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.
The Mobile Minute is here to bring you coverage on the rise of smartphone sales around the world, a crop insurance plan in Kenya that uses mobiles to process claims and distribute money, the effect of the 2010 U.S. elections on PBS' mobile web and app usage rates, a pilot in Zambia that uses SMS to rapidly transmit HIV test results between rural clinics and hospitals, and mGive's new mobile donation options.
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 Mobile Minute has info on social networking via mobiles, interactive mobile lesson plans in South Africa, a new ITU study that estimates more than 90% of the world's population has access to mobile networks, the Red Cross' work to battle a cholera outbreak in Haiti with SMS health updates, and the launch of a mobile money transfer pilot in the Philippines.
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.
Changhong Yang, Jun Yang, Xiangshu Luo & Peng Gong
Publication Type:
Journal article
Publication Date:
1 Jan 2009
Abstract:
Problem Quick detection and response were essential for preventing outbreaks of infectious diseases after the Sichuan earthquake. However, the existing public health communication system in Sichuan province, China, was severely damaged by the earthquake.
Approach The Chinese Center for Disease Control and Prevention set up a mobile phone emergency reporting system. In total, 495 light-powered mobile phones were delivered to local health-care agencies in earthquake affected areas. All phones were loaded with software designed for inputting and transmitting cases of infectious disease directly to a national database for further analysis.
Local setting The emergency reporting system was set up in 14 counties hit hardest by the earthquake in Sichuan province, China.
Relevant changes One week after delivering mobile phones to earthquake-affected areas, the number of health-care agencies at the township level that had filed reports returned to the normal level. The number of cases reported by using mobile phones accounted for as much as 52.9% of the total cases reported weekly from 19 May to 13 July in those areas.
Lessons learned The mobile phone is a useful communication tool for infectious disease surveillance in areas hit by natural disasters. Nevertheless, plans must be made ahead of time and be included in emergency preparedness programmes.
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.
Ping Yu, Maximilian de Courten, Elaine Pan, Gauden Galea, Jan Pryor
Publication Type:
Journal article
Publication Date:
1 Aug 2009
Abstract:
Epi Data and Epi Info are often used together by public health agencies around the world, particularly in developing countries, to meet their needs of low-cost public health data management; however, the current open source data management technology lacks a mobile component to meet the needs of mobile public health data collectors. The goal of this project is to explore the opportunity of filling this gap through developing and trial of a personal digital assistant (PDA) based data collection/entry system. It evaluated whether such a system could increase efficiency and reduce data transcription errors for public surveillance data collection in developing countries represented by Fiji.
120 participants were recruited from the Fiji School of Medicine were randomly assigned to be interviewed by one of six interviewers in one of the two ways: (1) paper-based survey followed by PDA survey and (2) PDA survey followed by paper-based survey. Data quality was measured by error rates (logical range errors/inconsistencies, skip errors, missing values, date or time field errors and incorrect data type). Work flow and cost were evaluated in three stages of the survey process: (1) preparation of data collection instrument, (2) data collection and (3) data entry, validation and cleaning. User acceptance was also evaluated in the two groups of participants: (1) data collectors and (2) survey participants.
None of the errors presented in 20.8% of the paper questionnaires was found in the data set collected using PDA. Sixty-two percent of the participants perceived that the PDA-based questionnaire took less time to complete. Data entry, validation and cleaning for the PDA-based data collection from 120 participants took a total of 1.5 h, a 93.26% reduction of time from 20.5h required using paper and pen. The cost is also significantly reduced with PDA-based protocol. Both data collectors and participants prefer to use PDA instead of paper for data collection. The trial results prove that eSTEPS is a feasible solution for public health surveillance data collection in the field. Several deficiencies of the softwarewere also identified and would be addressed in the next version.
eSTEPS offers the potential to meet the need for an effective mobile public health data collection tool for use in the field. The eSTEPS field trial proves that PDA was more efficient than paper for public health survey data collection. It also significantly reduced errors in data entry. The later benefit was derived from the software providing its users with the flexibility of building their own constraints to control the data type, range and logic of data entry.
Brian DeRenzi, Yaw Anokwa, Tapan Parikh, Gaetano Borriello
Publication Type:
Journal article
Publication Date:
1 Aug 2007
Abstract:
Over four and a half billion people live in the developing world and require access to services in the financial, agricultural, business, government and healthcare sectors. Due to constraints of the existing infrastructure (power, communications, etc), it is often difficult to deliver these services to remote areas in a timely and efficient manner.
The CAM framework has found success as a flexible platform for quickly developing and deploying high-impact applications for these environments. Many of the applications built with CAM have relied on a model where a field worker with a mobile phone regularly returns from a disconnected environment to one with connectivity. In this connected state, the phone and a centralized server can exchange information and get the collected data backed up on reliable media.
We propose extending CAM’s networking model to enable continual operation in disconnected environments. Using a set of heterogeneous paths made available through social and geographic relationships naturally present among workers, we describe a system for asynchronously routing data in a best-effort manner.
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.
The use of mobile phones for quick-time data collection is proliferating around the world. To get a better understanding of the scale and scope of these new data collection efforts, we partnered with UN Global Pulse initiative to conduct a survey of present and planned mobile data collection efforts. The survey results will help identify new, quick-time data sources.
The first findings of the global survey have been compiled in an inventory. The inventory is a living document that will be regularly updated as we become aware of new projects. If you are managing a mobile data collection project and you would like to have it featured in the inventory, please contact us or leave a comment.
We are also currently conducting for UN Global Pulse a mobile phone survey across multiple countries including Uganda, India, Mexico, Ukraine and Iraq. The survey is being conducted via text message and uses simple questions to understand how populations in different parts of the world perceive. We are drawing on our extensive network of partners on the ground to conduct the survey and will make the results publicly available (albeit in an anonymous and aggregate format). The survey is an exercise in rapid, bottom-up data collection. Questions in the survey focus on economic perceptions, including: