Programme Mwana2

Leveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and

Underserved Areas

Mobile health technology has the power and potential to make PMTCT more efficient and effective

The ProblemOverburdened health system and difficult to reach areas

The InnovationStrengthen entire PMTCT system using mobile technology

How Programme Mwana improves thisNow: Decrease turnaround time for PCR test results, increase number of results, enable real-time problem-solvingFuture: Track women and children to ensure that all individuals living with HIV are tested, enrolled in care, and treated

There are huge challenges implementing programs and tracking progress in line with the Global Plan and MDGs

The Global Plan seeks to eliminate vertical transmission by 2015Reduce new HIV infections among children by 90% & AIDS-related maternal deaths by 50%

However, we have no way to accurately identify the number of children currently infected

Using current methods, we will not know if we have reached the MDGs until the date has passed

Current monitoring: expensive, labor intensive, retrospective, one-way information flow

Failure to identify and enroll children living with HIV on treatment is a critical gap in the PMTCT cascade; many of these are in remote areas where UNICEF works

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0 ANC

MaternalHIV Test

Maternal ARVs

Institutional Delivery

Infant ARVs

Infant HIV Test

* Median of 22 PMTCT priority countries

Source: Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, 2011

Treatment

EID

?

Although Early Infant Diagnosis (EID) is a critical part of elimination efforts, many think that it is an intractable problem

Challenges with EID• Do not know true transmission

rates in countries• Lengthy transport of samples to the

central labs• Long distances that mothers have

to travel for multiple visits• Long turnaround times• Do not know whether mothers

receive results

Other approaches have failed• PCR turnaround time has been the

focus, but turnaround time is not enough

• No cohort data, only cross-sectional so hard to know longer-term results

• Faster results do not necessarily mean that infants are being treated

• Lack of community interaction• Point-of-care solutions are far away

from being implemented

Mwana is the response to that is faster, cost-effective, and approaches the problem at a systems level TODAY

• Health system focused, trained Clinic Staff

• Community focused, trained Community Health Workers (CHWs)

All SMS are free to end users

Programme Mwana utilizes two main software components

To build the software for Programme Mwana we moved to rural Zambia and spent six weeks co-creating it with clinic staff

Keemba Luyaba Manungu Mazabuka Hospital

Mbaya Musuma

Monze Urban Nakambala Urban

Nameembo Nega Nega Rusangu 0

102030405060708090

100

7468 71

61

75

89

38

90

7869

4035 33 29 33 37

30 29

48

71

Turnaround Time to Caregiver, Pre- vs. Post-SMS System, Southern Prov-ince, by Facility (uncensored)

Pre-SMS (N=569) Post-SMS (N=210)

Facility

Aver

age

turn

arou

nd ti

me

(day

s)

56% improvement in Turnaround Time of results

Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes

Sidenberg et. all, Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results, Bulletin of the World Health Organization 2012;90:348-356

SMS (N=146) Hard Copy (N=103)0

10

20

30

40

50

60

7060

42

SMS vs. Hard Copy, Volume of Results Received, Luapula Province

Method of Result Receipt

Perc

ent

30% more results delivered using SMS

Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes

Schaefer, Nicholson, Mugala; Monitoring and Evaluation Presentation to the Zambia Ministry of Health; 2011

Health Facility

District Medical Office

Provincial Medical Office

National IT Management Team

Implementing Partner

Lab Team

Software Development Team

Secondary Support

Primary Support

A MoH Tiered Management plan allows for redundancy in accountability

Reports provide aggregated health information for the MoH

Alerts allow for real-time management of the health system

Geo-locative dashboards provide real-time information on maps

EID before Mwana was primarily an “ad hoc” system

Clinic DBS test within 2 months

PCR lab analysis

DBS result back to clinic

CHW finds mother

Mother comes back to clinic

Mother goes to ART clinic

Infant born to HIV+ mother

Physical paper system in clinic but data not utilized at district or national level

Ad hoc

Ad hoc

?

?

?

?

?

Steps in EID Cascade Previous Follow-Up/Tracking System

Ad hoc

Ad hoc

Ad hoc

Mwana addresses every step of the EID cascade to ensure timely, accurate and consistent communication and to decrease loss to follow-up

Clinic DBS test within 2 months

PCR lab analysis

DBS result back to clinic

CHW finds mother

Mother comes back to clinic

Mother goes to ART clinic

Infant born to HIV+ mother

Steps in EID Cascade Mwana Follow-Up/Tracking System

DBS sample traced up to lab

CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic

Result sent to all clinic staff for retrieval

Clinic can initiate TRACE on mother

CHW tells system it has TOLD mother

Potential next steps would be to add ART clinics in to Mwana – providing a complete real-time monitoring and management tool

Clinic DBS test within 2 months

PCR lab analysis

DBS result back to clinic

CHW finds mother

Mother comes back to clinic

Mother goes to ART clinic

Infant born to HIV+ mother

Steps in EID Cascade Mwana Follow-Up/Tracking System

?

DBS sample traced up to lab

CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic

Result sent to all clinic staff for retrieval

Clinic can initiate TRACE on mother

CHW tells system it has TOLD mother

Next steps: FEEDBACK/VERIFY

(protocol & study design)

2010 2011 2012 2013 20140

100

200

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500

600

Zambia

Num

ber o

f EID

Fac

ilitie

sMwana is scaling nationally in both countries (more sites, more women and infants served)

2010 2011 2012 2013 20140

100

200

300

400

500

600

050

100

250

450

Malawi

Num

ber o

f EID

Fac

ilitie

s

1% 10% 38% 60% 100%% NationalCoverage

% NationalCoverage

11% 22% 55% 100%

This scale up is being led by government and supported by a wide range of partners.

Government & UN

Implementing Partners

Mobile Network

Operators

Donors

Mwana is also expanding in scope across the continuum of care

Mwana as a pilot

Mwana starts scaling nationally

Mwana replicates in other countries

New modules are added

Scale across countries and continuum

Through mobile technology, Mwana has a huge potential to positively impact health systems and reach “the last mile” more quickly and effectively

Improves program outcomes and increases health impacts

Simplicity allows wide use and uptake in low-resource/rural settings

Real-time data enables real-time management & strengthened M&E

Builds on existing infrastructure, partnerships, and lessons learned

Engages communities in the process

Thank You

Merrick Schaefermerrickweb@gmail.com@unimps

http://github.com/rapidsms/rapidsms/