Edendale Hospital: Ward 5B-2, Postal Address: Private Bag X 509
State/Province:
Plessislaer
Postal code:
3216
Country:
South Africa
Organization Type:
NGO
iTEACH stands for Integration of TB in Education & Care for HIV/AIDS, and is a registered NGO, committed to improving HIV and TB care and treatment for persons living in poverty. The iTEACH team is comprised of 20 local South Africans, and works in close partnership with the Department of Health and leaders in the community to pilot innovative interventions that have measurable outcomes and can be replicated and scaled-up in similar high-burden resource limited settings. For Project M, iTEACH provides clinical and cultural expertise and is responsible for content of the SocialTxt SMS messages as well as field-testing and piloting of the HIV self-test kit and development of the cell phone counseling service.
In this two-part series, MobileActive.org explores how mobile money services can support health care in developing countries. In part one, we described the key ways in which mobile money services can be adopted by the health sector.
At the primary level of care, subscription-based mobile payment services can create two-way links between patients and health care providers, as summarized here.
Patients can pay service providers directly for health care services delivered.
Service providers can use mobile transfer platforms to reward patients with monetary or airtime incentives for treatment compliance.
At the district, regional, and national levels, governments and organizations can improve management of funds and introduce better checks and balances by using mobile money platforms. Some uses include:
Mobile phones are being tried and tested in myriad ways in health care. They are used for data collection and disease surveillance, for ensuring treatment compliance, for managing health information systems and point-of-care support, for health promotion and disease prevention, and for delivering emergency medical services. Clearly, m-health, as this growing field is dubbed, is here to stay.
At the same time, achieving scale and sustainability in most m-health projects has been a challenge. One of the key aspects of beginning to think about ways to integrate m-health into health systems in a sustainable way is to establish financial systems to pay for health services and to ensure financial accountability within programs.
The Vodafone Americas Foundation and the mHealth Alliance are announcing a call for entries for the annual Vodafone Americas Foundation Wireless Innovation Project mHealth Alliance Award, a competition to identify and support promising wireless-related technologies to address critical social issues around the globe. Proposals will be accepted from September 27, 2010 through December 15, 2010, with the final winners announced in April 2011.
In the context of the rapid growth of mobile phone penetration in developing countries, mobile telephony is currently considered to be particularly important for development. Yet, until recently, very little systematic evidence was available that shed light on the developmental impacts of mobile telecommunication. The Information and Communication Technology for Development (ICT4D) program of the International Development Research Centre (IDRC), Canada, has played a critical role in filling some of the research gaps through its partnerships with several key actors in this area.
The objective of this paper is to evaluate the case of mobile phones as a tool in solving development problems drawing from the evidence of IDRC supported projects. IDRC has supported around 20 projects that cut across several themes such as livelihoods, poverty reduction, health, education, the environment and disasters. The projects will be analyzed by theme in order to provide a thematic overview as well as a comparative analysis of the development role of mobile phones. In exploring the evidence from completed projects as well as the foci of new projects, the paper summarizes and critically assesses the key findings and suggests possible avenues for future research.
Recently, MobileActive.org spoke to the Sana Mobile team to understand how the Android-based m-health application is being used in India. The Sana application, developed at MIT's Next Lab by students and volunteers, seeks to facilitate remote consultation between specialists, often in urban centers, and community health workers working in remote low-resource settings.
Instant remote consultation for complicated cases requiring specialist input helps bring care to patients, who would otherwise have limited access to tertiary care. Sana is developed on the Android platform, enabling users to integrate voice recordings, video and high resolution images in the diagnostic process.
Read our case study that describes the mobile tool and the pilot test in Bangalore where Sana was used to screen the risk of oral cancers.
Decision making support for nurses and health workers, even when connectivity is poor or low, is possible with Sana Mobile, an Android-based mobile health application. Formerly known as Moca Mobile, the Sana technology facilitates remote consultations between health care specialists and community health workers in remote areas.
Sana Mobile started at MIT's NextLab, where developers, faculty and students collaborate to tackle a problem using mobile technology. The Sana technology was developed by Sidhant Jena, Sana team lead and Harvard Business School student and Russell Ryan, lead engineer and MIT student.
