mHealth

 {Photo credit: Samy Rakotoniaina, MSH}Community health volunteers use a mobile phone app to guide their patient interaction in rural Madagascar.Photo credit: Samy Rakotoniaina, MSH

How community health volunteers are using mobile technology to provide better care in remote areas of Madagascar

In remote villages of Madagascar, people who live miles away from a health center largely depend on community health volunteers for basic health care, such as family planning services, or the diagnosis and treatment of simple childhood infections. These volunteers are identified and elected by the community, and are then trained and supervised by the head of the nearest health center. The country's national Community Health Policy places them at the foundation of the health pyramid, as they are serving the most isolated communities. However, ensuring the quality care provided by these volunteers can be challenging: one study reported that only 49% of health volunteers offer family planning in accordance with national standards, and only 53% of children under the age of five are correctly treated for diarrhea, malaria, and pneumonia by health volunteers.

Being a community health volunteer is a tricky job. Among the many difficulties they already face, they are expected to report their activities by completing paper registers on a daily basis. But these paper tools, which are long and time-consuming, often result in delays and errors in the reporting process.

Saving lives and improving health continues long after diagnosing disease or delivering medicines.

(Watch Faith tell her story)

Faith had been ill for months. She was 31 and had two daughters. She didn’t know what was wrong. A friend urged her to get an HIV test; it came back positive.

Faith started on antiretroviral treatment.

But, in 2013, one of her antiretroviral medicines started to work against her, causing misshapen fat deposits to develop on her body.

When she finally mustered the courage to speak up one year later, her doctor knew just what to do and shifted her to a different medicine.

(Medicine Movers: Kenya from Management Sciences for Health on Vimeo)

Faith didn’t know it, but her report to the doctor became part of a nationwide database that tracks adverse drug reactions, and poor quality or expired medicines.

African Strategies for Health (ASH) launches the mHealth database (screenshot, April 20, 2015).

It’s nearly impossible to find someone who doesn’t own or have access to a mobile phone these days. According to International Telecommunication Union (ITU) 2014 estimates, there are nearly seven billion mobile sub­scriptions worldwide, five billion of which are in low- and middle-income countries.

With mobile technologies accessible to 95.5 percent of the world population, a new platform for promoting and delivering health services has emerged. 

Mobile phones are increasingly being used by various cadres of health workers for tasks such as collecting health data; monitoring implementation of health interventions; or informing local communities about potential outbreaks of disease, as was done during the recent Ebola epidemic in West Africa.

These new, innovative ways to make use of mobile technologies to improve health outcomes are known as mobile health or mHealth.  

{Photo credit: Maeghan Orton/Medic Mobile}Photo credit: Maeghan Orton/Medic Mobile

For more than a decade, health teams in over 40 countries have improved their performance using MSH’s Leadership Development Program (LDP) and the latest version, Leadership Development Program Plus (LDP+), which improves public health impact and scale-up. During the same period, there has been a tremendous expansion of information and communication technologies (ICTs) in health and mHealth interventions, particularly using mobile devices. This past year, two MSH-led projects—the Prevention Organizational Systems AIDS Care and Treatment (Pro-ACT) project in Nigeria and The Leadership, Management & Governance (LMG) Project—collaborated with LMG partner Medic Mobile to pair the LDP+ with a mobile application to systematically capture, collate, and report LDP+ results in near-real-time.

 {Photo credit: Rachel Lieber/MSH.}ADDO owners and dispensers in Mafia Island, Tanzania, learn to use the mobile applications developed by SDSI. The applications allow ADDO personnel to access an SMS-based Pharmacy Council helpline, send service utilization reports to the Pharmacy Council, and to pay annual licensing fees via mobile money.Photo credit: Rachel Lieber/MSH.

Cross-posted with permission from mHealthKnowledge.org.

In the private sector, Tanzania has more than 1,000 pharmacies, 2,500 pharmaceutical personnel, 6,000 accredited drug dispensing outlets (ADDOs), and more than 18,000 ADDO dispensers. The Pharmacy Council of Tanzania has overseen these facilities and personnel since 2011, but lacked a comprehensive system to manage regulatory information. Without such a system, basic facility and personnel information was inaccessible, the locations of rural ADDO facilities were unclear, and tracking business and professional licensing status, including fees collection, was difficult. Furthermore, the Pharmacy Council had no way to efficiently communicate directly with the outlets.

 {Photo credit: MSH staff}A community health worker uses a mobile phone for health information while caring for a sick child in Salima, Malawi.Photo credit: MSH staff

Natalie Campbell and Elizabeth McLean of MSH and colleagues co-authored a new journal article, "Taking knowledge for health the extra mile: participatory evaluation of a mobile phone intervention for community health workers in Malawi," in the latest issue of Global Health: Science and Practice.

This post originally appeared on the K4Health blog.

A group of young men in Mwene Ditu discuss using a cell phone to access health information. {Photo credit: Overseas Strategic Consulting, Ltd.}Photo credit: Overseas Strategic Consulting, Ltd.

Mobile phones are being used increasingly throughout Africa to improve health. The USAID-funded Democratic Republic of Congo-Integrated Health Project (DRC-IHP) is using mobile phone technology to increase the number of people referred to health centers in the project’s 80 targeted health zones. In Mwene Ditu, project staff observed that low numbers of referrals to health centers would be improved by increasing communication—within the community, between the community and health service providers, and among provincial health officials.

Cross-posted from the K4Health Blog.

As the mHealth Summit gets underway this week in the Washington D.C. area amid thousands of mHealth projects taking shape around the world, one particular mobile activity is saving lives by helping to ensure that the contents of medicines match their labels.

The Problem:

According to a  2010 World Health Organization Fact Sheet, it is difficult to estimate the percentage of counterfeit medicines in circulation—WHO cites estimates in industrialized countries at about 1%, and adds that “many African countries, and in parts of Asia, Latin America, and countries in transition, a much higher percentage” of the medicines on sale may be falsely labeled or counterfeit.

This blog post originally appeared on K4Health's blog.

The most important item in Amon Chimphepo’s medical kit is a small cell phone. This single piece of technology has proved to be a lifeline for people living in one of the most remote regions of Malawi. Its power to reach and initiate help immediately from the closest hospital is saving lives and improving health outcomes. In fact, I met a woman, alive today, because Mr. Chimphepo and his cell phone were there to make an emergency call to the district hospital and get an ambulance.

There have been a collection of high-profile and well attended mobile health (mHealth) “summits” held around the world in the past few years, including last month’s second annual mHealth Summit in Washington, D.C. (headlined by Bill Gates and Ted Turner), but the really interesting conversations are happening on the African continent. While large providers in the “developed world” are talking about the need for business plans and analysis, the debate in Kenya and Nigeria and Ghana is on how country-based leadership can scale up proven programs, develop sustainability, and provide practical and integrated models for cooperation between the government, mobile service providers, the medical community and the private sector.

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