Dominic Atweam K Health Information Systems Analyst

1. Mobile technology for community health Dominic Atweam K Health Information Systems Analyst Policy Planning Monitoring and Evaluation Division- Ghana Health Service

2. Overview • What is MoTeCH? • Pregnant Parents Application (MOBILE MIDWIFE) • Tools for Community Health Workers(HIMS)

3. What is MOTECH? Using mobile phones to increase the quantity and qualityof maternal and child health services in Ghana Focus on frontline community health facilities (CHPS zone, Health Centre's)

4. Overview • What is MoTeCH? • Pregnant Parents Application (Mobile Midwife) • Tools for Community Health Workers (HIMS) • Social Impact Assessment

5. Challenges Challenges in Communities • ANC visits start late • Incomplete ANC coverage • Delay until newborns seen • Unattended births • Patchy immunization coverage • Low IPT uptake • Local myths

6. MOTECH Component 1: Mobile Midwife Messages provide key MCH information for “pregnant parents” and reminders to seek timely care: • Personal care during pregnancy • Newborn care • Recognition of danger signs • Developmental milestones • Nutrition and breastfeeding • Malaria • Immunization • Postpartum family planning • Diarrheal diseases • Pneumonia

7. Pregnant Parents’ Service Engage Both Parents • Relevant, actionable and fun information by SMS and/or voice • Encourage health seeking behavior • Available in local languages Product Development • Consultation with GHS stakeholders at all levels, midwives, lactating and expectant mothers, fathers, mothers-in-law, village chiefs. • Field testing of messages to ascertain appropriate messaging, voice, accent, dialect.

8. Why do we need injections for both mother & baby? What do we do about body swelling during pregnancy? Why do I need IPT? Why should we practice exclusive breast feeding? Why should I attend clinic at first signs of pregnancy? Why do I vomit when I’m pregnant?

9. Overview • What is MoTeCH? • Pregnant Parents Application (mobile Midwife) • Tools for Community Health Workers(HIMS)

10. HIMS Challenges ForNurses • Volume of paper: up to 20 different patient registers for each facility • Onerous data reporting: nurses spend 4-6 days per month aggregating data • Little information flows back to the nurse: difficult to identify defaulters or high risk patients • Nurse attitudes sometimes discourage clients from seeking health information

11. PROBLEM: Too much paper, too little useful information SOLUTION: Using the mobile phone for data entry and management

12. MOTECH Component #2: Nurses’ Application • Data collection & Reporting • Simplified paper registers • Nurses record patient data onto mForms • Upload data to central database • Data validation ensures high data integrity • Generates monthly reports for nurses and district officials • Alerts & Reminders • Sends alerts and reminders to nurses and clients about patient care

13. System effect • Improved supervision and feedback MOBILIZE SUPPLY • Simplified Register • Capture and store data more efficiently • + • Health worker focused mobile intervention • information to support service delivery and continuity of care • Increase quantity and improve quality of interactions between clients and health system • Improve work routine and time for service delivery MOBILIZE DEMAND • Phone-based health education • to pregnant women and new mothers to increase knowledge and awareness • Phone based alerts and reminders • at “critical” times to promote and encourage utilization of essential health services

14. MOTECH Pilot-to-Scale & Transition to GHS To date Full implementation in 2 districts in 2 regions – Upper East, Central Began expansion to 3 new districts in 2 new regions – Volta, Greater Accra Approximately 23,783 clients currently enrolled (2 districts) ` 100 facilities reporting (automated or enroute to automation) 469 nurses trained and using MOTECH

15. (Sustainable) Scale-up Status • National steering committee formed and chaired by Director General of GHS, similar platforms at Regional & District level actively leading the program • Proposed joint initiative to scale to an entire Region, led by GHS with TA from Grameen • Possible MTN partnership: fee-based Mobile Midwife service that will cross-subsidize the free service for those who cannot aford. • There are other similar programme running on different plat forms performing the HIMS COMPONENTS of MOTECH • GHS community eRegister • GHS - Sene Smart Phone Project • The Pregnant Parent Components(messaging ) to be integrated into the GHS Community eRegister

16. Challenges Ahead • Need for full implementation of national ehealth strategy to: • ensure alignment and interoperability between MOTECH and other mhealth/ICT solutions in Ghana • integration of the Nurses Application into DHIMS2 and GHS community eRegistersystems • Costing/packaging MOTECH model for full integration into GHS workplans and budgets • Cost of airtime remains high, need for negotiation with Telcos to bring rates down and increase network coverage • Securing mobile phones in high volumes at low prices for nurses • GHS resource availability to support roll out – health sector budget already strained, • Need to demonstrate the cost-efficiency of MOTECH vs. non-mhealth approaches for frontline data management/reporting and getting health information to women

17. GHS HIMS STRATEGY

18. Questions & Answers