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Tale of two mobile interventions to improve quality of health care Oluwaseun Adeleke, Abt Assoc Odartei Lamptey, Abt Assoc CRS ICT4D Conference March 19 th to 21 st , 2013. Two unrelated projects using common “ mhealth ” approaches.
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Tale of two mobile interventions to improve quality of health careOluwaseun Adeleke, AbtAssoc Odartei Lamptey, AbtAssoc CRS ICT4D ConferenceMarch 19th to 21st, 2013
Two unrelated projects using common “mhealth” approaches • Case study #1: Using smart phones for data-driven improvement at TB facilities in Nigeria • Case study #2: Evaluating impact of text messages on drug vendor treatment for diarrhea Ghana Shared themes
Case study #1 Using Smart Phones for Data Driven Improvements in Nigerian TB Clinics
Background • Nigeria (13th) rank among the highest Tuberculosis (TB) burden countries in the world. • Desk review revealed need for strengthening Supportive Supervision (SS) to improve performance and treatment outcomes • Nigeria was open to exploring new and innovative ways of improving quality through SS High-Burden TB Countries – WHO Global TB Report
Goals • Move away from long, paper-based checklists • Reduce time for data entry & analysis and human error • Concentrate on performance of clinical tasks and resolution of problems experienced by the health worker • Increase feedback from supervisors • Provide evidence for policy and planning (goal linked to online database)
Mobile ICT - Opportunities • Percentage of users accessing the web using mobile phones is increasing: Nigeria (63.9%) • Smartphones are getting cheaper (moving towards a retail price of $100 or less). • Today’s smartphones are essentially mini-computers – relevant not just for collecting data but also useful for analysis that will inform planning, policy direction & decision making
Innovation • Consolidated checklist loadedonto Smartphone • Forms programmed to do automatic calculations of critical indicators; reducing human error • Rapid review of critical indicators allows for immediate feedback and corrective action at the facility • Data sent immediately to an online database for State and Federal level analysis
Impact • Community-based defaulter tracing • Better record keeping • Drug stock-outs decreased • External quality control results obtained • SIM cards independently purchased = sustainability indicator! • Success recorded in Nigeria & Ethiopia has initiated increasing demand from other countries e.g. Malawi, South-Sudan …
Case study #2 Assessing Impact of Text Messages on Drug Vendor Treatment for Diarrhea
Background Information • Diarrhea Prevalence = 20% (2008 GDHS); diarrhea deaths represent 9% of all child deaths • WHO recommended treatment protocol zinc + ORS not widely followed • SHOPS Ghana program • Increase product supply through pharmaceutical partnerships • Conduct mass media communications campaign • Educate provider communities about protocols
Research to evaluate impact of text message reinforcement ALL LCS RECEIVE MANDATORY ZINC/ORS TRAINING
Text message impact evaluation • Methodology • Both control and treatment groups interviewed about knowledge and practice: researchers blind to assignment arms • Mystery shopper visited each seeking treatment for baby’s diarrhea • Results (preliminary, analysis is ongoing): • Training + texts result in statistically significant difference in knowledge of zinc/ORS as appropriate treatment, • Training + texts did not show statistically significant difference in sales of (non-recommended) antibiotics though the trend was in the right direction
Implementation feedback: Messages received as welcome and helpful “The quizzes cast my mind back to the seminar” “Both tips & quizzes were very educative” Universal support for Pharmacy Council to continue use of reinforcing text education
Challenges: Unexpected problems with correct formatting • Failure to use key word SHOPS • Chatty replies: “SHOPS that is not the answer we learned” • Literal replies: “Respond SHOPS A, B, or C” • Other reasons responses not received • Don’t know how to open/send text • Too busy • Phone problems Responders & non-responders did not vary in adherence to recommended treatment Majority non-responders said they read the texts (including correct quiz answers)
Lessons learnt • RCT results: • Correct knowledge is necessary condition for behavior change, but not sufficient. Widely used “self-reports” from providers on their practices may not be truthful. • Text message implementation: • Texts are a valuable way to stay in touch with large numbers of trainees, reinforce treatment guidelines • Interactive assessments may have low response rate due to embarrassment about getting quiz wrong, need for practice • Spacing text messages throughout the year likely to improve results: difference in knowledge between intervention and control groups decreased over time