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Mobile Technology for Community Health (MoTeCH) in Ghana. Bruce MacLeod Jim Phillips. MoTeCH Ghana:. Gates Foundation Learning Grant : “Can mobile technology improve health ? Columbia University, University of Southern Maine, Grameen Foundation, & Ghana Health Service

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Mobile Technology for Community Health (MoTeCH)

in Ghana

Bruce MacLeod

Jim Phillips


Motech ghana
MoTeCH Ghana:

  • Gates Foundation Learning Grant : “Can mobile technology improve health ?

  • Columbia University, University of Southern Maine, Grameen Foundation, & Ghana Health Service

  • Looking for transformative technologies that can scale to nationwide operations and inform global m-health strategies.


The Geographic Context:

Sahelian West Africa

The socio-economic Context:

Ghana’s most impoverished region


In a challenging setting
In a challenging setting….

  • …can mobile-phone-based health information technology incrementally improve health outcomes?

  • …and will m-Health enhanced services improve the quality and accessibility of care for needs that span “the continuum of care”

    Focus:

  • Information delivered to “pregnant parents” through “Mobile Midwives”

  • 2) Information relevant to the delivery of health services by “Community Health Officers” (CHOs) – part of the “Community-based Health Planning and Services” (CHPS) Initiative


Challenges in uer region
Challenges in UER Region

Challenges in Communities

Challenges for CHPS Nurses


Problem 1 constrained information for supporting health service supply and demand
Problem #1: Constrained Information for Supporting Health Service Supply and Demand

Catalyzing

demand

Enabling supply


Problem #2: Different information requirements across the “Continuum of Care” are poorly suited to paper systems….

Pre-pregnancy

Pregnancy

Delivery

Newborn/Postnatal Care

Childhood

Family planning, prevention of STI, equal opportunity for girls

Early detection of pregnancy, and a focus on ANC

SBA,

Improve linkages between home and facility, Clean childbirth practices, and essential newborn care

Promotion of healthy behaviors (Baby – EBF, immunization, warming ,etc.; Mother –Family planning)

Management and care of LBW, care of Sepsis for NBs, nutrition, malaria, immunizations


Despite pervasive poverty the mobile technology revolution has reached africa
Despite pervasive poverty, “Continuum of Care” are poorly suited to paper systems….the Mobile Technology Revolution has reached Africa:

  • The total African mobile subscriber base has passed 500 million which is probably greater than 50% of the population,

  • Subscription in Africa is the fastest growing of any region in the world (growing at 18%/yr)

  • Over 70% of the population has access to mobile telecommunication

  • At least 15 companies have already announced plans of introducing 3G voice and data services

  • SMS (Text messages) are being used in innovative ways such as

    • Pricing information for agricultural products,

    • Mobile banking

    • Human rights violations

  • Typically pay as you go with kiosks selling “minutes”

  • “Mobile Money” is emerging as a business model.


Cell phone coverage
Cell Phone coverage “Continuum of Care” are poorly suited to paper systems….


The MoTeCH Approach…. “Continuum of Care” are poorly suited to paper systems….

First, ease information capture for community-based healthcare workers by simplifying paper registers


Motech alleviating these challenges using phones
MOTECH: alleviating these challenges using phones “Continuum of Care” are poorly suited to paper systems….


  • MoTeCH Use Cases “Continuum of Care” are poorly suited to paper systems….

    • 1) Supports Nurses with an information system:

      • Data entry using Java enabled phones, (16 distinct e-forms)

      • Alerts/reminders for service delivery to patients (weekly)

      • Query for “defaulters” (2 e-forms)

  • 2) Provides patients with health information, including:

    • Patient control of choice to enroll in the message program, selection of optimal time of day for messaging, language .

    • Support for personal phones, shared phones, community phones.

    • Regular health messages relevant to patient needs.

    • Alerts for Service Delivery .

    • Automated answers to health queries.

  • 3) Equips GHS & MoTeCH administrators with a medical record system with functionality for:

    • Maintaining and updating patient data.

    • Providing routine reporting information for District Health Information System.

    • Providing operational and supervisory reports.


Data input on mobile devices
Data Input on Mobile Devices “Continuum of Care” are poorly suited to paper systems….

Mobile forms, openXData using xForms specification


Nurses use java mobile phone app
Nurses use Java Mobile Phone App “Continuum of Care” are poorly suited to paper systems….

