mhealth: revolutionizing healthcare worldwide

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  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    mHealth: Revolutionizing Healthcare Worldwide Roshani KothariCommunications & Development Director

    Internet Capacity Building for Social GoodFebruary 12, 2016

    D-tree.org, @DtreeIntBetter Decisions Save Lives

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Mobile Trends

    Mobile phone penetration hasdrastically increased over the last decade especially in developing countries.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Mobile Trends

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Mobile Features

    Send and receive voice dataSend and receive alphanumeric

    data (text msgs)Run programs using processingStore data and voice Listen to music Take & Store photos & videos Location and Navigation (GPS) Use diagnostics

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    mHealth Components

    mHealth Systems not Apps!

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    mHealth Overview

    PatientDatabase

    growth monitoringimmunizationslab testspregnancy registrationreferral tracking

    Continuum of careClinical

    Protocols

    19

    69

    56

    72

    16

    65

    13

    29

    0

    20

    40

    60

    80

    y g

    who completed 12 months of ARVs

    78 %90 %VL undetectable75 %87 %CD4 > 20083 (19 %)13 (2 %)Lost to follow-up58 (13 %)99 (17 %)Deaths289 (68 %)483 (81 %)Still on ARVs430595PatientsHOSPITALCLINICS

    78 %90 %VL undetectable75 %87 %CD4 > 20083 (19 %)13 (2 %)Lost to follow-up58 (13 %)99 (17 %)Deaths289 (68 %)483 (81 %)Still on ARVs430595PatientsHOSPITALCLINICS

    patients lost to f/u

    1. ali samuel2. ben hasan3. etc.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives

    Provide decision support tools for use by frontline health workers- Design, test and deploy applications- Partner with Ministry of Health and other health NGOs

    Focus areas- Maternal and Child Health- Chronic Disease

    D-tree > Decision tree

  • D-tree.org, @DtreeIntBetter Decisions Save Lives

    1. Develop clinical protocols that enable better quality care

    2. Design software that can scale up and uses of protocols correctly

    3. Create Electronic Patient Record to improve care and provide information

    What We Do

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Challenges

    Shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide, especiallyin developing countries.

    Obstacles to Good Healthcare- Limited number of healthcare providers- Heavy client load- Limited training - High burden of disease- Limited financial resources- Paperwork

  • D-tree.org, @DtreeIntBetter Decisions Save Lives

    Community Case Management, Malawi

  • D-tree.org, @DtreeIntBetter Decisions Save Lives

    Key Challenges

    Health Survellaince Assistants (HSAs) do not always follow guidelines- 56% asked about 3 danger signs- 37% assessed for 4 physical danger signs- 57% provided correct referrals and pre-referral treatment - Major gap in identification of fast breathing

    Medicine stock management

    Data flows for monthly reporting

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Patient History

    Health Surveillance Agent can review patient history

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Sick Child Form

    HSA is guided through sick child protocol.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Counting BreathsUse phone for time measurement

    Absence of such measuring device had been major reason for referral

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Assessment Outcomes

    Referral Home Treatment

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Vaccinations

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Monthly ReportsVisible to both HSA and Supervisor within the application.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    C-stock IntegrationHSA reminded when monthly stock report is due. They can enter stock levels.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Web Dashboard

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Lessons Learned

    Fast pace of technological change Change Management essential Encourage data driven management Field refinement is critical Users must feel application supports them Dont let technology push the program.

    Sometimes a phone is just a phone and thats great!

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Recommendations

    Get involved with mHealth working group in each country

    Look for existing projects to leverage Adapt each project around the in-country m/eHealth ecosystem Partner with Ministry of Health and consider the entire health system Plan for integration with HMIS from the start Leverage mFinance, mAgriculture, other e/mDevelopment initiatives

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Whats Next?

    Improved integration of facility and community

    Integration of across domains Improved dashboard analytics Continued usage of mobile money Exploration of integration with point of

    care diagnostics / unique identifiers.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Saving Mothers Lives, Zanzibar

    > 50% of births are at home

    When a transfer to hospital is needed there are 3 delays:

    The decision to seek care The transfer to a facility Treatment at the facility

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Community Health Workers

    Screen pregnant mothers to identify risks or danger signs.

    Establish community-based referral systems to transport women in labor.

    Coordinate payment of transport to health facilities and hospitals using mobile banking.

    Follow up with the family within 2-5 days after delivery to ensure a continuum of care, including post-partum and post-natal care.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Results: Facility Deliveries

    0.010.020.030.040.050.060.070.080.090.0

    100.0

    Pemba North Pemba South Unguja North

    Facility deliveries among project participants compared to demographic and health survey

    Project DHS

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Results

    Dramatic increase in facility delivery rates.

    82% of women had identified conditions for which delivery in a higher level facility is recommended.

    Facility delivery rate increased from approx. 50% to 75%.

    Average cost per delivery $22.

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Lessons Learned

    Fast paced (technology)Change Management essential at all levels.

    Field refinement is critical.

    Partner with MOH and consider entire health system.

    Users must feel application supports them.

    Phones can improve prestige and self-esteem of HWs

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Opportunities & Threats

    Opportunities Low cost smartphones Telcom partnerships possible on global scale Point of care diagnostics Content libraries being developed for

    applications Integration with other applications

    Threats Lack of intermediate funding Lack of power sources in hard to reach areas

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Our Partners

    http://www.d-tree.org/wp-content/uploads/2013/11/tanzania2.jpghttp://www.d-tree.org/wp-content/uploads/2013/11/tanzania2.jpg

  • D-tree.org, @DtreeIntBetter Decisions Save Lives D-tree.org, @DtreeIntBetter Decisions Save Lives

    Connect with Us

    Roshani [email protected]

    http://www.d-tree.org/https://www.twitter.com/dtreeinthttps://www.twitter.com/dtreeinthttps://www.linkedin.com/company/d-tree-internationalhttps://www.linkedin.com/company/d-tree-internationalhttps://www.facebook.com/DtreeInternationalhttps://www.facebook.com/DtreeInternational

    Slide Number 1Mobile TrendsMobile TrendsMobile FeaturesmHealth ComponentsmHealth OverviewD-tree > Decision treeWhat We DoSlide Number 9Community Case Management, MalawiKey ChallengesSlide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Num