When general practitioners lack the expertise to diagnose a case, they refer patients to specialists, who may not be easily accessible. The Sana technology addresses the lack of accessibility to specialty care in places, where specialist doctors and tertiary care centers are sparse.
One of the largest problems facing the developing world is a lack of trained physicians. While there is not a shortage of untrained or semi-trained workforce, many health workers in many developing nations are not able to dispense adequate care due to a lack of expertise.
The Sana technology seeks to address the lack of accessibility to specialty care in places, where specialist doctors and tertiary care centers are sparse.
Brief description of the project:
Oral cancer is one of the most common cancers in India. It is related to the cultural practice of chewing paan masala and gutka, forms of chewing tobacco. It is estimated that about 40% of men and 15% of women chew tobacco on a regular basis. Detecting risk of oral cancer earlier is important for affordable treatment as late stage tumors can be very expensive to treat. To survey the risk of oral cancer in their community, Mazumdar Shaw Cancer Center and the Narayana Hrudayalaya Health to ran a pilot test in and around Bangalore over six months. One pilot was run in Belgaum, Raichur, a rural town about 12 hours away from the city of Bangalore. The other pilot was run in Bangalore. Equipped with the Sana application, ASHAs (community health workers) went door to door in and around Bangalore, asking questions and taking pictures of oral lesions, which were evaluated by oral surgeons. In six months, they were able to screen about 400 high-risk cancer patients and detected numerous lesions using Sana. Twenty ASHAs were trained in using the Sana software in Belgaum.
Target audience:
For this pilot, risk of oral cancer was assessed for men and women chewing tobacco. But the Sana application is also being used to do a large scale risk assessment for cardiovascular disease, to screen maternal complications (e.g. preclampsia) and assess nutritional status of children.
Length of Project (in months) :
6
Status:
Ongoing
Anticipated launch date:
What worked well? :
Sana invested in building local developer capacity in India. Local developers cost less than having an international technology consultant to conduct training.
Lots of enthusiasm from leaders at the Narayana Hrudayalaya hospital
Funding for Sana developers at MIT to travel to India to test and train users came from external support, not from program budget of the clients.
What did not work? What were the challenges?:
Semi- to low-literacy amongst community health workers can be a challenge if an application is available in limited languages. CHWs in Belgaum did not speak Kannada (the local script) or English. Developers adapted Sana to replace text in the medical procedures with voice prompts and pictorial labels
Health workers/nurses were not familiar with the touchscreen and needed some additional training and practice in order to understand how to use it (i.e. using fingerpad or fingernail to enter data)
Cost of phone was a major limiting factor
Some resistance faced from physicians, who were not quick to adopt a technology-based work flow management tool
The Sana Team is a volunteer based organization, and it is difficult for the team of developers to contribute time resources, but they consistently offer feedback to Sana users on their google group.
Sana, is a student organization based at the Massachusetts Institute of Technology (NextLab, Center for Transpotation and Logistics, Engineering Systems Division) that offers an end-to-end system that seamlessly connects health workers to medical professionals. In addition, the group assists its partner organization with implementation through collaborative innovation. The team consists of volunteers with diverse background – medicine, computer science, clinical informatics, health policy, social sciences, and business and operations management. It strongly believes that there is a need to bring together experts from various disciplines in order to design an operating system around the delivery of care that is facilitated by mobile technology. The technology is crucial, but not the sole component of the solution. It is the centerpiece of a learning system that is designed not only to improve clinical outcomes, but the health delivery process itself.
Ayesha De Costa, Anita Shet, Nagalingeswaran Kumarasamy, Per Ashorn, Bo Eriksson, Lennart Bogg, Vinod K Diwan, the HIVIND study team
Publication Type:
Journal article
Publication Date:
1 Jan 2010
Abstract:
[Adapted from Abstract]
This paper presents a year long study protocol for a trial, to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India (Chennai and Bangalore).
Researchers plan to enroll 600 treatment naïve patients for first-line treatment as per the national antiretroviral treatment guidelines at two clinics in South India. Patients will be randomized into control and intervention arms. The control arm will receive the standard of care; the intervention arm will receive the standard of care plus mobile phone reminders.
