ICMNH Seminar, JHSPH February 22, 2015

mInnovations Mobile Technology to Bridge Health Systems Gaps

and Improve RMNCH Outcomes

Alain B. Labrique, PhD, MHS, MS

DirectorJHU Global mHealth Initiative

Associate ProfessorDept. of International Health & Dept. of Epidemiology

Johns Hopkins Bloomberg School of Public HealthJHU School of Nursing

JHU School of Medicine (Health Informatics)

ChairWHO mHealth Technical Evidence Review Group

Maternal mortality data from 2000, Worldmapper.org

WHO 2013: ~289,000 maternal deaths = ~484 per day = 1 every 3 minutes

A future where: • Every family has access to

information, services and medicine

• Every health worker has the skills, training and support to do his/her job consistently well

• A health system counts and is accountable for every life.

Euclidean map of 10 million of the 850 million

Facebook users friend networks© Paul Butler, FB

The World is Rapidly Changing

0.2

.4.6

.81

Pro

ba

bili

ty o

f M

ob

ile P

ho

ne

Ow

ne

rship

2008 2009 2010 2011 2012

Year

Lowest Quartile WI (n=17,176) Low Quartile WI (n=19,789)

High Quartile WI (n=6,472) Highest Quartile WI (n=1,032)

Mobile Phone Ownership by WI over Time

Household Mobile Phone Ownership over time in rural

Bangladesh, by “Wealth Index” (n=44,469)

Labrique, Tran et al, 2013 (JMIR, in press)

Pro

po

rtio

n o

f H

H r

ep

ort

ing “

Mo

bile

Ph

on

e O

wn

ers

hip

”

mHealth

www.jhumhealth.org

137 mHealth Projects at JHU, as of February 2015

mHealth:The Four C’s

Harnessing ubiquitous information

and communication technology to

collect data, connect individuals,

compress time and create novel

opportunities to improve

individual and public health.

Labrique, Vasudevan, Kochi et al, mHealth Innovations as Health System Strengthening Tools. Global Hlth Sci Prac 2013

*Most downloaded / cited mHealth article 2013-14.

12 Common Applications of mHealth

Labrique et al. GHSP, 2013

mHealth is not a single THING.

Mobile tools can be used to strengthen

different parts of the health system.

mHealth Technical Evidence

Review Group for RMNCH

http://bit.ly/who-mterg

“Providing governments and implementing agencies

objective, evidence-based guidance for the

selection and scale of mHealth strategies

across the reproductive, maternal,

newborn and child health continuum”

-mTERG Mission Statement 2012

Health System Adequacy

Provider Competency and

Accountability

Patient Knowledge and

Self-Efficacy

ARTICULATING mHEALTH

STRATEGIESAS

HEALTH SYSTEMS

INNOVATION

• INFORMATION• DEMAND CREATION• SUPPORT SYSTEMS

• WORK MANAGEMENT• DECISION SUPPORT• ENUMERATION• SURVEILLANCE

• SUPPLY CHAIN• STAFF AND FACILITY

PERFORMANCE MONITORING

• REFERRAL SUPPORT

Frontline Health Worker

Task Shifted Responsibiliites

Community Education

Referral / Linkage to Facilities

Screening

Treatment

Monitoring / Support

Agarwal S, Perry H, Labrique AB, mHealth for FHWs, In press 2015

INTERVENTIONOF KNOWN

EFFICACY

EFFECTIVECOVERAGE

mHEALTH: A Health Systems Catalyst

Jo Y, Labrique AB et al. PLOS One 2013

Shift focus from “Does mHealth work?” to “Does mHealth optimize what we know works ?”

mHealth doesn’t work in a Vacuum

Targeting the CLIENT

Global PPP

Initiative

“If you have any bleeding during this month, seek medical attention right away”

Expectant women/ new mothers sign

up for service

Users receive 2 health-related SMS or Audio Message

weekly

NGO Partnership and “Freemium” Model of

Subscription

“Your baby needs an immunization this week

to stay healthy: Available free at all

EPI clinics”

US, Bangladesh, South Africa, Russian Federation, India

Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A Meta-Analysis of Randomized Controlled TrialsDavid J. Finitsis, Jennifer A. Pellowski, Blair T. JohnsonPLOS ONE 2014

Client-Driven Event Notification in “real-time”

Try it:

SMS “birth” to

+1 443 393 2228

Targeting the WORKFORCE

https://www.youtube.com/watch?v=hAgzvD7WNFI

Mobile Academy for Frontline

Health Workers

Burden has grown on health workers to collect and report data

Multiple Paper Tools & Registers

Inaccessible, Unusable data

Tremendous time and effort is invested in manual data summarization and reporting.

19 registers contain 473unique data fields !

Approximately 60 fields would be required for a

digital system to process the same information.

SmartRegister.org

Emphasis on user-focused design to facilitate FHW utilization and feedback.

Nutrition (6) >

Integrate workforce and client training as part of the exposures

mCARE: Community-Health Worker System to improve delivery of ANC/PNC and increase client demand

mCARE Tripled ANC and Doubled PNCin Rural Bangladesh

mTikka – Mobile phone enabled virtual vaccination registry

http://tinyurl.com/mtikka-video

Targeting the SYSTEM

Project Mwana: SMS to reduce Infant HIV PCR Turnaround Time

(Median 46% Reduction in DAYS)

New frontiers!

Remote, Point-of-care Diagnostic tools

Breslauer D., et al. 2009 Mobile Phone Based Clinical Microscopy for Global Health Applications. PLoS ONE 4(7): e6320

New frontiers!

• US FDA Approved• 2-lead ECG

Start simple –leverage ‘mhealth’ in its natural state

m-Labor

Notification

System

Pilot Study

Source: Gernand, JiVitA Data 2011

(Unpublished)

306 (88.9%)

Births Attended

Don’t underestimate the power of a phone… as a phone.

mHealthEvidence.org / mHealthKnowledge.org

Rigorous Process / Outcome / Impact Evaluationeg. RCTs

mHealth requires BOTH Engineering and Public Health Approaches

NEED ADEQUATE FUNDING FOR THIS

Mobiles ?

alabriqu@gmail.com

alabriqu jhumhealth

www.jhumhealth.org

THANK YOU