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
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.4.6
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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
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