Download - Better Information for Better Health and Opportunities for ICT-enhanced Solutions Mark Landry
The U.S. President’sEmergency Plan for
AIDS Relief
HIV/AIDS and the U.S. Government’s Response: The Power of Partnerships
Better Information for Better Health andOpportunities for ICT-enhanced Solutions
Mark LandryOffice of the U.S. Global AIDS CoordinatorFebruary 2, 2009
Overview
• Next 5 years of PEPFAR: emergency plan to a sustainability plan
• Health management information systems (HMIS): better information for better health
• ICT-enhanced solutions: what’s a good fit and how will you know it when you see it?
Goal this week: Help identify community-specific potential opportunities and plan to leverage relationships and resources to take action.
Beyond 2008: 10-Year Program Goals
Working in partnership with host nations, PEPFAR will support:
– Treatment for at least 3 million people – Prevention of 12 million new infections – Care for 12 million people, including 5 million
orphans and vulnerable children
• To meet these goals, PEPFAR will support training of at least 140,000 new health care workers in HIV/AIDS prevention, treatment and care.
PEPFAR Worldwide Activities
• Mission is two-tiered, focused on both:– Information systems needed to implement
HIV services under PEPFAR (collect, store, transmit, analyze, and disseminate data)
– Information systems needed for monitoring and evaluation, to ensure accountability
Effective HMIS interventions influence the success of PEPFAR.
HMIS Technical Working Group
• Developing written five-year strategic plans for health information systems
• Assessment/evaluation of implemented systems
• Improved data quality• Increase data use• Improved human capacity around HIS planning,
design, and implementation • Increased integration of separate information
systems
HMIS TWG Goals
• Automatic generation of indicators • Increased timelines and completeness of data • Improved sharing of technical expertise
(e.g., South-to-South technical assistance) • Use of IT to increase quality of service delivery • Fully functional implementations of systems for
clinics, labs, community interventions, program reporting, etc.
• Assisting other TWGs in articulating their information systems strategies
HMIS TWG Goals (continued)
Program/project management systems (indicators)Clinical, patient-level information systems (electronic medical records)Community-based services information systemsPalliative care (e.g., HIV/TB)Prevention activities and indicatorsOrphans and vulnerable children programsBlood safety tracking systemsLaboratory information systemsGeographic information systems GIS)Supply chain/logistics management information systemsComprehensive training management
Component HMIS Sub-Systems
Origin of Primary Data
Many Registries of the Primary Health Worker
DATA SOURCE
Weekly Data, manually computed by the data entry operator
Burden of Data Aggregation
Data Storage and Retrieval
RWANDA’S TRACnet / Phones for Health
LocalApplications Cell
Phone
PCs/Internet
PDA/Smartphone
SAMPLE DATA
Phone
1234
Modified after: Eddie Karisa, CDC-Rwanda, 2007
Strategic use of ICTs in the next generation of PEPFAR
• HMIS capacity building– Cohesive strategy– National, regional, community ownership– Coordination, targeting, and follow up
• Reaching the hard to reach– Target populations (e.g., most at-risk, remote,
underserved, priority, OVCs)– Emphasis areas (e.g., prevention)– Continuity of care– Leveraging resources and existing
infrastructure
Some PEPFAR Challenges
• Prevention case studies– Behavior Change Communication (BCC)– Prevention of Mother to Child Transmission (PMTCT)
• Care case studies– Orphans & Vulnerable Children (OVC)– Continuity of Care: tracking individuals and their
personal medical records– Community-Based Systems– Data Management and Use – “Data for Decision-
making”• Treatment case studies
– Patient services: ARV adherence and monitoring– Health Worker training and referral/consultation
services
Prevention Case Study: BCC now
ICT-enhanced BCC in the future
• HIV Free Generation
www.hivfreegeneration.warnerbros.com
• Gaming: PC and cell phone
• New technology: Microsoft MultiPoint
Care Case Study: Continuity of Care
Data ExchangeStandard
ART Care
HIV Register
HIV SupportServices
VCT
TB Care
General Medical Care
PMTCT
OI Care
Care Case Study: OVC
OVCs In-Depth: Who are these children?
