7/30/2019 ICT Week Mobile Technology Kuntiya
1/8
11/9/2012
THE IMPACT ANDSUSTAINABILITY OF MOBILETECHNOLOGY FOR HEALTHCARE DELIVERY IN MALAWI
KUNTIYA Kumbukani
Website: www.kkuntiya.tripod.comWordpress: www.kkuntiya.wordpress.com
Skype: kuntiya-k Email: [email protected]
November 2012
ICT Week 2012
How many senses do we have?
Acknowledgements:Mr. Kumwenda - supervisor
Dr. Maureen ChirwaMACRA
Organising committeeFamily
Contents1. Introduction2. Study Background3. Study sites4. Problem Statement & Study Aim
4.1 Study Objectives5. Methodology6. Study Limitations & Challenges7. Results8. Discussion9. Conclusion10. Recommendations11. References
3
1. IntroductionReport of a study on the evaluation of mobile technology projects undertakenby UNICEF, Evangelical Association of Malawi (EAM), and FrontlineSMS MedicEvaluating effectiveness, impact andsustainability of mobile technology as atool for healthcare service delivery in
MalawiStaff shortages in our health facilities.
4
2. Study BackgroundPopulation over 14 million
Health challenges like HIV/AIDS, maternalhealthLow numbers of health workersInadequate health facilities, long distancesCommunity Health Workers - Home BasedCare, CBOsSolution mobile technology projects by UNICEFs RapidSMS Mobile Technology project by EAM FrontlineSMS Medic at Namitete
5
3.1 UNICEFs RapidSMS
3 pilot sites in Kasungu, Salima and Dedzafor nutrition surveillanceAddress issues Slow data transmission Incomplete and poor quality data sets High operational costs Low levels of stakeholder ownershipSolution: RapidSMS SMS + Internet
Rolled out in 2009
6
7/30/2019 ICT Week Mobile Technology Kuntiya
2/8
11/9/2012
3.1 UNICEFs RapidSMS
Objectives Identify possible improvements in data
transmission and quality by using mobiletechnology
Quantify the quality and transmissionimprovements
Customize RapidSMS for use with the existingINFSS system.
Adapt, if necessary, for national roll-out
7
3.1 RapidSMS Project
8
3.2 EAM Mobile Technology Project
Pilot - 2008, EAM in partnership withTearfund UK 2 sites at Malindi andNkope health centreVolunteers trained in HBC + ZainpayphonesPhones used for communication +business
Facility level 2 sites equipped withtelephone equipment
9
3.2 EAM Mobile Technology Project
Aim - strengthening the referral systemObjectives: Improve the quality of care provided by the
HBC volunteers; Help the volunteers generate income from
the phones for their sustainability; Offer a technological solution that effectively
supports ICT related to health services
10
3.2 EAM Mobile Technology Project
11
3.3 FrontlineSMS: MedicRelies on free open source softwareplatform running FrontlineSMS coupledwith GSM technology (dongle)SMS communication between hospitalstaff and CHWs1 laptop computer acting ascommunication hub linked to 75 CHWsMajor site - Namitete (St. GabrielHospital)
12
7/30/2019 ICT Week Mobile Technology Kuntiya
3/8
11/9/2012
3.3 FrontlineSMS: MedicUsage: remote requests for medications
notification of patient deaths appointment reminders treatment adherence reminders patient or CHW queries requests for acute care replenishing CHWs SMS airtimeAimed at increasing efficiency of CHWs -maximizing productivity
13
3.3 FrontLine SMS Project
14
15
4. Problem Statement & Study Aim
Why the study? No collective and independent studies No literature that could be used to scale
up/replicate projects Implemented in isolation Most evaluations (if any) published externally
academic institutions Potential behind mobile technologyAim - determine impact of mobiletechnology usage for health care servicedelivery using the pilot projects
16
4.1 Study ObjectivesInvestigate the effectiveness and impact of mobile technology projects for healthservice delivery;Analyse cost-benefits and sustainability of mobile technologies in health servicedelivery in Malawi; andInvestigate the process and strategiesused to implement mobile technologyprojects for health care in Malawi.