Each reminder will take the form of an automated call and a picture message. Reminders will be delivered once a week, at a time chosen by the patient. Patients will be followed up for 24 months or till the primary outcome i.e. virological failure, is reached, whichever is earlier. Self-reported adherence is a secondary outcome. Analysis is by intention-to-treat. A cost-effectiveness study of the intervention will also be carried out.
A step-by-step outline of designing a 24-month long trial to determine effectiveness of phone reminders for anti-retroviral adherence.
Background: The objectives are to compare the effectiveness of cell phone-supported SMS messaging to standard care on adherence, quality of life, retention, and mortality in a population receiving antiretroviral therapy (ART) in Nairobi, Kenya.
Methods and Design: A multi-site randomized controlled open-label trial. A central randomization centre provided opaque envelopes to allocate treatments. Patients initiating ART at three comprehensive care clinics in Kenya will be randomized to receive either a structured weekly SMS (’short message system’ or text message) slogan (the intervention) or current standard of care support mechanisms alone (the control). Our hypothesis is that using a structured mobile phone protocol to keep in touch with patients will improve adherence to ART and other patient outcomes. Participants are evaluated at baseline, and then at six and twelve months after initiating ART. The care providers keep a weekly study log of all phone based communications with study participants. Primary outcomes are self-reported adherence to ART and suppression of HIV viral load at twelve months scheduled follow-up. Secondary outcomes are improvements in health, quality of life, social and economic factors, and retention on ART. Primary analysis is by ‘intention-to-treat’. Sensitivity analysis will be used to assess per-protocol effects. Analysis of covariates will be undertaken to determine factors that contribute or deter from expected and determined outcomes.
Discussion: This study protocol tests whether a novel structured mobile phone intervention can positively contribute to ART management in a resource-limited setting.
Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations.
We read with interest the modeling study by Bärnighausen et al. which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA). The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients.
The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points. In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda.
This paper presents a case study of the efficiency gains resulting from the introduction of electronic technologies to monitor and support adherence to highly active antiretroviral therapy (HAART) in Guguletu, South Africa. It suggests that the rollout of HAART to such resource-poor communities can be assisted significantly by the introduction of modified cellphones (to provide home based support to people on HAART and improve the management of adherence data) and simple barcoding and scanning equipment (to manage drug supplies). The cellphones have improved the management of information, and simplified the working lives of therapeutic counsellors, thereby enabling them to spend less time on administration and to devote a constant amount of time per patient even though their case loads have risen threefold. It has helped integrate the local-level primary health service provision of HAART with the kind of centralised data capture and analysis that could potentially support a national HAART rollout.
Mechael, P., Batavia, H., Kaonga, N., Searle, S., Kwan, A., Goldberger, A., Fu, L., Ossman, J.
Publication Type:
Report/White paper
Publication Date:
1 May 2010
Abstract:
This White Paper, written by a team of researchers at the Center for Global Health and Economic Development at the Earth Institute, Columbia University, examines and synthesizes the existing mHealth literature to assess the current state of mHealth knowledge, evaluate the impact of mHealth implementations in LMICs and to examine programming, policy and research-related barriers to and gaps in mHealth scale and sustainability.
The paper is divided into two main sections. The first section reviews and summarizes the peer-reviewed literature on mHealth initiatives (focus on LMICS) to highlight trends and challenges. The second section examines the existing mHealth policy environment, barriers and gaps, and key drivers needed for an enabling policy environment.
The major thematic areas include:
Treatment Compliance
Data Collection and Disease Surveillance
Health Information Systems and Point of Care Support
Health Promotion and Disease Prevention
Emergency Medical Response
The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.
Yaw Anokwa, Carl Hartung, Waylon Brunette, Gaetano Borriello and Adam Lerer
Publication Type:
Journal article
Publication Date:
1 Oct 2009
Abstract:
The ability to collect data is key to the success of many organizations operating in the developing world. Given the weaknesses of current tools and the surge in mobile phone growth, there's an opportunity for mobile and cloud technologies to enable timely and efficient data collection. This paper discusses Open Data Kit (ODK), a suite of tools that enable efficient and timely data collection on cell phones. ODK is designed to let users own, visualize, and share data without the difficulties of setting up and maintaining servers. The tools are easy to use, deploy, and scale. They also go beyond open source - they're based on open standards and supported by a larger community.
