mhealth: revolutionizing healthcare worldwide

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D-tree.org, @DtreeInt Better Decisions Save Lives D-tree.org, @DtreeInt Better Decisions Save Lives mHealth: Revolutionizing Healthcare Worldwide Roshani Kothari Communications & Development Director Internet Capacity Building for Social Good February 12, 2016 D-tree.org, @DtreeInt Better Decisions Save Lives

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Page 1: mHealth: Revolutionizing Healthcare Worldwide

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

Page 2: mHealth: Revolutionizing Healthcare Worldwide

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.

Page 3: mHealth: Revolutionizing Healthcare Worldwide

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

Mobile Trends

Page 4: mHealth: Revolutionizing Healthcare Worldwide

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

Page 5: mHealth: Revolutionizing Healthcare Worldwide

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

mHealth Components

mHealth Systems not Apps!

Page 6: mHealth: Revolutionizing Healthcare Worldwide

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.

Page 7: mHealth: Revolutionizing Healthcare Worldwide

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

Page 8: mHealth: Revolutionizing Healthcare Worldwide

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

Page 9: mHealth: Revolutionizing Healthcare Worldwide

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

Page 10: mHealth: Revolutionizing Healthcare Worldwide

D-tree.org, @DtreeIntBetter Decisions Save Lives

Community Case Management, Malawi

Page 11: mHealth: Revolutionizing Healthcare Worldwide

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

Page 12: mHealth: Revolutionizing Healthcare Worldwide

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

Patient History

Health Surveillance Agent can review patient history

Page 13: mHealth: Revolutionizing Healthcare Worldwide

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

Sick Child Form

HSA is guided through sick child protocol.

Page 14: mHealth: Revolutionizing Healthcare Worldwide

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

Page 15: mHealth: Revolutionizing Healthcare Worldwide

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

Assessment Outcomes

Referral Home Treatment

Page 16: mHealth: Revolutionizing Healthcare Worldwide

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

Vaccinations

Page 17: mHealth: Revolutionizing Healthcare Worldwide

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

Monthly ReportsVisible to both HSA and Supervisor within the application.

Page 18: mHealth: Revolutionizing Healthcare Worldwide

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.

Page 19: mHealth: Revolutionizing Healthcare Worldwide

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

Web Dashboard

Page 20: mHealth: Revolutionizing Healthcare Worldwide

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• Don’t let technology push the program.

Sometimes a phone is just a phone – and that’s great!

Page 21: mHealth: Revolutionizing Healthcare Worldwide

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

Page 22: mHealth: Revolutionizing Healthcare Worldwide

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What’s 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.

Page 23: mHealth: Revolutionizing Healthcare Worldwide

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

Page 24: mHealth: Revolutionizing Healthcare Worldwide

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.

Page 25: mHealth: Revolutionizing Healthcare Worldwide

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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

Page 26: mHealth: Revolutionizing Healthcare Worldwide

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.

Page 27: mHealth: Revolutionizing Healthcare Worldwide

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

Page 28: mHealth: Revolutionizing Healthcare Worldwide

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

Page 29: mHealth: Revolutionizing Healthcare Worldwide

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Our Partners