17
4.1.1 Effectiveness and impactConsidering: Cuts in delivery costs and time S/LT Remote service delivery vs normal service
delivery Effect on the community health workers Effect on the livelihood of the HBC
volunteers, CHWs Comparison of technology and non
technology(control sites)
18
7/30/2019 ICT Week Mobile Technology Kuntiya
4/8
11/9/2012
4.1.2 Cost-benefit and sustainability
Benefits/costs that came aboutTechnology and activity appropriatenessPhase out preparedness mechanisms forsustainability
19
4.1.3 Process and strategiesConsidered: Beneficiary targeting
Site identification Activity accessibility Project delivery - right form? Sufficiency of pre-project activities i.e. briefing,
mobilisation, training Project activity implementation Limitations and mitigation factors Recommendation for replication
20
5. MethodologyType of Study EvaluationUsed both quantitative and qualitativeresearch methodsSampling - 1 site randomly picked perorganization
21
5.1 Data CollectionKey Informant Interviews and FocusGroup DiscussionsExamined records and observations atfacility level by utilizing a checklistIn depth interviews
22
6. Study Limitations and Challenges
Non availability of recorded dataNo external funding data collectionlonger than anticipatedEnvironment for data collection hospitals (disturbances)Time frame limited
No compromise on results
23
7. Results52 participants F=25, M=27Age range 19 to 50 yearsEach of the participating project area hadon average 10 participantsAt non technology level - 26 participants
24
7/30/2019 ICT Week Mobile Technology Kuntiya
5/8
11/9/2012
7. Results
25
7. 1.1 Results (Impact) - RapidSMS
Data transmission delays cut down fromover 2 months to immediately
Cut in transport costs - data forms nolonger taken to Lilongwe physicallyResponses immediate feedback dataquality improvedData entry & analysis costs reduced toalmost zero automatically by system
26
7. 1.2 Results (Impact) - EAMTravel costs and delays reduced by both communityhealth workers and hospital staff K200 K20Used to spend almost whole day away to the hospitalbut now seconds on the phoneMedical assistant managed to cut down by 100% onall in hospital travel requirementsEmpowerment of HBC members through effectivepatient registration and referralCuts in travel times by over 50% by Medical Assistantand HBC supervisor - conduct supervision/conductoutreach clinics
CBOs were able to use part of the proceeds to buybasic items and medicine for the home based carepatients
27
7.1.2 Results (Impact) -EAM
28
-
5,000.00
10,000.00
15,000.00
20,000.00
25,000.00
30,000.00
35,000.00
Total Health 975.00 740.00 517.50 280.00 500.00 500.00 630.00 600.00 400.00
Total Business 3,057.50 21,712.50 28,617.70 31,475.00 27,635.00 15,712.50 27,535.00 10,732.50 10,090.00
April May June July Aug Sept Oct Nov Dec
7. 1.2 Results (Impact) -EAM
29
CBO NameRegistered
PatientsReferredPatients %
Mkadabwi 78 16 21%
Chikomwe 71 48 68%
Nkuli 70 4 6%
Mwalembe 60 9 15%
Mwanyama 42 1 2%
Lusalumwe 172 4 2%
Chiwalo 124 70 56%
Illiyoni 78 20 26%
Total 695 172 25%
7. 1.3 Results (Impact) - Namitete
30
Message Content
Number of
Messages
Percent
of TotalPatient Reporting or Referrals 410 30.83%Request for SMS Credits 219 16.47%Reporting Symptoms 199 14.96%Other 173 13.01%Request for Help 107 8.05%Patient Death Notification 75 5.64%Meetings 60 4.51%Requesting Supplies 59 4.44%Phone Problems 28 2.11%Total 1330
7/30/2019 ICT Week Mobile Technology Kuntiya
6/8
11/9/2012
7.1.3. Results (Impact) - Namitete
31
Department Pre-pilot Post-pilot % Increase
TB 100patientsenrolled
200patientsenrolled
100%
ART 25reports/month
67reports/month
168%
7.2.1 Results Cost-Benefit &Sustainability RapidSMS
Considerable costs server, mobile phones,internet presence, toll free number
Reduced delays in data transmissionImproved data quality - national level @2.7% (n=517)Pre-project phase needed data entry &analysis, re-entering of data - automationPrivacy and immediate attentionControl over drop outs & was easy tofollow up
32
7.2.2 Results Cost-Benefit &Sustainability - EAM
Costs: payphones, PABX installation atMalindi, HBC trainingEnhancing capacity building & infrastructureIncrease in patient registration, referral &follow upIncreased CBO income baseEasy communication & networking
No privacy - stationed at public placesPhones deployed along with ULCHs
33
7.2.3 Results Cost-Benefit &Sustainability - Namitete
Costs: Laptop + GSM, mobile phonesConstant breakdown of phones and solar chargersReduced costs of data transmission to the hospital -5Kms/bicycleTimely response to CHWs requests for support orambulance servicesPatients felt very closer to hospital careProvision of airtime by hospitalProvision of phones contributed towards easycommunication & networkingRecharge of phones a burden to CHWsPrivacy and immediate attentionEasy technology for both (automated system)Single laptop a hassle move round delivering messages
34
7.3.1 Results Process & Strategies
All projects had a shortfall in terms of theway they were designedLikely contribution to the shortfalls thatsome of them encountered.
