Photo credit: OneWorld South Asia
Using mHealth to
Implement the Global
Strategy
The Maternal mHealth
Initiative Globally and
in Practice
David Aylward
Executive Director, mHealth Alliance
Al Hammond
CEO, Healthpoint Services Global, Inc.
November 12, 2010
www.mHealthAlliance.org
The mHealth Alliance seeks to leverage the global reach of wireless networks and mobile devices to improve health outcomes in underserved communities through...
• Thought Leadership
• Develop Value Chains
• Research, Monitor & Eval.
• Communications
Information
• Co-Development
• Co-DeploymentImplementation
mHealth Alliance: Catalyzing Mobile
Innovation for Global Health
Founding Partners:
70% of mobile phones are in emerging economies –
and that continues to climb fast - ITU 2010
Credit: DataDyne.org…catalyzing the thought leadership and information sharing to co-develop and co-deploy innovative, interoperable mHealth solutions
www.mhealthalliance.org
Takeaways
• More health for the money = innovation
• Innovation means modern ICT, esp. mobile
• Reaching the unreached, equitable strategy = mobile
• Deploy ICT along continuum of care; then experiment
• Transformation is required
• Distributed health, not just electronic records
• Need to move beyond pilots and proofs of concept
• Need systems, integrated approaches
• Need scale: what are the value chains and business models?
www.mhealthalliance.org
• Beginning to see the value of mHealth for health and business; public health and carriers alike
• mHealth: “force multiplier and extender” for shortages of skilled personnel and facilities
• Today – Keep it simple. Use modern ICT (mostly wireless) to support implementation of known, valuable interventions
• Tomorrow – Add remote diagnostics and sophisticated decision support; chain of information support; CER
Context
www.mhealthalliance.org
• Innovative tools already exist in remote diagnosis,
medical consultation, just-in-time training
• Holograms of blood cells using phone camera
for malaria, HIV/AIDs, anemia, clean water
• Doc in the box package for primary care: msteth,
BP, Pulse/Ox, fetal monitor, ekg, body position
• Transfer of images: cervical cancer diagnosis
• USB-connected hand held ultrasound for $1000
• “Serious games” via handsets for training CHWs
Future Possibilities
www.mhealthalliance.org
Barriers to mHealth
• Lack of high level government understanding
• Lack of health value chain analysis
• Lack of business value chain analysis
• Lack of integrated systems
• Tragedy of the Commons
So . . .
• Inflection point in developing world
• Will they follow the Western model?
12/7/2010 7
Sources
de
Financement
Structure
d'appro-
visionnement
1er point
de stockage
2ème point
de stockage
3ème point
de stockage
ETAT BANQUE
MONDIALE
FONDS
MONDIAL
PNA
(Population)
U
S
A
I
D
UNICEF USAIDPNA
PNA
Systèmes d'approvisionnement des produits pharmaceutiques au SENEGAL. Avril 2008
F
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A
P
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A
V
I
MEDICAMENTS
ESSENTIELSARVs
PALUDISMEY compris ACT TB IO
ARVs
Ped
REACTIFS
sécurité du sang
(+ test HIV)
VACCINS Préservatifs ContraceptifsDispositifs
Médicaux
Etat
Bailleurs
multilatéraux
Bailleurs
bilatéraux
ONG/Privé
J
I
C
A
DLSIPEV
RM
Dépôt district
CS PS
DSR
OMS FNUAPJICA
PRA
SEIPS District
CHR SEIPSRelais
Communautaire
Centre de dépistage
VIH/SIDA
PATIENT
Grossistes
privés /
Population
Grossistes
privés
Grossistes
privés
Officines
Structure
dispensatriceDPCHU CHN Case de Santé
I
P
P
F
G
D
F
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I
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I
D
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CNTS CLINTON CNLS GDF FHI
CNTS PPJ
Banque de
sangCCA
Cliniques
privés
PNT
Ministère de la Santé
et de la Prévention MédicaleProcurement systems for pharmaceutical products – Senegal, Apr 2008
The Supply Chain for Health Products is Complex
Maternal mHealth Initiative
• The collaborating partners have designed this Maternal mHealth Initiative (MMI) to couple expertise of practitioners with ICTs, especially mobile.
• MMI features a multi-prong, global campaign of consultation, solution development, testing, monitoring, evaluation, and knowledge sharing to deliver progressively more integrated and expert solutions along the Continuum of Care.
Continuum of Care
Pre-Pregnancy
Pregnancy Birth Postnatal
MMI Initial Collaborators
• Partnership for Maternal, Newborn & Child Health
• BRAC, PATH, White Ribbon Alliance
• Rockefeller Foundation, GSM Association
• NORAD, Family Care International
• Johns Hopkins School of Nursing and Bloomberg School of Public Health
• HP, Healthpoint Services
Continuum of Care
Pre-Pregnancy
Pregnancy Birth Postnatal
www.mhealthalliance.org
Three Key Action Areas
• Information and dialogue: What is being done? What should we do? HUB
• Modeling the best practices design
• Trials designed for scale
What Does It Take to Have A Baby?
Confirm
PregnancyFinancial
planning for
growing
family
Nutrition
and Health
Education
Find
doctor
Consultation
and testing
Schedule and
remember
appointments
Travel to
birthing
centerTravel to
clinic Alerting
midwife
or nurseDelivery
Ante-natal
check ups
and
vaccinations
Formula,
diapers,
medicines
Knowing what to
do when
contractions
begin
5x +5x +
‘Maternal Health’ is not a thing, but a process.• For the process to work properly, so a woman can
have a healthy and safe pregnancy and delivery, a system must be in place.
