IT Solutions

Collectively referred to as IQSolutions

1. Electronic medical records1. IQCare   - Reviewed by CDC, WHO, USAID

2. IQChart - French language

2. Mobile Phone solution (SMS technology)

3. Site Capacity Assessment Dashboard (SCA)

4. Monitoring & Evaluation Electronic reporting

5. GIS and GPS related IQGeo

6. SQL Training, Virus Remediation Training

•  

Use of freely available, reusable, tools, “coded in country” Creative commons approach

Reusable software and technology across countries and programs

Offline Solutions, Disconnected modelLocal programmers, all IT staff in country (Africa)

Low costs, Inexpensive $200-$350 Netbooks Samsung Solar netbooks Solar mobile phones, SMS instead of

SmartphonesUse of inverters to address power

Health IT Solutions

IQCare – Go from Paper to mobile health tablet for EMR

HIV– TB, PMTCT, MCH, Immunization, Well Baby Indicators, Chronic Diseases

demo

http://173.203.65.108/iqcare/frmLogin.aspx Username: user1 Password: 1 Facility/Satellite: 001-01-01-Demo Site

IQSMS – Mobile Phone Reporting by Health Workers

PMTCT Currently consists of 4 types of monthly reports

1. PMTCT Antenatal Clinic (ANC) Monthly Summary Form2. PMTCT Care Register Monthly Summary Form3. PMTCT Maternity (L&D) Monthly Summary Form4. PMTCT Mother - Child followup SummarForm

IQSMS PMTCT Reports

Monthly and Quarterly Reports

PMTCT Report

Must Pass All Data Quality Rules,District Office

Data Quality Checks

NUMBER OF CLIENT HAD HIV TEST AT ANC

• Nurses and community health worker receive per diem or transports costs for picking up or bringing their list and reports back and forth to health facilities, district offices, etc.,– they’re not interested in losing out in reimbursement;

• After early adopters, health care workers not keen sending message unless they have free airtime and toll free number available from their mobile telecom provider ; we increase use by 50% when toll free is available

• The older staff have more difficulty using mobile for messaging and reporting;

• Often other people have access to the phones (25% share phone vs. Own) and often those text message can be forwarded to others

• Staff in rural areas want their SMS messages in Swahili or local language; Detailed instructions in Swahili to how to do reporting and use phones for reporting

technology isn’t the barrier to scale up

Facility Name DistrictDistance from Facility to District (KM)

Time spent to Deliver PMTCT Report (Hrs)

Bus Fare (Tsh)

MWANZA Region

NYAMAGANA DISTRICT

Mwamashimba Health Centre Kwimba 50 1.30hrs 10000Malya Health Centre Kwimba 25 1hr 5000Kikubiji Dispensary Kwimba 102 4hrs 20000Kiliwi Dispensary Kwimba 100 4hrs 20000

KWIMBA DISTRICT Nyakalilo Health Center Sengerema 46 2 HRS 8000Mwangika Health Centre Sengerema 98 4 HRS 10000Sengerema Health Centre Sengerema 10 20MIN 3000

SENGEREMA DISTRICT Kharumwa Health Centre Geita 115 3HRS 20000Nzera Health Centre Geita 48 2HRS 8000Katoro Health Centre Geita 50 45MIN 6000Nkome Dispensary Geita 80 2HRS 6000Nyang'hwale Health Center Geita 85 2HRS 7000Kasamwa Health Centre Geita 25 30MIN 4000Bukori Health Centre Geita 60 1:30HRS 6000

Tanzania

• Delays with data flow and information reporting from the District and Regional level to the National level

• Inaccuracy of reports being received thus requiring further on site data verification

• High cost of supervision and sending report to district in regards to travel costs to access the 535 health facilities

Ever used the phone for SMS servicesNo 52.17%Yes 47.83%Total 100 All staff own the

telephone handset and share it in daily personal uses

Any problems with small buttons on the phone?

Response Freq %

No 30 85.71 Yes 5 14.29 Total 35 100

Instruction on Swahili critical to using IQSMS

Response Freq %

No 6 17.14 Yes 29 82.86 Total 35 100

• Reasons For Not Sending Monthly Report– Majority said they don’t understand English language

– Need message understandable in Swahili language

IQSMS Instructions in Swahili

Anything that can be improved on report submission to make report to be on time

Response Freq %

No 14 40.00 Yes 21 60.00 Total 35 100

Barriers to implementing mobile phone reporting for submitting all four reports each month Mobile Network Problem/failure Server don’t respond on time PCR report type is hard It have been found that free

Airtime is critical for scale up

*EMRS – Electronic Medical Records System

Health IT Solutions

*EMRS – Electronic Medical Records System

Health IT Solutions

Tanzania mobile phone coverage and mobile penetration Vpdacom Tanzania

•  

Excel PMTCT MONTHLY REPORT   PMTCT Antenatal Clinic (ANC) Monthly Summary Form    

ANC 01. New ANC clients this month  1188

ANC 02. Previously known to be HIV positive   17ANC 03. Total number tasted   574ANC 04. Number of new client had HIV test at ANC   277ANC 05. Tested HIV-Positive   37ANC 06. Post-test counseled for positive and negative   574

ANC 07. Number of partners tested for HIV   16ANC 08. Tested HIV-Positive   4

Orphans Vulnerable Children (OVC), Most At Risk Population (MARPS), Maternal Child Health (MNH)

Ms Access Database

PDA device

Web Internet Desktop

Excel Only

M&E Electronic Reporting SystemSolar Power Cell phones

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.atsdr.cdc.gov

For more information Contact

Bjefferson at futuresgroup.com Lburrows at futuresgroup.com