Mobile Technology for Community HealthMobile Technology for Community HealthGhana Ghana

Using mobile phones to increase the quantity and quality of maternal and child health services in Ghana

Focus on frontline community health facilities (CHPS zone, Health Centre's) and poor women in rural areas

What is MOTECH?

In CommunitiesMyths & Traditional Practices•The evil eye •At birth hot compresses may be applied to a baby’s skull to deliberately mold the baby’s skull to give them a ‘special’ shape•Colostrum is dirty •Eating eggs or meat during pregnancy will make the child a thief•Giving the “welcome drink” to introduce baby to the world•Eating clay helps with morning sickness

Knowledge Gaps•Dietary requirements•Health-seeking and sanitation practices for pregnant women and children

Maternal & Child Healthcare Challenges

• Volume of paper: up to 20 different patient registers for each facility

• Onerous data reporting: nurses spend 4-6 days per month aggregating data

• Little information flows back to the nurse: difficult to identify defaulters or high risk patients

• Nurse attitudes sometimes discourage clients from seeking health information

Maternal & Child Healthcare Challenges

For Nurses

• Provides weekly, relevant, actionable pregnancy care voice messages in local languages 3 messages a week Tailored to stage of

pregnancyand first year of

child’s life Women use their own or

household/compound phones

Free service

• Provides maternal and child health information and encourages better and timely health-seeking behavior

• Personal care during pregnancy

• Newborn care• Recognition of danger signs• Developmental milestones • Nutrition and breastfeeding• Malaria• Immunization • Postpartum family planning • Diarrheal diseases• Pneumonia

Messages provide key MCH information for “pregnant parents” and reminders to seek timely care:

PROBLEM:Too much paper,

too little useful information

SOLUTION:Using the mobile phone for

data entry and management

CHPS Mobile Phone System

Data Entry using Structured SMS

Automatic Reminders and Reports

Data collection & Reporting

•Simplified paper registers

•Nurses record patient data onto mForms

•Upload data to central database

•Data validation ensures high data integrity

•Generates monthly reports for nurses and district officials

Alerts & Reminders

•Sends alerts and reminders to nurses and clients about patient care

District/Region Status of Implementation

Kassena –Nankana West District (Upper East Region)

15 CHPS Compounds 4 Health Centers 54 Public Nurses trained 114 CHVs trained 11,274 Clients enrolled

Awutu Senya District (Central Region)

17 CHPS Compounds 5 Health Centres 11 Maternity Homes and Private Clinics 127 Public Nurses trained 32 Private Nurses trained 12,509 Clients enrolled

District/Region Status of Implementation

Dangbe East District(Greater Accra Region)

Simplified Registers deployed: 13 CHPS 6 Health Centers 1 District Hospital 92 Public Nurses

Trained in mForms: 14 CHPS 2 Health Centers

South Tongu District(Volta Region)

Simplified Registers deployed: 13 CHPS 5 Health Centers 1 District Hospital 1 Private Hospital 72 Public Nurses

West Gomoa District(Central Region)

Simplified Registers deployed: 13 CHPS 6 Health Centers 1 District Hospital 82 Nurses

CHPS Nurse

“MOTECH has been good because it helps us with our reports. Sometimes our tallying gives us incorrect data. With the phones we know the data that we get at the end of the month is correct. We used to have to pick lots of forms in different places and take them elsewhere, now it’s much easier.”

“With MOTECH we get our clients easily because we get

messages listing our defaulters. Some of them

also come to access services because MOTECH sends

them messages telling them to come. We get people coming here telling us that MOTECH has told

them to come to the facility.”

CHPS Nurse

“Some months ago I used to get two or three, but last month I had ten deliveries [at the facility] because the clients get the messages and they come. For postnatal they come. Even if they deliver at home they get the messages [from MOTECH] which make them come for postnatal. So I have benefited from MOTECH a lot.”

Midwife

MOTECH Nurse Feedback

“When we see our clients for an outreach we gather them in

a big group to educate them but we don’t have time to do

that 1:1. Often these meetings are big and noisy so not

everyone picks up what you've said. That's why MOTECH is

good because it provides 1:1 information to clients

along with personalized reminder messages”

CHPS Nurse

“With MOTECH I don’t feel alone during my pregnancy, I feel

that there are people that care for me and are concerned about

me while I am pregnant.”

“MOTECH helps a lot with preparation for birth. I felt like I

had a good idea of what would happen and how to prepare

practically & financially. I went to Paga Health Center & had a safe

delivery.”

“I liked the messages especially on the nutrition as I was able to

share with my husband so he could hear it and now I am

allowed to get these things such as beans, vegetables,

small ground fish for the soup and sometimes meat.”

Mobile Midwife: Client Feedback

Simplified Register Capture and store data more

efficiently +

Health worker focused mobile intervention

information to support service delivery and continuity of care

Improve work routine and

time for service delivery

Increase quantity and

improve quality of interactions

between clients and health

system

Phone based alerts and reminders

at “critical” times to promote and encourage utilization of essential

health services

Improved supervision and

feedback

Phone-based health education to pregnant women and new

mothers to increase knowledge and awareness

System effect

To date

Full implementation in 2 districts in 2 regions – Upper East, Central Began expansion to 3 new districts in 2 new regions – Volta, Greater Accra

Approximately 23,783 clients currently enrolled (2 districts)` 100 facilities reporting (automated or enroute to automation)

469 nurses trained and using MOTECH

Integrated architecture of interoperable systemsIntegrated architecture of interoperable systems and infrastructures

(paper, computers, internet, mobiles telephones

Replicated at each administrative level:•National•Regional•District

Data Warehouse

Logistics MIS

Human Resource Records

Medical Records

Household Tracking

Open LMISiHRIS

Open MRS

Export e summary data

Import e dataDHIS2/NBIT

Register pregnant women and immunization

Monthly summary Reports

Telephone

Data from/to mobilephones

Data capture fromPaper reports

GHS HIMS Strategy

Health Care Transactions and Electronic Health Records

Data Warehouseand Archive

Aggregated Dataand Reports

DHIMS (ClinicalAnd Business

Reporting)

IHost(Inpatient and

Outpatient ElectronicHealth Records)

Smart phones for ServiceDelivery

(Public Health ElectronicHealth Records)

Other DataData Collection

Systems(Surveys, etc)

Data WarehouseFor Health Care

Transactions

GHS HIS STRATEGY

•Strong buy-in from Ghana Health Service particularly at Regional & District levels – demand to expand the platform to include other health areas.

•Once nurses get used to the technology they embrace it and the time it saves them for client data management

•Strong enthusiasm from community women – anecdotal “evidence” of healthier pregnancies, increased ANC attendance, timely immunization.

•National steering committee formed and chaired by Director General of GHS, similar platforms at Regional & District level actively leading the program

•Proposed joint initiative to scale to an entire Region, led by GHS with TA from Grameen

•MTN partnership: fee-based Mobile Midwife service that will cross-subsidize the free service for poor women

Challenges Ahead Need for full implementation of national ehealth

strategy and leadership to:• ensure alignment and interoperability between

MOTECH and other mhealth/ICT solutions in Ghana• integration of the Nurses Application into DHIMS2

and eRegister systems

Costing/packaging MOTECH model for full integration into GHS workplans and budgets

• Cost of airtime remains high, need for negotiation with Telcos to bring rates down and increase network coverage

• Securing mobile phones in high volumes at low prices for nurses

GHS resource availability to support roll out – health sector budget already strained,

• Need to demonstrate the cost-efficiency of MOTECH vs. non-mhealth approaches for frontline data management/reporting and getting health information to women

Questions & Answers