The overall goal of the PDAs for Malaria Monitoring in Maputo and Gaza Provinces, Centre was to improve the management of public health dat using handheld computers in order to provide the malaria program the Lubombo Spatial Development Initiative (LSDI) with appropriate assessment tools and the ability to make informed decisions.
The specific objectives of the project that would contribute to the achievement of the overall goal were
to enable personnel from District level of the health service to collect data and provide it to the Provincial level in a timely fashion;
to develop training courses and appropriate collection tools designed for use with handheld computers; and
to evaluate the utility of handheld computers for the malaria control program to provide data rapidly and accurately to allow better targeting of interventions and resources.
AED-SATELLIFE developed and successfully deployed electronic data collection tools which catalog drug and rapid diagnostic test stocks; spray operators daily work performance; weekly health facility data; localization of individual households with GPS, including demographic data on household members, house structure and divisions; and health facility surveys linked to GPS positioning. Training materials were developed inPortuguese.
Independent evaluation confirmed that the electronic data collection/transmission tools proved to be a useful, adoptable, and result in higher user satisfaction compared to paper based approaches. Some challenges need to be addressed before there can be widespread adoption of the technology, such as limited infrastructure, especially cellular coverage.
The usage of mobile phones is abundant in our daily lives in various aspects from making phone calls or sending text messages to checking e-mails or news updates to planning our activities or managing our budget. This project aims at making use of this wide spread usage of mobiles to help in the data collection process. It designs and develops a web based system called “MobiCollect” that is used for creating forms or questionnaires to be later accessed by the data collectors using their mobile phone web browser in order fill in the form with the appropriate data.
Once the system design and implementation is completed it will be tested and evaluated to ensure the satisfaction of at least the minimum requirements of the proposed system.
This paper provides an overview of the implications of this trend for the delivery of healthcare services and population health. In addition to addressing how mobile phones are changing the way health professionals communicate with their patients, a summary is provided of current and projected technologic capabilities of mobile phones that have the potential to render them an increasingly indispensable personal health device. Finally, the health risks of mobile phone use are addressed, as are several unresolved technical and policy-related issues unique to mobile phones. Because these issues may influence how well and how quickly mobile phones are integrated into health care, and how well they serve the needs of the entire population, they deserve the attention of both the healthcare and public health community.
Johan, Hellstrom; Swedish International Development Cooperation Agency
Publication Type:
Report/White paper
Publication Date:
1 Jan 2010
Abstract:
The Swedish International Development and Cooperation Agency (Sida) recently published a report that gives an overview of the current state of mobile phone applications for social and economic developments in East Africa. Drawing on successful adoption of mobile applications in the Philippines, this Sida report seeks to answer “what hinders the take off of m-applications for development in East Africa and what role donors play in the process.” While mobile phones is the one of the most widely accessible gateways for information in East Africa, with mobile penetration covering over 40% of the population, sustainable, scalable mobile services for social and economic development are limited. The report is supported by secondary data, statistics, and field work carried out in Kenya, Rwanda and Tanzania, along with numerous interviews, meetings and discussions with key stakeholders in East Africa. Major trends in mobile usage, barriers for increased use of m-applications, as well as opportunities for scaling are discussed.
A how-to guide on using and implementing RapidSMS for mobile data collection and communication.
Ths manual give an overview for how to implement and use RapidSMS in a mobile data collection project. RapidSMS is a SMS framework for data collection, group coordination, and complex SMS workflows. The tutorial outlines when and when not to use RapidSMS, guides the user through project steps and milestones, outlines factors for a successful implementation, and provides worksheets for project planning. Example training materials are included.
The aim of this paper is to encourage reflection and discussion around the potential of mHealth in developing countries and to consider how early experiences can inform the way forward. Toward this aim, I synthesize many reviews and presentations from the eight years I have been studying the evolution of mobile phones and health in developing countries. I include observations and discussions that are now shaping the creation of mHealth as a field, to highlight the ingredients we need to move from a series of pilot projects and isolated business opportunities to a full-scale maximization of health-related benefits.
