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The Grameen Foundation recently released an in-depth report on the state of MoTeCH, a multi-part project that uses mobile technology to send pre- and post-natal health information to Ghanaians and allows community health workers to collect and share health data. Launched in July 2010 in the Upper East Region of Ghana, the system rolled out the next phase of the pilot in April 2011 in the Awutu Senya distract in the Central Region of Ghana. The report, "Mobile Technology for Community Health in Ghana: What It Is and What Grameen Foundation Has Learned So Far," takes an honest look at the progress and challenges the organization has faced while implementing a long-term, large-scale mHealth project.

Mobile Midwife

Mobile Midwife, part of the MoTeCH initiative, is a mobile phone-based health education program for pregnant women and recent parents. Women register for the program and receive either SMS or voice messages with health information. The organization designed the messages to be applicable to both men and women, as they anticipated that both partners would listen to the messages (the report found that 99% of respondents chose to receive voice messages). The messages were designed to tell women what to expect during pregnancy, dispel myths and cultural practices, and provide general health information.

The group met some challenges while translating and recording the messages, as there were cultural implications necessary to consider (recommending diet advice that is applicable to each region in which MoTeCH is deployed, understanding the capacity of local health centers, the use of appropriate slang, and using the appropriate dialect for each region). The group also worked to create a free service, but as they were unable to develop a toll-free number before the launch of the practice, they used the culturally relevant practice of “flashing” (deliberately giving someone a missed call so that they return the call) which ended up being very popular as users were familiar with the practice.

The report also covers how the organization marketed MoTeCH, looking into what worked and what didn't by comparing both direct marketing from community health workers and MoTeCH field staff to advertisements in local health centers.

Nurses' Application

The other part of the MoTeCH project is an application for community health workers; MoTeCH uses a J2ME platform on low-cost GSM mobile phones to capture, transmit and manage health data collected by community health workers during client encounters.

The report explains how the organization overcame several challenges during the implementation of the nurses' application. For instance, they had originally planned to have the community health workers use their own phones to file SMS reports. However, they discovered that many of the CHWs shared their phones with family and community members, so patient privacy could have been comprised. They also found that the detailed syntax needed to file SMS reports led to errors, and that many phones did not have enough memory to store many SMS drafts. The organization found that purchasing Java-enabled handsets for the CHWs was ultimately more cost effective in the long run, as GPRS data transmission was significantly cheaper than bulk SMS transmissions.

Other challenges included developing a system in which nurses were responsible for the phones; they found that it was difficult to find a balance between penalties for losing the phone that were strict enough to encourage the nurses to take care of the phones, yet not so harsh that nurses would be reluctant to use the phones out of fear of financial or professional repercussions. The Grameen Foundation also found that it was necessary to promote the time-saving aspect of the nurses' application for automatically compiling reports, as many nurses originally viewed the application as an addition to their workflow.

As the program has seen success in its initial pilot and prepares to roll out the next phase, looking back at lessons learned and challenges overcome provides a good, honest look at the many different considerations necessary to implement large-scale mHealth projects. Check out the report for a more in-depth look at lessons learned in everything from technology development, cultural relevancy, marketing and health research. For more information, check out MobileActive.org's previous coverage of MoTeCH here.