• Children who parents have died due to AIDS– Now living with grandparents, extended family, community
members, in orphanages, on the street.– May be treated as second class children, e.g. less to eat
• Children who have a parent who is sick and can no longer care for them– They drop out of school to care for parent, to work, beg
• Children who are stigmatized and grieving– By 2010, orphaned by AIDS globally is projected to exceed 20
million, with 80% in sub-Saharan Africa– The number of other children made vulnerable because of
HIV/AIDS is estimated by some to be more than double that number.
What these children need
• Psychosocial– Provide recreational, cultural, and spiritual
activities that support life skills and self-esteem
– Individual or group counseling– Develop memory books
• Health – HIV and AIDS prevention messages– Age appropriate health education– Immunizations– HIV screening– Referral and follow-up for treatment services
including HIV
• Education /Skill– Subsidizing school related costs– Provide bursaries to support vocational
training– Support after-school programs that assist with
homework– Link older youth to resources for setting up
small businesses or employment opportunities
• Economic Strengthening– Participation in economic strengthening
activities
• Food & Nutrition– Nutritional assessment and counseling– Nutritional supplementation– Staples for food insecure HH– Therapeutic feeding for malnourished children– Linkages and referrals to health and nutrition
interventions
• Shelter & Care– Identify short-term, protective shelter for children
living outside of family care. – Monitor and provide for material needs, i.e. clothing
• Protection– Facilitate birth registrations/ inheritance/succession
planning; guardianship and adoption– Support transfer of abused children to temporary
safe houses or permanent placements– Report and litigate abuse cases
Strategies for Caring for the OVC
• Strengthen families to protect and care for OVC
• Facilitate access to or provide basic social and protective services
• Build capacities of communities, local gov’t, provincial/district gov’t, national gov’t, to support families and care for orphans and vulnerable children.
• Advance policy and legal reforms in order to enable supportive environments for children’s growth and development.
OVC Programming Challenges
• Comprehensive programming– Multisectoral– Lack of referral systems– Weak social service systems
• Varying strategies for Identifying children in need– Generalized, high prevalence – Use of community
committees– Concentrated epidemics – Identify through affected
families, e.g. treatment, C&T, PMTCT, and PLWHA.
Treatment Case Study: ART
• Challenge: ARV adherence and loss to follow up
• ICT-enhanced solution: SMS services– Adherence Reminders– Patient Monitoring / Adverse Events – Patient Tracking – SMS Info Feeds – FAQs– SMS Question Box – SMS Support Clubs
SMS Solutions
Phones for Health
MDNet
Frontline SMS
Mobile for Life
Treatment Case Study: Health Worker Training
Training centers in urban areas
What about hard to reach areas?
OLPHW: One Laptop per Health Worker
Emerging Telecenter Ecosystem
• A telecenter is a public place where people can access computers, the Internet, and other digital technologies that enable people to gather information, create, learn, and communicate with others while they develop essential 21st-century digital skills.
• Where are telecenters in your area? Sponsors ready to multi-purpose them with HIV/AIDS content.– Cisco Network Academies– Microsoft Community Resource Centers– Intel World Ahead Learning Centers– Inveneo/Intel mobile clinics/IT labs
• Behavior change communication to impact youth through HIV/AIDS awareness campaigns using multimedia
• HIV/AIDS curriculum development/gaming at school• Home PCs “pay as you go” with FlexGo technology• Expanding role of Microsoft-funded community centres• Enabling kiosks with HIV/AIDS messaging• Earning credits for cell phone usage• ICT support for country information systems• Co-sponsorship of meetings or symposiums• Knowledge management - delivering individual journals
over analog dial-up connection
• Research and Development with Microsoft health experts
Public-Private Partnerships: Microsoft