I begin by reviewing the strategic priorities within global health, where mobile telephony can have the greatest impact, along with organic health-related uses of mobile phones, and examples of formal mHealth interventions. I then demonstrate the potential for mobile phones to become an extension and an integral component of eHealth, describing how information and communication technology (ICT) can be used in health care, as well as mHealth, as a subset of mServices: using mobile devices to deliver services such as banking and health. I also show how trends and interests are converging among key stakeholders within the mHealth ecosystem, thus forming a foundation on which we can scale up and sustain more and better mHealth activities. Finally, I present some tactical guidance for a way forward that will further the objectives of both public health and business, particularly in outreach efforts to emerging markets, the bottom of the pyramid, and the next billion mobile phone subscribers.
Baseline under five child mortality in Sauri, Kenya as of 2005 was estimated to be 148 deaths per 1000 live births. By 2008, the rate had dropped to 81 deaths per 1000 live births due to Millennium Village Project (MVP) interventions. A review of child deaths revealed that among other causes, such as malaria, acute febrile illnesses, diarrheal illnesses and HIV, malnutrition contributed to more than 50% of all child deaths. Community health workers (CHWs) led several interventions, namely community-based management of acute malnutrition, home-based testing for malaria and diarrheal illnesses and immediate dispersal of appropriate treatments.
To support these interventions, MVP ran a pilot project where CHWs were equipped with mobile phones to use SMS text messages to register patients and send in their data with the goal of improving child health and empowering community health workers. This report seeks to detail the methods used, illustrate early results and initial findings of the ChildCount mHealth platform that CHWs have now been using since early July of 2009.
An overview of the components, approaches and techniques used to build mobile phone-accessible applications that use SMS text messages as a conduit for data collection and service delivery. SMS-based applications represent a paradigm shift allowing innovative new approaches to monitoring and data collection fundamentally changing the way we can approach the delivery of critical health, economic and social services in resource-poor settings. SMS has the potential to fill significant connectivity and service gaps, particularly for the world’s poor, until data networks and phones that can support them become more ubiquitous.
This guest post was written by Nicolas di Tada, Director of Platform Engineering at InSTEDD. He writes about an ingeniousway for health workers to accurately transmit semi-structured data via mobile. His post is reprinted here with permission.
During August 2009, we went on a number of field trips to health centers in remote areas of Thailand and Cambodia. The idea was to conduct a few usability tests on Geochat syntax alternatives that we were exploring. Our goal was to simplify the interaction between health workers and the system to ultimately allow them to report disease cases in a semi-structured way.
The case information always originates at the local health center level - this is where the patient comes and gets diagnosed. Most of the case reports are made through phone calls to the district level (the higher administrative level). Case details get lost when the district level summarizes the information by disease and reports the quantity of each to the provincial level.
This guest-post is by Arturo Morosoff who completed recently a project with D-Tree International and BRAC Tanzania to provide videos on mobile phones to assist Community Health Workers (CHWs) for health education. It is posted here with permission.
I recently completed a five week volunteer project working with Irene Joseph and Gayo Mhila of D-Tree International to provide videos on mobile phones to Community Health Volunteers with BRAC Tanzania in the Mbagala district of Dar Es Salaam.
A bit about me: I have no formal training in ICT or public health. My background is in technology and business and I live and work in the San Francisco Bay Area in California. I was on a two month trip in Tanzania and volunteered to help D-Tree with this project. As such, the project needed to be completed in a short time and we began with modest goals.
Among BRAC’s programs to help alleviate poverty is its health program, which relies on an all-female team of Community Health Volunteers (CHVs) to conduct monthly home visits to provide health education and support. Each CHV visits 150 – 200 homes each month, asking health related questions and providing healthcare information. In Tanzania, D-Tree has been collaborating with BRAC to provide the CHVs with a mobile phone-based tool called Commcare, to help improve the effectiveness of their home-based programs. About a year ago there was discussion with the CHVs of providing them with health education videos suitable for use on phones to provide additional support for their home visits.
Comprised of data from 17 articles representing 12 studies (five of which focused on disease prevention and seven of which focused on disease management), the authors draw conclusions on the effectiveness of using mobile phones (and more specifically, text messaging on mobile phones) to change health behaviors.