• Many of the processes within the system are repeated throughout the length of the pregnancy as well – it is not a linear system.
Integrated Systems Along the Continuum of Care & Support
Education & Awareness
Diagnostic & Treatment
Support
Administration & Training
Supply Chain Management
Monitoring & Evaluation
Finance & Payments
Provider Continuum of Support
Continuum of Care
Pre-Pregnancy
Pregnancy Birth Postnatal
If you live in a rural,
remote area, is all
of this even
possible?
Affordable?
If you live in a rural,
remote area, is all
of this even
possible?
Affordable?
If the
processes
necessary to
complete a system
could rely on a local,
technology-enabled facility,
not only is the system
possible, it can
be scalable, and affordable.
A local, technology-enabled, medical facility:E Health Point
On October 28, 2009, Healthpoint Services, in partnership
with Ashoka, launched an innovative market-based model
that has the potential to transform the rural healthcare
sector.
The medicines
are affordable,
high quality
generics.
Villagers who had never before
met with a real doctor, now speak
with them over a broadband
video link. Remote on-line diagnostic
tests and electronic health
records enable high quality,
evidence-based healthcare.
From diabetes to malaria, to HIV
and kidney function, over 60 point-
of-care diagnostics are available at
each E Health Point. The average cost to
the patient is $1.
Safe drinking water, collected daily
for about $1.50/month, is a critical
preventive aspect of primary
healthcare.
Healthpoint Service and Mobile
Maternal Health
• The first EHP birthing center will open in December, 2010 in rural Punjab, India
• Healthpoint intends to track every pregnancy and register every birth in the villages it serves via mobile-empowered health workers
• Healthpoint Services’ Goal is to achieve zero maternal deaths and 100% infant vaccination in the villages in which it operates
– An audacious goal but one that is possible when thinking at a systems level
But one business does
not a system make
What is the Ecosystem Required to
Deliver These Processes?
TechnologyHealthcare &
Medical
Government &
Foundations
Business &
Finance
• Mobile telecom co.
• Broadband
provider
• Water purification
technology
• Electronic health
record systems
• Video conferencing
• Low-power PCs
• Mobile data
platforms
• Solar power
suppliers
• Diagnostic
providers
• Medical supplies
providers
• Doctors, nurses
• Health workers
• Pharma suppliers
• Hospital chains
• Treatment
management
specialists
• Supplemental
nutrients provider
• Reimbursement /
funding for
vaccinations
• Public sector
medical facilities
• District medical
officers
• Supportive policy
environment
• Ambulance service
• Nutrition and health
information
• Mobile money
providers
• Health-related
consumer goods
providers
• Training providers
• Financing sources
• Micro health
insurance or
savings plans
TechnologyProcess Example of Provider
GPS location of local clinics or accessible
physician providers
Mapping systems, telecom providers
SMS reminders for appointment or meds,
appointment scheduling
Telecom providers, mobile apps
SMS to midwife or nurse, alerting delivery
team
Telecom providers, mobile apps, hospitals
Find
doctor
Schedule and
remember
appointments
Alerting midwife
or nurse
Healthcare & Medical
Confirm
Pregnancy
Consultation
and testingDelivery
Ante-natal
check ups
and vaccinations
Process Example of Provider
Receive pregnancy test Diagnostic providers
Doctor consultations and periodic testing Diagnostic providers, lab equipment
providers, hospitals
Delivery Hospital specialists, medical equipment
providers
Ante-natal check up and vaccination Pharma companies, hospitals, consumer
goods companies, diagnostic providers
Government & Foundations
Nutrition and
Health Education
Travel to
birthing centerTravel to
clinic
Knowing what to
do when
contractions begin
Process Example of Provider
Sign up for and receive nutrition and
health reminders
Public health organizations and SMS
providers
Traveling to and from a clinic, or
community health worker visiting patient
Government reimbursement/ funding
Receive training on SMS system to use
when contractions start
Public health organizations, local clinic, and
SMS providers
Travel to birthing center Hospital emergency team or government
reimbursement
Business & Finance
Financial planning for
growing family
Formula, diapers,
medicines
Process Example of Provider
Health and water savings accounts Mobile money providers, micro lenders
Pre-pay health services Financial institutions, mobile money
providers
Purchase of consumer goods, medicines,
products
Consumer goods companies, local
businesses
A Woman’s Journey Through the
Maternal Process Relies on an Ecosystem
Confirm
PregnancyFinancial
planning for
growing
family
Nutrition
and Health
Education
Find
doctor
Consultation
and testing
Schedule and
remember
appointments
Travel to
birthing
centerTravel to
clinic Alerting
midwife
or nurseDelivery
Ante-natal
check ups
and
vaccinations
Formula,
diapers,
medicines
Knowing what to
do when
contractions
begin
5x +5x +
Questions for Discussion:
• What are the challenges to building this ecosystem?
• How does the maternal health community create the
incentives needed for different actors to engage in the system?
• How can the public sector best facilitate the creation of this
ecosystem?
Email: [email protected]
Phone: +1.301.996.3228
www.globalhealthpoints.com
Email: [email protected]
Phone: +1.202.887-9040
www.mHealthAlliance.org
www.HealthUnBound.org
