Leveraging 4,000,000,000 Phones for Development:

TRACnet: A Case Study from Rwanda

by Pamela Johnson, VoxivaRuton Hinda, TRACplusJean Philbert Nsengimana, Voxiva SARL

Mobile Innovations for Social and Economic Transformation:From Pilots to Scaled-up Implementation

September 16, 2009

OutlineLeveraging 4,000,000,000 Phones for Development:TRACnet, A Case Study from Rwanda

I. Background

II. TRACnet

III. Implementing at Scale– ICT Infrastructure– Architecture and Integration– Sustaining Large-Scale Systems

IV. Extending the Model– Rwanda

• eSoko• mUbuzima

– Other Countries

V. Conclusions

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• Nine million people

• GDP/capita – $ 314/ year

• Health Statistics– Life expectancy

• 44, males• 47, females

– Immunization rate: 90%– Infant mortality rate: 86– Maternal mortality rate: 750/100,000 live

births

• 517 Health Centers

• Health Professionals– 401 physicians– 3593 nurses– 30,000 + Community Health Workers

*www.statistics.rw.gov, UNICEF, MoH

I. BACKGROUND: Rwanda*

CellPhone

PCs/Internet

PDA/Smartphone

SAMPLE DATA

A GoR information system that supports the national HIV/AIDS and other health programs.

Builds on existing telecommunications infrastructure

Allows TRACplus to:• Collect real-time information

from the field via web, phone, mobile application, paper...

• Communicate and send alerts and information back out to the field in a timely and systematic way.

• View Rapid visualization of data – in charts, tables, graphs and dashboards

LocalApplications

Phone

II. TRACnet:

COVERAGE• 2004: TRACnet launched to support

national ART treatment program operating in 16 facilities

• 2009: operating in all 225 ART treatment facilities in all districts

• End of 2009: expansion planned to all health facilities nationwide

5 CORE MODULES• Patient Registry

• Patient Registry• Longitudinal Patient Record

• Program Indicators• ART, VCT, PMTCT• Key Performance Indicators• Analytics and management views

• Inventory• Stock-level reporting• Stock-out and shortage alerts

• Laboratories• Lab result reporting and access from the field.

Disease Surveillance and Outbreak Alert

As soon as data is in the system, supervisors at multiple-levels view and analyze data in real-time via a web-based dashboard. They can: • Track new reports• Map and analyze data• Track and manage people. They can use communication tools to send alerts and broadcast messages out to the field.

SAMPLE DATA

Sample dashboards.

National

Disttrict

Facility

TRACKING > 105,000 PATIENTS

TRACnet: Results to DateACCESS AND USE• Widespread access - over 1,000 users at 219 facilities throughout Rwanda• > 7500 user sessions in April 2009 = > 85,000 sessions/year• Multi-channel access - using a national toll-free phone number, the web, a PC client

software, and a mobile phone client• 90% facilities reporting by IVR• Access to robust and easily navigable dataset of HIV/AIDS program indicators and

patient data

DATA• Aggregate program indicators since 2004 from all ART facilities and patient data• > 95% routine reporting• Longitudinal data on over 105,000 patients in care and treatment

TECHNOLOGY• A scaled national infrastructure - secure, access controlled, redundant infrastructure,

hosted in Rwanda at a carrier grade data center and managed 24x7• > 99% uptime• A robust enterprise architecture – built to support an evolutionary infrastructure,

TRACnet leverages a standards based infrastructure and software platform, evolving into an open standards framework for scale and interoperability

III: Implementing at Scale

• ICT Infrastructure

• Architecture and Integration

• Sustaining Large-scale Systems

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1998 2008Coverage Super-imposed on Health Facilities

a. ICT Infrastructure

Future Directions– Three mobile carriers– Fiber optic to be completed by

2009 (government, MTN initiatives)

– Submarine cable connection– Kigali, all district hospitals

connected– Site-level investments in

infrastructure and data management

– Support for connectivity in schools and health facilities

Current Reality: • Mobile is here• Internet is coming• You don’t have to wait

b. Sustaining Large-Scale SystemsSIMPLE FOR THE END USER

BACK-END: NOT QUITE SO SIMPLE

c: Architecture: Status QuoMOH

TB MalariaHIV/AIDS MCH EPI DiseaseSurv.

Donor 1

Donor 2

Donor 3

Etc

DistrictHealth Authority

ProvincialHealth Authority

Labs

Warehouse/Distribution Center

NGO NGO NGO NGO NGO

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In Peru, health workers spend 40% of time on paperwork and admin tasks.

Architecture: Integrated system• Rwanda eHealth

Strategy• Integrated national

system of systems• Common standards,

e.g. facility ID, national ID, SNOMED, etc

IV. Extending the Model: eSoko

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Community Health WorkersExtending the Model: mUbuzima

Other Countries• India

– Monitoring supply chain of family planning and other commodities to the community level

• Peru, Tanzania and Panama– National disease surveillance

• Peru– Monitoring maternal health program– Citizen safety

• Nigeria– Monitoring and evaluation of national HIV/AIDS program

• Zambia– Support for patients post-circumcision

• Kenya– Compliance support for patients on ART– Distribution of agricultural commodities

• Mexico– Compliance support for patients on ART– Cardiovascular risk assessment and support for behavior change– Support for diabetes patients

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V. Conclusions

• Mobile is here. Internet is coming

• Mobile telecommunication systems can be leveraged into large-scale enterprise information systems

• Mobile can be used to support health and other development sectors

• Sustaining any large scale enterprise information system requires investments in human capacity to use and maintain the system

• Mobile is a tool to reach citizens with services

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