35 36
7/30/2019 ICT Week Mobile Technology Kuntiya
7/8
11/9/2012
Criteria Project
RapidSMS EAM FrontlineSMSTargeting Under 5 visiting Growth
Monitoring Centres (HSAs)Community based structures CBOsand volunteers
Community based structures CHWs
Siteidentification
UNICEF implementation districts purposely selected withvarious reporting trends
Existing partnership through EAMand CHAM facilities
Existing collaboration betweenfunders and project site
Accessibility ofservices
Under five children andguardians/parents
Both home based care patients andgeneral community
Home based care patients
Delivery inright format
Yes Yes, privacy of patients compromisedfor some patients
Yes, privacy of patients promoted
Pre projectactivities Training provided to users,briefing to stakeholders Training provided to users, briefing tostakeholders, minimal on joint project
designTraining provided to users, briefingto stakeholders, and ongoingproject activities
Activityimplementation
Joint implementation byUniversity of Columbia, UNICEFand Bunda College
Joint between beneficiary andimplementers EAM providedfunding including operational costs
Joint implementation and is stillgoing on
Limitations& Mitigation
High cost of SMSing, High costof equipment (computer andinternet connection), availabilityof phones amongst HSAs
Availability of electricity for theserver
High cost of equipmentCBOs stopping activities at end of pilot phaseHigh staff retentionCompletion from other sources of communication (not sorted out aspilot phase closed)
Use of recycled phones, Use of solar chargers high cost for recharging, transport problems for CHWs to conduct home visitsNetwork problems phones
Provision of toll free number Computers and internetprocured by UNICEF
Nothing p ro je ct ph as ed o ut N ew p ho ne s a cq ui re dNetwork upgraded
Recommendations forreplication
Recommended but cost of internet might not be sustainableto most sites, computer softwareneeds some customization
Expensive to procure projectmaterials (pay phones)
Highly recommended, cheap toimplement
37
8. DiscussionEffectiveness and impact of projects
time savings cost savings
Additional or available resourcesReinforces international campaigns and other studiesand compares wellRapidSMS - great potential for achieving greatereffectiveness
reduced delays in data transmission improved data quality reduced manpower requirement reduced participant dropout rates improved reporting rates
38
8. DiscussionMore services deployed palliative careat NamiteteSeeing more patientsAdditional costs to beneficiaries phonerechargingSustainability and ownership problems externally funded, academic institutionsCapital outlay EAM vs UNICEF andFrontLine SMS
39
9. ConclusionFirst of its kindAll have contributed towards impactBoth patients and care givers appreciated introduction improvements in care, qlty + qtyReduction in stigma privacyAdvanced care acquired easily call ambulanceDrop outs low and easily traced (TB + ART)Report generation easy RapidSMS + FrontLineSMSNo collaboration amongst stakeholdersNo standards set out by government/regulator i.e pilots,pilots for how long? Beneficiary protection
Solution in itself and not part of the solution wrongSustaining the momentum - challenge
40
10. 2 Recommendations - GovtMoH take a leading role to facilitate
stocktaking and awarenessEstablish minimum standardsPromote adoption and usage of mobiletechnology for social services - MACRAReduction of ICT costs - removal of tax onICT equipmentSupporting academic/research institutions -contributing towards attainment of MDGs(mine was turned down by )
41
10. 3 Recommendations Implementers/Funders
Formal forum should be established -share any updates and collaborate effortsEngage MNOs innovations, negotiate forany discounts i.e. social responsibilityinitiatives (CallDoc)Social marketing telecentresExit strategies - safeguard sustainability;Case study of all the projects - learningand documentation purposes
42
7/30/2019 ICT Week Mobile Technology Kuntiya
8/8
11/9/2012
10. 4 Recommendations Community Members