1

2

3


Server side motech requirements
Server Side MoTeCH “Continuum of Care” are poorly suited to paper systems….Requirements

  • Patient Data needs to be stored :

    • Service delivery, pregnancy, morbidity & immunization data; but expect more types of data later

    • Private, confidential, role based access

    • Appropriate to low-income country context

  • Patients sign up for health messages

    • Health information, ANC& PNC appointments, ..

    • Personalized, multiple languages, time preferences

  • Messages need to be sent to Patients

    • Healthy Pregnancy information, newborn care messages

    • Upcoming Appointment messages

    • IVR to patients (2 for more info, get message with ID)

    • SMS (unclear if this will be useful in Upper East, Ghana)

  • Nurses need to be notified of community members in need of service

    • SMS weekly summary of service delivery defaulters (ANC, PNC, Immunization)

    • SMS Immediate alert (6 hour updates) if women delivers

  • Support for Telecommunication protocols

    • SMS, Voice IVR, Java Forms & GPRS transmission

  • Reports for District Health Information System


Over 120 Clinical & Research sites around the world “Continuum of Care” are poorly suited to paper systems….


Openmrs motech secure web based access to registration message program enrollment editing
OpenMRS “Continuum of Care” are poorly suited to paper systems…./MoTeCH : Secure, Web Based Access to Registration, Message Program Enrollment, Editing


Motech 1 0 architecture
MoTeCH 1.0 Architecture “Continuum of Care” are poorly suited to paper systems….


Health policy in ghana implements the conventional global expanded program of immunization epi
Health Policy in Ghana implements the conventional Global “Expanded Program of Immunization” (EPI)

  • Children:BCG (Bacillus Calmette-Guerin) - BirthOPV (Oral Polio Vaccine) - Birth, 6 weeks, 10 weeks, and 14 weeksPENTA (Pentavalent Vaccine, DPT-Hib-HeB) - 6 weeks, 10 weeks, and 14 weeksMeasles - 9 monthsYellow Fever - 9 months

  • Not to administer BCG or Yellow Fever immunization if child has HIV/AIDS

  • Women (12-44 years old):TT (Tetanus Toxoid) - 5 doses Early as possible (12 years old?)

    • Minimum 4 weeks after TT1

    • Minimum 6 months after TT2

    • Minumum 1 year after TT3 or during next pregnancy (When during pregnancy?)

    • Minumum 1 year after TT4 or during next pregnancy

  • Pregnant Women

    • Treated Nets in Malaria areas

    • IPT (intermediate preventative treatment for malaria)

    • PMTCT


The patient care schedule is updated when new data arrives
The patient care schedule is “Expanded Program of Immunization” (EPI)updated when new data arrives


Event workflow engine health tips upcoming service delivery
Event/Workflow Engine : “Expanded Program of Immunization” (EPI)Health Tips & Upcoming Service Delivery

Expected Service Delivery Dates are put on a Calendar :

Send Messages to Patient for Upcoming Delivery

Send Messages to Nurse when Overdue

Support Query Messages from Nurse


Specification for care schedules and messaging do not require programming: XML Declarative Logic for Tetanus Eligibility

  • <bean id="pregnancyTetanusSchedule" class="org.motechproject.server.service.impl.ExpectedObsSchedule">

  • <property name="name" value="TT" />

  • <property name="conceptName" value="TETANUS TOXOID DOSE" />

  • <property name="registrarBean" ref="registrarBean" />

  • <property name="requirements">

  • <list>

  • <bean class="org.motechproject.server.service.impl.AliveRequirement" />

  • <bean class="org.motechproject.server.service.impl.AgeRequirement">

  • <property name="minValue" value="12" />

  • <property name="minPeriod" value="year" />

  • </bean>

  • <bean class="org.motechproject.server.service.impl.GenderRequirement">

  • <property name="gender" value="FEMALE" />

  • </bean>

  • </list>

  • </property>

This Service is interested any Tetanus Toxoid doses in the OpenMRS DB associated with presently living females, 12 years and older.