IGAs - compliment towards cost of running projects i.e. buying airtime, re-
charging phone batteriesMore male involvement
43
11. ReferencesTearfund UK, Communication Technology Project Malawi Feasibility Study, December 2006Broadhead R.L. and MuulaA.S. Creating a medical school for Malawi: problems and achievements,Biomedical Journal 2002Nadim Mahmud, JoceRodriguez, Josh Nesbit, Mobiles in Malawi: A text-based intervention to bridge thepatient-physician gap in the rural developing world, Global Pulse, Vol. 6, 2010Karlstad University, Proceedings of 1 st International Conference on M4D, December 2008Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology forHealthcare in the De veloping World. Washington, D.C. and Berkshire, UK: UN Foundation-VodafoneFoundation Partnership, 2009Mobile Health, http://www.wikipedia.org/wiki/mhealth , Accessed 4 July 2010, 11.00amSheila Kinkade, and Katrina Verclas, Wireless Technology for Social Change: Trends in Mobile Use byNGOs, United Nations Foundation - Vodafone Foundation Partnership, 2008Smith MK and Henderson-Andrade N. Facing the health worker crisis in developing countries: a call forglobal solidarity, WHO, 2006Laura Naismith, Peter Lonsdale, Literature Review in mobile technologies and learning, Report 11,NestaFuturelab SeriesNigel Scot, Simon Batchelor, Jonathan Ridley, Britt Jorgensen, The Impact of mobile phones in Africa,Commission for Africa, 2004Chetan Sharma, Mobile services evolution 2008 2018, United Nations Foundation
Julie Solo, Expanding Contraceptive Choice to the Underserved Through Delivery of Mobile OutreachServices a handbook for program planners, USAID, 2009
44
10. Referenceshttp://www.cell-life.org/content/blogcategory/13/135/ Visited July 12, 2010, 11:40amhttp://www.simpill.com/ Visited July 12, 2010, 11:30amhttp://www.voxiva.net/rwanda.asp Visited July 12, 2010, 12:00pmRapidSMS: A Reviewhttp://www.mobileactive.com Last accessed July 28, 2010, 10:00am
Journal of Information Technology Impact, Vol. 3, No. 2, pp. 69-76, 2003 Information and CommunicationTechnology in Nigeria, The Helath Sector Experience ObafemiAwolwo University, NigeriaMechael, Patricia N., Exploring Health-Related Uses of Mobile Phones: An Egyptian Case Study, 2006Rafael Anta, ShireenEl-Wahab, and Antonino Giuffrida, Mobile Health: The potential of mobile telephonyto bring health care to the majority, Inter-American Development Bank, Innovation Note, February2009Globalization and Health 2006, 2:9. Can the ubiquitous power of mobile phones be used to im provehealth outcomes in developing countries? http://www.globalizationandhealth.com/content/2/1/9 Lastaccessed 12 January 2010, 12.00pmMedical Journal of Australia, Vol 183, No. 7, 2005. Use of SMS text messaging to improve outpatientattendanceSundararamanT. Community health-workers: scaling up programmes, Lancet 2007, 369Ministry of Health and Population, Malawi (2004), Treatment of AIDS, the two year plan to scale upantiretroviral therapy in MalawiUNAIDS (2006), 'UNAIDS 2006 Report on the global AIDS epidemic' , Annex 2: HIV/AIDS estimates anddata, 2005
45
Mobile Technology thesixth sense:
Challenge? How do weintegrate mobile technologyTowards Improving Lives of
Malawian People?
46
http://www.wikipedia.org/wiki/mhealthhttp://www.wikipedia.org/wiki/mhealthhttp://www.cell-life.org/content/blogcategory/13/135/http://www.simpill.com/http://www.voxiva.net/rwanda.asphttp://www.mobileactive.com/http://www.globalizationandhealth.com/content/2/1/9http://www.globalizationandhealth.com/content/2/1/9http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asphttp://www.unaids.org/en/HIV_data/2006GlobalReport/default.asphttp://www.unaids.org/en/HIV_data/2006GlobalReport/default.asphttp://www.globalizationandhealth.com/content/2/1/9http://www.mobileactive.com/http://www.voxiva.net/rwanda.asphttp://www.simpill.com/http://www.cell-life.org/content/blogcategory/13/135/http://www.cell-life.org/content/blogcategory/13/135/http://www.cell-life.org/content/blogcategory/13/135/http://www.wikipedia.org/wiki/mhealthTop Related