Motech technologies components motech builds on past efforts
MoTeCH require programming: Technologies & Components(MoTeCH builds on past efforts)

  • OpenMRS : Medical Record System

  • OpenXData : Mobile client & form designer

  • Spring Framework Application

    • Hibernate, mysql, java libraries

    • Maven build

  • Many open source libraries

  • CI : Continuous Integration Server

  • IntelliIVR : IVR system

  • SMS Gateway Support


Technical next steps motech ghana motech platform
Technical Next Steps require programming: MoTeCH Ghana  MoTeCH Platform

  • Improved use of Standards

    • VoiceXML for IVR

    • SDMX-HD for data aggregation

  • Common concept dictionaries (PIH, MVP…)

  • xForms MRS

    • With support for Server side validation, complex mappings, & data can initiate program logic

  • IVR  MRS

  • Rules Engine (Drools) for scheduling messages

  • Large Scale Implementations

  • Build and Support Open Source Community


Motech 2 0 architecture
MoTeCH 2.0 Architecture require programming:


Motech 2 0 architecture1
MoTeCH 2.0 Architecture require programming:


Motech 2 0 architecture2
MoTeCH 2.0 Architecture require programming:


Motech 2 0 architecture3
MoTeCH 2.0 Architecture require programming:


The future

The Future: require programming:

District

Sub-district

Community

Expanding MoTeCH Functionality over the continuum of care….

Doorstep

Pregnancy

Post-partum + neonatal

Post weaning

Etc…..

Etc…..

Etc…..

Etc…..

Delivery

Post-neonatal

Late childhood


Dimensions of the continuum of care

At each intersection there are unique information needs… require programming:

Dimensions of the continuum of care…

District

Sub-district

Community

Doorstep

Pregnancy

Post-partum + neonatal

Post weaning

Etc…..

Etc…..

Etc…..

Etc…..

Delivery

Post-neonatal

Late childhood


Dimensions of the continuum of care1

Most problems that are point of service related are solved by MoTeCH…but

At each intersection there are unique problems and needs…

Dimensions of the continuum of care…

District

Sub-district

Community

Doorstep

Pregnancy

Post-partum + neonatal

Post weaning

Etc…..

Etc…..

Etc…..

Etc…..

Delivery

Post-neonatal

Late childhood


Dimensions of the continuum of care2

Dimensions of the continuum of care… by MoTeCH…but

District

… but elements of the care continuum require development, such as family planning.

Sub-district

Community

Doorstep

Family-Planning

Post-partum + neonatal

Post weaning

Etc…..

Etc…..

Etc…..

Etc…..

ANC

&

Delivery

Post-neonatal

Late childhood


Dimensions of the continuum of care3

…such as by MoTeCH…but

supply and logistics, reporting to the National Health Insurance System, and….

..and some health systems support problems are not fully addressed by MoTeCH…

Dimensions of the continuum of care…

District

Sub-district

Community

Doorstep

Pregnancy

Post-partum + neonatal

Post weaning

Etc…..

Etc…..

Etc…..

Etc…..

Delivery

Post-neonatal

Late childhood


Dimensions of the continuum of care4

Other problems are emergency support, referral and information feedback related.

Dimensions of the continuum of care…

District

Sub-District

Community

Doorstep

Pregnancy

Post-partum + neonatal

Post weaning

Etc…..

Etc…..

Etc…..

Etc…..

Delivery

Post-neonatal

Late childhood


Dimensions of the continuum of care5

Other problems are emergency support, referral and information feedback related.

“Mobile money” could pay a crucial role in supporting facility based delivery and emergency logistics

Dimensions of the continuum of care…

District

Sub-District

Community

Doorstep

Pregnancy

Post-partum + neonatal

Post weaning

Etc…..

Etc…..

Etc…..

Etc…..

Delivery

Post-neonatal

Late childhood


Conclusions
Conclusions: information feedback related.

MoTeCH …

  • Provides an information system for nurses


Conclusions1
Conclusions: information feedback related.

MoTeCH …

  • Provides an information system for nurses

  • Provides health information to pregnant women and young mothers.


Conclusions2
Conclusions: information feedback related.

MoTeCH …

  • Provides an information system for nurses

  • Provides health information to pregnant women and young mothers

  • Supports the system of care: Management, supervision, monitoring.


Conclusions3
Conclusions: information feedback related.

MoTeCH …

  • Provides an information system for nurses

  • Provides health information to pregnant women and young mothers

  • Supports the system of care: Management, supervision, monitoring.

    MoTeCH…

  • Builds on and adds to the open-source health information software community.


Conclusions4
Conclusions: information feedback related.

MoTeCH …

  • Provides an information system for nurses

  • Provides health information to pregnant women and young mothers

  • Supports the system of care: Management, supervision, monitoring.

    MoTeCH…

  • Builds on and adds to the open-source health information software community.

  • Supports the science of scaling up.


Thank you
Thank you information feedback related.

www.ghsmotech.org

Feel free to contact Jim or Bruce for more information : [email protected] or [email protected]


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